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Neuromuscular Physical Therapy > Exam Pt 2 > Flashcards

Exam Pt 2 Flashcards

1
Q

The presence of flaccidity suggests..

A

LMN/segmental lesion (aka nerve root or peripheral nerve injury) ; -can also be present in the ACUTE stages of an UMN or supra segmental lesion

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2
Q

What is clasp knife rigidity ?

A

Rigidity that is present vs PROM but then suddenly gives way

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3
Q

How does a positive Babinski response present?

A

DF of great toe with fanning of other toes in response to stroking the lateral side of the sole of the foot -indicates a corticospinal/pyramidal tract disruption

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4
Q

Patients with UMN lesions may have — DTRs

A

Hyperreflexive

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5
Q

How do you test for form constancy?

A

Have patient choose a similarly shaped but different sized object from a group of objects

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6
Q

How do you test for FIGURE-GROUND DISCRIMINATION?

A

Choose an object from an array of objects (ie a brake from a wheelchair)

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7
Q

Agnosia vs apraxia

A

AGNOSIA is the inability to recognize an object with one sensory modality, while maintaining the ability to recognize it with others APRAXIA is the inability to perform voluntary, learned movement in the absence of loss of sensation, strength, coordination, attention, or comprehension

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8
Q

What does apraxia indicate?

A

A breakdown in the conceptual system or motor production system (or both)

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9
Q

If a patient cannot perform a voluntary, learned task on command (without having lost another modality) , they most likely have ..

A

Ideomotor apraxia

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10
Q

If a patient has marked ms tone increase thru most of the ROM BUT the affected part is easily moved, their grade on the modified ashwortj would be ..

A

2

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11
Q

If a patient has a slight increase in ms tone and minimal resistance at the end of the ROM, his or her modified ashworth scale score would be..

A

1

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12
Q

Topographical disorientation is..

A

Inability to navigate a familiar route

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13
Q

To test for a patient’s sense of position in space..

A

Have patient demo various limb positions aka place your hand under the table

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14
Q

The 3 ways to test Proprioceptive (deep) sensations are :

A
  1. Joint position sense 2. Kinesthesia (either have patient duplicate movement of the limb or give a verbal report) 3. Vibration sense (pallesthesia) - tuning fork
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15
Q

If you see ms fasciculations, indicative of..

A

Neurogenic injury

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16
Q

What is homonymous hemianopsia?

A

Loss of half of visual field in both eyes contralteral to the side of a cerebral hemisphere lesion

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17
Q

How do you test for homonymous hemianopsia ?

A

Bring two fingers behind head, slowly bring them forward into the patient’s visual field while asking them to look straight ahead

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18
Q

What are the 8 signs indicative of increased ICP 2/2 cerebral edema and brain herniation?

A
  1. Altered LoC 2. Altered vitals 3. HA 4. Vomiting (CN X compromise) 5. Pupillary changes (CN III compromise) 6. Papillaedema at entrance to eye (optic nerve compressed due to swelling) 7. Progressive impairment to motor function 8. Seizure activity
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19
Q

What is Kernig’s sign and what is it indicative of?

A
  1. Patient positioned in supine, flex hip and knee fully to chest then extend knee 2. (+) sign : causes pain and increased resistance to extending the knee 2/2 spasm of hs ; when B/L, suggestS MENINGEAL IRRITATION
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20
Q

If a patient is sacral sitting, you may suspect spasticity of..

A

hamstrings

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21
Q

if a patient is contracted in hip flexion, it could be spasticity of ..

A

iliopsoas, rec fem or pectinius

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22
Q

if a patient with an UMN lesion is contracted into hip IR, you may suspect spasticity of ..

A

adductor magnus OR gracilis

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23
Q

what are 4 possible consequences of uncontrolled spasticity?

A
  1. mvmt deficiencies
  2. contractures
  3. degenerative jt changes
  4. deformity
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24
Q

what structures are involved in LMN lesions?

A

SC: anterior horn cells, spinal roots, peripheral nerves

CN:cranial nerves

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25
Q

a positive Babinski response indicates..

A

an UMN lesion (specifically, disruption in the corticospinal tract)

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26
Q

how do strength deficits present in corticospinal tract lesions?

A

contralaterally IF above the decussation in medulla but ipsi if below

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27
Q

if a patient has rigidity that is uniform increased resistance to movement , it is classified as

A

leadpipe rigidity

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28
Q

A comatose pt maintains a posture of the UEs in flexion and the LEs in extension. this is called.. & is indicative of a lesion where?

A

decorticate; lesion above the superior colliculus

29
Q

A comatose pt maintains a posture of the UEs and the LEs in extension. this is called.. & is indicative of a lesion where?

A

decerebrate posturing; indicative of a lesion between the superior colliculus and the vestibular nuclei

30
Q

a patient p/w severe spasming of muscles, causing the head, back and heels to arch backwards while the arms and hands are held in rigid flexion. What is yoru differential diagnosis for the cause?

A

tetanus, severe meningitis, epilepsy, strychnine poisoning

31
Q

to test for C5/C6 reflex..

A

biceps or brachioradialis tendon

32
Q

what spinal reflex level does the ankle jerk reflex test?

A

S1-2

33
Q

how do you test for abdominal reflexes? & what spinal levels do these test?

A

stroke the abdomen toward the umbilicus, the umbilicus should move toward the stimulus; T6-L1

34
Q

when is teh cremaster reflex absent?

A

SCI and corticospinal lesion

35
Q

what is the traction reflex and when do you see it?

