An Overview of Neurologic Impairments Flashcards
Describe signs
These are objective findings of pathology that can be determined by physical examination
Give an example of sign
The presence of nystagmus suggests that a patient has a vestibular disorder
Describe symptoms
These are subjective reports associated with pathology that are perceived by patients, but may not necessarily be objectively documented on examination
Give an example of a symptom
Dizziness is a common symptoms associated with vestibular pathology
Describe positive signs/symptoms
the release of abnormal behavior
Give an example of some positive signs and symptoms
The presence of abnormal reflexes such as the Babinski reflex or hyperactive stretch reflexes resulting in spasticity
Describe negative signs/symptoms
the loss of normal behaviors
Give an example of some negative signs and symptoms
Paresis, the loss of descending control of LMNs
Describe how rehab utilizes positive and negative signs/symptoms
Rehab tends to emphasize positive symptoms, such as increased muscle tone, at the expense of negative symptoms, such as loss of strength
What two things contribute to motor control problems in the person with neurological dysfunction?
primary and secondary effects
Describe primary effects
These are impairments that result from a lesion in the CNS that causes problems in motor, sensory/perceptual and/or cognitive systems
Give a few examples of primary effects
Paralysis or spasticity
Describe secondary effects
These are impairments that are not directly resulting from the CNS lesion, but developed as a result of the original problems
Give a few examples of secondary effects
Changes in the structure and function of muscles, muscle contractures, and decreased joint ROM
*all of which are due to the primary effects of paralysis, spasticity, etc.
What are 3 systems in which neurological impairments can occur?
- action/motor system
- sensory system
- perceptual and cognitive systems
The action system includes areas of the nervous system such as what 3 things that perform processing essential to the control of movement?
- motor cortex
- cerebellum
- basal ganglia
Damage to the motor cortex results in what?
- motor weakness (paresis)
- abnormal synergies
- coactivation
- abnormal muscle tone (spasticity)
Define weakness
The inability to generate sufficient tension in a muscle
Define paralysis/paresis
Decreased voluntary motor recruitment that reflects an inability or difficulty in recruiting skeletal motor units to generate torque or movement
Paresis results from a lesion with _____ motor pathways
descending
How is motor weakness examined?
It is measured isometrically, isotonically, and/or isokinetically either manually or via dynamometer
What are some treatment options for muscle weakness?
- use of electrical stimulation
- strength training
How and why do abnormal synergies develop?
Lesions to the corticospinal centers can lead to loss of the ability to recruit a limited number of muscles controlling movement and the ability to control individual joints, which results in the emergence of mass patterns of movement called abnormal synergies.
Abnormal synergies reflect a lack of what?
The ability to move a single joint without simultaneously generating movements in other joints (fractionation)
True or False
The return of reflexes precedes the recovery of voluntary movement following stroke.
True
Describe Brunnstrom’s 6 stages of recovery from stroke
1) flaccid paralysis
2) development of minimal movement in synergies
3) voluntary movement synergy dependent
4) some movements out of synergy
5) movements almost independent of synergies
6) normal movements with normal speed
Define muscle tone
a muscle’s resistance to passive stretch
Define spasticity
A motor disorder, characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex
Spasticity is a component of ____ motor neuron syndrome
upper
List the continuum of muscle tone starting with flaccidity
1) Flaccidity
2) Hypotonia
3) Normal
4) Spasticity
5) Rigidity
Define flaccidity
The complete loss of muscle tone
Define hypotonia
A decreased muscle tone than normal
What is the difference between spasticity and rigidity?
Spasticity is velocity DEPENDENT, whereas rigidity is velocity INDEPENDENT
Spasticity is examined using what scale?
The modified Ashworth scale
What are some treatment approaches to spasticity?
- pharmacological treatments
- surgical management
- physical management
- strength training
What are some drugs that have shown to help treat spasticity?
- Baclofen
- Diazepam
- Tizanidine
Describe the neurophysiological approaches used physically manage spasticity.
These techniques are designed to alter muscle tone by changing the background level of activity in the motor neuron pool of the muscle
As the background level of activity in the motor neuron pool increases, the likelihood that the muscle will respond to any incoming stimulus ______.
increases
The opposite is also true; as background levels of activity decrease, the muscle is less likely to be activated.
