450 Formula Neurological Injuries & Degenerative Diseases

Anterior Cerebral Artery

ACA

Middle Cerebral Artery

MCA

Posterior Cerebral Artery

PCA

Head

PCA

trunk/arms

MCA

feet/legs

ACA

left side of body

Right CVA we will deficits on the

-language

-Praxis

-Math, analytical

-global aphasia

Left hemisphere

can’t produce or understand speech

Global ahpasia

Can’t speak/ can understand (expressive)

Broca’s Aphasia

where an individual can speak fluently but cannot comprehend language, often producing nonsensical speech.

Wernicke's Aphasia is a condition

compensate so they can:

-participate in therapy

-perform basic tasks

-communicate with CG

Aphasia intervention

-supplement talking with visuals

-close ended questions

-simple vocab

-use clear presentations (bold, large, headings)

-supported conversation (yes/no, gestures)

-Positive environment (face to face, allow enough time, eliminate noise and distraction)

L hemisphere Aphasia Interventions

-spatial reasoning, spatial neglect

-weird behavior-impulsive, lack of insight, L side motor apraxia, L side neglect

R hemisphere

-scanning strategies (lighthouse) to help improve attention

-compensate by rearranging necessary items/hazards to R side (declutter, color-code, same place every time)

-focus on task performance and practice (task-oriented approach)

R hemisphere spatial reasoning interventions

-lack of insight/self awareness & impulsiveness

-education pt and CG about condition

-role play

-predict-plan-evaluate

-pacing, slow down

R hemisphere weird behavior intervention

coordination and balance

cerebellar stroke

similar to Parkinson’s

basil ganglia stroke

facilitation techniques

Hypotonicity

inhibitory techniques

hypertonicity

-Need normal muscle tone to achieve movement

-Address muscle tone with sensory approaches to facilitate movement and motor learning

Rood Approach

-Progressive through stages of recovery, follows developmental sequence

-Flaccid>reflexive/synergist>active movement

- don’t care about what it looks like, care about success

-opposite NDT

Brunnstrom Approach (strumming guitar)

-want everything to be normal

-Handling techniques to facilitate typical movement patterns and inhibit abnormal movement

-once they can do them without handling you have them incorporate into activities on their own

NDT (normal, do touch)

-proprioceptive neuromuscular facilitation

-active movement to inhibit unwanted tone/reflexes

-movement patterns-D1 & D2

PNF

fasten seat belt

D1 (1 driver)

Sheathing sword

D2 (done dueling)

brushing hair

D1 flexion

closing car door

D1 extension

putting away dishes

D1 flexion

threading belt

D2 extension

protocol demands wearing for 6 hours day, but may have to build up over time

Constraint Induced movement therapy

gravity eliminated>against gravity>resistive

General motor approaches-Strengthening progression

-mental practice, mirror therapy

General motor approaches-cognitive or visual strategies to help motor recover

-use of affected extremity includes:

• WB (while using affected extremity)

• Helper hand during tasks (holding bowl while mixing)

General motor approaches-Bilateral training

-some promote motor recovery

-NMES/FES/E-stim-keep functional, not entry level

General motor approaches-modalities

-first concern is safety

-lacking protective sensation

-compensatory strategies like extra visual attention, wearing arm guard/glove

In regard to stroke and sensory

protract to protect

Stroke and shoulder position

DVT

Stroke pt are prone to complication

-warm to touch

-preventable with early, regular mobilization

-notify physician and follow their protocol

DVT signs

innervation below the level of the injury is partially spared

incomplete injuries

the SC was completely severed, no function is expected below the level of injury

complete injuries

a wait to see situation

incomplete injuries are_____

Complete-no motor/sensory

ASIA-A

Incomplete-No motor, some sensory

ASIA-B

Half or more muscles < 3 MMT

ASIA-C (count to 3)

Half or more muscles >3 MMT

ASIA-D (Don’t stop)

No impairment

ASIA-E (everything OK)

-Central cord syndrome

-Cauda Equina syndrome

-Brown-Sequard syndrome

-Anterior Spinal cord syndrome

Incomplete spinal cord injuries to different parts of the spinal cord results in different symptoms

