NEURO

Question 1

Explain the term freezing in Parkinsons

Answer 1

A phenomenon that occurs in those with Parkinson when a gait pattern needs go be altered
It happens because they are unable to control movement due to lack of inhibition from thalamus
Patients experience this when they need to stop walking, initiate walking or when they change direction

Question 2

How do we manage freezing

Answer 2

Think of walking as a higher level cognitive task rather than relying on autonomic movements
1. Counting steps or stepping over an imaginary line or brick block when approaching freezing time
2. Action observation training (explain)

Question 3

What is muscle tone

Answer 3

Resistance of muscle to passive stretch

Question 4

Expected functional recovery: C1-C3

Answer 4

Depend on ventilator
Limited talking
C3=limited neck movement

Question 5

Expected functional recovery: C3-C4

Answer 5

Usually have head and neck control
Initially requires ventilator
Ability to shrug shoulders

Question 6

Expected functional recovery: C5

Answer 6

Biceps brachii present
Has neck, shoulder shrug, head and shoulder control
Can bend elbow and face palms up
Independence with eating, drinking, face washing, tooth brushing and hair care
Push a manual wheelchair over short smooth surfaces
Can do self assisted coughs
Can do pressure relief by leaning forwards and to the side
May drive adapted car

Question 7

Expected functional recovery: C6

Answer 7

Tenodesis grip
Able to extend wrist
Can use manual wheelchair for daily chores but may need transfer board for transfers
May independently do bladder and bowel management
Have greater independence with ADLs

Question 8

Expected functional recovery: C7

Answer 8

Have intact triceps brachii
Have major part of latissimus dorsi
May need assistance with cutting food
Able to use manual wheelchair independently and transfers without transfer board

Question 9

Expected recovery function: C8-T1

Answer 9

Have better use of fingers
Have all latissimus dorsi
Independent with ADLs, transfers and bowel and vladder management

Question 10

Expected functional recovery: T2-T6

Answer 10

Good motor function of the head, neck, shoulders and arms with fingers
Better trunk control

Question 11

Expected functional recovery: T7-T12

Answer 11

Better abdominal control
Can have better cough
Ability to sit unsupported for functional activities

Question 12

4 aims of physiotherapy in acute stage of management.

Answer 12

1. Supportive
   Maintaining airway through adequate airway
   Relief pain
   Maintain MSK
2. Preventative
3. Educative (caregivers and pt themselves)

Question 13

Clinical features of Parkinsons

Answer 13

Loss of postural reflexes
Gait problems
Badykinesia
Rigidity
Tremor
Monotonous speech
Blank facial expression
Lack of blinking

Question 14

Which 4 nerves are likely to be affected by residual paralysis from GBS

Answer 14

Median nerves
Peroneal nerves
Ulnar nerve
Tibial nerve

Question 15

Define Parkinsons

Answer 15

A slowly progressive degenerative disorder of the extrapyramidal system

Question 16

Physiotherapy Principals for end stage parkinsons treatment

Answer 16

Pressure sore care if pt wheelchair bound
Passive movements to present contracture and maintain ROM
encourage active movement if available
Education for caregivers
Circulatory exercises to minimize risk of DVT
prevent chest complications by maintaining adequate airway and encourage breathing exercises
Endurance ??

Question 17

Presentation for MND and psuedobulbar palsy

Answer 17

Swallowing problems
Slurred speech
Aspiration
Dysphagia

Treatment:
Facilitating jaw and lip closure with microfiber cloth for sensory input
Elevation of the posterior third of tongue
Elevation of the boarders of the tongue
Cheek closure
Control of breathing in relation to swallowing

Question 18

Precautions for GBS

Answer 18

1. Do not overstretch (can cause pain and tissue damage)
2. Beware of postural hypotension
3. Do not exercise to the point of fatigue (paradoxical weakening)
4. Autonomic dysreflexia
5. DVT
6. Beware of decreased sensation

Question 19

Physiotherapy management to preventing chest complications

Answer 19

Increase respiratory muscle strength through incentive spiratory or PEP bottle
Postural drainage with frequent suctioning
Frequently asses breath sounds for added sounds
Monitor patients ABG and chest X-ray
Encourage coughing through ACBT

Question 20

Define the term positive impairments and give examples

Answer 20

Any impairment that is considered new or additional to the CNS injury
Spasticity
Babinski response
Extensor spasms
Flexor withdrawal spasms

