Neurological Assessment Quiz
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Questions and Answers

Which of the following is a potential impact of co-morbidities on patient management?

  • Complicated treatment and management (correct)
  • Decreased need for specialized equipment
  • Improved functional abilities
  • Increased recovery speed

    • Name one risk factor that can be related to further neurological incidents.

    Atrial Fibrillation

    Previous surgeries have no bearing on a patient’s assessment and treatment plan.

    False

    Patients may require the use of __________ for their management, such as special seating or gait aids.

    <p>specialized equipment</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>TIA = Transient Ischemic Attack, a temporary period of symptoms similar to those of a stroke CVA = Cerebrovascular Accident, commonly known as a stroke Aphasia = Loss of ability to understand or express speech Orthotics = Devices used to support or correct musculoskeletal deformities</p> Signup and view all the answers

    Which of the following is NOT a type of mobility consideration for patients prior to a stroke?

    <p>Cognitive mobility</p> Signup and view all the answers

    Technology dependency is irrelevant for patient assessments.

    <p>False</p> Signup and view all the answers

    What type of aids might a patient use for personal care management after a stroke?

    <p>Assistance devices/equipment</p> Signup and view all the answers

    Which of the following muscles are often strong in upper extremity spasticity after a stroke?

    <p>Shoulder adductors and elbow flexors</p> Signup and view all the answers

    Spasticity in a patient with stroke causes loose and flaccid muscles.

    <p>False</p> Signup and view all the answers

    What is the Modified Ashworth Scale (MAS) used for?

    <p>To grade the severity of spasticity based on resistance to passive stretch.</p> Signup and view all the answers

    Spasticity in the lower extremity is often strong in the pelvic ________, hip adductors, and internal rotators.

    <p>retractors</p> Signup and view all the answers

    Match the types of reflexes with their descriptions:

    <p>Hyporeflexia = Flaccidity observed initially after a stroke Hyperreflexia = Increased response often due to spasticity Clonus = A series of rapid muscle contractions in response to stretch Babinski sign = Indicates upper motor neuron damage</p> Signup and view all the answers

    What posturing might be common in a patient with moderate to severe spasticity?

    <p>A tightly fisted hand with elbow flexed</p> Signup and view all the answers

    The asymmetrical tonic neck reflex (ATNR) causes elbow bending on the same side as head rotation.

    <p>False</p> Signup and view all the answers

    Name one potential consequence of spastic posturing.

    <p>Painful spasms, degenerative changes, or fixed contractures.</p> Signup and view all the answers

    What is a common gait abnormality seen during the stance phase after a stroke?

    <p>Lateral lurching</p> Signup and view all the answers

    Only 80% of stroke survivors are able to walk individually after a stroke.

    <p>True</p> Signup and view all the answers

    What behavior is associated with poorer rehabilitation outcomes in stroke patients?

    <p>Ipsilateral pushing behavior</p> Signup and view all the answers

    Ischemic damage can lead to skin breakdown and __________ ulcers.

    <p>pressure</p> Signup and view all the answers

    Match the walking handicap category with its description:

    <p>Physiological walker = Can walk independently but requires aids Household walker = Walks within the home but not outside Community walker = Can walk independently in the community Wheelchair-dependent = Cannot walk independently at all</p> Signup and view all the answers

    What is a typical characteristic of the swing phase in stroke gait?

    <p>Hip circumduction</p> Signup and view all the answers

    Patients who become wheelchair-dependent represent the majority of stroke survivors.

    <p>False</p> Signup and view all the answers

    What factors help differentiate between household and community ambulators?

    <p>Strength, proprioception, isolated knee control, and velocity</p> Signup and view all the answers

    What is a common result of intense pressure applied for a short time to the skin?

    <p>Pressure ulcers</p> Signup and view all the answers

    Friction occurs when the skin is pulled along a surface without any movement against it.

    <p>False</p> Signup and view all the answers

    Name one type of pressure-relieving device (PRD).

    <p>Foam pad</p> Signup and view all the answers

    The _______________ scale is commonly used to assess cognitive function in stroke patients.

    <p>Mini-Mental State Examination (MMSE)</p> Signup and view all the answers

    Match the following interventions with their purpose:

    <p>Breathing exercises = Prevent respiratory complications Incentive spirometer = Prevent circulatory complications Position changes = Prevent skin ulcers Ankle pumping exercises = Prevent edema and DVT</p> Signup and view all the answers

    Which of the following is NOT a mode of testing for aerobic capacity in stroke survivors?

    <p>Static stretching</p> Signup and view all the answers

    The Barthel Index is used to assess cognitive function in stroke patients.

    <p>False</p> Signup and view all the answers

    What is the primary purpose of positioning splints in stroke patients?

    <p>To minimize the effect of tonal abnormalities</p> Signup and view all the answers

    What is essential for maintaining an upright posture during kneeling?

    <p>Postural control</p> Signup and view all the answers

    Hip extension range of motion (ROM) is not necessary for a patient’s ability to maintain posture.

    <p>False</p> Signup and view all the answers

    What muscles contract to help maintain pelvic alignment in standing posture?

    <p>Gluteus maximus and hamstrings</p> Signup and view all the answers

    To ensure stability, a patient must maintain their Center of Mass (COM) over their __________ during active kneeling.

