TOPIC 4

108問 • 1年前

問題一覧

Among the chief causes of poor rehabilitation progress for pts who havr sustained brain damage, even among those whose motor skills have returned

cognitive deficit, perceptual deficit

Brain may be damaged through several mechanisms

infection, anoxia, tumor, trauma, toxin, vascular disease

Inflammation of brain

encephalitis

Deprived of oxygen

anoxia

Act or process of knowing

cognition

Knowledge of situation and facts

awareness

Thinking in a logical and sensible way

reasoning

Making sensible conclusions

judgement

Ability to understand something immediately

intuition

Strong in remembering information

memory

Cognitive functions

plan, manipulate info, initiate and terminate activities, recognize error, solve prob, think abstractly

Integration of sensory impressions into formation that is psychologically meaningful

perception

Ability to select those stimuli that require attention and action, to integrate thos stimuli with each other and with prior info, and finally to interpet them

perception

The resulting awareness of objects and experiences within the environment enables the individual to make sense out of a complex and constantly changing internal and external sensory environment

perception

Appreciation of stimuli through organs of special sense, peripheral cutaneous, sensory system, or internal receptors

sensation

The term perception and sensation are often confused with each other

true

Cognitive deficits do not lie in the sensory ability itself but rather with the individual’s ability to interpret sensation accurately and therefore respond appropriately

false

Five approaches of therapy

retraining, sensory integrative, neurofunctional, functional, cognitive rehab and quadrophonic

Focuses on remediation of underlying skills the patient has lost

retraining

Transfer of training approach

retraining

Based on the assumption that a disruption in one brain region can have a negative impact on brain functioning as a whole

retraining

Premise that practice in one task with particular cognitive or perceptual requirements will enhance performance in other tasks with similar particular demands

retraining

Explain the relationship bet functioning and the behavior of children with sensorimotor or learning prob

sensory integrative

Describes normal sensory intergrative development and functioning, defines patterns of sensory intergrative dysfunction, and suggests treatment techniques

sensory integrative

Assumed that the production of an adaptive response facilitates sensory integration, which in turn enhances the ability to produce higher level adaptive behaviors

sensory integrative

Rood’s sensorimotor technique is used

sensory integrative

Some of the treatment modalities employed include rubbing or icing to provide sensory input, resistance and weight bearing to impart proprioceptive input, and the yse of spinning or rocking to provide vestibular input

sensory integrative

Different types of sensory stimuli which can facilitate or inhibit an action

rood’s sensorimotor technique

Assumes that patient with acquired brain injury must practice every activity in its true context in order to recover function

neurofunctional

Focuses on retraining real world skills rather than on retraining specific cognitive and perceptual processes

neurofunctional

Rehabilitative or compensatory

functional

Most commonly used in PT clinics

functional

Most widely used approach in treating perceptual deficits which offers a great deal of practical support for the physical therapist

functional

Direct repetitive practice of specific functional skills that are impaired is an efficient means of enhancing the patient’s independence in those specific tasks

functional

Favor addressing the functional problem over and above the treatment of its underlying cause when working with an adult posttroke population

functional

Therapy is viewed as learning that takes into consideration the unique strengths and limitations of the individual patient

functional

Complementary components of functional approach

compensation, adaptation

Changes that need to be made in the patient’s approach to tasks

compensation

Alterations that need to be made in the human or social and physical environment in order to facilitate relearning of skills

adaptation

Functional approach: to compensate for the disability, the patient first has to be made aware of deficiencies and must then be taught how to circumvent them using intact sensations and perceptual skills

true

General suggestions when teaching compensatory techniques:

simple directions, establish and carry out routine, do activity consistently, repetition

Focuses on training individuals with brain injury to structure and organize information

cognitive rehab

Addresses memory, high language disorders and perceptual dysfunction under one umbrella

cognitive rehab

Cognitive rehab addresses memory, high language disorders and perceptual dysfunction under one umbrella:

info processing, problem solving, awareness, judgement, decision making

Research has demonstrated that even in a non brain injured population, skills learned in one task do not automatically transfer to other tasks

true

Can be used to facilitate the carryover of skills learned in therapy to functional activities

cognitive strategies

Learning can be conceptualized as a dynamic interplay between:

patient characteristics, task characteristics, environment

Cognitive rehab proposes a number of strategies relevant to PT practice

analyze task to determine if transfer of learning took place, interventions to increase patient awareness of abilities, increase difficulty level of task and promote self examination of perfomance, relate new info or skills to previously learned ones, use multiple environments to enhance transfer of training

