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Neuromuscular I > Exam II > Flashcards

Exam II Flashcards

1
Q

what sensory information is the spinothalmic tract responsible for relaying?

A

crude touch, pain, and temperature

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2
Q

what sensory information is the DCML tract responsible for relaying?

A

discriminate touch, proprioception, vibration

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3
Q

what is steregnosis?

A

ability to identify objects (using sensory information) without looking

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4
Q

what is tactile localization?

A

capacity to differentiate where touch is on the body

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5
Q

what is two point discrimination?

A

ability to perceive two distinct points

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6
Q

what is graphesthesia?

A

ability to recognize letters, numbers or design

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7
Q

what is barognosis?

A

ability to evaluate the weight of an object

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8
Q

what are the five levels of alertness from most alert to least?

A

(1) alert
(2) lethargic
(3) obtunded
(4) stupor
(5) coma

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9
Q

what are characteristics of lethargy in regards to alert?

A

awake & attentive to normal levels of stimulation; responds appropriately to all interactions

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10
Q

what are characteristics of lethargy in regards to consciousness?

A

able to be aroused and answer questions, but is extremely drowsy and easily distracted

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11
Q

what are characteristics of obtunded in regards to consciousness?

A

difficult to arouse and when aroused the person is confused

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12
Q

what are characteristics of stupor in regards to consciousness?

A

can only be aroused with vigorous stimuli (sternal rub)

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13
Q

what are characteristics of coma in regards to consciousness?

A

unconscious patient, can not be aroused, eyes remain closed, no sleep wake cycles

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14
Q

how do you test CN II?

A

the four quadrants test; have patient cover one eye and test all 4 quadrants while wiggling or keeping the fingers still

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15
Q

what deficit would a patient present with following a lesion of the retina?

A

blind spot in affected eye

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16
Q

what deficit would a patient present with following a lesion of the optic nerve?

A

blindness of the ipsilateral eye

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17
Q

what deficit would a patient present with following a lesion of the optic tract?

A

homonymous hemianopsia (contralateral side of the lesion)

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18
Q

how does homonymous hemianopsia affect vision?

A

(1) ipsilateral loss of the temporal visual field
(2) contralateral loss of the nasal visual field

(ex. R homonymous hemianopia occurs when you lose: temporal visual field of R eye and nasal visual field of L eye)

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19
Q

what CN is responsible for pupil constriction?

A

CN III (oculomotor)

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20
Q

what may a patient present with if they sustained a lesion to CN III, IV, or VI?

A

double vision

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21
Q

how do you test CNs III, IV, and VI?

A

(1) H-test; making sure to perform the test twice and examine each eye individually
(2) pupillary accommodation reflex (eyes dilate when looking at further object)
(3) pupillary light reflex (eyes constrict in bright light)

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22
Q

what nerves does the H-test assess from top to bottom on the LATERAL side of an eye?

A

Top Lateral: CN 3
Middle Lateral: CN 6
Bottom Lateral: CN 3

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23
Q

what nerves does the H-test assess from top to bottom on the MEDIAL side of an eye?

A

Top Medial: CN 3
Middle Medial: CN 3
Bottom Medial: CN 4

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24
Q

what may a patient present with if they sustained a lesion to the oculomotor nerve? (3)

A

(1) inability to elevate eyelid
(2) inability to turns eye up, down, and medially
(3) inability to constrict pupil

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25
Q

what may a patient present with if they sustained a lesion to the trochlear nerve?

A

the eye will be unable to perform downward medial rotation

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26
Q

what may a patient present with if they sustained a lesion to the abducens nerve?

A

the eye will be unable to turn laterally

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27
Q

what is homonymous hemianopsia?

A

inability to see one side of their visual field (observed with CN II testing)

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28
Q

what is diplopia?

A

double vision

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29
Q

what is strabismus?

A

malalignment of the eyes leading to difficulty in depth perception (eyes aren’t parallel; one eye looking in different direction)

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30
Q

what is nystagmus?

A

involuntary oscillation of the eyes (vestibular disorder)

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31
Q

what is saccades?

A

rapid movement of the eye between two fixation points (this is normal)

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32
Q

what is the difference between spasticity and rigidity?

A

(1) spasticity is resistance of a muscle (usually due to UMN) and it’s velocity dependent
(2) rigidity is uniform resistance through slow passive movement (usually due to BG lesion)

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33
Q

what are a couple ways spasticity can be measured?

A

(1) Modified Ashworth Scale (MAS)

(2) Tardieu Scale

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34
Q

how is rigidity classified?

A

no scale for rigidity; classified as either:

(1) lead pipe: resistance to movement in both flexors and extensors
(2) cogwheel: essentially lead pipe with tremors (jerky)

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35
Q

what are a couple conditions that can result in spasticity?

A

CVA and TBI

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36
Q

what are a couple conditions that can result in rigidity?

A

Parkinson’s and Huntington’s

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37
Q

what is muscle stiffness?

A

secondary impairment; caused by the muscle being in a shortened position for an extended period of time

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38
Q

how is the Modified Ashworth Scale (MAS) scored?

