Neuro Rehabilitation Notes from 8/29-9/19
Neuro Rehabilitation Notes from 8/29-9/19 OT582
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This 14 page Bundle was uploaded by Jenny Burgos on Wednesday October 5, 2016. The Bundle belongs to OT582 at Husson University taught by Dr. Dorfman in Fall 2016. Since its upload, it has received 3 views. For similar materials see Neurorehabilitation: Research & Evidence Based Practice in Occupational Therapy at Husson University.
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Date Created: 10/05/16
NeuroRehabilitation Sensory deficits, fatigue, QOL after a neuro disorder 8/29/16 What causes decreased sensation? •touch •taste •smell •hearing •vestibular •vision What is the impact of sensory loss on daily functioning? Safety issues. Coordination impaired, fine motor coordination/dexterity. Sensory Dysfunction terminology: •Anesthesia: complete loss of sensation •Paresthesia: abnormal sensation - tingling or crawling •Hypo-esthesia: decreased sensation •Hyperesthesia (hypersensitivity): increased tactile sensitivity •Analgesia (like the topical pain reliever): complete loss of pain sensation •Hypo-algesia: diminished pain sensation Different types of sensation •Fine touch and proprioception •Pain, temperature, crude touch •Proprioception / kinesthesia •Smell / Olfactory sense •Hearing / Auditory •Taste / Gustatory •Vestibular sense •Vision Sympathetic issues: often occur in conjunction with sensory impairment •Change in vasomotor function (skin temp, skin color) •Sudomotor function (sweating – to much, to little) •Pilomotor changes (no goose bumps) •Trophic changes (atrophy of nails and/or finger pulps, change in hair) •Slowed healing Intervention for sensory impairment Treatment of sensory dysfunction: •Need to know the cause of the sensory dysfunction and the prognosis for return of sensation •Determine whether treatment will be compensatory or remedial Central nervous system dysfunction (stroke, brain injury, etc): •Compensatory treatment: üSafety from bumping, burning or becoming snagged üVisual monitoring of affected limb. •Remedial treatment: Sensory bombardment (can you tell difference between feeling of being rubbed by towel vs pillow case?) Touch or stroke affected part. Weight bearing on affected part. Integrate sensory retraining with motor retraining. Graded treatment: Pt. able to see and feel object, then eyes occluded asked to identify object, then pick object from others with eyes closed. In addition, a person post traumatic brain injury or stroke may experience hypersensitivity or abnormal sensation with: •Light •Sound •Touch •Taste •Smell •vestibular How do we assess sensory deficits post neurological event? Arm Care – Dealing with sensation loss (You Tube Video – 4.13 minutes) https://www.youtube.com/watch?v=HdRxrgPKqpU Difficulties with distractions and noise after TBI (You Tube Video – 2.13 minutes) https://www.youtube.com/watch?v=RKK-vogCygI Fatigue: MS fatigue is not different than fatigue from stroke except that the person has MS. Symptoms of MS Fatigue: •Generally occurs on a daily basis •May occur early in the morning, even after a restful night’s sleep •Tends to worsen as the day progresses •Tends to be aggravated by heat and humidity •Comes on easily and suddenly •Is generally more severe than normal fatigue •Is more likely to interfere with daily responsibilities http://www.nationalmssociety.org/Symptoms-Diagnosis/MS- Symptoms/Fatigue Other causes of fatigue •Depression •Having to expend more effort to complete daily tasks •Lack of or decreased sleep due to pain or discomfort http://www.nationalmssociety.org/Symptoms-Diagnosis/MS- Symptoms/Fatigue Explaining MS Fatigue (You Tube Video – 1.35 minutes) – https://www.youtube.com/watch?v=O3iXoh3fh7w Quality of Life (QOL) •Does not mean “good” health •Includes ability to •Have meaningful relationships with friends, family, spouse •Participate in meaningful work •Participate in meaningful leisure tasks Low Vision post Neurological Condition: Assessment 9/12/16 Always consider: Although you may be treating a person who has had a stroke or a brain injury, you must also be aware of pre-existing conditions such as acuity problems, macular degeneration, glaucoma, cataracts, and diabetic retinopathy. Vision Conditions post Neurological Event Cardio Vascular Accident (CVA) •Visual field cuts (homonymous hemianopsia) •Left neglect(Hemi-inattention) •Oculomotor changes Traumatic Brain Injury (TBI): •Visual field cuts (homonymous hemianopsia) •Left neglect •Oculomotor dysfunction blurred/double vision •Visual agnosia / prosopagnosia •Convergence insufficiency difficulty reading •Sensitivity to light •Difficulty with eye movements •Nystagmus & vertigo Windsor & Windsor, n.d. Multiple Sclerosis (MS) •Optic Neuritis blurred vision, graying of vision, blindness in one eye – usually recovery in days to months •Double vision/Diplopia •Nystagmus National Multiple Sclerosis Society. (2016). Parkinson Disease •Blurred or double vision •Dry eyes (because eyes do not blink) •Slowed saccades with delayed initiation (May need to blink to move the eye – Wilson’s sign) •Decreased contrast sensitivity •Convergence insufficiency •Altered color perception blue/yellow color blindness (red & green easier to see) (some places say this happens others say it doesn’t) •Decreased depth perception •Visual hallucinations (flickering lights from meds) •Parkinson meds may make symptoms better or worse Berman, 2016; Parkinson’s Disease Foundation, 2016 Alzheimer’s Disease •Motion Blindness •Decreased depth perception •Decreased color perception (50%) •Decreased contrast sensitivity •Decreased recognition of objects, faces & colors Dementia Today, 2016 Mary Warren’s Vision Hierarchy Visual Cognition Visual Memory Pattern Recognition Scanning Alert and Attending Oculomotor Control Visual Fields Visual Acuity Occulomotor Control -damage to CN III, IV, VI Problems you see with no occulomotor control: -Double vision -Blurry vision -Saccades & pursuits Tests: -ROM of occulomotor mm -Correal