question

Agnosia

answer

Inability to recognize familar objects with one form of sensation (e.g., visual agnosia)

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Akinesia

answer

inability to initiate movement

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Aphasia

answer

disturbance to language that results in errors of word-choice, comprehension, or syntax.

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What is expressive aphasia?

answer

Severe difficulty in verbal expression with impairment in object naming and writing abilities. Most found in those with R hemiplegia.

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What is global aphasia?

answer

Characterized by reduced speech and comprehension. Reading and writing are impaired.

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What is wernicke's aphasia?

answer

It is a severe distrubance in auditory comprehension. Reading, writing, and word recognition are impaired as well.

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What is apraxia?

answer

p= motor planning issue inability to perform movements previously learned even though there is no loss of strength, coordination, sensation, or comprehension

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What is the difference between ideational and ideomotor apraxia?

answer

Ideational is when the person no longer gets the idea of how to do a routine task for example washing hands or brushing teeth Ideomotor apraxia is when a person cannot do a task on command but can do it spontaneously.

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Astereognosis

answer

Is the inability to recognize objects by touch alone.

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Asynergia

answer

Inability to move muscles together in a coordinated manner

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Ataxia

answer

uncoordinated movement, especially gait

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Athetosis

answer

s=snake slow, involuntary, worm-like, twisting motions. Usually seen in forms of CP.

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Causalgia

answer

burning sensations, which are painful often associated with CRPS type one (formerly known as RSD)

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What is Cheyne-Stokes Respiration? With what conditions is it associated with?

answer

It is a common and bizarre breathing pattern characterized by a period of apnea lasting 10-60 seconds followed by gradually increasing, then decreasing depth and frequency of respirations Associated with 1) Frontal lobe and diencephalic function 2) Postulated to be a result of an abnormality in the neurological respiration center. 3) Can occur with severe cases of TBI or CHF

question

What is chorea?

answer

Rapid, involuntary, jerky movements. Seen especially in Huntington's chorea.

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What is clonus?

answer

It is a rhythmic oscillation of a muscle in response to sustained stretch in patients with UMN disease

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What is decerebrate rigidity?

answer

Contraction of the extensor muscles of the UEs and LEs Due to injury at the level of the brain stem

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What is decorticate rigidity?

answer

Contraction of the flexor muscles of the UEs with contraction of the extensor muscles of the LEs.

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What is delirium?

answer

Temporary confusion or loss of mental function. Often a result of illness, drug toxicity, or lack of oxygen. Often reversible.

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What is dementia?

answer

Loss of memory or intellectual functioning

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What is dysmetria?

answer

Inability to judge distances. Seen especially in cerebellar dysfunction

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What is EMG?

answer

It is the study of a graphic record of the contraction of a muscle as a result of electrical stimulation. Used to evaluate voluntary electrical activity of a muscle.

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What is glove and stocking anesthesia?

answer

Can occur in generalized peripheral neuropathies in which the distal portions of the nerves degenerate resulting in anesthesia of the distal extremities in a pattern as if the patient was wearing long gloves and stockings. Occassionally seen in Guillain-Barre Syndrome

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What is Herpes Zoster?

answer

Aka shingles, it is a painful inflammation of the posterior root ganglion, caused by a virus, resulting in the formation of vesicles (fluid filled sacs) along the course of a nerve (e.g. dermatome).

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What is Horner's syndrome?

answer

3 osis 1) Drooping eye (ptosis) 2) Constriction of the pupil (miosis) 3) Lack of sweating of ipsiltaeral face (anhydrosis) Often accompanying stroke involving the anterior inferior or posterior inferior cerebellar arteries.

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What is Morton's Neuroma?

answer

It is an excessive pronation during stances produces compression between the third and fourth metatarsals the nerve can enlarge, forming a neuroma on the interdigital nerve resulting in metatarsalgia.

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What is a nerve conduction velocity test?

answer

Determines the speed of propagation of an action potential along a nerve or muscle fiber. 1) If a nerve is compressed or damaged, the velocity of the action potential will be slowed and the latency, or time the potential takes to travel between two points, will be increased. 2) This test is utilized to determine the severity of nerve compression (e.g., from a herniated disc) prior to the surgery.

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What is nystagmus?

answer

rapid, usually back and forth, movement of the eyeballs

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What is reciprocal inhibition?

answer

inhibition of muscles antagonistic to those being facilitated. This is essential for coordinated movement.

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What is romberg's sign?

answer

Loss of balance in standing when eyes are closed

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What is somatagonsia?

answer

Lack of awareness of the relationship of one's own body parts or the body parts of others.

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What is vegetative state?

answer

A deep coma with abnormal posturing. The patient may not have rehab potential if this state persists.

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What is visual acuity?

answer

Sharpness of vision that generally decreases with age or certain disabilities such as diabetes. 1. May need reading glasses to focus on or read things near by. 2. Decreased ability to adapt to very dark or light environments may need more or higher intensity lighting at home or use color contrasts on walls, floors, and stairs to increase safety during ambulation

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Visual field deficits What is the difference between Homonymous hemianopsia and bitemporal hemianopsia?

answer

HHM: A deficit of either the right or left halves of the visual field, caused by damage to the contralteral optic tract Bitemporal hemianopsia: It is a deficit of the temporal or peripheral visual fields, Blindnesss in one eye is a result of damage to the optic nerve (monocular blindness).

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CVA common sites

answer

1) Common Carotid A 2) main bifurcation of the MCA 3) junction of the vertebral arteries with the basilar artery

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Characteristics of MCA Stroke?

answer

1) Most Commonly Involved in a stroke 2)Contralateral hemiplegia 3) Mostly upper extremity involvement 4) loss of sensation primarily in the arm and face 5) homonymous hemianopsia is common 6) infarction in a dominant left hemisphere may produce aphasia and apraxia 7) occlusion of the main stem of the middle cerebral artery can cause global aphasia

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Characteristics of stroke to ACA

answer

1) Rarely involved 2) Lower extremity more frequently affected resulting in contralateral hemiplegia and sensory loss 3) Can result in mental confusion, 4) aphasia 5) contralateral neglect if involvement is extensive on the dominant side

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Characteristics of Stroke to PCA (posterior cerebral A)?

answer

P think P is for pain 1) Persistent pain syndrome or contralateral pain and temperature sensory loss can occur 2) homonymous hemianopsia 3) aphasia 4) thalamic pain syndrome

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Characteristics of Vertebral-basilar stroke?

answer

1) Often results in death from the edema associated with the infarct 2) If a patient survives and the lesion is affected the pons can result in: Quadriparesis Bulbar palsy Locked in state- patient can communicate only by eye blinking 3) Vertebral artery symptoms include: vertigo, coma, diplopia, nausea, dysphagia, and ataxia

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Characteristics of stroke to AICA (anterior inferior cerebellar A)?

answer

1) unilateral deafness 2) loss of pain and temperature on the contralateral side 3) paresis of lateral gaze 4) Unilateral Horner's syndrome (ptosis, constricted pupil aka miosis, and loss of sweating aka anihydrosis) 5) ataxia 6) vertigo 7) nystagmus

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Characteristics of Superior cerebellar stroke?

answer

1) Severe ataxia 2) dysarthria ( loss of muscle articulation control 3) dysmetria, (finger to nose test) 4) Contralateral loss of pain and temperature

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Characteristics of PICA (posterior inferior cerebellar A) Stroke?

answer

Wallenberg's syndrome characterized by: 1)vertigo 2) nausea 3) hoarseness 4) dysphagia 5) ptosis 6) decreased impairment of sensation in the ipsilateral face and contralateral torso and limbs 7) Horner's syndrome may also appear

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Stages of Recovery Following a stroke: Define stages 1-6

answer

Stage 1: Flaccid, no limb movement Stage 2: Synergies may appear. Spasticity begins to develop. Minimal voluntary movement. Stage 3: Spasticity increases and may become severe. Voluntary control of movement synergies appears. Stage 4: Some movement independent of the synergies. Spasticity begins to decline. Stage 5: If patient progresses, synergies no longer dominate and movement becomes more complex Stage 6: Spasticity is gone. Coordination and movement approach is normal

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UE Flexion Synergy

answer

Scapular Elevation and Retraction Shoulder Abduction and External Rotation Elbow flexion (generally the strongest component) Forearm supination and wrist/finger flexion

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UE Extension synergy

answer

...