A

0: No increase in tone (normal)
1: Slight increase in tone, end of range (may catch and release)
1+ Slight increase in tone through less than ½ range
2: Marked increase through most of the range (still moves easily)
3: Passive movement difficult
4: Rigid (no movement)

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39
Q

what are the 3 velocities the Tardieu scale is performed at?

A

V1 - slow as possible
V2 - speed of limb falling under gravity
V3 - fast as possible

40
Q

how is the Tardieu scale scored for each of the 3 velocities?

A

Under Passive Movement

0: No resistance
1: Slight resistance throughout movement, no clear catch
2: Clear catch at a precise angle, followed by release
3: Fatigable clonus with less than 10 seconds
4: Unfatigable clonus with more than 10 seconds
5: Joint is immovable

41
Q

what is Brunnstrom’s Stages of Recovery for?

A

sequential motor recovery stages following stroke

42
Q

what are Brunnstrom’s Stages of Recovery?

A

Stage 1: Flaccidity
Stage 2: Spasticity begins; involuntary associated reflexes but no voluntary
movement
Stage 3: Spasticity worsens; voluntary movement occurs in synergy
Stage 4: Spasticity declines; some voluntary (isolated) movement out of synergy may occur
Stage 5: Spasticity continues to decline; relative independence from synergistic movement (i.e.
mostly isolated movement)
Stage 6. Spasticity disappears; all isolated joint movements present, coordination/ speed near
normal

43
Q

what are associated reactions?

A

abnormal reflex activities which may occur in the absence of voluntary movements (usually observed in hemiplegic stroke patients)

44
Q

what are the associated reactions to resistance applied to the UNINVOLVED side?

A

(1) Uninvolved UE Flex = Flex of involved UE
(2) Uninvolved UE Ext = Ext of involved UE
(3) Uninvolved LE Flex = Ext of involved LE
(4) Uninvolved LE Ext = Flex of involved LE

45
Q

what are the associated reactions to resistance applied to the INVOLVED side?

A

(1) Involved UE Flex = Flex of involved LE
(2) Involved UE Ext = Ext of involved LE
(3) Involved LE Flex = Flex of involved UE
(4) Involved LE Ext = Ext of involved UE

46
Q

what is dysdiadochokinesia?

A

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

47
Q

what is dysmetria?

A

the inability to judge distance and when to stop; also called past pointing because a person will move past their point of intention

48
Q

what impairments might a patient present with following a cerebellar lesion? (4)

A

(1) dysmetria
(2) dysdiadochokinesia
(3) tremors
(4) movement decomposition
(5) rebound phenomenon

49
Q

what impairments might a patient present with following a basal ganglia lesion? (4)

A

(1) tremors
(2) rigidity
(3) askinesia / bradykinesia
(4) involuntary movements

50
Q

what impairments might a patient present with following a dorsal column lesion? (2)

A

(1) dysmetria

(2) slowness of movement

51
Q

what is rebound phenomenon?

A

when a muscle is contracting against resistance and the resistance is removed, the antagonist contracts to slow down the movement; in ABSENCE of this phenomena, the muscle continues to contract without slowing and can cause limbs to slam into things

52
Q

in what order do muscles fire when using the ankle strategy? what order do muscles fire when using the hip strategy?

A

(1) ankle: distal to proximal

(2) hip: proximal to distal

53
Q

what muscles fire when using the ANKLE strategy to compensate when you are pushed forwards?

A

gastrocs, hamstrings and paraspinals

54
Q

what muscles fire when using the ANKLE strategy to compensate when you are pushed backwards?

A

tibialis anterior, quadriceps and abdominals

55
Q

how is balance impaired with muscle sequencing?

A

postural synergy muscles are activated in the wrong order (small perturbation should activate anterior tibialis first, but instead the abs activate first)

56
Q

how is balance impaired with co-activation? what patient population is this commonly seen in?

A

(1) agonist/antagonist contract simultaneously preventing a normal ankle or hip strategy
(2) PD

57
Q

how is balance impaired with delayed activation?

A

muscles don’t contract at an appropriate time, or not as quickly as they should

58
Q

how is balance impaired with difficulty scaling amplitude?

A

inappropriate activation of muscles leading to underestimated scaling of amplitude (seen in PD patients)

59
Q

how is balance impaired with motor adaptation issues?

A

UMN becomes fixed with a particular response even when not appropriate, unable to adapt to the current situation (only using ankle strategy)

60
Q

how is balance impaired with muscle paresis?

A

muscles are weak and lose the ability for postural stability or regaining balance after a loss of balance

61
Q

how is balance impaired with a loss of anticipatory control?

A

person can no longer use past experience to help predict; no ability to prepare stability in advance

62
Q

what type of balance deficits will a patient with a cerebellar lesion present with? (3)

A

(1) wide BOS
(2) incoordination and ataxia with stepping strategy
(3) difficulty with adaptive response (due to difficulty scaling)

63
Q

what type of balance deficits will a patient with a basal ganglia lesion present with? (3)

A

(1) increased flexed posture
(2) festinating gait
(3) difficulty with anticipatory response (due to bradykinesia)

64
Q

what type of balance deficits will a patient with a lesion of the cortex (CVA) present with? (4)

A

(1) asymmetrical weight bearing to unaffected side
(2) asymmetrical postural alignment to unaffected
(3) reach with univolved UE or step with uninvolved LE
(4) difficulty with adaptive response (due to lack of one sided motor control)

65
Q

what test is the gold standard for balance?