A

pull the forearm, causes flexion of entire UE; seen in infants but also in brain injuries

36
Q

firm pressure to palm of hand or ball of foot produces flexion of fingers or toes in what reflex?

A

grasp reflex

37
Q

how do you test for symmetrical tonic neck reflex?

A

either 1. flex the head: produces flexion of the UEs & ext of LEs

OR

  1. extend head –> extends UEs & flexes LEs
38
Q

what is the positive supporting reflex?

A

contact to the ball of the foot in teh standing position produces rigid extension (co-contraction) of the LEs

39
Q

what are “associated reactions”

A

strong voluntary movement in 1 body segment produces involuntary movement in another resting segment (brain injury)

40
Q

what type of fatigue do patients with MS, ALS & chronic fatigue show?

A

CNS/central fatigue

41
Q

what type of fatigue do patients with postpolio, GBS & myasthenia gravis typically show?

A

neural/myoneural junction fatigue

42
Q

If a patient p/w weakness of their R UE along with ipsilateral facial weakness, then their lesion is most likely..

A

above the brainstem (after the decussation in the midbrain)

43
Q

if a patient has weakness of the hips/shouldersor other proximal musculature, you suspect –

A

myopathy (direct muscle damaging disease)

44
Q

if your pt p/w progressive weakness of the LEs, this is an emergency. What is the differential diagnosis?

A

GBS vs acute myelopathy vs cauda equina syndrome

45
Q

what is the type of fatigue seen in muscular dystrophy?

A

muscle contractile failure: metabolic changes at the level of the muscle (ie depleted Calcium stores)

46
Q

How can you tell if a patient is experiencing overwork weakness or injury? & in what disorders is this common?

A

Prolonged decrease in absolute strength & endurance (ie fatigued more than 30 minutes after session has ended)

-typically seen in MS, MD, and postpolio syndrome

47
Q

What are the subscales of the modified fatigue impact scale?

A

Impact of fatigue on:

physical, cognitive & social function

48
Q

What is classified as “spasmodic contractions of specific muscles, typically including face, head, neck or shoulder muscles” & what area of the brain is suspected to be damaged?

A

= TICS

-suspect extrapyramidal or BG disorder

49
Q

An involuntary movement of a “single, quick jerk” is classified as..

A

MYOCLONUS

-seen in BG/extra pyramidal disorders

50
Q

An involuntary movement that is “slow, irregular, twisting sinuous movement occuring esp in the UEs”

A

ATHETOSIS

-BG and/or extrapyramidal disorders

51
Q

what type of tremor is seen in cerebellar disorders?

A

intention tremor

52
Q

If a pt experiences epilepsy OR tonic/clonic convulsive involuntary movements, you suspect the lesion to be..

A

CORTICAL

53
Q

The typical UE synergy pattern seen in pts post-CVA is called..

A

Extension synergy

-scap pro, sh add/IR, elbow ext, pronation, wrist/finger flex

54
Q

What are the recommended standardized tests and measures for fine motor coordination (3)?

A
  1. Jebsen-Taylor Hand Function Test
  2. Minnesota Rate of Manipulation Test
  3. Purdue Pegboard
55
Q

The inability to associate muscles together for complex movement is..

A

“dyssynergia”

56
Q

the inability to judge the distance or range of movement is

A

“dysmetria”

57
Q

the inability to perform RAM is..

A

dysdiadochokinesia

58
Q

Scoring of coordination should be done on what scale?

A

0- unable

1- severe impairment

2 - moderate impairment

  1. minimal impairment
  2. normal
59
Q

When evaluating a patient’s balance system and specifically looking at the visual system, you should examine:

A

1. visual acuity

2. depth perception

3. visual field deficits

60
Q

The Sensory Organization Test examines 6 different sensory conditions:

A
  1. EO stable surface
  2. EC stable surface
  3. visual conflict, stable surface
  4. EO, moving surface
  5. EC, moving surface
  6. visual conflict, moving surface
61
Q

which of these criterion in the SOT become unstable during VESTIBULAR loss?

  1. EO stable surface
  2. EC stable surface
  3. visual conflict, stable surface
  4. EO, moving surface
  5. EC, moving surface
  6. visual conflict, moving surface
A
  1. EC, moving surface
  2. visual conflict, moving surface
62
Q

which of the criterion on the SOT would become unstable in a VISUALLY DEPENDENT patient?

  1. EO stable surface
  2. EC stable surface
  3. visual conflict, stable surface
  4. EO, moving surface
  5. EC, moving surface
  6. visual conflict, moving surface
A

2, 3, 5, 6

63
Q

which of the criterion on the SOT would cause a SOMATOSENSORY dependent patient to become unstable?

  1. EO stable surface
  2. EC stable surface
  3. visual conflict, stable surface
  4. EO, moving surface
  5. EC, moving surface
  6. visual conflict, moving surface
A

4, 5, 6

64
Q

what does LOS stand for?

A

Limits of Stability

-ability to move their COM over the BoS during self-initiated movements; can document via force plate

65
Q

what is the center of alignment?

A

location of CoM within the center of the BoS (via force plate)

66
Q

What is the Romberg test used to detect?

how would you increase the sensitivity of the test?

A

posterior column (SENSORY) ataxia

-stand in tandem

67
Q

If a patient requires hand hold support and mod-max A to maintain static balance, their functional balance grade would be..

A

poor

68
Q
A

Neuromuscular Physical Therapy (7 decks)

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