Neuro Management Test 1 - Cognition and Behavior

Neuro Management Test 1 - Pedi, TBI, Cognition, Behavior, Perception, ECI

Cognitive and Perceptual Deficits (Question 1): A patient with cognitive and perceptual issues might exhibit difficulty switching tasks, reduced object identification, inability to sense light touch, or struggle with independent tasks.
Differentiating Apraxia (Question 2):
- To determine if a patient's apraxia is ideational or ideomotor, demonstrate the action first, allowing the patient to perform the activity automatically.
- Manual assistance is not a valid approach in this case.
Visual and Verbal Cues (Question 3): If a patient struggles to follow verbal instructions despite visual cues and demonstrations, this suggests difficulties with receptive aphasia, hemianopsia, or hearing loss—rather than a problem with hemi-neglect.
Cognitive Function Terms (Question 4): Common terms used to describe cognitive function include judgment, attention, and emotion. Lethargy is not among these terms.
Chronic Traumatic Encephalopathy (CTE) (Question 5): CTE is characterized by changes to brain tissue, which include Chiari formations, arteriovenous malformations, midline shift, and generalized atrophy.
CTE Mimicking Conditions (Question 6): The deficits of late-stage CTE are often incorrectly diagnosed as other conditions, such as Alzheimer's disease, multiple sclerosis, or post-traumatic stress disorder (PTSD). Supranuclear palsy is also a possibility.
Concussion Types (Question 7):
Concussions can result from penetrating injuries, acceleration/deceleration, blunt force trauma, and blast impacts.
Return to Sport (Question 8): The best recommendation for adolescents returning to sports after a concussion is gradual return based on symptom resolution rather than a fixed timeframe of rest days.
Concussion Severity (Question 9): Concussion severity is determined based on Glasgow Coma Scale (GCS) scores.

Motor and Cognitive Skills Assessment

Quadruped Position and STNR (Question 11):
- When a child with persistent STNR is in quadruped posture, the physical therapist assistant should keep the child's head and neck extended.
- Position the child's head to the nondominant side.
Pediatric Physical Therapy Assessment (Question 12):
- A child's standing and throwing a beanbag assessment involves motor planning, right-left distinction, eye-hand coordination, and equilibrium.
- Based on only the description, there is no mention of the specific skill being addressed.
Cerebral Palsy Assessment (Question 13): A child with spasticity and cerebral palsy likely has impaired areas of the brain including the cerebellum, basal ganglia, reticular formation, or the cortical-basal ganglia-thalamic loop.

Seizure Intervention and Neurological Conditions

Seizure Management (Question 15): Seizures in TBI patients require immediate intervention such as placing a soft object between the client's teeth to reduce the risk of biting the tongue. Protecting, but not restraining, the patient is also vital, ensuring they are safe.
APGAR Assessment (Question 16): The APGAR assessment includes muscle tone, skin color, and pulse. It does not include spontaneous eye opening.
Sensory Integration (Question 17): Impaired extrapyramidal tracts can cause athetoid cerebral palsy in a child.

Cognitive Tasks and Primitive Reflexes

Cognitive Function Assessment (Question 18):
- A primitive reflex is determined to be integrated when the reflex no longer elicits a response from the patient.
Hypertonicity (Question 19):
The prone position likely isn't the best to inhibit the hypertonicity in a 2-month infant with severe extensor hypertonicity.
Sidelying and supine positions are better for assessing these types of conditions.
Myelomeningocele (Question 20): A child with myelomeningocele and a lesion at L4-5 is most likely to reach community mobility with crutches and AFO's rather than household ambulation with crutches.
Spastic Diplegia (Question 21): Long sitting is the most appropriate position for a child with spastic diplegia.
Specific Activities (Question 22): A posterior rolling walker is the best piece of equipment for standing activities for a child with severe spastic quadriplegia.
Hypotonicity (Question 23):
- Children with hypotonicity are characterized by problems interacting with the environment
- Issues like weakness of the suck-swallow reflex, irritability, and lack of motivation are signs of this condition.
- Spasticity is often a complication of hypotonicity.

Neurological Conditions and Deficiencies

Bilirubin Encephalopathy (Question 24): Bilirubin encephalopathy can lead to spastic cerebral palsy, necrotizing enterocolitis (NEC), meconium staining of the skin or athetoid cerebral palsy.
Vestibular Hyperresponsiveness (Question 25): Children with vestibular hyperresponsiveness may exhibit limited responses to vigorous vestibular input but maintain a stable posture.
Motor Delay and Reflexes (Question 26): A child's ability to creep is interfered with if the tonic labyrinthine reflex is not properly integrated and/ or not operating normally.
Positioning and Motor Skills (Question 27): Failure to move against gravity in early childhood can result in decreased responses to vestibular and tactile input.
Spina Bifida (Question 28):
- Gait training with AFOs and crutches is a key aspect of physical therapy for a child with spina bifida at the T6-7 level.
Duchenne Muscular Dystrophy (Question 29): Physical therapy treatment goals for a child with Duchenne Muscular Dystrophy include progressive functional mobility, adaptive equipment needs, and respiratory function assessment.

Assessment and Interventions for Specific Conditions and Disabilities

Primitive Reflexes (Question 30):
A persistent tonic labyrinthine reflex could affect the skills of the motor and sensory integration of the child. Turning the head from side to side in sitting while prone are skills potentially effected by the presence of persistent reflexes.