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LE Flexion Synergy

answer

Hip flexion (generally the strongest component), adduction, external rotation. Knee flexion Ankle dorsiflexion and inversion Toe dorsiflexion

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LE Extension Synergy

answer

...

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Hypotonicity characteristics and treatment

answer

Characteristics 1) Floppy 2) Low tone 3) flaccid 4) risk of dislocation of the atlantoaxial joint (SCI potential), hip, knee, elbow, shoulder, etc. 5) hypoactive reflexes and shallow breathing patterns Treatment 1) avoid joint hyperextension 2) Work for joint compression and facilitation to help normalize tone 3) Use resistance functioning muscles and isometric holding to increase activation of inactive muscles 4) facilitation techniques include: quick stretch, tapping of the muscle belly or tendon, high frequency vibration, light touch, quick icing, fast spinning or rolling. Joint approximation facilitates concontraction

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Hypertonicity characteristics and treatment

answer

Characteristics: 1) Spastic, high tone with hyperactive reflexes 2) decreased thoracic mobility 3) risk of contractures and deformity 4) changes in body position affect tone Treatment: 1) Work to inhibit reflex activity via postures, positions, or techniques of relaxation training 2) Inhibition techniques include: a) prolonged static muscle stretch b)inhibitory casting c) slow repetitive rocking or rolling d) very low frequency vibration e) reflex inhibiting procedures f) limb movements emphasizing rotation g) slow stroking h) neutral warmth i) prolonged icing f) deep pressure to tendon 3) reciprocal inhibition: usuing facilitation techniques to the nonspastic muscles will cause inhibition of the spastic muscles.

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Hypertonicity tends to be associated with UMN or LMN issues?

answer

Hypertonicity associated with UMN Hypotonocity associated with LMN

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Common problems of the trunk/pelvis during stance phase

answer

1) unawareness of affected side due to poor proprioception 2) Forward trunk weak hip extension or flexion contracture

question

Common problems of the hip during stance phase

answer

1) Poor hip position (typically adduction or flexion) as a result of poor propioception 2) Trendelenburg gait due to weak abductors on contralteral side. 3) Scissoring as a result of spastic adductors

question

Common problems of the knee during stance phase

answer

1) Flexion during forward progression from a flexion contracture combined with weak knee extensors and/or poor propioception 2) Hyperextension during forward progression due to plantarflexion contracture past 90 degree of severe spasticity in quadriceps or weak knee extensors (compensatory locking of the knee).

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Common problems of the ankle/foot during stance phase

answer

1) equinus gait (heel does not touch the ground, aka tiptoe gait) from spasticity or contractures of gastrocsoleus 2) unequal step lengths due to hammer toes caused by spastic toe flexors

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Common problems of the trunk/pelvis during swing phase

answer

1) Insufficient forward pelvic rotation from weak abdominal muscles 2) inclination to sound side for foot clearance because of weakness of hip flexor muscles.

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Common problems of the hip during swing phase

answer

1) inadequate flexion from weak hip flexors, poor propioception, spastic quadriceps, hip abductor weakness of the opposite side. 2) exaggerated hip flexion due to strong flexor synergy

question

Common problems of the knee during swing phase

answer

1) inadequate knee flexion from spastic quadriceps or reduced hip flexion 2) exaggerated but delayed knee flexion due to spastic hamstrings or sustained total flexor pattern

question

Common problems of the ankle/foot during swing phase

answer

1) Persistent equinovarus from plantarflexor contracture or spasticity, weak dorsiflexors, delayed contraction of dorsiflexors (toe drag during midswing). 2) Varus position of the foot from spastic anterior tibialis, weak peroneals, and toe extensors. 3) exagerrated dorsiflexion due to strong flexor synergy pattern.

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Perceptual problems with Right hemisphere affected (left hemiparesis)

answer

1) problems with spatial relationships and hand eye coordination 2) Irritability, short attention span 3) Cannot retain information, difficulty learning individual steps 4) Poor judgment affecting personal safety 5) Diminished body image with left sided neglect 6) quick and impulsive

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Perceptual problems with Left hemisphere affect (right hemiparesis)

answer

1) apraxia 2) difficulty starting and sequencing tasks 3) perseveration 4) easily frustrated with high levels of anxiety 5) inability to communicate verbally 6) cautious and slow

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How to communicate with those with receptive aphasia

answer

Use word repetition and manual cues to assist in communicating desired actions during rehabilitation

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How to communicate with those with expressive aphasia

answer

Phrase questions for simple "yes" or "no" responses to avoid confusion and frustration.

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How to communicate with those with global aphasia

answer

Use symbolic gestures to reduce the chance of overestimating the patient's ability to understand speech

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TBI: List all 8 Levels

answer

I No response II generalized response III Localized response IV Confused/Agitated V Confused/Inappropriate VI Confused appropriate VII Automatic appropriate VIII Purposeful appropriate

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I No response

answer

Completely unresponsive to any stimuli

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II Generalized response

answer

Patient reacts inconsistently and nonspecifically to stimli

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III Localized response

answer

Patient reacts inconsistently but specifically to stimuli

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IV Confused/agitated

answer

Patient is in a heightened state of activity. Behavior is bizarre and non purposeful relative to the immediate environment Recall and attention span are poor

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V Confused inappropriate

answer

Patient is able to respond to simple commmands but not do complex tasks Memory is impaired Verbalization is inappropriate

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VI Confused appropriate

answer

Patient is dependent on external input but can perform consistently. Memory improved. Verbalization is inappropriate.

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VII Automatic appropriate

answer

Can perform automatically and appropriately in structured environments. Judgment remains impaired.

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VIII Purposeful appropriate

answer

Patient acts appropriately though not perfectly. May have some problems in stressful or unusual circumstances

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What is the Glasgow coma scale?

answer

It is an objective way to describe a patient's level of consciousness 3 categories: (EMV) Eye opening, motor response, and verbal response A Score of 8 or less is indicative of severe brain injury

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What is the definition of arousal?

answer

The overall level or alertness or reaction to stimuli Low arousal is associated with coma High arousal may occur with agitated state following brain injury Quiet environment and consistency in management (daily routine) may help patients in high state arousal

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treatment strategies for behavioral problems

answer

1) Use a calm voice, perhaps a reassuring touch 2) If patient becomes disruptive, redirect patient away from frustrating experiences 3) Sets limits on behavior and give positive feedback 4) offer treatment ("time out") only if patient becomes overstimulated or strikes out at the therapist 5) offer treatment choices to the patient and give greater patient responsiblites to increase their self-esteem 6) avoid surprises, keep therapist and schedule consistent 7) keep verbal instructions and descriptions to a minimum 8) Practice should follow right after demonstration of the activity 9) use a memory log with key information (address, phone number, apartment floor, etc.) if the patient demonstartes memory loss. Patient can carry it or attach it to clothing when leaving the home 10) may take up to a year or more before a patient with TBI achieves maximal functional return.

