Week 5 Readings (Neuro and Other Systems)

what are the two different types of strokes?

ischemic- a clot deprives the brain of essential oxygen and nutrients

hemorrhagic- when blood vessels ruptrue this causes leakage of blood in or around the brain

which type of stroke is more severe?

hemorrhagci stroke is more severe because it effects more parts of the brain

what are some signs and symptoms of anterior cerebral artery stroke?

think about a baby (ABCD)

contralateral hemiparesis (LE) and sensory loss

urinary incontinence

problems with imitation, bimanual tasks, apraxia

slowness, delay, motor inaction

contralateral grasp reflex, sucking reflex

what are some signs and symptoms of middle cerebral artery issues?

the UE is more affected than the LE

contralateral hemiparesis and sensory loss in the UE and face

language and speech impairments (Broca’s and Wernikes, global aphasia)

perceptual disorders (unilateral neglect in the parietal lobe)

contralateral homonymous hemianopsia

what is homonymous hemianopia?

if there is a stroke in the MCA or PCA there can be this disorder it will present on the opposite side of whatever side had the stroke

ex. L MCA stroke will present with R HH, the right side of vision will be gone in both eyes

Review! What is the difference between broccas and wernikes aphasia?

Brocas- expressive, non-fluent aphasia (frontal lobe) yes/no questions

Wernikes- receptive, fluent aphasai (temporal) word salad, use gestures and demonstrations

what side is perceptual deficits and neglect seen on?

lack of awareness of the weak side

seen with R CVA

encourage awareness and use of the environment

often forget to shave the one side of their face and have decreased turning of the head and turnk rotation

what are the two different areas of the posterior cerebral artery?

peripheral and central territory

what are the signs and symptoms of both sides of the peripheral and central territory

peripheral: contralateral homonymous hemianopsia, visual agnosia- prospagnosia

dyslexia even though they can wrtie

memory deficits

topographical disorientation

how does a stroke in the central area present?

thalamic pain syndrome

what are signs and symptoms of a stroke in the R hemisphere?

left hemiparesis, quick, impulsive, safety risk, difficutly with negative emotions, rigidity of thought, difficulty of visual cues

what are signs and symptoms of left hemisphere stroke?

right hemiparesis, aphasias, difficulty with verbal cues, slow, cautious, highly distractable, difficulty with positive emotions

what is the spasticity pattern of the UE and LE?

UE: chicken dance (retracted, elbow flexed, pronation, wrist and hand flexion

LE: ballet- hip IR, adducted, extended, knee extended, and foot PFwith inversion

what is the UE flexion/extension synergy?

flexion: shoulder ER, flexion, elbow flexion, wrist and finger flexion

extension: shoulder IR, adduction, elbow extension wrist flexion, forearm pronation

what is the LE synergy pattern?

Flexion: hip flexion, abduction, ER, knee flex, ankle DF toe DF

extension: IR, adducted, extended, knee extended, PF (same as spasticity pattern)

what are the stages of brunnstroms stroke recovery?

1-flaccidity

2- beginning of minimal voluntary movement (have increased tone)

3- voluntary control of movement synergy (peak level of tone)

4-movement outside of synergy ( decreased tone)

5- increase complex movement, greater independence from limb syneries

6- individual joint motion

7- normal function

what should positioning look like for someone who has a stroke?

should be the opposite of whatever position they are in

how many levels of ranchos are there and what are the 3 big stages?

8 stages of ranchos

1-3- Response

4-6 confused

7-8- appropriate

breakdown: what are the first 3 stages of ranchos?

1- no response (coma)

2- generalized response (non pursposeful whole body, vocal in consistent

3- local response (purposeful local and specific )

what are stages 4-5 like?

4- confused and agitated (heighted activity, no attention, no long or short term memory)

5- confused inappropriate (responds consistently to simple commands and inconsistently to complex commands

6- confused appropratie (follows simple instruction consistently, goal oriented behavior with external input

for stages 4-6 what should you avoid?

complex commands cannot be followed, avoid more complex environments

what are ranchos levels 7 and 8?

