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Neuroscience > Exam #1 > Flashcards

Exam #1 Flashcards

1
Q

Understanding C7 SCI

A 
key muscles still functioning:
C4 - UT, neck mm., Diaphragm
C5 - Biceps & wrist extensors
C6 - wrist extensors, SA, Lats
C7 - Triceps, Intercostals, Abs, back extensors
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2
Q

C7 SCI Best Stretching choice

A

Active Stretching b/c they have functioning muscles around elbow joint (Biceps/Triceps)

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3
Q

What type of Active Stretching is the best choice for C7 SCI?

A

Cathy’s opinion: Reciprocal inhibition

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4
Q

When is Passive Stretching most appropriate?

A

1) No functioning muscles around the joint
2) Contracture has a soft tissue endfeel
3) Prolonged stretching time or equipment is available

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5
Q

Reciprocal Inhibition

A

Strengthen Triceps while inhibiting (stretching) Biceps

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6
Q

Cross fiber massage

A

@ musculotendinous junction

Causes firing of GTO (1b afferent)

Inhibits the agonist
Facilitates the antagonist

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7
Q

Hold-relax technique

A

Strong contraction of Biceps may trigger the GTO to inhibit the Biceps.
Or may induce immediate relaxation of the Biceps after strong contraction.

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8
Q

Contract-relax technique

A

Active concentric (moving) contraction of Biceps may induce relaxation of Biceps

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9
Q

Muscle Spindles

A

Sense change in muscle length
complex Intrafusal muscle fibers
1) Nuclear Bag: larger diameter, clustered
~static OR dynamic
2) Nuclear Chain: smaller diameter, more spread out

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10
Q

2 sensory receptors in muscles

A

Muscle Spindles & Golgi Tendon Organs

function = proprioception

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11
Q

GTO’s

A

Sense change in muscle tension/force

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12
Q

Extrafusal muscle fibers

A 
"regular muscle fibers"
Include Slow (type 1), Fast (type 2a & 2b), and Intermediates (FOG)
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13
Q

1a Phasic afferent neurons

A

Senses change in velocity and muscle length

Come from Muscle Spindle, DYNAMIC Nuclear Bag Intrafusal fibers

  • synapses with either (+) AMN of Agonist or (-) interneuron going to (-) AMN of Antagonist
  • also forms DCML ascending tract to the brain
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14
Q

1a Tonic afferent neurons

A

Senses change in muscle length only

Come from Muscle Spindle, Nuclear Chain Intrafusal fibers

  • synapses with either (+) AMN of Agonist or (-) interneuron going to (-) AMN of Antagonist
  • also forms DCML ascending tract to the brain
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15
Q

1b afferent neurons

A

Come from GTO’s near musclulotendinous junction

In series w/ extrafusal muscle fibers

  • synapses with either (+) AMN of Antagonist or (-) interneuron going to (-) AMN of Agonist
  • also forms DCML ascending tract to the brain
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16
Q

Quick Stretch of a muscle

A

Causes 1a Phasic & Tonic neurons to fire which facilitate the agonist and inhibits the antagonist

All through the peripheral nerve of that muscle

Want to elicit a Monosynaptic Reflex Arc for facilitation of Agonist OR Disynaptic Reflex Arc for inhibition of Antagonist

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17
Q

Tendon Tapping

A

Tap tendon, quick stretch of muscle, sensed by 1a Phasic, efferent info comes in, synpases @ AMN, sends info back to Agonist muscle to contract

At the same time, inhibition of Antagonist muscle occurs.

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18
Q

Monosynaptic Reflex Arc

A

DTR activates 1a Phasics

Responsible for tone

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19
Q

Hypertonic

A

No inhibitory

UMN lesion always!

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20
Q

Hypotonic

A

No response to tendon tap

UMN or LMN Lesion

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21
Q

Clonus

A

Sustained Monosynaptic Reflex Arc

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22
Q

Modified Ashworth Scale

A

PROM to feel hypertonicity

0 = Normal
1 = Catch & Release
1+ = Catch & Resist 
2 = Increased tone throughout ROM
3 = PROM difficult due to increased tone
4 = Very rigid
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23
Q

Deep Tendon Reflex Scale

A 
0/1 = Hypo
2 = Normal
3/4 = Hyper
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24
Q

Tonic Vibratory Reflex

A

Vibrate skeletal muscle @ high frequency to get tonic contraction via monosynaptic reflex arc

Selectively stimulates Muscle Spindles (1a phasics)

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25
Q

TVR frequency on children

A

60 Hz with battery vibrator

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26
Q

TVR frequency on adults

A

100-120 Hz with electric vibrator

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27
Q

TVR effects

A

Progressively build in strength

Gradually fades out after vibrator is removed

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28
Q

TVR locations

A

Best on muscle belly or tendon

DO NOT vibrate over musculotendinous junction or GTO’s!

