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Neuro Flashcards

1
Q

Decorticate positioning

A

Elbow flexion
Shoulder AD/IR
Wrist flexion
Finger flexion
LE AD/IR/extension
Ankle plantar flexion

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2
Q

Decerebrate positioning

A

Elbow extension
Shoulder AD/IR
Forearm pronation
Wrist flexion
Finger flexion
LE AD/IR/extension
Ankle plantar flexion

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3
Q

Primitive reflexes present with midbrain damage

A

Righting reflexes

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4
Q

Primitive reflexes present with basal ganglia damage

A

Equilibrium and protective extension reflexes

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5
Q

Coma key indicators

A

No response to enviro stimuli
No sleep-wake cycle
No intentional movement
Eyes do not open to stimuli

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6
Q

Vegetative state indicators

A
  • No sustained, voluntary or reproducible movement to stimuli
  • No comprehension or verbal expression
  • Sleep-wake cycles varies in length
  • Self-regulate temp, breath, circulation
  • Incontinence of bowel and bladder
  • Variable CN function and spinal reflexes
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7
Q

Minimally conscious indicators

A

Awareness of self, enviro or both
Some reproducible behaviors such as ability to follow commands, yes/no responses, purposeful movement

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8
Q

What action results due to tonic labyrinthine reflex post TBI

A

Extensor tone / thrust pattern

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9
Q

Glasgow Coma Scale Scoring

A

8 or less = severe
9-12 = moderate
13 or more = mild

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10
Q

Glasgow Coma Scale Categories

A

Motor response
Verbal response
Eye opening

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11
Q

Glasgow motor response criteria

A

1 - no response
2 - extension to pain
3 - flexion to pain
4 - withdrawal from pain
5 - purposeful movement to pain
6 - obeys command for movement

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12
Q

Glasgow verbal response criteria

A

1 - no response
2 - incomprehensible speech
3 - inappropriate words
4 - confused but able to answer questions
5 - oriented

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13
Q

Glasgow eyes opening criteria

A

1 - no response
2 - open to pain
3 - when asked with loud voice
4 - spontaneous eye open

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14
Q

Bed mobility positioning to normalize tone

A

Side-lying “semi-prone” - supine can increase tone

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15
Q

Cone splints

A

Prevent fingers from damaging palmar surface

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16
Q

UE resting splint position

A

MCP flexion
IP extension
Thumb AB
Neutral wrist/slight extension

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17
Q

Ranchos level appropriate for IRU

A

V or higher

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18
Q

How to support ataxia

A

Weighted objects or body parts to support coordination deficits

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19
Q

How to support poor grasp or decreased strength

A

Built-up objects

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20
Q

What impact do TEDS and abdominal binder have on patients

A

Increase BP

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21
Q

How to position patients with AD

A

Sitting upright and remove clothing to identify noxious stimuli

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22
Q

How to position patients with OH

A

Supine and elevating feet above heart

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23
Q

Zone of partial preservation

A

Complete injuries that have some innervation in s4-5

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24
Q

Spinal shock period and symptoms

A

24 hours - 6 weeks
Absent reflexes/flaccidity
Assess ASIA post spinal shock

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25
Q

When does most recovery take place for SCI

A

3 months for complete and incomplete with continued recovery for 18 months with less gains

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26
Q

Tenodesis splint

A

Dorsal with wrist in extension and thumb in opposition allowing for MP/IP flexion to support grasp

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27
Q

How should forearm rest in C5 injury

A

Pronation to prevent supination contracture

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28
Q

How to encourage sensory feedback with splinting

A

Use dorsal based splints to allow for max sensory input

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29
Q

First line of med mgmt. for CVA

A

Thrombolytic agents

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30
Q

CVA side lying shoulder position

A

Shoulder in ER to neutral with scapular protraction to support muscle lengthening position

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31
Q

C5 Grasp facilitation

A

Mobile arm support to assist in supporting weight of arm during functional activity and using universal cuff or C-clamp to support grasp

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32
Q

C6 grasp facilitation

A

Tenodesis facilitated with radial wrist extensors to maximize grasp/pinch, use of tenodesis splint, use of palmar-cuff button hook

