What is the MAS?
Emergence from a minimally conscious state is signaled by:
consistent command following, functional object use, reliable use of communication system
What is normal cerebral blood perfusion pressure?
>60mmHg
Describe the common pattern of motor recovery in stroke
Proximal to distal
What are rule of 3s for botox?
starts working in 3 days, peaks in 3 weeks, stops in 3 months
Test scores used to define the end of PTA
75+ on the GOAT
25+ on O-log
for 2 consecutive days
Most frequently affected CN in TBI
CN1 olfactory nerve
Infarct of what artery would cause alexia without agraphia?
PCA
Describe withdrawal symptoms of intrathecal baclofen and how it's treated
fever, AMS, itching, agitation, seizures, death, increased spasticity
treat with oral baclofen and benzos
Good recovery is unlikely when coma lasts ____, or PTA lasts ___
Damage to one region of the CNS can produce altered function in other areas of brain
diaschesis
Where is the most common place for intracerebral hemorrhage secondary to hypertension?
putamen
List the mechanism of action for these medications:
Tizanidine
Dantrolene
Diazepam
Cyproheptadine
Tizanidine: alpha-2 agonist
Dantrolene: blocks RYR receptor from releasing calcium from the sarcoplasmic reticulum
Diazepam: GABA-A chloride channel
Cyproheptadine: antihistaminic and antiserotonergic effects
Severe disability is unlikely when coma lasts ___, or PTA lasts ___
<2 weeks, <2 months
Functions taken over by brain areas not originally managing that function
vicariation
Patient is presenting with a nonfluent aphasia, cannot comprehend or repeat. What type of aphasia is this and what specific area of the brain is affected?
Broca's - inferior frontal gyrus of the dominant hemisphere
What side effects must you tell patients about regarding phenol for the treatment of spasticity?
Phenol irreversibly blocks nerve fibers, causes denaturation of proteins and almost immediate neural transmission blockade.
Side effects: worse pain and dysesthesias for several weeks if neurolysis is partial, worsened gait
What are the 3 categories in the Glasgow coma scale and which one is the best predictor of outcome, particularly 2 weeks post-injury?
Motor, Verbal, and Eyes
motor response is the best predictor
In the Ranchos Los Amigos Scale confused and agitated behavior is what rating?
What are the levels one above and below?
Level IV
Level III is localized response
Level V is confused and inappropriate
Describe Bobath and Brunnstrom approaches to rehabilitation
Bobath: Avoids the use of synergistic patterns to inhibit primitive patterns of movement and focuses on normalizing muscle tone.
Brunnstrom: Uses primitive synergistic patterns in training in an attempt to improve motor control through central facilitation.