Prognosis in Patients with Neuromuscular Diagnosis Flashcards
1
Q
What are some factors that may impact prognosis
A
- Age: growth/develop Or experience
- lesion: site, location etc
- effect of experience/prior level of function
- comorbidities
- training
- motivation
- cognition
- depression/psychological issues
2
Q
Social determinants of health examples
A
- economic stability
- social and community context
- gender equity
- early child development/education
- globalization/urbanization
- health literacy and access to healthcare
- neighborhood and build environment
- stress
- income
- education
- work
- social support
- addiction
- transportation
3
Q
Prognostic imaging: CT
A
- on CT two signs have been correlated with prognosis:
- hyper dense middle cerebral artery (HMCA) shows bright on CT
- MCA “dot” sign
4
Q
HMCA sign
A
- significant stroke in that area
- positive when the MCA on one side appears denser than its counterpart and any other vascular structure
- associated with significant infarction of the MCA
- associated with severe ischemia and with poorer outcomes
- studies have shown that a positive HMCA alone is not a good prognosis indicator for poor function
5
Q
MCA dot sign
A
- MCA dot sign is smaller the HMCA sign
- associated with occlusion of the distal branches of the MCA
- on CT seen as hyper density of an arterial structure (seen as a dot) in the Sylvia fissure relative to the contralateral side or to other vessels within the Sylvia fissure
- the MCA dot sign with the HMCA sign is associated with a good prognosis
6
Q
Prognostic imaging: fMRI
A
- the activation pattern used by a patient after a stroke is well-correlated with level of recovery and outcomes
- activation maps similar to control associated with fewer residual impairments
- activation of motor areas in lesioned cortex associated with best recovery
7
Q
fMRI sign of good prognosis
A
- asked to move and there is B/L involvement on the brain
8
Q
Diffusion Tensor imaging
A
- uses diffusion of water at microscopic level to specifically view white matter (myelinated tracts)
- some association between corticospinal activity in acute stroke and functional outcomes at 3 months
- also used to look at brain activity in more severe injuries
9
Q
Determining infant prognosis
A
- MRI
- cranial ultrasound
10
Q
Pharmacology: prognosis and plasticity
A
- drugs for comorbidities
- drugs to enhance or promote recovery
11
Q
Name drugs that have been used to enhance or promote recovery
A
- serotonin
- dopamine
- antioxidants
- Bo Tox
- Gabapentin
12
Q
serotonin
what does it naturally do in the body
A
- important in modulating cognitive functions
- memory consolidation
- response inhibition: seeing something and it signs to stop
- learning and emotion
13
Q
Serotonin: SSRIs
A
- primarily used as anti-depressants
- inhibit removal of serotonin from synaptic cleft
- long-term use thought to desensitize and down regulate receptors
- may reduce neural inflammation, increase neurogenesis and increase neurotrophic activity
14
Q
FLAME study: SSRI fluoxetine (prozac)
A
- Fluoxetine for motor recovery after ischemic stroke
- subjects given fluoxetine after CVA
- improvement in arm and leg function after 3 months
15
Q
Dopamine
A
- important for movement (initiation, motor programs)
- important for learning, plasticity
- internal motivation and reward system
- studies using dopaminergic drugs or drugs that enhance dopamine have been inconclusive for improving motor recovery after stroke
- can lead to unwanted movement
16
Q
antioxidants
A
- elimination of free radicals
- modulation of epigenetic factors
17
Q
BO-tox
A
- used to decrease activity of a specific muscle
- muscle overactivity due to hypertonia
- periodic injections
- associated muscle weakness
18
Q
Gabapentin
A
associated with motor recoverery after stroke in mice
19
Q
Neuroplasticity rules
A
- use it or lose it
- use it and improve it
- specificity
- repetition matters
- intensity matterrs
- time matters
- salience matters
- age matters
- transference
- interference
20
Q
PT’s role in prognosis
A
- feedback: intrinsic (inherent) vs extrinsic (augmented)
- knowledge of performance
- knowledge of results
feedback
- constance
- summed
- faded
- bandwidth
- delayed
21
Q
Knowledge of performance vs knowledge of results
A
- knowledge of performance: exactly how you are doing something; broken down
- knowledge of results: during/after there is feedback of if you are successful
22
Q
Constant feedback
A
- given after every practice trial
23
Q
Summed feedback
A
- given after a set number of trials
24
Q
Faded feedback
A
- given at first after every trial and then less frequently;
25
Bandwidth feedback
- given only when performance is outside a given error range
26
Delayed feedback
- given after a brief time delay
27
Types of practice
- Massed vs distributed
- constant vs variable
- blocked
- serial
- random
- parts to whole
- mental practice
28
Massed practice
- a sequence of practice and rest times in which the rest time is much less than the practice time
29
distributed practice
- a sequence of practice and rest periods in which the practice time is often equal to or less than the rest time
30
blocked practice
-a practice sequence organized around one task performed repeatedly uninterrupted by practice on any other task
31
Serial practice
- a predictable and repeating order of practice of multiple tasks
32
random practice
- a practice sequence in which the tasks being practiced are ordered randomly across trials
33
instructions and tasks
- implicit: not a lot of direct instructions
- explicit: telling them EXACTLY what they have to do
34
Community and environment considerations with prognosis
- discharge location
- discharge environment; physical, social, community
- equipment and technology
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