Question 21

Define negative impairments and give examples

Answer 21

Impairments that represent a loss of previous function
Muscle weakness

Question 22

Define Neural plasticity

Answer 22

The ability of cells to undergo alterations in their form and function depending on environmental influences

Question 23

Mechanisms of Neural plasticity

Answer 23

Latent synapse
Potentiation
Recovery
Collateral sprouting
Terminal regeneration
Denervation supersensitivity

Question 24

Describe 2 supra-spinal level inhibitory influences contributing to spasms

Answer 24

Basal Ganglia- Refinement and inhibition movement. Akinesia, Rigidity, dyskinesia. Contraleteral to lesion

Vestibulocerebellum- primarily involved in maintenance of balance. Leads to bilateral ataxia and intention Tremor

Question 25

Define ASIA A

Answer 25

No motor or sensory function is preserved in the sacral segments S4-S5

Question 26

Define ASIA B

Answer 26

Sensory but no motor function preserved believe the neurological level of injury including sacral segments

Question 27

Define ASIA C

Answer 27

Motor function is preserved below neurological level of injury and the majority of key muscles have muscle strength less than 3

Question 28

Define ASIA D

Answer 28

Motor function is preserved below neurological level and at least half of key muscles have muscle strength greater than or equal to 3

Question 29

Define Parkinsons syndrome

Answer 29

Has a known cause (TBI or stroke or drug use) Sudden onset and progression can be altered if the cause if identified Can affect any age

Question 30

Define MS

Answer 30

An immune-mediated demyelinating disease that affects CNS

Question 31

Explain how increase in body temp causes decrease in conduction of nerve impulses in MS

Answer 31

Uhtoff's syndrome Heat increases the hydrolysis of Ach leading to decrease in motor unit recruitment. Decrease in motor recruitment leads to decrease in active motor neurons. Decrease in the no of active motor neurons leads to muscle weakness and fatigue

Question 32

Possible causes of fatigue for MS and how to manage it

Answer 32

1. Working against spastic muscles 2. Heat hydrolysis 3. Respiratory muscle weakness 4. Poor endurance from immobility/deconditioning 5. Loss of proprioception (makes it difficult to conduct coordinated movements)

Question 33

Define GBS

Answer 33

Acute inflammatory demyelinating poly neuropathy Ascending paralysis Demyelination only happens on peripheral nerves and cranial nerves

Question 34

What is Miller Fisher syndrome

Answer 34

Presents like GBS but paralysis starts in the eyes and have ataxic gait

Question 35

Clinical presentation of GBS

Answer 35

Abrupt parenthesia Symmetrical muscle wasting and weakness Decreased tone and reflexes Symptoms present in glove and stalking pattern Autonomic dysfunction I.e unstable BP

Question 36

Medical management for GBS patients

Answer 36

Mechanical ventilation Anticoagulants Injection with immunoglobulins Plasma filtration Flaccid bladder could lead to UTI

Question 37

Causes of MS

Answer 37

Low ultraviolet exposure Autoimmune etiology Recurrent infections Trauma Genetic THE CAUSE FOR MOST CASES IS MOSTLY UNKNOWN

Question 38

Pathology of MS

Answer 38

Mainly affects myelin sheath (Decreased conduction of nerve impulses) Nerve axons are secondarily affected Patchy areas of demyelination are spread throughout the CNS

Question 39

Why would remyelination fail in MS

Answer 39

Deficiency in precursor cell Failure of precursor cell recruitment Failure of precursor cell differentiation Failure of precursor cell maturation

Question 40

Clinical features of MS

Answer 40

Limb weakness (usually asymmetrical) Respiratory muscle weakness Spasticity (can progress to be painful) Fatigue Ataxia Intention Tremor Slurred speech Loss of proprioception Diplopia Urinary retention

Question 41

What are the main reasons for fatigue in MS

Answer 41

Working against spastic muscles Decreased nerve conduction due to decreased internodal distance Heat- hydrolysis of Ach Weakness due to deconditioning or immobility

Question 42

Define motor neuron disease

Answer 42

Progressive paralysis due to loss of motor neurons with no sensory involvement

Question 43

Name MND area of degeneration

Answer 43

Anterior horn cells = LMN Corticospinal tracts = UMN Motor nuclei of brainstem = Bulbar palsy Corticobulbar tracts = Pseudobulbar palsy

Question 44

List the types of MND

Answer 44

Progressive muscle atrophy - LMN Amyotrophic lateral sclerosis - UMN and LMN Pseudobulbar palsy- UMN Progressive Bulbar Palsy - LMN Mixed bulbar palsy