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Signs and Symptoms of ALS

answer

UMN and LMNs affected 1) muscle weakness is progressive and can affect muscles of respiration 2) weakness appears in the hands first 3) dysphagia and dysarthria can accompany the disorder 4) Muscle atrophy, cramping, and fasciculations (LMN sign) definition of fasciculation-muscle twitch", is a small, local, involuntary muscle contraction and relaxation which may be visible under the skin. Arise as a result of spontaneous depolarization of a lower motor neuron leading to the synchronous contraction of all the skeletal muscle fibers within a single motor unit. 5) Spasticity and hypereflexia (upper motor neuron signs) 6) often no sensory changes

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Treatment for ALS

answer

1) Maintain respiratory function and activity levels 2) PROM exercises 3) Positioning and skin care 4) Prevent further deconditioning and disuse atrophy 5) Avoid overworking muscles and teach energy conservation 6) Symptomatic treatment of pain, spasms, and spasticity 7) Provide psychological support and reassurance

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What is Bell's Palsy and what are some signs and symptoms?

answer

It is an inflammatory response affecting facial nerve CN VII, results in paralysis of the muscles of facial expression. The branch of CN VII affected will dictate symptoms

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Bell's Palsy Treatment

answer

1) Artificial tears or temporary patching to protect the cornea 2) Electrical stimulation to maintain tone and support function of facial muscles 3) teach facial muscle exercises 4) Provide functional retraining

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Guillain Barre Syndrome GBS: What is it? Signs and symptoms?

answer

1) LMN disease affecting cranial and peripheral nerves 2) Some sensory loss (stocking/glove) and paresthesias (tingling,burning) 3) Muscle weakness progresses from lower extremities to uppers. Distal to proximal progression 4) May produce full tetraplegia with respiratory failure. 5) Tachycardia, abnormalities in cardiac rhythm and blood pressure changes 6) Recovery is slow (up to one year) with some mild weakness persisting and a 3% mortality rate.

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Treatment for Guillan Barre

answer

Ascending phase (disease is progressing) 1)When disease is progressing include respiratory function (pulmonary PT) 2) PROM within tolerance 3) positioning to reduce contractures 4) skin care to prevent breakdown When the patient stabilizes, prevent injury of denervated muscles, avoid overuse and fatigue, begin gentle stretching, and initiate movement in a controlled environment Descending Phase (paralysis slows recedes) During the descending phase (paralysis slowly recedes) provide muscle reeducation with a moderate exercise program, improve cardiovascular fitness, and teach energy conservation.

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What is multiple sclerosis and what are signs and symptoms?

answer

A demyelinating disease more prevalent in colder climates of the world. The disease may be relatively mild, have bouts of remissions and exacerbations, or get progressively worse Signs and symptoms 1) Sensory Disturbances 2) Coordination problems and spasticity 3) fatigue (especially in the afternoon) 4) diplopia 5) B&B problems 6) Communication disorders 7)Psychosocial problems including euphoria and/or depression 8) adverse reactions to heat (e.g, heating modalities and hot environment)- Utoff's symptom

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Treatment for MS

answer

1) Improvement of function 2) Prevention of secondary problems; e.g., skin care if sensation is lost or diminished 3) breathing exercises 4) PNF to tolerance 5) Ambulatory or WC mobility 6) decreased tone 7) use positive approach and try to keep patient's stress levels low 8) overvigorous activity could fatigue the patient and may worsens symptoms 9) morning treatment sessions are preferable

question

What is PD and what are signs and symptoms?

answer

It is a progressive disease affecting the BG with a decrease in dopamine production and/or receptors in the brain. Signs and symptoms: Tremor, rigidity, and fatigue Difficulty initiating or slowness of movement (bradykinesia) Abnormal gait (festinating or slow shuffling) Flexed posture Mask-like face Decreased postural reflexes Behavioral changes including memory loss or apathy that can lead to secondary problems including decubitus ulcers, muscle atrophy, contractures, decreased vital capacity, and falls.

question

What are some treatments for PD?

answer

1) Gait training to increase stride width and length 2) Breathing exercises 3) Relaxation techniques (e.g., gentle rhythmic rocking, vestibular stimulation, and prone on a large ball) 4) mobility exercises 5) PNF diagonals with rhythmic initiation to overcome bradykinesia 6) ROM activities including PNF CR, inhibitory casting, or orthoses 7) Avoid excessive exercise or stretching. Pain or lack of endurance could lead to fatigue 8) Dopamine agonist medications may be used to decrease tremor and bradykinesia Medications sometimes lose effectiveness It is best to treat patients in the morning following dopamine agonist administration

question

Postpolio syndrome, S&S and treatment

answer

1) It is a new form of muscular dystrophy that may occur decades after the initial episode of polio 2) new denervation occurs with ASYMETRICAL muscular weakness S&S 1) Myalgia 2) joint pain 3) Variable asymmetrical muscle atrophy with decreased strength 4) excessive faitgue and decreased endurance contribute to loss of function. Treatment 1) Low intensity exercise never to the point of fatgiue. Stop with pain or weakness.

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Pain syndromes: Neuropathic pain

answer

1) Pain that is the result of lesions in some part of the nervous system 2) Usually accompanied by some degree of sensory deficit 3) Thalamic Pain a. Continuous, intense pain occurring on the contralateral hemiplegic side b.The result of a storke involving the posterior cerebral artery 4) CRPS- CRPS 1 cause is tissue injury without nerve damage and CRPS II involves a nerve injury. a. Pain is maintained by the sympathetic nervous system, characterized by burning pain (causalgia), hypersensitivity to light touch, coldness, and sweating. b. Usually associated with traumatic injury 5) Disorders of peripheral roots and nerves a. Neuralgia: pain occurring along a nerve b. radiculalgia: neuralgia of the nerve roots 6) Herpes Zoster (shingles) 7) Phantom Limb: pain in a residual limb following amputation

question

Muscloskeletal

answer

...

question

What is referred pain?

answer

Starts deep in visceral tissues and is felt in abody region remote from the site of pathology, resulting in tenderness and pain in superficial locations. Examples: 1) Medial left arm and jaw pain with a heart attack 2) R subscapular pain from a gallbladder attack 3) Thoracic or flank pain from kidney problems 4) Left upper quadrant and shoulder pain with spleen damage 5) Right upper quadrant pain with liver problems

question

What is the purpose of PNF?

answer

Uses total body patterns of movement and posture to promote motor learning in synergistic muscle patterns and prepare the body for advanced functional skills (e.g. gait)

question

What is the starting and ending position for D1 flexion for upper extremity?

answer

Starts with: IR ABD EXTENSION Ends with: ER ADD FLEXION

question

What is the starting and ending position for D1 flexion for lower extremity?

answer

Starts with: Hip IR ABD EXT Ends with: ER ADD FLEXION

question

What is the starting and ending position for D2 flexion o

answer

...

question

What are the different techniques for facilititation

answer

Agonist reversals (AR) Approximation Contract-Relax Hold-relax Repeated Contractions Rhythmic initiation Rhythmic stabilization Slow reversal (SR) Traction

question

What are agonist reversals? When are they used?

answer

Slow isotonic shortening contraction Through the entire range Followed by eccentric lengthening contraction with the same muscle groups Indications: Weak postural muscles Inability to eccentrically control body weight during movement transitions. For example sitting down

question

What is approximation? When is it indicated?

