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Neuromuscular I > Exam I > Flashcards

Exam I Flashcards

1
Q

What are factors that should be taken into account in clinical decision making?

A

-P.T and patient goals, values, pyschosocial skills, knowledge, expertise, and problem solving abilities

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2
Q

What are the 5 key elements that contribute to a comprehensive conceptual framework?

A

-Model of practice, Model of Disablement/Enablement, Hypothesis Oriented, Theories of Motor Control, and Evidence Based Practice

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3
Q

What is the emphasis on in a task oriented approach?

A

-Emphasis is on functional performance of very specific tasks (what function the patient can perform and how)

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4
Q

What type of strategies are looked at with the task oriented approach?

A

-Movement strategies

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5
Q

What is examined in the task oriented approach?

A

-The impairments that are limiting the functional task; why the patient is having difficulties

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6
Q

What is a direct impairment?

A

-Impairment that affect body structure/function

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7
Q

What is a secondary impairment?

A

-Secondary conditions resulting from the primary injury or disease; ie conditions due to sedentary lifestyle

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8
Q

What is a composite impairment?

A

-Impairment having multiple causes, can be direct or indirect

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9
Q

What two theories drive contemporary practice?

A

-Systems Theory and task oriented approach

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10
Q

What are the 4 P’s?

A

-Participation, Prediction, Plasticity, and Prevention

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11
Q

What is Participation as it relates to the 4 P’s?

A

-Functioning of a persons as a member of society

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12
Q

What is a participation restriction?

A

-Problems an individual may experience in involvement of life situations

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13
Q

What is Prediction as it relates to the 4 P’s?

A

-Predicting optimal response to intervention choice and is essential as it relates to primary prevention

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14
Q

What is Plasticity as it relates to the 4 P’s?

A

-The capacity of neurons and neural circuits to change, structurally and functionally in response to experience

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15
Q

What is Prevention as it relates to the 4 P’s?

A

-Actions taken to prevent the onset of diseases, to stop its progression and minimize its consequences

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16
Q

What is primary prevention?

A

-Prevention before the disease occurs

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17
Q

What is secondary prevention?

A

-Focuses on controlling the progression of the disabilities related to the disease

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18
Q

What is tertiary prevention?

A

-Focuses on minimizing the impact of a moving disorder

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19
Q

What is muscle weakness?

A

-The inability of a muscle to generate normal levels of force

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20
Q

What is muscle weakness a result of?

A

-mechanical properties and neural imput

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21
Q

Muscle weakness as a direct impairment is a result of what?

A

-Upper Motor Neuron Lesion

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22
Q

A result of an upper motor neuron lesion results in an immediate reduction of what?

A

-Neural input

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23
Q

Any lesions that occurs before the synapse at the ventral horn with result in an impairment on which side?

A

-Contralateral

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24
Q

What is an upper motor neuron lesion?

A

-A lesion before the synapse at the ventral horn

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25
Q

What is a lower motor neuron lesion?

A

-A lesion after the synapse at the ventral horn

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26
Q

A Lower Motor neuron lesion is considered a lesion to what?

A

-Spinal Nerves, peripheral nerves

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27
Q

A Lower Motor Neuron Lesion will affect what side of the body?

A

-Ipsilateral side

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28
Q

What is paralysis or plegia?

A

-Complete absence of muscle strength, inability of voluntarily recruit motor units

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29
Q

What is paresis?

A

-Muscle weakness

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30
Q

Damage to one sided of the motor cortex of the brain will affect what side of the body?

A

-Contralateral side

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31
Q

The anterior cerebral artery supplies the motor hommunculus to what part of the body?

A

-Lower Extremity

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32
Q

The middle cerebral artery supplies the motor hommunculus to what part of the body?

A

-Upper Extremity

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33
Q

When examining someone with upper or lower extremity muscle impairments, it is important to look at what two factors?

A

-Vascular Distributions and the Motor Hommonculus

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34
Q

What is important to consider when performing strength assessments on patients with upper motor neuron lesions?

A

-The patient may not be able to assume the testing position or perform isolated movements

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35
Q

What is an abnormal synergy pattern?

A

-When joint movement cannot be isolated due to an inability to activate or abnormal mass patters of movement occur

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36
Q

What type of patients generaly present abnormal synergy patterns?

A

-Stoke Patients

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37
Q

Why do synergy patterns occur?

A

-Muscle that move within the same mass pattern are strongly linked so movement usually occur in the same fixed pattern

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38
Q

What is muscle tone?

A

-resistance felt in the muscle during passive elongation

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39
Q

What is hypotonia?

