Week 11 - Haemorrhage, Tumours, Framework, spinal surgery, Flashcards
Outline the features of a framework for physiotherapy of neurological patients in the acute care environment
emphasis put on the impairment and activity limitations to determine when it’s safe for patients to go home
- interested in primary impairments and preventing secondary impairment along with other factors
List the guidelines for neuro intervention for primary motor impairments
Impariments:
- Weakness - strength training, muscle activity, mobilization, Estim
- Loss of coordination - task related training (part or whole task)
- Spasticity - eliminating inappropriate muscle force, training muscle activity for specific actions , preventing contracture secondary to spasticity
- Prevention of secondary musculoskeletal impairments - passive positioning, loading bone/cartilage, Estim, prevent pressure sores, task-related training
List activity limitations of the guidelines for neurological intervention.
Activities: 1. Bed mobility 2. sitting on edge of bed/out of bed 3. reaching for objects 4. holding and manipulating objects 5. standing up 6. standing/tilt table 7. walking on the spot 8. walking 9 stairs.
List the guidelines for neurological intervention for the activity limitations
- Graded mobilization - gradually increase the amount and intensity of the activities performed
- Follow medical/surgical instructions in medical record and commence graded mobilization as soon as medically stable
- Follow acute stroke - aim for frequent but short bouts of out of bed activity (Avert study)
What are the general management principles for neurological intervention seen in acute neuro wards?
- understand pathology and prognosis
- follow any contraindications or precautions
- check medical records to follow instructions
Describe reasons why people with Parkinson’s disease are admitted to hospital for an acute episode of care.
- Deep brain stimulator implanted - may assess pt before and after
- If patients having problems with medications - may take them off to sort out regime (assessing or intervention)
- May be having ways of medication delivered (ie. L-Dopa delivered directly into duodenum.
- Fractures
- pneumonia
- Infections
Describe reasons why people with Multiple Sclerosis disease are admitted to hospital for an acute episode of care.
- When they are first getting diagnosis - strand neurological symptoms
- Exacerbation - given steroids to limit and mx
- physiotherapists there to assess and set up programs for both exercising in hospital and getting assigned appropriate outpatient services when discharged.
Describe reasons why people with Motor neuron disease are admitted to hospital for an acute episode of care.
chest infection
What is Guillain Barre Syndrome?
Inflammatory disorder where person’s immune system attacks the peripheral nerves
Discuss factors to consider in the physiotherapy Mx of patients with Guillain Barre Syndrome
First presentation:
- monitor respiratory functions, spirometry, vital capacity and report changes of significance
- Continue vital capacity readings until patient plateaus or is intubated and ventilated (30% of patients)
Contraindications and precautions:
plasmapheresis, neuropathic pain (50%), low blood pressure (blood pooling, autonomic dysfunction)
What is the use of a halo and its potential impact on the life of the patient?
- To immobilize some cervical spine or upper thoracic fractures
- post-op immobilization to allow bone healing (following fusion)
- provides positional control and effective immobilization
allows early patient mobilization - worn up to 12 weeks
What are the contraindications and precautions for spinal surgery?
- Fusion - await post x-ray
- follow medical protocol (bed rest, graded mobilization and collar requirement)
- Log roll
- Restriction (ie. lifting <1.5kg for 4 weeks, no driving)
List the clinical signs of increased intracranial pressure
- Headache
- Vomiting
- Reduced level of consciousness
- Increased blood pressure
- Bradycardia
- Slow & irregular respiration
List and Describe the types of cerebral haemorrhage
Due to stroke or TBI
- Intracerebral haemorrhage (ICH)- Bleeding into the parenchyma
- Subarachnoid haemorrhage (SAH) - Bleeding into the subarachnoid space (often people <60 and due to ruptured aneurysm)
- Subdural haemorrhage (SDH) - Bleeding below dura, above arachnoid matter (usually due to trauma
- Extradural haemorrhage (EDH) - Bleeding between the dura and bone (usually due to trauma)
Discuss the contraindications and precautions for physio Mx of patients with cerebral haemorrhage
EDH and SDH - missing cranial bone flap so ensure helmet is worn when out of bed
SAH - If high doses of Nimodipine, monitor BP prior to mobilizing (vulnerable to postural hypotension), if vasospasm present do not mobilize (risk of ischaemic brain damage), liase with medical team re: cardiopulmonary intervention
Outline how cerebral external ventricular drains function and discuss the implications of this for physiotherapy Mx
- Work on pressure.
- Tube inserted in ventricle coming out of skull attached to drain (attached on pole) which has a laser pointer to line the height of drain with patients ear to maintain the right amount of pressure with the patients head pushing out extra fluid.
- can’t change level of head in relation to drain unless clamped first
List the medical Mx treatment for a TBI patient to control ICP
- Paralyse and sedate
- Ventilate to control arterial CO2 pressure
- Medications
- external ventricular drain
- possible decompressive craniectomy
Define Dysautonomia
Severe paroxysmal increase in HR, RR, BP and temp plus abnormal postures
Define Neurogenic heterotropic ossification and possible reasons it occurs
Ossification/bone formation in the muscle tissue (myositis ossificans) possibly connected to too vigorous PROM exercises
What is the most common Cerebral tumour?
Astrocytoma (44%)
What is the medical mx of cerebral tumours based on?
- Size
- location
- type and speed of growth
- effect on function
Define and describe hydrocephalus
Excessive cerebro-spinal fluid in ventricles of brain due to blockage or decreased reabsorption leading to increased ICP
Discuss the contraindications and precautions for physio Mx of patients with TBI
- PTA
- take care of injuries
- dysautonomia
- PROM exercises done slowly
Discuss the contraindications and precautions for physio Mx of patients with hydrocephalus
- Never move patient’s head height relative to EVD without it clamped (at risk of SDH)
