PCM III Final Exam (Based on Exam Breakdown PPT)

L MCA Ischemic Stroke Pathophysiology - -Frontal: impulse, planning movement (apraxia) -Pre-Central Gyrus: Motor control -Post-Central Gyrus: sensory reception -Parietal lobe: orientation in space, later opulsion (pusher's), limb position during mvmt -Temporal: sound, long term memory -Basal Ganglia: motor planning -Broca's: expressive aphasia -Wernicke's: receptive aphasia L MCA Ischemic Stroke Sensory & Motor Impairments - -CNs - corticobulbar tract -Unilateral tongue innervation -Sparing of mm of mastication and ability to wrinkle forehead due to B innervation (CN VII) -CN XI - low incidence of SCM impairment after stroke L MCA Ischemic Stroke Mobility & Functional Limitations - ROM, MMT, sensation, pain, spasticity, balance, bed mobility, gait, endurance, functional status, ADLs, task analysisL MCA Ischemic Stroke Aerobic Exercise - -Aerobic exercise 1) 20 - 60 min/ session or Multiple 10 min bouts 2)40 - 70% HRR 3) 3 - 5/wk L MCA Ischemic Stroke OMs – -Borg RPE -Berg Balance -Stroke Rehab Assessment of Mvmt (STREAM) Upper Limb Subscale -TUG BORG RPE – -6 (no exertion) -11 (light) -13 (somewhat hard) -20 (maximal exertion) berg balance scale interpretation – - 41-56 = low fall risk - 21-40 = medium fall risk - 0-20 = high fall risk*a change of 8 points required to reveal a genuine change in fxn btwn 2 assessments Chronic Kidney Disease (CKD) pathophysiology – -common causes: diabetes, HTN, glomerulonephritis ESRD (end stage renal disease) - -final phase of kidney disease -loss of kidney fxn -requires dialysis/kidney transplant -uremia cluster -reduced glomerular filtration rate (15 mL/min; 90 mL/min = normal) -Increased phosphate levels -Decreased Ca levels stimulus to parathyroid gland increased PTH release increased Ca uptake in kidneys (BUT kidneys are not fxning) -Cardiovascular: CAD, HTN, CHF, pulmonary edema, dyspnea, pericarditis -Leading cause of death: chest p!, nausea, SOB, sweating MSK issues assoc w/ ESRD - -renal osteodystrophy 1) renal rickets: bone weakness & deformation 2) osteomalacia: demineralization of bone 3) osteitis fibrosis: inflammation of bone & fibers that connect to bone -bone pain: worse w/ exercise & WB-fx: spine & long bones CKD & ESRD endurance, mobility & functional limitations - - Sensory/motor neuropathy -pain -SOB -decreased functional capacity (60 - 70% of norm) -HR is unreliable indicator of exertion -decreased endurance and functional status CKD & ESRD Interventions - -Use Borg RPE to monitor exercise tolerance -Dialysis- recommend routine exercise. Avoid exercises the day before dialysis. -Exercise testing not recommended b/c mm fatigue limits testing procedure. 4 - 6/wk -Low - Mod intensity, 2-3 sets, 8 - 15 reps *Take BP in UE opposite AV shunt