answer

It is joint compression It is indicated for: 1) Simulating afferent nerve endings and facilitate postural extensors promoting stability

question

What is contract-relax (CR)? What are its indications?

answer

Isotonic movement in rotation Followed by an isometric hold of range limiting muscles in the antagonistic pattern against slowly increasing resistance, then passive motion and active contraction of the agonistic pattern. Indications: 1. Limited ROM caused by a. tightness b. spasticity

question

What is hold relax (HR)? What are its indications?

answer

Isometric contraction of the antagonistic pattern against slowly increasing resistance Followed by voluntary contraction

question

What are repeated contractions (RC)? What are its indications?

answer

Repeated isotonic contractions induced by quick stretches and enhanced by resistance performed through the range or part of range at a point of weakness. Indications: 1) weakness 2) incoordination 3) muscle imbalances 4) lack of endurance

question

What is rhythmic initiation? What are its indications?

answer

Voluntary relaxation followed by passive movement through increasing ROM Followed by active-assisted contractions progressing to resisted isotonic contractions Indications: 1) Spasticity 2) Rigidity 3) hypertonicity 4) Inability to initiate motion (apraxia) 5) Motor learning deficits 6) Communication deficits (aphasia)

question

What is rhythmic stabilization? What are its indications?

answer

Simultaneous isometric contractions of both agonist and antagonist patterns Performed without relaxation using carfeul grading or resistance Cocontraction of opposing muscle groups Indications: 1) Instability in weight bearing and holding 2) poor antigravity control 3) Weakness 4) ataxia 5) Limited ROM caused by muscle tightness 6) painful muscle splinting

question

What is a slow reversal (SR)? What are its indications?

answer

Alternating isotonic contractions Indications: 1) inability to reverse directions, muscle weakness or imbalance 2) incoordination 3) Lack of endurance

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What is traction? What are its indications?

answer

Separation of the joint surfaces Indications for traction include: 1) facilitates flexor muscles, mobilizing patterns

question

Exteroceptive Stimulation

answer

Facilitation techniques a. repetitive brushing. facilitates tactile receptos and movement responses b. quick icing for the muscles c.quick stretch or tapping. agonist tendon or muscle belly is stimulated d. high frequency vibration. 50-300 Hz to agonist Facilitation techniques applied to the antagonist inhibit the agonist via reciprocal inhibition. Inhibition techniques a. Prolonged icing inhibits muscle b. neutral warmth relaxation by wrapping patient in towels or blankets to decrease postural tone. c. prolonged stretch. muscle tone decreased. d. low-frequency vibration. 5-50 Hz. inhibition of agonist. e. pressure on tendons. Firm, constant pressure may decrease tone.

question

Vestibular stimulation

answer

1. Slow rocking, rolling on ball. Inhibits postural tone and promotes head righting. 2. Fast spinning. Facilitates postural tone and promotes head righting. 3. Head down position, prone over a ball. Can activate postural extensors of the neck, trunk, and proximal joints. Has a soothing effect especially for sympathetic responses.

question

NDT, Bobath

answer

1. Motor learning (or relearning) can be facilitated by repetition or experience in the environment 2. Inhibition of unwanted activity (e.g., abnormal tone or reflex patterns) precedes practice of normal motor patterns 3. Guided movement. Active movements are guided or assisted only when needed. Usually early in the rehabilitation process. 4. Normalization of tone. a. Efforts are made to increase tone if hypotonic or decrease tone if hypertonic b. abnormal patterns of movements and reflexes are inhibited or prevented. 5. Normalization of sensory/perceptual experiences. Resumption of normal functional activities that are meaningful, goal-oriented (e.g., rolling, sitting up, standing, walking) 6. The validity of NDT (Bobath) has been questioned

question

Neurological Intervention strategies

answer

1. Motor control a. the ability to regulate or direct mechanisms essential to movement b. an area of study dealing with the understanding of the neural, physical, and behavioral aspects of movement c. motor program: a set of prestructured commands that, when initiated, results in the production of a coordinated movement sequence. d. motor plan: an overall strategy for movement; an action sequence requiring the coordination of a number of motor programs e. Feedforward: sending of afferent signals in advance of movement to ready the system; anticipatory responses in postural activity f. feedback: afferent information sent by various sensory receptors to motor control centers to shape ongoing movement or allow for adaptation of motor responses g. motor skill acquisition: behavior is organized to achieve a goal oriented task

question

What is motor learning?

answer

Motor learning is the study of the acquisition and/or modification of movement 1) Performance (of a skill or task) 2) retention: ability to demonstrate the skill after a period of no practice 3) generalizability: ability to apply what has been learned to other similar tasks 4) resistance to contextual change: ability to apply what has been learned to other similar tasks ( the clinic, home, and work) Components of motor learning 1) Feedback 2) Practice 3) Transfer

question

What are the different stages of motor learning?

answer

1) Cognitive: develop an overall understanding of the skill through trial and error practice 2) associative: refinement of the motor strategy is achieved through continued practice; concentrate on how to do the movement rather than what to do. 3) autonomous: after considerable practice the motor performance becomes largely automatic.

question

Asymmetrical Tonic Neck Reflex

answer

Stimulus: rotation of the head to one side Response: Flexion of the skull limbs, extension of the jaw limbs, "fencing posture" Strongest influence in the supine or sitting position Prolonged influence can result in: - scoliosis -hip subluxation/dislocation if there is marked hypertonia -if the reflex is severe, grasping of objects with an extended arm is onlly possible if the patient looks away from the object to lessen the reflex influence. onset: birth integrate: 4-6 months

question

Crossed extension Reflex

answer

Stimulus: noxious stimuli to the ball of foot of extremity fixed in extension; tested in supine position Response: (1) Opposite lower extremity flexes, then adducts, and extends (2) In patients with hemiplegia, lifting the uninvolved leg off the ground during ambulation results in increased extensor tone in the involved leg This reflex, when coupled with the positive supporting reaction, can result in hyperextension of the knee Onset: 28 week gestation integrated: 1-2 months

question

Equilibrium reactions

answer

Stimulus: displace center of gravity by tilting or moving support surface (e.g., with an equilibrium board or ball). Response: (1) curvature of the trunk toward the upward side along with extension and abduction of the extremities on that side (2) protective extension on the opposite (downward side) (3) the equilibrium reactions will be absent if there is marked spasticity Onset:.... Integrated: Persists

question

Grasp

answer

stimulus: maintain pressure to palm of hand (palmar)vor to ball of foot under toes (plantar) response: maintain flexion of fingers or toes onset: palmar at birth plantar: 28 weeks gestation Integrated: palmar 4-6 months Plantar 9 months

question

Landau's reflex

answer

Stimulus: Lift the child under the thorax in a prone position response: first the head and then the back and legs will extend If the head is pushed into flexion, the extensor tone will disapear onset: 3 months integrated: 2 years. absent in individuals that demonstrate a strong flexor spasticity

question

Moro reflex

answer

Stimulus: Sudden change in position of the head related to the trunk. e.g. drop patient backward from sitting position response: extension and abduction of UEs with hand opening and crying This is followed by flexion adduction and arms across chest onset: 28 weeks gestation integrated: 5-6 months

question

Optical and Labyrinthe righting reflexes

answer

Stimulus: Alter body position by tipping body in all directions For labryinthine, vision is occluded Response: head orients to vertical position and mouth horizontal onset: birth-2 months integrated: persists