A

-Decreased resistance of a muscle to passive elongation; Low tone

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40
Q

What is Flacidity?

A

-Complete lack of resistance to passive elongation

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41
Q

What is hypotonia/Flaccidity due to?

A

-Lack of voluntary Muscle Activation

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42
Q

What is Hypotonia associated with?

A

-Lower Motor Neuron Lesions, Could be spinal shock with an upper motor neuron lesion before tone increases

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43
Q

What is Hypertonia?

A

-Increased Resistance to Passive Elongation, Elevated Muscle Tone

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44
Q

What is Spacticity, Muscle Stiffness, and Rigidity associated with?

A

-An upper motor neuron lesion

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45
Q

When does Spacticity occur?

A

-When there is damage to the descending motor system

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46
Q

Damage to what descending tract is mainly responsible for spacticity?

A

-Corticospinal Tract

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47
Q

Is Spacticity or Rigidty velocity dependent?

A

-Spacticity

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48
Q

With a patient with spacticity, Increased the speed of the passive motion will have what effect with in the resistance?

A

-It will increase it

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49
Q

With a patient with Rigidity, Increased the speed of the passive motion will have what effect with in the resistance?

A

-It will not effect it

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50
Q

Hypertonia in the form for muscle stiffness, is what type of impairment?

A

-Indirect

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51
Q

What is muscle stiffness usually due to?

A

-being sedentary

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52
Q

What is Rigidity cuased by?

A

-A lesion to the basal ganglia

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53
Q

What two diseases affect the basal ganglia and may cause rigidity?

A

-Parkinson’s and Huntingtons

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54
Q

What structures contribute to normal coordination?

A

-The motor cortex, Basal Ganglia, Cerebellum, and Dorsal Columns

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55
Q

How can an upper motor neuron lesion affect coordination?

A

-It can cause delayed awkward and inaccurate movement

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56
Q

What is Dystonia?

A

-Excessive twisting and bizarre repetitive movement caused by axial and proximal musculature

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57
Q

Dystonia is commonly associated with a lesion to what?

A

-Basal Ganglia

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58
Q

What is Choria?

A

-Rapid and jerking limb movements

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59
Q

Choria is commonly associated with a lesion to what?

A

-Basal Ganlia

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60
Q

What is Athetosis?

A

-Slow, twisting snake like movements

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61
Q

What is athetosis associated with?

A

-Cerebral Palsy

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62
Q

What is the Spinothalamic system responsible for?

A

-Protective sensation (Pain, temp, touch, crude touch and pressure)

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63
Q

What is the dorsal column medial lemniscal system responsible for?

A

-Descriminative Touch ((Vibration, Proprioception, Descriminative Touch, and combined cortical sensation

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64
Q

What are cortical Senations?

A

-Barognosis, Sterognosis, Graphethesia, Tactile Location, Texture Regulation, & 2-point descimination

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65
Q

What does Vision help Control?

A

-Posture

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66
Q

An upper motor neuron lesion can cause what visual impairments?

A
  • Blurred Vision, Diplopia (double vision), Stabismus, Occipital Blindness, Nystagmus, Homonymous Hemianopsia
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67
Q

What nerve Is responsible for visual activity?

A

-Optic Nerve, CN II

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68
Q

What nerves are responsible for eye movement?

A
  • Occulomotor (CN III), Trochlear (CN IV), Abducens (CN VI)
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69
Q

The Semicircular Canal is responsible for perception of what?

A

-Angular Velocity of the nead and neck in space

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70
Q

The Utricle is responsible for perception of what?

A

-Linear Acceleration

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71
Q

What is Agnosia?

A

-The inability to recognize and process incoming information, The inability to recognize shapes or objects though sense are normal

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72
Q

What sided brain damage is agnosia associated with?

A

-Right Sided(non-dominant)

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73
Q

What is Apraxia?

A
  • the inability to perform a movement despite having normal sensation and strength
  • Inability to execute upon command
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74
Q

What sided brain damage is apraxia associated with?

A

-Left Sided (dominant)

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75
Q

What is a cognitive impairment?

A

-A deficit in the ability to sort, retain and manipulate informatoin

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76
Q

What structures of the brain is memory associated with?

A

-Limbic System, hippocampus and fornix

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77
Q

What is the continuum for Consciousness

A

-Normal-Lethargy-Obtunded-Stupor-Coma

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78
Q

What sided brain damage causes aphasia?

A

-Left (Dominant)

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79
Q

What is Expressive Dysphagia?

A

-Patients knows what they want to say but cannot; Comprehension is intact

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80
Q

What structure of the brain is damages with Expressive Dysphagia?

