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Neuro PTA > Added Info for Final > Flashcards

Added Info for Final Flashcards

1
Q

What does ABI stand for?

A

Acquired Brain Injury

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2
Q

What does GCS stand for?

A

Glasco Coma Scale

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3
Q

What does LOC stand for?

A

Loss of consciousness

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4
Q

What does PTA stand for?

A

Post traumatic amnesia

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5
Q

What is the definition of TBI?

A

Form of ABI

Caused from sudden trauma to the brain - IE. result of sudden and violent hit or when object pierces the skull and enters the brain

Symptoms can be mild, mod, or severe

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6
Q

What is an open TBI?

A

Penetrates the skull

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7
Q

What is a closed TBI?

A

No penetration to skull

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8
Q

What are the leading causes of TBI?

A

MVA
Falls
High risk behaviors
Gunshot wounds

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9
Q

What is a functional recovery of a TBI?

A

Uncertain mechanisms. Each brain is different and does not respond to injury the same.

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10
Q

What determines the extent of open TBI?

A

Location, depth, and pathway

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11
Q

What is a diffuse axonal injury?

A

Result of closed head injury

Brain is alt compressed and stretched

Axons can be stretch or severed resulting in neuronal death

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12
Q

What is a primary TBI injury?

A

Initial brain injury sustained by impact

IE. skull penetration, fractures, contusions

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13
Q

What is a coup lesion?

A

Direct brain lesion under the point of impact where brain damage occurs

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14
Q

What is countrecoup?

A

Injury on opposite side of brain due to rebound effect after impact

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15
Q

What is a secondary TBI injury?

A

Brain damage as response to initial injury

IE. Hematoma, hypoxia, ischemia

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16
Q

What is an epidural hematoma?

A

Hemorrhage that forms between skull and dura mater

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17
Q

What is a subdural hematoma?

A

Hemorrhage that forms due to venous rupture between dura and arachnoid mater

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18
Q

What are examples of seizure drugs?

A

Dilantin
Tegretol
Phenobarbitol
Keppra

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19
Q

What are the side effects of seizure drugs?

A

Drowsiness
Ataxia
Confusion

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20
Q

What is a craniotomy?

A

Removal of part of the skull to access brain

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21
Q

What ages are at risk for severe TBI?

A

Under 2

Over 60 years old

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22
Q

What are the levels of consciousness?

A 
Coma
Stupor
Obtundity
Delerium
Clouding of consciousness
Consciousness
Vegetative state
Persistent vegetative state
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23
Q

What is the definition of coma?

A

State of unconsciousness and level of unresponsiveness to all internal and external stimuli

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24
Q

What is the definition of stupor?

A

State of general unresponsiveness with arousal occurring from repeated stimuli

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25
Q

What is the definition of obtundity?

A

State of consciousness that is characterized by state of sleep, reduced alertness to arousal, and delayed responses to stimuli

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26
Q

What is the definition of delirium?

A

State of consciousness characterized by disorientation, confusion, agitation, and loudness

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27
Q

What is the definition of clouding of consciousness?

A

State of consciousness characterized by quiet behavior, confusion, poor attention, and delayed respones

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28
Q

What is the definition of consciousness?

A

State of alertness, awareness, orientation, and memory

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29
Q

What is the definition of vegetative state?

A

May have awoken from coma, but still have not regained awareness, have sleep-wake cycles

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30
Q

What is the definition of persistent vegetative state?

A

Same as vegetative state with a longer duration (> 4 weeks)

Decreased quality of life

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31
Q

What does A and O x 3 mean?

A

Assess alertness and orientation by asking person, place, and time

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32
Q

What is the Glasgow Coma Scale?

A

Classify/describe severity of injury during the acute stage of a TBI

Measures motor response, verbal response, and eye opening

Based on 3-15 point scale and categorize outcomes of TBIs

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33
Q

What is the general scale of the Glasgow Coma Scale?

