Cerebral vascular accidents (CVA, stroke)

A CVA is a result of ischemia (blood clot) or hemorrhage (rupture in blood vessels) in the brain causing sudden, focal neurological deficits. Ischemic strokes are more likely to occur in contrast to hemorrhagic strokes.

Definitions

Transient ischemic attack (TIA)

Brief stroke in which a temporary loss of blood flow causes stroke symptoms such as vision deficits, weakness, numbness. Symptoms will resolve without medical intervention. The time table for symptoms is variable but less than 12 hours.

The risk factors contributing to the likelihood of developing a stroke are due to hypertension, arteriosclerosis, diabetes, cardiac disease, hyperlipidemia, smoking, sedentary lifestyle, and previous history of TIA.

Ischemic strokes can be medically managed with tissue plasminogen activator (tPa) if given within the first 12 hours after onset of symptoms. Post 12 hour management is management via anticoagulant and antihypertensive medications.

Hemorrhagic strokes are medically managed via craniotomy or arterial clipping of bleeding arteries. Management also involves antihypertensive and epileptic medications.

Definitions

Craniotomy

Surgical procedure in which blood is removed from the brain via holes drilled into the skull

Arterial clipping

Clamp is placed on hemorrhaging brain artery to reduce blood flow and stop bleed

Cardinal symptoms of stroke

• Sudden weakness and/or numbness
• Difficulty speak
• Difficulty walking
• Confusion
• Visual changes
• Facial drooping

Neurological deficits associated with stroke

• Left hemisphere injury
  • Right side hemiplegia
  • Right side hemisensory
  • Speech-language deficits
  • Trouble planning/sequencing movement
  • Difficulty processing
• Right hemisphere injury
  • Left side hemiplegia
  • Left side hemisensory
  • Visual-perceptual deficits
  • Poor judgement
  • Impulsive
  • Abstract concepts difficulty to comprehend
  • Difficulty perceiving emotions
• Middle cerebral artery stroke
  • Contralateral hemiplegia with upper extremity weakness greater than lower extremity weakness
  • Contralateral paresthesia with upper extremity weakness greater than lower extremity weakness
  • Homonymous hemianopsia
  • Motor speech deficits
    • Broca’s aphasia
  • Receptive speech deficits
    • Wernicke’s aphasia
  • Loss of gaze to opposite side
• Anterior cerebral artery stroke
  • Contralateral hemiplegia with lower extremity weakness greater than upper extremity weakness
  • Contralateral paresthesia with lower extremity weakness greater than upper extremity weakness
  • Urinary incontinence
  • Apraxia
  • Mutism (less verbal)
  • Akinetic (less mobile)
• Posterior cerebral artery stroke
  • Contralateral sensory loss
  • Involuntary movements
    • Intention tremors- unintentional movement of extremity when performing a task
    • Choreoathetosis- irregular, involuntary movements that can be chorea or writhing
    • Hemiballismus- forceful throwing of body segments
  • Visual agnosia: difficulty recognizing objects, people, places
  • Dyslexia
  • Thalamic pain: chronic, burning, or constrictive pain all over the body
  • Oculomotor nerve palsy
• Generalized brainstem deficits
  • Vertebral-basilar artery injured- occlusion to large portion of vertebral- basilar artery
    • Locked in syndrome develops
      • Paralysis of all muscles with except eye movement
      • Cognition remains intact
• Ventral pons area deficits
  • Millard-Gilbert syndrome
    • Basilar artery injured- small branch of occlusion
    • Impacts the facial and abducens cranial nerves, as well as corticospinal tract
      • Facial muscles and lateral rectus impacted on ipsilateral side
      • Inability to abduct eye on ipsilateral side
      • Weakness of upper and lower extremities contralateral side (hemiplegia)
• Lateral medulla deficits
  • Lateral medullary syndrome (Wallenburg syndrome or PICA syndrome)
    • Impacts the posterior inferior cerebellar artery
      • Deficits in cranial nerves- trigeminal and vagus on ipsilateral
        • Deficits in pain and temperature
        • Decreased gag reflex
      • Nystagmus on ipsilateral side
      • Horner’s syndrome on ipsilateral side
        • Diplopia (double vision), anhidrosis (inability to sweat), ptosis (drooping of eyelid)
      • Pain and temperature of contralateral
      • Hemiparesis contralateral

