class 2: neuro DD Flashcards
UMN lesion - tone
hypertonicity
UMN lesion - reflexes
hyper reflexia
UMN lesion - sesnsation
decreased
UMN lesion - involonary muscle moevemnts
muscle spasms
UMN lesion - voluntary movements
movement in syngerist patterns
LMN lesion - tone
hypo tone
UMN lesion - what is involved
cortex, BS, SC
LMN lesion - what is involved
peri nerves, nerve roots, CN
LMN lesion - reflexes
hypo-reflexia
LMN lesion - sensationn
decreased
LMN lesion - voluntary movement
fasiculations
basal ganglia lesion - tone
rigid
basal ganglia lesion - reflexes
normal or decreased
basal ganglia lesion - sensation
normal
basal ganglia lesion - involintary movement
resting tremor
basal ganglia lesion - voluntary movements
bradykinsia or akinesia
what is bradykinesia
slowness of movement
what disease is bradykinesia a common symtom of
park
cere - tone/reflexes
decreased or normal
cere - senstation
normal
cere - involuntary movements
normals
cere - voluntary movement
axtia, intention tremor, D and D, nystagmus
what is the purpose of a CT scan vs MRI
better for imaging bones and blood vessels, while MRIs are better for imaging soft tissue
spacity vs rigidity
spa: movement and then it is restricted, velocity dependent
rigdity: will not let you move from the start
difference between hypokinesia and bradykinesia
Bradykinesia is a complex consisting of slowness of movement
hypokinesia (small or decreasing amplitude movement),
what is akinsia
inability to initiate movement
what happens with parkinsons
depletion of dopamine in substantia nigra
what is the difference between resting tremor and intention tremor
resting - seen at rest
intention - seen when starting to move
is park seen more in men or women
men
older adults
what are the cardinal signs of parks
- Tremor (Resting)
- Rigidity
- Akinesia
- Postural instability
what is park gait
a walking pattern that’s characterized by short, shuffling steps, reduced arm swing, and difficulty starting and stopping
TRAP - park
tremor - intention
Rigidity - cogwheel or leadpipe, proximal, intially proximal
Akinesia - cannot inciate movement
postural instability - throcic kyphosis and forward head
what is the diffierence between cog wheel and leadpipe
cog - rachet like
lead- smooth and consistent thorughout
Hoehn and Yahr Classification of Disability - 1
unilateral if present.
Hoehn and Yahr Classification of Disability - 2
Minimal bilateral or midline involvement.
Balance not impaired.
Hoehn and Yahr Classification of Disability - 3
Unsteadiness when turning or rising from chair.
Some activities are restricted, but patient can live independently
Hoehn and Yahr Classification of Disability - 4
Standing and walking possible only with assistance.
Hoehn and Yahr Classification of Disability - 5
Confined to bed or wheelchair.
Early symptoms: park
- Loss of smell
- Constipation
- Sleep disorders
motor sign of park
Hypophonia, mask-like face, micrographia
what us hypophonia
a person’s voice to be abnormally soft, weak, and breathy.
respiration and park
a person’s voice to be abnormally soft, weak, and breathy.
Cognition/Behavior: park
Difficulty with dual tasking, depression, dementia
BP and park
ortho hypotensio
what is Freezing of Gait in park
Sudden inability to initiate movement
what are some things to do to combat reezing of gait
̶Visual Targets – Drop a tissue, music, wide doorways/modify
environment
what is Festinating Gait park
Short stride, shuffling, increasing speed, anteropulsive, decreased arm swing
what can we do for Festinating Gait park
̶Add toe wedge or declined heel to move COM posteriorly
what is the main treatment for park
big movements
what is the main drug treatment for park
Levodopa/Carbidopa:
what is the issue with Levodopa/Carbidopa:
on/off phases
Random fluctuations in motor performance and
responses
what are the on/off time call for levodopa
̶Dyskinesia: On phase
̶Dystonia: Off phase
when should a PT be scheduled around levodopa
PT one hour after dose
diet and levodopa
*High-protein diet can block the effectiveness of levodopa
what is DYSKINESIA
Involuntary, repetitive, smooth,
muscle movements
* e.g., snake-like twisting of arm
what is enbloc turning
the whole body terms instead of just the head of body
what muscle groups do DYSKINESIA effect
Affects large muscle groups
(arms, head, trunk, legs)
is DYSKINESIA on or off phase
on
what is DYSTONIA
Prolonged, involuntary muscle
contractions; muscle spasm
* e.g., toe curling
what muscle groups do DYSTONIA effect
Affects a specific muscle or group
of muscles
DYSTONIA on or off
off
what causes MS 2/2
AUTOIMMUNE disease
- Progressive demyelination
of the neurons in CNS
MS - motor symtoms
spasicty
MS - sensory
numbness and paratheis
what is Pseudobulbar affect
a neurological disorder that causes uncontrollable episodes of laughing or crying that are inappropriate for the situation
is MS a UMN or LMN disorder
UMN
Pseudobulbar affect is often seen with what disease
MS and ALS
what is Optic Neuritis,
nerve becomes inflamed and swollen, which can cause vision loss and other symptoms
seen with MS
what is Trigeminal Neuralgia
a chronic pain condition that causes sudden, severe, shock-like facial pain.