UE affected

Central cord syndrome (Centaurs have arms)

LE affected

Cauda-Equina syndrome (horsed are all legs)

Hemiplegia and contralateral sensory loss

Brown-Sequard syndrome (b on one side, sensory of the other side)

No motor, sensory spared (Asia B)

Anterior cord syndrome (can feel ants)

-Neck control, likely needs respirator

C1-C4

Keep diaphragm alive

C3, 4, 5

-They need power w/c with adaptive control units

-Sip and puff, chin control, head array

-power chair, tilt in space pressure relief

-prevent contractures: anti-deformity orthotics, ROM

C1-C4

mouth stick

C4

-Mobile are support, universal cuff

-Drive power chair

-Elbow orthotic

C5

-wrist extension

-tenodesis

-short opponens split

-manual/electric w/c rim projections

-still power tilt for pressure relief

-likely s/u or some assist ADLs, lots of equipment use

C6

-Triceps

-Ind transfer/pressure relief

-Manual w/c with gloves

-Ind ADLs with AE (universal cuff, leg lifters, everything)

C7

-wrist and finger flexion

-close to normal function of hands

C8 (ate)

-Lumbricals (intrinsic)

-Full dexterity of hands

T1

UE have full function

If thoracic injury

Automatic dysreflexia

T6 complication

safer going up curbs and maneuvering b/c better core control in wc

T7-T12-particularly T10-T12

sideboard possibly Ind or may need assist

C6 transfers

Ind level surface sideboard

C7

Ind bed mobility & all transfers with/without equipment

T2

-Sweating/Anxious

-Sit up

-remove noxious stimuli (clothes, catheter)

Complications of Autonomic Dysreflexia

spasticity

UMN injuries results in______

-consistent ROM

-stretching

-splints/serial casting

Contracture prevention:

-C6 and above-tilt in space/recliner chair

-turning in bed routing

-wc seat cushions

-CG self examination routine

-Frequent reposition (30 min)

Complications-Pressure relief

-Swelling, warmth, decreased ROM (hard end feel)

Signs and symptoms of heterotopic ossification

-stretching past available range contraindicated

-ROM through available range to maintain

-compensate with equipment training

-contact physician (meds, surgery)

Heterotopic ossification treatment

Glasgow Coma Scale, Ranchos Los Amigos

TBI assessments 55

severe head injury

Glascow Coma Scale, 3-8

mild head injury

Glascow Coma Scale 13-15

moderate head injury

Glascow Coma Scale 9-12

-Stimuli looking for response

-positioning & ROM to prevent contractures

Rancho 1 (I) Intervention

-Stimuli looking for response

-positioning & ROM to prevent contractures

Rancho 2 (II) Intervention

-Attempting to get localized response/attention

-AAROM

Rancho 3 (III) Intervention

-Assist in simple ADLs

-Restraints may be necessary (physicians orders requested)

Rancho 4 (IV) Intervention

-Build habits of self orienting, checking external sources

-Multi-step tasks

Rancho 5 (V) Intervention

Task re-learning utilizing self cueing

Rancho 6 (VI) Intervention

Working on IADLs, role playing useful

Rancho 7 (VII) Intervention

Routine tasks are fine, difficulty/working with problem solving and planning

Rancho 8 (VIII) Intervention

Driving

Rancho 9 (IX) Intervention

All good

Rancho 10 (X) Intervention

-Remedial

-Compensatory

ND diseases are incurable and progressive so all interventions are:

try to help client improve their abilities (P in PEO)

Remedial interventions for ND diseases

try to help clients by changing something in environment (EO in PEO)

Compensatory interventions for ND diseases

-weighted utensils for tremors

-bed alarm for night time wandering

-education for caregivers

Compensatory interventions for ND disease examples

not noticeable

Alzheimer’s/Dementia 1

forget names, mem aids,

Alzheimer’s/Dementia 2

mod, daily structure, loose items, avoid new learning

Alzheimer’s/Dementia 3

home safety

Alzheimer’s/Dementia 4

wander

Alzheimer’s/Dementia 5-6

Profound decline

Alzheimer’s/Dementia 7

stimulation

Allen 1

gross motor

Allen 2