Follow with resistance or active contraction to enhance muscle response and increase motor learning

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29
Q

If Biceps is hypertonic due to flexion synergy, what muscle would you vibrate?

A

Antagonist = Triceps

b/c facilitates antagonist and inhibits the agonist (Biceps)

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30
Q

TVR precautions

A

Over 200 Hz = damaged skin
Holding in one place = blisters or bruises

Be careful around pt. with hydrocephalus (area of shunt)

Be careful around major blood vessels around neck (reducing BP or dislodging a clot)

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31
Q

If Biceps is hypertonic due to flexion synergy, what muscle would you perform cross fiber massage on?

A

Agonist = Biceps

b/c facilitates antagonist and inhibits the agonist (Biceps)

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32
Q

Prolonged Muscle Stretch

A

Excites 1b afferents

If GTO input to agonist “wins” over Muscle Spindle input to agonist, then GTO will INHIBIT the agonist.

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33
Q

Sensation

A

Receptors receive and route info to the spinal cord and brain for processing

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34
Q

Perception

A

Integration of sensation

“Make sense” of sensory info

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35
Q

Proprioception

A

Besides Muscle Spindles and GTO, there are other inputs from joint and skin receptors

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36
Q

Joint Receptors

A

Cutaneous receptor

Sense joint position @ ends of ROM (short or long)

ex) III afferents from ligaments & IV from capsules

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37
Q

Dorsal Column Medial Lemniscus

A

Ascending sensory info

1st order = 1a phasic/tonic, 1b, III, IV (ascend ipsilaterally to medulla)

2nd order = in Caudal Medulla & cross over to contralateral brainstem

3rd order = from Thalamus to Somatosensory cortex

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38
Q

Efferent Motor Neurons

A

Gamma MN’s (Intrafusal)

  • Static innervate ends of static nuclear bag and chain
  • Dynamic innervate ends of dynamic nuclear bag

Alpha MN’s
-Innervate extrafusal muscle fibers

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39
Q

Enhanced Proprioception

A

Happens when dynamic and static Gamma MN’s are firing

Makes muscle spindles more sensitive

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40
Q

Sensory Unit

A

Composed of sensory receptor, 1 sensory neuron, and its branches

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41
Q

Sensory Receptors

A

@ surface of skin

ALL are transducers
SOME are modality specific
SOME are polymodal

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42
Q

Free Nerve Endings

A

Polymodal = cold, warm, touch, pain

Neurons are myelinated/unmyelinated
Receptors are unmyelinated

Around hair follicles, sense direction of light moving touch

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43
Q

Mechanoreceptors

A

Touch and Pressure

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44
Q

Meissner’s Corpuscles

A

Phasic Mechanoreceptor

Encapsulated ovoid bodies in hairless portions of skin

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45
Q

Pacinian Corpuscles

A

Phasic Mechanoreceptor

Central unmyelinated tip surrounded by concentric lamellae (“onion”)

Press on corpuscle, bend receptor, ppens channels (depolarization), NA in & K out

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46
Q

Phasic Receptors

A
  • Fast adapting
  • Quick info and then stops (on & off)
  • Doesn’t keep sending us info

ex) Pacinian & Meissner’s

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47
Q

Tonic Receptors

A
  • Slow adapting
  • Minutes, hours, days
  • Gives info for a long time

ex) Muscle Spindle, GTO, Pain receptors, Baroreceptors

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48
Q

Thermoreceptors

A

Changes in temp. alters permeability of Na+ influx in the neuron membrane

Cold = Krause receptors
Warm = Rufini Corpuscle
Pain = hot/cold free nerve endings
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49
Q

Nociceptors

A

Detect pain
ex) inflammation compressing free nerve endings that causes pain will bring info to spinal cord (spinothalamic tract) associated with pain into the brain

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50
Q

Eye-Head-Hand Coordination

A

First eyes
Then head
Then hand

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51
Q

Eye-Head-Hand Coordination

Initial vs. Final

A
  • entire reach guided by vision
  • Initially, need to know vaguely where object is and distance (peripheral vision
  • Final part is vision dependant (foval vision)
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52
Q

