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Notes since first exam MED 545 Music in Rehabilitation
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This 8 page Class Notes was uploaded by Jacqueline Vilca on Sunday February 22, 2015. The Class Notes belongs to MED 545 Music in Rehabilitation at University of Miami taught by in Spring2015. Since its upload, it has received 27 views. For similar materials see Music in Rehabilitation in Music at University of Miami.
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Date Created: 02/22/15
Music in Rehab 2 For resource citations you don39t have to put URL S for journal articles because they have printed versions Be speci c with range in descriptions the exact notes of range Include decades for the music 2122015 ACQUIRED BRAIN INJURY 1 STROKE Acquired brain injury Any brain injury acquired after birth Congenital is when it did NOT happen after birth Three causes CVA TBI and Hypoxic brain injury due to oxygen deprivation caused by maybe a heart attack near drowning electrical shock lightning strike choking allergic reaction or drug or alcohol abuse or exposure to toxic chemicals Glasgow coma scale a behavioral assessment of brain injury It is used when patient is in a coma Degree Of unconsciousness and to determine recovery They look at eye response verbal response and motor response chart A lower score means a higher amount of injury This was the rst scale that provided the rst indicators to really look for But it39s only for comas so what if your patient isn t Coma quotDisorders of consciousnessquot PostTraumatic Amnesia PTA The rate of amnesia postinjury Where they are in terms of injury and recovery CVA STROKE Stroke The sudden appearance of neurological symptoms as a result of an interruption of blood ow Infarct An area of dead or dying tissue resulting from the obstruction of blood vessels The one on the right of WHAT IS A STROKE is the one with the infarct 2 TYPES OF STROKES Ischemic CVA Caused by vessel blockage that prevents suf cient supply of blood to the brain This type of stroke is the most common 8087 of strokes Also more typically found in older adults Thrombosis a blood clot develops in the blocked part of the vessel causing an ischemic stroke Embolic a blood clot forms somewhere else in the body and breaks away to travel to some arteries in the brain and gets stuck in that artery Causing an ischemic stroke The precursor for both causes is arteriosclerosis a narrowing of the artery through a thickening of hardening buildup of plaque Second kind of stroke Hemorrhagic Stroke Damage in the brain due to ruptured blood vessels in the brain Its bleeding your hemorrhaging massive bleeding you can39t stop Most commonly caused by high blood pressure or hypertension Or congenital defects Can39t remember Two types of ruptured blood vessels Aneurysms A blood vessel becomes too weak to move the blood through and it expands and then pops AVM arteriovenous malformation a cluster of abnormally formed vessels Most closely related to a congenital defect to abnormally formed vessels and they can rupture 2 Areas this can happen Hemorrhagic CVA lntracerebral the rupture of vessels inside of the brain A rupture of small arteries deep in the brain It results in additional in ammation and swelling of brain tissue as well as damage to deeper structures Like the hippocampus basal ganglia cerebellum or brain stem thalamus etc This kind of hemorrhage 1 Symptoms tend to be really diverse There39s no speci c symptom list It really depends on where it is and since it happens so deeply it can affect many areas 2 It has a good prognosis better than ischemic stroke Subduralsubarachnoid meninges are layers that protect your brain and these are those areas underneath those layers lt s bleeding that happens underneath the protective brain covering dural and arachnoid space When this happens it forces blood to the brain and causes damage very quickly The onset is abrupt and is typically fatal N EU RAL AREAS IM PACTED Anterior Cerebral Artery ACA Serves Medial and Dorsal parts of the brain Symptoms include contralateral leg weakness because of the area of the motor cortex and somatosensory cortex that is affected If both hemispheres are impacted then you could have profound mentalcognitive symptoms because of damage to the frontal lobe Middle Cerebral Artery MCA Lateral parts of the brain This is the one most commonly affected 1 You39ll nd contralateral muscle weakness 2 Contralateral loss of sensation 3 Loss of speech production if on the left side None of this is speci c because it covers a wide area Posterior Cerebral Artery PCA Ventral and posterior This one is not as common Thalamus can be affected symptoms could be numbness or severe or chronic pain colorblindness occipital lobe color blindness and contralateral visual eld defect The loss of the blood supply location will determine what neural area or areas are impacted Two things to consider 1 Artery supply 2 Which hemisphere Remember her example of where damage occurs in the hands Study NEURAL AREAS OF IMPACTED slide pictures STROKE SYMPTOMS HEMISPHERE The hemisphere also affects what is affected in a stroke Most common for stroke to affect either one hemisphere or the other instead of both sides Left hemisphere CVA right side sensory motor dif culties The upper extremity is often affected Difficulties in balance is common and gait Hemiparesis Muscular weakness affecting one side of the body Hemiplegia paralysis of one side of the body Communication impairments Expressive aphasia and receptive aphasia and dysarthria Expressive aphasia may see disturbed prosody effortful and slow speech long pauses between words word nding dif culties poor word repetition it39s hard to repeat things Dif culty with word nding and sentence structure Slow and effortful speech as in the video of the woman in the night gown Lack of prosody