Final Exam Flashcards
Performing a lumbar pucture on a patient with MS will reveal what?
-Elevated IgG Proteins, indicative of myelin sheath separations
What do evoked potentials measure?
-electrical activity of the brain in response to specific sensory pathways
What pathway is often the most tested pathway for evoked potentials?
-optic
What will an MRI of a patient with MS present with?
-Acute lesions and chronic plaques
How many people live with MS in the US?
-400,000
What is the average onset of MS?
-Between 20 and 40
What gender is more effected by MS?
-Women
What race is at the highest risk for MS?
-Whites
Livings above what latitude increases the risk for MS?
-40 Deg
What causes MS?
-Chronic Demyelination of the CNS
What type of disorder is MS?
-Autoimmune; can be triggers by an infection
Who can genetics effect your chances of getting MS?
-A generic predisposition, but NOT inherited
What two things can increase your risk for getting MS?
-A vitamin d deficiency and smoking
In MS, the immunsystem attackes what?
-Myelin and Oligodendrocytes (make myelin in the CNS)
The break down and inflammation of myelin in the CNS associated with MS causes what?
-decreased nerve conduction in the CNS
What is most effected in the CNS by MS?
-White matter
What structures does MS commonly affect?
- Optic Pathways
- Corticospinal tract (motor)
- DCML (sensory)
- Cerebellar Peduncles
What are commony symptoms of MS?
-Fatigue, coordination and balance impairments, depression, visual disturbances, bowel and bladder dysfunction, paresis, spasticity, UMN lesion signs (babinskis, impaired proprioception, cerebellar signs
What is the most common type of MS?
-Relapsing Remitting (85%)
What is Relapse-Remitting MS?
-Acute attacks, followed by remission
What type of MS has the best prognosis?
-Relapse-Remitting MS
What MS is associated with steady and nonreversing attacks without remission that leads to an ongoing loss of function?
-Secondary Progressive MS
What MS is associated with a steady decline and no accute attacks?
-Primary progressive MS
Though primariry progressive MS leads to a steady decline in function, what might be seen?
-Plateau periods
What type of MS is associated with a steady decline of function with occasional acute attacks?
-Progressive, relapsing MS
What is the difference between Relapse-Remitting MS, and Progressive-Relapsing MS?
-Relapse-Remitting has periods where the regain some function
Patients with MS will have intolerance to what, which may cause symptoms?
-Heat
MS symptoms from heat exposure typically last how long?
-24 hours
Does ALS affect Upper or Lower Motor neurons?
-BOTH
ALS causes a degeneration of what?
-Motor neurons in the Brain, Brain stem and Spinal cord
What type of onset of ALS is the most common?
-Limb onset (70-80%)
What is often the first sign of limb onset ALS?
-Foot drop
What is often the first sign of bulbar onset ALS?
-Difficulty speaking or swallowing
How do early symptoms of ALS present?
-Unilateral and focal
Do symptoms of ALS start proximal or distal?
-Distal
What are the typically Bulbar onset ALS symptoms?
-Bulbar muscle weakness, dysarthria, uncldysphagia, Sialorrhea, uncontrlled emotions
What is the most common MOI for a central cord SCI?
-Hyperextension injury
What is the signs and symptoms of a central cord lesion?
-paralysis and sensory loss of UEs, Trunk and LE involvement vary
What is Brown Sequard syndrome?
-A Hemisection Injury
What are the presenting symptoms of Brown Sequard Syndrome?
-Ipsilateral loss of proprioception, vibration, motor functino at and below the level of lesion
What contrlateral deficits will occur with a brown sequard syndrome?
-loss of pain and temp
What is the most common MOI for an anterior cord SCI?
-Flexion injury of the C-spine
What deficits will be present with a anterior cord lesion
-Bilateral loss of motor function, pain and temp at or below the level of the lesion
What two things are still intact with an anterior cord lesion?
-Light touch and proprioception (DMCL is spared)
What is a injury to the lumbosacral nerve roots?
-Cauda Equina
What defecits will present with cauda equina syndrome?
-Flaccid paralysis of the LEs and Areflexic bowel and bladder
What should the series of steps be if a patient is having autonomic dysreflexia?
- SIT UP THE PATIENT
- CALL EMERGENCY CODE
- FIND AND REMOVE STIMULI
What types of SCIs usually cause an autonomic dysreflexia?