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33
Q

C8 grasp facilitation

A

Use MCP/IP joints for grasp using extrinsic finger muscles and thumb flexors

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34
Q

Global aphasia

A

Loss of all language ability

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35
Q

Broca’s aphasia

A

AKA expressive aphasia, broken speech, slow, labored, mispronunciation

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36
Q

Wernicke’s aphasia

A

AKA receptive aphasia, fluent but nonsensical

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37
Q

Anomic aphasia

A

Inability to name objects

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38
Q

Rancho Los Amigos Scale

A

10-point descriptive measure of cognitive function and awareness

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39
Q

Rancho Level I

A

TD
No response to any stimuli

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40
Q

Rancho Level II

A

TD
Generalized response
Non-purposeful reaction to stimuli

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41
Q

Rancho Level III

A

TD
Localized response
Inconsistent reaction to stimuli

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42
Q

Rancho level IV

A

Max A
Confused and agitated
Heightened state of activity
Poor ability to process information

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43
Q

Rancho level V

A

Max A
Confused, inappropriate and non-agitated
Alert with consistent reactions with simple commands

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44
Q

Rancho level VI

A

Mod A
Confused and appropriate
Some goal-directed behavior with cueing

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45
Q

Rancho level VII

A

Min A
Automatic and appropriate
Oriented to place and routine
Difficulties with recall

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46
Q

Rancho level VIII

A

SBA
Purposeful and appropriate
Tolerance of ~60 minutes

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47
Q

Rancho Level IX

A

SBA on request
Purposeful and appropriate
Tolerance of ~20 minutes

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48
Q

Rancho Level X

A

Mod I
Purposeful and appropriate
Awareness of abilities
Simultaneous tasks

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49
Q

Two types of neglect

A

Spatial and body

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50
Q

Open chain exercises

A

Distal end not fixed

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51
Q

Closed chain exercises

A

Distal end fixed

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52
Q

Closed loop

A

Completing unfamiliar task with no motor plan and benefits from feedback

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53
Q

Open loop

A

Completing familiar task with motor plan and no feedback

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54
Q

Open task

A

Environment is dynamic and unpredictable with most interaction between environment and client

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55
Q

Closed task

A

Environment is stable and predictable with least interaction between environment and client

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56
Q

Internal focus

A

Paying attention to how body is performing a task with cues to body function/structure

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57
Q

External focus

A

Playing attention to the task and what is happening in the environment

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58
Q

Massed practive

A

Little rest between repetitions

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59
Q

Distributed practice

A

Rest time > practice time doing a little bit every day

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60
Q

Blocked practice

A

Repetitive practice of same task

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61
Q

Random practice

A

Practice is ordered randomly, typically open tasks

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62
Q

Whole part practice

A

Entire task without breaking into discrete steps with less initiation/termination

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63
Q

Part task practice

A

Task broken down into discrete steps (typically done with blocked practice)

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64
Q

Knowledge of performance

A

Extrinsic feedback about the process of performance

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65
Q

Knowledge of results

A

Extrinsic feedback about the outcome or end product

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66
Q

Forward chaining

A

Patient starts, OT finishes

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67
Q

Backward chaining

A

OT starts, patient finishes

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68
Q

Structure for motor control intervention

A
  1. Align
  2. Elongate
  3. Activate
69
Q

Activate exercises

A

Weight bearing, trunk rotation, place and hold, functional task with HOH, stabilization or bilateral use

70
Q

Facilitation technique

A

Increase muscle tone and activate agonists
- Light touch/tapping 2 fingers
- Ice
- FES
- Quick stretch
- Vibration
- Weight bearing
- Heavy compression

71
Q

Focal brain injury

A

Direct blow to the head resulting from collision with external object

72
Q

Muti-focal and diffuse brain injury

A

Sudden declaration of the body and head from MVA or fall from high surface

73
Q

Ataxia

A

Abnormal movement resulting from cerebellum damage

74
Q

Effective positioning post TBI

A

Stable base of support at the pelvis with maintenance of trunk in midline and facilitation of head in upright midline position

75
Q

Sensory stimulation post TBI

A

Effectiveness in improving level of consciousness has not been established but it is helpful to use when identifying when a client has emerged from a coma

76
Q

Major TBI acute interventions

A

Positioning to prevent pressure ulcers
PROM to prevent secondary impairment
Splinting to prevent contracture
Sensory stimulation
Management of agitation
Family/caregiver educatoin

