TherapyEd - neuro terminology, CVA, TBI

agnosia

inability to recognize familiar objects w/ 1 form of sensation

akinesia

inability to initiate movement (found in PD)

apraxia

inability to perform previously learned movements despite no loss of strength, coordination, sensation, or comprehension

• ideational apraxia

• ideomotor apraxia

ideational apraxia

impaired concept of how to do a routine task (unable to sequence steps)

ideomotor apraxia

understands the concept of how to do a routine task but unable to execute the right action on command

astereognosis

inability to recognize objects by touch alone

• damaged somatosensory association cortex

asynergia

inability to move mms together in a coordinated manner, associated w/ cerebellar dysfunction

ataxia

uncoordinated movement, esp. gait

athetosis

slow, involuntary, worm-like, writhing motions

causalgia

painful burning sensation, often associated w/ CRPS

chorea

rapid, involuntary, jerky movements seen in Huntington’s chorea

decerebrate rigidity

involuntary contraction of UE & LE extensor mms

• damage to brainstem (pons) above vestibular nucleus & below red nucleus

decorticate rigidity

involuntary contraction of UE flexor mms & LE extensor mms

• damage to motor tracts above red nucleus (midbrain)

dysdiadochokinesia

impaired RAM, associated w/ cerebellar dysfunction

dysmetria

inability to judge distances, associated w/ cerebellar dysfunction

• hypermetria = overshooting

• hypometria = undershooting

Herpes zoster (shingles)

painful inflammation of DRG d/t virus → vesicle formation along course of nerve in dermatomal pattern

Horner’s syndrome

ptosis (droopy eyelid), miosis (constricted pupil), & anhidrosis (lack of sweating) of ipsilateral face d/t damage to sympathetic tract (e.g. sympathetic chain)

somatagnosia

lack of awareness of the relationship of one’s own body parts or the body parts of others

visual acuity

sharpness of vision that generally decreases w/ age or diabetes

• may need glasses, increased color contrast on walls/floors/stairs

• reduced ability to adapt to very dark/bright environments

homonymous hemianopsia

deficit of either the R or L halves of the visual field

• damage to contralateral optic tract

bitemporal hemianopsia

deficit of the temporal or peripheral visual fields (tunnel vision)

• damage to optic chiasm

monocular blindness

blindness of one eye

• damage to optic nerve

inferior quadrantanopia

pie on the floor (contralateral)

• damage to parietal lobe

superior quadrantanopia

pie in the sky (contralateral)

• damage to temporal lobe

What is the difference between ischemic & hemorrhagic stroke?

• ischemic: clot blocks or impairs blood flow → depriving the brain of essential O2 & nutrients (more common)

• hemorrhagic: blood vessels rupture → bleeding in or around the brain (worse prognosis)

What are the effects of CVA on the middle cerebral artery (MCA)?

• sensorimotor deficits in the contralateral face & UE

• contralateral homonymous hemianopsia

• L hemisphere → aphasia

  • superior division of MCA → Broca’s

  • inferior division of MCA → Wenicke’s

  • main stem of MCA → global aphasia

• R hemisphere → perceptual deficits (unilateral neglect)

What are the effects of CVA on the anterior cerebral artery (ACA)?

• sensorimotor deficits in the contralateral LE

• urinary incontinence

• mental impairments (confusion, amnesia, apathy, short attention span)

• problems w/ imitation, bimanual tasks, apraxia

• slowness, delay, motor inaction

• contralateral re-emergence of grasp reflex, sucking reflex

What are the effects of CVA on the posterior cerebral artery (PCA)?

• contralateral homonymous hemianopsia

• visual agnosia → prosopagnosia (difficulty naming familiar faces)

• dyslexia w/o agraphia

• difficulty w/ color discrimination

• memory deficits

• topographical disorientation (difficulty w/ directions)

• aphasia

• hemiplegia if cerebral peduncle of midbrain involved

• central territory: thalamic pain syndrome

What are the effects of CVA on the vertebrobasilar artery?

• often results in death from the edema

• quadriparesis & bulbar palsy → locked-in syndrome (pt can only communicate by eye blinking)

• vertigo, coma, diplopia, nausea, dysphagia, ataxia, CN impairments

What are the effects of CVA on the anterior inferior cerebellar artery (AICA)?

• unilateral deafness

• contralateral loss of pain & temperature

• paresis of lateral gaze

• unilateral Horner’s syndrome

• ataxia, vertigo, nystagmus

What are the effects of CVA on the superior cerebellar artery (SCA)?

• severe ataxia

• dysarthria

• dysmetria

• contralateral loss of pain & temperature

What are the effects of CVA on the posterior inferior cerebellar artery (PICA)?

Wallenberg’s syndrome

• nausea

• vertigo

• hoarseness

• dysphagia

• reduced sensation of ipsilateral face

• reduced sensation of contralateral torso & limbs

• Horner’s syndrome

What are the characteristics of hypotonicity?

How can you treat this?

• low or flaccid tone

• risk of joint subluxation or dislocation

• hypoactive reflexes

• shallow breathing

Treatment:

• isometrics

• quick stretching

• tapping of mm belly or tendon

• high-frequency vibration

• light touch

• quick icing

• fast spinning or rolling

• joint approximation for co-contraction

What are the characteristics of hypertonicity?

How can you treat this?