-Injuries above T6, usually complete lesions
What should you avoid for patient with orthostatic hypotension?
-Constant transfer, fast standing etc
What should you do if a patient experience a drop in BP?
-Lay down and elevate their legs above level of the heart, tilt if in a wheel chair
what type of clothing can prevent sudden drops in BP in those with OH?
-Compression socks
What occurs immediately after a SCI and is associated with a period of areflexia?
-Spinal Shock Syndrome
What is the initial time frame of spinal shock syndrome?
-24 hours
how long can a spinal shock syndrome take to resolve?
-1 to 3 days
What is sacral sparing?
-refers to having motor and sensory function at the s4-s5 level
What type of SCI will not have sacral sparing?
-A complete SCI
How can you check to see if someone has sacral sparing?
-If the have deep anal pressure
What are some secondary impairments of SCIs?
-Pressure sores, Pneumonia, DVT, pain, contractures, osteoporosis and fractures
What is the neurological level of injury?
-The most caudal segment of the spinal cord with 5/5 strengths and normal sensation on both the left and right side, and every segment above it has to be 5/5
What is the best predictor of motor recovery?
-preserve motor function
SCI prognosis can improve if what is present within 4 months post injury?
-pinprick sensation in BLEs, and sacral sparing is present
What has a better prognosis, Brown Sequard syndrome or Anterior cord lesion?
-Brown Sequard
What outcome measures the level of independence someone with an SCI has?
-Spinal Cord Injury Independence Measure (SCIM)
What is an Asia A SCI?
-Complete lesion, no motor or sensory in S4/5 segments
What is an Asia B SCI?
-Incomplete, Sensory is preserved below the neurological level but no motor function
What is an Asia C?
-Incomplete lesion, motor function is preserved below the neurological level, more than half of the key muscles below the neurological level have an MMT grade less than 3/5
What is an Asia D SCI?
-Incomplete lesion, Motor function is preserved below the neurological level, more than half of the key muscle below the level have an MMT grade or 3/5 or more
What outcome measure is used to measure the severity of fatigue in a patient with GBS?
-Fatigue Severity Scale (FSS)
What outcome measure is used to measure the impact that fatigue has on a GBS patients ADLs?
-Fatigue Impact scale
What other measure can be used to determine a GBS patients level of fatigue?
-Visual analogue for Fatigue Scale
What are the function specific outcome measures for GBS?
- Barthal Index
- Modified Hughes scale of GBS Diability
- Functional Independence Measure
What is the gold standard for function in an acute care setting?
-Functional Independence Measure
What does treatment focus on in an acute setting?
-supportive care, prevention of secondary impairments, and recovery
What does treatment focus on in the chronic stage?
-Addressing impairments, addressing activity limitations and participation restrictions
With GBS, how does motor weakness occur?
-In a rapid progression
How do motor symptoms present with GBS?
-Symetrical and proximal to distal
What are reflexes like with GBS?
-Areflexic
How do sensory symptoms present with GBS?
-Mildly
What type of symptoms indicate autonomic dysfunction with GBS?
-Tachycardia, Arrhythmias
GBS patiens typically have a history of what?
-Flu like symptoms (no fever at onset)
What will labs present if a patient has GBS?
-Increased protiens in CSF
How will nerve conduction be affected in a patient with GBS?
-It will not be
How long does it usually take for a GBS patient to recover?
-2 to 4 weeks (After a plataeu of symptoms)
What is the first step of reach/grasp?
-Locating the target
What system most involved in step one of reach/grasp?
-The visual system
What is the second step of reach/grasp?
-Reaching: transportation of hand/arm
What is involved in stage 2 of grasp/reach?
-Proprioception, coordination, and motor
What is stage 3 of reach/grasp?
-Grasp (grip formation, grasp and release)
What plays a huge role in stage 3 of reach/grasp?
-Coordination
What is stage 4 of reach/grasp?
-Hand manipulation of object
What are some intrinsic causes of Shoulder subluxation?
-Trunk/joint alignment, imbalance of muscle activation, weakness,abnormal tone, and soft tissue extensibility
What are some extrinsic causes of shoulder subluxation?
-Positioning, handling, and assistive devices
What is the main extrinsic cause of shoulder subluxation?
-Handling (dont grab by arm)
What are the steps to manage a shoulder subluxation?