7- oriented in home and hospital, daily routine, judgement impaired, able to initiate social or recreational activity with structure

8- carryover of new skills present, impaired judgement in an emergency situation, abstract reasoning and reduced tolerance for stress

how do you treat levels 7 and 8?

focus on reentry to work and community

emphasize skills related to problem solving, social interaction

trial period of independent living

adaptation at work or school to return to normal life

what is scoring of glasglow coma scale?

eye response, verbal response, and motor response

what are the grading for the eyes?

eyes- open spontaneously (4)

open to verbal command (3)

open to pain (2)

no eye opening (1)

what are the grading for verbal response

oriented (5)

confused but able to answer questions (4)

inappropriate words (3)

incomprehensible sounds (2)

no verbal response (1)

what are the grading for best motor response?

obeys commands (6)

localizes pain (5)

withdrawl from pain (4)

flexion to pain (3)

extension to pain (2)

no motor response (1)

what is the classification of TBI’s?

mild: 13-15

moderate: 9-12

severe: less than 8

what is the modified ashworth scale?

0- no increase in tone

1- catch and release; slight increase in tone; minimal resistance at end of ROM

1+ slight increase in tone, minimal resistance at end of ROM

2- more marked increase in tone throughout most of ROM

3- considerable increase in tone, PROM difficulty

4-affected part rigid in flexion and extension

what is metabolic syndrome?

a condition that if you have 3 out of the 5 puts you at a high risk of developing type 2 diabetes, cardiovascular disease and stroke

what are the 5 things that put you at risk for metabolic syndrome?

blood glucose greater than 100

HDLs men <40 females <50

Triglyercides: 150

waist circumference males > 40 inches females >35 inches

blood pressure: systolic greater than 130 or diastolic 85 or higher

what are the 6 hormones that are produced by the anterior pituitary gland?

ACTH

TSH

GH

Prolactin

LH

FSH

what are the primary thing the adrenal gland secretes?

Cortisol and aldosterone

what is the hormone cortisol in charge of?

regulating blood pressure, producing new glucose, and helping with inflammation

what is the hormone aldosterone in charge of?

water and mineral regualtion, kicks out potassium

what are signs and symptoms of addisons disease?

decreased cortisol and decreased aldosterone (think old grandma)

decreased BP,

hyperkalemia

decreased glucose

brown pigmented skin

generalized weakness

intolerance to cold and stress

weight loss, anoerexia,

what are signs and symptoms of cushings disease?

increased cortisol and aldosterone (think santa claus)

increased BP, water retenion

moon phase, buffalo hump

ruddy apperance

increased glucose

proximal muscle weakness

centripetial obesity and weight gain

what is the difference between cushings disease and cushiosn syndomre?

disease: ACTH and coritsol are high

syndrome: only the cortisol is high, there is nothing stimulating the ACTH

what are some signs and symptoms of hypothyroidism?

decreased T3 and T4, increased TSH

cold intolerance

increased diastolic, weight, and TSH

decreased perspiration

prolonged deep tendon reflexes

constipation

sleepiness, tiredness, proximal muscle weakness

(hashimotos)

what are some signs and symptoms of hyperthyroidism?

increased T3 and T4, low TSH ( graves disease)

increased HR

heat intolerance

diarrhea

decreased diastolic, weight and TSH

increased perspiration

increased basal metabolic rate

what things are released with parathyroid hormone?

calcium and serum phosphate

what are signs and symptoms of hyperthyroidism?

elevated calciuum and decreased serum phosphate

osteopenia, gout, kidney stones, arthralgia, fatigue, depression, confusion, drowsiness, glove/stocking sensory loss

what are signs and symptoms of hypoparathyroidism

low calcium and high phosphorus

symptoms: convulsions, cardaic arrythmias, muscle twitching, tetany, muscle cramps, muscle spasms, paresthesia of fingertips, fatigue, weakness

what is the difference between type 1 and type 2 diabetes?

