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Physiotherapy > PY1105 - Intro to Neurorehabilitation Physiotherapy > Flashcards

PY1105 - Intro to Neurorehabilitation Physiotherapy Flashcards

1
Q

WEEK 1

A

Principles of Neurorehabilitation

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2
Q

what is the WHO ICF

A

■ The world health organisation (WHO) developed a framework for describing disability in 2001.
■ It was developed to move from the previous model (based on the medical model of healthcare) to a more social based model – it shifted the focus from impairment and disability to health and functional ability
■ It is universally accepted for use in describing neurological disability
■ Composed of five categories that relate to the health condition and impact on the ability of the person

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3
Q

What are the main principles of neurorehabilitation (13)

A

The ICF
Teamwork
Person-centered care
Prognosis
Neural Plasticity
The systems model of motor control
Functional movement Re-education
Skill acquisition
Exercise prescription
Self-management
Health promotion
Mindset
Behaviour change

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4
Q

What is Teamwork

A

Central to all work with neurological patients – you cannot do this alone! Who are the members of the team?

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5
Q

what is person centered care

A

The patient and their wishes and situation have to be at the heart of everything that we do, Feeds into neuroplasticity (we will come to this!), Everyone is an individual

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6
Q

what is prognosis

A

Our ability to understand the course and prognosis of the disease/injury, Based on understanding of pathology, anatomy, physiology and neuroplasticity, Often dealing with people with a life limiting condition (MS, PD, MND), Or people who may not make a ‘full recovery’/will be affected permanently (Stroke, brain injury, spinal cord injury), Some people do get better! (GBS), Often involved in decisions around end of life/feeding/moral and ethical as well as medical debates, Based on the best available evidence

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7
Q

what is Neural plasticity

A

The ability of the CNS to reorganise following injury or disease, Task specific, Salient, Reps (#1000 reps), Intensity – suitably challenging

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8
Q

what is the systems model of motor control

A

The most accepted model of how we move

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9
Q

Functional movement re-education

A

Basis of treatment is the ability to practice functional tasks or movement (e.g. rolling, lying, sit to stand, walking, balance), In order to re-educate movement, you need to be able to analyse and recognise normal movement patterns, You also need to know kinematic ranges of normal movement patterns and the anatomy and biomechanics that go along with this, Training of movement rather than pure ‘exercise’

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10
Q

what is skill acquisition

A

motor learning - In order to learn or relearn a motor skill, Reps!

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11
Q

what is Exercise prescription

A

Improving cardiovascular endurance, muscular fitness or flexibility, FITT

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12
Q

what is self-management

A

Most neurological conditions will have ongoing consequences – therefore people with neurological diagnoses need to be supported to manage their own disease, E.g. checking skin if poor sensation, Managing their own catheters, Home exercises, Fatigue management, Self-efficacy

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13
Q

what is health promotion

A

Many people with neurological conditions do not meet the recommendations for a healthy lifestyle advocated by the chief medical officer for many reasons, Many individuals with neurological conditions have cardiovascular risk factors and secondary prevention is an important component of their long-term management, Many will face additional barriers, due to their neurological condition, to active healthy lifestyle that may require support in overcoming, Need to support exercise, diet, smoking cessation, mental health/wellbeing

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14
Q

what s Mindset

A

Thoughts, beliefs and expectations that influence recovery, Adopting strategies to foster motivation, resilience and hope with service users and therefore bring about a positive mindset, Communication – active listening, Goal Setting, Self-management, Praise, Plus, many more

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15
Q

what is behaviour change

A

Facilitating behaviour change to enable individuals to live with a neurological condition, Health promotion, Self-management, Habit formation

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16
Q

what is body structure or function (WHO ICF)

A

■ Relates to the impairment caused by a health condition which may or may not impact on activity
■ E.g Loss of strength, Loss of sensation, Loss of range of motion, Spasticity – more next year, Decreased balance, Pain

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17
Q

what is activity (WHO ICF)

A

■ Relates to the activities performed by an individual
■ E.g Walking, Transferring, Washing and Dressing, Feeding, Toileting, Grooming, Taking Medication, Stairs

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18
Q

what is participation (WHO ICF)

A

■ Relates to the areas of life in which the individual encounters societal opportunities or barriers
■ E.g Work, Volunteering, Practising a religion, Parenting, Shopping, Finances,

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19
Q

what is environmental factors (WHO ICF)