- Actively align the trunk
- Scapula in neutral alignment
- Alignment of the humerus
Why should you not perform PROM pulleys with a patient with low RTC tone?
-It will result in impingment
What outcome measures are used to measure upper extremity function?
- 9 hole peg
- Action Research Arm test
- Fugl Meyer
How can you prevent shoulder subluxation?
-Maintaining alignment, and Caregivier education
What are the effects of shoulder subluxation?
-Will not be painful, patient will be traumatized
What is the onset of a disability?
-Sudden
What normally occur with a disability?
-Depression, grief over loss of function
What is the onset for chronic illness?
-insidious
What is depression related to with chronic illness?
-Fear of the future, death and the unknown
What is sensory aphasia commonly known as?
-Wernickes Aphasia
What is the most common type of fluent aphasia?
-Sensory
What is sensory aphasia?
-Impaired ability to understand spoken or written words
What is motor aphsia commonly known as
-Brocas aphasia
What is motor aphasia?
-Akward artiulations, restricted vocabulary but patients language comprehension is in tact
What is dysphagia?
-Difficulty swallowing
What is dysphasia?
-Abnormal articulation
What is the cognitive abilities that enable a person to engage in purposeful action, recognize erros, problem solving and think abstractly?
-Executive function
What is visual agnosia?
-Inability to recognize familiar objects despite normal function of the eye and optic tracts
What is auditory agnosia?
-Inability to recognize non speech sounds or discriminate between them
What is tactila agnosia?
-Inability to recognize forms when handling them
What is ideamotor apraxia?
-Patient understands what to do, and can perform tasks on their own but not on command
What is ideational aphasia?
-Person losses the idea of what to do; patient is unable to conceptualize the task, and cant perform it automatically or on command
What will a patient with unilateral neglect present like?
-Will ignore on side of the body, will write numbers on one side of the plate, will no eat food on one side of the plate
What is imediate recall?
-Retention of info thats been stored for a few seconds
What is short term memory?
-retentions of events or learning thats taken place within a few minutes, hours or days
What is long term memory?
-early experiences and info acquired over period of years
What is the ability to select and attend to specific stimulus while simultaneously supressing extraneous stimuli?
-Attention
What is sustained attention?
-the capacity to attend to relevant info during activity (constant response during activity)
What is focused or selective attention?
-the capacity to attend to a task despite environmental visual or auditory stimuli
What is alternating attention?
-The capacity to flexibily move between tasks and respond appropriately to the demands of each task
What is divided attention?
-The capacity to respond to two or more stimuli or tasks when they are all relevent
What is the capacity to determine what one needs/wants to do?
-Volition
What is the ability to identify and organtion steps and elements need to carry out an intention or goal?
-Planning
What is purposive action?
-Productivity and self-regulation, which includes the ability to initiate, maintain, switch, and stop complex action sequences
What is effective performance?
-capacity for quality control, including ability to self monitor and self correct ones behavior
What is the preocess of selection, integration and interpretation of stimuli from ones own body an the surrounding environment?
-Perception
What is cognition?
-an act or process of knowing, including aweness, reasoning, judgement, intuition and memory
What is Anosoagnosia?
-the lack of awareness, or denial or paretic extreminity that belongs to self, disowning a paralyzed limb
What is somatoagnosia?
-The lack of awareness of body structure and relationship of body parts, doesnt understand terms related to body parts (transfers may be difficult)
What is finger agnosia?
-The inability to identify fingers of ones own hands or examiners
What is spatial relations disorder?
-Impairments that perceiving the relationship between self and two or more objects
What is figure-ground spatial relation disorder?
-The inability to distinguish an object from the background in which it is embedded in
What is form spatial relation disorder?
-The inability to percieve or attend subtle differences in form and shape
What is spatial relations?
-The inability to perceive the relationship between one object in space to another
What is position in space spatial relations disorder?
-the inability to perceive or interpret spatial concepts such as up, down, in, out, over, under
What is the impairment caused by the impairment itself?
-Direct impairment
What is an indirect impairment?
-the impairment caused by the direct impairment
What are the 4 Ps?
-Prediction, Participation, Prevention, Plasticity
How will a person with a Basal Ganglia lesion present?
-Bradykinetic. resting tremour, festinating gate
What will a person with a cerebellum lesion present like?
