Exam 1 Flashcards
Difficulty swallowing
Dysphagia
Slurred speech caused by weak muscles for speech
Dysarthria
Broca’s aphasia is known as?
Non-fluent or expressive aphasia
What is broca’s aphasia?
Can understand but CANT speak fluently
Wernicke’s aphasia is known as?
Fluent or receptive aphasia
What is wernickes aphasia?
Can speak fluently but can’t understand
What part of the brain would u find wernickes aphasia?
Left temporal lobe
Dysmetria
Lack of coordination; undershoots or overshoots
How do you test for dysmetria?
Finger to nose coordination test
Anemia
Decreased # of RBCs
Polycythemia
Elevated RBC count due to reduction in plasma volume
Thrombocytopenia
Platelets less than 140,000 –> increased risk for bleeding
Prothrombin time?
Normal?
Time required for clot to form. Normal is 11 - 13.5 seconds.
Partial thromboplastin time and normal is?
Blood separated into plasma and cells; looks at intrinsic cascade and normal is 30-45 secs.
International normalized ratio
Unitless measure used to correct prothrombin time difference; 2-3 is therapeutic
Inability to smell; seen with lesion where?
Anosmia; seen with frontal lobe lesion
Esotropia
Eyes pulled inward
Strabismus
Eyes pulled outward
Rinne test
Vibrating tuning fork on mastoid bone
Weber test
Vibrating tuning fork on head
Hoarseness- vocal cord weak; nasal quality- palatal weak
Dysphonia
Alpha neurons do what and what kind of fibers?
Generate force and extra fiscal
Myopia
Can’t see far
Presbyopia
Can’t see close
Ability to control the COG over the BOS in any environment
Balance
Gamma neurons do what and what kind of fiber?
Stretch; intrafusal fibers (within the muscle)
Paresis
Weakness, cant recruit motor units, results from lesion within descending motor pathways
Plegia?
Can’t move
Akinesia
Loss of power to voluntarily move
Bradykinesia
Slow movement
Ataxia
Impaired balance and coordination; lose control
Dyskinesia
Abnormal voluntary mvmt
Dystonia
Involuntary muscle contractions that cause repetitive/twisting movements
Apraxia
For verbal its like your brain cant put together the muscles for speech but everything is still INTACT like sensation and motor, etc
Somatagnosia
Lack of body scheme
Anosognosia
Denial of how severe the paralysis is (non dominant parietal lobe)
Ideomotor apraxia
Can’t perform movement on command
Ideational apraxia
Can’t move on command or automatically
8 stages of arousal:
Alert, agitated, delirium, dementia, somnolent, obtundant, stupor, coma
5 parts of MMSE
Orientation, registration, attention and calculation, recall, language
The state of being aware, attentive and mentally functional
Aware
Double vision
Diploplia
The patient is excessively restless; demonstrates physical/mental activity
Agitated
The state of disorientated accompanied by irritability, agitation, suspicion, and/or fear; pt may also mispercieve stimuli
Delirium
State of altered mental processes that usually does not change arousability
Dementia
Prolonged drowsiness; sleepy trance
Somnolent
Dulled response to stimuli; pt is typically confused and needs constant stimulation
Obtundant
The pt is aroused only by intense stimuli; motor response and reflex action are typically preserved
Stupor
Unconsciousness arousal
Coma
State all grades for modified ashworth
0:no increase
1: catch and release
1+: resistance after the catch
2: increased tone throughout
3: difficult to move t/o but can get through
4: rigid
Name the 5 descending tracts
Rubrospinal Medial and lateral vestibulospinal Tectospinal Medial and lateral corticospinal Reticulospinal (medial)
4 descending tracts
Spinothalamic (anterior and lateral)
Fasc. Cuneatus
Fasc. Gracilis
Spinocerebellar
Weakness is seen with damage to:
Which only presents with weakness?
Primary motor cortex
Corticospinal tract
Alpha motor neurons
Muscle
*muscle and corticospinal ONLY present with weakness
Weakness from disuse is seen with damage to?
Premotor region
Supplemental motor region
Basal ganglia
Cerebellum
Akinesia
Bradykinesia
Abnormal postural adjustment
Ataxia
Negative signs of impairment
Hypertonicity is a lesion in?