Brunnstrom stages for recovery

The Brunnstrom stages of recovery are a guide to describe the motor recovery status post stroke. Individuals post stroke may progress through all stages or remain at a certain level for an extended period of time. There is no timetable for recovery.

• Stage 1: Flaccidity, with little or no voluntary movement
• Stage 2: Spasticity appears, and voluntary movement is possible
• Stage 3: Spasticity increases, and patients can voluntarily perform limb synergies
• Stage 4: Spasticity decreases, and patients can perform movement combinations that are not synergies
• Stage 5: Patients can perform complex movement combinations
• Stage 6: Spasticity disappears
• Stage 7: Patients return to normal function

Synergy patterns

Synergy patterns are abnormal muscle patterns developing status-post stroke. The two synergy patterns that exist are flexion and extension synergy patterns. Below are descriptions of muscle activation during the synergy patterns.

Flexion synergy

• Upper limb
  • Scapula: retraction and/or elevation
  • Shoulder: abduction and external rotation
  • Elbow: flexion
  • Forearm: supination
• Lower limb
  • Hip: flexion, abduction, and external rotation
  • Knee: flexion
  • Foot and ankle: dorsiflexion

Extension synergy

• Upper limb
  • Scapula: protraction and/or depression
  • Shoulder: adduction and internal rotation
  • Elbow; extension
  • Forearm: pronation
• Lower limb
  • Hip: extension, adduction, and internal rotation
  • Knee: extension
  • Foot and ankle: plantarflexion

Homonymous hemianopia

Homonymous hemianopsia is a type of visual field loss that affects the same side of the visual field in both eyes.

Key features

• Cause: Most commonly due to lesions in the optic tract, optic radiation, or occipital lobe on the opposite side of the vision loss (e.g., a left-sided brain lesion causes right homonymous hemianopsia).
• Common causes: Stroke (especially affecting the posterior cerebral artery), traumatic brain injury, brain tumors.
• Symptoms:
  • Bumping into objects on the affected side
  • Reading difficulties (especially when vision loss is on the right)
  • Difficulty with driving or navigating environments
• Diagnosis: Confirmed with visual field testing (perimetry).
• Rehabilitation focus:
  • Visual scanning training
  • Compensatory strategies (e.g., turning the head to scan the blind side)
  • Environmental modifications

Apraxia

Apraxia is a motor planning disorder characterized by the inability to execute purposeful, learned movements, even when the individual has the physical capacity and desire to perform the movement. It is commonly caused by lesions in the left hemisphere of the brain, particularly the parietal and frontal lobes, and can significantly impair functional independence. Understanding the various forms of apraxia is essential for physical therapists working in neurological rehabilitation.

Ideomotor apraxia

Ideomotor apraxia is the inability to perform purposeful motor acts on command or imitation, even though the idea of the task is understood and motor function is intact

Clinical presentation:

• A patient can describe a movement but cannot perform it when asked.
• May improve with automatic or habitual actions.
• Common errors include awkward or incorrect limb positioning during tasks like waving or brushing teeth.

Common causes:

• Left parietal lobe lesions
• Stroke, particularly in the dominant hemisphere

Ideational apraxia

Ideational apraxia is the inability to carry out a sequence of actions to achieve a goal, due to loss of the concept of the task

Clinical presentation

• Misuse of objects (e.g., attempting to write with a fork)
• Skipping essential steps in a task (e.g., putting on shoes before socks)
• Incoherent task sequencing (e.g., pouring juice after trying to drink from the empty cup)

Common causes:

• Extensive damage to the left hemisphere
• Dementia or widespread cortical disease

Traumatic brain injury (TBI)

A traumatic brain injury occurs when a force to the skull causes rotational acceleration to the brain at varied severities.