-Ataxia, DDK, Dysmetria, poor coordination
What extremity is more involved with an ACA stroke?
-The LE
What extremity is more involved with an MCA stroke?
-The UE
A peson with a right hemisphere lesion will have what traits?
-Agnosia, may have unilateral neglect, might be a flight risk
What will a person present like with a left hemisphere lesion?
-may have aphasia, apraxia, will be depressed
If a PD patient experiences freezing of gait, what will it look like?
- Usually when walking through doorways or onto distracting flooring
- Steps will become very small
What is a Ranchos Level 1:
-No response: complete absence in change of behavior when presented with a stimulus of any kind
What is a Ranchos level 2?
-Generalized Response: Demonstrates a generealized response to painful stimuli or repeated auditory stimuli
What is a Ranchos Level 3?
-Localized Response: With demonstrate withdrawl or auditory response to painful stimuli, will turn head toward or away auditory stimuli, will blink if light passes through visual field, will follow object through visual feild
What is a Ranchos Level 4?
-Confused Agitated: going crazy, may perform a motor task but with no real purpose, may cry out even after stimuli is removed, short term memory is absent, may be aggressive or a flight risk
What is Ranchos 5?
-Confused, Inappropriate Non-Agitated: Alert, not agitated bt may wonder with the vague intention of going home, not AAOX3, may be able to perform previously learned tasks with instruction and cues, unable to learn new information
What is a Ranchos 6?
-Confused-Appropriate: inconsistently AAOx3, able to attend highly familiar tasks for 30 minutes in a non-distracting environment with minimal redirection, Max assistance with new learning with little to no carry over
What is a Ranchos 7?
-Automatic Appropriate: consistently oriented to person and place in a familiar environment, ability to attend a task for 30 minutes in a nondistracting environment with minimal assistance to complete the task, minimal supervision for new learning, some carry over, over estimates abilities
What is a Ranchos 8?
-Purposeful Appropriate: Consistently AAOX3, ability to attend familiar tasks for 60 minutes in a distracting environment, able to recall and integrate past and recet events, uses to do lists
What is stereognosis?
-The ability to recognize an object
What is the ability to identify where a stimulus is touching the body with out looking?
-tactile location
What is the ability to identify a letter or number written on the palm of your have?
-Graphesthesia
What is barognosis?
-The ability to identify weight
What is spasticity caused by?
-AN UMN lesion, hyperexcited alpha motor nueron
What is a brunnstrom level 1?
-Flaccidity: no tone or movement
What is a Brunnstrom level 2?
-Spacticity begins, no voluntary movement, only associated reactions or reflexes
What is a brunnstrom level 3?
-Spasticity Worsens: voluntary movements only occur in synergy
What is brunnstrom level 4?
-Spasticty decline: some movement occurs outside of synergy
What is a Brunnstrom level 5?
-Spasticity continues to decline: relative freedom of movement from synergy
What is a brunnstrom level 6?
-Spasticity Disappears: all movement normal
How does an UMN lesion affect reflexes?
-Increases them (hyperreflexia)
How does an UMN lesion affect tone?
-Increases if
What is primary muscle weakness from an UMN lesion caused by?
-reduced motor unit recruitment, impaired firing rates, and decreased contraction times
What is secondary muscle weakness from an UMN caused by?
-Atrophy from disuse
What is motor control?
-The ability to regulate or direcct the mechanisms essential to movement
What is postural control?
-the ability to acheive and maintain an upright posture
What is orientation?
-knowing where your body is in space
What are ankle strategies used for?
-Small pertebations, on a firm surface
Describe the ankle strategy used when when someone pushes you backward?
- muscle fire anterior tibialis, quads, then abs
Describe the ankle strategy used when someone pushes you forward?
-muscles fire gastroc, then hamstrings then paraspinals
When is a hip strategy used?
-with large pertebations or with a small BOS
Describe the hip strategy when someone pushed you forward hard?
-muscles fire abs then quads
Describe the hip strategy when someone pushes you backward hard?
-Muscles fire paraspinals, hamstrings
A functional reach less than what indicates a fall risk?
-6 inches
What should you use the Berg Balance test for?
-For balance only
What outcome measure should you used to test someones balance and gait?
-Tinetti
Why would you used the foam and dome test?
-To determine which system a person relies the most on for balance