77
Q

Major inpatient rehab interventions

A
  • Optimize motor, visual, visual-perceptual, cognitive, speech function
  • Restore competence in maintenance tasks
  • Behavioral and emotional adaptations
  • Support care givers
78
Q

Neglect compensatory technique

A

Placing objects in field of vision to maximize success

79
Q

Neglect rehabilitative technique

A

Encourage client to use the neglected side during functional activity

80
Q

Major implications for SCI

A

Skin breakdown/pressure sores
Decreased vital capacity
Orthostatic hypotension
Autonomic dysreflexia
Spasticity
Heterotrophic ossification
DVT
Bowel & bladder
Temperature regulation

81
Q

Embolism

A

Obstruction of an artery by blood clot

82
Q

Ischemic CVA

A

Embolism
Thrombosis
Blood clot

83
Q

Hemorrhagic CVA

A

Aneurysm
Rupture

84
Q

Aneurysm

A

Abnormal bulge or ballooning in the wall of a blood vessel that ruptures and causes internal bleeding

85
Q

Dysarthria

A

Difficulty speaking due to weakened musculature

86
Q

Ideational apraxia

A

Unable to plan movements related to interaction with objects for task completion

87
Q

Ideomotor apraxia

A

Unable to complete common motor tasks when asked or imitate basic actions

88
Q

Best practices for apraxia intervention

A

Transitive symbolic gesturing (real-life and meaningful use of objects)

89
Q

Homonymous hemianopsia

A

Field loss deficit in the same halves of the visual field of each eye

90
Q

Intervention strategies to facilitate postural stability while seated

A
  1. Establish neutral and active sitting alignment
  2. Perform reaching activities while maintaining neutral sitting alignment
  3. Perform activity to maintain trunk in midline ( core strengthening AG, weight shifting with pelvis)
91
Q

Active and neutral sitting alignment

A

Both feet flat on floor
Equal weight on pelvis
Neutral or slight anterior pelvic tile
Erect spinal posture
Head over shoulders
Shoulders over hips

92
Q

Intervention strategies to facilitate postural stability while standing

A
  1. Maintain center of mass over base of support with activity
  2. Maintain or restore equilibrium (beam walking)
  3. Use stepping to widen base of support
93
Q

Frontal lobe

A

Voluntary muscle activation
Higher-order cognitive functioning (EF)
Emotional control and judgement
Motor aspects of speech (Broca)

94
Q

Parietal lobe

A

Integration of sensations
Touch, proprioception, pain, temperature

95
Q

Temporal lobe

A

Process auditory stimuli
Language comprehension (wernicke’s)

96
Q

Occipital lobe

A

Process visual stimuli

97
Q

Anterior horn

A

(Ventral) efferent motor neurons

98
Q

Posterior horn

A

(Dorsal) affects sensory neurons

99
Q

Autonomic nervous system

A

Innervates involuntary structures including smooth muscle, hear, glands to maintain homeostasis
1. Sympathetic
2. Parasympathetic

100
Q

Sympathetic nervous system

A

Flight or fight/emergency response
Increase HR and RR
Constriction of peripheral blood vessels
Inhibit peristalsis

101
Q

Parasympathetic nervous system

A

Restores homeostasis
Slows HR and RR
Reduced BP
Increases peristalsis

102
Q

Cerebrospinal fluid

A

Provides support/cushions brain, controls brain excitability by regulating ions, supports exchange of nutrients and waste

103
Q

Central cord lesion

A

Hyperextension injury (UMN lesion of central cord) UE impairment > LE impairment, bilateral loss of pain and temperature, preservation of proprioception and discriminatory sensation

104
Q

Brownsquared syndrome

A

Caused by trauma (infection, gun shot) (UMN lesion of spinal cord), ipsilateral paralysis and loss of tactile discrimination and contralateral loss of pain and temperature

105
Q

Anterior cord syndrome

A

Flexion injury (UMN lesion of anterior cord), bilateral loss of motor function, pain and temperature and preservation of proprioception and kinesthesia

106
Q

Posterior cord syndrome

A

UMN lesion of posterior cords resulting in bilateral loss of proprioception, vibration, pressure and stereognosis with preservation of moot function

107
Q

Transient ischemic attack

A

Brief blood supply block to the brain with symptoms lasting for about 1 hour, warning sign of future CVA