Types of injury:

• Open head injury: skull fracture that results in brain exposure
  • Increased risk for development of infection
• Closed head injury: no skull fracture or exposed brain
  • Increased risk for intracranial pressure

Pathophysiology:

• Local brain injury
  • Damage to a specific region of the brain due to bruising, bleeding, laceration, or swelling
• Coup-countercoup injury
  • Injury in which the brain is damaged due to point of impact and opposite point of contact due to acceleration of brain in skull
• Diffuse axonal injury
  • Tearing of axons and small vessels due to acceleration of brain in skull leading to neuronal death
• Edema
  • Increased swelling due to increased intracranial pressure typically from increased volume of cerebrospinal fluid in ventricles
• Hypoxic-ischemic injury
  • Loss of cerebral circulation due to compromise typically from deficits in cardiovascular and respiratory systems

Stratification of brain injury

Brain injuries can be stratified into three (3) categories: mild, moderate, and severe based on symptomatology present. Stratification can be done with use of Glasgow Coma Scale (GCS):

• Mild TBI (i.e. concussion)
  • GCS score: 13-15
  • Loss of consciousness: 0-30 minutes
  • Alteration of consciousness: brief; >24 hours
  • Post-traumatic amnesia: <1 day
  • Imaging: normal
  • Recovery: full recovery of all physical and cognitive with patient seen in outpatient setting
• Moderate TBI
  • GCS score: 9-12
  • Loss of consciousness: >30 minutes; less than 24 hours
  • Alteration of consciousness: >24 hours
  • Post-traumatic amnesia: 1-7 days
  • Imaging: normal or abnormal
  • Recovery: potential to have full recovery of physical and cognitive function with intense rehabilitation of inpatient rehabilitation or skilled nursing facility
• Severe TBI
  • GCS score: 8 or less
  • Loss of consciousness: >24 hours
  • Alteration of consciousness: >24 hours
  • Post-traumatic amnesia: >7 days
  • Imaging: normal or abnormal
  • Recovery: permanent physical and cognitive impairment; typically in nursing home setting or home setting with total care

Definitions

Alteration of consciousness

Change in baseline perception, awareness, and mental functioning

Post-traumatic amnesia

Inability to recall events occurring after injury

Retrograde amnesia

Inability to recall events preceding the injury

Imaging

Magnetic resonance imaging (MRI) utilized to assess level of injury

Behavioral stratification of traumatic brain injury

Ranchos los amigos cognitive scale utilized to classify behaviors through a predictable sequence. Individuals progress through levels in sequence but can plateau at any point. Level of behavior:

