after a TBI to the dorsolateral aspect of the prefrontal area, what deficits would you expect?
impaired concentration, possibly decreased motivation & problem solving
after a TBI to the premotor aspect of the frontal lobe, what characteristics would you expect a patient to display?
apraxia or motor planning deficits
If a patient is displaying unstable emotions and/or unpredictable behaviors, you may suspect damage to..
the orbitofrontal aspect of the frontal lobe
If a patient sustains damage to the SMA, what characteristics would you expect them to display?
loss of b/l control of posture
If a patient sustains damage to teh primary motor cortex during a TBI, what characteristics would you expect them to display?
contralateral paralysis and paresis, most pronounced in distal parts of limbs and lower part of face
if, after a TBI, a patient has difficulty with conjugate eye movements to the right, you would expect an injury to..
the LEFT middle frontal gyrus of the frontal lobe
after a concussion, a patient will have impaired functioning of the ..
brainstem reticular activating system
To be classified as a severe TBI, a patient will have lost consciousness for..
>24 hours (GCS score of <9)
If, after a TBI, a patient demonstrates visuospatial or body scheme disorders, they most likely have a lesion in the..
R hemisphere of the parietal lobe
LOCF =
Rancho Los Amigos Level of Cognitive Functioning
If after a TBI a patient has an impairment of taste in the contralateral side of the tongue, they most likely have a lesion..
in the gustatory cortex of the parietal lobe
a lesion where would cause a patient to have profound memory loss of recent events & no new learning?
parahippocampal region of the temporal lobe
If a patient is at LOCF IV-VI, what would be your focus and emphasis for their care?
- provide structure, avoid overstimulation if agitated/confused
- use daily schedules & memory logs
3. provide consistency, give clear feedback
- use task-specific training, but limit your activities to well-liked, familiar ones
5. provide freq orientation to time, place, etc
6. emphasize safety, behavioral mgmt
what is the most severe ASIA level?
ASIA A - complete, no motor or sensory function is preserved in the sacral segments S4-5
the level of an SCI indicates..
the most distal uninvolved nerve root segment with normal function
-muscles MUST have at least a grade of 3+/5
a C6 ASIA C patient would p/w..
Motor function below C7 is preserved but most ms have <3/5 grade
what type of SCI is considered a LMN lesion?
cauda equina injury (loss of long nerve roots at or below L1)
-flaccid paralysis w NO spinal reflex, also bladder and bowel paralysis
-regeneration is SLOW, often INCOMPLETE; stops after about 1 year
what is the result of Brown-Sequard syndrome?
IPSIlaterally :
-loss of dorsal columns w loss of tactile discrimination, pressure, vibration and proprioception
-loss of corticospinal tracts with loss of motor fxn & spastic paralysis below level of lesion
Contralaterally:
-spinothalamic tract loss w loss of pain and temp; b/l loss of pain & temp at level of lesion
with a central cord lesion, what is preserved?
proprioception and discriminatory sensation
- loss of spinothalamic tracts with b/l loss of pain and temp
- loss of ventral horn w b/l loss of motor fxn (primarily UEs)
what nerves innervate the diaphragm?
C3-5 (ie if a lesion is above C4, respiratory insufficiency or failure occurs)
If a patient with an SCI p/w increased spasticity/spasms, what could be the likely cause?
look for nociceptive stimuli that may trigger the increased tone (i.e. blocked cather, tight clothing/straps, body position, environ temp, infection or decubitus ulcers)
what are the symptoms of autonomic dysreflexia?
1. paroxysmal HTN 2. bradycardia 3. HA
4. sweating (diaphoresis) 5. flushing 6. diplopia
- convulsions
- FIRST: elevate head, check & empty catheter
what is spinal shock
a transient period lasting anywahere from several hours to 24 weeks; involves reflex depression & flaccidity
for patients with high cervical lesions, the most ideal w/c would be:
electric w/c w tilt in space OR reclining seat back,
-microswitch OR puff-and-sip controls
-possibly a portable respirator
If a patient has a cervical lesion SCI with at least shoulder function & elbow flexion (C5), what type of w/c is recommended?
manual chair w propulsion aids
-indep for short distances on smooth flat surfaces
-may choose electric w/e for distance/nrg conservation
what w/c is recommended for someone with a C6 SCI?
they still have radial wrist extensors, so a manual w/c with friction surface hand rims (independently)
If a patient has a C7 SCI, the w/c recommended is..
manual w/c with friction handrims with increased propulsion
what kind of ambulation is expected of a midthoracic lesion SCI (T6-9)?
supervised ambulation for short distances
-req b/l KAFOs and crutches, swing to pattern,
what type of gait is expected of a high lumbar lesion SCI (T12-L3)?
**maintained: hip flex, knee ext
independent ambulators on all surfaces and stairss using a swing thru OR four-point gait pattern & B/L KAFOs and crutches
what type of gait would you expect from an SCI patient with a low lumbar lesion (L4-L5)?
maintained: DF, g toe ext
independent w b/l AFOs and crutches or canes
typically are indep community ambulators
what are CV precautions associated with tetraplegia & high-lesion paraplegia?
- blunted tachycardia
- lack of pressor response
- very low VO2 peak
- higher variability of responses
ABSOLUTE contraindications to exercise with SCI patients
1. autonomic dysreflexia
2. UTI
3. symptomatic hypotension
4. Unstable fx
5. insufficient ROM to perform task
6. severe/infected skin on WBing surface
7. Uncontrolled hot/humid environments
what does BWSTT do for a patient with an incomplete SCI?
promotes spinal cord learning/activation of spinal locomotor pools
what is the freq/duration of BWSTT suggested for incomplete SCIs?
4x/week x20-30 minutes
(8-12 weeks)
some precipitating or exacerbating factors of MS would be..
infections, trauma, pregnancy & stress
diagnostic tests for MS =?
- LP/CSF
- elevated gamma globulin
- CT or MRI
- myelogram
- EEG
what types of sensory differences might be found in a patient with MS?
- hyperpathia (hypersensitivity to sensory stimuli)
- dysesthesias (abnormal sensations)
- trigeminal neuralgia
- Lhermitte’s sign
what’s the EDSS and what patient population is it used for?
expanded disability status scale
-outcome measure for MS
what pharmacological intervention is used during an acute flair up
immunosuppressant drugs ie ACTH & steroids
what drugs are used in MS to slow the progression of the disease?
interferon drugs