When a client with a progressive condition has a change in function, it is important to _____________ so that appropriate ___________ can be planned/implemented
re-evaluate
interventions can be planned
Used to test vibration
A.
Used to test the ability to sweat
A.
Used to test cutaneous pressure thresholds
A.
Used to test for 2-point discrimination
B.
What type of evaluation is used for evaluating one's capabilities for the physical demands of a specific job or for a group of occupations.
Functional Capacity Evaluation (FCE)
Stages of motor learning (3)
1. Skill acquisition (cognitive stage)
2. Skill retention (associated stage)
3. Skill transfer (autonomous stage)
What stage occurs during initial instruction & practice of skills
Skill acquisition, cognitive stage
What stage involves "carry over", as ind. are asked to demonstrate their newly acquired skills after initial practice
Skill retention, associated stage
What stage involves the ind. demonstrating the skill in a new context
Skill transfer, autonomous stage
Practice of several tasks in random order encouraging reformulation of the solution to the presented motor problem
Random or variable
Repeated perf. of the same motor skill
blocked practice
practice of skills in various contexts to improve transfer of learning & retention of skills
variable conditions
T/F generalization is a tx technique
F
Child with C-7 lesion is able to complete what act I.
UE dressing
Personal grooming
Tabletop act.
T/F Child with c-7 injury would need to focus intervention on LE dressing
T
Light joint compression throughout the trunk & LE during a reaching act. is consistent with what approach
Rood
Therapeutic handling to affect the CNS is what approach
neurodevelopmental theory approach
Providing a stool to sit on during reaching act. can be used for safety is what type of approach
compensatory
Verbal & visual feedback while practicing reaching is what type of approach
Motor-re-Learning Program (MRP)
What practice is used when a client moves numerous one pound cans of veggies from the counter to the cabinet
blocked-invloved repeated perf. of the same motor skill.
What practice is used for a client who lifts cans of different sizes, shapes, and/or weights from the counter to the cabinet
Random-invloves the perf. of several tasks in random order to encourage re-formulation of the solution to the presented motor problem.
Direct therapy for oral motor intervention utilizes a __________________________
bolus
Indirect therapy for oral motor intervention does not include the use of a _______________
bolus
What is aura
Brief warning including numbness, taste, smell, or other sensation before tonic phase of seizure.
First aid steps for seizure
1. Remain calm
2. remove dangerous objects & protect ind. from harm w/out interfering with ind. movements
3. If upright, gently guide to floor, loosen clothing
4. turn ind. on side to prevent choking
5. Don't put stuff between teeth
6. don't be alarmed if they seem to stop breathing momentarily
7. if breathing stops, use standard rescue breathing.
Post-seizure care
1. Let rest/sleep
2. call dr. if 1) 1st seizure, 2) followed by another seizure, 3) lasts more than 5min.
3. notify parent/caregiver/guardians or emergency person that seizure occurred
4. observe safety precautions if ind. seems groggy, confused, weak
Landau-Kleffer Syndrome
1. Acquired epileptic aphasia
2. Progressive encephalopathy (disease affecting tissues of the brain)
3. loss language skills
4. auditory agnosia (inability to distinguish different sounds)
5. Behavioral disturbances, inattention,
Lennax-Gastaut syndrome
1. Children w severe seizures, mental retardation, specific EEG pattern
2. Begin 1st 3yrs life, diff. to control
3. associated w diff. brain disorders-structural abnormalities to birth asphyxia (lack oxygen)
4. regression of dev. status can occur
D1 PNF pattern
reach down on same side
reach up and across to opp. side
L-side impairment
dishwasher on L side cabinet on R
reach and grab dishes with L hand & cross to put in r-sided cabinet
D2 PNF pattern
reach down on opposite side
reach up on same side
R-side impairment
dishwasher on L-side & cabinet on R-side
reach down and across with right hand
put up in cabinet on r side.