• Level I- No response
  • Cognitive assistance needed: total assistance with all cognitive functions
  • Response to stimuli: inconsistent responses to stimuli
  • Single step commands: unable to follow single step commands
  • Characteristics of level: individuals typically in comatose state
• Level II- Generalized response
  • Cognitive assistance needed: total assistance with all cognitive functions
  • Response to stimuli: consistent, generalized response to stimuli
  • Single step commands: unable to follow single step commands
  • Characteristics of level: individuals in vegetative state
• Level III- Localized response
  • Cognitive assistance needed: total assistance with all cognitive functions
  • Response to stimuli: localized response to stimuli
  • Single step commands: unable to follow single step commands
  • Characteristics of level: individuals within minimally conscious state; able to inconsistently track objects and respond to their name
• Level IV- Confused, agitated
  • Cognitive assistance needed: maximal assistance for cognitive function
  • Response to stimuli: localized response
  • Single step commands: unable to follow single step command
  • Characteristics of level: confused, combative, easily agitated, hypersexual behaviors
• Level V- Confused, inappropriate
  • Cognitive assistance needed: maximal assistance for cognitive function
  • Response to stimuli: localized response
  • Single step commands: unable to follow single step command
  • Characteristics of level: confused, inappropriate behaviors (combative and hypersexual behaviors have subsided), severely impaired memory
• Level VI- Confused, appropriate
  • Cognitive assistance needed: moderate assistance for cognitive function
  • Response to stimuli: localized response
  • Single step commands: able to follow single step commands
  • Characteristics of level: remote memory more consistent than recent memory, requires assistance with problem solving, minimal carry-over with new tasks
• Level VII- Automatic, appropriate
  • Cognitive assistance needed: minimal assistance for cognitive function
  • Response to stimuli: localized response
  • Single step commands: able to follow single step commands
  • Characteristics of level: improve carry over with activity, minimal assistance for learning new tasks, increased awareness of deficits
• Level VIII- Purposeful and appropriate
  • Cognitive assistance needed: stand by assistance for cognitive function
  • Response to stimuli: localized response
  • Single step commands: able to follow single step commands
  • Characteristics of level: able to integrate new and old memory into making decisions, able to make adjustments to behavior in social interaction with minimal assistance

Spinal cord injury

Partial or complete disruption of the spinal cord resulting in paralysis, sensory loss, altered spinal reflexes, and altered autonomic function.

The causes of spinal cord injury can be falls, motor vehicle accidents, penetrating wounds, disc prolapse, or vascular compromise.

Pathophysiology:

• Primary injury: direct injury to the spinal cord or disruption of vascular supply
• Secondary injury: edema, demyelination, or necrosis of axons

Severity of injury:

• Complete: no sensory or motor below level of injury; no sacral sparing
• Incomplete: inconsistent sensory or motor below the level of injury; sacral sparing present

Definitions

Sacral sparing

Sensory and/or motor innervation to the anus; indicates better prognosis for recovery in presence of sacral sparing

American spinal cord injury (ASIA) levels of injury

• A- Complete
  • No motor or sensory preserved below the level of injury
  • No motor or sensory in sacral segment S4-S5 (sacral sparing)
• B- Incomplete
  • Sensory but no motor below the level of injury
  • Sensory to sacral segments S4-S5 but no motor to these segments
• C- Incomplete
  • Motor function is present below the level of injury with major muscle have a manual muscle test grade less than 3
• D- Incomplete
  • Motor function is present below the level of injury with major muscles have a manual muscle grade greater than 3
• E- Normal
  • Motor and sensory are normal

Classifications of incomplete spinal cord injuries

• Central cord syndrome
  • Etiology; Cervical hyperextension
  • Deficits:
    • Loss of bilateral pain and temperature contralateral (spinothalamic tract)
    • Loss of bilateral motor function - primarily upper extremities (corticospinal tract)
  • Intact:
    • Preservation of proprioceptions, vibratory sense, and kinesthesia (dorsal column lateral meniscus)
• Anterior cord syndrome
  • Etiology Cervical flexion, vascular compromise
  • Deficits:
    • Loss of motor function bilaterally below the level of injury (corticospinal tract)
    • Loss of bilateral pain and temperature (spinothalamic)
  • Intact: : Preservation of proprioceptions, vibratory sense, and kinesthesia (dorsal column lateral meniscus)
• Brown-sequard syndrome
  • Etiology: Penetrating wound from gunshot or stab wound
  • Deficits:
    • Ipsilateral loss of two-point discrimination, pressure, vibration, and proprioception (dorsal column lateral meniscus)
    • Ipsilateral loss of motor function (corticospinal tract)
    • Controllateral loss of pain and temperature (spinothalamic)
  • Intact: None
• Posterior cord syndrome
  • Etiology: Cervical hyperextension
  • Deficits:
    • Bilateral loss of proprioception, vibration, pressure (dorsal column lateral meniscus)
  • Intact:
    • Preservation of motor function (corticospinal)
    • Pain and temperature (spinothalamic)
• Cauda equina injury (classified as lower motor neuron lesion)
  • Etiology: Trauma, herniated disk, spinal stenosis, infections below L1 nerve root
  • Deficits:
    • Flaccid paralysis of bladder, bowel function (incontinence)
    • Impaired/motor function- specifically lower extremities
    • Absent spinal reflexes
  • Intact: Variable dependent upon severity of injury