light -Pupillary light reflex -Convergence Visual Fields With damage you see Field Cuts, Scotoma (can be dense so you cant see through it or it can be translucent so you can see through it but its blocking some light). You can test it with confrontation testing, or goniometry, Or a perimetry test (but only ophthalmologist can do this test) Visual Acuity Different parts of it: Sharpness, Contrast sensitivity (test: chart with different levels of contrast), Near and Far acuity (test: chart with words from various distances), color vision (test: color blindness chart or paint chips from home depot) Attention Reflexive (orienting response) Voluntary (orienting response) Problems with loss of attn: hemi-inattention (same as left neglect), distractibility, all can lead to decrease safety. Scanning Small Field vs. Large Field Scanning Pattern Recognition Being able to recognize patterns of all things based on shape, etc. Visual Memory Same as testing memory Visual Cognition Making meaning about everything, knowing what things are all in context. Neuro Low Vision Intervention 9/19 General ways to intervene with a person who has low vision: 1.Increase lighting 2.Increase contrast 3.Decrease clutter/ increase organization 4.Reduce background pattern 5.Enlarge print or other objects that need to be seen Resources for People with Low vision: •IRIS (headquarters in Portland, but they have three people who work out of Bangor) •National Library Services for the Blind •Radio reading services •Free directory assistance from telephone companies •Pharmacies can produce large print labels •Large print books at library •Public transportation Intervention for Visual Field Deficits •Major OT focus is compensation •Learn to use head movements to see into impaired field •For these techniques to work client must have awareness of the problem Intervention for Visual Field DeficitsBU Mobility Limitations: •May run into objects on blind side •Clients tend to be hesitant when walking & keep head down and eyes fixed on the floor cannot monitor surrounding environment •Develop a search strategy involving head turning •Start in smaller, static field larger field, moving Intervention for Visual Field Deficits Desired outcomes of developed search strategy: •Client uses wide head turn toward blind side •Client increases number of head turns to affected side •Ct increase speed of head turns to affected side •Ct develops organized efficient search pattern that begins on affected side •Ct can attend to visual detail on affected side •Ct can rapidly shift attention and search on blind side Intervention for Visual Field Deficits Methods to increase scanning into affected field: •Scan courses •Find red objects (as you are walking) •Narrated walks (client describes everything he/she sees as you walk) •Client points out landmarks during an outside walk •Teach client to identify potential safety issues such as: curbs, steps, broken pavement, etc •Add color & contrast to the environment Intervention for Visual Field Deficits Reading limitations: •Begin with pre-reading exercises •Word and number searches •Large print books •Anchoring •Ruler to help move line to line Intervention for Visual Field Deficits Writing limitations: •Pre-writing exercises (line tracing) •Monitor pen tip •Practice in completing blank checks, envelopes, check registers •Large print checks & registers •Use black felt tip pens to increase contrast •Bold lined paper Intervention for Deficits in Visual Scanning & Attention Increase awareness of left inattention: •Review cancellation and other tests with client allow client to retake a test if they wish. •Use environmental modification & compensatory strategies •Teach client to scan search from left to right •Left to right linear search pattern (reading) •Left to right clockwise or counterclockwise pattern for unstructured arrays (food dish) Intervention for Scanning & Attention Deficits •Large field & interactive. •Left right strategy •Emphasize conscious attention to detail, care inspection & comparison of objects •Client should check & recheck work throughout game or project •Try occluding the right half of the visual field Intervention for Scanning & Attention Deficits •Games: cards, dominos, ballgames, scrabble, Connect four, checkers •ADLs & IADLs: selecting cloths from closet, searching refrigerator or cabinet •Do this is varied contexts Intervention for Scanning & Attention Deficits If client has decreased attention: •Reduce background pattern •Good lighting •Increase contrast Intervention for Oculomotor Dysfunction •Should be addressed within the context of functional tasks. •Four treatments: Occlusion Application of a prism (optometrist) Eye exercises Surgery (Ophthalmologist) Intervention for Oculomotor Dysfunction Occlusion: •Involves covering one eye •Full occlusion: entire eye is covered (pirate patch, translucent tape, clip on occlude Decreases depth perception, decreases balance, decreases peripheral vision For client comfort, alternate patch between eyes every hour. Intervention for Oculomotor Dysfunction •Partial occlusion: block nasal portion of glasses using translucent or opaque tape. Peripheral vision is left intact. Disadvantage: client must wear corrective lenses of be fitted with non-corrective lenses Intervention for Oculomotor Dysfunction Prisms •Prisms may be prescribed by optometrists and ophthamologists. •These bend the light allowing clients to see into the blind field •Disadvantage: Often distortion Intervention for Oculomotor Dysfunction Eye Exercises •Not much research support •May empower the client by making them take part in the recovery process. •Use of eye exercises should be directed by an optometrist Intervention for Oculomotor Dysfunction Surgery: •Performed by ophthalmologist •Tightens up a muscle or muscles Compensation Again 1.Increase lighting 2.Increase contrast 3.Decrease clutter/ increase organization 4.Reduce background pattern 5.Enlarge print or other objects that need to be seen
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