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NMS > Dorsal Column and Cerebellar Tests > Flashcards

Dorsal Column and Cerebellar Tests Flashcards

1
Q

The cerebellum is important for ________ and ___________

A

Motor learning

Timing of motor activity

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2
Q

The cerebellum fine tunes the force of agonist and antagonist muscle activity simultaneously and sequentially across multiple joints to produce _________

A

Smooth flowing, goal directed movements

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3
Q

Cerebellar dysfunction will result in:

A
  • Decomposition of movements

- Under and over shooting of goal directed movements

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4
Q

Under and over shooting of goal directed movements

A

Dysmetria

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5
Q

Romberg Test

A
  • Have patient stand still with heels together.

- Ask patient to remain still and close their eyes

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6
Q

Positive Romberg test

A

Patient falls

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7
Q

To achieve balance, a person requires 2 out of the following 3 inputs to the cortex:
1)
2)
3)

A
  • Visual confirmation of position
  • Non-visual confirmation of position (including proprioception and vestibular input)
  • A normally functioning cerebellum
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8
Q

+ Romberg test with eyes open and closed may indicate:

A
  • Cerebellar deficit

- Vestibular mechanism deficit

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9
Q

+ Romberg test with eyes closed only may indicate:

A

Dorsal column pathology

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10
Q

Positive Hoping on one foot test

A

-Patient takes a step to maintain posture

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11
Q

+ Hopping on one foot test with eyes open and closed may indicate:

A

Cerebellar deficit

Vestibular mechanism deficit

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12
Q

+ Hopping on one foot test with eyes closed only may indicate:

A

Dorsal column pathology

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13
Q

Best test to assess minor weaknesses of the lower extremity

A

Squatting on one foot test

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14
Q

+ Squatting on one foot test with eyes open and closed may indicate:

A

Cerebellar deficit

Vestibular mechanism deficit

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15
Q

+ Squatting on one foot test with eyes closed only may indicate

A

Dorsal column pathology

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16
Q

Finger-to-nose test

A
  • Arms straight out to side and attempts to touch tip of the nose. Perform eyes open and closed
  • Movement should be smooth and accurate
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17
Q

+ Finger-to-nose test where movements are uncoordinated is known as _________

A

Dyssynergia

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18
Q

+ Finger-to-nose test where the person displays inaccuracies in measuring distance

A

Dysmetria

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19
Q

Undershooting

A

Hypometria

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20
Q

Overshooting

A

Hypermetria

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21
Q

Finger-to-finger test

A

Patient begins with arms stretched out to the side and attempts to touch index fingers together in front of them with eyes open and closed
-Movement should be smooth and accurate

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22
Q

+ Finger-to-finger test that shows uncoordinated movement is known as __________. If movement is coordinated, but inaccurate in measuring distance, it is known as __________

A 
Uncoordinated = Dyssynergia
Inaccurate = Dysmetria
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23
Q

Finger-to-nose-to-finger Test

A

Dr. stands with finger about 2 feet from patient alternating touching the nose then the finger.

  • Dr changes position of his finger after each touch
  • Movement should be smooth and accurate
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24
Q

+ Finger-to-nose-to-finger test would indicate only __________

A

Dyssynergia

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25
Q

Heel-to-shin test

A

Patient attemps to run heel from one side down the anterior shin from the knee to the ankle of the opposite leg.

  • Perform bilaterally with eyes open and closed
  • Movement should be smooth and accurate
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26
Q

+ Heel-to-shin test that shows uncoordinated movement is known as ___________, while inaccuracies in assessing distances is known as ________

A 
Movement = Dyssynergia 
Accuracy = Dysmetria
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27
Q

Ability to perform rapid alternating actions properly and improperly

A 
Properly = Diadochokinesia
Improperly = Dysdiadochokinesia
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28
Q

Dysdiadochokinesia indicates a possible ___________

A

Cerebellar dysfunction

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29
Q

Holmes Rebound phenomenon

A

Patient contracts flexors of forearm against Dr’s resistance.

  • Dr. releases quickly
  • Performed bilaterally with eyes open and closed
  • Should see normal check reflex
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30
Q

+ Holmes Rebound that is an uncoordinated movement is known as ___________, while coordinated but inaccurate movement is known as______

A 
Uncoordinated = Dyssynergia
Inaccurate = Dysmetria
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31
Q

Tandem Gait

A

Walking in a straight line placing heel directly in front of opposite toes

  • Performed with eyes open and closed
  • Movement should be smooth and accurate
32
Q

+ Tandem gait findings

A 
Dyssynergia = uncoordinated movement
Dysmetria = inaccurate movements with respect to distance
33
Q

Joint position test

A

Dr. examines one digit of the patients hand or foot grabbing a single digit from the sides performs moving the joint

  • Patient should identify if the joint went up or down
  • Done with eyes closed only
34
Q

+ Joint position test indicates what pathology?

A

Posterior column disease

35
Q

Deep pain and pressure sensation is mediated by what area of the spinal cord?