A

■ Factors in the environment that impact on the ability of a person to carry out activities/participation
■ E.g Steps and stairs, Kerbs, Lack of beeps on a pedestrian crossing, Written work not available in audio or braille, Written captions on a film, Background colours

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20
Q

what is personal factors (WHO ICF)

A

■ Personal factors that impact on the ability of an individual to carry out activities/participation
■ E.g Marital status, Wealth, Educational Level, Previous experience, Family situation

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21
Q

What is neuro clinical reasoning

A
  • We take the information that we gather from the subjective and objective assessment and the individual
  • We apply our knowledge of anatomy, physiology and the pathology of the disease
  • We apply our knowledge of the guiding principles of neurological physiotherapy and the evidence for our treatments
    This allows us to develop:
  • Problem lists (so we know what we are trying to address)
  • Goals (so we know what we want to achieve)
  • Treatment plans (so we know how we are going to achieve it)
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22
Q

What is part of neuro clinical reasoning

A

Subjective Ax, Objective Ax, develop problem lists, person centered goals, treatment

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23
Q

what are the factors that influence neuro clinical reasoning

A

■ Individual patient - their wants, needs and beliefs
■ Assessment findings
■ Fluctuation and variability in clinical presentation over time
■ Long-term nature of most neurological conditions
■ Psychological impact of neurological disease
■ Underpinning knowledge of anatomy, pathology, normal movement and physiology.
■ Evidence base within field of Neurosciences and Neurorehabilitation