Associated disorders with spinal cord injury

• Spinal shock:
  • Immediately after injury a time of absent reflexes and flaccidity due to the body working to protect itself after injury
  • Timeframe can vary from 24 hours to 24 weeks
    • Difficult to get accurate ASIA assessment due to spinal shock and changes in level of injury
• Autonomic dysreflexia
  • Medical emergency for individuals with T6 or above injury
  • Caused by noxious stimuli in which spinal cord injured individual is unable to physically
    • Noxious stimulus causes activation of sympathetic nervous system and due to spinal cord injury the parasympathetic nervous system is unable to be enacted due to injury to spinal cord (activation of parasympathetic system will cancel out the effects of sympathetic nervous system
      • Noxious stimulus can be constipation, catheter malfunction, pressure injuries, tight clothes, sitting on sharp object
  • Symptoms: headache, increased blood pressure, bradycardia, diaphoresis above the level of injury, flushing below the level of injury, seizures. If left untreated, it can lead to death.
  • Medical management: sit patient up and assess for noxious stimulus
• Spasticity
  • Increased tone to extremities or trunk due to consistent contraction; leads to range of motion deficits and functional impairment
  • Will only be seen in upper motor neuron lesions
  • Occurs most often in incomplete lesions
  • Utilize Modified Ashworth Scale to assess
• Heterotrophic ossification
  • Abnormal bone growth in muscle
  • Symptoms: firmness at muscle site, pain with palpation, pain with muscle stretch or palpation
  • Typically involves the quadriceps and brachialis muscles
• Deep vein thrombosis:
  • Medical emergency
  • Development due to immobility of extremities which places individuals at increased risk for blood clot development
  • Treatment options:: grade compression socks, anti-coagulation medication

Levels of independence (for complete injuries)

• Transfers
  • C1-C5: dependent transfers
  • C6: independent with sliding board transfers on level surfaces
  • C7 and beyond: independent with transfers without sliding board on unlevel surfaces
• Wheelchair use
  • C1-C5: power wheelchair use with use of head control, mouth control, or joystick
  • C6: manual wheelchair on level surfaces with use of wheel projections and large knobby wheels- independent status
  • C7 and beyond:: manual wheelchair usage without adaptations in all surfaces- independent status
• Gait
  • T12:
    • Exercise only ambulation due to high energy needs
    • Hip-knee-ankle orthosis (HKAFO) with hip locked in extension or reciprocating gait orthosis (RGO) necessary for gait
    • Manual wheelchair used primarily
  • L1-L2:
    • Exercise only ambulation due to high energy needs
    • Hip-knee-ankle orthosis with hip unlocked to allow for flexion to occur necessary for ambulation
    • Manual wheelchair used primarily
  • L3:
    • Household ambulation
    • Ankle foot orthosis (AFO) used to assist with knee control
    • Manual wheelchair used in community
  • L4 and below:
    • Community ambulation
    • Ankle foot orthosis (AFO) used to assist with ankle control
    • Manual wheelchair used as needed

Definitions

Reciprocating gait orthosis

Services of interconnected braces aiding in ambulation by a lever system attached to the torso; unweighting of extremity is performed by lateral movement of torso causing swing leg to move forward while stance leg is pushed backward

Parkinson’s disease

A chronic, professing disorder in which there is a deficiency in dopamine and degeneration of the substantia nigra in the basal ganglia. The loss of dopamine causes excess excitation from the cholinergic system of the basal ganglia.