A

BERG Balance Scale (BBS)

66
Q

what does the BERG Balance Scale measure?

A

static and dynamic balance

67
Q

how is the BERG Balance Scale scored? what is the maximum score for this test?

A

(1) Includes 14 tasks; each is scored from 0-4 (4 being the high score)
(2) Max Score: 56

68
Q

what score on the BERG indicates that a fall risk for the elderly?

A

45 OR LESS

69
Q

what is the gold standard for determining if a patient is at risk for falls?

A

Timed Up and GO (TUG)

70
Q

how is the Timed Up and Go administered?

A

(1) patient stands up from chair, walks 3 meters (10 feet), turns around and walks back to the chair and sits down
(2) a total of two trials is performed, only the 2nd is recorded for time (1st is a trial)

71
Q

what TUG score indicates an elderly person is freely independent? what score indicates they’re dependent in most activities?

A

(1) independent: < 10 seconds

(2) dependent: > 30 seconds

72
Q

a TUG score of what indicates the person is at a higher risk for falls?

A

15 OR GREATER

73
Q

what is the PASS? what does it assess?

A

(1) Postural Assessment Scale for Stoke Patients
(2) assesses:
(a) ability to maintain a given posture
(b) ability to maintain equilibrium when changing postures

74
Q

what is the Mini BEST? what does it test for?

A

(1) Mini Balance Evaluation Systems Test (mini version of the best; has 14 items instead of 36)
(2) tests DYNAMIC balance

75
Q

what score on the functional reach test indicates a person is at a higher risk for falling?

A

LESS than 6 inches

76
Q

what is the purpose of the Foam and Dome Test?

A

to determine if one of the three sensory systems is impaired (visual, vestibular, somatosensory)

77
Q

what are the 6 conditions of the Foam and Dome Test?

A

(1) firm surface, eyes open
(2) firm surface, eyes closed
(3) firm surface, dome
(4) foam surface, eyes open
(5) foam surface, eyes closed
(6) foam surface, dome

78
Q

how is the Foam and Dome Test scored?

A

each of the 6 conditions is scored between 1-4

(1) minimal sway
(2) mild sway
(3) moderate sway
(4) fall, loss of balance

79
Q

for the Foam and Dome, increased sway or LOB in which conditions indicate the patient is DEPENDENT on VISION for postural control?

A

2, 3, 5, 6

80
Q

for the Foam and Dome, increased sway or LOB in which conditions indicate the patient is DEPENDENT on SOMATOSENSATION for postural control?

A

4, 5, 6

81
Q

for the Foam and Dome, increased sway or LOB in which conditions indicate the patient has VESTIBULAR LOSS?

A

5 and 6

82
Q

for the Foam and Dome, increased sway or LOB in which conditions indicate the patient has sensory selection problems (can’t adapt) for postural control?

A

3, 4, 5, 6

83
Q

what are the 3 components of normal gait?

A

(1) progression (moving in a particular direction)
(2) stability (COM over BOS)
(3) adaptation (various surfaces / changing environments)

84
Q

how much does the COM VERTICALLY displace during gait?

A

5 cm (measured using the head)

85
Q

during which phase of gait does the maximum vertical displacement occur? when does the minimum occur?

A

(1) Max: midstance

(2) Min: during each double limb support phase

86
Q

how much does the COM displace MEDIAL-LATERALLY during gait?

A

4 cm

87
Q

during which phase of gait does the maximum medial-lateral displacement occur for the left and right sides?

A

Max Right: right leg midstance

Max Left: left leg midstance

88
Q

what does the 10m walk assess?

A

gait speed

89
Q

what are the gait speeds for:

(1) community ambulator
(2) limited community ambulator
(3) houshold with a walker

A

(1) community ambulator: 0.8 m/s (2mph)
(2) limited community ambulator: 0.4-0.8 m/s (1-2mph)
(3) household with a walker: <0.4 m/s

90
Q

what is the DGI? what does it assess?

A

(1) Dynamic Gait Index

(2) assesses ability to modify gait in response to changing task demands

91
Q

what is the FGA? what does it assess?

A

(1) Functional Gait Assessment

(2) modified version of DGI used to assesses ability to modify gait in response to changing task demands

92
Q

a score of what on the DGI classifies a person at an increased risk for falls?

A

< 19

93
Q

a score of what on the FGA classifies a person at an increased risk for falls?

A

<= 22

94
Q

what does the Tinetti assess?

A

Gait and Balance

95
Q

a score of what on the Tinetti classifies a person at an increased risk for falls?

A

(1) Gait score less than 9 = high fall risk
(2) Balance score less than 10 = high fall risk
(3) Total score range of 19-24 indicates a fall risk
(4) Total score less than 19 = high fall risk

96
Q

what does the 6-minute walk test measure?

A

endurance

Neuromuscular I (2 decks)

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