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111 Cards in this Set
- Front
- Back
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What is Level I of Ranchos Los Amigos Scale?
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No Response: Total Assistance
- Complete absence of observable change in behavior when presented with sensory stimuli |
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What is Level II of Ranchos Los Amigos Scale?
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Generalized Response: Total Assistance
- generalized reflex response to painful stimuli - responds to repeated auditory stimuli - responds to stimuli with physiological changes, gross body movements, non purposeful vocalizations - responses may be significantly delayed |
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What is Level III of Ranchos Los Amigos Scale?
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Localized Response: Total Assistance
- withdrawl or vacalization to painful/uncomfortable stimuli - turns toward/away from auditory stimuli - blinks in response to strong light - follows moving object - inconsistent response to simple commands - may respond more to familiar people |
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What is Level VI of Ranchos Los Amigos Scale?
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Confused/Agitated: Maximal Assitance
- alert and aroused - may perform motor activities such as sitting, reaching, and walking without apparent purpose - absent short term memory - disproportionate reaction to stimulus - agressive/flight behavior - mood swings for no reason (euphoric to hostile) - brief non-purposeful moments of divided attention |
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What is Level V of Ranchos Los Amigos Scale?
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Confused, Inappropriate Non-Agitated: Maximal Assistance
- not oriented to person, place, time - Absent: goal directed, problem solving, self-monitoring - unable to learn new information - able to respond to simple commands with external structures and cues - able to converse on a social, automatic level for brief periods of time when provided external structure and cues - able to perform previously learned tasks when structured and cues provided |
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What is Level VI of Ranchos Los Amigos Scale?
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Confused, Appropriate: Moderate Assistance
- inconsistant orientation to person, time, and place - can attend to highly familiar tasks in non-distracting environment for 30 minutes with mod redirection - vague recognition of some staff - assistive memory aide with max assist - supervision for old learning (self care) - shows carry over for relearned familiar tasks (self care) - max assist for new learning with little to no carry over - consistantly follows simple directions - verbal expressions are appropriate in highly familiar and structured situations |
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What is Level VII of Ranchos Los Amigos Scale?
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Automatic, Appropriate: Minimal Assistance for Daily Living Skills
- consistant orientation to person and place with highly familiar environments; mod assist for orientation to time - can attend to highly familiar tasks in non-distracting environment for 30 minutes with min assist for tasks - minimal supervision for new learning - demonstrates carry over of new learning - minimal supervision for safety in routine home and community activities - unable to think about consequences of a decision or action - overestimates abilities - unaware of others' needs and feelings - oppositional/uncooperative - unable to recognize inappropriate behavior |
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What is Level VIII of Ranchos Los Amigos Scale?
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Purposeful, Appropriate: Stand-By Assistance
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What is Level IX of Ranchos Los Amigos Scale?
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Purposeful, Appropriate: Stand-By Assistance on Request
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What is Level X of Ranchos Los Amigos Scale?
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Purposeful, Appropriate: Modified Independent
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What is a Transient Ischemic Attack (TIA)?
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A transitory stroke that lasts only a few minutes. They occur when the blood supply to part of the brain is briefly interrupted.
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What are the symptoms of a TIA?
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Symptoms occur suddenly and are similiar to those of a stroke but typically disappear within an hour or as much as 24 hours.
numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; difficulty with walking, dizziness, and/or loss of balance and coordination |
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What are TIAs a warning sign for?
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TIAs are often warning signs that a person is at risk for a more serious and debilitating stroke. About 1/3 of those who have a TIA will have an acute stroke in the future.
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What is a Cerebral Infarction?
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Due to either embolism or thrombosis of the intra or extracranial arteries
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What is a Cerebral Hemorrhage?
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Bleed secondary to hypertension or aneurysm
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What is a Cerebral Arteriovenous Malformation (AVM)?
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Abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures
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What is the Left Hemisphere responsible for?
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- movement and processing of sensory information of right side of body
- visual reception from right field - visual verbal processing - bilateral motor praxis - verbal memory - bilateral auditory reception - speech - processing of verbal auditory information |
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What is the Right Hemisphere responsible for?
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- movement and processing of sensory information of left side of body
- visual reception from left field - visual spatial processing - left motor praxis - nonverbal memory - attention to incoming stimuli - emotion - processing of nonverbal auditory information - interpretation of abstract information and tonal inflections |
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What are the symptoms of a CVA?