A

3-8: severe brain injury and coma in 90% of pts

9-12: mod brain injury

13-15: mild brain injury

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34
Q

What are the 3 categories of GCS?

A

Eye opening
Motor response
Verbal response

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35
Q

What is decorticate posture?

A

Trunk and LE in ext

UE in flex

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36
Q

What is decerebrate posture?

A

Trunk and extremities in ext

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37
Q

What characterizes a mild TBI?

A

LOC and/or confusion <30’

MRI and CT scans often are normal

Commonly overlooked

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38
Q

What are the sx/sx of mild TBI?

A 
Fatigue
HA
Visual disturbances
Memory loss
Poor attention
Sleep disturbances
LOC
Dizzy
Irritability
Depression
Seizures
Nausea
Loss of smell
Sensitivity to light and sounds
Mood changes
Getting lost or confused
Slowness in thinking
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39
Q

What is the definition of moderate brain injury?

A

BI resulting in LOC from 20 min to 6 hr

GCS = 9 to 12

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40
Q

What is the definition of severe brain injury?

A

BI resulting in LOC for greater than 6 hours

GCS = 3 to 8

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41
Q

What are the prognosis indicators for TBI?

A

Duration of coma
Memory impairments
Age

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42
Q

What does aterograde mean?

A

Inability to create new memory

Last to recover post-coma

*Think anterior = not able to move forward and create new memories

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43
Q

What is the definition of post-traumatic?

A

Time b/t injury and when pt able to recall recent events

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44
Q

What is the definition of retrograde?

A

Inability to remember events prior to injury

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45
Q

What occurs during the acute management/ICU of TBI?

A

Minimize secondary injury and life support

Mechanical ventilation

Stent to control ICP

Meds

Surgical intervention

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46
Q

What ICP level is considered dangerous?

A

20 mmHg

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47
Q

What are the classification tools for TBI?

A

Glasgow Coma Scale

Rancho Los Amingos Scale

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48
Q

What is the Ranchos Lose Amigos scale of cognitive functioning?

A

Assess BI recovery

Measures levels of awareness, cognition, behavior, and interaction with environment

Can plateau at any time and not get completely through Ranchos scale

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49
Q

How are the levels of RLAS ranked?

A

Level 1 = most serious

Level 8 = normal and appropriate

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50
Q

What is the developmental sequence for TBI posture treatment?

A 
POE
Quadruped
Bridging
Sitting
Kneeling/half-kneeling
Modified plantigrade
Standing
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51
Q

What is modified plantigrade?

A

Standing with B UE support

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52
Q

What is a suspensory strategy?

A

Crouch strategy

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53
Q

What is Alzheimer’s Disease?

A

Progressive neurodegenrative disorder

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54
Q

What are the physiologic characteristics of Alzheimer’s Disease?

A

Neurons normally involved in ACh transmission deteriorate within the cerebral cortex

Amyloid plaques and neurofibrillary tangles = more damage

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55
Q

What causes Alzheimer’s Disease?

A

Unknown

Thought to be lower levels of NT, higher levels of Al- within brain tissue, genetic inheritance, autoimmune disease, abnormal processing of amyloid, and virus

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56
Q

What are the sx/sx of Alzheimer’s disease?

A

Difficulty with new learning and changes in memory and concentration

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57
Q

What is the progression of AD?

A

Disorientation, word finding difficulties, emotional lability, depression, and poor judgement

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58
Q

What are the middle stages of AD?

A

Behavioral and motor probs such as aphasia, apraxia, rigidity, bradykinesia, shuffling gait, decrease (I) ADLs, perseveration, agitation, violent behavior, and wandering

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59
Q

What are the end stages of AD?

A

Severe intellectual and physical destruction, incontinence, functional dependence, seizure activity, and inability to speak

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60
Q

What is the tx for AD?

A

No cure

Meds can help symptoms

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61
Q

How does PT benefit AD?

A

Maximize function and education

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62
Q

What risks are posed to AD pt?

A

High risk for infection and pneumonia, contractures, decubiti, and fractures

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63
Q

What is ALS?

