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Stroke,TBI,, Stages of motor recovery Stage 1 - Flaccidity Stage 2 -…

- - - - Locked in syndrome (Damage to pons):
        Pt aware, complete paralysis, eyes spared. Sudden onset
    - - Pusher Syndrome
        Postural control disorder pushing weight towards affected/hemiparetic side
        Posterior thalamus affected
        
        Tilting towards paretic side
        
        AB & E of unaffected limbs
        
        Resistance to correction
        
        Avoid TF to paretic side (may push themselves over)
        
        Avoid gait aids
        
        Beware on environment where they can push against things
        
        Train active mvt shift towards strong side with tactile, verbal or visual cues & encourage pt to problem solve
        e.g. "lean into wall" or " tapping on strong quad to push DOWM"
    - - Aphasia
        Receptive/Wernicke's/Fluent: difficulty comprehending, speech flows smoothly
        Expressive/Broca's: Difficulty with speed production. Slow & hesitant.
        Global = Both, extensive brain damage
      - Homonymous Hemianopia (CN2)
        
        Perceptual deficits
        
        Unilateral neglect (Visual, auditory & somatosensory)
        
        Anosognosia (lack of insight)
        
        Apraxia
        
        Spatial disorganisation/depth perception
        
        Right-left discrimination
        
        Agnosia (Tactile, visual, auditory)
    - - Apraxia: Difficulty planning mvts (often L sided)
        Ideational: inability to produce mvt on command
        Ideomotor: Able to perform habitual mvt automatically but not on command
  - - - Intracerebral
        Subaracnoid
- - - - NLI 1-4
        
        Ventilator (IPPV)
        
        Power WC
      - NLI 5
        
        Breathing indep (abdominal binder)
        
        Manual & power WC
        
        Drive
        
        No transfers
      - NLI 6
        
        Slide TF (indep to minimum assist)
        
        Tenodesis grip some ADLs
        
        Indep manual cough
        
        Manual & power WC
        
        Indep pressure relief maneuvers
        
        Capable of living indep
      - NLI 7
        
        Indep slide board TF
        
        Most ADLs, bed mobility
        
        Manual WC (trouble outdoors)
      - NLI 8
        
        Full hand use, indep ADLs
        
        Manual WC
      - NLI T1-12
        
        Orthoses (HKAFO, KAFO) with crutches
        
        Manual WC for community
      - NLI L1-3
        
        HKAFO, KAFO, AFO with crutches
        
        Manual WC for community
      - NLI L4-S1
        
        AFO + crutches
        
        L4 may use WC for long distances
      - Position changes: Every 2hrs in bed. Every 15mins in WC for at least 2 mins
      - Early Strength, ROM & mobility
        
        Pelvic neutral when performing LL exercises
        
        SLR less than 60 degrees
        
        Hip F less than 90
        
        Tetraplegia: Mvt head/neck & sh mvt above 90 contraindicated until cleared
        
        May experience postural hypotension early (recline trunk, elevate legs)
        
        Gradual exposure to upright position
        
        Abdominal binders & stockings may help decease venous pooling
        
        Tight lower trunk muscles = trunk stability & sitting posture
        Tight long finger flexors = tenodesis grip (intrinsic plus splint "hamburger")
        SLR of 100degrees helps with long sitting & dressing
- - - - S&S of :arrow_up: ICP
        
        Headache
        
        Decreased consciousness
        
        Nausea
        
        Widened pulse pressure
        
        Irregular (cheyne-stokes) breathing
        
        Non-reactive pupils
        
        Papilledema (optic nerve swelling)
        
        Progressive motor impairment
        
        Seizure
        
        Rx: elevate HOB 30degrees
    - - Glasgow coma scale (3-15)
        Measures level of consciousness & severity of injury
        Moderate: 9-12
        Loss of consciousness: 30-24hrs
        Altered consciousness: 24hrs
        Post-traumatic amnesia: 1-7days
        3 stimulus: Eyes, motor, verbal. Lower score = worse
      - Rancho Los Amigos levels of cognition
        
        Unresponsive
        
        Non-purposeful response
        
        Inconsistently purposeful
        
        Bizarre
        
        Simple commands
        
        Goal directed (with help)
        
        Hospital environ
        
        Normal
      - Galveston orientation & amnesia test: Name, date, city etc