Comp Exam Flashcards
Scapula Spasticity Pattern
retraction
downward rotation
Shoulder Spasticity Pattern
adduction and IR
depression
Elbow Spasticity Pattern
Flexion
Forearm spasticity pattern
pronation
Wrist spasticity pattern
flexion
adduction
Hand spasticity pattern
finger flexion
clenched fist
thumb adducted in palm
Pelvis spasticity pattern
retraction (hip hiking)
Hip spasticity pattern
adduction
IR
extension
Knee spasticity pattern
extension
Foot and ankle spasticity pattern:
plantarflexin inversion equinocarus toe claw toe curls
UE flexion synergy pattern:
scapular retraction/elevation, shoulder abduction, ER, elbow flexion, forearm supination, wrist and finger flexion
UE extension synergy pattern:
scapular protraction, shoulder adduction, IR, elbow extension, forearm pronation, wrist and finger flexion
LE flexion synergy pattern:
hip flexion, abduction, ER, knee flexion, ankle dorsiflexion and inversion
LE extension synergy pattern:
hip extension, adduction, IR, knee extension, ankle plantarflexion and inversion
BERG balance low fall risk
41-56
BERG balance moderate fall risk:
21-40
BERG balance high fall risk
0-20
ACA stroke:
contralateral hemiparesis of mainly LE
contralateral hemisensory loss mainly LE
urinary incontinence
problems with bimanual tasks. apraxia
MCA stroke:
contralateral spastic hemiparesis and sensory loss of face, UE and LE with face and UE more involved broca's or nonfluent aphasia wernicke's or fluent aphasia global aphasia neglect contralateral homonymous hemianopsia
PCA stroke:
contralateral homonymous hemianopsia visual agnosia dylexia memory defect topographic disorientation
Stage 1 motor recovery:
initial flaccidity, no voluntary movement
Stage 2:
emergence of spasticity, hyperreflexia, syngeries
Stage 3:
voluntary movement possible, only in synergies, spasticity strong
Stage 4:
voluntary control in isolated joint movement emerging, decline of spasicity and syngergies
Stage 5:
increasing voluntary control out of syngery
coordination deficit present
Stage 6:
control and coordination near normal
Typical right sided CVA:
apraxia, impulsive, neglect
Typical left sided CVA:
aphasia, overly cautious
Synergy:
stereotyped set of movements that occur in response to a stimulus or voluntary movement
Associated reaction:
stereotyped movements in which effortful use of one extremity influences the posture and tone of another
CIMT criteria:
10 degrees active wrist extension
thumb abduction
finger extension
Mild TBI
LOC: 0-30 mins alteration of consciousness: less than 24 hours amnesia: less than 1 day GCS 13-15 imagining: normal
Moderate TBI:
LOC: more than 30 mins, less than24 hours Alteration of consciousness: > 24 hours amnesia: >1 day < 7 days GCS: 9-12 imaging: normal or abnormal
Severe TBI
LOC: > 24 hours Alteration of consciousness: > 24 hours Amnesia: > 7 days GCS: < 9 Imaging: normal or abnormal
Stage progression following diffuse axonal injury?
coma unresponsive vigilance/vegetative state confusional state emerging independence intellectual/social competence
Common levels of injury to spinal cord:
C5, C7, T12, L1
Level A:
complete
no motor function below lesion
Level B;
incomplete
sensory but not motor function is preserved below the neurological level
Level C:
incomplete
motor function is preserved below neurological level and most key muscles have a muscle grade of less than 3
Level D:
incomplete
motor function is preserved below neurological level and most key muscles have a muscle grade of greater than 3
Level E:
normal
Central Cord Lesion
UMN
Loss of bilateral pain and temp
Loss of bilateral motor function; primarily UE
Preservation of proprioception and discriminatory sensation
Brown-Sequard Syndrome
UMN
hemisection of spinal cord
Ipsilateral loss of tactile discrimination, pressure, vibration and proprioception
Ispilateral loss of motor function and spastic paralysis below level of lesion
Contralateral loss of pain and temp below level of lesion; at level of lesion bilateral loss
Anterior cord syndrome:
UMN
loss of bilateral motor function, spastic paralysis below level of lesion
loss of bilateral pain and temp
preservation of proprioception kinesthesia and vibration
Posterior cord syndrome:
UMN
bilateral loss of proprioception, vibration pressure and stereognosis and 2 pt discrmination (DCML)
preservation of motor function, pain, and light touch
Stage 1 (PD)
minimal or absent disability
unilateral symptoms
Stage 2 PD
minimal bilateral or midline involvement
no balance involvement
Stage 3 PD
impaired balance
some restrictions in activity
Stage 4 PD
all symptoms present and severe
stands and walks only with assistance
Stage 5 PD
confined to bed or w/c
Loss of archicerebellum (flocculonodular)
central vestibular symptoms: ocular dysmetria, poor eye pursuits, dysfunctional VOR, impaired hand eye coordination
gait and trunk ataxia
Lesion of paleocerebellum (anterior)
hypotonia
truncal ataxia: poor posture, wide BOS
ataxic gait
Lesion of neocerebellum
intention temor dysdiadochokineisa dysmetria dyssynergia errors in timming
Additional impairments in cerebellar lesions:
asthenia hypotonia motor learning impairments cognition emotion dysregulation
Bulbar palsy:
LMN affecting CN VII-XII
flaccid paralysis of pharynx and larynx
CN IX and X
Pseudo-bulbar palsy:
UMN
spastic paralysis of pharynx and larynx
Bell’s palsy:
loss of control of salivation and lacrimation
CN VII
drooping of corner of mouth, eyelids that don’t close
Which cranial nerves should be examined in GBS?
