NPTE Studycast | Physical Therapy

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15 – Neuro – Autonomic Dysreflexia Aug 20, 2018

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Episode 15- Autonomic Dysreflexia What is it? Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above) The stimulus can be noxious or non-noxious Usually it is a noxious stimulus Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response Anatomy Know what level it can occur at (T6 level of injury and above) Noxious/non-noxious stimuli Differential Diagnosis Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising Migraine: a lot of reports from patients involve a pounding headache Essential hypertension: a person is becoming hypertensive with a certain activity Anxiety Withdrawal from pharmacologic drugs Special tests BP Clinical diagnosis: look at the signs & symptoms Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury Symptoms: pounding headache, chills, anxiety, nausea How it will look on the test: Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is Fun way to remember how to treat immediately: AD: BP up, sit the patient up OH: BP down, lay patient down

14 – Neuro – Huntington’s Disease Aug 20, 2018

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Episode 14: Huntington’s Disease Host Jimmy McKay Featured guest Bridget Ripa Notes by Alexis Lancaster What is it? Inherited, an autosomal dominant trait Causes degeneration to specific brain regions Huntington’s disease gene is on chromosome 4 and it produces the Huntington protein that’s found throughout the body Signs/Symptoms Symptoms can present at any age Symptoms can include physical, cognitive, and psychiatric signs & symptoms The disease is divided into 5 stages Preclinical, early, middle, late, end of life Anatomy/Presentation Mechanism unclear Hallmark sign: atrophy of striatum that later involves cerebral cortex and subcortical structures Leads to severe loss of neurons in caudate and putamen Also affects basal ganglia pathways, the indirect pathway is affected before direct pathway (important) Differential diagnosis Lupus, chorea, ataxia, generalized neurodegenerative disorder R/O with genetic testing Treatment PT will see patients in middle/later stages (95% of pts) Check medications→ should have meds for abnormal movements and psychiatric disorders Specific to individual Family training Management of falls and decreased mobility On the NPTE Medications will be important (drastically changes function) Know meds they may be on Antipsychotics Antidepressants disorder. Side effects may include nausea, diarrhea, drowsiness and low blood pressure. Mood stabilizing drugs Know the PT management of disease progression (family education, etc.)

13 – Neuro – Guillain Barre Aug 18, 2018

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13 - Neuro - Guillain Barre

12 – Neuro – Orthostatic Hypotension Aug 18, 2018

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Episode 12: Orthostatic Hypotension NPTE Studycast Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Notes by Alexis Lancaster, SPT What is it * A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position Causes * Cardiovascular system, BP, blood supply to the brain Signs & Symptoms: * Physical signs: pallor, diaphoresis, loss of consciousness (potentially) * Symptoms pt will report: dizziness, light-headedness, faintness, nausea Differential Diagnosis: * Autonomic dysreflexia * Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP * Vertigo, BPPV: b/c of dizziness and light-headedness symptoms * Generalized nausea from infection, etc. Special tests * Orthostatic testing: monitor BP with position changes Treatment examples: * Immediately: lay the person down, elevate legs to prevent loss of consciousness * After: talk to the team about BP treatment medications * Encourage fluids with pt * Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes * Abdominal binders, ace wraps on legs to keep BP up How can it look on the test? * The important part: recognizing OH and manage it * Emergent scenario: decide that it’s OH and what you would do about it * May need to differentiate between OH and more emergent conditions, such as AD *

11 – Neuro – TIA Aug 17, 2018

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TIA – Transient Ischemic Attack Notes by Nick O'Hanlon, SPT What is it? The same underlying mechanism as an ischemic stroke; with the main difference being the duration of symptoms is significantly less In other words, a brief episode of neurological dysfunction caused by ischemia (lack of blood supply) to the brain No tissue death occurs Signs and Symptoms Clinically presents like a stroke, but can also look like: a seizure disorder, tumor, migraines, or hypoglycemia Stroke symptoms – slurred speech, paralysis, overactive reflexes, balance and coordination issues, reduced sensation A complete resolution of symptoms occurs within 24 hours Anatomy Dependent on an area of the brain the ischemic attack occurs, but any part of the brain Crescendo TIAs – having more than one TIA within a specified time period 2 within 24 hours 3 within 3 days 4 within 2 weeks Special Tests Imaging – CT/MRI Clinical Exam – ABCDD2 prediction rule, which can predict risk of stroke after a TIA Age, >60 years BP, >140/90 Clinical presentation: unilateral weakness with or without speech impairment Duration of symptoms Diabetes Above a certain point threshold for the rule, patient is at increased risk for a stroke Differential Diagnosis Can present similarly to stroke, but the duration of symptoms for a stroke is much longer Causes Risk factors for TIA include: smoking, high blood pressure, high cholesterol, diabetes, and family history Treatment examples Treating the person as they present with their impairments There is a good possibility the duration of symptoms is too short for us to see them during the dysfunctional window before resolution of symptoms Education about risk factors and crescendo TIAs How does it look on the test? ABCDD prediction rule is important to know Be able to differentiate between TIA and stroke

10 – Neuro – Ischemic Stroke Aug 13, 2018

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10- Neuro - Ischemic Stroke

9 – Neuro – Heterotrophic Ossificans Aug 13, 2018

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9 - Neuro - Heterotrophic Ossificans

8 – Neuro – Spasticity Aug 13, 2018

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8 - Neuro - Spasticity

7 – Neuro – Traumatic Brain Injury Aug 13, 2018

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7 - Neuro - Traumatic Brain Injury