neuro summary 5-10 exam.pdf

intervention rationale & implementation strength training: gravity-eliminated positions, using a powder board (w or w/o roller) and focusing on concentric activation. progress to multi-planar and multi-joint mvmnts and begin increasing gravity, then resistance. overtime, training should target fast...

intervention rationale & implementation strength training: gravity-eliminated positions, using a powder board (w or w/o roller) and focusing on concentric activation. progress to multi-planar and multi-joint mvmnts and begin increasing gravity, then resistance. overtime, training should target fast twitch muscle fibers and eccentric muscle contractions. note: assess for fatigue, muscle belly tenderness, and overwork weakness functional tasks : rolling, supine to sit and sit scooting transfers aerobic training: moderate exercise intensity level to improve overall cardiopulmonary status and endurance. interprofessional remember interprofessional roles in GBS in tertiary rehabilitation: OT for improving independence w activities of daily living, and ability to return to work when discharged SP to address dysphasia physician and nursing staff for symptom and pain management psychology if poor mood results from having had condition. dietary and nutrition may also need to be consulted due to excessive weight loss during the acute phase social work may need to be involved to address financial loss due to his care and recovery time conclusion will need outpt PT pt ed as he ages and recovers looking for flags that may warrant further screening/attention 6.2 ALS case Obj: Have a plan of care, Including: assessments, outcome measures, interventions, and management of an individual with ALS Luis Male. Difficulty walking, 3 years ago off balance Believes to be caused by back pain. 2 months ago diag with ALS Problems lifting leg to bed, Meds: Riluzole and Edaravone VItals: Normal Communication: Dysarthria CASE Respiratory Screen: 89% predicted value MMT: LE weaker than UE Fasciculations in both LEs. Imaging: shows hypersensitivity in Cortical Spinal Tracts for the Primary Motor Cortex through projection fibers and down into the spinal cord Video: Patient ambulatory function. Leans to non-paretic side to ease weight off paretic leg to walk. Losing size and strength in right thigh. REHAB MANAGEMENT outcome measures 6 minute walk test 5x sit to stand Gait velocity Strenght testing Respiratory testing Screen for cognitive and behavioral changes Movement Diagnosis. Decreased forced production POTENTIAL Increased UMN involvement, movement pattern coordination def or Fractionated movement deficits may occur Prognosis mortality 5-10 years from diagnosis. Forced vital capacity is above 75% younger side with LE involvement and no bulbar symptoms. Prognosis not good…… Goals Short term endurance and gait speed Home exercise program for balance training to decrease fall risk EDUCATION is important for him AND his family. Intervention rationale and Implementation Education is important Understand role of medication Understand prognosis Need Durable home equipment Accessible home environment Neuroprotective PT UE training- because of their minimal involvement delay diseases progression Respiratory training contractions of up to 20% max voluntary contraction can help maintain strength LE Training Functional Targeted strengthening and a lower intensity Aerobic training Mod intensity 65% Daily 15-20 minutes Monitor peripheral muscle fatigue along with central fatigue Interprofessional MD, Nursing, Respiratory staff, Home health, Kinesiology for supervised exercise, Social worker, Dietician, Speech language pathologist