Exam I Flashcards
what are the 4 P’s?
(1) participation
(2) prediction
(3) prevention
(4) plasticity
what is participation?
functioning of a person in all areas of life
what is prediction?
prediction of optimal response to intervention choice
what is plasticity?
capacity of cerebral neurons and neural circuits to change
what is prevention? what are the 3 different types?
actions to prevent the onset of disease or disability
(1) Primary: prevention before it happens
(2) Secondary: prevention screening (detect and treat pre-clinical symptoms)
(3) Tertiary: improve movement and quality of life
what type of prevention is the main focus of PT practice?
tertiary
what is the Schenkman article about?
an integrated framework for decision making in neurologic physical therapy practice
what is the Potter article about? what are the 5 components?
Outcome Measures in Neurological PT
(1) Referral
(2) Initial observations
(3) History
(4) Systems Review
(5) Final selection
what is paralysis?
complete absence of muscle strength (inability to voluntarily recruit motor units)
what is paralysis synonymous with?
plegia
what is plegia?
complete absence of muscle strength (inability to voluntarily recruit motor units)
what is paresis?
muscle weakness
what is hemiplegia?
one sided paralysis
what is hemiparesis?
one sided weakness
what is paraplegia?
LE paralysis
what is tetraplegia?
UE & LE paralysis (AKA quadriplegia)
if there is a lesion in the left side of the brain, which side of the body is likely to have paresis?
right side
what are synergistic patterns associated with?
CVA
what is hypotonia?
low tone; decreased resistance to passive movement
what is hypotonia typically associated with? (2)
lower motor neuron lesions; also first 24-48 hours of UMN due to cerebral shock
what is flaccidity?
complete lack of resistance to passive movement
what is hypertonia?
elevated muscle tone; increased resistance to passive movement
what is spasticity?
form of hypertonia; the faster you passively elongate the muscle, the more resistance the muscle will provide
what condition is spasticity associated with?
CVA (stroke)
what is rigidity?
form of hypertonia; not velocity dependent; can affect agonist and antagonist muscles
what condition is rigidity associated with? (2)
Parkinson’s Disease / Huntington’s
what is dystonia? what is it associated with?
(1) excessive twisting and bizarre repetitive movements caused by axial and proximal limb musculature
(2) basal ganglia lesions (Parkinson’s disease)
what is chorea? what is it associated with?
(1) rapid and jerky limb movements
2) basal ganglia lesions (Huntington’s Chorea
what is athetosis? what is it associated with?
(1) slow, twisting, snake like movements
(2) CP
what are tremors? what is it associated with?
(1) rhythmical, oscillating and alternating movement of a body part
(2) Parkinson’s Disease
why is fatigue present with patients who present with involuntary movements?
because their muscles work harder attempting to correct involuntary movements
what is agnosia? damage to what side of the brain usually cause this disorder?
(1) can’t recognize an object using vision but if given an object will know what to do with
(2) right sided brain injury
what is unilateral neglect? damage to what side of the brain usually cause this disorder?
(1) inability to perceive and integrate stimuli on one side of the body
(2) right sided brain injury
what is apraxia? damage to what side of the brain usually cause this disorder?
(1) inability to execute movements despite normal sensation and strength
(2) left sided brain damage
what is Broca’s aphasia?
also known as expressive aphasia; intact auditory comprehension, but have trouble expressing what they want to say
what is Wernicke’s aphasia?
receptive aphasia; have difficulty understanding what is being asked and don’t understand what they’re saying is inaccurate or awkward
what is global aphasia?
a combination of expressive and receptive aphasia
where is Broca’s area?
frontal lobe of left (dominant) hemisphere
where is Wernicke’s area?
temporal lobe of left (dominant) hemisphere
what is dysarthria?
slurred speech
what is dysphagia?
impaired swallowing
what is abarognosis?
inability to determine the weight between objects
what is astereognosis?
inability to recognize objects using active touch of the hands
what is agraphesthesia?
inability to recognize a written number or letter traced on the skin
what is diplopia?
double vision
what is strabismus?
eyes have an altered visual axis (eyes aren’t parallel; one eye looking in different direction)
what is nystagmus?
rapid, rhythmic, repetitive involuntary eye movements
what is homonymous hemianopsia?
partial blindness
what is occipital blindness?
legally blind
what is aphasia?
loss of ability to understand or express speech
cranial nerves are related to what type of lesions? which side of the body will the lesion affect?
