How would you assess decreased ROM of left upper limb?
- Start on right unaffected limb
- Assess cognition, proprioception, sensation.
- Ask them to perform active
Shoulder: extension, flexion, abduction, adduction, external + internal rotation.
Elbow: extension and flexion.
Wrist: extension, flexion, ulna + radial deviation, pronation + supination - The findings should be normal ROM
- Compare to affected left upper limb, but do active assisted as 3/5 weakness. However, do not go past 90 degree flexion due to possible sublaxation.
How would you treat decreased ROM in left upper limb?
- get patient to clasp hands together and perform shoulder extension (active assisted).
- do the same as above but elbow and wrist ROM.
- encourage patient to reach for item at bed side etc
- using small tennis ball, get him to place onto bed and pick up
How do you assess decreased left upper limb strength (grade 3/5)?
- Test both limbs, proprioception, sensation etc
- Do ROM test for shoulder, elbow and wrist BUT against gravity
- state why it is not 4/5
How do you treat decreased left upper limb strength (grade 3/5)?
- similar to rom exercises, perform against gravity
How would you assess decreased chest expansion?
- observe respiratory rate (12-16)
- tactile fremitus (feel for symmetry)
- also listen for wheezing etc
- Rate of perceived exertion scale
- Palpate accessory muscles
How would you treat decreased chest expansion?
- Teach ACBT (thoracic breathing, diaphragmatic breathing, FET)
- incentive spiromter
- flutter device
What evidence supports treatment of decreased left upper limb ROM?
KIM et all 2013
- 24 patients
- one group normal weight exercises, one group WBE
- 30 mins 3x week 6 weeks
- weight-bearing exercise can be effective in improving the ability to perform upper extremity movements and grasping power and thus can be used in stroke rehabilitation.
- weight bearing exercises shown to help increase upper limb movement and grasping strength (particuaraly extension).
What evidence supports treatment of decreased strength left upper limb ROM?
Kim et all 2022
- Explain aims, experiment, findings and conclusions
- weight bearing exercises shown to help increase upper limb movement and grasping strength (particuaraly extension)
-with increased range of motion, from repetitive practise they can increase strngth as it is using 3/5 muscle strength.
- can progress to using small weights or body weight exercises.
What evidence supports treatment of decreased chest expansion?
- Sum et al 2019
-Explain aims, experiment, findings and conclusions - Using incentive spirometer ahs shown to increase the risk of developing pulmonary complications which he may face
- how many times? a day?
explain the layers of the skull + spine
- 3 layers of membrane called meninges
- dura matter = outer layer
- arachnoid matter = middle layer
- pia matter = inner layer closest to brain tissue
explain the lobes of the human brain
- frontal = voluntary movement, language and functional skills
- Parietal lobe = sensory perception and integration
- Occipital = visual processing and mapping
- Temporal = Manages emotions, pain and auditory processing.
what is grey matter in the brain?
- holds all nerve synapses
- abundant in cerebrum and cerebellum
- interprets sensory info. If grey horn damaged, can cause paralysis.
what is white matter in the brain?
- holds axons coated in myelin
- conducts, processes and sends nerve signlas up and down spinal cord
- if damaged can affect ability to move and react appropriately to external stimuli.
isDescribe a subdural haemotoma
- Hematoma = bruise caused when blood vessels under skin are damaged
Subdural Hematoma =
the blood seeps between the dura and the arachnoid layers, collecting in the brains tough out lining.
define confusion
Symptoms of mild TBI · Inability to remember the cause of the injury or events that occurred immediately before or up to 24 hours after it happened.
Explain contusion
Contusions (bruising of the brain) can be a coup or contrecoup type.
- Contrecoup injuries classically occur when the moving head (brain) strikes a stationary object
- coup injury is associated with a moving object impacting a stationary head.
what is retrogade amnesia
loss of memories that were formed shortly before the injury.
what is anteretrograde amnesia
loss of memory from the moment of TBI is called post-traumatic amnesia
what is the circle of willis
A ring of blood vessels connecting the anterior and posterior circulations of the brain and providing important communication between them.
Name the arteries of the brain
- right + left carotid artery
- Anterior + posterior cerebral artery
- Middle cerebral artery
- Anterior communicating artery
Explain the structure of axons
- nucleus
- dendrites
- axon terminal
- myelin sheath
- node of ranvier
- synapse
Explain how action potentials are generated
- Sodium and Potassium gates open causing the resting potential to be maintained.
- Sodium ions move in causing depolarization
- Potassium gates open, sodium moves out
- Potassium moves in called repolarization
- Action potential generated
what are spinal tracts
The Spinal Tracts are pathways by which motor signals are sent from the brain to lower motor neurons
what are the ascending tracts
(afferent) neural pathways by which sensory info from peripheral nerves is transmitted to the cerebral cortex