seen with MS
what is the big feature seen with MS
fatigue
what are the Unique Signs and Symptoms of MS
- Lhermitte’s Sign
- Uhthoff’s Phenomenon
- Charcot’s Triad
- Cranial Nerve- II
what is Lhermitte’s Sign
transient electric shock sensation down the spine and extremities caused by neck flexion.
MS
hair messy - when you bend your head you hair gets messy
what is Uhthoff’s Phenomenon
It is characterized by a temporary worsening of MS symptoms when your body’s temperature is raised by fever, exercise, or using a hot tub or sauna.
MS
Utha is warm
what is Charcot’s Triad
nystagmus, intention tremor, and ataxic dysarthria.
SIN - scanning, speech, intention tremor, nys
what is Progressive Relapsing MS
Steady increase
in disability with superimposed attacks
what is Secondary Progressive MS
Initially RR,
then symptoms increase without
periods of remission
what is Primary Progressive MS
Steady increase in
disability without attacks/exacerbations
CN 2 and MS
marcus gun pupil
with the oupillary light reflex the eye dilated instead of contricting
what is Relapse-Remitting RR MS
Short duration
attacks with full or partial recovery,
may or may not leave lasting
symptoms/deficits
what is optic neutris
inflammation of CN II
seen with MS
what is the most common type of MS
Relapse-Remitting RR MS
what are the main MS intervention
Do not overfatigue
- Manage Overheating/
Temperature - Energy conservation
when is the best time to work with MS pt’s
Exercise is best in the morning
what is the best intensity for MS pt’s
Low intensity (3-5 METS)
50-70% VO2 (SUBMAX)
MS pt - freq
3-5x/week (alternating days,
mornings if possible)
what is ALS
Progressive neurological
disorder that damages
nerve cells and causes
disability
- Death of motor neuron
what are the signs and sym of ALS - motor neurons
UMN & LMN presentation without sensory loss
ALS - LMN sign
̶Muscle atrophy, fasciculations (LMN)
ALS - UMN sign
̶Spasticity, hyperreflexia (UMN)
what are bulbar ALS symtoms
̶Dysphagia, dysarthria (Bulbar)
what is the only thing effects with ALS
only motor neurons
what is the most common cause of death in ALS pt’s
Respiratory muscle weakness
what is the medical managment for ALS
no specific ALS
- No effective treatment for disease
PT Management for ALS
Focus on functional activities/ADLs and energy conservation initially and end stages
avoid over fatigue
what type of issues is Guillain-Barré Syndrome
an autoimmune issue
when does Guillain-Barré Syndrome appear
after an infection
what is Guillain-Barré Syndrome
Acute inflammatory DEMYELINATING
POLYRADICULONEUROPATHY
Rapid asymmetrical loss of myelin in
nerve roots, peripheral nerves and
cranial nerves
what are the sign and sym of Guillain-Barré Syndrome - motor
̶DISTAL TO PROXIMAL
̶Rapid and progressive
what are the sign and sym of Guillain-Barré Syndrome - sensory
̶Glove and stocking
̶Burning, tingling, numbness
what are the sign and sym of Guillain-Barré Syndrome - reflexes
- Decreased reflexes/Areflexia
Guillain-Barré Syndrome - * Respiratory and cranial involvement:
VII (facial)
IX (gloss)
X (vestibular)
XI (accessory spinal)
XII (hypoglossal)
what is GBS Intervention
- Respiratory care
- Teach energy conservation techniques
- Avoid overuse and fatigue (can prolong recovery)
what is the recovery rate for GB
Recovery: 6-12 months, may recover fully
Parkinson is associated in what part of the brain where is the substantial Niagara?
The basil ganglia
whatis the worst type of MS
progressive relapsing
what is clincal isolated syndrome
they have only had one MS episode
how many episode do you need to have MS
at least 2 episodes
and 2 lesions on MRI imaging
what temp should MS patient work out at
<85-deg
what part of the cervical spine doesALS effect
the c-spine extensors
this leads to a flexed neck position
GB is normally after what kind of infection
respiratory infection
what is the GBS acroymn
G: glove and stocking
B: bilateral
S: sym
what CN are most commonly involved with MS
2 and 5
optic neuritis
trigeminal neuralgia
what happens with marcus gun syndrome and MS
with the pupillary light reflex the eyes dilate instead of contrict
what is a cataract
cloudy area in the lens of the eye that leads to a decrease in vision of the eye.