or intonation Her sentences had a lot more slurring than even just the single words Receptive aphasia Speech itself is uent But the language is incorrect or inappropriate They may use nonsensical words mispronounce words or may use too many words Use of nonsensical words don39t always follow through on directions NOT COGNITIVE it39s a language processing skill The video showing the man saying quotit39s a footballquot while he39s gesturing to his mouth He is not disturbed as the woman with expressive aphasia He may not even be aware of his aphasia This is commonly the difference between the two aphasias Aphasia is a language disorders There are other types of aphasias but we won t get to them Dysarthria a SPEECH disorder Poor articulation poor voice control and distorted or slurred speech as if they are drunk They don39t the oral motor or vocal control It39s the oral motor and voice control that is affected but noting cognitive Muscle weakness Video Boy who is making a blog and drools a lot He39s speaking about the impairment What he39s saying makes sense and you can make out what he39s trying to say It39s just the physical act that39s stiff and dif cult Cognitive impairments of Left Hemisphere CVA short attention span poor short term memory impaired analytical and abstract thinking There39s poor frustration tolerance form working so hard fatigue and disinhibited behavior can t control behaviors as well as inappropriate laughing and crying RIGHT HEMISPHERE CVA Biggest differences are in cognition and social emotional Left side sensory motor dif culties upper extremities often affected Sensory motor dif culties involves dif culty with posture balance and weight shifting like in walking There39s also impairments in handeye coordination hard to eat cook and other ADLs Communication Very verbose and tangential speech No aphasias or dysarthria but They say too many words on an offtopic tangent There will be some comprehension dif culties such as following fastpaced conversations and understanding meanings in conversations Also dif culties in nonverbal communication behaviors such as eye contact gestures and vocal intonation When you lack vocal intonation it39 aprosody They have dif culty understanding recognizing and interpreting nonverbal communication from others raising brows crying etc 2172015 STROKE SYMPTOMS HEMISPHERE continued Accident on the right side of the brain BOTH sides can have hemi the two of them Cognitive impairments there are more in right CVA than there are in left CVA in general Poor attention skills in general short attention span poor selective attention as well as alternating and divided Poor problem solving skills Poor initiation and completion of tasks Learning and memory poor short term memory and dif culty learning new information Left visual neglect is also seen in a right CVA this is an ATTENTION disorder NOT A VISUAL IMPAIRMENT It39s an inattention to contralateral visual information Social Emotional effects Emotional Lability Lability is the regular occurrence of unstable disproportionate emotional displays Unstable meaning it can happen quickly and be trigger easily Disproportionate meaning under or over exaggerated More likely it39ll be over exaggerated There39s poor body image and at affect in the social emotional effects of right CVA as well as apathy impulsivity egocentricity and poor insight MOTOR DEFICITS This is not speci c to a hemisphere This is referring to CVA39s in general 1 Reduced muscle strength and endurance over all even on the unaffected side 2 Reduced exibility 3 Disturbed muscle tone 4 Abnormal gait patterns Muscle tone remember that you can see as the person regains their functions there will be three stages of muscle tone that goes towards the typical level of functioning 3 muscle tone stages 1 Flaccid limp dif culty initiating movement then 2 Muscle spasticity more tightness Movements are there but they are awkward and uncoordinated and 3 Return to normal muscle tone and smooth coordinated movements Gait characteristics abnormal gait comes with dif culties in weight shifting decreased exibility strength and endurance Poor balance and posture decreased arm swing poor foot clearance the opposite foot automatically swings when the other takes a step with a stroke you may not be able to lift your toes and then you39ll trip when walking uneven stride length distance of one heel strike to another The shorter stride leg is the affected leg The unaffected leg just catches up quickly remember the video of the quotthreepoint gaitquot with the woman walking with the cane She didn39t really lift her toes at all TREATMENT With a CVA you can do drug therapy but only effective if they are within 3 hours of the accident It39s to reduce the blood ow Anticoagulants to reduce blood pressure to dilate vessels reduce the extent of the damage etc Once a person has a stroke they39ll commonly receive the physical occupational and speechlanguage pathology Physical mostly focuses on gait for stroke patients Occupational will mostly focus on developing and recovering daily working skills upper extremity sensory motor skills ne and gross motor and cognitive skills like decision making meal planning etc Speechlanguage pathology will of cially diagnose which diagnosis it is and take care of it from there Music therapists will cotreat a lot They39ll see what goals and objectives would be appropriate to work on in music therapy TBI CP amp MS ACQUIRED BRAIN INJURY TBI TBI DEFINED TBI a wound to the brain that results from a blow to the head Most often an external mechanical force They are nondegenerative and noncongenital Open head and closed head Music therapists mostly see closed head Open head the skull is penetrated such as a gunshot wound or a sort of laceration Effects are localized and speci c to where the blow was Closed head When the skull is not penetrated Some causes car accidents