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10 - Rehabilitation > Rehab Exam 2 Review > Flashcards

Rehab Exam 2 Review Flashcards

1
Q

Types of stroke

A
  • Ischemic: Clot blocks blood flow, most common type (80% of strokes)
  • Hemorrhagic: Blood vessel rupture
  • Brain attack
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2
Q

Stroke (modifiable risk factors)

A
  • Hypertension
  • Heart Disease
  • Diabetes
  • Diet
  • Obesity
  • Stress
  • Smoking
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3
Q

Stroke (non-modifiable risk factors)

A
  • Age ( > 55 yo)
  • Gender (females b/c they live longer)
  • Family History
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4
Q

Transient Ischemic Attack (TIA)

A
  • Temporary interruption of blood flow
  • No residual brain damage/deficits
  • “TIA only lasts a day” - sx lasts few minutes or hours, but no more than 24 hours
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5
Q

Stroke (CVA)

A
  • 4th leading cause of death in US
  • Deficits last longer than 24 hours
  • Permanent changes
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6
Q

T-PA

A
  • Clot-buster for ischemic, not hemorrhagic CVA

- Given within 3 hours

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7
Q

L sided CVA (R sided deficits)

A
  • Difficulties with communication, processing info in sequence and linear
  • Behaviors: Cautious, anxious, disorganized, more hesitant
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8
Q

R sided CVA (L sided deficits)

A
  • Difficulties with spatial-perceptual tasks, understanding the whole idea of a task or activity
  • Behaviors: Over-estimate abilities, unaware of deficits, impaired safety insight (affects motivation), impulsive
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9
Q

CVA positioning (Bed Supine)

A
  • Affected shoulder-supported (pillow)

- Affected knee supported (bolster/pillow)

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10
Q

CVA positioning (Bed Sitting)

A
  • Affected knee supported (bolster/pillow)
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11
Q

CVA positioning (Lying on unaffected side)

A
  • 1/4 turn back from complete sidelying
  • Affected shoulder forward, support on pillow
  • Affected side supported on pillow
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12
Q

CVA positioning (Lying on affected side)

A
  • Sidelying
  • Affected shoulder forward, no support
  • Affected knee slightly bent, no support
  • Unaffected hip/knee @ 90˚, pillow support
  • Affected side of body, pillow support
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13
Q

CVA positioning (Sitting in chair)

A
  • Affected shoulder forward, supported on pillow, arm trough

- Feet flat on ground

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14
Q

Pusher Syndrome

A
  • Ipsilateral pushing (contraversive pushing)
  • Active pushing with stronger extremities toward weak side –> fall toward hemi side (high-fall risk)
  • Caused by deficit in processing somesthetic info - no sense of pushing, fear in pt; instability, asymmetry, deficits in transfers, standing
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15
Q

Pusher Treatment (Interventions)

A
  • Vertical positioning (postural orientation)
  • Active movements and WS toward stronger side
  • Visual cues (mirror, lines, environmental prompts - walk around table, push onto wall)
  • Ball
  • Cross weaker LE over stronger/pusher LE
  • Air splints: promote weaker LE extension
  • Tapping: promote muscular activation
  • If use cane, shorten it to facilitate WS to stronger side
  • Doorway or corner to facilitate symmetry
  • Block stronger extremities from moving onto postures that will result in pushing
  • Engage pt in problem solving
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16
Q

How to work with patient that exhibits left-sided neglect

A
  • Active visual tracking/scanning with head and trunk rotation to left side (involved side); red line on floor or mirror to separate sides
  • Imagery
  • Direct pt attention to neglected/hemi side
  • Cover good eye; force to see with left side
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17
Q

Thalamic Pain

A
  • Central Post-Stroke Pain (CPSP)
  • Constant burning pain
  • Intermittent sharp pains
  • Exaggerated pain response to stimuli
  • Intolerable
  • Delayed onset (weeks to months)
  • Spontaneous recovery is rare
  • “Shoulder Syndrome”: RSD (Reflex Sympathetic Dystrophy) or Shoulder-Hand Syndrome - Arm is on fire (4 stages - first two stages are reversible, last two stages are not)
  • Treat RSD with scapular mobility, RSD
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18
Q