Describe some physical management techniques to treating spasticity
- joint approximation
- joint traction
- prolonged icing
- low frequency vibration
What are the 3 categories of signs and symptoms of cerebellar pathology?
- hypotonia
- ataxia/coordination problems
- action/intention tremor
True or False
The capacity to generate force in a single muscle does not predict the ability of that muscle to work together with other muscles to perform a specific task
True
Define dysmetria
Problems in judging the distance or range of a movement
Define hypometria
Underestimation of the required force or range of movement needed for a specific task
Define Hypermetria
Overestimation of the force of range of movement needed for a specific task
Describe an intention tremor
A tremor that occurs during the performance of a voluntary movement, and is characterized by pathology of the cerebellum and its afferent and efferent pathways
When is an intention tremor most marked?
At the end of a movement, when the patient attempts to brake a movement
Pathology in the basal ganglia results in one of what 2 things?
- hypokinetic disorders
- hyperkinetic disorders
What is the best example of hypokinetic disorder?
Parkinson’s Disease
What are the 4 characteristics of Parkinson’s Disease?
- bradykinesia, akinesia, hypokinesia
- rigidity
- resting tremor
- postural instability
Define bradykinesia
The time which is taken to execute a task-specific movement once it has been initiated (movement time) is slow
Define Akinesia
Reduced ability to initiate movement
Define hypokinesia
Movements are decreased in amplitude
What is the best example of hyperkinetic disorder?
Huntington’s Disease
Define chorea
involuntary, rapid, irregular and jerky movements that result form basal ganglia lesions
Define athetoid movements
Slow, involuntary, writhing and twisting movements
Define dystonia
A syndrome dominated by systained muscle contractions, frequently causing twisting and repetitive movements of abnormal postures
What are 3 kinds of deficits that result from impairments in the sensory system?
- Somatosensory deficits
- Visual deficits
- Vestibular deficits
What does a lesion in the dorsal column-medial lemniscal system result in?
Loss of discriminative touch, including light touch and kinesthetic sense.
What does a lesion in the anterolateral spinothalamic system result in?
Loss in pain sensibility and the ability to detect thermal changes, in addition to more coarse touch and kinesthetic discrimination
What does a lesion of the somatosensory cortex result in?
Loss of discriminative sensations, such as proprioception, two-point discrimination, stereognosis, and touch localization
Somatosensory effects are _____ to the side of the lesion
contralateral
Describe Fess’s hierarchy of sensory functioning from the lowest level to the highest
- Detection
- Discrimination
- Quantification
- Recognition
A lesion of the optic nerve results in what?
loss of vision in ipsilateral eye
A lesion of the optic chiasm results in what?
loss of vision in the temporal visual fields from both eyes (bitemporal hemianopsia or tunnel vision)
A lesion of the optic tract, temporal lobe, or parietal lobe results in what?
loss of vision in contralateral visual fields in both eyes (homonymous hemianopsia)
What visual characteristic is critical for functional skills?
Depth perception
Vestibular afferent information is essential for what 3 things?
- gaze stabilization
- posture and balance
- our conscious sense of orientation in space
What is the most common cause of vertigo?
Benign Paroxysmal Positional Vertigo (BPPV) due to displacement of otoconia into the posterior semicircular canal
How are vestibular deficits assessed?
via the Dix Hallpike maneuver
How are vestibular deficits treated?
- Canalith Repositioning Maneuver
- habituation exercises
Damage to which lobe of the brain results in perceptual impairments?
the parietal lobes
What is perception responsible for?
integrating sensory inputs into meaningful information
Define body scheme/image
The awareness of body parts and their relationship to one anther and the environment
Define apraxia
The inability to carry out purposeful movement in the presence of intact sensation, movement, and coordination
Describe ideomotor apraxia
Movement may occur automatically but cannot be performed on command
Describe ideational apraxia
Purposeful movement is not possible either automatically or on command
Describe why patients with primary sensory impairments will have some cognitive/perceptual problem.
Because intact sensation is a necessary prerequisite for perception
What are 4 strategies for modifying treatment to accommodate patients with cognitive problems
- Reduce confusion: use concise and clear instruction
- Improve motivation: work on important and relevant tasks
- Improve problem-solving ability: begin with simple tasks and gradually increase task complexity
- Encourage declarative and procedural learning
