Lab Information Flashcards
Health Condition
-past medical history
Body Structure & Function
-past medical tests of body structures and functions
Activities
- preferred leisure activities
- work activities that are limited by impairments
- handedness
Participation
- roles in home, work & community
- legal issues enabling participation
- advocacy for participation
Environmental Factors
- psychosocial environment
- physical environment
Personal Factors
- age
- gender
- ethnicity/culture
- lifestyle habits
- medications
- family history
- social history
10 Steps for Performing a Neuromuscular Examination
- review client history
- hypothesize problems based upon client chart & related information
- prepare your station with needed tests, materials, & equipment
- observe the client upon arrival
- evaluate the client based upon what you observe
- interview the client
- perform selected tests & measures
- interpret results of tests & measures
- share results of the examination with the client
- coordinate, communicate, & document your examination
confusion/disorientation
-client has difficulty understanding present events & is disoriented to person (who person is), place (where person is), time (what day, time of day, season, year), and/or purpose (why person is being screened)
confabulation
-client generates false information to account for memories the person is unable to recall. It is common for clients with brain injury to generate intricate & complex false stories to fill in for missing parts of their memory
concrete thinking
-client is unable to interpret events & language with any meaning other than the literal meaning. This person has difficulty “getting” jokes, innuendoes, and subtle comments that need to be understood figuratively rather than literally
delayed processing time
-client is unable to answer questions or formulate ideas in a timely manner. the delay is due to problems with mental processing rather than motor problems. this type of client needs additional processing time to answer questions and formulate ideas
disinhibition
-client is unable to monitor and regulate socially inappropriate impulses & behaviors. this disinhibited client may verbalize sexualized language & may dress and behave in socially inappropriate ways. for example, the client may inappropriately remove clothing & make sexual propositions to both familiar people and strangers
distractibility
-client has difficulty remaining on one task for any length of time & may require verbal cues to help the person attend to one task at a time
tangential speech (or “flight of ideas”)
-client is unable to concentrate on one idea at a time for any length of time. instead, client jumps from thought to thought without any obvious connection between thoughts. this client’s verbalizations appear to be a stream of unrelated ideas
perserveration
-client is unable to stop an activity once it is started. client is usually unable to interpret cues that they need to stop a task or change a strategy - instead they continue to implement the behavior over and over again. this is commonly seen in speech patterns of clients with TBI who repeat the same word, phrase, or gesture over & over again
memory deficits
-client typically has short-term memory deficits that may indicate neurological pathology and/or inappropriate use of medications
poor insight
-client lacks an accurate awareness of one’s own strengths and deficit areas relating to one’s functional status. as a result, the client commonly attempts tasks that are too high a level, causing a series of failure. this client is also unable to draw relationships between his/her own behaviors and other’s responses to the patient’s behaviors
poor safety judgment
-client is unable to discern the inherent danger of a situation. the client may become involved in situations that place the person at risk for injury or assault and the person may be taken advantage of
learning disability
-client has difficulty with reading, writing, arithmetic, or language, causing the person to sometimes express frustration and/or irritability. these behaviors may be compounded by difficulties with attention & hyperactivity. while this person’s intelligence is likely normal, their learning is impaired by the inability to bring information together from various parts of the brain
pain receptors
-detect tissue damage
chemoreceptors
-receptors that are sensitive to change in chemical concentration
thermoreceptors
-respons to temperature differences
mechanoreceptors
-respond to changes in pressure or movement
photoreceptors
-receptors in the eyes that respond to light energy
sensory adaptation
-sensory impulses are sent at decreasing rates until receptors fail to send impulses unless there is a change in strength of the stimulus
somatic senses
-receptors associated with the skin, muscles, joints, and viscera make up the somatic senses
What are the 3 types of receptors that detect touch and pressure?
- free ends of sensory nerve fibers
- meissner’s corpuscles
- pacinian corpuscles
free ends of sensory nerve fibers
-in epithelial tissues and are associated with touch and pressure
Meissner’s corpuscles
-flattened connective tissue sheaths surrounding two or more nerve fibers and are abundant in hairless areas that are very sensitive to touch, like the lips
Pacinian corpuscles
-large structures of connective tissue & cells that detect deep pressure
visceral pain receptors
-the only receptors in the viscera that produce sensations
Why does referred pain occur?