108
Q

Left lesion presentaion

A

Apraxia
Aphasia
Frustation

109
Q

Right lesion presentation

A

Unilateral neglect
Poor insight to deficits

110
Q

Anterior/ventral

A

Motor

111
Q

Posterior/dorsal

A

Sensory

112
Q

Areflexic bowel

A

Cannot feel need to have bowel movement AND reduced reflex to control anal sphincter (empty on its own)

113
Q

Conus medullaris

A

Injury of sacral cord and lumbar nerve roots causing sensory/motor loss and areflexic bowel/bladder

114
Q

C1-C3 considerations

A
  • Ventilator required
  • Use of hospital bed and lift
  • Use of power wheelchair with tilt and mouth/chin/voice activation
  • Neck flexion, extension, rotation
  • 24/7 total assistance for ADL
  • Use of environmental control unit with voice activation or mouth stick
115
Q

C4 considerations

A
  • Innervation of diaphragm/no ventilator
  • Shoulder elevation
  • 24/7 total assistance for ADL
116
Q

C5 considerations

A
  • Elbow flexion / innervation to biceps
  • ADL with adaptive devices
  • Significant help for transfers/bathing
  • Use of wrist cock up splint and universal cuff
  • Mobile arm support
  • Power wheelchair with arm drive control outdoors
  • light wheelchair indoors
  • Driving may be possible with highly specialized modified van
  • Padded tub transfer bench
  • TD for transfers
117
Q

C6 considersations

A
  • Tenodesis grasp with wrist extension to promote functional grasp
  • Cannot sustain grasp due to last of hand strength
  • Wrist-driven flexor hinge splint
  • Standard bed
  • Independent ADL with AE
  • Loops to zipper pulls, palmar cuff buttonhook, built up handles, bath mitts/gloves
  • Pressure relief independently
  • Power w/c with standard arm drive control or manual lightweight rigid with modified rims
118
Q

C7 Considerations

A
  • Triceps/elbow extensions (can push up and lift)
  • Independent with all ADLS using AE
  • Full strength of shoulder
  • Depression transfer independently
119
Q

C8 Considerations

A
  • Improved hand function and FMC
  • Complete functional use of both UE
  • Decreased use of AE
120
Q

Neuropraxia

A

Spontaneous recovery with damage to myelin

121
Q

Axonotmesis

A

spontaneous recovery with damage to myelin and axon

122
Q

Neurotmesis

A

No spontaneous recovery with completely severed nerve

123
Q

Goal of motor learning

A

Acquisition of functional skills that can be generalized to multiple situations and environments

124
Q

Skill acquisition stage of motor learning

A

Cognitive phases that occurs during initial instruction and practice of skill

125
Q

Skill retention stage of motor learning

A

Associated phased that involves carryout when asked to demonstrate the newly acquired skill after initial practicing

126
Q

Skill transfer stage of motor learning

A

Autonomous phases that involves demonstrates skill in new contexts

127
Q

Intrinsic feedback

A

Information received by the learned as result of performing the task, usually tactile, vestibular, visual

128
Q

Factors that lead to generalization

A

Intrinsic feedback
Knowledge of performance
Variable and random practice conditions
Whole task practice
Naturalistic settings
High contextual interference

129
Q

Variable motionless task

A

Stable environment but features of environment are likely to vary (ADLs outcome of typical living environment)

130
Q

Consistent motion task

A

Environmental condition are in motion but are consisten and predictable (stepping on escalator)

131
Q

Strategies during skill acquisition stage

A

Highlight purpose of task
Demonstation
Pt. verbalize task components
Feedback after every trial
Variable feedback
Blocked/repeated practice
Structured and stable environment

132
Q

Strategies during skill retension stage

A

Variable practice and feedback
Progress towards open and dynamic environment
Emphasize proprioceptive feedback to establish internal reference

133
Q

Strategies during skill transfer stage

A

Allow for self-evaluation
Performance in variable environments

134
Q

Focus of NDT treatment approach

A

Handling techniques to promote normal movement

Focus is on improving quality of movement through integration of both sides of the body, weight bearing, normal righting/equilibrium patterns

Avoidance of movements and activities that increase tone

135
Q

Focus of PNF treatment approach

A

Focused on diagonal patterns of movement and posture during functional activities

