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Neuro Rehab 1 > Impairment Oriented Neuro Exam III > Flashcards

Impairment Oriented Neuro Exam III Flashcards

1
Q

what is coordination

A

sequence, timing, and force production of multiple ms groups to produce smooth, accurate, and controlled movement

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2
Q

what is coordinated movement characterized by

A

appropriate:
- speed
- distance
- direction
- timing
- ms tension

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3
Q

what are 3 types of coordinated movement

A

intralimb
interlimb
visual motor

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4
Q

what is intralimb coordination

A

occurring within one limb
- ex: brushing hair, shaving

need coordination of distal and proximal working together

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5
Q

what is interlimb coordination

A

bimanual movements
integrated performance of 2 or more limbs
- ex: dressing, walking

could be arm and leg, two arms, two legs, etc.

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6
Q

what is visual motor coordination

A

ability to integrate both visual and motor abilities (driving a car)

see something and then interact w it
- including force you need d/t wt of object

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7
Q

what is the role of the basal ganglia in coordinated movements

A

nuclei that regulate initiation of gross intentional movements, and complex planning and execution

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8
Q

what structures are responsible for coordinated movements (4)

A
  1. basal ganglia
  2. DCML
  3. motor cortex & descending pyramidal pathways
  4. cerebellum
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9
Q

what does the DCML do in terms of coordinating movement

A

transmission of discriminative sensations, can cause “sensory ataxia”

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10
Q

what is sensory ataxia

A

description of movement that is uncoordinated

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11
Q

what is the motor cortex and descending pyramidal pathways role in coordinating movements

A

receives info from basal ganglia and cerebellum

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12
Q

what is the physio behind why you see uncoordinated movement in Parkinsons

A

basal ganglia is interruped by parkinsons
- freezing episodes or bradykinesia
- body has trouble starting movement

external cues help bc don’t have the internal cue from body anymore

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13
Q

what are 5 cerebellar functions

A
  1. coordinate the range, velocity, and strength of ms contractions to produce steady, volitional movements and postures
  2. equilibrium in conjunction w vestib system
  3. ms tone regulation
  4. eye-head coordination
  5. coordination of ms for speech
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14
Q

what is the cerebellum’s role in eye-head coordination

A

ability to keep eye on something while moving head around

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15
Q

how is the cerebellum coordinating the range/velocity/strength of ms contractions

A

gets info on how you are performing and tells you how its going
- did it feel good? or not what you wanted?

then unconsciously selects right motor plan for you

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16
Q

how does the cerebellum coordinate ms for speech

A

controls tongue and lips to help regulate how you are coordinating different sounds

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17
Q

information comes from which prominent motor pathways for cerebellar functions

A

reticulospinal
vestibulospinal

not exclusively, but most commonly found in these two

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18
Q

what is the cycle of information traveling for cerebellar functions

A

PERIPHERAL feedback: GTOs, ms spindles, joint & cutaneous receptors, peripheral vestib

–>

modulated and corrected by cerebellum

–>

CENTRAL: info from motor pathways, most commonly reticulospinal and vestibulospinal tracts

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19
Q

what can cerebellar functions be summarized into most simply?

A

vast processing power
- checks and balances
- fact checker

lets you know that everything is doing what it is supposed to be doing

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20
Q

what anatomic part of the cerebellum has output for balance and eye movements

A

vestibular nuclei
- in flocculonodular lobe

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21
Q

what anatomic part of the cerebellum gives output for motor planning

A

dentate nuclei via areas 4&6
- in cerebro-cerebellum

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22
Q

what anatomic part of the cerebellum gives output for motor execution

A

fastigial nuclei - medial descending systems
interposed nuclei - lateral descending systems

both nuclei are in the spinocerebellum

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23
Q

what is cerebellar ataxia

A

disordered movements
- umbrella term used to describe motor impairments of cerebellar origin