Diplopia

A
  • Double vision
  • Both eyes work, but not together
  • Treat by covering one eye with patch to see world how it should be
  • Switch periodically - refer to OT to see how often to change eyes
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19
Q

Homonymous Hemianopsia

A
  • Loss of vision in the contralateral half of visual field (nasal of one eye and lateral field of other eye)
  • R sided damage results in L-sided deficit
  • Incorporate mirror, PNF to cross midline
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20
Q

Ataxia

A
  • Uncoordinated movement appears when voluntary movement attempted (Ex: trying to walk on floor, lack of proprioception)
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21
Q

Apraxia

A
  • Impaired voluntary learned movement characterized by inability to perform purposeful movements
  • Motor Praxis: Ability to plan and execute coordinated movement
  • Types of apraxia: Ideational (cannot produce movements either on command or automatically); Ideomotor (cannot produce movements on command, but able to carry out habitual tasks automatically)
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22
Q

Agnosia

A
  • Inability to recognize familiar objects

- Object (visual), Auditory (nonspeech sounds), Tactile (by touch), Finger (cannot recognize fingers)

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23
Q

Anosognosia

A
  • Lack of awareness and insight
  • Perceptual impairment (includes denial, neglect, lack of awareness of the presence or severity of one’s paralysis)
  • You can teach them, but they still don’t think they need treatment
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24
Q

Affect

A
  • Emotion or outcome of emotion
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25
Q

Brain injury

A
  • CHI: Closed head injury

- Open HI: Open head injury

26
Q

Focal Injury (TBI)

A
  • Injury localized to site of impact on skull

- May cause hematoma, edema, contusion, laceration, or combination

27
Q

Coup-countercoup injury (Focal)

A
  • Blow –> injury under site of impact –> bouncing of brain off opposite side of skull
  • Two areas of impact directly oppsote each other
  • Sports injury/MVA
28
Q

Diffuse Axonal Injury (TBI)

A
  • Widespread shearing of axons
  • Caused by acceleration, deceleration, rotational forces
  • Axons shear, retract and separate from neuron cell body
  • Severe MVA - multiple forces acting on brain
29
Q

Hypoxic-Ischemic Injury (TBI)

A
  • Lack of oxygenated blood flow to brain
  • Causes: Systemic hypotension (LBP due to arteriosclerosis); Anoxia (Lack of oxygen due to drowning, suffocation, asthma); Vascular damage to brain
  • Global brain damage: Poor cognitive function, outcome expectations lower
30
Q

Increased Intracranial Pressure (TBI)

A
  • Causes: Brain edema (swells); Abnormal CSF Fluid Dynamics; Hematomas (Epidural, Subdural, Intracerebral)
  • Normal pressure is 4-15 mmHg
  • Greater pressure causes damage
31
Q

Blast-related head injuries (TBI)

A
  • Mild: LOC = less than 1 hr; PTA = less than 24 hrs
  • Moderate: LOC = 1 hr up to 24 hrs; PTA = 24 hrs to 7 days
  • Severe: LOC = greater than 24 hrs; PTA = greater than 7 days
  • Injuries: Primary (changes in atmospheric pressure); Secondary (Flying debris to head; Tertiary (Head hits solid object)
32
Q

Blast-related head injuries (Symptoms)

A
  • Severe headaches
  • Decreased sleeping ability
  • Mood swings
  • Balance problems
  • Memory/concentration issues
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Sensitivity to noise and light (most common to mTBI)
33
Q

Levels of consciousness

A
  • Coma
  • Stupor
  • Obtunded
  • Delirium
  • Clouding of consciousness
  • Consciousness
34
Q

