NM comp review

Strategy and Movement in Patients with Lower Extremity Issues

  • Spasticity and Paresis
    • Issues with lower extremity due to spasticity (increased muscle tone) and paresis (weakness).
    • Ankle strategy is ineffective because spasticity causes plantar flexion, pushing individual back.
    • Stepping strategy cannot be utilized due to impairments in both lower extremities.
    • Primary focus shifts to hip strategy for balance management due to limitations in the lower body.

Management of Intracranial Pressure During Therapy

  • Intracranial Pressure (ICP)
    • Example: Individual has ICP of 19 mm Hg during physical therapy (PT) session.
    • Management involves keeping the patient in an upright position from supine.
    • An ICP of 19 mm Hg is considered normal post-traumatic brain injury (TBI).
    • Raise the patient if the ICP remains stable, even if it rises a little (e.g., 19 mm Hg).
    • Monitoring is crucial; if ICP creeps past 25 mm Hg, adjust therapy protocols.
    • Pay attention to trends; an increase from 17 mm Hg to higher levels warrants concern.

Levels of Consciousness and Arousal

  • Consciousness Levels
    • The best level of consciousness related to normal wake/sleep cycles indicates active responses and not vegetative states, which show generalized responses.
    • Lethargy refers to lower levels of arousal, whereas the focus is on localized responses.
    • Consciousness deals with both cognition and behavior but does not directly inform on motor function.
  • Consciousness Models
    • Rancho levels provide information on behavior and cognition but not movements, which is outside of its scope.

Brain Injury Mechanisms

  • Contrecoup Injury
    • Injury occurs when the brain hits bony structures on both sides of the brain due to sudden movements, often during impact.
  • Diffuse Axonal Injury (DAI)
    • The prognosis for DAI is generally poorer due to widespread axonal damage affecting brain function.
    • Axonal damage does not always require surgery but may warrant procedures to reduce swelling.
  • Blast Injuries
    • Understanding types of blast injuries: primary (blast wave), secondary (projectiles), and tertiary (individual being thrown).
    • They may involve polar injuries and coup-contrecoup mechanisms due to sudden movements.

Monitoring Intracranial Pressure in TBI

  • Risk Assessment
    • An ICP above 20-30 mm Hg raises concerns about cerebral blood flow and requires intervention.
    • At 25 mm Hg, careful monitoring and adjustments to therapy are necessary.
    • Higher readings (closer to 40 mm Hg) are problematic, indicating needs for adjustments and possibly medical intervention.

Patient Behavior and TBI

  • Combative Behavior
    • Not all patients with TBI will exhibit combative behavior; it varies based on emotional regulation.

Managing Guillain-Barre Syndrome (GBS)

  • Acute Symptom Management
    • Patients frequently require ventilatory support or tracheostomy due to weakness and autonomic dysfunction.
    • Autonomic dysfunction may result in urinary retention and incontinence due to difficulty relaxing pelvic floor muscles, impacting the ability to manage bowel or bladder function.
  • Cardiovascular Assessments
    • Autonomic dysfunction complicates interaction with patients during assessments; movement transitions should be performed cautiously to avoid sudden drops in blood pressure.

Prognostic Factors in GBS

  • Importance of Prognostic Indicators
    • Slow progression leads to worse outcomes in GBS, with rapid onset being a positive indicator for recovery.
    • Older age and comorbidities (like type 2 diabetes) are negative prognostic factors in GBS.

Mobility Assessments and Fall Risk

  • Timed Up & Go (TUG) Test
    • A timing greater than 25 seconds indicates a significant fall risk. Scores between 13 and 15 seconds represent normal risk.

Multiple Sclerosis and Its Effects

  • Symptom Management
    • Common symptoms include fatigue and vision changes along with spasticity.
    • TIA (Transient Ischemic Attack) will not result in spasticity changes but may involve recovery of function after brief deficits.

Assessing Gait and Movement Mechanisms

  • Gait Phase Mechanisms
    • Dorsiflexion Weakness: Results in poor foot clearance during swing phase, possibly leading to foot drag.
  • Hip Extensor Weakness: Can cause fast, poorly controlled mid-swing to terminal swing phases.
  • Spasticity and Contralateral Movements: Ipsilateral trunk lean can occur due to a drop in the opposite pelvis side during stance phase, resulting in compensatory movements.

Visual and Perceptual Considerations

  • Visual Agnosia: A patient might recognize an object when held but fail to identify it visually without interaction.
  • Tactile Agnosia: The inability to identify objects through touch while vision is blocked, necessitating sensory checks.
  • Agnosias in Neuro Disorders: Important for differential diagnosis and understanding of specific functional impairments in patients with neurological conditions.

Conclusion

  • Evaluation and Prognosis
    • Assessments must take into context the duality of motor cognition and function in patients with neurological impairments.
    • Being aware of indirect vs. direct consequences of conditions such as MS, GBS, and TBI facilitates better therapy strategies.