A

Chronic, degenerative resulting in UMN and LMN impairments

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64
Q

What are the physiologic characteristics of ALS?

A

Demyelination, axonal swelling, and atrophy within cerebral cortex, premotor areas, sensory cortex, and temporal cortex cause the sx

Rapid degeneration that causes denervation of mm fibers, mm atrophy, and weakness

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65
Q

What is the cause for ALS?

A

Unknown

Thought to be caused by genetics, slow acting virus, metabolic disturbances, toxicity of lead and aluminum

More common in men between 40-70 years old

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66
Q

What are the sx/sx of ALS?

A

Asymmetric mm weakness, cramping, and hand atrophy

Mm weakness d/t denervation cause fasciculations, atrophy, and mm wasting distally to proximal. Ends in eventual resp paralysis

Dysarthria, dysphagia, and emotional lability

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67
Q

What is the primary indicator of ALS?

A

Motor impairment without sensory impairment

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68
Q

What is the tx for ALS?

A

No cure

Meds may help with sx

69
Q

What PT interventions are there for ALS?

A

QOL and education

Low-level exercise

ROM, mobility training, AD, w/c prescription, bronchial hygiene, and energy conservation

70
Q

What is Parkinson’s Disease?

A

Primary degenerative disorder

Decrease dopamin production

Degeneration of dopaminergic pathways create imbalance b/t dopamine and ACh

71
Q

What is Parkinsonism?

A

Describes sx that are most commonly seen. Can be used to describe sx outside of PD such as hand tremors, slow movement, limb rigidity, and gait and balance pattern

72
Q

What makes Levadopa a successful drug for PD?

A

Can cross BBB and convert to dopamine

73
Q

What is the etiology of PD?

A

Unknown

Thought to be caused by genetics, CO toxicity, excess manganese or copper, vascular impairment of striatum, encephalitis, and HD or AD

74
Q

What are the sx/sx of PD?

A

Resting tremor (pill-rolling) that increases with stress and disappears during sleep

75
Q

What are the early sx/sx of PD?

A

Balance impairments, difficulty rolling and rising from bed, fine motor impairments, and difficulty bathing and dressing

76
Q

What are the progressive sx/sx of PD?

A

Hypokinesia, sluggish movement, difficulty initating and stopping movement, festinating and shuffling gait, bradykinesia, poor posture, dysphagia, and cogwheel/lead pipe rigidity

77
Q

What is cogwheel rigidity?

A

Tension in mm that gives way in little jerks when the Mm is passively stretched

78
Q

What is lead pipe rigidity?

A

A “smooth” rigidity

Does not stop and give, stop and give

79
Q

What is freezing in a PD patient?

A

Body can’t move the way they want to during amb

80
Q

What is tx of PD?

A

Dopamine replacement to reduce movement disorders, bradykinesia, rigidity, and tremor - IE. levadopa, sinemet, madopar

81
Q

What PT interventions are there for PD?

A

PWR
LSVT BIG
Rock Steady

82
Q

What is Guillain-Barre Syndrome?

A

AKA acute polyneuropathy

Autoimmune disorder

Temp inflammation and demyelination of the peripheral myelin sheaths

Potential axonal degeneration

83
Q

What is the etiology of Guillain-Barre Syndrome?

A

Unknown

Thought to be autoimmune response in response to previous resp infection, flue, immunization, or surgery

84
Q

What are the sx/sx of GBS?

A

Distal symmetrical motor weakness and mild distal sensory impairment, and possible resp paralysis

Absent DTRs, inability to speak or swallow

85
Q

When does GBS normally peak?

A

2-4 weeks after onset

86
Q

What is the tx of GBS?

A

Hospitalization - immunosuppressive and narcotics

Cardiac monitoring, plasmapheresis, and possible mechanical vent

87
Q

What PT interventions are involved with GBS?

A

Education, pulm rehab, strengthening, mobility training, w/c and orthotic prescription, and AD training

88
Q

What PT interventions are involved in acute care for GBS?