sporting injuries assault a fall combat injuries recreational activities like skiing etc These TBls could have localized or generalized effects Localized effects involve a coup andor countercoup Coup brain bruised A swelling of the brain Countercoup a secondary bruising that happens on the opposite side Often caused by the swelling from the original coup More discreet impairments with speci c impacts Generalized effects could be that the WHOLE BRAIN swells up with the coup Sometimes a TBI can lead to seizures can of course impact functioning DAI Diffuse axonal injury injury to axons or white matter tracks in the brain Hydrocephalus can also lead to more generalized impairment increased uid on the brain that brings pressure on the brain Continuum Of effects TBI can be a concussion most closedheaded TBls ARE concussions Nausea problems with concentration balance sensitivity of lights and sounds are temporary affects You may have complete loss of consciousness Impact of the closedheaded TBI will depend on the intensity of the impact itself and the extent of the damage from that impact There are a variety of symptoms that don39t present that same way from person to person headache fatigue drowsiness nausea vertigodizziness and loss of balance some numbness sensitivity to lights and sounds and blurred vision Cognitively memory and concentration problems may be seen Slurred speech too Mood changes and feelings of depression and anxiety ACUTE TREATMENT There39s the Glascowcoma scale as we talked about before Or the Posttraumatic amnesia or a CT scan to assess brain damage There may be a surgical procedure to reduce swelling and minimize it getting worse Primary goal to limit any secondary damage like seizures Once the person is stable functional goals can be worked towards SMA Supplementary Motor Area FUNCITONAL IMPAIRMENTS Gross motor functioning impairments in strength balance speed and coordination Fine motor skills decreased speed and coordination It s harder to grasp objects and it takes a lot of time and effort Impairments in tone and movements too Spasticity speaks to tone It is tightness from increased muscle tone It makes them stiff and movements very dif cult Ataxia is impairments to movement patterns Unbalanced uncoordinated and jerlq movements Damage to the cerebellum could lead to ataxia Movements are strongly connected to the length they are in a coma The longer the harder it39ll be to get to some sort of functional motor skill Sensory hearing and visual Hearing loss if generally unilateral one side If it happens it39s generally with higher frequencies Visual impairments visual processing could be impaired overall If TBI results to damage in cranial nerves you could have limitations in eye movements for tracking and moving them up and down This could lead to double vision and decreased acuity accuracy FUNCTIONAL IMPAIRMENTS CONTINUED Dysarthria the slurred speech we saw earlier No control of oral motor muscles There may be generalized processing issues NOT aphasia like not being able to take turns or a less appropriate use of language Social communication behaviors are impaired More could be starting a conversation or engaging in a conversation Attention learning and memory executive functioning could all be cognitive challenges in TBIs In general with cognition there could also be slower processing They can39t respond right away they need to think about what you said and then think about what they are going to say Socialemotionalbehavioral challenges with impulsivity Or impaired ability to regulate in general It could be emotional regulation behavior regulation to self manage and control behaviors like kids shifting from recess to in the classroom there could be social isolation that person and their family now has to get used to a new normal that involves a strong emotional process or you could just not want to see anyone at the moment or mood and personality changes TREATMENT Severity the more severe the worse the prognosis Also length of time in ICU Age of injury whether it occurs in childhood rather than adulthood And older adult may have a worse prognosis than someone in their twenties Environmental factors like the stronger your support network access to resources and services socioeconomic standing Each of these make a difference MOST TBI39s are mild 75 with full recovery because they39re mainly just concussions Interdisciplinary physical speech recreational occupational social workers psychologist etc As an adult the team will also look for the adult to have a good community reintegration They are different now so they may need help with adjusting to the new normal They may need a new job how are their friends and family going to adjust OTHER NEUROLOGICAL DISORDERS CEREBRAL PALSY A group of disorders Neurological disorders that lead to motor impairments It39s common to have cognitive impairments with that Not always but very common Most are congenital Some are acquired but most are congenital They permanently impact body muscle movements and coordination BUT NOT DEGENERATIVE No recovery but it doesn39t get worse Therapy can really help to maintain or improve their functioning Different types of cp spastic dyskenetic and ataxic Each of the three have speci c areas in motor processing that are affected In spastic CP motor cortex abnormal increase in muscle tone the most common CP commonly congenital they will often have shorter muscles imbs pelvis and spine may have deformities when they39re adults because those muscles didn39t develop correctly Dyskenetic CP Basal Ganglia Slow writhing types of distorted movements and movement patterns It impacts walking and ability to control their muscles Ataxic cerebellum is impacted Trouble maintaining posture and movements are jerky and uncoordinated CP there39s a lot of variability between individuals
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