question

Positive supporting reaction

answer

Stimulus: contact to the ball of the foot in an upright standing position Response: Rigid extension (cocontraction) of the lower extremities with ankle PF and INV, "toe clawing," and hip internal rotation. Variations: (1) In the patient with CP, adductor spasm may occur (2) In patients with hemiplegia, the results may produce hip abduction (3) Ambulation will be disrupted by the inability to dorsiflex the foot or to properly move the leg joints onset: birth Integrated: 6 months

question

Protective extension reaction

answer

Stimulus: Displace center of gravity outside base of support Response: 1) Arms or legs extend and abduct to support and to protect the body against falling. 2) Protective extension downward (parachute reaction) develops first, followed by forward, sideward, and backward protective extension. onset: arms: 4-6 months legs: 6-9 months

question

Rooting reflex

answer

Stimulus: side of face is stimulated with light touch Response: the infant turns the head toward the side of stimulation and opens the mouth. onset: present in premature infants integrated: 3 months

question

Symmetrical Tonic Neck Reflex (STNR)

answer

Stimulus: flexion or extension of the head Response: 1) With head flexion: flexion of arms and extension of the legs 2) With head extension: extension of the arms and flexion of the legs onset: 4-6 months integrated: 8-12 months Can strongly influence the ability to assume quadruped position (hands and knees) as well as ability to crawl. Head follows arms, legs do opposite

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Tonic Labrinthine reflex

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Stimulus: prone or supine position response: 1) with prone: increased flexor tone 2) with supine: increased extensor tone onset: birth Integrated: 6 months It may be impossible for the patient to turn side lying from the supine position because the extensor tone limits flexion of the shoulder or hip on one side, which is needed to turn over

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Traction Reflex

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a. Stimulus grasp forearm and pull up from supine into sitting position b. response: grasp and total flexion of the upper extremity and the head will lag behind. c. onset: 28 weeks gestation d. integrated: 2-5 months

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Developmental Milestones: 1 month

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Lifts head Follows a moving object Exhibits a reflex stepping Positive support reflex Decreased flexion Hands fisted with indwelling thumb most of the time, reciprocal and symmetrical kicking and neonatal reaching

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Developmental milestones: 2 months

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Lifts head 45 degrees in prone Head lags on pull to sitting (traction reflex) Smiles Begins prone on elbows with elbows behind shoulders Head bobs in supported sitting

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Developmental milestones: 3 months

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Can prop self into prone on elbows with weight on forearms Coos Chuckles Takes weight with toes curled in supported standing Head elevation to 90 degrees

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Developmental milestones: 4 months

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Can prop head and chest for a long time (pivot prone) Head no longer lags in pull to sitting Sits with support Laughs out loud Rolls prone to side Supine to side Optical labryinthine head righting present Ulnar palmar grasp

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Developmental Milestones: 5 months

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Can roll from prone to supine Head control in supported sitting Weight shifting from one forearm to the other in prone

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Developmental Milestones: 6 months

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Rolls from supine to prone Independent with sitting Pulls to stand Prone on hands with elbows extended while weight shifting from hand to hand

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Developmental milestones: 7 months

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Can maintain quadruped Pivots on belly Prone extension position (pivot prone) Assumes sitting quadruped Trunk rotation in sitting Recognizes tone of voice

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Developmental milestones: 8-9 months

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Belly crawls Quadruped creeping Side sitting Pulls to stand through kneeling Cruises sideways Can stand alone Has pincer grasp with thumb and forefinger Can transfer objects from one hand to the other moves quadruped to sitting

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Developmental milestones: 10-15 months

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Stands and begins to walk unassisted Begins self feeding Searches for hidden toys Plays patty cake Plays peek a boo Imitates Reaches with supination Neat pincher grasp with release

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Developmental milestones: 18-20 months

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Can walk up and down stairs with assistance Ascends stairs with step-to pattern Sits on a small chair Begins to run more coordinated Jumps off bottom step Plays make believe

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Developmental milestones: 2 years old

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Runs well Can go up stairs one at a time (reciprocal) Active Restless Tantrums

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Developmental milestones: 3 years old

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Goes down stairs reciprocally Rides a tricycle Begins to catch a ball Jumps with two feet Understands sharing Stands on one foot birefly

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Developmental milestones: 3.5 years old

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Hops on one foot Kicks a ball

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Developmental milestones: 4 years old

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Hops on one foot several times Climbs Throws a ball overhand Stands on tiptoes Relates to friends

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Developmental milestones: 5 years old

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Skips Kicks a ball well Dresses and undresses self

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APGAR

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Scoring system used to evaluate the status of an newborn Variables measured: Appearance Pulse Grimace Activity Respiration Heart rate, respiration, muscle tone, color, and reflex irritability are measured on a scale of 0-2 at birth and again 1,5,10, and 15 minutes after birth A total score of 7 or more is normal 5-6 requires some care (e.g. ventilation, stimulation, or resuscitation) and 4 requires or less requires immediate care

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Brachial Plexus Injuries: What is Erb's palsy (Upper)?

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Occurs when the C5 and C6 nerve roots are stretched during the birth process The patient has weakness in GH ABD and ER, elbow flexion, and supination Classically, the shoulder is adducted and IR and presents with the "waiter's tip" deformity. Neutral positioning of the arm with gentle ROM exercises may be done early Functionally, in severe cases (e.g., nerve root avulsion) the child may not be able to use the involved side to hug a doll, drink from a cup, zip up a coat, etc.

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Brachial plexus injuries: Lower (Klumpke's Paralysis)

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Occurs when C8 and T1 nerve roots are stretched during the birth process The result is weakness of the hand and wrist flexors A claw hand appearance is common Hand function will be affected

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What is the definition of a premature infant?

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The birth of an infant before 37 weeks gestation Categorized by birth weight

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What is the differences in posture between a premature neonate and a normal neonate?

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The normal neonate exhibits: 1. symmetrical flexed and 2. abducted posture of the upper and lower extremities. The premature neonate exhibits : 1. Hyperextended neck and trunk 2. Elevated shoulders 3. Scapular retraction 4. Shoulder's and hips abducted and extended 5. Anterior tilt of the pelvis 6. Decreased midline arm movement 7. WB on toes when placed in upright position

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Treatment for premature infant

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Stress side lying and prone with 1. chin tucked 2. trunk flexed 3. shoulders protracted 4. posterior pelvic tilt 5. Flexion of the legs 6. Prone positioning makes use of the influence of the tonic labryinthine reflex enhancing flexion 7. Gentle flexion of the hips and knees in supine and supported semisitting can also be used.

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Parental education (play and feeding)

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1. Teach parents to include play activities that bring the shoulders forward to counteract retraction 2. Suspend toys in front of the infant to encourage reaching 3. Position the head in midline 4. Tilt the child to encourage head balance and head righting 5. Position prone or sidelying 6. Minimize the use of infant jumpers or walkers, which increase extensor tone.

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Equipment and Devices

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There are useful aids in therapeutic exercise and handling of children with various disorders For example, a foam wedge can help a child function in a prone position.. Tilt and equilibrium boards can help elicit righting reactions

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Therapy (Swiss) Balls

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Can help with automatic reactions; e.g, seat a child on a therapy ball, displace it backward, and the child will perform a forward righting reaction and activate the abdominals

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Functional sitting 90 degrees of flexion

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1. Occurs when the pelvis is in a neutral position with hips and knees at 90 degrees of flexion 2. Various supports and seatbelts, or the tilting of the seat posteriorly while adding a wedge under the thighs may be necessary to properly position a child in the seat. 3. If the child has increased extensor tone, a tilt in space WC seat can be used to maintain hip flexion at 90 degrees 4. Tilting the child backward will activate a forward righting reaction and the patient's abdominal muscles.

