OA final after week 11

secondary complications after stroke 6

Dehydration � DVT and PE � Respiratory complications and infections � Cardiac complications � Bowel and bladder dysfunction � Increased risk of another stroke

how do you address Inability to perform chosen occupations while seated for stroke patients

Use activities that involve weightshifting and reaching to challenge sitting balance and tolerance for improved function while seated

standing balance exercises for stroke
6

Feet shoulder width apart, together, then tandem � Quarter or Mini-Squats � Rocking toe to heel � Side step � Pick objects up off the floor � Step forward and sideways over objects

Common movement patterns of UE after stroke:

Scapula elevation and fixation � Humeral abduction � Elbow flexion � Wrist flexion

4 questions to ask when assessing UE in stroke patients

can they weight bear? can client move objects across a work surface with a static grasp? can client reach smoothly and with coordination? can they combine movements of the thumb and fingers for grasp, pinch, and object manipulation?

what ranchos levels are in disorder of consciousness

1-4

what are the disorders of consciousness

coma, veg state, min. consciousness

The person shows no signs of being awake and no signs of being aware. ? Lies with eyes closed and does not respond to their environment, voices or pain. ? Usually lasts for less than 2 to 4 weeks, during which time a person may wake up or progress into a

coma

: Similar features to disorder of consciousness occur, HOWEVER, the person is both conscious AND aware, but completely paralyzed and unable to speak. Usually, individuals with this diagnosis are able to move eyes and can communicate via blinking.

locked in syndrome

The person is awake but is showing no signs of awareness. ? May open eyes, wake up and fall asleep at regular intervals, have basic reflexes (e.g., blinking when startled or withdraw hand when squeezed hard). ? Able to regulate heartbeat and breathing wit

veg state

when is a veg state permanent

NTBI cause and > 6 months ? TBI cause and >12 months

The person shows clear but minimal or inconsistent awareness. ? May have periods of communication or respond to commands (e.g., move finger on command). ? May enter this state after being in a coma or in a vegetative state. ? For some, this may be a stage

min conscious

care in disorders of consciousness include 7

Nutrition through a feeding tube ? Regular positioning to prevent pressure ulcers ? PROM ? Keeping skin clean to maintain skin integrity ? Bowel & bladder management ? Oral hygiene ? Participation in meaningful activity (e.g., listening to music or TV, be

? Individuals with a severe TBI are unable to calm down the sympathetic response due to the brain being injured and the urge cannot be inhibited.
symptoms: what is this called and what are 7 symptoms

neurostorming
High blood pressure � Increased heart rate � Fever � Sweating � Increased respirations � Posturing � Hyperthermia

3 stages of cog rehab

. Acquisition 2. Application 3. Adaptation

is a low score good on the modified ashworth

yes

when does the rooting reflex integrate and what is the stimulus

0-4 months, corner of mouth

when does the bite reflex integrate and what is the stmilus

4-7 mos, gums or teeth

when does the suck swallow integrate

0-4 months

�Elevation of hyoid and larynx and anterior movement of the epiglottis to close the ___ so it doesn't go into lungs

larynx

where does food go down

esophagus

what is your voice box

larynx

what is peristalsis

involuntary constriction and relaxation of the muscles

when is HD typically diagnosed

30 and 50

etiology of HD
3

�Each child of a parent with HD has a 50-50 chance of inheriting the HD gene from their parents
�Defect is a dominant gene
�Around 10% of those diagnosed with HD do not have a family history

6 signs and symptoms of HD
�Muscular:
�Cognitive:
�Behavioral:
�Psychological:
�Mood: anxiety,
�Also common:
�<- Chorea common with Huntington's disease pictured here; Deteriation of corpus striatum

�Muscular: abnormality walking, increased muscle activity, involuntary movements, problems with coordination, loss of muscle, or muscle spasms
�Cognitive: amnesia, delusion, lack of concentration, mental confusion, slowness in activity, or difficulty thin

early stages of HD

behavior change, cog functioning, and choreiform in the hands (due to caudate nucleus), irritability, depression,

middle stages of HD

selfcare becomes difficult
memory, changes in gait and balance, bradykinesia and akinesia (initiation of mvmt). Saccadic eye movements and ocular pursuits may be slowed at this stage of HD. slight dysarthria may be noted, which compromises communication.

late stages of HD

chorea all over body
can no longer manage daily activities

role of ot in early stages of HD

�Routines, work site evaluation, engaging in purposeful activity, community support, fine motor modifications, home modifications in prep for later stage, home exercise program for strength and endurance

role of OT in middle stages of HD

�Job loss/ IADL, family education, simple cues, energy conservation because client becomes fatigued, also mobility education, positioning when eating (dysphagia)

role of OT in late stages of HD

�Positioning and splints, may need a feeding tube, daily scheduling to reduce outburst, dementia is also a common symptom

what is GBS

(also known as acute idiopathic neuropathy, infectious polyneuritis, and Landry's syndrome) is an acute inflammatory disorder in which the body's own immune system attacks part of the peripheral nervous system. The immune system destroys the myelin sheath

