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CVA, TBI, Vestibular, Concussion, Outcome Measures, Neglect, Balance…
CVA
Pusher
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62 % patients resolve in 6 weeks, 21 % longer than 3 months
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TBI
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JFK Coma Recovery Scale
6 subscales, auditory, visual, motor, oromotor, communication, arousal
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Auditory Startle is 1, localization is 2
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Rancho 2: Generalized Response, total assistance
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5 Confused, inapprop, non agit
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Vestibular
Treatment options
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Substitution
working on visual, and somatosensory, and vestibulospinal
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Oculomotor Exercises
smooth pursuit, saccades, convergence, visual fixation with gait
start 15-30 seconds, 2-3 x per day, increase by 15-30 seconds to max of 2 minutes if asymptomatic.
Vestibulo-Ocular Reflex
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1:1 ratio, high speed, only reflex at high speed. images would blur without VOR (Oscillopsia)
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20 min to 24 hours
Menieres, TIA, Perilymph fistula
Dysequilibrium
Cervicogenic Dizziness, Neuropathies, multisensory
24 hours: Vestibular Neuritis, CNS disease
Concussion
Most common Symptoms?
headache, balance/dizziness problems, double/blurred vision
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Autonomic Issues (HR ^), uncoupling
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Evaluation
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ImPACT (Klima Lacrosse)
can't do after exertion within 3 hours, huge limiting factor
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Examination
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VOMS
pursuits, saccades, convergence, VOR, VOR cancellation
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Cervicogenic Dizziness
Neck Torsion Test, Orthopedic Screen
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Metabolic Issue!
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Influx of Ca2+ poisons mito in brain, glutamate (toxic at high levels)
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Management
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Use Relative Rest, reduce Energy demands
24-48 Hours, limit school, tv, no physical exertion
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Outcome Measures
Berg
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MDC's: 8 older, 6.9 stroke, 5 parkinsons,
Tug
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MDC: park 2.9, comm dwelling 3, same as DGI
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5 times sit to stand
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cutoff: commun dwl, 15, park 16
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Neglect
Affects spatial perception, spatial representation, and motor action planning
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Assessments
KF-NAP
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0 No Neglect, 3 SEVERE (think 0 has a NO in it)
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Balance Management
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Strategies
Ankle: Slow, near COG, broad support base
Hip: Fast, COG near perimeter, narrow support base
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