Function off the basis that there are shifts between flexor and extensor dominance

136
Q

5-point Ashworth scale

A

0 = no increase in muscle tone
1 = slight increase in tone (catch and release)
1+ = slight increase in tone (catch and release followed by resistance rest of ROM)
2 = marked increase in tone through ROM but part easily moved
3 = considerable tone, passive movement difficulty
4 = affected part in rigid flexion or extension

137
Q

Dysmetria

A

Undershooting or overshooring of target

138
Q

Dyssynergia

A

Joints move separately opposed to moving together in smooth pattern

139
Q

Dysdiadochokinesia

A

Impaired ability to perform rapid alternating movements

140
Q

Cog-wheel rigidity

A

Alternative contraction and relaxation of muscle

141
Q

Direct intervention for oral motor dysfunction

A

Modification of consistency, amount and pacing of solids and liquids

Postural intervention to increase swallow efficiency including chin tuck, forward head tilt and head turn

Utilizing swallowing adaptations

142
Q

Supraglottic swallow

A

Swallowing technique in which a person coughs right at the end of a swallow to help prevent any swallowed food or liquid from going down into the airway

143
Q

Mendelsohn maneuver

A

Method of intentionally holding the larynx when the larynx is elevated, so that activation of the suprahyoid muscles is induced

144
Q

Indirect intervenion for oral motor dysfunction

A

Cold stimulus to elicit swallow reflex

Strengthening, facilitation and coordination of oral movements

Positioning to maintain the trunk, head and neck in correct postures

145
Q

CIMT

A

Task-oriented approach that involves massed practice and shaping of affected limb during functional receptive activities while less affected extremity is constrained

146
Q

Requirements for CIMT

A

Need some control of wrist and digit including ability lift/release a small towesl off tabletop using any form of prehension

147
Q

Olfactory CN

A

Sensory: smell
Test: sniff variety of aromatic substance

148
Q

Optic CN

A

Sensory: vision
Test: eye chart, visual field

149
Q

Oculomotor CN

A

Motor: eye movement, pupil constriction, eye lid
Test: visual tracking, pupil size comparison, pupillary reflex

150
Q

Trochlear CN

A

Motor: inwards/outward eye movement
Test: visual tracking

151
Q

Trigeminal CN

A

Motor: muscles of mastication
Sensory: facial input
Test: pain/touch/temp with stimulus, move jaw through ROM

152
Q

Abducens CN

A

Motor: lateral eye movement
Test: visual tracking

153
Q

Facial CN

A

Motor: muscles of facial expression
Sensory: taste buds and anterior 2/3 tongue
Test: symmetry of face, attempt facial expressions, apply sweet/sour to tongue

154
Q

Vestibularcholear CN

A

Sensory: sense for equilibrium and hearing
Test: tuning fork

155
Q

Glossopharyngeal CN

A

Motor: pharynx and salivary glands
Sensory: pharynx and tongue
Test: gag/swallow reflex, taste

156
Q

Vagus CN

A

Motor: larynx and pharynx
Sensory: larynx and pharynx
(parasympathetic
Test: gag/swallow reflex

157
Q

Spinal accessory CN

A

Motor: sternocleidomastoid, traps, neck, shoulder
Test: MMT trap and SCM

158
Q

Hypoglossal

A

Motor: tongue movement
Test: stick out tongue

159
Q

Hypoglossal

A

Motor: tongue movement
Test: stick out tongue

160
Q

Mobility T1-T5

A

Independent transfers, manual wheelchair

161
Q

Mobility T6-T12

A

Independent transfers, manual wheelchair, standing frame, walk with braces

162
Q

Mobility L1-L5

A

Independent transfers, manual wheelchair, walk with
brace

163
Q

Mobility S1-S5

A

Independent transfers, able to walk with assistance or aids (slowly and difficulty)

164
Q

SCI level that patient may start driving with hand controls

A

C6

165
Q

SCI level that patients are independent with transfers

A

C7

166
Q

SCI level that patients have normal UE ROM and strength

A

T1

167
Q

SCI level that patients only have partial paralysis in hips
and legs

A

LI - L5

168
Q

SCI that patients only have some loss of hip and leg

A

SI-S5

Exam Prep (19 decks)

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