VII, IX, X, XI, XII
Which cranial nerves should be examined in ALSS?
VII, IX, X, XI, XII
Stage I ALS:
early disease, mild focal weakness, asymmetrical distribution, symptoms of hand cramping and fasiculations
Stage II ALS:
moderate weakness in groups of muscles, some wasting of muscles
modified independent with AD
Stage III ALS
severe weakness of specific muscles, increasing fatigue, mild to moderate functional limitations
ambulatory
Stage IV ALS:
severe weakness and wasting of LEs, mild weakness if UEs, moderate assistance and AD required, wc
Stage V ALS:
progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk; spasticity, hyperreflexia, loss of head control, max assist
Stage VI ALS:
bedridden, dependent in ADLs, FMS, progressive respiratory distress
C1-C4 w/c;
electric w/ tilt in space
puff and sip
C5 w/c
shoulder function and elbow flexion
manual w/c with propulsion
may choose electronic w/c for energy conservation
C6 w/c
radial wrist extensors
manual w/c with friction surface hand rims
independent
C7 w/c
triceps
same as C6 with increased propulsion
Gait for T6-T9:
bilateral KAFO
crutches, swing to
supervised ambulation for short periods
Gait for T12-L3:
independent in all ambulation on all surfaces and stairs swing through or 4 pt pattern bilateral KAFO and crutches independent household ambulators w/c community
Gait for L4-L5:
independent with bilateral AFOs and crutches or canes
independent community ambulators
may use w/c for high endurance
Peripheral vestibular symptoms:
sudden memorable onset
less than 24 hours
head movement provokes symptoms
more likely to have auditory involvement
Peripheral disorders:
vestibular neuritis labyrninthitis acoustic neuroma meniere's disease BBPV toxicity
Vestibular neuritis
imbalance, nausea improving over 1-4 days
head movement sensitivity
Labryinthitis
similiar to vestibular neuritis except with hearing loss before onset of vertigo
Acoustic neuroma
tumors from Schwann cells
progressive unilateral hearing loss or tinnutus without vestibular symptoms
balance issues mild and intermittent
Meniere’s disease
postural imbalance,nystagmus, nausea, vomitting, hearling loss and aural fullness
vertigo will persist 30-42 hours
vestibular exercises not appropriate
BPPV
most common
vertigo when head is turned
Central vestibular symptoms:
sudden onset of vertigo with one of D: diplopia, dysphagia, diaphoresis, dysarthria, drop attacks
vertigo lasts 24/7
Central vestibular disorders:
disequilibrium of aging
CVA
migraine
head trauma
Exam generalizations of peripheral symptoms:
direction fixed nystagmus-horizontal
abnormal VOR via head thrust
nystagmus more likely to be seen with fixation removed
nystagmus exacerbated when gazing in fast component (Alexander’s law)
pursuit and saccade normal
nystagmus exacerbated post horizontal head shake (horizontal nystagmus)
Exam generalization of central symptoms:
direction change nystagmus nystagmus seen with fixation nystagmus to be pure vertical or torsional nystagmus post shaking vertically abnormal pursuit/ saccades cannot walk or stand with assistance
