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Neuro Rehab 1 > Impairment Oriented Neuro Exam > Flashcards

Impairment Oriented Neuro Exam Flashcards

1
Q

why is sensation important (3)

A
  1. critical to motor learning and motor performance
  2. guides selection of movement pattern required in a given sensory environment
  3. used by CNS to modify or adapt ongoing movements
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2
Q

what is sensory integration

A

CNS ability to organize, interpret, and effectively utilize sensory input

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3
Q

why is sensory integration so important

A

can feel all the stimuli in the environment (including pain)
- can’t feel all that at once, would be super overwhelming
- brain filters out what isn’t important so you can focus

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4
Q

sensory integration and pain

A

pain is a stimuli
CNS can filter out the pain so can focus on other things

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5
Q

pathway of somatosensation

A

originates in sensory receptors
carried via afferent neurons to CNS

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6
Q

somatosensation - conscious vs unconscious

A

conscious - feeling pain
unconscious - proprioception

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7
Q

how would someone w impaired somatosensation move?

A

movement is more jerky/robotic
- don’t have the somatosensation to tell you whether movement feels right

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8
Q

what can ataxia be d/t

A

cerebellar disorders
sensory disorders (ie somatosensation loss)

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9
Q

what is ataxia

A

person can’t tell how to locate their body in space and tell where the floor is when they take steps

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10
Q

how do you treat ataxia

A

teach compensations w vision and other sensory means

lots of repetition

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11
Q

what are the 4 main patterns of loss associated w somatosensation

A

nerve root
peripheral nerve
neuropathy
sensory cortex

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12
Q

what could cause somatosensation loss at the nerve root

A

disc herniation
sciatica

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13
Q

what does a nerve root somatosensation loss present as

A

dermatomal pathway loss
- pattern of loss along the dermatomes

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14
Q

what are causes of peripheral nerve somatosensation loss

A

cuts
trauma
carpal tunnel

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15
Q

what does a neuropathy somatosensation loss present as

A

stocking/glove pattern
more impaired distally

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16
Q

what can cause neuropathic somatosensation loss

A

vascular issues
diabetes

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17
Q

what does somatosensation loss at the sensory cortex present like

A

happens at brain level
- right vs left side differences

not necessarily can’t feel anything but might be certain pathways that are impaired on that side

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18
Q

what can cause somatosensation loss at the sensory cortex level

A

stroke
TBI

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19
Q

what are the two main parts of somatosensation

A
  1. pain, temp, some light touch
  2. vibration, 2 point discrimination, proprioception
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20
Q

where are vibration, 2 point discrimination and proprioception signals sent to/processed

A

dorsal/posterior column of SC

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21
Q

where is the majority of light touch (but not all) signals sent to

A

dorsal/posterior column

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22
Q

fibers detecting pain/temp vs vibration/2 point/proprioception

A

pain/temp = fibers small & slow
vibration = large & fast

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23
Q

where are pain/temp and some light touch signals sent to/processed

A

anterolateral column of SC

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24
Q

where is tactile discrimination (light touch) mediated

A

DCML

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25
Q

where is crude touch (light touch) mediated

A

anterolateral / spinothalamic pathway

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26
Q

what are some examples of superficial sensations that may be detected

A

pain
temp
light touch
pressure

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27
Q

how is superficial sensation stimuli received (in general terms)

A

skin and subQ exteroreceptors

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28
Q

describe how and when a superficial sensation clinical exam would be conducted

A

when - usually exam first

exam distal to proximal
random fashion
subject in supine w eyes closed

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29
Q

superficial somatosensation: how would you test/measure pain

A

sharp/dull
- pins or paper clips

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30
Q

superficial somatosensation: how would you test/measure temp

A

hot/cold

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31
Q

superficial somatosensation: how would you test/measure light touch

A

cotton balls/swabs
Q tips
monofilaments

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32
Q

superficial somatosensation: how would you test/measure pressure

A

finger tip
cotton swabs

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33
Q

what are some types of deep sensations

A

kinesthesia
proprioception
vibration perception

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34
Q

how is deep sensation perceived

A

proprioceptors transmit info from ms, tendons, ligaments, and joints

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35
Q

kinesthesia vs proprioception

A

kinesthesia - movement sense
proprioception - joint position

36
Q

how is kinesthesia tested

A

passive ROM
verbally describe direction and range WHILE IN MOTION

37
Q

how is proprioception tested

A

describe position of joint in a STATIC position

38
Q

how is vibration perception tested

A

ability to perceive vibratory stimulus of a tuning fork that vibrates at 128Hz (on a bony prominence)

39
Q

how would you conduct a deep sensation clinical test in general

A

have pt close their eyes (usually)
start more distally (toe) and move proximally

40
Q

what does combined cortical sensations mean

A

involves both superficial and deep sensation

41
Q

where is combined cortical sensations transmitted to

A

cortical sensory association areas

42
Q

what are types of combined cortical sensations

A

stereognosis
2-point discrimination
double simultaneous stim
graphesthesia
barognosis

43
Q

what is stereognosis

A

object recognition
- could you reach in a bag and touch object and then know what that object is

44
Q

how do you test 2-point discrimination

A

2-point discriminator
- two point start close together and move apart gradually to see if person can distinguish b/w 1 or 2 stimuli

45
Q

how do you test double simultaneous stimulation

A

apply stimuli in the same spot on contralateral body parts
- identify b/w one or two stimuli

ex: on R knee and L knee

46
Q

how do you test graphesthesia

A

identify figures drawn on skin

47
Q

how do you test barognosis

A

identify if object is heavier or lighter after lifting them

48
Q

what is a standardized test/measure of somatosensation in people w SCI

A

American Spinal Injury Association (ASIA)

