Clinical path test 1 .docx

Clinical path test 1 **stroke and brain injury week 1** **\ what are temporary or permanent effects from a stroke?** - Motor - Perceptual - Cognitive - Sensory - Emotional **what is a thrombotic stroke?** - Blood clot (thrombus) blocks flow to the brain causing the area of t...

Clinical path test 1 **stroke and brain injury week 1** **\ what are temporary or permanent effects from a stroke?** - Motor - Perceptual - Cognitive - Sensory - Emotional **what is a thrombotic stroke?** - Blood clot (thrombus) blocks flow to the brain causing the area of the brain to be deprived of blood. **What is a embolic stroke?** - Fatty plaque or blood clot(embolism) breaks away and flows to the brain where blocks an artery depriving the brain of blood **what is a cerebral hemorrhage?** - Break in blood vessel in brain causing the brain to bleed **Contributing factors for stroke** - Age - Stress - past medical history - smoking **Factors for stroke** - Abdominal obesity - High blood pressure - Diabetes - Heart disease - Smoking **CVA vs TIA** **CVA (cerebrovascular accident)** - Non- temporary interruption of blood in the brain - Neurological deficits likely permanent **TIA (transient ischemic attack)** - Temporary interruption of blood to the brain - Neurological deficits no permanent **Post CVA presentation left hemispheric stroke** - Right sided paralysis - Slow and cautious behaviour - Expressive (know what you want to say but can't say it) and/or receptive( unable to understand speech or read) aphasia **Post CVA presentation right hemispheric stroke** - left side paralysis - quick and impulsive behavior **post stroke presentation** - vison - Dysphagia (difficulty swallowing) - Impaired memory - Loss of face control - Frequency, urgency, incontinence - Frustration, depression, and lability **Preventing CVA recurrence** - Possibly surgery - Control hypertension - Medication to prevent clots - Treat pre- disposing conditions - Physical and occupation therapy should begin immediately after CVA **Word/ signs for stroke** - **F**ace ( is it drooping) - **A**rms( can you raise both) - **S**peech( is it slurred or jumbled ) - **T**ime( to call 9-1-1 right away) **Contributing factors for a acquired brain injury** - Age 15-30 - Trauma to the head **Acquired brain injury** - Subcarinal bleeding - Increased pressure - Brain cell death - Signs and symptoms **Signs and symptoms of ABI** - Vomiting - Confusion - Drowsiness - Paralysis - Pupil dilation - Mood changes **Post stroke or brain injury** - Paralysis - Sensory disturbances - Aphasia - Problem with thinking and memory - Emotional disturbances **Effects on exercise response** - Aerobic capacities are 67% to 74% below predicted levels for height and age - Only 24%of individuals are able to achieve 85% of age predicted max heart rate - -tend to breath harder - Fatigue 2.5 times more quickly - Fatigue and lack of endurance may have significant functional consequences **Sulcus signs** - Gap or feeling of depression, indication of shoulder joint subluxation **Alzheimer's disease** - A progressive neurological disorder resulting in impaired mental function - Most common cause of dementia - Nerve cells degenerate, losing connections with other neurons causing intellectual impairment - Cause is unknown, no known cure or reversal of progression - Affects 1 in 11 over the age for 65 Dementia - Syndrome consisting of a number of symptoms that include loss of memory, judgement and reasoning, changes in behavior and mood **Alzheimer's ad Parkinson's disease week 2** **Characteristics for Alzheimer's** - Declines in cognition and memory - Balance impairments - A decline in spatial orientation - A decline in performance of routine tasks - Changes in communication skills and judgment - Changes in mood and behaviours - anxiety **symptom's of progression in phases** **phase one** - forgetfulness - anxiety associated w/ forgetting **phase two** - confusion and intellectual impairment - problems with short terms memory - problems concentration and orientation **phase three** - increased delusions, agitation loss of basic abilities and incontinences **sundowning** - the person can become confused, anxious, aggressive, agitated, or restless consistently later in the day can affect the person quality of life **sundowning characteristics** - becoming demanding or aggressive - experiencing delusions and hallucinations - pacing or wandering - doing impulsive things - attempting to leave home - having difficulty understanding others - having difficulty doing tasks that were done without difficulty earlier that day **what causes sundowning** - being tired at EOD - low lighting and more shadows(objects looking different when dark) - disruption in sleeping pattern - not as much or no activity in the afternoon compared to the morning **responding to sundowning** - behavior is being caused by discomfort - allow for rest and naps between activity's - avoid making appointments, bathing, or other potentially stressful activities in the late afternoon or evening - prevent over stimulation from the television or radio, which can lead to increased confusion - provide good lighting to lessen shadows when it begins to get dark - rocking chair can provide stimulation while having a calming effect. - Brisk walks or other forms of physical activity throughout the day may reduce restlessness or the need to wander later - Allow quiet times if needed - Restrict the amount of sugar or caffeine - Maintain a regular eating and sleep schedule - Familiar routines - Journal to pinpoint causes of sundowning symptoms **Effects of exercise** - Gains in physical fitness and mood - Maintenance if language - Slower than typical decline and mental status after a year of treatment - Significant improvement in cognitive function - Improved health and decreased level of depression **Parkinson's disease** - A progressive neurological disorder associated with the neurotransmitter dopamine - Degenerative changes in the basal ganglia of the brain lead to lower dopamine production and changes in motor coordination, cognition, and emotion. - Affects 1.5 million people - Cause is unknown - **Contributing factors to Parkinson's** - Age 40-70 - Head injury - Genetic predisposition - Occupational pesticide exposure **Signs for parkinson's** - Rigidity - Stooping and flexed posture - Shuffling gait - Mask- like face - Oily skin - Resting tremors - Changes in speech - Drooling and difficulty swalling - Fatigue and depression **Things to help the Parkinson's** - Meds to increase dopamine level - Deep brain stimulation **Symptoms** - Chronic and progressive - Stiffness - Slowing of movement - Poor balance/ postural change - Resting tremors **Abnormal gait pattern** - Forward lean at waist - Short, shuffling steps - More common to fall cause of disturbance in center of gravity **Symptoms of progression ( hoen and yahr scale )** **Stage one** - Symptoms on one side of the body only **Stage two** - Symptoms of both sides of the body, no impaired balance **Stage three** - Balance impairment, mild to moderate disease, physically independent **Stage four** - Severe disability, but still able to walk or stand unassisted **Stage five** - Wheelchair bound or bedridden unless assisted **Effects of exercise** - **Improvements in...** - Motor performance - Trunk rotation - Hand- eye coordination - Stability and balance during walking - Non-motor symptoms - Muscle volume and strength **Concussion week 2** **What is a concussion** - A type of traumatic brain injury cause by a bump, blow or jolt to the head or hit to the body that causes the head and brain to move rapidly back and forth **What causes a concussion** - Sports - Motor vehicular accidents - Violence/ gunshot wounds - Falls **Symptoms of a concussion** - Headache - Feeling preasure in the head - Temporary loss of consciousness - Confusion - Foggy - Amnesia around the event - Dizziness or seeing stars - Ringing in the ears - Nausea - Vomiting - Slurred speech - Delayed respone to questions - Appared dazzed - Fatigue - Weakness or shakiness - Double or blurred vision - Neck shoulder or back pain **Post traumatic amnesia** **Retrograde amnesia** - No memory of some of the time immediately before the injury **Anterograde amnesia** - No memory if being Injured or of the time immediately following the injury **Long term symptoms** - Concentration - Irritability and other personality changes - Sensitivity to light and noise - Sleep disturbances - Psychological adjustment problems - Disorders of taste and smell - Mental illness - Neck, shoulder and back pain - Vision and hearing impairment - Balance issues **Immediate response to aid recovery** **THEN:** recommended to take 7-14 days off before returning to work or sports **TRANSITIONED TO:** zero brain activity until symptoms decreased completely **NOW:** take a few days to a week to completely rest, then slowly introduce brain stimulation **Contributing factors for recovery time:** - age - concussion history - how the injury occurred - what part of the brain was injured - neck and back musculature - fitness level prior to injury bone density - whether or not the client followed concussion protocol - other medical condition **second impact syndrome** - the brain swells rapidly after a person suffers a second concussion before symptoms from and earlier one have subsides - it make occur minutes days, weeks after the initial concussion - condition if fatal **post-concussion syndrome** - various symptoms last for weeks and sometimes months after the injury that caused the concussion **concussion treatment** - no cure - ice or hear - medications (ibuprofen, acetaminophen) - rest - avoidance of alcohol and drug **precautions when returning to activity's** - brightness - noise level - crowd - balance/ lack of stability - mood and mental health - memory loss - mind/ boyd connection - muscle imbalance - **common neurological disorderds** - MS(multiple sclerosis0 - Parkinson's - Huntington's - ALS( amyotrophic lateral sclerosis) - CVA( cerebrovascular accident) - SCI( spinal cord injury) - ABI( acquired brain injury) **ALS** - Destruction of motor neurons leading to loss of control of body's function - Loss of Extremity movement, speaking swallowing, chewing, respiration **Statistics** - 3,000 Canadians are living with ALS - 80% of people with ALS die within 2-5 years of diagnosis **Factors contributing to ALS** - Age 40-70 - Male gender - Familial 5-10%( the remaining 90-95% is defined as sporadic meaning no clear genetic link) - Military service **Presentation of ALS** - Muscle weakness and cramps - Muscle flaccidity and atrophy( loss of muscle movement and tone) - Contracture - Dysarthria ( difficult to form words and pronounce words) - Dysphagia( difficulty swallowing) - Dyspnea( shortness of breath ) - Fatigue - Emotional lability ( exaggerated emotion) **Things not effected by ALS** - Mild to no loss of cognitive function - Five senses - Rarely affects eye muscles, heart, cladder, bowel or sexual muscles **Treatment of ALS** - Optimizing function, comfort and quality of life - Medications - Speech therapy - Enteral feeding - Mechanical ventilation **MS( multiple sclerosis )** - Progressive demyelination of scarrng of CNS resulting in - Loss of balance - Impaired speech - Extreme fatigue - Paralysis - Cause unknown **MS statistics** - Canada has the highest rate of MS in the world - Over 90,000 people living with MS 1-400 people - Most common disabling neurological disease **factors contributing to MS** - Age 20-40 - Female - Northern European background **Presentation of MS** - Blurred or double vison (often first symptom) - Muscle stiffness and weakness - Extreme fatigues - Loss of balance, dizziness, clumsiness - Dysphagia () difficulty swallowing) - Dysarthria (speaking) - Altered sensation (sexual arousal....) - Bladder and bowel issues - Paresthesia (tingling, numbness, burning **Long term- presentation** - Euphoria - Depression - Impaired judgement - Inappropriate affect - Mental deterioration **Types of MS** **Relapsing remitting MS** - 85% of people with MS - Cycle of attacks and remission - Attacks (unpredictable, clearly defined episodes, new symptoms appear or old get worst) - Remission last years or months, complete or nearly complete recovery **Primary progressive MS** - 10% of people with MS - Only form to effect men and woman equally - Slow accumulations f disability - May stabilize for period of time - No period of remission **Secondary progressive MS** - 50% of people with MS will develop SPMS within 10 years of diagnoses - Over time distinct attacks & remissions become less apparent - Disease and resulting disability begin to worsen steadily **Progressive relapsing MS** - 5% of people with MS - Steadily worsening disease from beginning - Also experience clear attacks of symptoms with or without recovery - Do not experience remissions or recovery **Diagnosing MS** - No MS specific test - Past medical history - Neurological exam - MRI to image lesions - Other potential causes of symptoms needed to be ruled out **Treating MS** - **Meds to treat underlying condition** - \- immunomodulatory therapies - -prevent inflammation which causes attacks - **Meds to decrease severity and duration of attacks** - **-** steroids - Suppress inflammation of CNS - \- **Meds to treat symptoms** - Ataxia - Parathesia - Muscle spasticity - Neurogenic blatter **Important consideration** - Absent sudomotor response (increased or decreased sweating patterns) **Huntington's disease** - Inherited brain disorder - Causes call death in specific areas of the brain - Caudate (learning and memory) - Putamen (motor skills) - Cerebral cortex - Resulting in uncontrolled movement, emotional disturbances and cognitive - losses **HD statistics** - **about 1- 7,000 Canadian has HD** - **HD gene is dominant** - **Each child born to a parent with HD has a 50% chance of having it** **Early presentation of HD** - **Usually appear at 30-45 years of age** - **Twitching** - **Fidgeting** - **Clumsiness** **later presentation** - **Dysphagia(difficulty swallowing)** - **Slurred speech** - **Depression irritability and apathy** - **Constant movement of arms and legs, making walking difficult, then impossible** - **Intellectual speed, attention, and short-term memory** **Diagnosing HD** - **Blood test to determine presences of the gene** **Treatment** - **No treatment to prevent disease** - **Not treatment to control symptoms**