A

-Broca’s Area

81
Q

What is Receptive Aphasia?

A
  • Patients comprehension of language is impaired

- Patient rambles on, unaware of the impairment

82
Q

What Structure of the brain is damaged with receptive apahasia?

A

-Wernicke’s Area

83
Q

What is Dysarthria?

A

-Slurred Speech, Lacks coordiation of muscle used for articulation

84
Q

What type of patients is Dysarthria common in?

A

-C.P., TBI, Stoke, M.S., and PD

85
Q

What is Dysphasia?

A

-Impaired swallowing

86
Q

What patients is Dysphagia common in?

A

-Stroke patients

87
Q

What are composite impairments?

A

-A combination between direct and indirect impairments, or involve more than 1 system

88
Q

What type of lesions are Cranial Nerve lesions considered?

A

-Lower Motor Neuron Lesion

89
Q

What sided deficits will present with a cranial nerve lesion?

A

-Ipsilesional impairments

90
Q

80% of all stroke are what type of strokes?

A

-Ischemic

91
Q

Which type of stroke has a higher mortality rate?

A

-Hemorragic

92
Q

Where are emboluses most commonly thrown through?

A

-The heart

93
Q

What are hemorrhagic strokes commonly associated with?

A

-Anuerisms or trauma

94
Q

How can a blood clot cause neuronal death?

A

-By irritating the neurons

95
Q

What is an intracranial Hemorrhage?

A

-A brain bleed from smaller ruptured arteries that penetrate the brain, usually more deadly and leads to significant impairments

96
Q

What is a subarachnoid hemorrhage?

A

-Bleeding from larger vessels in the subarachnoid space, usually due to a barry aneurism

97
Q

What is the Cascade of events leading to neuronal death in a stroke?

A

-Blood flow is occluded>Neurons release excessive glutamate>This opens calcium ions channels in the neurons>Influx of calcium>Influx of calcium sensitive destructive enzymes>Enzymes are activated and cause cell death

98
Q

What extremity would be most effected with an Anterior Cerebral Artery Stroke?

A

-Lower Extermity

99
Q

What else is commonly seen with Anterior Cerebral Artery Strokes?

A

-Mental Confusion due to involvement of the frontal lobe

100
Q

What is the most common artery for strokes?

A

-Middle Cerebral Artery

101
Q

What extremity is mainly effected with a Middle Cerebral Artery Stroke?

A

-Upper Extremity

102
Q

What else becomes impaired due to Middle Cerebral Artery Stoke?

A

-Vision

103
Q

Stroke of this artery is likely to result in death?

A

-Vertebrobasilar

104
Q

What features are associated with a right sided stroke?

A

-Unilateral Neglect, Agnosia, quick Impulsive Behaviors, Poor Judgement, and not being aware of impairments

105
Q

What features are associated with a left sided stroke?

A

-Aphasia, Apraxia, Hesistent behavior, and depression

106
Q

What is the etiology of Parkinon’s?

A

-Idiopathic

107
Q

What percent of the population over the age of 65 have PD?

A

-2%

108
Q

What is the average age of onset for PD?

A

-50-60 y/o

109
Q

What is secondary parkinsonism?

A

-Mimicks true pd but is caused but the cause is known

110
Q

What most commonly causes secondary parkinsonisms?

A

-Normal Pressure Hydrocephalus

111
Q

What are the signs/symptoms of normal pressure hydrocephalus?

A

-shuffling gait, incontinence, and confusion

112
Q

How does normal pressure hydrocephalus differ from PD?

A

-NO Tremor

113
Q

What two symptoms do Parkinsonism plus syndromes present with that true parkinsons also presents?

A

-Bradykinesia and Rigidity

114
Q

What are the two most common types of parkinsonism plus syndromes?

A

-Progressive Nuclear Atrophy, and Multi system Atrophy

115
Q

What is the pathophysiology of PD?

A

-Neural Degeneration of the Basal Ganglia, specifically the substantia nigra, resulting in the reduction of dopamine acting on the striatum

116
Q

What two loops does the lack of dopamine effect in PD?

A
  • The Direct look-initiates voluntary movement

- The Indirect Loop- inhibits involuntary movement

117
Q

What happens in the direct loop with pd?

A

-It is over active= causes tremors or rigidity

118
Q

What happens in the indirect loop with pd?

A

-too much inhibition= bradykinesia and poor balance

119
Q

What are the cardinal features of PD?

A
  • TRAP
  • Tremors
  • Rigidity
  • Akinesia/ Bradykinesia
  • Postural Instability
120
Q

Which tremors come first, Resting or acting?