A client recovering from CVA demonstrates increased flexor tone in the dominant right UE while trying to re-learn to right with L hand. What is he exhibiting?
An associated reaction
Normalization of tone & muscular responses are achieved via controlled sensory stimulation
Rood
Rood's facilitation techniques
1. Fast brushing
2. Stretch/tendon tapping-quick manual tapping to apply quick stretch to desired muscle.
3. High frequency vibration
4. Quick icing
5. Heavy joint compression-manually & longitudinally in WB position
6. Resistance-utilizing gravity or OTs hand stimulates muscle recruitment.
Rood's Inhibition Techniques
1. gentle rocking
2. slow stroking over post. rami of spine
3. slow rocking from supine to side-lying and back in rhythmical pattern
4. Tendinous pressure over muscle insertion
5. maintained stretch-inhibit spastic muscle
6. neutral warmth
7. prolonged icing
Fast brushing over the muscle belly is considered a ________ approach and is used to __________ movement.
Rood
facilitate
Slow brushing & firm pressure over a muscle belly are a _______ approach and are used to _________ movement.
Rood
inhibit
Slow responses, hesitancy, fearfulness, cautious behavior; can appear slow due to cautious behavior are indicators of what side CVA
Left CVA
Impulsive behaviors, poor judgement & disregard for safety are indicators or what side CVA?
Right CVA
Bilateral motor praxis, bilateral auditory reception, speech, verbal memory, processing verbal auditory info, visual verbal processing.
What sided CVA?
Left CVA
visual spatial, nonverbal memory, nonverbal auditory, attention, emotion, interpret abstract info & tonal inflections.
What sided CVA?
Right CVA
Lobe?
voluntary muscle control
plan movements
emotions/judgement
Broca's
Frontal Lobe
Lobe?
receives/processes auditory info
wernicke's, comprehension
Temporal
Lobe?
integration of sensory
touch, proprioception, temp on opposite side of body
Sensory cortex
parietal lobe
Lobe?
receives & interprets visual
occipital
Lobe?
Connects with vestibular system; equillibrium & regulation of muscle tone
receives input from propriocpetive pathways; modifies tone & synergistic actions of muscles
maintenance of posture, voluntary movement control
smooth coordination of voluntary movements; accurate force, direction, degree of movement.
cerebellum
What would you screen for in ind. who had tumor removed on cerebellum
proprioception & coordination
What would you screen for in ind. who had tumor removed on parietal lobe
sensory & tactile integration
What would you screen for in ind. who had tumor removed on occipital
vision & visual perceptual
What would you screen for in ind. who had tumor removed on temporal
audition & communication
What would you screen for in ind. who had tumor removed on frontal lobe
An adult incurred an injury to the anterior spinal artery at T12. What sensory eval should be preformed on the client.
proprioception
An adult incurred injury to dorsal (posterior) columns, which sensory should be tested.
pain, light touch, temperature
What level can ind. use joystick control?
C-8
What level can ind. use tendonesis splint?
C-6 & C-7
What level can ind. use chin switch?
C-3 & C-4
What level can ind. use dorsal splint with universal cuff?
C-5
Symptoms of CVA
1.numb, weak (face, arm leg) usually unilateral
2. confusion
3. diff. talking, seeing 1 or both eyes, walking, dizziness, loss balance & coordination
Glasgow Coma Eye responses
spontaneous eye opening 4
eyes open to speech 3
open to pain 2
no opening 1
Glasgow Verbal Responses
Oriented, coherent, appropriate answers 5
confused coherent to questions with some disorientation/confusion 4
inappropriate words, random, no conversation 3
incomprehensible sounds, moaning, no words 2
none 1
Glasgow Motor Repponse
obeys commands, simple tasks 6
localizes pain, purposeful movement towards changing painful stimuli 5
withdraws from pain 4
flexion (decorticate) to pain 3
extension (decebrate to pain) 2
no motor response 1
Decorticate rigidity
abnormal flexion
Decerebrate rigidity
extension posturing
Rancho Levels
Total Assistance
I. no response
II. Generalized Response: reflex, responds to repeated auditory stimuli
III. Localized Response: withdraw/vocalize to pain, turns toward/way auditory stimuli, blinks at light, follows moving object in field, pulls tubes, respond to family
Interventions: positioning, PROM, splints, sensory stimuli, promote functional mobility skills by upright posture for arousal & body alignment.