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24
Q

what is SMART goal setting

A

Specific
Measurable
Achievable
Realistic
Timely

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24
what is an example of a longer term goal
1) To return to football training and play for 5 minutes without crutches within 4 months
24
what is examples of short term goals
1) To be able to walk 10m with 2 crutches indoors using a 4-point pattern within 2 weeks 2) To be able to climb 2 steps using 2 rails leading with his left leg within 1 week.
25
what is an example of a medium term goals
1) To be able to walk 50m outdoors with supervision of 1 person and 2 crutches within 4 weeks
26
what is a treatment plan
■ The interventions that you propose to enable a patient to achieve their goals. ■ Not all treatments will be restorative, some may be compensatory, and some may be related to broader management, but they should all be focused on the shared goal. ■ Based on your problem list you can begin to consider what you are going to do address each problem – this is your treatment plan ■ Remember you need to be able to explain your treatment choice in relation to the assessment findings and your understanding of the pathology. This is clinical reasoning.
27
WEEK 2 pt1
Gross structure of CNS + PNS
28
what makes up the CNS
brain + spinal cord
29
what forms the CNS
collection of bundles of axons (nerve cells) and clusters of nerve cell bodies
30
what is a ganglion
collection of cell bodies
31
what is a Fasciculus
Cluster of axons forming a recognisable bundle
32
what is the Funiculus
Bundle of Axons forming a raised bump on the surface of the CNS (especially in the spinal cord
33
what is a tract
cluster of axons with similar functions
34
what is the nucleus
cluster of cell bodies with similar functions
35
which 4 large sections can the brain be divided in
* Brainstem * Diencephalon * Cerebellum * Cerebral Hemispheres or Cerebrum
36
what does the brainstem link
cerebrum and the spinal cord
37
what does the brainstem comprise of
Medulla, midbrain and the pons
38
what functions does the brainstem control
breathing, heart rate and level of consciousness
39
what is the Diencephalon composed of
Thalamus, Hypothalamus and Epithalamus
40
what does the Diencephalon play a role in
the intergration of sensory information and the interpretation of pain (some role with hormone release)
41
what is the cerebellum involved in
maintaining balance and control
42
what matter is the Cerebrum made out of
Grey Matter, deeper groups of white matter
43
what are sulci
grooves in the cerebral cortex (separate the gyri)
44
what are the lobes of the brain
Frontal, Parietal, Occipital, Temporal
45
where is the frontal lobe located and what is it responsible for
at the front, its responsible some aspects of movement, behaviour, emotion and higher executive function, expressive speech
46
where is the Parietal lobe located and what is it responsible for
Behind the frontal lobe, its responsible for language, sensation, perception of space
47
where is the occipital lobe located and what is it responsible for
located at the back, responsible for vision
48
where is the temporal lobe located and what is it responsible for
located at the sides, responsible for hearing, expressive speech and memory
49
what is the primary motor cortex responsible for
actual execution of movement
50
what is the premotor cortex responsible for
preparation of sensory triggered movement and guiding complete behavioural acts
51
what is the role of the Supplementary motor area
Involved in preparation of self-initiated movement
52
what is the somatosensory cortex involved in
it is involved in the complex processing of sensory information
53
roughly how long is the spinal cord
roughly 45cm long
54
where does the spinal cord terminate
approx T12
55
do the sensory tracts in the spinal cord ascend or descend
ascend
56
do the motor tracts ascend or descend the nervous system
descend
57
what is the function of the PNS
carries sensory information to your brain, carries information from your brain to your muscles and organs, allows both conscious and unconscious bodily functions to take place
58
what are the key anatomical features of a Peripheral Nerve
Epineural Sheath, Epineurium, Perineurium, Endoneurium
59
what are the key anatomical features of a motor neuron
dendrites, cell body, nucleus, myelin sheath, node of ranvier, schwann cells, axon terminal
60
what are the key anatomical features of the spinal cord and vertebra
spinous process of verterbra, fat in epidural space, subarachnoid space, spinal cord, denticulate ligament, posterior root ganglion, spinal nerve, vertebral body, meninges (Dura mater (dural sheath), Arachnoid mater, Pla mater)
61
WEEK 2 pt2
Neuro Objective Assessment
62
what are the principles of a neuro objective assessment
Health condition, activity, participation, body functions and structure, personal factors, environmental factors
63
What might influence the objective assessment of a patient with a neurological disease of injury?
* Setting - Inpatient v outpatient * Fatigue * Pain * Level of consciousness * CVR instability/stability * Cognition * Behaviour * Communication
64
what different elements are there to be tested during an objective assessment/ affect an objective assessment
Observe, AROM, PROM, Tone, Sensation, Proprioception, coordination, power/ strength, bed mobility, balance, balance control, Gait, Vision, hearing, speech and swallow, mood, cognition
65
what are you looking at/ for while observing a patient
position, posture, drips, drains, lines, monitoring
66
what is AROM
Can the patient move all their joints actively through full range of movement – if not, why not?
67
what is PROM
does the patient have full passive ROM at all joints? if not, why?
68
what is tone
the internal state of muscle-fibre tension within individual muscles and muscle groups, It is the normal resting state of the muscles, * Tone can increase over time and the patient presents with spasticity which can lead to pain, loss of function and contracture as well as interfering with return of active movement
69
how can tone present
Clonus, Spasm, Spasticity, Tone, Hypertonia, Rigidity
70
what different types of sensation are there/ can we test
light touch, pressure, sharp/ blunt, Hot/cold, 2-point discrimination
71
how do we test proprioception
mirroring, joint position sense
72
what are the coordination tests
heel-shin, finger-nose, disdiachokinesia (DDK)
73
how do we test strength, power
* Test all four limbs for strength – be joint specific in required * Check grip strength * Use Oxford Scale if appropriate
74
functional assessments
bed mobility, balance, balance control
75
what are the bed mobility assessments
rolling, lie to sit and sit too lie, transfers
76
what types of balance need to be functionally assessed
sitting balance, standing balance, visuospatial issues - push and neglect
77
what are the different elements of balance control
* Anticipatory Postural Adjustments * Predictive control of balance * Predictive contraction of muscles to resist whole body movement * Postural Adjustments * Ankle strategy * Hip strategy * Stepping mechanism
78
how is balance assessed
* Berg balance test * Tinetti * Activities-specific Balance Confidence Scale (ABC) * Sitting or standing: * Reaching * Small base of support * Eyes closed * Standing – tandem, one foot
79
what are you looking for while assessing gait
* Walking aids * Pattern * Safety * Assistance * Speed and distance * Stairs
80
what are upper limb functional tests
button undoing, writing
81
what are other aspects to assess in a neurological patient
* Vision * Diplopia – oculomotor deficits and smooth pursuit * Field loss/hemianopia * Neglect * Hearing * Do they usually wear hearing aids? * Speech and swallow
82
what are you mentally assessing about a patients mood
* Appropriate? * Disinhibited * Withdrawn * Formal screens – HADS, DISCS, PHQ9 and GAD7
83
what is cognition
* Orientation – person, place, time and situation * Ability to follow commands – one stage, two stage, three stage * Basic object recognition and use * Ability to give an accurate history * Memory and attention * Formal screens – MOCA, MMSE, Oxford cognitive screen, CAMS, etc, etc.

Physiotherapy (3 decks)

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