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24
Q

what side is ataxia seen on relative to the cerebellar lesion

A

ipsilateral

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25
Q

what are types of causes of cerebellar ataxia

A

congenital
acquired

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26
Q

what are congenital causes of cerebellar ataxia

A

infection
autoimmunity
vitamin deficiencies

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27
Q

what are acquired causes of cerebellar ataxia

A

stroke
tumors
trauma
demyelination

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28
Q

what is the most common sign of a cerebellar lesion

A

ataxic gait

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29
Q

what does an ataxic gait look like

A

dec arm swing
uneven step length
inability to alter gait w change in surface
inc or dec in BOS
staggering
variable foot placement
high movement variability

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30
Q

someone with cerebellar ataxia will have difficulty or a delay in what

A

initiating volitional movements

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31
Q

someone with cerebellar ataxia will have errors in

A

rate, rhythm, and timing of ms firing

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32
Q

basal ganglia vs cerebellum in initiation of volitional movements

A

basal ganglia - immediate initiation, gross movements, fire to start the grill

cerebellum - more motor planning and coordination of how to start the movement
- more important w complicated and fine motor movements

BOTH SYSTEMS WORK SIMULTANEOUSLY

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33
Q

what is a common compensation for initiation of volitional movement when a cerebellar disorder is present

A

use of visual system

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34
Q

what are 6 types of coordination impairments

A

dysmetria
dyssynergia
intention & postural tremors
dysdiadochokinesia
rebound phenomenon (“check reflex”)
asthenia

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35
Q

dysdiadochokinesia & physio behind it

A

dec rapid alternating movements (RAM)
- cannot sustain regular rhythm or produce an even amt of force

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36
Q

physio behind dysdiadochokinesia

A

antagonistic ms firing overlaps w agonist

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37
Q

dysmetria

A

deficit in reaching a target requires corrective movement to reach target

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38
Q

what is dysmetria a result of

A

d/t loss of direction, extent, force and timing of ms contractions

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39
Q

what are two types of dysmetria

A

hypermetria - over shoot target
hypometria - under shoot target

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40
Q

dyssynergia

A

decomposition of movement

errors in relative timing of components of complex multi-joint movements

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41
Q

what does dyssynergia look like

A

movement performed in a sequence of component parts, rather than one smooth activity

movement appears robotic and stiff
everything is a bit isolated

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42
Q

intention tremors

A

oscillation of limb w volitional movement
- most pronounced w termination phase of goal directed movement

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43
Q

postural tremors

A

oscillation of head, neck, trunk

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44
Q

rebound phenomenon

A

inability to rapidly activate an antagonist muscle when resistance is removed from agonist

aka lack of “check reflex”

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45
Q

what are 3 additional clinical manifestations of cerebellar pathology

A

hypotonia
asthenia
dysarthria

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46
Q

hypotonia is d/t what?

A

less excitation of alpha and gamma motor neurons

47
Q

what is an example of hypotonia manifesting in a cerebellar pathology

A

pendular reflexes - oscillates 6-8 times

48
Q

asthenia

A

generalized weakness
- differs from hypotonia

49
Q

how does asthenia manifest in cerebellar pathology

A

excessive efforts required for tasks & c/o early fatigue

50
Q

dysarthria

A

dec melody and rhythm of speech

51
Q

how does dysarthria manifest in cerebellar pathology

A

grammar and words selection intact
may be nasal, soft, tremulous, staccato
not regulated (tone, enunciation)

52
Q

what are non-equilibrium tests looking for when assessing coordination

A

ability of limbs to do something

53
Q

what are examples of non-equilibrium tests for assessing coordination (7)

A
  1. finger to nose
  2. finger opposition
  3. pronation/supination
  4. pointing, past pointing
  5. heel to shin
  6. tapping (PF/DF)
  7. fixation or position holding (rebound phenomenon)
54
Q

what are 6 equilibrium tests for coordination

A
  1. tandem stance
  2. perturbations
  3. romberg - EO/EC
  4. walking on heels or toes
  5. figure 8
  6. stop-start
55
Q

what are equilibrium tests looking at when assessing coordination

A

plays into vestibular system
mostly looking at balance

56
Q

what does the vestibular system work in conjunction with and what do they do together

A

visual and somatosensory systems

all yield estimates of body position and motion if intact
- all happening/processed in brain

