Week 6 - Fxnal mobility, FES and ABI Flashcards
Functional mobility
ability to move from one place to another to complete an activity or task
Purpose of fxnal assessment
measures functional abilities
info base for goal setting
Components of functional mobility
moving in bed (assist level - min, mod, or max?)
transitional movements
transfers
ambulation
stairs
How to increase patient participation
decrease hands-on by PT/PTA
decrease need for cueing/prompting
Progressive decrease in need for aids
2ww -> 4ww -> cane -> no aid
FES
Functional Electrical Stimulation
What does an FES do?
A neurological Tx. approach for flaccid/weak muscles that uses and EMS to retrain/perform a functional activity
Putting the pads on two parts of a muscle to activate it.
What is an ABI?
Acquired Brain Injury
Damage to brain, which occurs after birth and not related to a congenital or degenerative disease
ABI includes
TBI (car accident, falls)
Non-traumatic (tumor, stroke)
severe ABI’s can cause deficits in…
thought
behaviour
motivation
personal traits
talents
movement
cognition
social skills
ABI - Coup injury
1 direction hit injury
contrecoup injury
2 direction hit (whiplash in a car)
Cerebral Herniation
when brain tissue, blood and CSP shift from normal position in skull
Cerebral Herniation charactizations
decreased level of consciousness - can lead to coma
progressive motor dysfunction
vegetative disturbances
abnormal posturing
CSP
Cerebrospinal fluid
Diffuse brain injury
rotational and shaking forces on brain (car roll over) - brain being injured in every part of skull
worst one
Diffuse axonal Injury (DAI)
DAI
resulting in severe widespread degeneration of white matter, microscopic structural disruption
DAI clinical picture
Coma
person cannot wake up, but knows and hears everything people are saying
ABI - abnormal posturing
Decorticate
Decerebrate
Decorticate
feet in plantar flexion
arms at core
Decerebrate
arms held in extension
wrists held internal rotation and flexion
feet in plantar flexion
Coma emergence
patient may experience significant agitation, anxiousness and aggression during time after coming out of coma
Coma: structured Tx. sessions should be
in quiet areas to reduce distractions
broken up into multiple shorter sessions
Coma emergence Tx.
pt. may be progressively mobilized through tilt table or standing frame activities
vital signs monitored for changes and adverse physiological responses to positional changes
secondary brain damage
results from initial injury
- raised intracranial pressure
- arterial hypoxia and brain
ischemia - cerebral edema
- arterial hypotension
- impaired salt and water balance
- intracranial infection
- hydrocephalus (swelling of
brain
ABI recovery factors
age
size of lesion(s)
extent of diffuse injury
premorbid skills, intelligence, behaviours
genetic inheritance
neural plasticity
nutritional history
environment
medical management, rehab, family involvement
availability of support services
ABI - PT management considerations
Behavioural management
motor learning
motivation
attention
memory
motor control
family education
ABI - managing impulsivity
stay aware at all times
give patients 1 command at a time
ABI - How to get pt. up and going!
give choices - want to go to the bathroom first, or go straight to walking
ABI - emotional liability
reassure patients this is not unusual and carry on
ABI - decreased memory
use memory aids
repetition
Managing comm issues - Apraxia
Hard to get message out - speech muscles are affected
encourage breath control and pauses
clarify words
Managing communication issues - Dysarthria
speech muscles are damaged, paralyzed or weakened
breath control
clarify words
Dysphasia - managing comm issues
partial loss of ability to produce and understand spoken language
use tools/diagrams
liaise with SLP and follow recommendations
Paraphasia - managing comm issues
production of unintended syllables, words or phrases while speaking
breath control
clarify words
Dysphagia - managing comm issues
difficulty/painful swallowing
encourage to follow recommendations from SLP and dietician
Mild TBI means what?
concussion