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Standers

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Can be prone or supine and help to reduce the influence of primative reflexes, promote weight bearing and aid bladder and bowel function.

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Posture control (rollator) walkers

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a. Facilitate alignment and gait in children and adults who must use walkers to ambulate. b. lightweight aluminum frame makes it easy for very young users to maneuver through tight spaces. c. Each model offers more or less maneuvering flexibility depending on whether a two-wheel, four wheel, or front swivel wheel type.

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What is CP? What are the main causes and 4 types?

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It is a group of non progressive disorders resulting from gestational, perinatal, or postnatal central nervous system (CNS) damage. Characterized by voluntary movement impairments Major causes 1) Hemorrhage below the lining of the ventricles 2) Hypoxic encephalopathy 3) Malformations 4) Trauma of the CNS 4 types include: 1. Spastic 2. Athetoid 3. Ataxic 4. Mixed

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What are some characteristics of spastic CP?

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a) The most common syndrome b) Affects the UMN with the spasticity affecting - both limbs on one side (hemiplegia) -both legs (paraplegia) -all four limbs (tetraplegia) -immediate form between para- and tetraplegia that affects mostly the legs Affected limbs have: 1. Increased DTRs 2.Increased muscle tone 3. Abnormal postures and movements with mass patterns of flexion or extension 4. weakness 5. tendency to contractures 6. Scissors gait and toe walking are characteristic 7. Visual, auditory, cognitive, and oral-motor deficits may be present.

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What are some characteristics of athetoid CP?

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1) Results from BG involvement 2) Slow, writhing, involuntary movements may affect the extremities 3) Decreased muscle tone 4) poor functional stability in proximal joints 5) poor visual tracking 6) speech delay and oral motor problems 7) Tonic reflexes (ATNR, STNR, and tonic labyrinthine reflex (TLR) may be persistent, blocking functional positions and movement.

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What are some characteristics of ataxic CP?

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1) Uncommon 2) Results from cerebellar involvement 3) Weakness, poor coordination, and intention tremor produce unsteadiness, a wide based gait, and difficulty with rapid or fine movement

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What is mixed form CP?

answer

Mixed forms most often spasticity and athetosis and less often ataxia and athetosis

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What does treatment include for CP?

answer

1) Goal is to develop the maximal independence allowed by the individual's abilities, age, and type of CP 2) Utilize principles of motor learning and motor control to facilitate functional motor skills 3) Adaptive equipment and orthotic devices may be needed to improve posture, trunk control, function, and socialization.

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What is Down Syndrome(Trisomy 21)?

answer

1) A congenital chromosomal abnormality, resulting in an extra chromosome 21. 2) Babies may present with * hypotonia * decreased muscle force * congenital heart defects *visual and hearing losses *laxity of ligaments *cognitive deficits *limitations could include gross motor delay and difficulties in eating and speech development. *cognitive and perceptual deficits may result in a delay of fine motor and psychosocial development *forceful neck flexion and rotation activities should be limited due to atlantoaxial ligamentous laxity and potential for a subluxation and/or spinal cord injury.

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Treatments for Down Syndrome?

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1) Facilitate gross and fine motor development via postioning, posture, and movement activities. 2) Increase strength and stability by modifying resistance and gravity in a graded manner 3) Encouraging motor function and avoid hyperextension of the elbows and knees during weight bearing activities. 4) Consider energy conservation strategies or activities if congenital heart defects are present.

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What is Duchenne's Muscular Dystrophy?

answer

It is a genetic disease that affects males and causes destruction on muscle cells Progressive weakness from proximal to distal presenting in boys from 3-7 years old 1. Waddling gait pattern 2. Toe walking 3. Lordosis 4. Frequent falls 5. Difficultly standing up (Gower's sign to use UEs to walk up the legs) 6. Problems climbing stairs due to weak gluteal and quadriceps muscles 7.Contractures and deformities develop due to muscle imbalances especially of the heel cords and TFL 8.As the disorder progresses, the child will develop kyphoscoliosis (after 11 years of age) Treatment: 1) Maintain mobility 2) Encourage recreational activities to maintain strength and cardiopulmonary function 3) Use positioning devices and orthoses to prevent contractures and maintain joint ROM 4) Educate and support the parents and family 5) Do not exercise at a maximal level. Heavy exercise may injure muscle tissue.

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What is Myelomeningocele (spina bifida)? What are some functional problems associated with spina bifida? What does treatment consist of?

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A defect in the vertebrae resulting in protrusion of the spinal cord and meninges After surgical closure, hydrocephalus may become a problem and require shunting of the CSF to decrease intracranial pressure. Functional problems will vary depending upon the level of spinal cord defect. Possible problems: 1) Strength deficits 2) Hip flexor and adductor tightness 3) Foot deformities, especially club foot or talipes equinovarus 4) Bowel and Bladder problems 5) Sensory loss 6) Low tone with poor head control 7) Developmental delays Treatment 1) Proper positioning 2) Orthotic devices 3) Standing fraames 4) parapodia 5) Swivel and rollator walkers for lower thoracic lesion 6) Reciprocating gait walkers or orthoses (reciprocating gait orthosis (RGO) for upper lumbar lesion. 7) Adapted WCs for upper thoracic lesion 8) Assistive devices will vary depending on the level of the lesion

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What is Charcot Marie Tooth disease (peroneal muscular atrophy)?

answer

A hereditary disorder of the peroneal and distal leg muscles Patient problems include foot drop and "stork leg deformity" Orthotic devices that correct for equinovarus deformity can be helpful during treatment of the patient with this disorder.

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What is Legg-Calve-Perthes Disease?

answer

Idiopathic aseptic necrosis of the femoral capital epiphysis Usually unilateral. Affecting mostly boys between 5 and 10 years of age. Treatments: 1) includes prolonged bed rest 2) mobile traction and slings 3) Casting 4) A special hip abduction orthosis

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Spinal Cord Injuries: MOI of non traumatic injuries

answer

Non traumatic a. approximately 10% of spinal cord injuries. Most likely to occur in individuals with narrowing spinal canals b. possible causes: 1. disc prolapse 2. vascular insult 3. neoplasm 4. rheumatoid arthritis 5. radiation 6. spinal stenosis 7. surgery 8. cardiac arrest 9. aortic aneurysm 10. infection

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Spinal Cord Injuries: MOI of traumatic injuries

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Traumatic a. Most injuries involve a single level or a limited number if contiguous vertebrae b. Result from forces that create violent motions of the head or trunk Causes 1. MVA 2. Jumps and falls 3. Athletic injuries 4. Driving accidents 5. Gun shot wounds the degree of impingement upon the cord. the cord's vascular supply, or the spinal nerves determine the extent of resulting neurological damage. Cervical 1. Most often areas injured traumatically are C5 and C7 2. Flexion, vertical loading, and extension accompanied by rotation or lateral flexion are the motions most likely to cause cervical spine injuries Thoracic: 1. Less likely to be injured from traumatic causes due to rib cage and higher stability as compared to the cervical region 2. T12-L1 junction is the most common site of injury 3. Flexion motion or vertebral compression can cause wedge compression or burst fractures of the vertebral bodies damaging the spinal cord. Lumbar: 1. Neurological damage from trauma is usually incomplete die to large vertebral canal and relatively good vascular supply 2. Most injuries occur at L1-L2 levels. Below these levels the cauda equina is less likely to sustain a complete injury.

