neurological impairments

traumatic brain injury (TBI)
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Terms in this set (53)
traumatic brain injury (TBI)
-damage to the brain from an external mechanical or blunt force accompanied by a loss of consciousness, post traumatic amnesia, skill fx, or other unfavorable neurologic findings attributed to the event
-most common cause of death and disability in young people between ages 16 and 30
-leading causes include falls, MVA, being struck by an object, assault
focal brain injury (type of TBI)
direct blow to the head resulting from collision with an external object, a fall, or a penetrating injury
multifocal and diffuse brain injury (type of TBI)
sudden deceleration of the body and head, possibly from a motor vehicle, bicycle, or skateboard accident or a fall from a high surface
decorticate rigidity
UE are in spastic flexed position with internal rotation and adduction. LE are in spastic extended position, internally rotated and adducted
decerebrate rigidity
upper and lower extremities are in spastic extension, adduction, and internal rotation. Wrist and fingers flex, plantar portions of the feet flex and invert, trunk extends, head retracts
glasgow coma scale
traditional method to assess levels of consciousness post-TBI
-score below and 8 is indicative of a severe brain injury
-score between 9 and 12 indicate moderate brain injury
-score above 14 indicate a minor brain injury
bed positioning for TBI with abnormal tone or posutring
lying on the side or semiprone is preferred to help normalize tone and provide sensory input
client wear resting / functional splints when..
client is not involved in active movement or functional tasks
-wear schedule includes alternating 2-hour periods
-frequent monitoring for skin break down is necessary
elbow casts
are used for the loss of PROM in the elbow flexors
cone splints
worn to keep fingers from digging into or damaging the palmar surface
management of agitation-common in acute phase -a yes-no system is generally the starting point and is possible using eye blinks, head nods, of discernible motor movementsOT tx for acute phase of TBIw/c positioning, bed positioning, PROM, splinting and casting, sensory stimulation, management of agitationOT tx for inpatient rehab phase of TBI-for clients who are able to demonstrate stimulus-specific responses -generally at Rancho level V or higher -optimize motor function (beginning with GM), visual abilities (contrasting colors), visual-perceptual function (like neglect), cognitive function, voice and speech function, restore competence in self-maintenance tasks, bed mobility, w/c management, functional ambulation, community mobility, transfers, home management, community reintegrationataxianeurological condition that results in uncoordinated movements, but not as a result of muscle weakness (abnormal movement resulting from the cerebellum damage of TBI)apraxiamotor disorder caused by damage to the brain, in which the individual has difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and he/she is willing to perform the task.dysphagia and feeding with TBI-feeding instruction may begin in an isolated and quiet room to prevent distraction and then be graded to include social situations -impulsivity may be controlled by requiring client to place the fork down after each bite to ensure that a full chew and swallow routine is completedbed mobility for TBIprogresses from scooting up and down in bed to rolling, bridging, and moving from and to supine and from and to sitting and standing positionscommunity reintegration for TBI clientcan be accomplished through community trips to practice IADLs in natural environmentsOT Tx for postacute rehab phase of TBI-optimizie cognitive function, visual and visual-perceptual, competence in self-maintenance, leisure and social participation, work, contribute to behavioral and emotional adaptationcognitive function in *inpatient rehab phase* of TBI focuses onengagement in ADLs and IADLs to allow client to develop problem solving, planning, organization, concentration, frustration tolerance, sequencing, and categorizationcognitive function in *postacute rehab phase* of TBI focuses onresidual cognitive deficits including memory problems, executive function, client's self-awarenessspinal cord injury (SCI)most often results from trauma including MVA, gunshot or stab wounds, falls and diving accidents -may occur secondary to diseases such as tumors, myelomeningocele, syringomelua, MS, cancer, ALScomplete lesionsresult in the absence of motor and sensory function below the level of injuryincomplete lesionsmay involve a number of neurological segments, and sensorimotor function may be partially or completely intactzone of partial presevationrefers to complete injuries that have some innervation of dermatomes below the level of injury -strengthening muscles in this area for complete injuries may dramatically improve functional performancespinal shockinitial stages of SCI that may last between 24hours to 6 weeks -reflex activity ceases below the level of injury, resulting in spasticityautonomic dysreflexia-post acute life threatening emergency when an individual's blood pressure may rise to dangerous levels and if not treated can lead to stroke and possibly death -Clients with SCI at T6 or above are at greater risk -may be addressed by standing the client up, loosening restrictive clothing or devices, and checking the catheter for obstructionpurpose of SCI rehab is to..prevent further medical complications and to maximize the client's functionsensory loss in SCIincreases the risk of skin breakdown, resulting in pressure sores or decubitus ulcersorthostatic hypotensionform of low blood pressure that happens when you stand up from sitting or lying down -to avoid this, have client move slowly to allow time for the blood pressure to adjust -position client in supine and elevate the feet above the heartheterotopic ossificationbone formation at an abnormal anatomical site, usually in soft tissue -can be controlled through proper positioning in bed and the w/c and maintenance of the client's joint ROM -splint for sustained stretching and aggressive PROM are contraindicated for this condition -best intervention is to preserve AROMbowel and bladder function in SCIaffected for all injuries at and above S2-S5 level -establish new routines for bowel and bladder elimination is essential to minimize risk of infection and autonomic dysreflexiaSCI and sex-injury does not alter a person's sexual drive or need for physical and emotional intimacy -in men, erections and ejaculations are often affected, potentially compromising fertility -in women, menstruation usually ceases for weeks to months after injury, although no changes occur in fertilityassessments to use for SCI pt.