EXAM REVIEW

Question 1

What system supports upright posture?

Answer 1

*lateral vestibulo pathway (linear movement, gravity); inversion affects otilith organs

Question 2

In clinic, working with low tone kiddo:

Answer 2

• linear movement on platform swing
• back and forth barrel or therapy ball, throw bean bags at targets
• Tarzan swing over barrier of “alligator” pillows
• activate postural extensors

Question 3

Activate postural flexors

Answer 3

*reticulospinal pathway

Question 4

Tripping scenario:

2 upright posture pathways and additional structure

Answer 4

• reticulospinal pathway
• lateral vestibulospinal
• cerebellum (smoothing out movement, balance, righting = vestibulocereballar functions)

Question 5

Tripping scenario:

• What allows you to notice the visual stimulus?
• What systems are in play?

Answer 5

• superior colliculi
• vestibular system, semicircular canals, oculomotor/abduscens/trochlear CN = visual system
• vestib/visual system allows you to keep stable visual field as you turn your head

Question 6

Tripping scenario:

What keeps your body from following your head movement?

Answer 6

basic primitive reflex integration of body on head, head on body

Question 7

Tripping scenario:

What peripheral functions facil. ability to stay upright?

Answer 7

*reflex arc (before cerebellum!) = too much stretch resulting in contraction

Question 8

Tripping scenario:

What central system played a role in regaining balance?

Answer 8

visual, vestibular, proprioception (VPL to 3-1-2)

Question 9

Phone rings after you trip:

What allows you to bend you neck to find your pocket?

Answer 9

medial vestibulospinal pathway (bend neck);
dorsal column (tactile discrimination)
lateral corticospinal
visual/tactile (stereognosis to find phone)

Question 10

New considerations:

What regions involved in motor control play a role in your response?

Answer 10

cerebellum (stored a previous plan from experience)
basal ganglia (to initiate movement)
limbic overlays (expecting a phone call, excited for a call)

Question 11

New considerations:

Neurotransmitters

Answer 11

Dopamine: excitement
Norepi: change arousal
Saratonin: change arousal
*monoamine bodies with nuclei in RF

Question 12

New considerations:

Function of PFC in tasks that follow the ring?

Answer 12

dorsal lateral dlPFC - executive function, judgment

Question 13

New considerations:

As you plan to return the call?

Answer 13

ventral medial PFC (impulse control to return call)

Question 14

Reactive neuroplascticity

Developmental neuroplascticity

Answer 14

post hemispherectomy, OTs can work with people because of this neuroplasticity

Question 15

Spina bifida (2 types)
*Why would you see OT?

Answer 15

Oculta: cord does not come out and does not require surgery
Cystica: cord comes out and requires surgery
*OT = developmental concerns; motor planning; visual perception problems

Question 16

TENS

Answer 16

maintain pain; has not been shown to be very clinically effective

Question 17

Vestibular Rehabilitation

Answer 17

positioning therapy; exercise based intervention so OTs usually shy away from it but it is a technique that works so consider using it and attach to functional occupational engagement

Question 18

Pt: middle age man, admitted to hospital secondary to right face, arm and leg weakness & inability to speak or understand what is being said. Hx hypertension

Answer 18

• temporal
• motor: frontal (primary motor cortex)
• middle cerebral artery b/c it goes to regions of primary motor cortex supplying language/speech areas and if you look at humunculus leg, arm, and face internal areas

Question 19

Pt: some voluntary movement with leg, UE still problematic

Answer 19

*looking at humunculus, pulls you back towards middle artery a bit

Question 20

Pt: follow simple commands and responds “yes”

Answer 20

motor speech issue, some resolution with Wernicke’s area and may be more of an issue in frontal lobe (Broca’s)

Question 21

Pt 2: involuntary, flinging movement in L arm and leg; spontaneous jerkiness R leg

Answer 21

NOT cerebellum, sounds like basal ganglia problem; more than likely a neurochemical issue and MD will medicate; OT can work on safety (remove throw rugs, uncluttered environ)

Question 22

Pt 3: 27 female, gradual develop emotional lability and increasing risk taking behavior, no specific even around behaviors

Answer 22

prefrontal impact (perhaps tumor, seizures)

Question 23

Pt 3: friends have been increasingly concerned about personality change; what might be reason?

Answer 23

PTSD (most assoc with behavior changes)