The Acute Neurological/Neurosurgical patient

Question 1

Why might a PD patient be admitted to the acute ward?

Answer 1

1. Implantation of DBS (deep brain stimulator) - electrodes in subthalamic nucleus, wires run down side of the neck and attached to a device that sits under the clavicle; PHYSIO can be assessing the patient before/after this procedure
2. PD patients also can have a lot of #s - hips, wrists - due to falls
3. PD pts apt to have lot of infections

Question 2

Why might an MS patient be admitted to hospital?

Answer 2

1. Initial diagnosis

2. Acute exacerbations (steroid injections given)

Question 3

Why might an MND patient be admitted to hospital?

Answer 3

1. If they have chest infection (usually they are in palliative care depending on stage of disease so you won’t see them much)

Question 4

What factors should be considered in physio management of Guillain Barre?

Answer 4

• MONITOR VITAL CAPACITY!
• may be required 2x/day or 1x every 2 hours depending on pt
• these results determine whether BiPAP or intubation/ventilation is needed
• no point giving exercises since they won’t work
• standardize vital capacity testing

Question 5

CI’s + Precautions to treatment for GBS

Answer 5

1. plasmapheresis (blood taken from body - plasma is seperated - ABs removed; plasma returned) - pt feels exhausted after this process
2. neuropathic pain - 50% of GBS pts get terrible neuropathic pain so even mild touch causes excruciating pain - pain meds needed before
3. Low BP - lack of mm pump (precaution for mobilising+tilt table)

Question 6

What are the different types of spinal surgery?

Answer 6

DECOMPRESSION:
Laminoplasty
Laminectomy (relieves pressure on SC but also creates more instability; might also need fusion)
Foraminotomy
Discectomy

Spinal Fusion
Disc replacement

Question 7

What are the differences between an anterior and posterior cervical spine surgery approach?

Answer 7

Anterior approach:

• better access
• less destructive to mm’s
• but nerves controlling speech+swallowing are here so can have problems with these

Posterior approach:
- more pain bc cutting through more mm

Question 8

What are the considerations for managing after anterior spinal surgery (cervical)?

Answer 8

Monitor for signs of DYSPHAGIA (since these mm’s can be affected by damage to nerve in anterior cx)

• DURING EATING: multiple swallows, cough/sneeze/’pcoketing food’
• AFTER EATING: wet/hoarse voice
• drooling, poor oral hygeine

Monitor for signs of DYSARTHRIA

• hoarse
• garbled
• slurred

Question 9

CIs + Precautions

Answer 9

• Log roll (to prevent spinal cord injury)
• Follow medical protocols!
• Follow restrictions post surgery (<1.5kg for 4 weeks)

Question 10

What is the management for spinal fracture

Answer 10

• bed rest
• collar
• log roll
• do NOT treat unless specifically asked to do so (since risk of SC injury)

Question 11

What are the 3 diff types of collars and what is their effect on mobility?

Answer 11

Soft collar - more for pain relief that immobilization
Hard collar - partial immobility
Halo - complete immobility

Question 12

When are halos used?

Answer 12

• when external immob needed (post op immob to allow for healing; cx or upper tx #s)
• can be on 6 weeks to 3 mons
• put on in OR - 4 screws drilled into skull to attach it; infection risk so must be cleaned regularly