Rancho Confused Stages/Mid-Level Recovery
IV (agitated) & V (inappropriate): MAX A
VI (appropriate): MOD A
Interventions: Provide structure, preventing overstimulation for confused, agitated patient- Providing a closed, reduced stimulus environment- daily schedules, memory logs, relaxation techniques, providing consistency: use team-determined behavioral modification techniques- give clear feedback, writen contracts, engage the patient in task-specific training- limit activities to familiar well-liked ones- offer options; break down complex task into component parts- provide verbal or physical assistance, Control the rate instruction; - Provide frequent orientation to time,place, your name and task- Emphazie safety, behavioral management techniques- Model calm, focused behavior
Rancho Appropriate stages
VII (auto-Min A)
VIII (purposeful, Stand by A
IX (purposeful, Stand by on request)
X Purposeful, MI
Interventions: Allow for increasing independence: wean patient from structure (from closed to open environments); involve patient in decision making, Assist patient in behavioral, cognitive, emotional reintegration: provide honest feedback, prepare for community re-entry, Promote independence in functional tasks: Functional Mobility Skills, ADLs, in real-life environment, Improve postural control, symmetry and balance- encourage active lifestyle, improve cardiovascular endurance, Provide emotional support, encourage socialization, behavioral control, and motivation- re-orient and reassure- provide patient and family education
ASAI scale for degree of severity
A. complete, no sensory or motor function is preserved in sacral segments
B. incomplete, sensory but no motor is preserved below neurological level to sacral
C. incomplete, motor preserved below neurological level, key muscles below level muscle grade less than 3/5
D. incomplete, motor preserved below neurological level, key muscles greater or equal to 3/5
E. Normal
Brown-Sequard Sumdrome
Ipsilateral: spastic paralysis, loss position sense, loss discriminate touch
Contralateral: loss pain, temp
Anterior Cord Syndrome
Loss motor, pain, temp bilaterally below level of lesion
Conus Medullaris Syndrome
Injury of sacral cord & lumbar nerve roots
LE motor & sensory loss
Reflexive bowel, bladder
Cauda Equina Syndrome
injury L1 & below
Lower motor lesion
flaccid paralysis-no spinal reflex activity
Automatic Dysreflexia Signs
rise in BP
pounding headache
profuse sweating
medical emergency, if not reversed by removing irritating stimullus
Deep Vein Thrombosis Signs
swelling
pain/tenderness
warm
red/discolored
Parkinson's signs
Resting: pill rolling tremor in 1 hand
Cardinal Signs: tremors, rigidity, akinesia, postural instability, festinating gait, retropulsion, propulsion, mask face, micrographia, resistance to passive motion (cogwheel or lead pipe)
Stage _____ Parkinsons
unilateral tremor, rigidity or akinesia
Min to no fun. impairement
I
Stage _____ Parkinsons
Bilateral tremor, rigidity, akinesia with or without axial signs
I ADLs
no balance impairment
II
______ Stage of Parkinsons
Impaired righting reflexes, onset of disability in ADL perf., can lead I life.
III
Stage _____ Parkinsons
Needs helps with some or all ADLS
unable to live alone
can stand, walk unaided
IV
Stage ______ Parkinsons
Confined to W/C or bed
MAX A
V
Spina Bifida with Myelomeningocele
Sensory & motor deficits below level of lesion
LE paralysis &/or deformities
bowel/bladder incontinence
Shunts may be needed due to intracranial pressure
Signs of blocked shunts
1st year
2nd year
Signs infected shunts
What to do?