A

-Resting

121
Q

What is the common gait pattern for those with PD?

A

-Shuffling; reduction of stride length and foot clearance (reduced dorsiflexion due to tight plantar flexors)

122
Q

Where does rigidity start?

A

-Proximally

123
Q

What is an early symptom that may be a predictor of PD?

A

-Lack of smell

124
Q

What is a major sign that is used to diagnose PD?

A

-Response to dopamine therapy

125
Q

What are the two clinical subgroups of PD?

A

-Tremor (main one), and PIGD

126
Q

What clinical subgroup of PD usually has an earlier onset?

A

-Tremor

127
Q

Which clinical subgroup of PD progresses faster?

A

-PIGD

128
Q

Which clinical subgroup of PD is more likely to develop cognititive impairments and dementia?

A

-PIGD

129
Q

A patient that has a tremor and rigidty on thier right side, and is still able to work would be considered what on the H&Y scale?

A

-I; Unilateral symptoms, can still work

130
Q

A patient that has a bilateral tremor and rigidity but can normal mobility would be considered what on the H&Y scale?

A

-II; Bilateral symptoms but no mobility impairments

131
Q

A patient that has bilateral tremors, and some balance impairments but is still able to live independently would be considered what on the H&Y scale?

A

-III, First signs of Postural Instability but can still live indedpendetly

132
Q

A patient with bilateral symptoms, and significant postural instability would be considered what on the H&Y Scale?

A

-IV, diseased is progressed

133
Q

A patient that is W/c bound with out help would be considered what on the H&Y scale?

A

-V

134
Q

What two drugs are combined to make sentimet?

A

-levadopa and carbidopa

135
Q

What is levadopa?

A

-A dopamine precursor that inhibits the metabolsm of dopamine and allows it to cross the blood-brain barrier

136
Q

What is end of dose deterioration?-

A

-When a drug is wearing off son before the next dose is to be administered, symptoms return, is predictable

137
Q

What is the on-off phenomenon?

A

-Unpredictable return of symptoms; a fluctuation of symptoms

138
Q

How long have a person been taking a dopamine drug when the on-off phenomenon normally starts to occur?

A

-4-6 years

139
Q

What are two side effects associated with the on-off phenomenon?

A

-dyskinesia and dystonia

140
Q

What do dopamine agonists do?

A

-stimulated post synaptic dopamine receptors, allow for less dopamine to be taken

141
Q

What are anitocholinergenics use to treat?

A

-Tremors

142
Q

What do minoamine oxidase b-inhibitors do?

A

-inhibits the enzyme that degrades dopamine, allows for less dopamine to be administered

143
Q

What must a person show to be a candidate for DBS?

A

-They must respond to dopamine treatment

144
Q

What are the leading causes of TBIs?

A

-Falls (32%), MVAs (19%), Being struck by an object (18%), Assualts (10%)

145
Q

What is a TBI defines as?

A

-An alteration in brain function or evidence of a brain pathology caused by an external force

146
Q

What is the most common cause of TBIs in people aged 5-65?

A

-MVA’s

147
Q

What is the most common cause of TBIs in people younger than 5 or older than 65?

A

-Falls

148
Q

What is an open head injury?

A

-A TBI where the skull is fractured

149
Q

What is commonly associated with open head injuries

A

-Intracranial hemorrhages and dural tears, which often lead to intracranial infections

150
Q

What is a focal brain injury?

A

-The injury that occurs at the site of impact, may cause a contusion, laceration or both

151
Q

What normally causes brain lacerations?

A

-bony irregularities of the skull cutting the surface of the brain

152
Q

What are lacerations always associated with?

A

-Hematomas

153
Q

What is a coup-countercoup injury?

A
  • Where the brain bounces to make contact with the skull opposite the side of impact
  • Coup: site of initial impact
  • Counter coup: impact opposite initial site
154
Q

Polar brain injuries are common in what type of injuries?

A

-Head on collisions

155
Q

What two lobes are most susceptible to polar brain injuries?

A

-Frontal and temporal lobes

156
Q

In a blast injury, what causes the primary injury?

A

-the blast shockwave causes pressure on the organs

157
Q

What causes the secondary injury in a blast injury?

A

-Shrapnel

158
Q

What causes the tertiary injuries in a blast injury?

A

-Hitting the ground

159
Q

What is a diffuse axonal injury?

A

-widespread tearing of the neural axons and myelin sheaths; subcortical white matter shearing

160
Q

What would happen is a diffuse axonal injury involved the brain stem?

A

-Come an abnormal posturing

161
Q

What does secondary brain damage involve?