Standardized Tests and Assessment Tools

Neurological Status Assessment (Question 31): Problems in a newborn include abnormal muscle tone, failure to turn the head from side to side in the prone position and physiological flexion. Using the APGAR score is useful.
Sensory Integration and Motor Skills (Question 32): Sensory integration techniques aren't necessarily needed for several diagnosis. Using different sensory inputs for balance is not a specific concern.
Duchenne Muscular Dystrophy (Question 33): Early signs of Duchenne Muscular Dystrophy which are common in five-year-olds include cranial nerve weakness, respiratory dysfunction, distal muscle weakness, and proximal muscle weakness. Respiratory problems should be a primary concern.
Tonic Labyrinthine Reflex (Question 34): A persistent tonic labyrinthine reflex (TLR) in a two-year-old could impact head and neck control.
Sensory Integration Techniques (Question 35): A child with a sensory deficiency and a desire to consume cleaning fluid needs to be addressed as having difficulties in sensory integration processes.
Neurological Conditions (Question 36): Cri-du-Chat syndrome is associated with a cry that is similar to a cat's meow, congenital heart disease, muscle weakness, and a loss of acquired skills. There are also 4 types of bone involvement with this condition.
Treatment of Neurological Disorders (Questions 37-40):
- The development of problem-solving skills in a patient with TBI requires a targeted approach.
- In cases of argumentative or aggressive behavior in patients with traumatic brain injury, the best intervention is to acknowledge and empathize with the patient.
- Support the patient's feelings, and find ways to vent frustration and anger constructively.
Intracranial Pressure (ICP) (Questions 41-44): -Elevated intracranial pressure (ICP) is sometimes treated with positioning and sedating medications.
- A normal intracranial pressure (ICP) is typically 5-15 mmHg.
- Decorticate rigidity is a neurological term describing a specific pattern of muscle rigidity in which a person's upper extremities are flexed and lower extremities extend
Neurological Assessment and Interventions (Question 45-48):
- A normal 3-month old infant displays certain behaviors and milestones.
- Treatment strategies for a child with ataxic cerebral palsy often involve strategies to improve midline alignment, increase excursion of movement, and incorporate sensory cues.
- Sensory integration techniques may NOT be necessary or used in cases of learning disabilities.
Infant Development and Assessments (Question 47-50):
- Specific conditions, like cerebral palsy, can lead to some developmental delays.
Impairments and Possible Conditions (Question 51-54):
- Down syndrome has some unique motor challenges, like trunk and proximal stability challenges.
- Children with traumatic brain injury can be assessed with a focus on cognitive function and/ or sensory integration.
- Children with significant developmental delays may need consistent sensory stimulation, using repetitive and gradual stimulation practices.

Neurological Conditions and Developmental Differences

Medical Conditions (Question 55-58):
- The presence of different medical conditions is not a risk factor for developmental delays in a child.
Positioning (Question 59-62):
- In cases of developmental delays in 10-month-old infants, the best way to approach the intervention and implementation is to use age-appropriate activities, providing a nurturing and safe environment.
- It's important to support the child's effort to achieve a proper posture.
Intracranial Pressure and Assessments (Question 63-66):
- Assessing, monitoring, and managing ICP involves considerations for both the environment and the patient's needs.
- Elevated ICP, is often associated with a significant medical concern in patients.
- Patients with TBI or other neurological conditions might need therapies involving positioning, sensory stimulation, and cognitive exercises.

Neurological Conditions and Interventions

Traumatic Brain Injury (TBI) Management(Questions 67-70):
- If a teen has a traumatic brain injury, treatments may involve PROM, serial casting and/ or PNF.
- When working with a patient that has TBI, you should initially observe and focus on a specific range of motion for improved and effective rehabilitation.
Medical Conditions (Questions 71-74):
- Various medical conditions present in patients which may signal specific deficiencies, including a minimally conscious state.
- When working with patients in an ICU, the therapist should have a comprehensive approach involving the patient's safety and the environment.
Neurological Assessment and Treatments (Question 75-78):
- Specific neurological tests, such treatment techniques, are used to evaluate various aspects of neurological status of patients.
- A patient with a brain injury can experience impairments in their sensory, motor, and cognitive function. Interventions may target sensory integration, motor skills and cognitive tasks.
Sensory Stimulation and Reflexes (Question 79-81):
- Sensory stimulation plays a critical role in patient rehabilitation and in providing comfort.
Intracranial Hemorrhage (ICH) (Question 82): Factors like handling, asphyxia, blood vessel fragility, and appropriate oxygenation are crucial for preventing ICH in infants.
Rancho Los Amigos Levels (Questions 83-86):
- Level 4 is related to increasing accomplishment of tasks by patients.
Mucopolysaccharidosis Type 1 (MPS-I) and Genetic Conditions (Question 87):
- Different genetic conditions lead to developmental differences.
Specific Skill Deficiencies and Interventions (Questions 88-91):
- Perceptual deficits in individuals may lead to an inability to understand and coordinate and/ or perform motor tasks.
- If an individual with TBI is experiencing difficulties performing daily tasks, interventions may involve structured learning or adaptive equipment.
Patient Considerations (Questions 92-95):
- With patients having hypersensitivity to vestibular input, use a structured approach.
- A patient with TBI needs a gradual increase in tasks and a combination of sensory and motor skills assessment and intervention.
Medical Conditions and Interventions (Question 96-100):
- Various medical conditions and conditions of the extremities can be associated with specific diagnoses or impairments.

Additional Notes

Abbreviations: APGAR (assessment of a newborn's status), GCS (Glasgow Coma Scale) and others are used.
Medical Conditions: Some conditions (e.g., cerebral palsy, TBI, Down syndrome, etc.) are frequently mentioned.
Treatment Approaches: Various approaches, including PROM (passive range of motion), sensory integration, and functional exercises, are described.
Developmental Milestones: The various test questions incorporate the concept of stages of development and how they may vary by specific condition.