-because of the common nerve pathways leading from skin and internal organs
acute pain fibers
-thin, myelinated fibers that carry impulses rapidly & cease when the stimulus stops
chronic pain fibers
-thin, unmyelinated fibers that conduct impulses slowly & continue sending impulses after the stimulus stops
Where are pain impulses processed?
-in the gray matter of the dorsal horn of the spinal cord
Where are pain impulses conducted?
-to the thalamus, hypothalamus, and cerebral cortex
What types of receptors are olfactory receptors (sense of smell)?
-chemoreceptors
What is the pathway for sensory impulses?
-first analyzed in olfactory lobes, then travel along olfactory tracts to the limbic system, and lastly to the olfactory cortex within the temporal lobes
Where are taste buds located?
-located within papillae of the tongue and are scattered throughout the mouth and pharynx
What is the pathway for taste impulses (including both the nerves and locations in the brain)?
-travel on the facial, glossopharyngeal, and vagus nerves to the medulla oblongata and then to the gustatory cortex of the cerebrum
tympanic membrane
- where the middle ear begins
- it is an air-filled space that houses the auditory ossicles
function of auditory ossicles
-transmit and amplify sound waves
inner ear
-transmits and receives sound information to the auditory pathway responsible for carrying the impulses to the auditory cortices of the temporal lobes where they are interpreted
What are the two parts associated with the sense of equilibrium?
- static (head and body are still)
- dynamic (head is suddenly moving)
Where are the organs of static equilibrium located?
-within the bony vestibule of the inner ear, inside the utricle & saccule (expansions of the membranous labyrinth)
How do the impulses of equilibrium travel to the brain?
-via the vestibular branch of the vestibulocochlear nerve
dynamic equilibrium
-the three semicircular canals detect motion of the head, & they aid in balancing the head & body during sudden movement. mechanoreceptors associated with the joints, and the changes detected by the eyes also help maintain equilibrium
What are the visual receptors?
-rods (dim light & colorless) and cones (bright light & color)
Where do fibers from the medial half of the retina cross over?
-in the optic chiasm
Where are the impulses for sight transmitted?
-to the thalamus and then to the visual cortex of the occipital lobe
Clinical tests for the anterolateral neurological system?
- pain perception (sharp or dull)
- temperature
- crude touch
Clinical tests for the dorsal column-medial lemniscus neurological system that are exteroceptors?
- light touch (touch awareness)
- touch threshold
- pressure
Clinical tests for the dorsal column-medial lemniscus neurological system that are proprioceptors?
- kinesthesia (joint movement sense)
- proprioception (static joint position sense)
- vibration
What are the clinical tests for the combined cortical or integrative neurological systems?
- stereognosis
- tactile localization
- two-point discrimination
- double simultaneous stimulation
- tactile extinction
- graphesthesia
- recognition of texture
- barognosis
What is the primary sensory area of the parietal lobe?
-the sensory homunculus
anosmia
-loss of smell
hyposmia
-decreased smell
dysosmia
-distorted smell
Which neurological disease can the loss of smell be an early marker for?
-Parkinson’s Disease
myopia
-impaired far vision
presbyopia
-impaired near vision
homonymous hemianopsia
-visual field deficits in one direction
consensual response of the pupillary light reflex
-the eye constricts in the eye opposite of the eye that the light is shown into
direct response of the pupillary light reflex
-eye that a light is being shown into constricts
How do you know when ptosis present during the pupillary light reflex?
-if the eyelid covers part or covers all of the pupil when looking directly ahead
optokinetic nystagmus
-test of smooth pursuit with quick resetting saccades
strabismus
-loss of ocular alignment
diplopia
-double vision
esotropia
-eyes deviate outward, deficit of CN III
exophthalmos
-eye is in a downward, abducted eye position due to the unopposed action of the superior oblique & lateral rectus muscles, deficit with CN III
anosomia
inability to detect smells
optic neuritis
inflammation of CN II (optic nerve)
contralateral homonymous hemianopsia
bilateral deficits on the temporal or nasal fields of both eyes suggesting an optic tract lesion
Bell’s Palsy
CN VII (facial nerve) damage
bone conduction testing
testing the bones of the outer and middle ear structures by placing a tuning fork on the bone
air conduction testing
testing air conduction by holding a tuning fork near the ear
hypoactive gag
reduced gag reflex
dyspnea
difficulty breathing
dysphonia
hoarse voice
dysphagia
difficulty swallowing
dysarthria
difficulty enunciating words, slurring words
lateral medullary syndrome (aka Wallenburg’s syndrome)
stroke in the lateral medulla
