P1 - Positioning Patients

Question 1

what are primary problems relating to neurological issues

Answer 1

• Tonal changes
• Sensory deficit
• Neglect
• Balance and Coordination deficit
• Visual and speech deficit
• Weakness
• Cognitive issues

Question 2

what are secondary problems relating to neurological issues

Answer 2

• Compensation
• Disuse: Weakness/atrophy
• Postural changes
• Altered body imagining
• Fatigue
• Pain from poor joint position
• Tight muscles

Question 3

What can neurological injury lead to?

Answer 3

Neurological injury can lead to tonal changes.

Question 4

What are the two general types of tonal changes based on the injury?

Answer 4

High tone or low tone

Question 5

What are the two types of features of tonal changes?

Answer 5

Positive features and negative features.

Question 6

how can a tonal change be positive

Answer 6

high tone in legs can help standing

Question 7

What type of tone is associated with an Upper Motor Neuron (UMN) injury?

Answer 7

Hypertonicity (increased tone).

Question 8

What type of tone is associated with a Lower Motor Neuron (LMN) injury?

Answer 8

Hypotonicity (decreased tone).

Question 9

How does pain relate to tone changes?

Answer 9

Pain causes increased tone, and increased tone can also cause pain.

Question 10

What is the typical tonal change pattern in the upper limb following neurological injury?

Answer 10

Flexion pattern.

Question 11

What is the typical tonal change pattern in the lower limb following neurological injury?

Answer 11

Extension pattern.

Question 12

Do both Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) injuries lead to weakness?

Answer 12

Yes, both UMN and LMN injuries lead to weakness.

Question 13

What are two possible causes of weakness following neurological injury?

Answer 13

Weakness can result from disuse or pure loss of recruitment of motor units due to lack of descending drive.

Question 14

What is a common symptom in many neurological conditions such as stroke, MS, and Parkinson’s Disease?

Answer 14

Lack of dexterity due to weakness and tonal changes.

Question 15

Can someone have high tone and underlying muscle weakness at the same time?

Answer 15

es, one can have high tone with underlying muscle weakness at the same time.

Question 16

Is muscle tone the same as voluntary muscle power?

Answer 16

no

Question 17

What is neglect syndrome?

Answer 17

Neglect syndrome is a multifaceted neurological disorder where individuals fail to report, respond, or orient to external stimulation located contralateral to a brain lesion.

Question 18

What differentiates neglect from primary sensory or motor deficits?

Answer 18

Neglect occurs when the failure to respond cannot be attributed to primary sensory or motor deficits such as hemianopia or paralysis.

Question 19

What percentage of acute stroke patients report neglect?

Answer 19

Neglect is reported in 80% of acute stroke patients.

Question 20

How does neglect lead to altered weight-bearing symmetry?

Answer 20

Neglect can result in individuals favoring one side of the body, leading to asymmetrical weight-bearing.

Question 21

What is the first step to address altered weight-bearing symmetry in neglect?

Answer 21

Treat any tonal problems or range of movement issues that may be exacerbating the problem.

Question 22

What type of exercises are recommended for the unaffected side in neglect patients?

Answer 22

Strengthening exercises for the unaffected side, focusing on functional movements to increase muscle activation and sensory feedback.

Question 23

How can we help patients “retrain” their awareness of the affected side?

Answer 23

By encouraging them to weight-bear or orientate on the affected side to break the “vicious cycle” and increase sensory awareness.

Question 24

how can you position a patient which hemiplegia

Answer 24

Question 25

What is the ideal alignment of hips and knees in a chair or wheelchair?

Answer 25

The ideal alignment is 90 degrees of flexion at the hips and knees.

Question 26

How can you assess whether a wheelchair seat is appropriate?

Answer 26

Check if the seat is too deep and if the footplates are at the correct height.

Question 27

What should you consider when choosing a pressure cushion for a patient?

Answer 27

Consider the type of pressure cushion needed based on the patient’s specific requirements for pressure relief.

Question 28

Why is trunk symmetry important in wheelchair positioning?

Answer 28

Trunk symmetry is crucial for balance and stability; assess if the patient needs trunk support and if they are leaning to one side.

Question 29

How do you determine if a patient requires head support?

Answer 29

Assess whether the patient has adequate head control; if not, head support may be necessary.

Question 30

What should be evaluated regarding armrests in a wheelchair?

Answer 30

Evaluate the type of armrests; consider their height, support, and functionality based on the patient’s needs.

Question 31

What types of wheelchair propulsion should be considered?

Answer 31

Consider whether the wheelchair is self-propelling, push only, or powered, based on the patient’s abilities.

Question 32

Why is it important to think about cognitive function when positioning in a chair or wheelchair?

Answer 32

Cognitive function, attention, vision, and neglect can all affect a patient’s ability to maintain proper positioning and use the chair effectively.

Question 33

Why is it important to prevent the shortening of the Achilles tendons and gastrocnemius muscles?

Answer 33

Preventing shortening is crucial to avoid contractures, which can hinder rehabilitation and weight-bearing activities.

Question 34

What are key interventions for preventing contractures in the Achilles tendon and gastrocnemius?

Answer 34

Splinting and stretching are key interventions.

Question 35

What can be used initially to maintain a plantar grade position for the feet?

Answer 35

Pillows can be placed under the soles of the feet to maintain plantar grade

Question 36

When might a referral to orthotics be necessary?

Answer 36

A referral may be needed to create a custom-made splint to ensure correct foot positioning.

Question 37

What type of boots can be worn at night to prevent pressure sores?

Answer 37

Pressure-relieving boots can be worn at night to prevent pressure sores on the heels.

Question 38

What should be considered if a person is only looking to the right in bed?

Answer 38

Consider positioning; visitors should sit on the left to provide auditory and visual stimulation from the neglected side.

Question 39

How can the environment be adjusted to encourage orientation to the neglected side?

Answer 39

Move the bed, and place pictures or objects to look at on the wall or window/door on the neglected side.

Question 40

What can be used to provide sensory stimulation to the neglected side?

Answer 40

A weighted blanket may be used for sensory stimulation.

Question 41

What is an important communication strategy when providing touch therapy?

Answer 41

Talk to the patient before touching their arm and leg, explaining what you will do beforehand.

Question 42

What type of handling should be used during physiotherapy sessions?

Answer 42

Use firm handling and touch to provide effective sensory feedback.

Question 43

What is the goal of improving a person’s body schema in physiotherapy?

Answer 43

The goal is to enhance their representation of their body in space.

Question 44

How can sensory and visual stimulation be increased for patients?

Answer 44

Use yourself, carers, equipment, and the environment to provide more sensory and visual stimulation.