Interactive rehab that provides a holistic perspective for the management of stroke, TBI, brain tumors, cerebral palsy and other neurological conditions

quadrophonic

Based on the idea that therapist can apply both micro and macro perspectives for evaluation and treatment, which is an assumption shared by many OT who work in this field

quadrophonic

Holistic or humanistic and provides guidelines for the management of functional performance and real life occupations

macro perspective

Characteristics of client in macro perspective

life status, life stage status, health status, disadvantage status

Functional or top down in focus

macro perspective

take note

macro

take note

micro

More remedial in focus and provides guidelines for the management of performance components or subskills

micro perspective

Micro perspective evaluation and treatment is based in these theories:

info processing, teaching and learning, neurodevelopmental, biomechanical

Micro persopective: Changes in clients are further influenced by these factors

therapist, environment, what client brings to therapy

One of the most common forms of sensory loss affecting pt with hemiplegia

visual impairment

Commonly encountered visual impairment by pt with hemiplegia

poor eyesight, diplopia, homonymous hemianopia, visual cortex or retina damage

Loss of peripheral vision

homonymous hemianopia

Double vision often present following brain damage

diplopia

Patient sees two of the entire environment

diplopia

Usually the result of defective function of extraocular muscles in which noth eyes are open but not in conjunction with the other

diplopia

Horizontal

CN6

Vertical

CN4

Treatment for diplopia

exercise eye muscles, patch on alternate eyes, prisms

Most common visual deficit affecting patients with hemiplegia

hemianopsia

Lesion interrupts inflow to the optic pathways on one side of the brain

homonymous hemianopia

Loss of outer half of visual field from one eye and inner half of visual field of the other eye

hemianopsia

Loss of incoming info from half of visual environment contralateral to the side of lesion

hemianopsia

Testing procedures of hemianopsia

confrontation, compensation

Confrontation method

face to face with therapist, pt is instructed to maintain gaze on therapist’s nose, therapist slowly brings target into pt’s field of view simultaneously or alternately from left to right, pt is instructed to indicate when and where they see the targets

take note

compensation

Common in patients who have had a stroke

oculomotor impairment

Eye movements, which are controlled by the ________ muscles are used to detect, identify, and derive meaning from objects and environment

extraocular

They allow person to become oriented to and explore the critical visual aspects of the environment

oculomotor

Two types of eye movements are important to examine

visual fixation, ocular pursuits

Allows patient to maintain focus on an object as it is brought nearer or farther away

visual fixation

Enable the eyes to follow a moving object and visuallt scan the environment

ocular pursuits

Often the eyes will follow a moving object visually, although the patient seems aware of the presence of that object and can locate it if asked

false

Visual scanning test

sit opp to patient, hold up pencil with colorful topper, slowly move pencil horizontally, vertically, diagonally. repeat each direction two to three times, note smoothness of eye movements, presence of midline jerk jump and whether eyes move together

Pencil topper in visual scanning test

18 inches, 45.7 cm

One that has a uniform procedure to administer and score, provides operational definition for all germs, is norm-referenced, and has information available concerning its reliability and validity

standardized tests

Results can be communicated to other therapists who will share an understanding of patient’s capacities or abilities

standardized tests

Can be administered at both admission and discharge to provide therapist with reliable and valid measure of the outcome of therapy

standardized test

Read standardized tests page 35-37 on ppt

The patient’s own feedback is always accurate because they owe the perceptual and cognitive dysfunctions

false

Information regarding whether or not the patient attained the correct outcome

knowledge of results

Information regarding the manner in which the task was accomplished

knowledge of performance

Form in which feedback is delivered

verbal, visual, tactile

When involving the patient in educ sessions, the patient must be addressed as a competent adult and not patronized

true

Physical therapists must be regarded as the principal participants in the rehab process

false

In situation in which the perceptual deficit does not interfere with assimilation of info, patients should have the minor role in decision making process regarding the goals of therapy

false

Three point approach

educate patients and caregivers, begin using remedial, patient improves = switch to compensation

Pressure to discharge patients quickly, possibly before the full extent of cognitive and perceptual deficits has been revealed, means that the patients may be discharged to potentially hazardous situations at home

true

Therapists need to do an initial screening of all patients with brain damage to determine potential problems as early as possible and ensure that patients are diacharged to a safe environment

true

Changing the environment or strategy for task completion so that the patient can be safe and independent as quickly as possible

true

Focus on patient’s deficits and attempt to improve functional ability by retraining specific perceptual components of behavior

remedial

100

Bottom up approach

remedial

ROM

Kyla Rafols · 71問 · 2年前

ROM