57
Q

what 3 roles does the vestibular system also play

A
  1. works w sensory and motor systems
  2. sensor of gravity and head acceleration
  3. one of nervous system’s most important tools in controlling posture
58
Q

what are the 3 main components of the vestibular system

A
  1. peripheral sensory apparatus
  2. central processor
  3. motor outputs
59
Q

what composes the peripheral sensory apparatus as part of the vestibular system

A

bony labyrinth
- part of ear system
membranous labyrinth
- within the labyrinth itself

60
Q

what composes the central processor of the vestibular system

A

vestibular nucleus complex
- one of the CN nucleus (VIII)
cerebellum

61
Q

what composes motor outputs of the vestibular system

A

ocular ms and SC
- vestibulo-ocular reflex (VOR)
- vestibulospinal reflex (VSR)
- vestibulocollic reflex (VCR)

62
Q

what do the semicircular canals in the peripheral vestibular structures detect

A

rotational movements
angular acceleration

63
Q

describe the orientation of semicircular canals in the peripheral vestibular structures

A

horizontal, anterior, posterior

64
Q

how do the semicircular canals in the peripheral vestibular structures detect rotational movements?

A

canals filled w endolymph
head motion moves the endolymph which causes hairs at the base of canals to deflect
this produces a firing of CNVIII

brain detects direction of head movement based on direction hairs move and the firing of CNVIII

65
Q

what is endolymph and how does it help detect motion

A

viscous fluid, when moves will drag hairs with it

causes excitation on one side and inhibition on the other
- need them both bc check each other

66
Q

what are otolith organs

A

saccule
utricle

67
Q

saccule

A

detects vertical linear acceleration and static head tilt

ex: on escalator / elevator as you move up or down floors

68
Q

utricle

A

detects horizontal linear acceleration

ex: stay on same level and move in any direction
- when on that flat conveyor belt in airport

69
Q

what are the 3 primary functions of the peripheral vestibular system

A
  1. stabilize images on fovea of retina during head movements (VOR)
  2. maintain postural stability; esp w head movements (VSR)
  3. spatial orientation info
70
Q

describe the VOR

A

vestibular ocular reflex

keep your eyes on something while you move your head

71
Q

if there is an issue w the VOR what could this be an indication of and what does this look like

A

NOT AN INDICATION OF lesion w CNS or cerebellum

could indicate lack of function/firing on one side (hypofunction)
- your eyes would go w head movement and then maybe jump back after head movement

72
Q

describe the VSR

A

vestibulospinal reflex

how you isolate your head movements

73
Q

what does spatial orientation from the peripheral vestibular system look like

A

are you upright, on your side, prone

74
Q

what might an issue w spatial w orientation present like

A

walking leaning sideways

don’t know what upright is or where to be in space

75
Q

what are the components for central processing of vestibular input

A

vestibular nuclear complex
cerebellar flocculus

76
Q

what is the vestibular nuclear complex

A

four major nuclei in pons and medulla

primary processors of vestibular input and have fast connections to motor output neurons

77
Q

what is the cerebellar flocculus’s role in processing of vestibular input

A

monitors vestibular performance and readjusts central vestibular processing if necessary
- telling you what is going on and if something is off, will make that adjustment if needed

78
Q

what are the vestibular pathways involving the vestibular nuclei

A

nuclei integrate info from vestibular, visual, and somatic receptors

sends collaterals to the cerebellum

the cerebellum sends corrective adjustments to motor cortex - maintenance of balance and posture

79
Q

the central vestibular system has connections with:

A

cortex
thalamus
reticular formation

80
Q

the central vestibular systems connections w the cortex, thalamus, and reticular formation allows the vestibular system to: (3)

A
  1. contribute to integration of arousal and body awareness
  2. discriminate b/w movement of self and environment
  3. control of vestibular reflexes/motor output
81
Q

what specific central vestibular system function is primarily accomplished by the reticular formation

A

contribute to integration of arousal and body awareness

82
Q

what is the function of the VOR

A

maintain stable vision/gaze stability during head motion

83
Q

what does the VOR work w to function successfully

A

works closely w ocular muscles and visual system

one of the fastest reflexes in body
- how it accomplishes this

84
Q

what is the ratio of eye movement to head movement amplitude associated w VOR gain? why?

