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37 Cards in this Set
- Front
- Back
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What is are the stages of the Rancho Los Amigos Levels of functioning? |
I: no Response. Completely unresponsive to any stimuli II: Generalized respones. Pt. reacts inconsistently and nonspecifically to stimuli III. Localized Response. Pt. reacts inconsistently but specifically to stimuli IV: Confused/agitated. Pt. is in a heighted state of activity V: Confused-inappropriate: Pt. able to respond to simple commands but not do complex tasks. Memory is impaired. verbalization is inappropriate VI: Confused-appropriate. Patient is dependent on external input but can perform consistently. Memory improved VII. Automatic-appropriate. Can perform automatically and appropriately in structured environments. Judgment remains impaired VIII. Purposeful-appropriate. Pt. acts appropriately though not perfectly. May have some problems in stressful or unusual circumstance |
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What is the Glasgow Coma Scale? |
-objective way to describe level of consciousness 3 categories 1. eye opening. Spontaneous to none 2. Motor response. Follows commands to abnormal responses to no responses 3. Verbal response. Oriented to inappropriate to no response < or = 8 indicates severe brain injury |
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What is the definition of arousal and examples of low and high arousal conditions? What therapy interventions would help pts with high arousal? |
-overall level of alertness or reaction to stimuli -low associated with coma -high may occur during agitated state following TBI -quiet environment and consistency in management (daily routine) may help with high arousal |
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What behavioral difficulties occur with TBI? |
DDDASAP 1. Depression: crying, apathetic, poor self-care 2. Dependent: child-like, follows therapist around 3. Denial: blames others for problems or lack of progress, may not go to treatment 4. Aggressive: physically abusive or verbal obscenities 5. Sexually inappropriate: verbally or physically 6. Agitated: low frustration tolerance, combative, impatient 7. Poor Judgment: regarding actions and behaviors |
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What are treatment strategies for behavioral problems with TBI? |
1. use calm voice and reassuring touch 2. if pt becomes disruptive, redirect pt 3. give positive feedback. set limits on behavior 4. offer treatment choices and provide greater responsibilities to incr self esteem 5. remove pt from treatment environment ("time out") only if pt becomes overstimulated and strikes out at the therapist 6. avoid surprises. keep therapist and schedule consistent 7. keep verbal instructions and descriptions to minimum 8. Practice should immediately follow demonstration 9. use memory log with key info (address, phone number, etc) if pt demonstrates memory loss. Pt can carry it or attach to clothing when leaving the home 10. it may take up to a year before pt with TBI achieves maximal functional return |
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What are signs and symptoms of ALS? |
degenerative disease involving UMN and LMNs and sometimes CNs 1. progressive mm weakness (may affect respiratory mms) 2. Hand weakness may present 1st 3. Dysarthria and dysphagia 4. Muscle atrophy, cramping, and fasciculations (LMN signs) 5. spasticity and hyperreflexia (UMN signs) 6. no sensory changes |
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What are treatment strategies for ALS? |
1. maintain respiratory function and activity levels 2. PROM exercises 3. Positioning and skin care 4. prevent further deconditioning and disuse atrophy 5. avoid overworking mms and teach energy conservation 6. symptomatic treatment of pain, spasms and spasticity 7. provide psychological support and reassurance |
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What are signs and symptoms of Bell's Palsy? |
-inflammatory response affecting facial nerve (CN VII) results in paralysis of mm of facial expression -branch of CN VII affected will dictate the symptoms -may have difficulty wrinkling the forehead, closing the eye tightly and smiling 1. loss of control of salivation 2. one-sided facial mm weakness or paralysis 3. normal sensation 4. Mouth droops 5. Decrease taste on ant 2/3rds of tongue |
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What is treatment for Bell's Palsy? |
1. artificial tears or temporary patching to protect cornea 2. estim to maintain tone and support function of facial muscles 3. teach facial mm exercises 4. provide functional retraining (e.g. chewing on the opposite side) |
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What are the signs and symptoms of Guillain-Barre syndrome (GBS)? |
polyneuropathy of probable immune-mediated viral origin resulting in symmetric motor paralysis and progressive mm weakness that develops quickly 1. LMN disease: affects peripheral and CNs 2. some sensory loss (stocking/glove) and paresthesias (tingling and burning) 3. mm weakness progresses from LE to UE and from distal to proximal 4. may progress to full tetraplegia with respiratory failure 5. Autonomic instability: tachycardia, abnormalities in cardiac rhythm and BP changes 6. recovery is slow (up to 1-2 years) and usually complete (85%) with some mild weakness persisting (3% mortality rate) |
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What are PT treatment techniques for GBS? |
1. during ascending phase (disease progressing): respiratory function, PROM within tolerance, positioning to reduce contractures, and skin care to prevent breakdown 2. when pt stabilizes, prevent injury to denervated muscles, avoid overuse and fatigue, begin gentle stretching, and initiate movement in a controlled environment 3. During descending phase: mm reeducation with mod exercise program, improve CV fitness, teach energy conservation |
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What are signs and symptoms of MS? |
-demyelinating disease more prevalent in colder climates. may be relatively mild, have bouts of remissions and exacerbations, or get progressively worse 1. sensory disturbances including tingling, numbness, and pain 2. coordination problems and spasticity 3. Fatigue (esp in afternoon) 4. diplopia 5. bowel and bladder problems 6. communication disorders 7. psychological problems including euphoria and/or depression 8. adverse reactions to heat (e.g. heating modalities and hot environment) |