type 1: diagnosed mostly at childhood, insulin dependnet

signs: polyphagia, polyuria, weight loss, ketoacidosis, burred vision, dehydration

type 2: body’s resistance to insulin, occurs secondary to other dysfuncitons

signs: similar to type 1 with rare occurence of ketoacidosis

what does fastign glucose and random blood glucose levels have to be to be diabetes mellitus?

fasting: greater than 126

randome: greater than 200

what should HbA1C levels be? what is considered abnormal?

glycosylated hemoglobin normal reference range Is 4-6%

greater than 10% immediate insulin therapy

greater than 7% is abnormal

what are early signs and symptoms of hypoglycemia?

blood glucose is less than 70

pallor, sweating, dizziness, poor coordination, dizziness, fainting, excessive hunger

what are early signs and symptoms of hyperglycemia?

glucose is greater than 300

weakness, dry mouth, frequent urination, dull senses, confusion, kussmual breathing, excessive thrist, fruity odor, hyperglycemic coma

when should exercise be done and when should it not?

exercise should not be done if blood glucose is less than 70 or greater than 300, greater than 250 is ketoacidosis

avoid exercise during peak insulin levels 2-4 hours after administration

exercise in the morning and put insulin in abomen or arm, not moving extremities

what are some things to do for diabetic foot care?

feet should undergo screening

wash feet

wear white socks

alternate shoes

snug fit with laces or velcro

what muscles make up the levator ani? what nerve innervates them?

pubococcygeus, puborectalis, illococcygues

nerve: pudenal

what is the difference between stress incontinence and urge?

stress: aggravated by coughing, sneezing, or exertion (often due to pelvic floor weakness)

urge: involuntary contraction of detrusor muscle, can be seen with infections, parkinsons disease or UMN lesions

what is the difference between overflow incontinence and functional incontinence?

overflow: incontinecne casued by an acontractile or underactive detrusor muscle. Bladder is overdistended, can not emppty completely, urine dribbles out

functional: incontinence due to mobility, dexterity, or cognitive deficits, can be seen with dementia, lower extremity weakness

what are treatments for the all the incontinence types?

stress: strengthen pelvic floor

urge: treat infections, voiding schuedle

functional: clear clutter, improve accessibility, and promted voiding

overflow: behavioral modifications like double voiding, medication, cathing

what should sodium and potassium lab values be?

Na: 135-145

postassium: 3.4-5

what shoudl hemoglobin and hematocrit be in males and females?

hemoglobin: Females 12-16, hematocrit: 36-46%

hemoglobin males: 13-18, hematocrit: 37-49 %

what should prothrombin time be?

12-15 seconds, prolonged with liver damage

doubled for people taking anticoagulants

what should platelets be?

150,000-400,000

what shoudl normal INR be? when is exercise contraindicated and when is bed rest needed?

.9-1.1

exercise is contraindicated: greater than 4.0

bed rest: greater than 6.0

exercise guidelines for platelet count: what levels are no exercise allowed, therapuetic exercise with resistance, therapeutic exercise with or without resistance?

no exercise: less than 10,000

therapuetic exercise without resistance: 10,000-20,000

therapuetic exercise with or without resistance: greater than 20,000

what is exercise guidelines for hemoglobin?

less than 8 essential activites of daily living

8-10 essential activites of daily living, assistance as needed for safety

greater than 10: ambulation and self care as tolerated; resistance and aerobic exercises

what is hematocrit exercise guideliens?

less than 25%: essential activites of daily living; assitance as needed for safety

25-35%= essential activites of daily living; assistance as needed, light weights 1-2 lbs

greater than 35%: ambulation and self-care as tolerated resistance and aerobic exercises

what is white blood cell count?

less than 5000 with fever: no exercise permitted

greater than 5000: light exercise permitted with progression to resistave exercise