Smooth Pursuit

A

Tracking moving object
Keeping object in focus
Can only be done @ certain speed then will shift to saccade

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53
Q

Saccade

A

Rapid eye movements

Focus on each location w/o noticing anything in between

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54
Q

Cerebellar Trauma (Stroke)

A

Dysmetria: poor measurement in 3D space when performing saccades
(looks off to the right/left when you think you are focusing on object)

Hypometric
Hypermetric

55
Q

Dorsal Pathway (Superior)

A

“Spatial Vision”

  • Exits Occipital Lobe to the Parietal Lobe
  • Processes spatial relationship b/w you and object
56
Q

Ventral Pathway (Inferior)

A

“Object Vision”

  • Exits Occipital Lobe to the Temporal Lobe
  • Processes physical qualities of object
57
Q

Transport

A

Proximal joints moving the hand where it needs to be

58
Q

Transport within arms length

A

Trunk is STABLE

-scapula, shoulder, elbow, forearm moving

59
Q

Transport beyond arms length

A

Trunk is DYNAMIC

  • sitting includes the trunk
  • standing may include the LE’s too
60
Q

Within arms length facilitation

A

-Facilitation of abs and lumbar (co-contraction)

61
Q

Beyond arms length facilitation

A
  • Facilitate weight shift over Ischial Tube. (same side as reach)
  • Diagonal is lateral & anterior
  • Facilitate pelvic tilt (posterior>anterior)
  • Facilitate lumbar (flexion>extension)
  • Facilitate trunk elongation on reach side
  • Facilitate trunk lateral flexion on contralateral side
62
Q

Scapula protraction

A

ABD, up rotation, elevation

63
Q

Scapula retraction

A

ADD, down rotation, depression

64
Q

Ankle Strategy

A
  • Facilitate weight shift to ipsilateral foot and trunk elongation (dynamic)
  • keep body/knees straight and just pivot @ ankles (DF)
65
Q

Hip Strategy

A

-Facilitate trunk/hip flexion & ankle PF (dynamic)

  • Pelvis COM shift posterior
  • Chest COM shift anterior
66
Q

Stepping Strategy

A
  • Facilitate through pelvis to encourage step (diagonal lateral & anterior shift)
  • Facilitate through upper chest & lower trunk elongation
67
Q

UE Reaching

A

-Faciliate scapula protraction, shoulder elevation and elbow extension

(maybe a little wrist flexion and MCP extension)

68
Q

Grasp

A
  • Distal joints of the wrist and hand performing manipulation
  • Fine motor control
69
Q

Whole Hand Grasp

A
  • Need to open fingers larger than width of object and then close fingers to grasp object
  • Open 2-3 times larger than object
  • Smaller object = use thumb and index
70
Q

Whole Hand Grasp and Lift

A

-Need to do the same as normal grasp but must match the grasp force to the weight of the object in order to lift it

71
Q

The Reaching Movement

A

Vary the task and object characteristics to drive movement outcomes

72
Q

Spatial Trajectory

A

Reaching = Multi-joint movemnt = straight line trajectory (more complex calculation)

-Single joint movment would make a curvilinear trajectory

73
Q

Variability in Spatial Trajectory

A

Some variability is normal

Patients who have problems planning or executing direction of movement may move slow enough to realize they are off and have enough time to correct themselves.

74
Q

Pointing Effector

A

Tip of index finger

75
Q

Grasp Effector

A

Tips of thumb and index finger

76
Q

Punch Effector

A

Knuckles

77
Q

Joint Reversal Movement

A

Joint needs to flex more than extend to reach for an object or get to an endpoint

78
Q

Accuracy (Distance error vs. Direction error)

A

Distance error = force calculation is off

Direction error = calculation of multi-joint movements is off

*both increase with distance

79
Q

Constant Error (CE)

A

Distance from the mean endpoint location to the center of target

80
Q

Variable Error (VE)

A

Measure of error dispersion

1 standard deviation in the X&Y directions

81
Q

Speed-Accuracy Tradeoff

A

Increase speed = Decrease accuracy

Decrease speed = Increase accuracy

82
Q

Fitt’s Law

A

MT=a+b log2 (2A/W)

MT = movement time
A = amplitude (distance start to target)
W = width of target
83
Q