A

-intracranial hematomas, causing a rise in ICP and leading to the shifting and compression of the brain structures

162
Q

What is a epidural hematoma?

A

-blood accumulating on the top of the dura

163
Q

Damage to what artery is associated with an epidural hemtoma?

A

-Medial Meningeal

164
Q

What is a subdural hematoma?

A

-Blood accumulating beneath the dura

165
Q

What population are subdural hematomas common in?

A

-Elderly patients

166
Q

What is an intracerebral hematoma?

A

-Blood floow accumulation

167
Q

What type of hematoma is the most deadly?

A

-Intracerebral

168
Q

What is an uncal herniation?

A

-herniation involving the midbrain, hypocampal gyrus, Occulomotor nerve, cerebral pundecles ( cuases hemiparesis), RAS (can cause coma), PCA (causes homonymous hemianopsia)

169
Q

What structure are involve with a central herniation?

A

-Midbrain and pons (cause regidity), and the RAS (causes coma)

170
Q

What structures are involve with a tonsillar herniation?

A

-Cerebral tonsils of the medulla (Cuases neck pain and stiffness), RAS (causes coma), Vasomotor centers (causes alteration of pulse, respiration and BP)

171
Q

What two things can cause a hypoxic ischemic

A

-Arterial Hypoxia, and Arterial Hypotension

172
Q

What is an arterial hypoxia?

A

-A systemic injury such as an obstruction of an airway, pneumothorax or pulmonary embolism which reduced the amount of oxygen in the blood

173
Q

What is arterial hypotension?

A

-occurs when there is systematic blood loss due to injury that may lead to low bp, and as a result the brain does not receive enough blood floow

174
Q

How can increased ICP lead to a hypoxic ischemic injury?

A

-can cause the brain to shift and cut off circulation

175
Q

What is the top priority of acute management of a TBI?

A

-Restore vital function and prevent secondary brain injuries

176
Q

What is normal ICP?

A

4-15

177
Q

What is abnormally high ICP?

A

->20

178
Q

What ICP is expected after a TBI?

A

-15-20

179
Q

A mean value of ICP great that what calls for means to reduce the pressure?

A

-25

180
Q

An ICP greater than what can impair blood flow to the brain?

A

-40

181
Q

If a patient has an ICP greater than 20, what should the PT do?

A

-notify the medical team and modify treatments to not spike ICP

182
Q

if a patient has an ICP great than 30, what should the PT do?

A

-Stop intervention and notify medical team

183
Q

What should you never do with a patient with high ICP?

A

-Invert them

184
Q

What cognitive functions can be affect with a TBI?

A

-Arousal levels, attention, concentration, memory, learning, and executive function

185
Q

What nueromuscular impairments can an TBI cause?

A

-Paresis, abnormal tone, motor function, and balance

186
Q

What neurobehavioral impairments can a TBI cause?

A

-agressiveness, disinhibition, frustration, iriitation, cmmunication and swallowing

187
Q

A patient that cannot be aroused, does not open their eyes and has no sleep/wake cycle would be considered to be in what state?

A

-Coma

188
Q

A patient that does have an active sleep/wake cycle, and demonstrates reflexive movement is considered to be in what state?

A

-Vegetative (awake but not aware)

189
Q

A person in a vegetative state for longer than 3 months is considered to be in what state?

A

-Persistent vegetative state

190
Q

A patient that responds to local stimulation, and may reach for object is considered to be in what state?

A

-Minimally conscious

191
Q

A patient scoring between 3 and 8 on the GCS is considered to have a what TBI?

A

-Severe

192
Q

A patient scoring between 9 and 12 on the GCS is considered to have a what TBI?

A

-Moderate

193
Q

A patient scoring between 13 and 15 on the GCS is considered to have a what TBI?

A

-Minor

194
Q

What is a concussion?

A

-a brain injury defined as a complex physiological process affecting the brain, induced by biomechanical forces

195
Q

Is a concussion a functional or structural injury?

A

-Functional, no evidence of injury with concussion

196
Q

What is an important symptom when diagnosing a concussion?

A

-Slowed Reaction time

197
Q

What is the pathophysiological cascade of event of a concussion?

A
  • Ion Channel Dysfunction: Potassium ions rush out and desructive calcium and sodium ions rush in
  • Metabolic Energy Crisis: Glucose demand is increased but blood flow is decreased, which causes the crisis
  • Axonal Stretching: Axonal Dysfunction
198
Q

What is the biggest predictor of prolonged recovery with a mTBI?

A

-On feild dizziness

Neuromuscular I (2 decks)

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