(1) LMN (peripheral neurons)
(2) affects ipsilateral side
what side of the body do UMN lesions typically affect?
contralateral side
what side of the body do LMN lesions typically affect?
ipsilateral side
what is the difference between minimal detectable change (MDC) & minimally clinically important difference (MCID)?
(1) MDC: statistically significant difference
(2) MCID: clinically meaningful difference to the patient
what is the difference between a direct and indirect impairment?
(1) direct impairments are a direct result of the injury / dysfunction
(2) indirect impairments are as a result of direct impairments
(ex. tremors (direct) cause difficulty ambulating (indirect)
what is the difference between a resting tremor and an intention (action) tremor?
resting tremors occur at rest and intention tremors occur with the initiation of movement
what does the Spinothalamic System regulate? (3)
protective sensation
(1) pain
(2) temperature
(3) crude touch and pressure
what does the Dorsal Column-Medial Lemniscal System regulate? (4)
Discriminative sensations (Dorsal = Discriminative)
(1) vibration
(2) proprioception
(3) discriminative touch
(4) combined cortical sensations
what are some examples of combined cortical sensations?
(1) Barognosis (weights)
(2) Sterognosis (object recognition)
(3) Graphesthesia (letter/number)
(4) Tactile Location
(5) Texture recognition
(6) 2-point discrimination
what are characteristics of lethargy in regards to consciousness?
level of arousal is diminished; drowsy but able to answer questions
what are characteristics of obtunded in regards to consciousness?
diminished arousal and awareness; difficult to arouse and when aroused the person is confused
what are characteristics of stupor in regards to consciousness?
altered mental status and responsiveness to one’s environment; can only be aroused with vigorous stimuli
what are characteristics of coma in regards to consciousness?
unconscious patient, can not be aroused, eyes remain closed, no sleep wake cycles
what is reactive postural control?
occurs in response to an external force or perturbation (feedback mechanism)
what is anticipatory postural control?
occurs in anticipation of a destabilization force (feed forward mechanism)
what type of stroke is a type 1 stroke?
ischemic stroke
what type of stroke is a type 2 stroke?
hemorrhagic stroke
what is the pathophysiology of a stroke? (4)
(1) ischemia causes release of glutamate
(2) glutamate causes influx of Ca+ into the cell
(3) this influx causes activation of destructive Ca+ enzymes
(4) this causes neuronal cell death
what are the warning signs of stroke?
Acronym FAST
Face
Arm
Speech
Time
what are the symptoms associated with an anterior cerebral artery (ACA) stroke? (3)
where in the body does an ACA primarily affect?
(1) Contralateral hemiparesis or hemiplegia
(2) Contralateral sensation loss
(3) Mental confusion
(4) usually LOWER extremity
what are the symptoms associated with a middle cerebral artery (MCA) stroke? (7)
where in the body does an ACA primarily affect?
1) Contralateral hemiparesis or hemiplegia
(2) Contralateral sensation loss
(3) Homonymous hemianopsia (loss of vision on right or left side)
(4) Neglect (if non-dominant hemisphere)
(5) Apraxia (dominant hemisphere)
(6) Aphasia (dominant hemisphere)
(7) Coma
(8) usually UPPER extremity
what are the symptoms associated with a posterior cerebral artery (PCA) stroke? (4)
(1) Visual changes
(2) Homonymous hemianopsia (loss of vision on right or left side)
(3) Transient contralateral hemiparesis or hemiplegia
(4) Transient contralateral sensory loss
what are the symptoms associated with a vetebrobasilar artery (VBA) stroke? (6)
(1) Ipsilatersal ataxia and coordination
(2) Coma
(3) Diplopia
(4) Tetraplegia
(5) Locked-in syndrome
(6) Death
how does an ischemic stroke present on a CT?
shows up dark
how does a hemorrhagic stroke present on a CT?
shows up bright
what is tPA and when should it be used?
(1) tissue plasminogen activator
(2) it’s used to break up clots and should be administered if pt. has an ischemic stroke NOT a hemorrhagic stroke
what is the ideal time frame to get a patient treatment for a stroke?
within 3 hours of onset of symptoms
how does a right sided CVA present?