The basal ganglia are a group of structures within the cerebrum working in synchrony to aid in initiation of voluntary movements and the smoothness of these movements by coordinating muscle activation The basal ganglia contains dopamine which assists in movement control. A deficit in dopamine causes difficulty with initiation of movement and decreased ability to voluntarily activate muscles to perform tasks.

Image #77

https://upload.wikimedia.org/wikipedia/commons/5/55/Blausen_0076_BasalGanglia.png

Common impairments of Parkinson’s disease

• Resting tremor
• Impaired postural reflexes
• Cogwheel rigidity
• Bradykinesia
• Slowed reaction time
• Masked face
• Dysarthria
• Hypophonia (decreased speech volume)
• Contractures in flexor and adductor muscles
• Postural deficits- rounded shoulders, kyphosis
• Restrictive lung disease
• Visual impairment
• Dementia in later stages

Standardized test for Parkinson’s disease

Hoehn & Yahr classification of disability

Stage 1

• Disability: Minimal or absent
• Extent of disability: Unilateral

Stage 2

• Disability: Minimal
• Extent of disability: Midline involvement and bilateral

Stage 3

• Disability: Impaired postural reflexes, unsteadiness when rising from chair; continues to be independent and work
• Extent of disability: Midline involvement and bilateral

Stage 4

• Disability: All symptoms present; ambulation only with assistive device
• Extent of disability: Midline involvement and bilateral

Stage 5

• Disability: All symptoms present; confined to wheelchair or bed
• Extent of disability: Midline involvement and bilateral

Retropulsion pull test

Testing Procedures:

1. The subject stands in a comfortable stance with eyes open (have feet shoulder width apart if they assume an unusually wide or narrow stance).
2. The examiner stands behind the subject.
3. The subject is instructed to do whatever it takes to not fall and are told that the examiner will catch them if they do fall.
4. The examiner gives a sudden, brief backward pull to the shoulders with sufficient force to cause the subject to have to regain their balance.
5. The subject should not know exactly when the pull is coming.

Interpretation of results: scoring is from 0 to 4:

• 0 = recovers independently may take 1 or 2 steps or an ankle reaction
• 1 = three steps or more backward but recovers independently
• 2 = retropulsion, needs to be assisted to prevent fall
• 3 = very unstable, tends to lose balance spontaneously
• 4 = unable to stand without assistance (UPDRS method)

Medication for Parkinson’s disease

• Levodopa
  • Mechanism of action: relieve symptoms of Parkinson’s disease by turning levodopa into dopamine (due to lack of dopamine in basal ganglia)
  • Side effects: mental confusion, hallucinations, postural hypotension, restlessness, abnormal movements
  • On and off time: Levodopa should be given 1 hour prior to initiation of activity for optimal effects; medication will wear off and symptoms will occur
• Anticholinergic medications
  • Mechanism of action: decrease tremors by blocking cholinergic production in basal ganglia
  • Side effects: dry mouth, urine retention, constipation

Huntington’s disease

A progressive, genetic neurodegenerative disorder causing damage to the central nervous system. An abnormality in chromosome 4 causes mutation and protein production of huntingtin (HTT) protein which causes permanent disability. Although congenital, symptoms do not present into 30s or 40s.

Symptoms

• Involuntary writhing movements (choreic movements) at rest
• Muscle rigidity
• Poor balance
• Difficulty with swallowing/speaking
• Impaired executive function
• Decline in overall mental health
• Functional decline

Physical therapy considerations with Huntington’s disease

• Balance/gait exercise- using weighted walker
• Postural stability
• Family education/training as needed
• No modalities indicated

Multiple sclerosis (MS)

A chronic, progressive demyelinating disorder causing plaques within the central nervous system causing fatigue in nerves.