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An abrupt onset of unilateral neurological signs (weakness, vision loss, sensory changes, etc,)
Symptoms progress over several hours to 2 days |
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What are the specific symptoms of a Middle Cerebral Artery (MCA) stroke?
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- contralateral hemiplegia
- hemianesthesia - homonymous hemianopsia - aphasia - apraxia |
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What are the specific symptoms of an Internal Carotid Artery (ICA) stroke?
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Similar to those of a MCA CVA
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What are the specific symptoms of an Anterior Cerebral Artery (ACA) stroke?
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- contralateral hemiplegia
- grasp reflex - incontinence - confusion - apathy - mutism |
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What are the specific symptoms of a Posterior Cerebral Artery (PCA) stroke?
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- homonymous hemianopsia
- thalamic pain - hemisensory loss - alexia |
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What are the specific symptoms of the Vertebrobasilar system?
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Results in pseudobulbar signs
- dysarthria - dysphagia - emotional instability |
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What are the Modifiable Risk Factors of a CVA?
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- hypertension
- cardiac disease - atrial fibrillation - diabetes mellitus - smoking - alcohol abuse - hyperlipidemia |
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What are the Nonmodifiable Risk Factors of a CVA?
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- age: relative risk increases with age
- gender: males are at higher risk - race: African-American and Latino are at greater risk - heredity |
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What medical management can be given for a CVA?
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Immediate Care:
- airway maintenance - adequate oxygenation - nutritional IV fluids, alternative feeding routes - decubiti prevention - tx of underlying cardiac dysfunction (dysrhythmias) Pharmacologic Therapies - Antithrombotic therapy for rapid recanalization and reperfusion of occluded vessels to reduce infarction area (aspirin, heparin) - Thrombolytic therapy for acute strokes to open occluded cerebral vessels and restore blood flow to ischemic areas |
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What is the etiology of a Traumatic Brain Injury (TBI)?
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- damage results from penetration of the skull or from rapid acceleration or deceleration of the brain
- injury occurs in the tissue at the point of impact (coup), at the opposite pole (contrecoup), and diffusely along the frontal and temporal lobes |
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What are the symptoms of a TBI?
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- concussion characterized by post-traumatic loss of consciousness
- cerebral contusion/laceration/edema accompanied by surface wounds and skull fractures - hemiplegia or monoplegia and abnormal reflexes - decorticate or decerebrate rigidity - fixed pupils - coma - changes in vital signs |
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On the Glascow Coma Scale, what scores are considered as severe, moderate, and minor?
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Severe: <8
Moderate: 9-12 Minor: >13 |
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What are the scores for the Best Eye Response (E) on the Glascow Coma Scale?
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1: no eye opening
2: eyes opening in response to pain 3: eyes opening to speech 4: eyes opening spontateously |
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What are the scores for the Best Verbal Response (V) on the Glascow Coma Scale?
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1: none
2: Incomprehensible sounds / moaning 3: Inappropriate words (random) 4: Confused (coherent but disoriented/confused) 5: Oriented and appropriate |
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What are the scores for the Best Motor Response (M) on the Glascow Coma Scale?
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1: no motor response
2: extension to pain (decerebrate) 3: flexion to pain (decorticate) 4: withdraws from pain 5: localizes to pain (purposeful movement to change painful stimuli) 6: obeys commands as asked |
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What is the etiology of a Spinal Cord Injury (SCI)?
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- trauma: compression, shearing force, contusion from MVA, diving accident, penetration wound (gunshot or knife), sports injury, or fall
- non-traumatic: tumor or progressive degenerative disease |
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How are SCIs classified?
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Using the ASIA Impairment scale rating A-E
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What is A on the ASIA Impairment Scale for SCIs?
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A= complete, no sensory or motor function is preserved in the sacral segments S4-S5
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What is B on the ASIA Impairment Scale for SCIs?
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B= incomplete, sensory but no motor function is preserved below the neurological level and extends through the sacral segments
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What is C on the ASIA Impairment Scale for SCIs?
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C= incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade less than 3/5
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What is D on the ASIA Impairment Scale for SCIs?
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D= incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the level have a muscle grade greater or equal to 3/5
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What is E on the ASIA Impairment Scale for SCIs?
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E= normal, sensory and motor function are normal
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What is Spinal Shock?
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- occurs 4-8 weeks following a SCI
- all reflex activity is obliterated below the level of the injury presenting as flaccid paralysis |
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What are common symptoms associated with SCIs?