Clearance

A

Movement around obstacles
Forces curvilinear trajectories
Minimum clearance = closet approach to obstacle

  • move fast = increase min. clearance
  • move slow = decrease min. clearance
84
Q

Hand Grasp

A

-Max aperture @ 60-80% of reach

Pre-shaping AS YOU REACH

85
Q

Maximum Aperture

A
  1. 5-3 times larger than object width
    - Fingers start to match shape of object @ END of reach trajectory (not pre-shaping!)
    - Then fingers mold to match object AFTER CONTACT
86
Q

Johansson & Westling Grip Force

A

Less grip force needed for Sandpaper vs. Suede vs. Silk

87
Q

Varying Grasp

A
  • size and shape of object
  • weight and texture of object
  • orientation of object
  • use of object
  • “slipperyness”
  • fragility of object
  • vary functional use
  • write, throw, lift, manipulate
  • stationary vs. moving objects OR person (taxonomy)
  • environment stationary or moving
88
Q

Interlimb Timing Constraints and Phase Characteristics

A

Both hands are temporally and spatially linked

ex) stroke pts. use uninvolved limb to drive movement patterns and timing in affected limb

89
Q

Interlimb Timing Constraints and Phase Characteristics

A

Both hands are temporally and spatially linked

ex) stroke pts. use uninvolved limb to drive movement patterns and timing in affected limb

90
Q

Momentum Strategy

A
  • Motion by head, lead shoulder and trunk
  • Immediately followed by lead UE reaching
  • Lead leg may lift and rotate over opposite leg
91
Q

Force Strategy

A
  • pt. pushes w/ LE in a flexed position to get them sidelying
  • flexion of shoulder, head, trunk and lead UE assisting
92
Q

1st common form of rolling

A 
Arms = lift & reach above shoulder level
HT = shoulder girdle leads
Legs = unilateral lift
93
Q

2nd common form of rolling

A 
Arms = lift & reach above shoulder level
HT = shoulder girdle leads
Legs = Unilateral push down through heel with far side leg
94
Q

3rd common form of rolling

A 
Arms = lift & reach above shoulder level
HT = shoulder girdle leads
Legs = bilateral lift
95
Q

1st common form of supine to standing

A 
UE = symmetrical push
Axial = symmetrical
LE = symmetrical squat
96
Q

2nd common form of supine to standing

A 
UE = symmetrical push
Axial = symmetrical
LE = asymmetrical squat
97
Q

3rd common form of supine to standing

A 
UE = asymmetrical push and reach
Axial = partial rotation
LE = half kneel
98
Q

1st common form of supine to standing (4-7yrs.)

A 
UE = asymmetrical push
Axial = forward w/ rotation
LE = asymmetrical wide-based squat
99
Q

Supine to Erect Stance

A
  • symmetrical form of rising = greatest control of direction and force
  • 15 year olds
  • less balance = partition movement into discrete components
  • taller/lighter pts. = more advanced symmetrical
  • shorter/heavier pts. = more basic asymmetrical
100
Q

Sit to Stand Task

A

move COM from buttock BOS to feet BOS

101
Q

Sit to Stand Neck Joint

A

Neck = flexion to extension

0% - 2deg flexed
30% - 4deg flexed
100% - +4deg extended

8deg total neck movement

102
Q

STS Momentum Strategy

A
  • requires a certain amount of speed
  • no breaks in motion
  • accelerate then decelerate the COM
  • concentric forces to propel body
  • eccentric forces to control body motion
103
Q

STS Force Strategy

A
  • frequent stops
  • bring COM over BOS and stops
  • Then, LE forces lift of the body into standing
104
Q

Momentum Strategy: Phase 1

A

“Flexion-Momentum”
Begins: movement initiation
End: just before butt lift-off

  • weight shift COM horizontal
  • E. Spinae eccentric control
105
Q

Momentum Strategy: Phase 2

A

“Momentum-Transfer”
Begin: butt lifted
End: max ankle DF

  • transfer of momentum from upper body to total body
  • hip & knee extensors contract
106
Q

Momentum Strategy: Phase 3

A

“Extension”
Begin: after max ankle DF
End: hips stop extending

-body moves vertical

107
Q

Momentum Strategy: Phase 4

A

“Stabilization”
Begin: after hip extension
End: stabilization completed

108
Q

Momentum Strategy Safety

A

Backward fall = rushing phase 1&2, not getting COM over BOS

Forward fall = phase 3 too late, COM too far over BOS, accelerate too much and decelerate too late