Types of Multiple sclerosis

• Relapsing-remitting
  • Characterized by cycles of disease exacerbation followed by periods of remission; varied levels of disability
• Primary progressive
  • Characterized by disease consistently being present without remission; permanent disability results
• Secondary-progressive
  • Characterized by disease beginning as cyclic relapse/remitting initially followed by continuous progression of disease without remission; permanent disability results
• Progressive-relapsing
  • Characterized by progressive disease with unpredictable times of remission; permanent disability results

Image #78

https://upload.wikimedia.org/wikipedia/commons/2/2a/Multiple_Sclerosis.png

Symptoms of multiple sclerosis- symptoms will vary depending on location of plaques

• Weakness
• Spasticity
• Hyperreflexia
• Impaired coordination
• Visual deficits
• Ataxia
• Vestibular dysfunction
• Dysarthria
• Paresthesia
• Lhermitte’s sign: electric shock like symptoms resulting from neck flexion

Special considerations with multiple sclerosis

• Avoidance of precipitating factors:
  • Stress
  • Trauma
  • Pregnancy
  • Trauma
  • Heat
  • Hyperventilation
  • Dehydration
  • Increase exertion

Amyotrophic lateral sclerosis (ALS)

A progressive disorder causing degeneration of motor neurons in lateral aspect of the spinal cord, brainstem, and cerebral cortex. Eventually leading to amyotrophic muscle fiber atrophy from peripheral nerve involvement. ALS can be characterized as both an upper and lower motor neuron lesion. Cognition remains intact during disease process progression. Death typically occurs 2-5 years after onset of symptoms due to respiratory compromise.

Symptoms

• Asymmetrical weakness
• Facial weakness
• Difficulty with swallowing
• Hyperreflexia
• Spasticity
• Compromised cranial nerve integrity

Stages of ALS

Stage 1- early stage

• Mild weakness or stiffness in the hands, feet, or limbs
• May have difficulty with fine motor tasks (e.g., writing, buttoning)

Stage 2- middle severe

• Weakness spreads to other parts of the body
• Difficulty walking, speaking, or swallowing
• May require assistance with daily activities

Stage 3- late state severe:

• Late Stage Severe weakness and paralysis, Difficulty breathing, and Need for a wheelchair and ventilator.

Stage 4- end stage

• Total paralysis
• Loss of cognitive function in some cases may occur but rare

Medical management is treatment of symptoms as there is no cure for ALS. Motor function progressively diminishes until the individual becomes totally dependent for activities of daily living and mobility while on ventilator support. Physical therapy assists with prescription of assistive devices and family education/training as appropriate.

Epilepsy

A disorder characterized by recurrent abnormal electrical discharges within the brain (seizures). Common causes can be due to tumor, stroke, dementia, illicit drug use, electrolytes disorders, infections, or pregnancy complications such as eclampsia.

Symptoms:

• Altered consciousness
• Convulsions
• Sensory phenomena: heightened somatosensory, visual, auditory, or olfactory senses
• Autonomic phenomena: tachycardia, anxiety, diaphoresis
• Cognitive phenomena: inability to communicate, hallucinations

Classification of epilepsy

• Generalized
  • Involves all areas of the brain
  • Symptoms include loss of consciousness, rhythmic movements of extremities (convulsions), loss of bladder function, alterations in breathing
  • Lasting 1-5 minutes
• Absent
  • Typically no symptoms are present which increase the difficulty to diagnose
    • Repetitive blinking or small movements may be present
  • Last for seconds and can occur multiple times per day
• Partial or focal
  • Only one part of the brain is involved which cause symptoms to be focal
• Status epileticus
  • Prolonged seizures or series of seizures with only brief moments of recovery
  • Lasting 30 minutes or longer

Physical therapy and epilepsy

• To do if seizure occurring
  • Protect airway
  • Roll to sidelying
  • Loosen restricting clothes
  • Remove harmful objects that may be nearby
  • Do not restrain limbs
  • Seek medical attention immediately at conclusion of convulsions