1st-head growth, ten soft spot forehead
2nd-severe headache, vomiting, irritability
infected-seizures, deterioration of physical/cognitive function
Might see changes in behavior, school perf., fever, pallor, visual perceptual difficulties
Call neurosurgeon immediately
What syndrome?
Hairy patch, hemangioma, dimple lower spine
difficulty with bowel/bladder, gait disturbances, deformities of feet
Tethered Cord
Recovery of _______ & _________ precede recovery of _____________ & _______ ________.
pain and temperature (small unmylenated fibers, recover faster)
Part of protective primary sensory system, received simple info
discrimitative or epecritic system, carry complex info
Wrist-driven flexor hinge splint used with what population
C-6 injury
extensor tone of muscles in conjunction with the splint will operate the power for prehension force
When sensation begins to return, it is important to provide ___________ activities for sensory retraining.
Remedial
Stimulate the involved extremity by rubbing or stroking (tactile input) or through WB (proprioceptive input)
Compensatory strategies such as teaching how to feel water with uninvloved UE would be part of original treatment.
T/F When working with an ind. with diabetes on a macrame project for increasing standing tolerance, it's MOST relevant to take into consideration
A. length of cord
B. thickness of cord
C. texture of cord
D. type of surface
C-coarse materials may shred or cause splinters or injure skin. For ind. with poor circulation & sensation, skin damage must be avoided, as healing is compromised.
Length-Limited ROM
Thicknesss-limited hand functions
Surface-back pain
T/F When working with a client with apraxia it is best to have the ind. visualize the task first and then provide general statements such as "Let's get ready".
T-visualizing a task & its movement sequences helps the ind. by giving visual model to refer to during the act.
Using general statements rather than step-by-step is more effecitve as ind. with motor apraxia have diff. imitating or initiating motor tasks on commands.
They understand the concept of the task.
persistent rednessskin intact with nonblanchable redness over localized area. warm or cool, pain, itchy
partial thickness ulcer
stage I ulcer
can present as a blister that is intact or open/ruptured.
wound bed is pink without slough or bruising
partial thickness ulcer
Stage II
Involves full thickness loss with subcutaneous fat possible visible
depth of tissue loss is not obscured if sloth (dead matter/necrotic tissue) is present.
Bone, tendon, muscle not exposed or palable
Stage III
Extend to muscles, tendon, fascia, and/or joint capsule
Osteomyelitis is a concern
Stage IV Ulcer
Compensatory strategy for homonymous hemianopsia
teach client to turn head to the affected side.
1. T/F An ind. with complete C6 can not set a goal to dress independently.
2. T/F Same ind. would need MAX A to don socks & shoes
1. F- an ind can I don underwear & pants while laying in bed.
2. F- need MIN A to don shoes & socks
When using a deficit-specific approach for an ind. with residual body neglect due to CVA, what is the best approach to use
Bilateral activities using both UE. During these act. the OT can guide the affected extremity through the activity.
T/F The most severe spinal cord injury level that an ind. can have to perform I bowel & bladder training including skin inspections is C6
F- C7-C8, C6 and above don't have fine motor control to perform skills needed for I in bowel & bladder
What is the best PNF pattern to use with ind. with stiffness recovering from CVA
D1 and D2 flexion with traction
T/F A person returning to work with C5 injury will be working on a keyboard. What is the best splint and device to use
A wrist splint in functional position with a slot to hold a typing stick
T/F Slow stroking is a PNF approach to help with relaxation when restriction is felt during ROM.
F- Rood approach
PNF approach is rythmic rotation
OT repeats rotation all the components of PNF pattern at the point of restriction slowly and gently. As relaxation response occurs, movement is continued through larger range.
Transfer of training approach is remedial/restorative that focuses on restoration of components to increase skill. It is deficit specific & utilizes _________ and _________ activities as treatment modalities