A

PROM, positioning, and light exercise

89
Q

What are special considerations to GBS?

A

May experience pelvic floor weakness, deep mm p!, arrhythmia, tachycardia, postural hypotension, and heart block

90
Q

What is a heart block?

A

Heartbeat decreases and becomes so slow and the beat does not occur fast enough between chambers to pump out

91
Q

What is Huntington’s Disease?

A

CNS disorder characterized by degeneration and atrophy of basal ganglia and cerebral cortex

Progressive disease

92
Q

What is the cause of Huntington’s Disease?

A

Genetics

93
Q

What are the sx/sx of Huntington’s disease?

A

Involuntary choreic movement, mild alt in personality, grimacing, tongue protrusion, and ataxia

94
Q

What are the sx/sx of late stage Huntington’s disease?

A

Mental deterioration, depression, dysphagia, incontinence, immobility, rigidity

95
Q

What is the tx for Huntington’s disease?

A

Meds to tx sx (anticonvulsants and antipsychotics)

96
Q

What PT interventions are done for Huntington’s Disease?

A

Max endurance, strength, balance, postural control, and functional mobility

No way to stop or reverse sx

97
Q

What is MS?

A

Produce patches of demyelination of myelin sheaths that surround nn within brain and SC

Decrease nn conduction

Sx based on location and extent of demyelination

98
Q

What is relapsing-remitting MS?

A

Relapse with full recovery or some residual neurological sx

99
Q

What is primary-progressive MS?

A

Disease progression from onset, without plateaus or remission

Usually dx later in life

100
Q

What is secondary-progressive MS?

A

Initial relapse-remitting course, followed by progression at variable rate that may also include occasional relapses and minor remissions

101
Q

What is secondary-progressive MS?

A

Progressive disease from onset, but without clear acute relapses that may or may not have some recovery or remission

102
Q

What is benign MS?

A

~20%, abrupt onset, one or a few exacerbations and complete or near complete remissions

103
Q

What is Lhermitte sign?

A

Flex of neck may induce a tingling, electric shock like feeling down the shoulders and back

104
Q

What is the cause of MS?

A

Unknown

105
Q

What are the possible causes of MS?

A

Genetics, viral infections, and environment

Slow-acting virus may initiate an autoimmune response

106
Q

What population is most at risk for MS?

A

20-35 y/o, caucasian, F

107
Q

What are the sx/sx of MS?

A

Visual problems (blurred or double)

Paresthesias

Clumsiness

Weakness

Ataxia

Balance dysfunction

Increased tone

Fatigue

108
Q

What is the tx for MS?

A

Lessen the length of exacerbation and minimize health

Corticosteroids
Nutritional and psych counseling
PT education

109
Q

What are added risks of MS?

A

Fatigue increased with heat and can be exhausting

Suicide is 7x> than when compared to same age without MS

110
Q

What are the common PT interventions for MS?

A 
Avoid max exercise
Exercise in AM is best
Use RPE not HR
Educate on skin care
Biofeedback for stress management/relaxation
Exercise guidelines
111
Q

What is myasthenia gravis?

A

Autoimmune disease that affects neuromuscular signals

112
Q

What is the cause of myasthenia gravis?

A

Associated with enlarged thymus, diabetes, RA, lupus, and other immune disorders

113
Q

What are the sx/sx of myasthenia gravis?

A

Extreme fatigue and mm weakness

Ocular mm

Proximal weakness over distal

Dysphagia, dysarthria, and cranial nn weakness

114
Q

What are tx options for myasthenia gravis?

A

Medical emergencies = exacerbations can cause resp mm requiring ventilators

ACh drug therapy, plasmapheresis, and immunosuppressive therapy

PT interventions

115
Q

What PT interventions are involved in myasthenia gravis?

A

Resp and pulm intervention

Energy conservation

Sub-max strengthening

116
Q

What is post-polio syndrome?