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- spinal shock
- sensory deficits - loss of bowel/bladder control - loss of temperature control below the lesion - decreased respiratory function - sexual dysfunction - changes in muscle tone (spasticity in upper motor neuron lesion and flaccidity in lesions below L1) - loss of motor function resulting in tetraplegia (quadriplegia) or paraplegia: may be complete or incomplete |
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What is Central Cord syndrome?
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Resulting from hyperextension injuries and presenting as more upper extremity deficits vs. lower extremity
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What is Brown-Sequard syndrome?
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Hemi-section of the cord resulting in:
- ipsilateral spastic paralysis - ipsilateral loss of position sense - ipsilateral loss of discrimitive touch - contralateral loss of pain - contralateral loss of thermal sense |
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What is Anterior Cord syndrome?
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- caused by flexion injuries
- motor function, pain, and temperature sensation are lost bilaterally below the lesion |
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What is Conus Medullaris syndrome?
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Injury of the sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and a relfexic bowel and bladder
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What is Cauda Equina syndrome?
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Injury at the L1 level and below resulting in a lower motor neuron lesion; flaccid paralysis with no spinal reflex activity
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What are common complications of SCIs?
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- respiratory complications, decreased vital capacity, pneumonia
- decubitus ulcer formation - orthostatic hypotension - deep vein thrombosis - autonomic dysreflexia - UTI - heterotropic ossification |
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What is Orthostatic Hypotension?
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An excessive fall in blood pressure upon assuming the upright position
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What is Autonomic Dysreflexia?
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An abnormal response to a noxious stimulus that results in an extreme rise in blood pressure, pounding headache, and profuse sweating. This is a medical emergency if not reversed by removing the irritating stimulus quickly.
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What are some examples of irritants that can cause Autonomic Dysreflexia?
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- bowel irritation or over-distention
- bladder infection or over distention - skin irritation - sexual activity irritants - heterotopic ossification/myositis ossificans - skeletal fractures - appendicitis |
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How can Autonomic Dysreflexia be prevented?
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- teach patient/caregiver frequent pressure relief principles
- ensure compliance with intermittent catheterization - practice well-balanced diet habits - ensure medication compliance - teach patient and caregiver to recognize the cause, signs, and symptoms |
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What is Heterotopic Ossification?
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The formation of bone in abnormal anatomical locations.
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What is the etiology of Cererbral Palsy (CP)?
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- caused by an injury or disease prior to, during, or shortly after birth resulting in brain damange and secondary neurological and muscular deficits
- common causes during perinatal period: lack of oxygen, intracranial hemorrhage, meningitis, chronic alcohol abuse, toxicosis, infections, genetic factors, endocrine and metabolic disorders |
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What symptoms may accompany CP?
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- deformities and contractures
- seizures - intellectual and behavioral disorders - significant motor deficits - persistent primitive reflexes - initial hypotonia which may evolve into spasticity |
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What characteristics of CP occur with a lesion of the motor cortex?
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Spasticity with flexor and extensor imbalance.
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What characteristics of CP occur with a lesion in the basal ganglia?
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- fluctuations in muscle tone causing dyskinesia, dystonia, or athetosis
- choreoathetosis with jerky involuntary movements more proximal than distal and lack of cocontractions - writhing involuntary movements more distal than proximal |
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What characteristics of CP occur with a lesion in the cerebellum?
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- Ataxic movements
- lack of stability so coactivation is difficult resulting in more primitive total patterns of movement |
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What complications are common with CP?
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- language and intellectual deficits: 50-75% of cases
- seizures: 50% of cases - visual impairments: 40-50% of cases - feeding disturbances |
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What is a Tremor?
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- rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation
- classified by rate, rhythm, and distribution - resting tremor: occurs at rest - action or intention tremor: occurs during activity |
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What is Dyskinesias?
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involuntary, nonrepetitive, but occasionally stereotyped movements affecting distal, proximal, and axial musculature in varying combinations
most dyskinesias are representative of basal ganglia disorders |
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What is Myoclonus?
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A brief and rapid contraction of a muscle or group of muscles.
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What are Tics?
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- brief, rapid, involuntary movements, often resembling fragments of normal motor behavior
- tend to be stereotyped and repetitive, but not rhythmic |
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What is Chorea?
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- brief, puposeless, involuntary movements of the distal extremitites and face
- usually considered to be a manifestation of dopaminergic overactivity in the basal ganglia |
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What is Dystonia?
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- results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone
- may be generalized or focal |
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What is Ataxia?