    <p>Base of Support (BOS)</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Kneeling = A position providing opportunities for posture and balance control Modified plantigrade = An early standing posture with four-limb weightbearing Weight shifting = Active side-to-side movement of the pelvis Postural tone = Muscle activity required to maintain standing posture</p> Signup and view all the answers

    Which of the following best describes the position of the patient in modified standing?

    <p>Shoulders flexed and hands flat on a treatment table</p> Signup and view all the answers

    The posterior muscles are primarily responsible for anti-gravity during standing.

    <p>True</p> Signup and view all the answers

    In kneeling, the patient engages in __________ shifts through rolling the ball.

    <p>anterior/posterior</p> Signup and view all the answers

    Study Notes

    Past Medical History

    • Consider the impact of past medical conditions on treatment and management, including previous neurological conditions and reliance on specialized equipment.
    • Note any past surgeries and specific risk factors that could impact future neurological events, such as atrial fibrillation, hypertension, and diabetes mellitus.
    • Recognize any contraindications for physiotherapy treatment based on medication history.

    Mobility

    • Assess the patient's mobility before the stroke and the factors that influenced it.
    • Consider mobility in general, indoors, outdoors, using steps and stairs and any history of falls.

    Personal Care

    • Determine the patient's level of independence in personal care before the stroke, including washing, dressing, and continence management.

    Other

    • Note any use of assistive devices for vision and hearing.
    • Assess communication abilities, including difficulties with expression or comprehension.
    • Evaluate cognitive function, including concentration, understanding, and following instructions.

    Spasticity

    • Spasticity is often strong in the shoulder, elbow, wrist, and finger flexors of the upper extremity and the hip, knee, and ankle extensors of the lower extremity, leading to tight muscles that restrict volitional movement.
    • Assess tone through passive motion testing and use the Modified Ashworth Scale (MAS) to grade the severity of spasticity.
    • Observe resting postures and voluntary movements for tonal influences.

    Reflexes

    • Stroke initially causes hyporeflexia with flaccidity.
    • As spasticity and synergies emerge, hyperreflexia is seen, with hyperactive deep tendon reflexes, clonus, clasp knife response, and a positive Babinski.

    Tonic Reflexes

    • Tonic reflexes may appear following a stroke, similar to those seen in TBI and CP.
    • Observe for the asymmetrical tonic neck reflex (ATNR), where head rotation causes elbow extension on the jaw side and elbow flexion on the opposite side.

    Voluntary Movements

    • Abnormal and stereotyped obligatory synergies emerge with spasticity following a stroke.
    • These synergies may lead to difficulties with weight bearing, walking, and using canes.
    • Ipsilateral pushing behavior can negatively impact rehabilitation outcomes.

    Gait and Locomotion

    • Gait abnormalities may include no heel contact, excessive heel inversion, loss of knee flexion, excessive knee hyperextension, hip circumduction, hip hiking, and unequal step lengths.
    • Classify walking handicap using functional categories (physiological walker, household walker, and community walker), considering factors like strength, proprioception, isolated knee control, and velocity.

    Integumentary Integrity

    • Pressure ulcers can develop due to ischemic damage and subsequent necrosis, especially over bony prominences.
    • Pressure, friction, shearing, and maceration contribute to skin breakdown.
    • Use pressure-relieving devices (PRDs) and monitor positioning to minimize pressure.

    Aerobic Capacity and Endurance

    • Supervised exercise testing with ECG monitoring may be indicated for stroke survivors with cardiovascular disease.
    • Consider leg cycle ergometry, semi-recumbent cycle ergometry, arm-leg ergometer, treadmill walking, or a seated stepper, depending on the patient's abilities.
    • Test protocols should be individualized and gradually progressive.

    Cognitive Function

    • Stroke patients may experience cognitive deficits, impacting their recovery.
    • Assess cognitive function using the Mini-Mental State Examination (MMSE), which can detect unilateral visual neglect and amnesia.

    Functional Status

    • Evaluate functional disability using performance-based measures, such as the Barthel Index and the Functional Independence Measure (FIM).

    Flaccid Stage

    • Focus on preventing respiratory, circulatory, and skin complications through breathing exercises, incentive spirometry, frequent position changes, passive ankle pumping, and air mattress use.
    • Minimize the impact of tonal abnormalities through positioning and splints; maintain hip extension ROM to avoid contractures.

    Standing

    • Postural stability in standing requires muscle activity for postural tone and contraction of antigravity muscles.
    • Modified standing, or modified plantigrade, is an early standing posture involving weight bearing on both hands and feet, with a wide BOS and a high COM.
    • Gradually adjust the BOS and upper limb weight bearing by varying the distance from the supporting surface.

    Kneeling and Half-Kneeling Exercises

    • These exercises focus on postural alignment and even weight distribution in a kneeling position.
    • Practice weight shifting in both medial/lateral and anterior/posterior directions.
    • Progress to walking from a kneeling position.

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    Description

    This quiz evaluates key aspects of a patient's neurological history and mobility, focusing on past medical conditions and how they affect treatment and rehabilitation. It also assesses personal care independence and communication abilities prior to a neurological event, like a stroke.

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