Neuro Rehab Final

What time is associated with fall risk on a Four Square Step Test?

15 seconds (can use AD with test)

What PNF principle utilizes Successive induction?

Dynamic Reversals (slow reversals)

Pathophysiology of hematomas

Epidural - fx of temporal bone and rupture of meningeal artery subdural- rupture of bridging veins in subdural space subarachnoid-often a result of blood vessels posterior fossa

JFK Coma Recovery Scale

Extended DOC 23 subscales, good for emerging consciousness body structure/function of ICF

Components of Orthotics

Foot plate (full, 3/4 foot) Joint assists (spring) Joint stops (End Range) Straps

Intracranial pressure

normal = 5-15 mmhg aim to keep lower than 20 mmhg

Verticality & LOS Postural Impairments

- Alignment (Posture, WB, ROM) - Sensation - Perceptions

Types of Peripheral Vestibular Hypofunction Issues

- Anything thats not a Disease, TBI, or CVA such as -BPPV, -Vestib neuritis, -lybryinthitis, -acoustic neuroma, -disuse dysequilibrium, -Menier's disease, -perilymphatic fistula

Behavioral and emotional symptoms of a concussion

- Drowsiness - Fatigue/Lethargy - Irritability - Depression - Anxiety - Difficulty falling asleep - Sleeps longer than usual - Difficulty concentrating, remembering - feeling in a fog or dazed

Types of Joints for for AFO's

- Fixed - Locking - Free Swinging - DF Assisted/Stop - PF Assisted/Stop

Reasons to Px a Solid AFO

- Foot clearance - Quad Strength >3/5 - Knee Hyperextension - PF Contractures

Considerations for Orthotic Prescription

- Max Function with Min Bracing -Edema present -Integumentary intact -CLOF (standing, walking, etc...) -Strength Level (3/5 needed to hold joint pos in gravity) -Proprioception/sensation in area -Cognitive/emotional

Reasons to Px an articulating AFO

- More active lifestyle - Adjustable for progression -

Why does postural control get worse with age?

- Muscle fibers change to mix of type 1 and 2 - Skeletal changes - Less peripheral receptors - Overall weaker/slower

What is the short Fullerton Advanced Balance (FAB) Scale?

- Only Top 4 items associated with falls - Score of 9 or less = fall risk

Types Of AFOs

- Rigid - high level of M-L Support - Semi Rigid - M-L walls are cut back - Posterior Leaf Spring - DF Assist from flexible plastic and GRF (Springs)

Sensory Postural Impairments

- Somatosensation - Vision (Diplopia and other impairments) - Vestibular (use and dysfunction)

Cognitive Postural Impairments

-Attention limitations • Sustained focus and/or distractibility • Memory

In general, what are the return to play/return to learn stages?

-Nothing -light practice/aerobic ex -back to school part time/ sport specific -part time school again/non contact drills -full time school/contact practice -fulltime school/back in the game

Biomechanical Postural Impairments

-ROM - Posture (A-P/M-L)

Anticipatory Postural Impairments

-Strength • Force grading • Neural transmission • Motor planning

Reactive Postural Impairments

-Strength and force grading -Sequencing -Neural Transmission -Somatosensory

How does older adults stepping strategy differ from younger adult?

-Takes 1 or more additional steps after the initial stepping reaction -Often a side-step following a forward or backward step n -Multiple side-steps instead of a cross-over step - Leg collisions noted more frequently with lateral stepping

What might cause lateral trunk lean toward less involved side during swing phase

-Using Gluteus Medius to lift affected LE off of the ground. -Weakness of trunk muscles on affected side. -Scoliosis -IT band shortness-hip pain

Knee hyperextension during mid-terminal stance on the more involved side

-Weakness of knee flexors/extensors -Impaired proprioception -Quadriceps spasticity -Accommodation to fixed plantarflexion -Locking knee for stability due to weakness

What are some impairment based interventions for concussion?

-cervical/MSK -Vestibular/oculomotor -exertional -motor function/balance

What are some Dual-task Examination Considerations?

-does one or both tasks suffer -which task is prioritized -are they using posture first strategy

Describe the cognitive demands of postural control and implications for dual-task stability and task performance.

-finite amount of cognitive attentional resources -when reaching our attentional limits one or multiple tasks decrease -reaction times are slowest when postural demands higher -attentional demands increase with balance challenge

Describe the pathophysiology of concussion

-k ions rush out of cell -Ca ions rush into the cell -metabolic dysfunction ensues

Acute Recovery phase of Concussion

0-4 weeks Emphasize: ● Recovery facilitation ● Education ● Reassurance ● Sub-system threshold training ● Nonpharmacological interventions

5 signs of a concussion immediately after injury

1. Altered Mental Status at time of injury. 2. Loss or Decreased LOC <30 mins 3. Memory impairments for events less than 24 hours 4. No Evidence of Intracranial Injury 5. Physical Symptoms i.e. Vestibular, Balance, Weakness, Headache, Visual, Hearing (impairments or sensitivity), Dizziness, Abnormal eye movement, Pupil dilation, Bruising, Slurred speech, tinnitus, Nausea, Vomiting

Sacades - Peripheral or central?

Central

Post-acute recovery phase of concussion

4-12 weeks Referral to interdisciplinary clinic Managing symptoms: ● Sleep Headache ● Mood ● Fatigue ● Memory & attention ● Graduated return to activity

What is the general rehab timeline for a peripheral vestibular hypofunction?

