Neuro Flashcards
1
Q
Decorticate positioning
A
Elbow flexion
Shoulder AD/IR
Wrist flexion
Finger flexion
LE AD/IR/extension
Ankle plantar flexion
2
Q
Decerebrate positioning
A
Elbow extension
Shoulder AD/IR
Forearm pronation
Wrist flexion
Finger flexion
LE AD/IR/extension
Ankle plantar flexion
3
Q
Primitive reflexes present with midbrain damage
A
Righting reflexes
4
Q
Primitive reflexes present with basal ganglia damage
A
Equilibrium and protective extension reflexes
5
Q
Coma key indicators
A
No response to enviro stimuli
No sleep-wake cycle
No intentional movement
Eyes do not open to stimuli
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
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
8
Q
What action results due to tonic labyrinthine reflex post TBI
A
Extensor tone / thrust pattern
9
Q
Glasgow Coma Scale Scoring
A
8 or less = severe
9-12 = moderate
13 or more = mild
10
Q
Glasgow Coma Scale Categories
A
Motor response
Verbal response
Eye opening
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
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
13
Q
Glasgow eyes opening criteria
A
1 - no response
2 - open to pain
3 - when asked with loud voice
4 - spontaneous eye open
14
Q
Bed mobility positioning to normalize tone
A
Side-lying “semi-prone” - supine can increase tone
15
Q
Cone splints
A
Prevent fingers from damaging palmar surface
16
Q
UE resting splint position
A
MCP flexion
IP extension
Thumb AB
Neutral wrist/slight extension
17
Q
Ranchos level appropriate for IRU
A
V or higher
18
Q
How to support ataxia
A
Weighted objects or body parts to support coordination deficits
19
Q
How to support poor grasp or decreased strength
A
Built-up objects
20
Q
What impact do TEDS and abdominal binder have on patients
A
Increase BP
21
Q
How to position patients with AD
A
Sitting upright and remove clothing to identify noxious stimuli
22
Q
How to position patients with OH
A
Supine and elevating feet above heart
23
Q
Zone of partial preservation
A
Complete injuries that have some innervation in s4-5
24
Q
Spinal shock period and symptoms
A
24 hours - 6 weeks
Absent reflexes/flaccidity
Assess ASIA post spinal shock
25
When does most recovery take place for SCI
3 months for complete and incomplete with continued recovery for 18 months with less gains
26
Tenodesis splint
Dorsal with wrist in extension and thumb in opposition allowing for MP/IP flexion to support grasp
27
How should forearm rest in C5 injury
Pronation to prevent supination contracture
28
How to encourage sensory feedback with splinting
Use dorsal based splints to allow for max sensory input
29
First line of med mgmt. for CVA
Thrombolytic agents
30
CVA side lying shoulder position
Shoulder in ER to neutral with scapular protraction to support muscle lengthening position
31
C5 Grasp facilitation
Mobile arm support to assist in supporting weight of arm during functional activity and using universal cuff or C-clamp to support grasp
32
C6 grasp facilitation
Tenodesis facilitated with radial wrist extensors to maximize grasp/pinch, use of tenodesis splint, use of palmar-cuff button hook
33
C8 grasp facilitation
Use MCP/IP joints for grasp using extrinsic finger muscles and thumb flexors
34
Global aphasia
Loss of all language ability
35
Broca's aphasia
AKA expressive aphasia, broken speech, slow, labored, mispronunciation
36
Wernicke's aphasia
AKA receptive aphasia, fluent but nonsensical
37
Anomic aphasia
Inability to name objects
38
Rancho Los Amigos Scale
10-point descriptive measure of cognitive function and awareness
39
Rancho Level I
TD
No response to any stimuli
40
Rancho Level II
TD
Generalized response
Non-purposeful reaction to stimuli
41
Rancho Level III
TD
Localized response
Inconsistent reaction to stimuli
42
Rancho level IV
Max A
Confused and agitated
Heightened state of activity
Poor ability to process information
43
Rancho level V
Max A
Confused, inappropriate and non-agitated
Alert with consistent reactions with simple commands
44
Rancho level VI
Mod A
Confused and appropriate
Some goal-directed behavior with cueing
45
Rancho level VII
Min A
Automatic and appropriate
Oriented to place and routine
Difficulties with recall
46
Rancho level VIII
SBA
Purposeful and appropriate
Tolerance of ~60 minutes
47
Rancho Level IX
SBA on request
Purposeful and appropriate
Tolerance of ~20 minutes
48
Rancho Level X
Mod I
Purposeful and appropriate
Awareness of abilities
Simultaneous tasks
49
Two types of neglect
Spatial and body
50
Open chain exercises
Distal end not fixed
51
Closed chain exercises
Distal end fixed
52
Closed loop
Completing unfamiliar task with no motor plan and benefits from feedback
53
Open loop
Completing familiar task with motor plan and no feedback
54
Open task
Environment is dynamic and unpredictable with most interaction between environment and client
55
Closed task
Environment is stable and predictable with least interaction between environment and client
56
Internal focus
Paying attention to how body is performing a task with cues to body function/structure
57
External focus
Playing attention to the task and what is happening in the environment
58
Massed practive
Little rest between repetitions
59
Distributed practice
Rest time > practice time doing a little bit every day
60
Blocked practice
Repetitive practice of same task
61
Random practice
Practice is ordered randomly, typically open tasks
62
Whole part practice
Entire task without breaking into discrete steps with less initiation/termination