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- describes a lack of coordination while performing voluntary movements
- may appear as clumsiness, inaccuracy, or instability - movements are no smooth and may appear disjointed or jerky |
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What is the first sign of Parkinson's disease?
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Insidious "pill-rolling" tremor of one hand
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What are the cardinal signs of Parkinson's disease?
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- tremor
- rigidity - resistance to passive motion that is not velocity dependent (cogwheel or lead pipe) - akinesia - postural instability - festinating gait - falling backwards (retropulsion - falling forwards (propulsion) - mask face - micrographia |
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What is Stage I of Parkinson's disease using hoehn and Yahr's 5 stage scale?
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- unilateral tremor
- rigidity - akinesia - minimal or no functional impairment |
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What is Stage II of Parkinson's disease using hoehn and Yahr's 5 stage scale?
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- bilateral tremor
- rigidity or akinesia - independent with ADL - no balance impairment |
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What is Stage III of Parkinson's disease using hoehn and Yahr's 5 stage scale?
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- worsening of symptoms
- first signs of impaired righting reflexes - onset of disability in ADL performance - can lead independent life |
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What is Stage IV of Parkinson's disease using hoehn and Yahr's 5 stage scale?
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- requires help with some or all ADLs
- unable to live alone without some assistance - able to walk and stand unaided |
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What is Stage V of Parkinson's disease using hoehn and Yahr's 5 stage scale?
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- confined to a wheelchair or bed
- maximally assisted |
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What are common side effects of medications used for Parkinson's disease?
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- as disease progresses, the drug works less evenly and predictably
- may experience involuntary movements (dyskinesia), primarily when the medication is having its peak effects - the length of time that each dose is effective may begin to shorten (wearing-off effect), leading to more frequent doses - movement proglems may appear and disappear suddenly and unpredictably - hallucinations - drop in blood pressure when standing (orthostatic hypotension) - nausea |
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What is the etiology of Spina Bifida?
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- genetic, intrauterine, and/or environmental factors contribute to the neural tube defect involving the vertebral arches and the spinal column
- some studies suggest medications and a lack of folic acid may induce neural tube defects |
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What is Spina Bifida Occulta?
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A bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations
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What is Spina Bifida Occult Spinal Dysraphism (OSD)?
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When external manifestations such as a red birthmark (hemangioma or flame nevus), patch of hair, a dermal sinus (opening in skin), a fatty benign tumor (lipoma), or dimple covering the site are present.
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What is Spina Bifida Cystica?
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An exposed pouch
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What is Spina Bifida with Meningocele?
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Protrusion of a sac through the spine, containing cerebral spinal fluid and meninges; however, does not include the spinal cord.
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WHat is Spina Bifida with Myelomeningocele?
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Protrusion of a sac through the spine, containing cerebral spinal fluid and meninges as well as the spinal cord or nerve roots.
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What are the symptoms associated with Spina Bifida Occulta?
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Usually does not result in any symptoms
Occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur |
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What are the symptoms of Spina Bifida - Occult Spinal Dysraphism?
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May result in the spinal cord being split (diplomyelia) or being tied down and tethered (diastematomyelia) which may lead to neurological damage and developmental abnormality as the child grows.
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What are the symptoms of Spina Bifida Meningocele?
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Usually does not present with symptoms impacting on function as the spinal cord itself is not entrapped.
Occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur. |
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What are the symptoms of Spina Bifida with a Myelomeningocele?
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- Results in sensory and motor deficits occuring below the level of the lesion, and may result in lower extremity paralysis and/or deformities, and bowel and bladder incontinence.
- The level of lesion impact leg movements. - Lesions of S2-S4 results in bladder and bowel problems |
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What complications can occur with Spina Bifida?
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- hydrocephalus (resulting in needing a shunt) can cause brain damage and MR
- Arnold Chiari Syndrome - shunts can become blocked or infected |
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What is Arnold Chiari Syndrome?
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A portion of the cerebellum and medulla oblongata slip down through the foraman magnum of the cervical spinal cord
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What are signs that a shunt is blocked resulting in increased intra-cranial pressure?
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- first year of life: extreme head growth and often a ten soft spot on forehead
- second year of life: severe headache, vomiting, and/or irritability - paralysis of the sixth crainal nerve: visual impairments occur - seizure disorders and deterioration of physcial and/or cognitive functioning |
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What are signs that a shunt is infected?
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- vomiting, lethary, and/or fever
- seizures and deterioration of physical and/or cognitive functioning |
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What is Tethered Cord Syndrome?