(1) Left sided hemiplegia / paresis
(2) Unilateral neglect
(3) Agnosia
(4) Poor judgement
(5) Unaware of deficits
(6) Uncontrollable emotion
(7) safety concerns because they think they’re better off than they really are
how does a left sided CVA present?
(1) Right sided hemiplegia / paresis
(2) Aphasia
(3) Apraxia
(4) Slow and cautious
(5) Aware of deficits
(6) More likely to have clinical depression
(7) Need a lot of extrinsic motivation
at what level does a lesion occur to cause decorticate rigidity?
diencephalon corticospinal tract lesion
at what level does a lesion occur to cause decerebrate rigidity?
brainstem (between the superior colliculus and vestibular nucleus) corticospinal tract lesion
how does decerebrate rigidity present clinically?
(1) extension of limbs and trunk
(2) elbows are extended, forearm pronated, shoulders adducted
(3) wrist and fingers flexed
(4) plantarflexion
how does decorticate rigidity present clinically?
(1) upper limbs are flexed
(2) lower limbs are extended
(3) elbows, wrists, and fingers are flexed
(4) shoulders adducted
(5) legs are IR and plantarflexed
what is the UE flexion synergy pattern?
(1) Scapular retraction
(2) Shoulder ABD and ER, flexion
(3) Elbow Flexion
(4) Forearm supination
(5) Wrist and finger flexion
what is the UE extension synergy pattern?
(1) Scapular protraction
(2) Shoulder ADD and IR, extension
(3) Elbow extension
(4) Forearm pronation
(5) Wrist and finger flexion
what is the LE flexion synergy pattern?
(Captain Morgan Pose)
(1) hip flexion, abduction, ER
(2) knee flexion
(3) ankle dorsiflexion and inversion
(4) toe dorsiflexion
what is the LE extension synergy pattern?
(1) hip extension, adduction, IR
(2) knee extension
(3) ankle plantarflexion and eversion
(4) toe plantarflexion
what are synergy patterns?
a combination of movements to compensate for the lack of isolated control at a specific joint; observed following 90% of strokes
what is the purpose of a CT scan of the brain following a stroke?
(1) used to rule in/rule out a hemorrhagic stroke (for treatment)
(2) can’t determine ischemic stroke or cerebral edema until 3-5 days after the event
what is the Spinothalamic tract from start to finish?
(1) 1st order neuron: periphery to dorsal horn
(2) 2nd order: dorsal horn crosses anterior / lateral of spinal cord up to VPL of thalamus
(3) 3rd order: VPL to primary somatosensory cortex
what is the Dorsal Column - Medial Lemniscal System tract from start to finish?
(1) 1st order: peripheral nerves to medulla oblongata
(2) 2nd order: medulla oblongata to thalamus
(3) 3rd order: thalamus to ipsilateral primary sensory cortex
what is dysmetria?
the inability to judge distance and when to stop; also called past pointing because a person will move past their point of intention
what is dysdiadochokinesia?
loss of the ability to arrest one motor impulse and substitute the opposite (ex. pronate and supinate forearm); this leads to uncoordinated progression of movement
what is the pathophysiology of PD?
(1) reduced dopamine production in the basal ganglia due to neuronal death in the substantia nigra
(2) this deprives the striatum of dopamine causing causes an over activity of both the direct and indirect loops
(3) excessive voluntary movement (tremors) and suppression of voluntary movement (bradykinesia / balance problems)
what are the main differences between an UMN and LMN lesion? (3 each)
UMN (1) Contralateral symptoms (2) Hypertonia – velocity dependent (3) Reflexes increased LMN (1) Ipsilateral symptoms (2) Hypotonia – velocity independent (3) Reflexes decreased
what is the Hoehn and Yahr classification for PD?
I - unilateral (no functional disability)
II - bilateral (no balance deficit)
III - bilateral (balance deficit) (independent and CAN work)
IV - severly disabled, can walk with assistance (CAN’T work)
V - confined to bed or w/c
what is on-off phenomenon?
abrupt, random fluctuations in motor performance, occurs after years of taking the medications
what is end dose deterioration?
worsening of symptoms toward the end of the medication effectiveness (meds are starting to wear off)
what are the cardinal signs of PD?
TRAP Tremors Rigidity Akinesia / Bradykinesia Postural Instability
what makes a person a good candidate for DBS?