-The Spinal Cord Measure (completed by healthcare team for ADL perf, sphincter control, respiration, and mobility) -The Quadriplegia Index of Function -FIM -COPMacute phase of SCI (aka recovery phase)-OT for short sessions limited to 15 minutes in ICU -client and family education maintain normal UE ROM, positioning, splinting -emphasis on scapular rotation, shoulder scaption, external rotation, elbow extension, pronation -UE should be positioned at 80degrees should abduction, external rotation with scapular depression, full elbow extension and pronation to avoid supination contractures -splints should be dorsal and support wrist in extension and thumb in opposition allowing for proper flexion of MCPs and PIPsacute rehab phase of SCI (aka active phase)-education on pressure ulcer awareness and weight shifting when performing self-care tasks -care giver training -OT should guide clients in finding optimal desired functional independence rather than maximal functional independence -training in equipment that is essential (to avoid costly and unnecessary purchases) -compensatory techniques for wrist and hand function in activities -psychosocial adaptations begins immediately, and is most prominent during this phase (positive coping skills, encouraged to solve their own problems, make decisions, engage in meaningful occupations, etc)interventions for C5 SCImay benefit from mobile arm support to assist in supporting the weight of the arm during activities -t-bar splint can provide necessary wrist stabilization and use of a universal cuff for grasping and holding objectsinterventions for C6-C7 SCIhave more fully innervated shoulder girdles, allowing greater force for rolling in bed and crossing midline -grasping of objects is facilitated by innervation of the radial wrist extensors, which allows for tenodesis -wrist-drive wrist-hand orthosis is useful in maximizing pinch strengthinterventions for C8should focus on grasping objects with MCPs in extension and PIP and DIP in flexiontransition rehab phase of SCI-may be outpatient services if Pt has been unable to achieve optimal outcomes in the acute rehab phase -focus is to maximize strength gains in the first year postinjurystroke (aka CVA)-neurological dysfunction caused by a lesion in the brain -ischemia may result from a brain embolism from cardiac or arterial sources -hemorrhage results from subarachnoid and intracerebral hemorrhages (ruptured vessel) in 13% of strokes -prognosis for recovery is largely dependent on which artery supplying the brain was involvedTransient ischemic attacks (TIA)may result from vascular disease in the brain and may cause mild, either single or repetitive neurological symptoms -referred to as ministrokesimpairment of communication-is most often, but not always, caused by damage to the left hemisphere of the brain -including aphasia and dysarthriaglobal aphasialoss of all language abilityBroca's aphasiamotor speech area and it helps in movements required to produce speech. When there is an issue in this area, a patient can understand the speech of others, but can't produce any speech him or her self (or it's impaired with slow, broken, labored speech)Wernicke's aphasiaHelps in understanding speech and using the correct words to express our thoughts. When there is an issue in this area, a patient may be able to produce speech, but cannot understand the speech of others. -speech may be fluent, but is often meaningless or nonsensicaldysarthriamotor speech disorder. It results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm -articulation disorderOT eval for stroke-top down approach -emphasis on client's roles and occupational performance related to those roles, and goals related to role engagement --SELF-CARE ASSESSMENTS -donning a shirt is good to assess -Bathel ADL Index (measures if client is unable, needs some help, or independent in ADLs) -FIM -COPM -Assessment of Motor and Process skills -Stroke Impact Scale -Arnadottir OT-ADL neurobehavioral eval --PERFORMANCE SKILLS ASSESSMENTS -postural adaptation observation during tasks -ROM, sensory function, muscle tone, pain, strength, endurance, etc -Functional Test for the Hemiplegic/paretic UE -Arm Motor Ability Test -Wolf Motor Function TestStroke phases-acute phase immediately following stroke -rehab phase -community or continuing adjustment phasetask-oriented approach-This approach is based on a systems model of motor behavior and emphasizes the interrelatedness of client, task, and environment factors on motor performance -often cited as a preferred neurorehabilitation intervention to improve occupational performance, especially for clients with neurological conditions such as cerebral vascular accident (CVA) and traumatic brain injuryvisual agnosiaa condition in which a person can see but cannot recognize or interpret visual information -to address this deficit, prompt client to use touch to identify objectssubluxation-one factor that may limit functional use of affected UE after a stroke -prevent pulling on unstable joint -perform PROM and AROM activities to maintain soft tissue length and promote function -ensure proper positioning to prevent the arm from handing -careful evaluation is required when considering the use of sling or w/c table traymotor learning interventions to address cognition should focus onthe client's participation in the task rather than on remediation of specific cognitive deficits such as attention and memory