Primary motor cortex, cereb, basal ganglia/descending motor systems
What are the positive signs of impairment?
Hypertonicity Dyskinesia Tremors Chorea Ballisimus Ticks
What is reciprocal inhibition?
When a muscle contracts, the antagonist is stimulated as well
Sherringtons second law
Law of reciprocal innervation AKA reciprocal inhibition
What kind of interneurons control the law of RI?
Inhibitory interneurons
How do we test for spasticity?
Velocity
SpasticityL Hyperexcitability of alpha motor neuron pool can be due to?
- loss of descending input to the brain
- postsynaptic denervation sensitivity
- shortened distance
- collateral sprouting (a lot of afferent interactions happen)
Rigidity is hyperactivity of what system?
Fusimotor system
Rigidity is predominant in what muscles?
Flexor muscles of the trunk and limbs
Involved in initiation and inhibition of movement as well as initiation of thought
Basal ganglia
2 problems with an impairment in RIGHT lateral cerebellum?
- difficulty with verb generation
- learning and performing complex nonmotor tasks
3 functional divisions of cerebellum
Cerebrocerebellum- motor planning and coordination
Spinocerebellum- controlled ongoing body mvmts
Vestibulocerebellum- postural balance and eye movements
4 basal ganglia impairments
- involuntary movements (dyskinesia)
- disorders of muscle tone and posture reflex
- chorea
- dementia
Parkinson’s disease affects what?
Substantia nigra (lack of dopamine) in basal ganglia
Parkinson’s disease is characterized by what two things?
Resting tremor and increased muscle tone which leads to rigidity
What is fractionation?
Breaking up/isolating the movement
3 timing problems:
Initiation
Slowed movement time
Terminating movement
2 reasons under initiating movement?
Time between decision to move and actually moving.
Cognitive issues.
Time b/w decision to move and actual moving is due to what 3 things?
Inadequate force generation
Decreased firing rate
ROM loss
3 reasons why there are cognitive issues with initiating movement?
Motivation to move.
Can’t recognize commands.
Difficulty in remembering the movement and selecting a plan.
2 tests for dysmetria:
Finger to nose
Heel on shin
Sustained muscle contraction
Dystonia
Involuntary, rapid, irregular jerky movements that result from lesions to basal ganglia
Choreiform movements
Slow, involuntary writhing and twisting, usually more UE, neck, face and tongue
Athetoid movements
Where does somatognosia occur?
Dominant parietal lobe
OR dominant posterior temporal
Which lobe does left/right discrimination occur in?
Parietal lobe
Where does anosognosia occur?
Non dominant parietal lobe
Where does unilateral spatial neglect happen?
Inferior posterior regions of right parietal
Awareness of body parts and their relationship to one another and the environment
Body scheme
Pt who is R hand dominant and has lesions in LEFT angular gyrus has what 3 impairments in the association cortices?
1- confusion b/w left and right
2- difficulty in naming fingers (touch okay)
3- difficulty writing even tho motor and sensory are intact
Which cell in the cerebellum controls motor coordination output?
Purkinje fibers
5 types of apraxia?
Verbal
Buccofacial
Limb (ideomotor and ideational)
Constructional- dressing
WHats the term for when you cant remember places?
Topographic disorientation
Pts who have problem with position and space (over and under) is an issue where?
Non dominant parietal
He I cord pathology affects touch and volition all movement on?
Contralateral side
Medical brianstem stem pathology often affects
All volitional movement and touch sensation
Anterior horn cell/LMN pathology, youlll see:
Diminished reflex
Atrophy- wasting away
Fasciculations (twitch in muscle)
Lateral brainstem pathology often affects
Pain and perception
Thalamus infarct usually affect only?
LEFT infarcts common
CONTRA censors perception, mvmt and consciousness
Very painfu
Weakness form disuse and difficulty with complex motor tasks is a lesion where?
Supplementary motor cortex
Incoordination, weakness from disuse, balance problems and changes in tone are a presentation in which region?
Cerebellum
Which two structures have only weakness?
Corticospinal and muscle
Loss of sensation, perception, proprioception, problems with motor control are where?
Sensory cortex
Lesion site for weakness or paralysis, change in tone
Primary motor cortex
Lesion site for weakness or atrophy
Alpha motor neuron
Anisocoria
Unequal pupil size