Special considerations in neurological rehabilitation

what is the disability rating scale for coma?

designed to track progress from coma to community, maximum score is 29= vegetative state

what does the coma near coma scale look at?

provides reliable and valid assessment response to stimuli in persons in persistent vegatative state (designed to measure small clinical changes)

what is coma management in rancho level 1-3 patients?

orientation, monitor alterness, mobility activities with vestibular, tactile, and verbal cues, bed mobility, PROM, bed positioning

define: serial casting

whatever muscle needs to be lengthened it is put into that position and then casted, left like that for one week then redone

define: static progressive splinting

similar to serial casting but a splint is worn for 2 hours on and 2 hours off

define: dynamic splinting

spring loaded and is set up to provide resistance so GTO’s are able to quiet down the tension

what are some things that should be remembered when working with restorative TBI patients?

control environment, re-orient, use contextual cues, establish boundaries, reward participation, give choices,

what are some compensatory things that should be done with dementia patients?

control environment, work within patients reality, use contextual cues, stay in safe and familiar environment, don’t force

define: aphasia

acquired communication disorder in individuals who could previously use langague appropriately

how does broccas aphasia normally present?

slow hesitant speech, awkward articulation, restircuted use of grammar, reading comprehension good, writing frequently poor, good awareness of deficit

how does global aphasia present?

demonstrates limitations across all language modalities

how should you interact with patients who have aphasia?

keep instructions simple, allow extra time for patients to respond, ask simple questions, use gestures and demonstration, use written communication

define: dysarthria and dysphagia

dysarthria: speech impairment caused by weakness, paralysis or incoordination of the motor-speech system

dysphagia: interruption in eating function or maintenance of hydration

what are the 2 phases of swallowing?

oral phase- bolus held between tongue and upper palate and propelled to back of tongue

velopharyngeal closure- pharyngeal contraction, laryngeal elevation and closure, and esophageal opening

what are some presentations that would lead to swallowing concerns?

wet voice, pocketing food, food consistency, and aspiration

where in the eye does unilateral loss of vision, bitemporal hemianopia and homonymous hemianopia occur?

unilateral: optic nerve

bitemporal: optic chiasm

homonymous: optic tract

define: visual agnosia vs. apraxia

visual agnosia: unable to recognize or name an object

apraxia: difficulty motor planning

define: ideomotor apraxia and ideational apraxia

ideomotor: can’t perform motor actions with declarative memory recall or on common

ideational: can’t perform multi-step actions

how does pushers syndrome present?

damage to posterior thalamus, active pushing of COG to the paretic side, loss of balance and postural control

where does a lesions for pushers syndrome occur? what about spatial neglect and aphasia

pushers:both but mostly right lesions

spatial: right

aphasia: left

what are the 3 big features of pushers syndrome>

1.consistent body posture/alignment with a lateral tilt toward the hemiparetic side

2.use of non-hemiparetic extremities to produce the lateral tilt

3.resistacne to physically guided correction

when is shoulder subluxation most common? what are types of subluxes?

most common in patients without movement and occur in first 2-3 weeks post stroke

inferior (most common)

anterior

superior

when and how do inferior, anterior, and superior subluxations occur?

inferior: severe weakness and flaccidity, acute stage, downward rotation of scapula

anterior: atypical movement patterns and trunk rotation, downwardly rotated scapula that is also elevated

superior: due to imbalanced muscle activity, scapula abducted and elevated with rotation neutral

what is protection and support for subluxations and what muscles can NMES be done on?

arm rest, taping, slings

NMES: supraspinatus, posterior deltoid, sometimes middle deltoid

what are some hemiplegic shoulder complications?

capsualr tightness/frozen shoulder, can be developed in subacute and chronic stroke secondary to spasticity and immobliziatoin

what is CRPS type 1 associated with?

shoulder trauma, ANS changes, motor deficits, spasticity, sensory deficits, initial coma

what are symptoms of Stage 1,2,3 CRPS?

stage 1: painful shoulder, discoloration, skin hypersensitive, patient guarding against movement

stage 2: subsiding pain, muscle and skin atrophy, vasospasm, course hair and nails, osteoporosis

stage 3: vasomotor changes rare, pain, progressive atrophy of skin and muscles, severe osteoporosis

what is CRPS management?

prevention, reduce pain, improve/maintain appropriate PROm, manage edema, avoid infusions to veins, pharmacological

what are UE specific task interventions?

CIMT, bilateral movement, robotic therapy

what are the scales used for stroke?

modified rankin (0-6)

NIHSS (0-42)

good to worse for both

what are the scales used for TBI?

GCS (15-3) only one that is low number with poor function

PTA 30 min- 24 hours

LOC (0-7 days)

what are the scales used for MS?

kurtzke expanded disability status (0-10) good to bad

what are the scales used for PD and ALS?

PD: Hoehn Yahr (0-5)

ALS: Sinaki phases (1-6)

what are exercise suggestions for MS?

diet, exercise, healthy lifestyle, adaptive equipment, energy conservation, functional mobility

what are exercises suggested for parkinsons?

flexibility, trunk segmentalization, postural alignment, community engaged boxing, big and loud, aerobic exercise, resistance training, external cuing, task specific training