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Occurs in the tail end of the spinal cord when it is stretched as a result of compression, being trapped with a fatty mass, or a developmental abnormality
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What are symptoms of Tethered Cord Syndrome?
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- hairy patch of skin
- hemangioma - dimple of the lower spine - difficulties with bowel and bladder - gaid disturbances - deformities of the feet |
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muscular dystrophies/ atrophies
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group of hereditary degenerative disorders
-low muscle tone/weakness => delayed milestones, feeding difficulties, deformities of limbs& spine -may require feeding tubes, trachs |
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Duchenne's muscular dystrophy
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most common form; detected age 2-6; males only
enlargement of the calf muscles d/t to ^adipose tissue weakness of proximal joints and voluntary muscle (inc. heart and diaphragm) death in early 20's gowers sign present |
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Arthrogryposis multiplex congenita
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detected at birth; loss of anterior horn cells--weakness, deformities, joint contractures
position of rest UE: shoulder int. rot.. elbow ext., wrist flex. LE: hip flex& int. rot. w/ clubfeet |
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limb-girdle muscular dystrophy
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onset: 1st-3rd decade of life
slow progression proximal muscles of pelvis and shoulder effected initially |
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fascioscapulohumeral muscular dystrophy
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onset: adolescence
involves face, upper arms, scapula weakness leads to facial masking and inability to flex or abduct shoulder above 90 |
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Spinal muscular atrophy
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infantile form: quick progression w/ life expectancy of 2 years
intermediate form: detected from 6 months to 3 years; quick progressive weakness w/ life expectancy of early childhood |
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congenital myasthenia gravis
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onset: near birth affects males> females
disordered transmission of impulses in neuromuscular junction => progressive weakness |
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charcot-marie-tooth disease
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involves peripheral nerves with progressive weakness primarily involving inperoneal (fibular) and distal leg muscles
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progressive supranuclear palsy
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onset: mid-late life w/ death 15 years after dx
loss of voluntary eye movements (reflexive still intact) bradykinesia, rigidity, axial dystonia, pseudobulbar palsy, dementia |
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huntington's chorea
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onset: middle age (autosomal dominant)
choreiform movements, progressive cognitive decline, psychiatric disturbance may be present before the movement disorder precents |
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spinocerebellar degenerations
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cause progressive ataxia due to degeneration of
brain stem spinal cord peripheral nerves basal ganglia |
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friedrich's ataxia
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onset: early childhood/adolescence (autosomal recessive)
spinal ataxia, gait unsteadiness, upper extremity ataxia, dysarthria, tremor, areflexia, loss of large fiber senses, scoliosis and cardiomyopathy are common in late stages |
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cerebellar cortical degeneration
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onset: 30-50
pathologic changes seen in cerebellum and inferior olives -produces cerebellar symptoms only |
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multiple systems degeneration
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onset: young-midlife
spasticity, extrapyramidal symptoms, sensory, lower motor neuron, and autonomic dysfunction |
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amyotrophic lateral sclerosis
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onset: average 57 y/o men> women; death in 2-5 years
distal asymmetrical muscle weakness beginning in hands. lower motor neuron signs early on, then spasticity, hyperactive DTR's, corticospinal tract involvement, dysphagia, dysarthria |
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brachial plexus disorder
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develops as a result of birth or traction injury, cancer, radiation tx
causes motor and sensory disorders of limb: erb's palsy klumpke's palsy |
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erb's palsy
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upper brachial plexus injury C5-6 possibly 7
arm cannot be raised, weak elbow flexion, weak scapular protraction/retraction arm held in "waiters tip" position. contractures may develop--splinting and ROM exercises needed |
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klumpke's palsy
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lower brachial plexus injury C7-8--T1
flaccid paralysis of hand and wrist ipsilateral horners syndrome (miosis, ptosis, facial anhidrosis) |
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guillain-barre syndrome
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recovery begins 2-4 weeks after onset
80% are ambulatory in 6 months, many w/ residual functional/ neuro deficits. usually begins in symmetrical distal to proximal loss of motor function. may need artificial ventilation |
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myasthenia gravis
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onset: in women young adult; in men older adult
autoimmune attack on acetylcholine receptors leading to muscle weakness, ptosis, diplopia, dysarthria, dysphagia, proximal limb weakness. intact sensation and DTR's |
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post-polio syndrome
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onset: 15 years after polio infection
reinnervated muscles after initial polio attack break down causing muscle weakness, pain, joint pain, atrophy, loss of function, cold intolerance |