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Neuropathology of SCI

answer

General information a. Damage to the cord can be from physical impingement on the cord or by interruption of the cord's vascular supply. b. actual transection of the cord is rare. Pathological changes a. Blunt trauma to the cord results in some primary destruction of neurons at the level of injury b. Most of the damage is caused by secondary sequelae of the initial trauma, which begins a process of progressive tissue destruction within the cord c. tissue damage may travel up and down the cord, usually one to three segments d. necrotic tissue is gradually resorbed and replaced by scar tissue.

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What are the mechanisms of secondary tissue destruction for SCI?

answer

Ischemia: Decreased blood flow to the traumatized area of the spinal cord may be due to chemicals in the body that cause vasoconstriction or thromboses, metabolic disturbances, or elevates pressure due to edema. Edema: Disruption of cell membranes results in abnormal concentrations of sodium and potassium in the extracellular tissue. This ion imbalance causes an increase in osmotic pressure in the damaged area of the cord and creates excessive edema in this area Demyelination and destruction: 1) When the cells of the spinal cord are traumatized, calcium ions accumulate in the injured cells. This abnormal concentration of calcium disrupts functioning and causes demyelination and destruction of the cell membrane and axonal cytoskeleton. 2) The necrosis of axons progresses to scar tissue formation

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What is spinal shock?

answer

It is a temporary phenomenon that occurs after trauma to the spinal cord, in which the cord ceases to function below the lesion. Spinal relfexes, voluntary motor control, sensory function, and autonomic control are absent below the level of the lesion. Usually resolves within 24 hours of injury with the return of the anal and bulbocavernosus reflexes. Sparing of sensation or voluntary motor function below the lesion indicates that the lesion is incomplete

question

Functional classification of spinal cord injuries

answer

Spinal cord injuries are named according to the level of neurological injury and are classified as complete or incomplete,

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Designation of spinal level

answer

a. Defined as the most caudal level of the spinal cord that exhibits intact sensory and motor functioning b. Muscles must have a grade of at least 3+/5 strength to demonstrate intact innervation c. Sensory areas are well demarcated and are innervated by a single spinal cord segment. d. Complete lesions. Total and permanent functional (sensory and motor) disruption of the spinal cord more than three segments below the level of the lesion.

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Incomplete lesions

answer

a. The spinal cord is not totally disrupted at the level of the injury b. Preservation of some sensory or motor function more than three segments below the lesion, c. Ascending and descending tracts are undamaged, and the resulting function is called sparing.

question

What is Brown-Sequard syndrome?

answer

1) Hemisection of the spinal cord, usu from stab or gunshot wounds 2) Ipsilateral side of lesion has weakness or motor paralysis, loss of propioception, vibratory sense and two-point discrimination, decreased reflexes, clonus, and spasticity. 3) Contralateral side has loss of pain and temperature starting a few levels below the lesion.

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What is the Anterior cord?

answer

1) Results from trauma to the anterior cord or damage of the anterior spinal artery usu related to flexion injuries of the cervical region 2) Characterized by loss of motor function and loss of pain and temperature below the level of the lesion.

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What is the Central cord?

answer

1) Most commonly occurs from hyperextension injuries with minor trauma to the cervical region. 2) Results in damage to the central aspect of the spinal cord affecting upper extremity sensation and motor functioning with normal lower extremity functioning.

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What is the Posterior cord?

answer

1) Very rare with deficits of kinesthesia (e.g., stereognosis and two-point discrimination) and propioception 2) An ataxic gait with a wide base of support may result.

question

What is the Cauda equina?

answer

1) Injury below the L1 segment that results in damage to the lumbar and sacral nerve roots 2) Sensory loss, paralysis, and loss of bladder/bowel can occur. 3) Because the damage is to the peripheral nerve roots, regeneration may be possible.

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What is sacral sparing?

answer

1) Refers to an incomplete lesion in which the most centrally located sacral tracts are spared. 2) Perianal sensation, rectal contraction, cutaneous innervation in the saddle area and active-contraction of the sacrally innervated innervated toe flexors are intact.

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What are the primary effects of SCI

answer

a. Paralysis of voluntary motor control occurs from damage to descending motor tracts, anterior horn cells, or spinal nerves. b. Spasticity c. Loss of sensation can lead to discoordination of body movements, vulnerability to trauma, and impaired body awareness. d. respiration 1) Depending on the level of the lesion, the diaphragm (innervated from C3 to C5) may not be active, affecting the patient's ability to breathe (primarily inhalation). 2) An artificial ventilator or phrenic nerve stimulator may be required to sustain life. 3) Disruption to the intercostals and abdominal muscles can impair respiration to sustain life. 4) Following spinal cord injury (SCI), tidal volume and vital capacity are reduced and secondary respiration muscles are utilized more (e.g. scalenes) e. Bowel and bladder continence 1) Voluntary control of urination and defecation is lost after an injury to the sacral cord (S2, S3, and S4) 2) Following spinal shock, two types of bladder conditions will develop. (a) Reflex (upper motor neuron) bladders, which empty in response to a certain level of filling pressure. (b) autonomous or nonreflex (lower motor neuron) bladders, which are flaccid an can be emptied by increasing intrabdominal pressure or by manually compressing the lower abdomen. f. genital function. injury to the thoracolumbar and sacral regions of the cord can alter functioning of the genitals, disrupting sexual responses. Female fertility is unchanged, but men are likely to become infertile. g. cardiovascular function (1) When an injury to the cord blocks communication between the brainstem and thoracolumbar cord, sympathetic input to the heart is lost and parasympathetic input remains, resulting in bradycardia, peripheral vasodilation and hypotension. (2) Orthostatic hypotension occurs due to a drop in blood pressure when the patient moves from a horizontal to upright position, (3) Problems are usually significant in people with lesions above T6 and often resolve within a few weeks of injury. h. thermoregulation (1) Cord injury that interrupts communication with the hypothalamus can cause hypothermia due to peripheral vasodilation (2) Reflexive tone returns in the peripheral vasculature, resolving this problem (3) Later, hyperthermia occurs due to a loss in sympathetic control of the sweat galnds (4) Below the level of the lesion sweating does not occur. To compensate, diaphoresis occurs above the level of the lesion.

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Complications of SCI

answer

1. Decubitus ulcers 2. Respiratory 3. Contractures 4. Osteoporosis 5. Deep vein thrombosis (DVT) 6. Gastrointenstinal 7. autonomic dysreflexia 8. postural or orthostatic hypotension 9. heterotrophic bone formation

question

Decubitus Ulcers

answer

1) Pressure sores are prevalent in patients with complete lesions and with tetraplegia

question

Empathy-What is it?

answer

The capacity to understand what your patient is experiencing from that patient's perspective The use of empathy helps you understand more clearly the meaning of illness or disability that the patient is experiencing

question

How do communicate with empathy with our patients?

answer

Respond to the patient by asking opne-ended questions that seem to reflexr what the patient is feeling. 1) The patient's responses may become deeper and more extensive if the therapist... 2) If the initial response does not accurately empathize, the patient-therapist relationship may remain superficial and perhaps less productive. 3) For example, if the patient said " I am very angry about this pain and can no longer cope with it" an empathetic response would be. "it sounds like you are very upset about your condition and the pain that your trying your best to cope with it on a regular basis. A non empathetic response would be, 'Have you sought the help of another doctor?" or Don't worry, be happy."