(1) responds well to L-dopa
(2) has started experiencing on-off syndrome
what is the difference between coma, vegetative state, and MCS?
Coma (1) no sleep wake cycles (2) does not respond to stimuli Vegetative (1) has sleep wake cycles (2) manage basic cardiac, respiratory functions (3) generalized response to stimuli MCS (1) has sleep wake cycles (2) localization to stimuli
what is the rating on the Glasgow Coma Scale for severe, moderate, and minor brain injuries?
(1) severe: 3-8
(2) moderate: 9-12
(3) mild: 13-15
what is the best diagnostic tool for concussions?
SCAT
what is the biggest risk factor predicting prolonged recovery in concussion (mTBI)? (4)
(1) acute “on field” dizziness
(2) greater number & severity of acute symptoms
(3) adults =>10 days of on-going symptoms
(4) children => 3 weeks of on-going symptoms
what symptoms accompany each stage of CTE?
Stage 1: headache, can’t concentrate, irritable
Stage 2: depression (suicidal thoughts), STM loss
Stage 3: executive dysfunction, cognitive impairments
Stage 4: dementia, aggression, gait & speech abnormalities, parkinsonism
what is the pathophysiology of a blunt force concussion? (3)
(1) Ion channel dysfunction: K+ leaves the cell, Ca+ and Na+ rush in
(2) Metabolic energy crisis: cerebral glucose demand is increased & cerebral blood flow is decreased
(3) Physiologic axonal stretching: microscopic axonal dysfunction
what is the pathophysiology of a blast related concussion? (3)
(1) Primary injury - shock waves from blast disrupts brain tissue; widespread injury
(2) Secondary injury - fragments cause penetrating injury
(3) Tertiary injury - blunt trauma from striking solid surface
what is level 1 of the RLA of cognitive functioning? what are trademarks of this stage?
- No Response
(1) patient doesn’t respond to any stimuli
(2) appears to be in deep sleep
what is level 2 of the RLA of cognitive functioning? what are trademarks of this stage?
- Generalized Response
(1) demonstrates generalized reflex response to painful stimuli
(2) non-purposeful responses
(3) ex: patient may groan when hand is pinched
what is level 3 of the RLA of cognitive functioning? what are trademarks of this stage?
- Localized Response
(1) demonstrates withdrawal or vocalization to painful stimuli
(2) turns away or towards auditory stimuli; follows moving object
(3) ex: patient withdraws hand when pinched or turns head toward someone calling their name
what is level 4 of the RLA of cognitive functioning? what are trademarks of this stage?
- Confused / Agitated
(1) purposefully attempts to remove restraints or tubes and crawl out of bed
(2) absent short-term and long-term memory
(3) may exhibit aggressive or flight behavior
(4) ex. patient that tries to hit you when you take away their food
what is level 5 of the RLA of cognitive functioning? what are trademarks of this stage?
Confused / Inappropriate
(1) may wander randomly or with a vague intention of going home
(2) may become agitated in response to eternal stimulation
(3) can converse for short periods but not oriented X3
(4) may be able to perform previously learned tasks; can’t learn new tasks
(5) ex: patient is able to put shirt on with strong cues and assistance from PT
what is level 6 of the RLA of cognitive functioning? what are trademarks of this stage?
Confused / Appropriate
(1) inconsistently oriented X3
(2) can attend highly familiar tasks in non-distracting environment for 30 minutes
(3) max assistance for new learning with little or no carry over
(4) ex: patient is able to shower by themselves
what is level 7 of the RLA of cognitive functioning? what are trademarks of this stage?
Automatic / Appropriate
(1) consistently oriented X3
(2) shows carryover for new learning but at a decreased rate with minimal supervision
(3) - Able to initiate social or recreational activities in structured environments; judgement still impaired (overestimates abilities)
(4) ex: patient is able to tell you their name and where they are; they also made themselves dinner last night.
what is level 8 of the RLA of cognitive functioning? what are trademarks of this stage?
Purposeful / Appropriate
(1) consistently oriented X3
(2) independently attends to and completes familiar tasks for 1 hour in distracting environments
(3) can recall and integrate past and recent events
(4) uses assistive memory devices to recall daily schedule, “to do” lists
(5) ex: can drive a car, even with other people in the car
