PTA roles for Neuro patient involvement
contribute to progress notes and re-evals, help obtain info for pt history, follow through with collections of tests and measures
vital signs
BP, HR, RR, SpO2, temp.
observations
visual inspection, general movement patterns (more abnormal), ease of movement, general affect, communication skill
arousal stages
alert, lethargic, obtunded, stuporous, comatose, vegetative state
alert
is what it is, alert and aware
lethargic
awake, but sleepy
obtunded
hard to wake up, then confused
stuporous
react only to noxious stimuli (sternal rubs)
comatose
no sleep/wake cycle, non-responsive to any type of stimulation
vegetative state (minimally conscious state)
unconscious, varying sleep/wake cycle
prefer over comatose
attention
awareness of the environment, ability to focus
ways to test cognition
orientation, memory, following commands, higher cognitive functions, standardized assessments
orientation
A & O x ______
person, place, time, situation
1 2 3 4
memory
word recall, day to day events (short term mem)
birthdays and anniversaries (long term mem)
following commands
can they follow commands? steps to a task?
higher cognitive functions
math, reasoning, judgement and intuition
standardized assessments
mini-mental exam (in class)
is impulsive good or bad?
bad, not safe with potential movements
what does sensation provide about?
environment, body, and the relationship of the environment to the body. (walking on ice)
where does sensory info get processed?
in CNS (brain) leads to selection of movement strategy or modification
what does a loss of sensation cause?
issues with functional activities and movements
what is regulation of movement dependent on?
sensory afferent (incoming to the brain) information
define proprioception
sense positions
define kinesthisia
the awareness of the movement
strength
measurable force exerted by a mm or a group of mm to overcome a resistance in one maximal effort
endurance
ability to sustain forces repeatedly or generate forces over a period of time
will affect functional ability
poor endurance leads to fatigue
flaccid
no tone
hypotonic
low tone
hypertonic
high tone
rigid
type of hypertone
lead pipe
cogwheel
lead pipe
resistance throughout ROM and does not depend on velocity
cogwheel
ratcheting and catchy through the movement
spasticity
high tone plus velocity dependent
clasp knife response
faster joint moves=increase in resistance
clasp knife response
resist-resist-lets go like a pocket knife
dystonia
the wiggle dance, twisting, writhing movements-
ashworth 0
no increase in mm tone
ashworth 1
slight increase in mm tone, manifested by a catch and release of by minimal resistance at the end of the ROM when the affected parts is moved in flexion or extension
ashworth 1+
slight increase in mm tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
ashworth 2
more marked increase in mm tone through most of the ROM, but affected parts easily moved
ashworth 3
considerable increase i mm tone, passive movement difficult
ashworth 4
affected parts rigid in flexion or extension
hyperreflexia
too much upper motor neuron
hyporeflexia
not enough lower motor neuron
plantar reflex normal
curl toes and point foot
plantar reflex abnormal (babinski sign)
flexion of big toe and fanning of less toes
upper motor neuron
increase tone (spasticity), hyperreflexia, clonus, babinski sign, voluntary movements (elaine dancing)
lower motor neurons
decreased or absent tone. decreased or absent reflexes, voluntary movements-weak or absent
what are normal synergies?
patterns of movement that tend to go together i.e. PNF patterns
what is an abnormal synergy?
stereotypical movements that may be present and elicited in a patient with neurological insults
UE flexion synergy
scapular retraction, shoulder ABduction, elbow flexion, forearm supination and finger flexion
strongest is elbow flexion
UE extension synergy
scapular protraction, shoulder DDuction, IR, elbow extention and finger/wrist flexion, and pronation
strongest is shoulder ADduction and pronation
LE Flexion Synergy
hip flexion, shoulder Abduction, ER, knee flexion, ankle dorsiflexion and inversion
strongest is hip flexion
LE extension synergy
hip[ ext. ADduction IR knee ext. ankle plantar flexion toe plantar flexion and inversion
strongest ADD knee ext and ankle pf
CN 1
Olfactory
CN 2
Optic
CN 3
Oculomotor (motor)
CN 4
trochlear nerve
CN 5
trigeminal nerve
CN 6
Abducens (motor)
CN 7
facial nerve
CN 8
vestibulocochlear nerve
CN 9
glossopharyngeal nerve
CN 10
vagus nerve
CN 11
accessory nerve
CN 12
hypoglossal nerve
athetosis and where it comes from
writhing movements and basal ganglia
akinesia and where it comes from
inability to initiate movement (parkinsons) and basal ganglia
hypermetria
over estimation of distance or range of a movement
hypometria
under estimation of distance or range of a movementq
non equilibrium coordination testing
finger to nose, pronation/supination, pointing and past pointing, toe to examiners finger, heel on shin
equilibrium coordination testing
standing normal to narrowing bases
standing eyes open to eyes closed
tandem standing
walking; straight, sideways, backwards, grapevine
balance/postural stability
COG is maintained within the boundaries of the BOSf
what are the two ways sensory input is utilized?
1. reactive - catch yourself when you slip on the ice
2. anticipatory- see the ice and you choose to walk differently to keep from falling
COG
center of gravity
BOS
base of support
LOS
limits of stability
static balance
stationary balance
dynamic balance
balance with movement
somatosensory
weight bearing and body part positioning. ex. standing and walking
vision
judge what is upright
vestibular
head position relative to gravity and head movement
what do the somatosensory, vision, and vestibular influence?
shape motor response to help with balance and provide information to CNS
what does the CNS system do to process
processes this info and initiates conscious and unconscious adjustments
what is the limit of stability LOS?
maximum angle of vertical that can be tolerated without LOB loss of balance
what mm kicking with peturbation from the front
trunk flexors kick in
what mm kick in with peturbation from the back
back mm kick in
what mm kick in with peturbation from the side
ADductors and lateral flexors kick in
what leg parts kick in first with a push
ankles
what leg parts kick in second with a push
hips
what leg parts kick in third with a push
stepping to accommodate outside BOS shift