63
Part task practice
Task broken down into discrete steps (typically done with blocked practice)
64
Knowledge of performance
Extrinsic feedback about the process of performance
65
Knowledge of results
Extrinsic feedback about the outcome or end product
66
Forward chaining
Patient starts, OT finishes
67
Backward chaining
OT starts, patient finishes
68
Structure for motor control intervention
1. Align
2. Elongate
3. Activate
69
Activate exercises
Weight bearing, trunk rotation, place and hold, functional task with HOH, stabilization or bilateral use
70
Facilitation technique
Increase muscle tone and activate agonists
- Light touch/tapping 2 fingers
- Ice
- FES
- Quick stretch
- Vibration
- Weight bearing
- Heavy compression
71
Focal brain injury
Direct blow to the head resulting from collision with external object
72
Muti-focal and diffuse brain injury
Sudden declaration of the body and head from MVA or fall from high surface
73
Ataxia
Abnormal movement resulting from cerebellum damage
74
Effective positioning post TBI
Stable base of support at the pelvis with maintenance of trunk in midline and facilitation of head in upright midline position
75
Sensory stimulation post TBI
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
Major TBI acute interventions
Positioning to prevent pressure ulcers
PROM to prevent secondary impairment
Splinting to prevent contracture
Sensory stimulation
Management of agitation
Family/caregiver educatoin
77
Major inpatient rehab interventions
- Optimize motor, visual, visual-perceptual, cognitive, speech function
- Restore competence in maintenance tasks
- Behavioral and emotional adaptations
- Support care givers
78
Neglect compensatory technique
Placing objects in field of vision to maximize success
79
Neglect rehabilitative technique
Encourage client to use the neglected side during functional activity
80
Major implications for SCI
Skin breakdown/pressure sores
Decreased vital capacity
Orthostatic hypotension
Autonomic dysreflexia
Spasticity
Heterotrophic ossification
DVT
Bowel & bladder
Temperature regulation
81
Embolism
Obstruction of an artery by blood clot
82
Ischemic CVA
Embolism
Thrombosis
Blood clot
83
Hemorrhagic CVA
Aneurysm
Rupture
84
Aneurysm
Abnormal bulge or ballooning in the wall of a blood vessel that ruptures and causes internal bleeding
85
Dysarthria
Difficulty speaking due to weakened musculature
86
Ideational apraxia
Unable to plan movements related to interaction with objects for task completion
87
Ideomotor apraxia
Unable to complete common motor tasks when asked or imitate basic actions
88
Best practices for apraxia intervention
Transitive symbolic gesturing (real-life and meaningful use of objects)
89
Homonymous hemianopsia
Field loss deficit in the same halves of the visual field of each eye
90
Intervention strategies to facilitate postural stability while seated
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
Active and neutral sitting alignment
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
Intervention strategies to facilitate postural stability while standing
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
Frontal lobe
Voluntary muscle activation
Higher-order cognitive functioning (EF)
Emotional control and judgement
Motor aspects of speech (Broca)
94
Parietal lobe
Integration of sensations
Touch, proprioception, pain, temperature
95
Temporal lobe
Process auditory stimuli
Language comprehension (wernicke's)
96
Occipital lobe
Process visual stimuli
97
Anterior horn
(Ventral) efferent motor neurons
98
Posterior horn
(Dorsal) affects sensory neurons
99
Autonomic nervous system
Innervates involuntary structures including smooth muscle, hear, glands to maintain homeostasis
1. Sympathetic
2. Parasympathetic
100
Sympathetic nervous system
Flight or fight/emergency response
Increase HR and RR
Constriction of peripheral blood vessels
Inhibit peristalsis
101
Parasympathetic nervous system
Restores homeostasis
Slows HR and RR
Reduced BP
Increases peristalsis
102
Cerebrospinal fluid
Provides support/cushions brain, controls brain excitability by regulating ions, supports exchange of nutrients and waste
103
Central cord lesion
Hyperextension injury (UMN lesion of central cord) UE impairment > LE impairment, bilateral loss of pain and temperature, preservation of proprioception and discriminatory sensation
104
Brownsquared syndrome
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
Anterior cord syndrome
Flexion injury (UMN lesion of anterior cord), bilateral loss of motor function, pain and temperature and preservation of proprioception and kinesthesia
106
Posterior cord syndrome
UMN lesion of posterior cords resulting in bilateral loss of proprioception, vibration, pressure and stereognosis with preservation of moot function
107
Transient ischemic attack
Brief blood supply block to the brain with symptoms lasting for about 1 hour, warning sign of future CVA
108
Left lesion presentaion
Apraxia
Aphasia
Frustation
109
Right lesion presentation
Unilateral neglect
Poor insight to deficits
110
Anterior/ventral
Motor
111
Posterior/dorsal
Sensory
112
Areflexic bowel
Cannot feel need to have bowel movement AND reduced reflex to control anal sphincter (empty on its own)
113
Conus medullaris
Injury of sacral cord and lumbar nerve roots causing sensory/motor loss and areflexic bowel/bladder
114
C1-C3 considerations
- 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