A

LMN pathology affecting anterior horn cells in those previously affected by polio

Autoimmune

117
Q

What is polio?

A

Viral infection resulting in neuropathy that includes focal and asymmetrical motor impairments

118
Q

What is the cause of post-polio syndrome?

A

Previous dx of polio

Rarely life threatening

119
Q

What population is most affected by post-polio syndrome?

A

F > M

120
Q

What are the sx/sx of post-polio syndrome?

A 
Asymmetrical weakness
Slow and progressive weakness
Fatigue
Mm atrophy
Pain
Dysphagia
121
Q

What is the tx of post-polio syndrome?

A

No meds to alter progression

Lifestyle modification and symptom intervention

PT education

122
Q

What is involved in PT interventions of post-polio syndrome?

A

Supervised exercise to improve overall conditioning

Functional independence

Adaptive equipment

123
Q

What is the Mini Mental State Examination?

A

Looks at different parts of the brain

124
Q

What is muscle tone test?

A

Modified Ashworth Scale

Go for a slower pace through PROM

125
Q

What are the tests for spasticity?

A

Modified Ashworth Scale

Clonus

126
Q

What is Bell’s Palsy?

A

Temp unilateral facial paralysis secondary to trauma to facial nn

Abnormal pressure from edema or inflammation

127
Q

What is the function of the facial nerve?

A

Sensory - taste anterior tongue

Motor - facial mm, lacrimal, submandibular, and sublingual glands

128
Q

What is the test for Bell’s Palsy?

A

Close eyes tight, smile and show teeth

Whistle and puff cheeks and identify familiar taste

129
Q

What are the sx/sx of Bell’s Palsy?

A

Inability to furrow brow

Drooping eyelid and cannot close eye

No mm tone in cheek

Drooping mouth and cannot smile or pucker lips

130
Q

What is the cause of Bell’s Palsy?

A

Unclear

Could be viral infection or inflammation

131
Q

What is the tx of Bell’s Palsy?

A

The earlier the tx the better the outcome

Mild involvement should resolve in 2 weeks

More severe might require anti-viral meds and corticosteroids

PT intervention

132
Q

What PT intervention is included with Bell’s Palsy?

A

Stimulate facial nn

Facial massage

Exercise

133
Q

How can you stimulate the facial nn?

A

Mm tapping
Manual therapy
Visual feedback

134
Q

What is CTS?

A

Compression of median nn

Normal tissue pressure of the carpal tunnel

135
Q

What makes up the carpal tunnel?

A

Floor - carpal bones
Ceiling - transverse carpal ligament

Nerves, vasculature, and tendons run through

136
Q

What causes CTS?

A 
Overuse
Pressure
Trauma
RA
Pregnancy
Diabetes
Tumor
Hypothyroidism
Wrist sprain or fracture
137
Q

What are the sx/sx of CTS?

A 
Night pain
Decreased hand mobility
Hand weakness
Atrophy
Clumsiness
138
Q

What are the tests to dx CTS?

A

Tinels sign

Phalen’s test

139
Q

What is the Phalen’s test?

A

Inverted prayer sign ~60 sec and see if sx reproduce

140
Q

What is the reverse Phalen’s test?

A

Prayer sign - wrist ext

141
Q

What is polyneuropathy?

A

Damage or disease affecting multiple peripheral nn

May involve damage to the axon, myelin sheath, or nerve’s cell body

142
Q

What is the cause of polyneuropathy?

A 
DM
Advanced age
Drugs (chemo)
Alcohol abuse
AIDS
Environmental toxins
Inherited neurological conditions
143
Q

What are the sx/sx of polyneuropathy?

A

Begins B distal LE

Numbness, tingling, and pain in a stocking glove pattern

Loss of position and vibration sense, ataxia, mm weakness, and possible atrophy

Constipation, loss of b/b control, and orthostatic hypotension

144
Q

What is the tx of polyneuropathy?

A

Wound management/education
Vestibular/visual balance
Gait training

145
Q

What kind of gait training is involved with someone who has polyneuropathy?