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Defense Mechanisms: What are they? What is Compensation? What is denial? What is displacement? What is projection? What is rationalization? What is reaction formation? What is regression? What is repression?

answer

Typically unconscious responses by which the ego is protected from anxiety, guilt, or shame and the individual resolves or conceals conflicts or anxities Compensation: covering up a weakness by stressing a desirable or strong trair (e.g., a child with a learning disability becomes an outstanding athlete. Denial: the refusal to recognize reality (e.g., refusal to acknowledge a fatal disease) Displacement: The transfering of an emotion to a substitute (e.g., yelling at your child instead of your boss) Projection: the attributing of your own unwanted trait onto another person (e.g., "He made me do it") Rationalization: the justification of behavior using reasons other than the real reason (e.g. presenting an attitude of not caring) Reaction formation: demonstrating a behavior that is exactly the opposite of what is expected (e.g., a messy individual becomes neat) Regression: resorting to an earlier behavioral or developmental level (e.g., a possible characteristic behavior of those with TBI during high stress situations). Repression: an ability or refusal to recall undesirable past thoughts or events

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Behavior Modification

answer

Attempting to change the patient's attitude toward pain, their appearance, willingness to participate in therapy, etc, by reinforcing healthy, positive, and socially appropriate behavior and ignoring inappropriate behaviors.

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Perservation

answer

A patient continue to repeat a movement, word, or expression, even though it is meaningless. Often accompanies TBI or brain damage from a stroke or other event.

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Placebo

answer

a. A sham or inactive treatment given for potential psychological benefit b. The therapist "sells" the patient on the benefits of the treatment and encourages the patient to improve with the inactive treatment. c. Can also be used a part of a research project.

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What is anxiety? What are sympathetic responses to anixety?

answer

a. Feelings of apprehension, worry, uneasiness, etc. that are normal reactions to tensions, conflicts, or stress. b. Sympathetic responses usually accompany anxiety (e.g. increased heart rate, dyspnea, hyperventilation, dry mouth, GI symptoms (nausea, vomiting, and diarrhea), palpitations.

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Motivation

answer

a. Frequently, a chronically ill individual will be unmotivated to continue her/his rehabilitation effort b. Patients with Alzheimer's disease, depression, or other psychiatric conditions might fall into this category. c. Reasons: (1) Their goals do not match the goals of the therapist. (2)The patient fears they will not achieve complete recovery (3) The patient wishes to punish or control others and remain dependent (4) The patient is in shock or mourning about their disability (5) The patient enjoys the secondary gains of being disabled (6) The patient is emotionally overwhelmed or is a malingerer Management: (1) Set realistic goals with patient input (2) Time the treatment program properly to allow the patient to adjust their disability. (3) Meet the patient's individual needs and use positive reinforcement

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Sexuality

answer

a. A therapist or assistant should be aware of the impact of spinal cord injury, cardiac disease, pregnancy, or other kind of disability on sexual functioning of their patients. b. If the patient asks questions about these matters, the therapist should give professional advice consistent with their knowledge level.

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Grief Process What are the different stages?

answer

Patients who lose bodily parts, functional capabilities, clarity of mental processing, or loved ones may go through some or all of the stages of this process. Denial (disbelied, isolation). Patients insist they are fine, joke about themselves, or are not motivated to participate in the treatment. Anger (resentment): Patients may become disruptive, blame others, and do not admit to any improvement. The defense mechanism of displacement may occur. Bargaining: Patients may turn to religion or others in charge and make pronises to effect a return of function or any further loss of function. Depression (grieving, mourning). Patients may withdraw, cry, or lose interest in treatment. Motivation is low and needs to be monitored closely by the therapist. The patient has an overwhelming sense of loss. Acceptance. Patients have worked through other grief stages, accept their condition, relate more to their treatment, and make plans for the future.

question

What is alzheimers disease? How do we deal with alzheimer's as PTs?

answer

It is a chronic progressive disease with widespread deterioration of the cerebrum Intellectual decline, loss of memory, confusion, anxiety, depression, loss of reasoning, possible motor impairment, and gait problems or contractures as the disease progresses Management: 1) Keep treatments consistent and redirect the patient to another task is she/he becomes frustrated during treatment 2) If there is memory impairment, the therapist should instruct the patient in the use of a memory log to always be carried by or attached to the patient

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Anxiety Disorders

answer

1) Related to excessive anxiety not associated with a realistically threatening situation. 2) Panic attacks are acute, intense reactions filled with anxiety or terror. May be uncomfortable and give a sense of impeding death.

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Bipolar Disorder (Manic Depressive Illness)

answer

1) A disorder characterized by mood swings from depression to mania 2) In the manic phase, patients often present with - intense outbrusts - high energy and activity - excessive euphoria -decreased need for sleep -unrealistic beliefs -distractibility -poor judgment -denial

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Conversion Disorder (conversion reaction or hysterical paralysis)

answer

A response to severe emotional stress resulting in involuntary disturbance of physical functions 1) These disturbances are often connected with the nervous system, resulting in problems with vision, sensation, hearing, or motor disturbances such as hemiplegia, paraplegia, quadriplegia, tics, or tremors. 2) The patient is frequently indifferent to the symptoms Management 1) Treat the patient as you would any others with similar symptoms that have resulted from physical pathological causes. 2) If the patient shows signs of improvement or return of function, offer encouragement and inform the physician of their progress.

question

What is depressive reaction?

answer

A neurotic reaction to a personal loss or failure that is disportionate in intensity and duration. The individual is listless and dejected, feels helpless, may cry easily, and may have an eating disorder. Frequently, excessive fatigue (neurasthenia) and hypochondriasis (excessive worry about one's health) may accompany depression. Depression is common with many chronic disorders. Medication such as Valium, Prozac, Elavil, and others may help. 1) Most drugs require 3-4 weeks for mood elevating effect. 2) Symptoms of sleep and appetite disturbances, fatigue, and agitation are first to improve 3) Patients should be encouraged to continue taking medications as prescribed and contact their physician before discontinuing or tapering dosage. 4) side effects include: dry mouth, blurred vision, disturbed sleep, increased anxiety, disturbed balance, postural hypotension, increased heart rate, weight gain, and blood glucose fluctuations Management: 1) The therapist needs to take a positive attitude, build in successful treatment experiences for the patient, give the patient hope, and involve the patient in making choices about the types of treatments available. 2) If the therapist suspects that a patient is depressed, the referring physician must be informed 3) Exercise has been known to benefit clinical depression. If a patient is taking antidepressive drugs (tricyclic), heart rate during peak exercise needs to be monitored due to increased heart rate side effect. 4) Orthostatic hypotension may increase fall risk in elderly patients taking antidepressive medications.

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Paranoia

answer

It is a psychotic disorder Characterized by delusions that may be grandiose delusions (feelings of power or great wealth), delusions of persecution, erotic delusions, and feelings of jealousy.

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Schizophrenia

answer

A psychotic disorder Characterized by loosening of association (fragmented thoughts, errors of logic, bizarre ideas), autistic withdrawal (withdrawal into one's own world), ambivalence to themselves and others, and inappropriateness of affect (mood shifts, obscene language or acts, improper responses). Medications (e.g. Haldol, Seroquel, Risperdal) 1) probably blocks post synaptic dopamine receptors. 2) side effects: -sedation -drowsiness -insomina -seizures -headaches -back pain -tachycardia -orthostatic hypotension -dry mouth -constipation -weight gain

question

claustrophobia

answer

a neurotic disorder Characterized by a fear of confined spaces and restricted movement Some orthotic devices, e.g. Halovest orthosis, will most likely cause a problem for a person with this disorder.

Expressive Aphasia: Difficulty in Verbal Expression

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