A

Dorsal columns

36
Q

Abadies sign

A

Loss of pain when pinching the achilles

37
Q

Pitre’s sign

A

Loss of pain when pinching the testicles

38
Q

Biernacki’s sign

A

Loss of pain when pinching or striking the Ulnar nerve (proximal medial aspect of the Ulna)

39
Q

Last test for deep pain and pressure

A

Pressure on the eyeball

40
Q

Classic example of a posterior column disease

A

Tabes dorsalis

41
Q

Combined superficial and deep sensations which are subject to higher function of memory

A

Multimodal sensation

42
Q

Stereognosis test

A

Place a common object in the hand (pin, key, button, paperclip) with the eyes closed

  • Patient should be able to identify it in that hand
  • Perform bilaterally
43
Q

Barognosis test

A

Assess relative weight of similarly sized and shaped objects that have differing weights

44
Q

Topognosis test

A

Touch patient somewhere on skin and have them point to the area

45
Q

Graphognosis test

A

Test by writing a letter or number on palm, chest, or back

46
Q

Normal values for the 2-point discrimination test on the fingertips, dorsum of fingers, palm, and dorsum of the hand

A

Tips = 2-4 mm
Dorsum fingers = 4-6 mm
Palm = 8-12 mm
Dorsum of hand = 20-30 mm

47
Q

Other name for a lower motor neuron lesion

A

Radiculopathy

48
Q

Primary sensory modality worker order deficit is known as:

A

Anesthesia

Analgesia

49
Q

Where in the brain stem do the dorsal columns synapse (mechanosensory)?

A 
Cuneate nucleus (UE)
Gracile nucleus (LE)
50
Q

Where do the cuneate and gracile nuclei synapse as they travel from the brains tem to the cerebral cortex?

A

Both synapse in the Ventral Posterior Lateral Nucleus (VPL) of the Thalamus and are further relayed to the Primary Somatosensory Cortex (Brodmann 3,1,2)

51
Q

What tracts in the spinal cord relay pain and temperature to the cortex?

A

Anterior and Lateral Spinothalamic tracts

52
Q

Pathway of pain and temperature from the ascending spinothalamic tracts to the cerebral cortex

A

-Both tracts synapse in the Ventral Posterior Medial Nucleus (VPM) of the thalamus. Nerves are further relayed to the primary somatosensory cortex (Brodmann 3,1,2)

53
Q

C4 dermatome

A

Posterior aspect of the shoulders

54
Q

C5 dermatome

A

Lateral aspect of the upper arms

55
Q

C6 dermatome

A

Tip of the thumb

56
Q

C7 dermatome

A

Tip of the middle finger

57
Q

C8 dermatome

A

Tip of the pinky finger

58
Q

T1 dermatome

A

Medial aspect of the lower arms

59
Q

Superficial sensory examination includes tools to test for the following sensations:

A
  • Pain = sharp, pin prick
  • Temperature = test tubes with hot or cold water
  • Light touch = cotton swab, small brush
60
Q

Mechanoreceptor for light touch

A

Tactile disc of Merkle

61
Q

Neuropathway for light touch would be the _________________ of the cord to the thalamus

A

Anterior spinothalamic tract

62
Q

Deficits to light touch in dermatomal pattern or pain exmination may indicate _________ or __________ lesions

A
  • Nerve root compression

- Peripheral nerve lesions

63
Q

Pain examination

A
  • Use sharp and dull sides of safety pin or pinwheel
  • Patient is instructed to say if it is sharp or dull and to point to the spot
  • When comparing side to side only use sharp
64
Q

Differences in pain examination from side to side is used to find problems in what neuropathway that relays information to the thalamus?

A

Lateral spinothalamic tract

65
Q

Areas insensitive to pain

A

Alganesthesia/Analgesia

66
Q

Decreased pain sensation

A

Hypalgesia

67
Q

Increased pain sensitivity

A

Hyperalgesia

68
Q

Vibration examination

A
  • Begin at ankles using a tuning fork
  • If no sensation move to knee, then hip.
  • Patient should report vibration sensation
69
Q

Loss of vibration sensation. What tracts are affected if no vibration sensation is felt

A

Pallanesthesia

  • UE = Cutaneus
  • LE= Gracilis
70
Q

What sensation is carried along the same pathways as pain?

A

Temperature

71
Q

T/F Routine temperature exam is not required, but it would be more localized findings compared to pain sensation

72
Q

MC symptoms of dorsal nerve root compression

A

Numbness

Tingling

73
Q

Other symptoms of dorsal nerve root compression

A
  • Pallanesthesia
  • Loss of position sense
  • Hyporeflexia with no muscle atrophy
74
Q

Compression of anterior nerve root symptoms

A
  • Muscle weakness
  • Loss of deep tendon reflex
  • Vasomotor changes (ANS affected)
75
Q

T/F Compression of the anterior nerve root will never cause muscle atrophy

A

FALSE.

It may cause muscle atrophy

76
Q

Causes of nerve root compression

A
  • Disc herniation
  • DJD
  • Recent trauma
  • Inflammatory changes
  • Tumors

NMS (16 decks)

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