• spastic, high tone

• risk of contractures & deformity

• hyperactive reflexes

• decreased thoracic mobility

• ∆s in body positioning can affect tone

Treatment:

• inhibit reflex activity via postures, positioning, or relaxation training

• reciprocal inhibition (facilitation techniques to nonspastic mms)

• prolonged static stretching

• inhibitory casting

• slow repetitive rocking or rolling

• very low-frequency vibration

• reflex inhibiting postures

• limb movements emphasizing rotation

• slow stroking

• neutral warmth

• prolonged icing

• deep pressure to tendons

What are the perceptual problems associated with R hemisphere CVA?

• L sensorimotor loss, homonymous hemianopsia

• visual-perceptual deficits: L sided neglect, problems w/ spatial relationship & hand-eye coordination, difficulty w/ visual cues

• irritability

• short attention span, cannot retain info, difficulty learning individual steps

• quick, impulsive, poor safety

• rigidity of thought

• difficulty w/ negative emotions

What are the perceptual problems associated with L hemisphere CVA?

• R sensorimotor loss, homonymous hemianopsia

• language deficits: aphasia, difficulty w/ verbal cues

• apraxia

• difficulty initiating & sequencing tasks

• perseveration

• irritability

• cautious & slow

• highly distractible

• difficulty w/ positive emotions

What are some mobility activities to consider for a pt with CVA?

• focus on using both sides of the body initially

• active assisted movements

• focus on bed mobility & transfers

• control & stability in sitting & standing, add dynamic challenges

• transfers to both sides to promote NM re-education

What are some respiratory activities to consider for a pt with CVA?

• improve chest expansion w/ manual contacts, resistance, & stretch to chest wall segments

• diaphragmatic breathing & coordinated breathing w/ movement

• avoid Valsalva

What are some oromotor activities to consider for a pt with CVA?

• establish sitting posture w/ hips well back, symmetrical WB, & feet flat on the floor

• head in normal position (not extended or tipped back) to avoid aspiration or choking and promote normal swallowing

Describe the Brunnstrom Stages of Stroke Recovery

• stage 1: flaccidity, no active limb movement

• stage 2: beginning of minimal voluntary movement, some synergy w/ associated reactions, some spasticity

• stage 3: voluntary control of movement synergy, spasticity at its peak

• stage 4: some movement outside of synergy, less spasticity

• stage 5: complex movement, greater selective control of movement from synergy

• stage 6: individual joint movement, coordinated movement

• stage 7: normal function

What is the difference between synergy & spasticity?

• synergy: combined motion pattern w/ AROM

• spasticity: increased tone w/ PROM, resting position, velocity-dependent

Describe the spasticity pattern

UE (chicken dance)

• scapula: retraction, downward rotation

• shoulder: ADD, IR, depression

• elbow: flex

• forearm: pronation

• wrist: flex, ADD

• hand: finger flex, clenched fist thumb, ADD in palm

LE (ballet dancer)

• pelvis: retraction (hip hiking)

• hip: ADD (scissoring), IR, ext

• knee: ext

• foot & ankle: PF, INV, equinovarus, toes claw (TMT ext, MTP flex), toes curl (TMT, MTP flex)

Describe both flexion & extension synergy pattern

Flexion synergy

• scapula: retraction, elevation, or hyperextension

• shoulder: ABD, ER

• elbow: flex

• forearm: supination

• wrist & finger: flex (same as ext synergy)

• hip: flex, ABD, ER

• knee: flex

• ankle: DF, INV

• toe: DF

Extension synergy

• scapula: protraction

• shoulder: ADD, IR

• elbow: ext

• forearm: pronation

• wrist & finger: flex (same as flex synergy)

• hip: ext, ADD, IR

• knee: ext

• ankle: PF, INV

• toe: PF

What is the Rancho Los Amigos Classification?

Response

• 1: no response

• 2: generalized response

• 3: localized response

Confused

• 4: confused & agitated

• 5: confused & inappropriate

• 6: confused & appropriate

Appropriate

• 7: automatic appropriate

• 8: purposeful appropriate

Describe RLA 1-3

How can you manage pts in these levels?

• 1: no response: coma

• 2: generalized response: non-purposeful, whole body, vocal, inconsistent response

• 3: localized response: purposeful, local & specific, inconsistent response; follows simple commands (close eyes, squeeze hands)

Management

• head in neutral, prevent ulcer, sit if stable

• gentle PROM for joint & skin integrity

• postural drainage, percussion, vibration

• family education on what to expect & how to be more involved

Describe RLA 4-6

How can you manage pts in these levels?

• 4: confused & agitated: heightened activity, coming out of coma, doesn’t cooperate, incoherent speech, confabulations (making up stories), no selective attention, no memory

• 5: confused & inappropriate: responds consistently to simple commands, inconsistently to complex commands, able to socialize for short period, impaired memory, inappropriate use of objects, can’t learn new task

• 6: confused & appropriate: responds consistently to simple commands, goal-oriented behavior w/ external input, carryover of previous skills present (self care)

Management

• consistency: same therapist, same staff, family introduce themselves daily, establish a routine

• orient the pt: calendar, clock

• memory: no carryover, chart & graph to measure progress

• agitated: calm behavior, no confronting, closed environment to prevent harm to others, give options, no yes/no or open-ended questions

Describe RLA 7-8

How can you manage pts in these levels?

• 7: automatic appropriate: oriented in home & hospital, daily routine but automatic & robot-like, impaired judgment, able to initiate social or recreational activity w/ structure

• 8: purposeful appropriate: carryover of new skills present, impaired judgment in an emergency situation, abstract reasoning, low tolerance for stress

Management

• focus on re-entry to work & community

• emphasize skills related to problem solving, social interaction

• trial period of independent living

• adaption at work or school to return to normal life