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What are PT treatment techniques for MS? |
1. improvement of function 2. prevention of secondary problems (skin care if sensation is lost or diminished) 3. Breathing exercises 4. PNF to tolerance 5. ambulatory or w/c mobility 6. decr tone 7. use positive approach and try to keep pt's stress levels low 8. overvigorous exercise or activity could fatigue the patient and may worsen symptoms 9. morning sessions are preferable |
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What are signs and symptoms of Parkinson's Disease? |
progressive disease affecting basal ganglia with a decr in dopamine production and/or receptors in the brain 1. Resting tremor (incr with emotion and fatigue. Decr with voluntary effort) 2. Rigidity (not velocity dependent) 3. fatigue 4. difficulty initiaing or slowness of movement (bradykinesia) 5. abnormal gait -festinating gait = decr step length, incr cadence -shuffling = slow, decr step length, decr cadence (related to bradykinesia) 6. Flexed posture 7. Mask-like face 8. decreased postural reflexes 9. Behavioral changes: memory loss or apathy leading to secondary problems including decubitus ulcers, mm atrophy, contractures, decreased vital capacity, and falls |
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What are PT treatment strategies for PD? |
1. gait training to incr stride width and length 2. breathing exercises 3. relaxation techniques (gentle rhythmic rocking, vestibular stimulation, prone on large ball) 4. mobility exercises 5. PNF diagonals with rhythmic initiation to overcome bradykinesia 6. ROM activities including PNF contract-relax, inhibitory casting or orthoses 7. avoid excessive exercise or stretching. Pain or lack of endurance could lead to fatigue 8. Dopamine agonist meds to decr tremor and bradykinesia -meds lose effectiveness over time -best to treat pts in morning following dopamine agonist administration |
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What are signs and symptoms of Postpolio syndrome? |
-new form of muscular dystrophy that may occur decades after the initial episode of polio -new denervation occurs with asymmetrical muscular weakness 1. Myalgia 2. joint pain 3. variable asymmetrical mm atrophy with decr strength 4. excessive fatigue and decr endurance contribute to loss of function |
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What are PT treatment strategies for post-polio syndrome? |
1. Low-intensity exercise never to the point of fatigue. Stop exercise with pain or weakness 2. use orthotic devices as needed to improve function 3. work on endurance and energy conservation techniques |
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What is the definition of Neuropathic pain and examples? |
-pain as a result of lesions in some part of the nervous system -usually accompanied by some degree of sensory deficit 1. Thalamic pain 2. CRPS 3. Disorders of peripheral roots and nerves 4. Herpes zoster 5. Phantom Limb |
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What is thalamic pain? |
continuous, intense pain occurring on the contralat hemiplegic side -result of stroke involving PCA |
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What is CRPS? |
Type I: tissue injury without nerve damge Type II: involves nerve injury -pain maintained by sympathetic NS -burning pain (causalgia) -hypersensitivity to light touch -coldness -sweating -usu associated with a traumatic injury |
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What types of pain occur with disorders of peripheral roots and nerves? |
neuralgia: pain occurring along a nerve Radiculalgia: neuralgia of nerve roots |
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What are musculoskeletal types of pain syndromes? |
1. Fibromyalgia 2. Myofascial Pain Syndrome |
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What is Fibromyalgia? |
widespread pain accompanied by tenderness of muscles and adjacent soft tissues -nonarticular rheumatic disease of unknown origin |
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What Myofascial pain syndrome (MPS)? |
1. persistant, deep aching pains in muscle 2. nonarticular in origin 3. characterized by well-defined, highly sensitive spots (trigger points) |
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What is referred pain definition and give one example? |
-starts in deep visceral tissue and is felt in body region remote from site of pathology, resulting in tenderness and pain in superficial locations ex: flank pain from kidney problems
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what is source of referred pain to medial left arm? |
heart attack |
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what is source of referred pain to jaw? |
heart attack |
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what is the source of referred pain to the right subscapular area? |
gallbladder attack
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what is the source of referred pain to the lower thoracic spine? |
kidney problems
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what is the source of referred pain to the flank? |
kidney problems |
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what is the source of referred pain to the Left upper quadrant? |
spleen (or stomach?)what is the source of referred pain to the |
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what is the source of referred pain to the shoulder? |
spleen damage |
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what is the source of referred pain to the right upper quadrant? |
liver problems |
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what is the source of referred pain to the right side of neck? |
liver |
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what is the source of referred pain to the left side of the neck? |
lung |
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what is the source of referred pain to the Right Lower Quadrant? |
appendix |
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What are goals and interventions for physical therapy for pain syndromes? |
1. assist patient in identifying pain behaviors 2. teach coping skills 3. provide relaxation training 4. provide direct pain/symptom control (time-limited) 5. establish a realistic daily exercise program |
