Evaluation
True or false: Most spinal cord injuries are non-traumatic
FALSE
90% of spinal cord injuries are traumatic
How long after recovery from Polio would a new bout of weakness, muscle fatigue, and/or pain be considered post-polio syndrome?
Typically 15 years after recovery from Polio
This degenerative neuromuscular disease involves boths upper and lower motor neurons, is often asymmetric and first presents in the distal extremities, and is characterized by little to no sensory symptoms…
Amyotrophic Lateral Sclerosis (ALS)
In this type of neuromuscular disease, most death occurs within 3-5 years, usually due to respiratory failure
ALS
Adaptive equipment like wheelchairs are necessary during which stage of neurological diseases like Parkinsons, MS, and ALS?
Late stage / Palliative / Compensation Rehabilitation
You are evaluating a patient who just suffered a TBI. Upon evaluation you notice they are very agitated and their behavior is non-purposeful. What Ranchos Los Amigos Level are they presenting as?
Level IV: confused/agitated
True or False: Myopathy can be inherited or acquired.
TRUE. Inherited form example: Muscular dystrophy. Acquired from example: inflammatory/infectious/toxic myopathies, myopathies associated with systemic diseases
You have your patient whistle, wink, smile, and wrinkle their forehead; you notice that they are only able to perform these tasks with one side of their face. You have ruled out stroke, but now are concerned they may have this neuromuscular disease…
Bell's Palsy
In Parkinson’s Disease, longer life expectancy can be expected with these two factors.
No cognitive involvement
L-dopa use
Individuals who experience a stroke most commonly experience a foot drop, what specific AFO would compensate for this impairment to improve mobility?
Posterior Leaf Spring
You are evaluating a patient who recently suffered a stroke. When assessing the right upper extremity you note the limb is flaccid. What stage of recovery is the patient in?
Stage 1
Demonstrate Festinating Gait. In what neurologic pathology is this typical to see?
Gait in which the trunk is flexed, legs are flexed at knees and hips, and stiff; steps are small, shuffled, and progressively more rapid. This is commonly seen in parkinson’s.
Name 3 potential causes of polyneuropathy
Any of the following: endocrine/metabolic (e.g. diabetes or thyroid), gastrointestinal (e.g. gastric bypass), nutritional (vit B deficits), autoimmune conditions (e.g. Guillian-Barre syndrome, RA), infectious conditions (HIV, Hep B/C), hereditary (Charcot Marie Tooth), neoplastic conditions (multiple myeloma), medication (chemo), exposure to toxins (e.g. alcohol abuse)
Post-polio syndrome typically occurs __ or more years after recovery from polio resulting in a new bout of weakness, muscle fatigue, and/or pain
15
Name FOUR different alternative drives on a power wheelchair that a patient with TBI, stroke, MS, or ALS can use if they do not have UE function
Sip and puff – straw to blow fwd, suck to go backward
Head array – sensors can use head to move in all directions
Mini joystick – chin stick or mouth to drive chair with head control
Foot control – no function in UE, but in the LE, ALS
Eye drive – looks at retina mvmt to direct them where to go
You are evaluating a patient who recently suffered a stroke and you note that they are demonstrating deficits in their gait pattern. Following a stroke, there are many reasons one could be demonstrating these deficits. Name 4 reasons.
Sensation issues
Perception issues
Hypertonic
Hypotonic
Motor control impairments
Name 3 expected signs or symptoms associated with cerebellar dysfunction
Impairments in coordination, dysmetria/hypometria/hypermetria, weakness and fatigue, intention tremor, ataxic gait, postural instability and falls.
Your patient has previously been diagnosed with Multiple Sclerosis (MS). They tell you that initially, they would go through “ebs and flows” of their symptoms; they would drastically get worse, but then return back close to their baseline. Now, they feel like they have been consistently getting worse without going back to their normal baseline. What type of MS do you hypothesize the patient has?
Secondary progressive MS
Name 3 favorable prognostic indicators for Multiple Sclerosis
Onset with only 1 symptom
Course of disease (relapsing/remitting: better outcome)
Onset before age of 40
Neurological status at 5 years (if motor and cerebellar signs at 5 years: worse outcome)
Name one spinal cord injury level that would benefit from the use of a head or mouth stick to assist with eating, holding utensils, and or dialing a phone.
C3, C4, C5
You are evaluating a patient who is demonstrating a lower extremity flexion synergy, what will you observe? (4 parts)
Hip flexion, abduction and external rotation
Knee flexion
Ankle dorsiflexion and inversion
Toe dorsiflexion
Myasthenia Gravis and Lambert-Eaton myasthenic syndrome are both neuromuscular junction disorders. Name one difference in their presentations.
MG signs and symptoms include ptosis and diplopia (ocular muscle involvement), difficulty swallowing, and proximal greater than distal muscle weakness. LEMS rarely presents with ocular symptoms, and may present with distal extremity sensory loss.
Name the 4 KEY impairments of Parkinson’s Disease
(1) resting tremor, (2) akinesia or bradykinesia, (3) rigidity, (4) postural instability
Name 4 Progressive Diseases
ALS
Parkinson’s
Multiple Sclerosis
Guillain-Barre Syndrome
Charcot Marie Tooth Disease
Diabetic Neuropathy
Alcoholic Polyneuropathy
Hansen’s Disease
Myasthenia Gravis
Your patient has recently suffered a TBI and you know that this patient is unable to perform independent pressure relief, cannot operate a power wheelchair, and is dependent for care. What specific wheelchair would they benefit from?
Tilt in space power wheelchair