6-8 weeks with daily exercises

HiMAT tool

Activity domain of ICF must be able to walk 20 meters without AD, orthoses are permitted

Which PNF techniques increase Strength?

Agonist Reversals Rhythmic Stabilization (one direction) Slow Reversals (2 directions)

Which PNF pattern focuses on eccentric strength?

Agonist reversals/ Combination of isotonics

Which PNF techniques increase ROM?

Alternating Isometrics Contract Relax Hold Relax Hold Relax Active Motion Rhythmic Initiation

Different APR strategies for Postural Stability

Ankle - Slowly moves COM over Large Distance Hip - Rapidly moves COM over Small Distance Stepping - relocate BOS Reach (and grasp) - add more contact w/support surfaces

What is the Postural Assessment Scale for Stroke used for?

Assessing of balance during stable and changing positions with stroke - lower functional abilities

If your patient begins to describe vertigo what might be some possible causes?

BPPV, UVH, unilateral central lesion affecting the vestibular nuclei, migraine affecting central vestibular pathways

Possible Causes of Dysequilibrium (feeling off balance)

BVH, Chronic UVH, LE Somatosensation loss, Upper brainstem/vest. cortex lesion, Cerebellar and motor pathway lesions

What should you watch out for after a pt acquires their AFO?

Build up wear schedule starting with short time increments Check for skin breakdown Check shoe fit check sock fit

What are some possible causes of dizziness?

Cardiopulmonary Metabolic MSK psychological TIA Migraine Post concussion Vestibular

What Gait Assessment is the FGA a more advanced form of?

DGI (Dynamic Gait Index)

Does ankle strategy go proximal to distal or distal to proximal?

Distal to proximal

Tests, and Treatments for Peripheral Vestibular Hypofunction

HIT - nystagmus towards hypofunction HSN - Fast phase of nystagmus is away from involved side DVA - any nystagmus Txs: Adaption (Gaze Stabilization), Substitution, Habituation, Balance, Mobility

Medial-Lateral Postural Stability Primarily comes from...?

Hip and Trunk diagonal = TFL and RF

Retinal Slip

Image moves off retinal fovea - this is what causes visual blurring

Traumatic Brain Injury

Injury to the brain caused by an external force after birth -birth trauma does not count or internal sources

Difference between Best and Mini Best Balance Assessment

Mini Best Assessment leaves out Biomechanical and Verticality and Stability Limits

Glascow Coma Scale (GCS)

Neurologic assessment of a patient's best verbal response, eye opening, and motor function. less than 9 is severe

Brandt-Daroff Exercises

No longer supported for canalith repositioning May be used for habituation. Looks like sermont

If your patient begins to describe light-headedness what might be some possible causes?

Orthostatic hypotension, hypoglycemia, anxiety, panic disorder

Participation objective, Participation subjective measure (POPS)

Participation domain of ICF Self report measure

Orthotic Materials

Plastic - light and modifiable, no edema Carbon Fiber - light, strong, non-modifiable Steel - strong, heavy Titatium - light, strong, non-modifiable

What factors are associated with poorer outcomes of a BI?

Pre-existing/concurrent medi dal conditions or Post-injury symptoms * These are associated with poorer outcomes

What rancho level should you use a memory book?

Rancho levels 5-6

Second Impact Syndrome

Rapid decrease in consciousness, cranial nerve function, respiratory distress

Which PNF pattern is used to teach a pattern?

Rhythmic Inititiation

Which PNF pattern is used for stability?

Rhythmic Stabilization/Stabilizing Reversals

What is the difference between sensory organization vs. sensory reweighting?

Sensory organization - CAN one reshift the senses used under different task & environmental conditions Sensory reweighting - Reliance on one input increases while utilization of another decreases

What is the FIST test used for?

Sitting Balance

True/False: Symptom severity in initial days following BI is most consistent predictor of recovery rate

True

what is the Fullerton Advanced Balance Scale used for?

Used to assess balance in independent older adults - Score Less than 25 = high fall risk

Difference between vertigo and Oscillopsia

Vertigo is feeling or illusion of movement (person or environment) - Often invoked position or movement Oscillopsia is VISUAL DISTURBANCE where one sees objects oscillating. - Often invoked by busy environment

What are the 6 subtypes of concussion

Vestibular ocular Anxiety/Mood Cervical Post-traumatic Migraine Cognitive/Fatigue

What are the three sensory contributors to balance?

Vestibular, Somatosensory, Vision

Persistent recovery phases of concussion

greater than 12 wks Interdisciplinary team if not already in place Individualized symptom management approach with goal of returning to pre-injury activities

Motion Sensitivity quotient

higher score is worse 31-100 severe

What systolic bp is associated with high mortality?

less than 90

Moss Attention Rating Scale (MARS)

observational rating scale based on rating client for two days some items are reversed or flipped when scored and only validated for rancho 4 or higher

DHI

self report measure higher score=greater sx impact

Community Integration Questionnaire (CIQ)

self report performance of independent activities

Irradiation

spreading of the strength response

Gait Instability Postural Impairments

• A composite • Includes other subsystems • Numerous impairments

perceptual Postural Impairments

• Can include disorders &/or psychosocial perceptions • Verticality disorders • Self-efficacy and fear of falling

Gait - things to think about

•How to set up your environment •What AD to use - hemiwalkers •Other equipment •To stool or not to stool •How to get the patient to learn the correct movement patterns Gait facilitation.pptx slide 2