109
Q

Force Strategy: Phase 1

A

Trunk flexion & APT to bring COM over feet

110
Q

Force Strategy: Phase 2

A

Trunk, hip, knee extension w/ force to bring body to vertical

111
Q

Force Strategy: Phase 3

A

Stabilization

112
Q

Sit to Stand Interventions

A
  • Manually assist @ knee (prevent buckling)
  • Progress from higher to lower seat height
  • Pressure downward through knee and foot to facilitate WB
113
Q

Sit to Stand Rules

A

Feet shoulder width apart
Anterior symmetrical alignment
Sagittal view aligned but feet can be staggered

114
Q

Stand to Sit

A
  • Eccentric control of body as pt. lowers

- Eccentric paraspinals, quads, gastroc/soleus

115
Q

Typical Stand to Sit

A
  • Forward trunk movement
  • Downward trunk movement
  • Knee Flexion
  • Backward trunk movement
116
Q

Stand to Sit Common Maladjustments

A 
-Decreased eccentric control
(plopping)
-Hip flexion initiating movement
-COG too far back
-Too much UE use
-Unequal weight distribution in LE
117
Q

Sit to Stand Common Maladjustments

A
  • COG kept posterior
  • Feet in front of knees
  • Hip extension before knee extension
  • Using back of legs to assist
  • Too much UE use
  • Unequal weight distribution in LE
118
Q

Sit to Stand Common Maladjustments

A
  • COG kept posterior
  • Feet in front of knees
  • Hip extension before knee extension
  • Using back of legs to assist
  • Too much UE use
  • Unequal weight distribution in LE
119
Q

Patients who have trouble with Gait Initiation

A

PD
MS
CVA
TBI

120
Q

Center of Pressure

A
  • Location of vertical GRF measured by a force plate
  • Equal & opposite to a weighted average of the location of all downward forces acting on the force plate
  • Independent of COM!
121
Q

Gait Initiation w/ RLE

A
  • Ankle Strategy
  • 1st 40% = Left DF contract to accept weight shift, Quads decelerate Left knee flexion, then Right GS & HS bring leg forward
122
Q

Steady-state gait velocity

A

Achieved in 1-3 steps for healthy individuals

123
Q

Gait Initiation: PD

A
  • stooped posture
  • shuffling gait
  • smaller steps
  • lack of heel strike
  • can’t extend knee or PF in terminal stance
  • forward trunk flexion
  • no arm swing
  • freezing or festinating gait
124
Q

Gait Obstacle Clearance

A
  • Older people do not step over obstacles with higher clearance b/c legs are heavy, takes more energy, need more strength, challenges balance.
  • Instead, they slow down their approach and clearance speed and take shorter steps
125
Q

Stair Ascent/Descent

A
  • No concentric = trouble with stair ascent

- No eccentric = trouble with stair descent

126
Q

4 out of 5 falls occurs during…

A

stair DESCENT

127
Q

Stair Ascent Phases

A

Stance (64%)

  • weight acceptance phase
  • pull up
  • forward continuance

Swing (36%)

  • foot clearance
  • foot placement
128
Q

Greatest point of instability during stair ascent is…

A

@ contralateral toe off

-when the ipsilateral leg accepts body weight and ipsilateral hip, knee, ankle are in flexion

129
Q

Stair Descent Phases

A

Stance

  • weight acceptance
  • forward continuance
  • controlled lowering

Swing

  • leg pull through
  • preparation for foot placement
130
Q

Sit to Stand Trunk Joint

A

Trunk = flexion to extension

0% - 10deg rapid flexion
45% - 42deg flexed, begin rapid extension
100% - extend to vertical

131
Q

Sit to Stand Pelvis Joint

A

Pelvis = PPT to APT to PPT

0% - 26deg behind vertical (PPT)
50% - 12deg in front of vertical (APT)
100% - 1deg in front of vertical (PPT)

132
Q

Sit to Stand Hip Joint

A

Hip = flexion to extension

1st 40% - flexion
2nd 60% - extension

133
Q

Sit to Stand Knee Joint

A

Knee = extension throughout

1st 40% - 6deg extension
2nd 60% - 76deg extension

134
Q

Sit to Stand Ankle Joint

A

Ankle = DF to PF

1st 45% - 6deg DF
2nd 55% - 12deg PF

Neuroscience (11 decks)

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