A

1:1

ensures equal movement of head and eyes and a stable image projected to the retina
- eye and head movement need to be in opposite direction and equal speed

85
Q

is the VOR gain ratio always 1:1

A

in some cases the VOR will need to adapt i order to ensure proper gain

86
Q

how can peripheral vestibular pathology affect VOR gain?

A

tonic firing rate of VOR becomes disrupted
- gain is not achieved

87
Q

if the VOR isn’t intact what does your body do? how do we treat this?

A

cervico-ocular reflex (COR) supplements the VOR
- driven by neck proprioceptors

VOR can be trained if not intact

88
Q

what is the function of the VSR

A

stabilize the body via compensatory movement using otolithic input
- whenever moving head or eyes, keep you from falling over and keep yourself upright

89
Q

VSR vs VOR speed

A

VOR - one of fastest reflexes in the body
VSR - slower than VOR
- still considered primary vestibular reflex

90
Q

what are examples of visual disturbance presentation

A

oscillopsia
diplopia

91
Q

what are examples of how oculomotor dysfunction present

A

nystagmus
ocular dysmetria
saccadic intrusions

92
Q

what are 6 clinical presentations of vestibular dysfunction

A

dysequilibrium - balance is off
nausea
vertigo
dizziness
visual disturbances
oculomotor dysfunction

93
Q

vertigo vs dizziness

A

vertigo - spinning sensation
- is room spinning or are you spinning

dizziness - broad term
- lightheadedness
- fuzzy foggy

94
Q

what is oscillopsia

A

unable to stabilize and hold gaze
- just keeps bouncing around

95
Q

what is diplopia

A

double vision, eyes aren’t working in conjunction
- eyes should together form one image
- eyes each creating a separate image

96
Q

how does someone w diplopia usually compensate? what is the issue w this?

A

compensate w one eye closed
- problem is you lose depth perception

depth perception is gained when two images come together

97
Q

what is ocular dysmetria

A

constant under- or over-shooting of the eyes when attempting to focus gaze on something
- eyes work together to perceive depth/distance

98
Q

what are saccadic intrusions

A

saccades - smooth pursuit when following an object

intrusions - will see eyes jump

99
Q

what are 4 ocular tests for screening vestibular dysfunction

A

nystagmus
smooth pursuit
saccades
VOR/gaze stabilization

100
Q

how do you test/screen for nystagmus

A

check for ability to fixate on target
- holding gaze

101
Q

how do you test smooth pursuit

A

ability to follow target smoothly
- no saccadic intrusion

102
Q

how do you test saccades

A

ability to shift gaze quickly between points
- no under-shooting or over-shooting of target

103
Q

how do you test VOR/gaze stabilization

A

image stays clear during testing
- no visual disturbances

104
Q

what are 4 ex of peripheral vestibular testing

A
  1. head shake and head thrust
  2. positional testing for BPPV (ex dix - hallpike)
  3. dynamic visual acuity test for hypofunction (ex: snellen chart)
  4. balance and gait evals
105
Q

what is the head shake and thrust testing specifically in the peripheral vestibular systme

A

VOR system
- quick movements and tell them to keep looking at your nose

106
Q

what are 2 tests used in a central vestibular exam

A

VOR cancellation test
vergence test

107
Q

what is the VOR cancellation test used in a central vestibular exam

A

ability to bypass VOR if you would like to
- have pt put their hands clasped in front and look at your thumb nails
- now rotate trunk (kinda swinging your arms)

ability to cancel out looking at something else in the distance

108
Q

what would a vergence test have pts do in a central vestibular exam

A

putting finger up and down like pencil pushups

109
Q

what are the 4 main points hit in a PT exam

A

subjective hx
body structures and function
activity limitations
participation

110
Q

what might be asked in a subjective hx

A

when did sx start?
what made them worse? better?
main problem or CC?
falls? n/v?
dizziness?

111
Q

what is assessed specifically in the body structure and function

A

coordination tests
reflexes
ms tone
strength
CNs

112
Q

what is assessed in terms of activity limitations

A

all
- fine motor
- gross motor
- reaching
- balance
- gait
- stairs
- transfers

113
Q

what is assessed in terms of participation

A

play
school
sport
family roles
employment

Neuro Rehab 1 (27 decks)

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