Coma

A
  • Minimally conscious: Severly altered consciousness; Minimal, but definite, awareness of self or environment; reproducible cog-mediated behavior; sustained behavior; orient to noxious stimulus and reach for objects
  • Vegetative: Decreased level of awareness; Intact eye opening; Intact sleep-wake cycles; Unable to follow commands; Unable to speak
  • Persistent Vegetative: No meaningful motor function; No meaningful cognitive function (reflex withdrawal from noxious stimuli); Absence of awareness of self and environment
35
Q

Stupor

A
  • Unresponsive state

- Pt can be aroused briefly with vigorous, repeated sensory stimulation

36
Q

Obtunded

A
  • Sleeps often
  • Decreased alertness, interest in environment when aroused
  • Delayed reactions
37
Q

Delirium

A
  • Characterized by disorientation, confusion, agitation, loudness
38
Q

Clouding of consciousness

A
  • Characterized by quiet behavior, confusion, poor attention, delayed processing
  • Does not interact a lot; not sure what’s going on or where they are
39
Q

Consciousness

A
  • Alert and aware; oriented; memory intact
40
Q

Rancho Los Amigos - Level of Cognitive Functioning I, II, III

A
  • Decreased of Low-Level Response
  • Low level pt (coma)
  • Treat with ROM, positioning interventions, early transition to sitting posture, stretching, serial casting
  • Promote movement/learning by guiding pt’s body; provide tactile, proprioceptive, kinesthetic stimulation
  • Educate pt family on behavior issues, memory recall, that it’s part of the injury(important part of POC)
  • Co-treatments (ex: work with OT)
  • Guided techniques for ADL: sitting, grooming
41
Q

Rancho Los Amigos - Level of Cognitive Functioning IV

A
  • Confused-Agitated Response
  • Most challenging stage
  • Post-traumatic agitation, confusion, amnesia, disorientation, aggression, non-compliance, combative
  • Interventions are creative/flexible
  • Work near pt level of function and attempt to improve endurance rather than progressing
  • Will not carryover new learning - pt lacks short and long term recall
  • Requires positive reinforcement
  • Plan what to work on before you enter room
  • Consistency, model calm behavior, expect egocentricity; pt has limited attention span; if can’t redirect, change task; treat age appropriate; give control between two options
  • Safety: Pt unaware of limitatons, impulsive and unsafe
  • Pt/family education
42
Q

Rancho Los Amigos - Level of Cognitive Functioning V, VI

A
  • Confused-Inappropriate and Confused- Appropriate
  • Pt confused, but with structure; can follow simple commands
  • Goals: Functional task; meaningful task; shape task to pt ability; optimize succes; increase complexity and task demand progressively
  • Can handle simple tasks and commands; can break down complex tasks into sections
  • BWSTT, CIMT
  • Developmental sequence, facilitation techniques
  • Pt education: pt may improve mobility skills but lack insight into safety awareness (educate on safety)
43
Q

Rancho Los Amigos - Level of Cognitive Functioning VII, VIII

A
  • Late confused-appropriate (Early stage - Automatic-appropriate)
  • Goal: Can function/perform tasks into community environment
  • D/C from inpatient rehab (wean from external structure of rehab hospital)
  • Day treatment program: Interdisciplinary (PT, OT, ST); Recreational therapist (community activities); Community re-entry; Return to work/school; Address behavioral issues
  • Integrate into community: cog, physical, emotionally; treatment simulates or integrates “real world” - community skills, social skills, daily living skills
  • Pt included in decision making
  • Pt/family education: How to cope with residual deficits
44
Q

Treating ROM/Contractures in BI

A
  • Guided –> Assist –> Active –> Resist –> Independent
45
Q

Glasglow Coma Scale

A
  • Measures level of consciousness: Scene of accident –> ER –> During early recovery
  • Three areas: Eye-opening; Motor response; Verbal response
  • Scores = 3-15
  • Coma = equal to or less than 8 (severe TBI)
  • Mod TBI = 9-12
  • mTBI = 13-15
46
Q

Autonomic dysreflexia

A
  • Pathological autonomic reflex that can be life threatening (Call 911 immediately)
  • Occurs in SCI T6 and above - autonomic nervous system - with complete and incomplete lesions
  • Noxious stimulus below level of lesion (urinary retention, catheter kink, tight clothing)
47
Q