49
Q

what types of tests (in general) are primarily used to measure somatosensation

A

clinical tests
- self standardize to ensure consistency and validity

50
Q

what level does motor planning happen at

A

cortical

51
Q

what is another word for motor planning

A

motor praxis

52
Q

ideational vs ideomotor apraxias

A

IDEATIONAL - not able to create movement automatically or w command
(ex: brush your teeth command)

IDEOMOTOR - not able to create movement based on command, but if you gave them something that implied what to do - they could do it
(ex: hand them a toothbrush)

53
Q

what is a motor unit

A

motor neuron and muscle fibers it synapses upon

54
Q

location of UMN vs LMN (general terms)

A

UMN - cortical/brain area
LMN - after the SC

55
Q

in general what does a lesion to LMNs do

A

interrupts the LMN

56
Q

when there is a LMNL what are the treatment options from there and why

A

brain and SC are fine, but the pathway was broken

can take a different route
or wait until nerves/pathway regenerates and heals

57
Q

how do LMNL present (s/sx)

A

flaccid paralysis
hypotonia
dec or absent DTRs
ms fasciculations
dec ms bulk/atrophy

58
Q

what are two types of LMNs

A

somatic motor neurons
special visceral motor neurons

59
Q

what do UMNL result from? what are specific examples of this

A

results from destruction of neurons in major descending pathways

ex: corticospinal, vestibulospinal, reticulospinal, rubrospinal

60
Q

how do UMNL impact LMN

A

LMN might just keep doing whatever they want bc still activated and have potential
- inc tone, can lead to contractures
- could maintain ms bulk bc nerves still can be activating the muscles

61
Q

how do UMNL present (s/sx)-7

A

paralysis
hypertonia
inc DTRs
clonus
impaired ACOM
tremors
may have inc or dec in muscle bulk

62
Q

what does ACOM stand for

A

active control of movement
aka motor control

63
Q

what is motor control/ACOM

A

ability to execute a motor plan and isolate ms or ms groups

64
Q

how do you test ACOM

A

begin w observation of postural alignment

test for active movement, patient initiated, volitional

65
Q

what does healthy ACOM present as

A

selective isolated volitional movements

presents as typical movement patterns

66
Q

what does unhealthy ACOM present as

A

abnormal synergistic patterns

mass obligatory firing of multiple muscle groups

67
Q

what could abnormal synergistic patterns look like but are different from

A

posture or positioning

68
Q

when would abnormal synergistic patterns be triggered

A

with attempt to actively move limb

69
Q

what types of patients are abnormal synergistic patterns seen in

A

UMNL

70
Q

what are the 5 steps that you should progress through in a clinical exam of ACOM

A
  1. is motion absent? initiated?
  2. is motion completed through full or partial range?
  3. AG or GM?
  4. is motion isolated? if yes, then measure MMT
  5. any abnormal synergistic motion/patterns?
71
Q

what are two important things to be addressing and looking for when testing for ACOM

A

isolated
stabilize in position

72
Q

why might motion not be isolated when testing ACOM

A

substitution?
abnormal synergy?
consider ability to understand directions

73
Q

if substitutions are implicated based on tested ACOM not being isolated, what are the next steps

A

further testing at impairment level
- joint integrity
- sensation
- weakness

74
Q

what does obligatory flexion synergy patterns look like in the UE

A

scapular retraction and elevation
shoulder ABD/ER
elbow flexion
forearm supination
wrist/finger flexion

think a shrug w arms out but fingers in fists instead

75
Q

what does obligatory flexion synergy patterns look like in LE

A

hip flex/ABD/ER
knee flexion
ankle DF/inversion

think passe, but flexed and sickled foot

76
Q

what is an important deficit to note with obligatory flexion synergy patterns when addressing them

A

these patterns don’t work w functional movement
- can’t do their hair, cook a meal, etc.

77
Q

what does classic extension synergy patterns look like in UE

A

scap protraction
shoulder ADD/IR
elbow ext
forearm pronation
wrist/finger flexion

think hunching shoulders, making yourself smaller, turning inward - but wrist/finger flexed

78
Q

what does classic extension synergy patterns look like in LE

A

hip ext/ADD/IR
knee ext
ankle PF/inv

think back tondu but IR

79
Q

what is one pro of a classic extension synergy pattern that you can utilize when treating

A

this pattern can assist w the movement that you want
- ie extension w standing

80
Q

what is the clinical reasoning when assessing ROM for a neuro vs MS client

A

w neuro focus on function

81
Q

what do you document for ROM in a neuro exam

A

both PROM and AROM
end feel - firm, boggy, tension
joint integrity / joint play
effect of ROM limitations on ACOM/tone

82
Q

what sensations travel along the lateral spinothalamic tract

A

non discriminative touch
- pain
- temp
- crude touch

83
Q

what sensations travel along the dorsal column medial lemniscal tract (DCML)

A

discriminative touch
kinesthesia
proprioception
vibration

84
Q

dorsal vs anterior root of the spinal cord

A

dorsal root = sensory info
anterior = motor

85
Q

what is the importance of knowing where tracts/nerves synapse and decussate in terms of if there is a lesion on SC

A

will tell you if sx are ipsilateral or contralateral from lesion on a SC

86
Q

if there is a lesion on the spinothalamic pathway, how would the sx present? why?

A

contralateral of the injury
- sensory info crosses over at level is received

87
Q

if there is a lesion on the DCML how would the sx present? why?

A

sx will be ipsilateral of the lesion
- sensory info crosses higher up, at the bottom of the medulla

Neuro Rehab 1 (27 decks)

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