adult exam 2 SCI, neurodegenerative

cauda equina syndrome

-horse tail (very bottom) -injury to lumbar and sacral nerve roots

ASIA D

-incomplete -motor function preserved below neuro level & more than 1/2 of key muscles below injury have muscle grade of 3 or greater -antigravitational strength

ASIA C

-incomplete -motor function preserved below neuro level & more than 1/2 of key muscles below level of injury have muscle grade less than 3

ASIA B

-incomplete -sensory but no motor below neuro level

since 2010, most common injury is...

-incomplete tetraplegia -followed by incomplete paraplegia

complications related to SCI

-AD --seen w/ increase in BP --noxious stimuli -postural hypotension --sudden drop in BP -pressure ulcers

T10-L1 ADLs, wc, transportation, standing/ambulation

-ADLs: (I) -wc propulsion: (I) -transportation: (I) in car, including loading and unloading wc or driving w/o A -standing/ambulation: SPV to (I) using bracing, KAFO w/ crutches/walker, must consider function and UE overuse

L2-S5 ADLs, wc, transportation, standing/ambulation

-ADLs: (I) -wc propulsion: (I) -transportation: (I) in car, including loading and unloading wc or driving w/o A -standing/ambulation: standing (I) & ambulation functional, (I) to some A

T1-T9 ADLs, wc propulsion, transportation

-ADLs: (I) in all -wc propulsion (I) -transportation --(I) in car, including loading and unloading wc

C1-C3 ADLs & wc mobility

-ADLs: dependent -wc mobility --power wc w/ alt control (I) or manual wc (dep in tilt in space)

C4 ADLs & wc mobility

-ADLs: dependent -wc mobility --power wc w/ alt control (I) or manual wc (dep in tilt in space)

MS assessments for cognition

-MMSE -Minimal assessment of cognitive function in MS (MACFIMs) -MS neuropsychological screening questionare -paced auditory serial addition test -symbol digit modalities test (SDMT)

what to do for AD

-STAY UPRIGHT; DO NOT LAY DOWN; THIS COULD BE LETHAL -find noxious stimuli

Guillain Barre Syndrome

-an acute inflammatory demyelinating polyneuropathy -autoimmune disorder -results in acute neuromuscular failure -the body's immune system attacks the myelin sheath covering the nerve, resulting in a slower signal transmission through the nerve

intention tremors test

-bring spoon to mouth -finger to nose -finger to finger

ASIA A

-complete -no motor or sensory function preserved in sacral segments S4-5

pain

-crucial to communicate pain issues to DR

Tx for ALS special considerations

-exercise -equipment -AT -dysphagia mgmt

assessments/screens/test used with MS for fatigure

-fatigue severity scale -modified fatigue impact scale -rochester fatigue diary scale -the comprehensive fatigue assessment battery for MD (MACFIMS)

C7-C8 ADLs

-feeding: (I) -grooming: (I) -dressing: UE (I) LE partial A to (I) -bowel mgmt: partial A (some may achieve (I)) -bladder mgmt: partial A (some may achieve (I)) -bathing: UB (I) & LB partial A to (I)

C5 ADLs

-feeding: setup -grooming: partial-total A -dressing: UE partial A; LE total A -toileting: total A -bathing: total A

C6 ADLs

-feeding: setup to (I) -grooming: partial A to (I) -dressing:UE (I) & LE partial A (some may achieve (I)) -bowel mgmt: partial A (some may achieve (I)) -bladder mgmt: partial A (some may achieve (I)) -bathing: UE (I) & LE partial A (some may achieve (I))

conus medullaris syndrome

-flaccid paralysis of LEs

central cord syndrome

-greater weakness in UE than in the LE

cerebellar screening procedures

-intention tremors -dysmetria -dysdiadocokinesia -rebound phenomom -nystagmus -dysarthria

cerebellum ADLs are affected by

-intervention tremors and ataxia -wide based staggering gait -dysarthria

ALS

-late onset fatal neurodegenerative disease of UMN and LMN -voluntary muscle control is affected and early manifestations indicating UMN or LMN disease vary with the site of the initial disease process

what to do for postural hypotension

-lay them down -elevate feet to get blood to brain

how do we define SCI injury (2 ways)

-level of SC damaged -amount of damage to SC *generally neurological level classified by lowest (most caudal) level of SC with normal sensory and motor function bilaterally AKA completely intact

cerebellum cognition

-loss of brain volume; mostly grey matter --memory(retraining and learning new info) --word funding --attention --concentration --executive function --slowed info processing speed --neuropsychosocial assessment (SDMT)

functional outcomes for SCI summary

-may vary by individual d/t --completeness of injury --associated medical complications (pain, spasticity, contractures, cardiac disease, musculoskeletal injury) --the amount of rehab training pt receives --rehab teams level of expertise --pts motivation, age, and family and financial resources

C7-C8 wc mobility & transportation

-mobility --manual wc (I) indoors, some A w/ uneven terrain in custom wc -transportation --(I) car if (I) with tx and wc loading/unloading, (I) driving modified van from captains seat

brown sequard syndrome/ hemi cord

-motor and proprioceptive loss ipsilateral to injury -loss of pain and temp contralateral

ASIA E

-normal motor and sensory function

spasticity med management

-not always a negative, can be used functionally -communicate with DR

ALS possible assessments

-pain scale -berg depression scale -FIM -COPM -7 point GBS disability scale -semmes weinstein -ROM -MMT -dynamometer -grip, pincer, 3 point, lateral pinch

MS assessment for pain, tremors, ataxia, and dysphagia

-pain scale -multidimensional assessment of tremor (MAT) -COPM -swallow study -6 minute walk test -MS walking scale -sleep history questionare or diary -home assessment -beck depression inventory-- fast screen -FIM -ADL, IADLs, dysphagia assessments -9 hole peg -semmes-weinstein -MMT -ROM -grip strength -vestibular evaluation

dysdiadochokinesia

-palms up/down while seated -impairment: lose rhythm or one hand lags behind the other

dysmetria test

-place object at ct arms length -ask them to reach it -impairment if over/undershoots 2/3 objects or tries to stabilize UE

C5 wc mobility & transportation

-power wc likely for community mobility or manual wc (some sort of self propel custom manual wc on level surfaces, some require total A outdoors) -transportation --some may drive (I) with highly specialized equipment --most remain in wc as passenger w/ wc toe down system

cerebellum major function

-proprioception -error correcting service for motor system

dysarthria test

-read a sentence

rebound phenomenon test

-resist pulling elbow into extension -limb hits torso

basal ganglia

-stereotypic and automated mvmt patterns -first patterns are learned cortically and then integrated subcortically -problems initiating and terminating mvmts -rigidity or dystonia -festinating gait, hemiballismus, athetosis, choreas, and tics

Tx for ALS

-therapist must be aware of cts level of tolerance for gadgets, financial resources ,a and social and cultural context

nystagmus test

-visually scan moving object H and X pattern

C6 wc mobility & transportation

-wc mobility --power wc (I) --manual wc partial A to (I) w/ custom setup -transportation --(I) driving may tx or drive from wc (some can (I) load and unload a manual wc to/from vehicle)

MS

chronic immune mediated disease

up to 65% of individuals with MS have...

cognition problems

MS psychologist

focuses on eval and treatment of cog and emotion problems

LMN injury effects

how pts manage bladder and bowel