NPTE Studycast | Physical Therapy

Episode17: Posterior Cord Syndrome

Notes by Alexis Lancaster, SPT

What is it?

Damage to the posterior cord itself

Occlusion of posterior spinal artery

Very rare

 

Differential diagnosis

Any of the other spinal cord syndromes (anterior/brown sequard/central cord)

 

Clinical presentation

Isolated loss of proprioception, vibration, & discriminative touch

 

Special tests

Clinical presentation stated above

CT/MRI for confirmation

 

Treatment

ICF model

Medical management

Bowel/bladder program

Motor learning

Task-specific training

Weight-bearing

Neuromuscular re-education

Tone management

FES

Aerobic training

Positioning

Bracing/splinting

Locomotion

Keeping an eye on shoulder pain

Allow compensation in this population

 

Sample question

Identification of the mechanism of injury related to this condition

Identification of clinical presentation

 

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16 - Neuro - Anterior Cord Syndrome

Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx

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

Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx

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.)

Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx

13 - Neuro - Guillain Barre

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

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