C4 considerations
- Innervation of diaphragm/no ventilator
- Shoulder elevation
- 24/7 total assistance for ADL
116
C5 considerations
- 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
C6 considersations
- 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
C7 Considerations
- Triceps/elbow extensions (can push up and lift)
- Independent with all ADLS using AE
- Full strength of shoulder
- Depression transfer independently
119
C8 Considerations
- Improved hand function and FMC
- Complete functional use of both UE
- Decreased use of AE
120
Neuropraxia
Spontaneous recovery with damage to myelin
121
Axonotmesis
spontaneous recovery with damage to myelin and axon
122
Neurotmesis
No spontaneous recovery with completely severed nerve
123
Goal of motor learning
Acquisition of functional skills that can be generalized to multiple situations and environments
124
Skill acquisition stage of motor learning
Cognitive phases that occurs during initial instruction and practice of skill
125
Skill retention stage of motor learning
Associated phased that involves carryout when asked to demonstrate the newly acquired skill after initial practicing
126
Skill transfer stage of motor learning
Autonomous phases that involves demonstrates skill in new contexts
127
Intrinsic feedback
Information received by the learned as result of performing the task, usually tactile, vestibular, visual
128
Factors that lead to generalization
Intrinsic feedback
Knowledge of performance
Variable and random practice conditions
Whole task practice
Naturalistic settings
High contextual interference
129
Variable motionless task
Stable environment but features of environment are likely to vary (ADLs outcome of typical living environment)
130
Consistent motion task
Environmental condition are in motion but are consisten and predictable (stepping on escalator)
131
Strategies during skill acquisition stage
Highlight purpose of task
Demonstation
Pt. verbalize task components
Feedback after every trial
Variable feedback
Blocked/repeated practice
Structured and stable environment
132
Strategies during skill retension stage
Variable practice and feedback
Progress towards open and dynamic environment
Emphasize proprioceptive feedback to establish internal reference
133
Strategies during skill transfer stage
Allow for self-evaluation
Performance in variable environments
134
Focus of NDT treatment approach
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
Focus of PNF treatment approach
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
5-point Ashworth scale
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
Dysmetria
Undershooting or overshooring of target
138
Dyssynergia
Joints move separately opposed to moving together in smooth pattern
139
Dysdiadochokinesia
Impaired ability to perform rapid alternating movements
140
Cog-wheel rigidity
Alternative contraction and relaxation of muscle
141
Direct intervention for oral motor dysfunction
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
Supraglottic swallow
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
Mendelsohn maneuver
Method of intentionally holding the larynx when the larynx is elevated, so that activation of the suprahyoid muscles is induced
144
Indirect intervenion for oral motor dysfunction
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
CIMT
Task-oriented approach that involves massed practice and shaping of affected limb during functional receptive activities while less affected extremity is constrained
146
Requirements for CIMT
Need some control of wrist and digit including ability lift/release a small towesl off tabletop using any form of prehension
147
Olfactory CN
Sensory: smell
Test: sniff variety of aromatic substance
148
Optic CN
Sensory: vision
Test: eye chart, visual field
149
Oculomotor CN
Motor: eye movement, pupil constriction, eye lid
Test: visual tracking, pupil size comparison, pupillary reflex
150
Trochlear CN
Motor: inwards/outward eye movement
Test: visual tracking
151
Trigeminal CN
Motor: muscles of mastication
Sensory: facial input
Test: pain/touch/temp with stimulus, move jaw through ROM
152
Abducens CN
Motor: lateral eye movement
Test: visual tracking
153
Facial CN
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
Vestibularcholear CN
Sensory: sense for equilibrium and hearing
Test: tuning fork
155
Glossopharyngeal CN
Motor: pharynx and salivary glands
Sensory: pharynx and tongue
Test: gag/swallow reflex, taste
156
Vagus CN
Motor: larynx and pharynx
Sensory: larynx and pharynx
(parasympathetic
Test: gag/swallow reflex
157
Spinal accessory CN
Motor: sternocleidomastoid, traps, neck, shoulder
Test: MMT trap and SCM
158
Hypoglossal
Motor: tongue movement
Test: stick out tongue
159
Hypoglossal
Motor: tongue movement
Test: stick out tongue
160
Mobility T1-T5
Independent transfers, manual wheelchair
161
Mobility T6-T12
Independent transfers, manual wheelchair, standing frame, walk with braces
162
Mobility L1-L5
Independent transfers, manual wheelchair, walk with
brace
163
Mobility S1-S5
Independent transfers, able to walk with assistance or aids (slowly and difficulty)
164
SCI level that patient may start driving with hand controls
C6
165
SCI level that patients are independent with transfers
C7
166
SCI level that patients have normal UE ROM and strength
T1
167
SCI level that patients only have partial paralysis in hips
and legs
LI - L5
168
SCI that patients only have some loss of hip and leg
SI-S5
