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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
where is crude touch (light touch) mediated
anterolateral / spinothalamic pathway
26
what are some examples of superficial sensations that may be detected
pain temp light touch pressure
27
how is superficial sensation stimuli received (in general terms)
skin and subQ exteroreceptors
28
describe how and when a superficial sensation clinical exam would be conducted
when - usually exam first exam distal to proximal random fashion subject in supine w eyes closed
29
superficial somatosensation: how would you test/measure pain
sharp/dull - pins or paper clips
30
superficial somatosensation: how would you test/measure temp
hot/cold
31
superficial somatosensation: how would you test/measure light touch
cotton balls/swabs Q tips monofilaments
32
superficial somatosensation: how would you test/measure pressure
finger tip cotton swabs
33
what are some types of deep sensations
kinesthesia proprioception vibration perception
34
how is deep sensation perceived
proprioceptors transmit info from ms, tendons, ligaments, and joints
35
kinesthesia vs proprioception
kinesthesia - movement sense proprioception - joint position
36
how is kinesthesia tested
passive ROM verbally describe direction and range WHILE IN MOTION
37
how is proprioception tested
describe position of joint in a STATIC position
38
how is vibration perception tested
ability to perceive vibratory stimulus of a tuning fork that vibrates at 128Hz (on a bony prominence)
39
how would you conduct a deep sensation clinical test in general
have pt close their eyes (usually) start more distally (toe) and move proximally
40
what does combined cortical sensations mean
involves both superficial and deep sensation
41
where is combined cortical sensations transmitted to
cortical sensory association areas
42
what are types of combined cortical sensations
stereognosis 2-point discrimination double simultaneous stim graphesthesia barognosis
43
what is stereognosis
object recognition - could you reach in a bag and touch object and then know what that object is
44
how do you test 2-point discrimination
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
how do you test double simultaneous stimulation
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
how do you test graphesthesia
identify figures drawn on skin
47
how do you test barognosis
identify if object is heavier or lighter after lifting them
48
what is a standardized test/measure of somatosensation in people w SCI
American Spinal Injury Association (ASIA)
49
what types of tests (in general) are primarily used to measure somatosensation
clinical tests - self standardize to ensure consistency and validity
50
what level does motor planning happen at
cortical
51
what is another word for motor planning
motor praxis
52
ideational vs ideomotor apraxias
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
what is a motor unit
motor neuron and muscle fibers it synapses upon
54
location of UMN vs LMN (general terms)
UMN - cortical/brain area LMN - after the SC
55
in general what does a lesion to LMNs do
interrupts the LMN
56
when there is a LMNL what are the treatment options from there and why
brain and SC are fine, but the pathway was broken can take a different route or wait until nerves/pathway regenerates and heals
57
how do LMNL present (s/sx)
flaccid paralysis hypotonia dec or absent DTRs ms fasciculations dec ms bulk/atrophy
58
what are two types of LMNs
somatic motor neurons special visceral motor neurons
59
what do UMNL result from? what are specific examples of this
results from destruction of neurons in major descending pathways ex: corticospinal, vestibulospinal, reticulospinal, rubrospinal
60
how do UMNL impact LMN
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
how do UMNL present (s/sx)-7
paralysis hypertonia inc DTRs clonus impaired ACOM tremors may have inc or dec in muscle bulk
62
what does ACOM stand for
active control of movement aka motor control
63
what is motor control/ACOM
ability to execute a motor plan and isolate ms or ms groups
64
how do you test ACOM
begin w observation of postural alignment test for active movement, patient initiated, volitional
65
what does healthy ACOM present as
selective isolated volitional movements presents as typical movement patterns
66
what does unhealthy ACOM present as
abnormal synergistic patterns mass obligatory firing of multiple muscle groups
67
what could abnormal synergistic patterns look like but are different from
posture or positioning
68
when would abnormal synergistic patterns be triggered
with attempt to actively move limb
69
what types of patients are abnormal synergistic patterns seen in
UMNL
70
what are the 5 steps that you should progress through in a clinical exam of ACOM
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
what are two important things to be addressing and looking for when testing for ACOM
isolated stabilize in position
72
why might motion not be isolated when testing ACOM
substitution? abnormal synergy? consider ability to understand directions
73
if substitutions are implicated based on tested ACOM not being isolated, what are the next steps
further testing at impairment level - joint integrity - sensation - weakness
74
what does obligatory flexion synergy patterns look like in the UE
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
what does obligatory flexion synergy patterns look like in LE
hip flex/ABD/ER knee flexion ankle DF/inversion think passe, but flexed and sickled foot
76
what is an important deficit to note with obligatory flexion synergy patterns when addressing them
these patterns don't work w functional movement - can't do their hair, cook a meal, etc.
77
what does classic extension synergy patterns look like in UE
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
what does classic extension synergy patterns look like in LE
hip ext/ADD/IR knee ext ankle PF/inv think back tondu but IR
79
what is one pro of a classic extension synergy pattern that you can utilize when treating
this pattern can assist w the movement that you want - ie extension w standing
80
what is the clinical reasoning when assessing ROM for a neuro vs MS client
w neuro focus on function
81
what do you document for ROM in a neuro exam
both PROM and AROM end feel - firm, boggy, tension joint integrity / joint play effect of ROM limitations on ACOM/tone
82
what sensations travel along the lateral spinothalamic tract
non discriminative touch - pain - temp - crude touch
83
what sensations travel along the dorsal column medial lemniscal tract (DCML)
discriminative touch kinesthesia proprioception vibration
84
dorsal vs anterior root of the spinal cord
dorsal root = sensory info anterior = motor
85
what is the importance of knowing where tracts/nerves synapse and decussate in terms of if there is a lesion on SC
will tell you if sx are ipsilateral or contralateral from lesion on a SC
86
if there is a lesion on the spinothalamic pathway, how would the sx present? why?
contralateral of the injury - sensory info crosses over at level is received
87
if there is a lesion on the DCML how would the sx present? why?
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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