A 
Visual scan
Create an obstacle course
WB facilitation through WS
Righting reaction
Orthotic training
AD training
Home/community amb
146
Q

How can you integrate sensation in someone with polyneuropathy?

A

Different textures - IE. wipe with cotton t-shirt, washcloth, hot water, cold water, etc

Attempt to wake up/stim nn

Fluidotherapy

147
Q

What is sciatica?

A

Due to compression of sciatic nerve - herniated disc, tumor, infection, spondylolisthesis, stenosis, and blood clots

148
Q

Where does sciatica take place?

A

L4-S3

149
Q

What is the cause of sciatica/herniated disc?

A

Natural aging process

Instability of disc

150
Q

What are the sx/sx of sciatica?

A

LBP/gluteal pain with radiculopathy

Decreased ROM, TTP, and mm guarding

SLR test

Increased pain in sitting, lifting, forward bending/twisting, sneezing, and coughing

151
Q

What is the tx of sciatica?

A

NSAIDs
Cortisone epidural or local anesthetic injections
Surgery - laminectomy, discectomy, laser discectomy

PT education

152
Q

What PT interventions are there with someone with sciatica?

A 
Pain management
Traction
Heat
Core stabilization
McKenzie exercises
Stretching
Endurance activities - swimming, biking, and walking
153
Q

What is thoracic outlet syndrome?

A

Neurovascular compression and damage of brachial plexus nn trunks, subclavian vascular supply and/or axillary artery

154
Q

What is the cause of thoracic outlet syndrome?

A

Abnormal first rib, postural deviations, body composition, chronic overhead work, scalenes hypertrophy or spasm, degenerative disorders, and elongated cerv transverse process

155
Q

What are the sx/sx of thoracic outlet syndrome?

A

Diffuse arm pain most common at night

Paresthesias

Mm weakness and atrophy

Poor posture

Edema

Discoloration

156
Q

What are the tests for thoracic outlet syndrome?

A 
Adson's maneuver
Wright's test
Roo's test
Costoclavicular test
Hyperabduction test
Allen test
157
Q

What is the tx for thoracic outlet syndrome?

A

NSAIDs
Surgery
PT education

158
Q

What PT interventions are involved in thoracic outlet syndrome?

A 
Posture
Breathing
Ergonomics/body mechanics
Stretching
Pain management
Joint mobs
Physical agents PRN
159
Q

What is the Allen’s test?

A

See vascular response

Palpate radial pulse and then ulnar artery

Pt fist pumps and holds

Release radial artery then ulnar to see if vascularity comes back

Repeat to the ulnar side

160
Q

What is trigeminal neuralgia?

A

Abnormal pressure on or irritation of trigeminal nerve

161
Q

What sensory and motor impact does trigeminal neuralgia?

A

Sensory - touch and pain, mucus membranes of nose, sinuses, mouth, and anterior tongue

Motor - mastication

162
Q

What are the tests of trigeminal neuralgia?

A

Corneal reflex
Face sensation
Clench teeth
Push down on chin to separate jaw

163
Q

What is the cause of trigeminal neuralgia?

A

Tumor or swollen blood vessel

164
Q

What population is trigeminal neuralgia most commonly at risk?

A

Females over 50

Common with MS

Most common injury location in narrow space where nn exits brainstem

165
Q

What are the sx/sx of trigeminal neuralgia?

A

Unilateral and episodic or constant

166
Q

What is episodic trigeminal neuralgia?

A

Sudden sharp, jolting, stabbing, or stock-like pain

Spasms/tics

Triggered by touch or sound most common during shaving, chewing, or oral care

167
Q

What is chronic trigeminal neuralgia?

A

Persistent aching or burning that can exacerbate

168
Q

What are the tx of trigeminal neuralgia?

A

Pt education of resting jaw position

Massage to masseter

Diaphragmatic breathing

Desensitizing

Neuro PTA (3 decks)

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