Autonomic dysreflexia (symptoms)

A
  • Sudden onset
  • Pounding, excrutiating headache
  • Hypertension
  • Bradycardia
  • Profuse sweating
  • Increased spasticity
  • Restless
  • Vasodilation (flushing) above level of lesion
  • Vasoconstriction below level of lesio
  • Constricted pupils
  • Nasal congestion
  • Goose bumps
  • Blurred vision
48
Q

Autonomic dysreflexia (treatment)

A
  • Some facilities: activate code
  • If pt is flat, bring him to sitting (to lower BP)
  • Identify stimulus and relieve it (usually bladder)
  • If do not immediately find stimulus, drain bladder - when was last time voided bladder, check clothing, catheter
49
Q

Brown-Sequard Syndrome

A
  • Hemisection of SC (usually by stabbing)
  • Ipsilateral loss: proprioception, vibration (paralysis, sensory loss)
  • Contralateral loss: pain, temperature
  • Contralateral loss is several dermatome levels below lesion level (b/c spinalthalamic tract ascends 2-4 segment in same side prior to crossing)
50
Q

Central Cord Syndrome

A
  • UE involvement > LE involvement
  • Can walk, but not use arms
  • Caused by cervical hyperextension injury
  • Compressive forces –> hemorrhage and edema in central SC
51
Q

Posterior Cord Syndrome

A
  • Rare condition
  • Loss of proprioception, epicritic sensation (wide base steppage)
  • Intact pain, light touch
  • Intact motor
52
Q

Anterior Cord Syndrome

A
  • Loss of pain and temperature (spinothalamic tract damaged)
  • Loss of motor (corticospinal tract damaged)
  • Cause: Cervical flexion injury –> damage to anterior SC
53
Q

Sacral Sparring

A
  • Incomplete lesion
  • Sacral tracts spared from injury (most central of sacral tracts preserved)
  • Intact perianal sensation
  • External sphincter muscle contract
  • Often first sign of incomplete cervical SCI
54
Q

Cauda Equina Injuries

A
  • Usually incomplete (large number of nerve roots and large surface area
  • Peripheral injury (not central), LMN
  • Potential to regenerate like, because it’s peripheral nerve
  • Full neurological recovery is uncommon
  • Long axons make location of injury far from site of innervation
  • Scarring on axon may block regeneration
  • Muscle may not be functional once regeneration occurs
  • Regeneration slow (1mm/day)
55
Q

Compensation vs Recovery

A
  • Consider:
  • Severity of sensorimotor deficits
  • Severity of secondary complications/co-morbidities
  • Is motor recovery feasible?
  • Chronic versus acute (Recovery more likely to occur in acute)
  • Strength/weakness of pt - Ability to learn harder tasks
  • Severity of cognitive, behavorial, medical barriers
  • Funding
  • Discharge destination
56
Q

Dual-Task Intervention

A
  • Performing physical task (walking) simultaneously with a cognitive task (talking)
  • Should match goals the patient must achieve
57
Q

Conflabulation

A
  • Pt fills in missing info with stories
  • Info missing b/c lack of memory/lack of knowledge
  • Not attempt to be deceptive; pt truly believes what they’re saying
  • Lesion in prefrontal cortex
58
Q

Persveration

A
  • Pt “gets stuck” with continued repetition of words, thoughts, actions
  • Unrealted to current context
59
Q

Apathy

A
  • Dulled/blunted response
  • Can be misinterpreted as depression or lack of motivation
  • Not under volitional control of pt
60
Q

Labile

A
  • Uncontrolled or exaggerated emotion
  • Emotion inconsistent with mood or circumstance; quick change
  • Pt unable to control emotional fluctuations
61
Q

Executive Function

A
  • Complex, inter-related processing to produce action

- Volition, planning, purposeful reaction, effective perfanceds

10 - Rehabilitation (25 decks)

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