what does GBS typically include 8

�Tingling or prickling sensation in your fingers and toes
�Weakness starting in legs
�Unsteady gait
�Difficult with eye and facial movements, including speaking, chewing, and swallowing
�Severe pain can be worse at night
�Rapid heart rate
�Difficulty brea

when do symptoms in GBS plateau

week 4

how long can recovery in GBS last

6/12 months- up to 3 years

medical treatments for GBS

�Plasma Exchange: drain plasma from body and separates RBC and replaces RBC into body. Tries to replace antibodies that may be attacking peripheral nerves
�Immunoglobin Therapy: give healthy antibodies from donor through the vein to block bad antibodies f

client factors and functional testing in GBS

�Client factors: ROM, MMT, eating and swallowing assessment, pain scale, sensory testing, depression scale, Ways of coping scale
�Functional testing: movement/coordination, transfers, self-care tasks and other functional tasks related to the patient's wor

inpatient goals for GBS

going home, mobility, ADL's, disease progression, devices maybe, med. management

outpatient goals in GBS
6

strengthening, f. mobility in home and community, med. Management, vocational, home modifications, meal prep

7 most common forms of cancer

Carcinoma (skin or tissue lining organs) Sarcoma (connective tissue) Leukemia (bone marrow or blood-forming organs) Lymphoma (immune system) Multiple myeloma (plasma cells and bone marrow) Melanoma (skin) CNS (brain and spine)

most common type of cancer for men 5

prostate, lung, colon, bladder, and skin

most common type of cancer for women 5

breast, lung, colon, uterine, and thyroid

common forms of cancer in women over 60

breast, lung, colon, uterine

most common forms of cancer in men over 60
4

prostate, lung, colon, skin

secondary complications related to cancer (6)

fatigue, cog dys, CIPN, pain, lymphedema, cardiovascular

signs and symptoms of ALS

?Focal weakness begins in the arm, leg, or bulbar muscles. The individual may trip or drop things, may have slurred speech, abnormal fatigue, shortness of breath, and emotional lability, which is uncontrollable periods of laughing or crying
?As the diseas

what is ALS

A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord, causing reduced functionality of the muscles the nerve cells supply

As ALS progresses, the disorder does not affect a

?person's eye function, bowel and bladder function, or sensory function.

8 OT interventions for ALS

1.ADL, IADL, work, and leisure training using adaptive equipment and task modifications to compensate for weakness
2.Sensory stimulation
3.Education on strategies to manage fatigue and conserve energy (also family education)
4.Train in safe and efficient

4 main interventions for MS

o ) problem-solving compensatory strategies, (2) fatigue management group treatment intervention, (3) role delegation, and (4) the use of adaptive equipment to compensate for motor, sensory, endurance, cognitive, and visual deficits.

MS attacks

myelin, oligodendrocytes, & the nerve fibers (that the myelin are put in place to protect)

signs and symptoms of MS

?Fatigue
?Motor, sensory, visual, & autonomic systems affected
?Gross / Fine Motor Incoordination
?Vestibular Dysfunction
?Spasticity
?Diplopia: Double Vision
?Loss of visual acuity
?Dysesthesia / Paresthesia
?Cognitive Deficits
?Dysphagia

4 patterns of MS

?Benign or Clinically Isolated Syndrome
?not technically MS but could develop into it, only one occurrence of symptoms
?Relapsing-remitting-nonprogressive
?Relapsing-remitting-progressive
?Primary progressive

for MS diagnosis usually occurs between

?20-40 years old, with peak onset 30 years old

most common form of ALS

sporadic

stage 1 of ALS (independent)

mild weakness, clumsiness, ambulatory, independent with ADLs

occupation interventions for ALS stage 1

energy conservation

asl stage 1- interventions for client factors

ROM, add strengthening, gentle resistance

als stage 2 (independent)

mod/ selective weakness, slightly decreased independence in ADLS

als stage 2 interventions

continue ROM, be more cautious on strengthening, adaptive equipment

als stage 3

severe weakness in hands, wrists, ankles, increased resp effect, easily fatigued

als stage 3 occupation based interventions

manual or power wheelchair, work simplification, cuffs, start talking about home mods, communication devices

client factor based interventions for als stage 3 (independent)

chest stretching, deep breathing, postural draining maybe

at what stage of als does one become partially independent.. describe it

4
hanging arm, pain and edema in hand, lower extremity weakness is severe, can do some ADLs but becomes fatigued

als interventions for stage 4

arm slings, mobile arm support, power wheelchair, communication, environmental control systems, home and bathroom modifications, positioning, pain and spasm management-- massage, anti-edema, AAROM or PROM, isometric

stage 5 als

sever lower extremity weakness, moderate to severe upper extremity weakness, wheelchair dependent

occupation interventions for stage 5 of als

family member training for self-care, may need a lift, adapt home env, may need resp. on wheelchair

stage 6 als (dependent) interventions

evaluate dysphagia, feeding tube maybe, augmentative speech devices, PROM, sensory

client factor interventions for ALS

skin inspection, wheelchair pressure relief