NEURO Flashcards
Explain the term freezing in Parkinsons
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
How do we manage freezing
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)
What is muscle tone
Resistance of muscle to passive stretch
Expected functional recovery: C1-C3
Depend on ventilator
Limited talking
C3=limited neck movement
Expected functional recovery: C3-C4
Usually have head and neck control
Initially requires ventilator
Ability to shrug shoulders
Expected functional recovery: C5
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
Expected functional recovery: C6
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
Expected functional recovery: C7
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
Expected recovery function: C8-T1
Have better use of fingers
Have all latissimus dorsi
Independent with ADLs, transfers and bowel and vladder management
Expected functional recovery: T2-T6
Good motor function of the head, neck, shoulders and arms with fingers
Better trunk control
Expected functional recovery: T7-T12
Better abdominal control
Can have better cough
Ability to sit unsupported for functional activities
4 aims of physiotherapy in acute stage of management.
- Supportive
Maintaining airway through adequate airway
Relief pain
Maintain MSK - Preventative
- Educative (caregivers and pt themselves)
Clinical features of Parkinsons
Loss of postural reflexes
Gait problems
Badykinesia
Rigidity
Tremor
Monotonous speech
Blank facial expression
Lack of blinking
Which 4 nerves are likely to be affected by residual paralysis from GBS
Median nerves
Peroneal nerves
Ulnar nerve
Tibial nerve
Define Parkinsons
A slowly progressive degenerative disorder of the extrapyramidal system
Physiotherapy Principals for end stage parkinsons treatment
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 ??
Presentation for MND and psuedobulbar palsy
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
Precautions for GBS
- Do not overstretch (can cause pain and tissue damage)
- Beware of postural hypotension
- Do not exercise to the point of fatigue (paradoxical weakening)
- Autonomic dysreflexia
- DVT
- Beware of decreased sensation
Physiotherapy management to preventing chest complications
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
Define the term positive impairments and give examples
Any impairment that is considered new or additional to the CNS injury
Spasticity
Babinski response
Extensor spasms
Flexor withdrawal spasms
Define negative impairments and give examples
Impairments that represent a loss of previous function
Muscle weakness
Define Neural plasticity
The ability of cells to undergo alterations in their form and function depending on environmental influences
Mechanisms of Neural plasticity
Latent synapse
Potentiation
Recovery
Collateral sprouting
Terminal regeneration
Denervation supersensitivity
Describe 2 supra-spinal level inhibitory influences contributing to spasms
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
Define ASIA A
No motor or sensory function is preserved in the sacral segments S4-S5
Define ASIA B
Sensory but no motor function preserved believe the neurological level of injury including sacral segments
Define ASIA C
Motor function is preserved below neurological level of injury and the majority of key muscles have muscle strength less than 3
Define ASIA D
Motor function is preserved below neurological level and at least half of key muscles have muscle strength greater than or equal to 3
Define Parkinsons syndrome
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
Define MS
An immune-mediated demyelinating disease that affects CNS
Explain how increase in body temp causes decrease in conduction of nerve impulses in MS
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
Possible causes of fatigue for MS and how to manage it
- Working against spastic muscles
- Heat hydrolysis
- Respiratory muscle weakness
- Poor endurance from immobility/deconditioning
- Loss of proprioception (makes it difficult to conduct coordinated movements)
Define GBS
Acute inflammatory demyelinating poly neuropathy
Ascending paralysis
Demyelination only happens on peripheral nerves and cranial nerves
What is Miller Fisher syndrome
Presents like GBS but paralysis starts in the eyes and have ataxic gait
Clinical presentation of GBS
Abrupt parenthesia
Symmetrical muscle wasting and weakness
Decreased tone and reflexes
Symptoms present in glove and stalking pattern
Autonomic dysfunction I.e unstable BP
Medical management for GBS patients
Mechanical ventilation
Anticoagulants
Injection with immunoglobulins
Plasma filtration
Flaccid bladder could lead to UTI
Causes of MS
Low ultraviolet exposure
Autoimmune etiology
Recurrent infections
Trauma
Genetic
THE CAUSE FOR MOST CASES IS MOSTLY UNKNOWN
Pathology of MS
Mainly affects myelin sheath (Decreased conduction of nerve impulses)
Nerve axons are secondarily affected
Patchy areas of demyelination are spread throughout the CNS
Why would remyelination fail in MS
Deficiency in precursor cell
Failure of precursor cell recruitment
Failure of precursor cell differentiation
Failure of precursor cell maturation
Clinical features of MS
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
What are the main reasons for fatigue in MS
Working against spastic muscles
Decreased nerve conduction due to decreased internodal distance
Heat- hydrolysis of Ach
Weakness due to deconditioning or immobility
Define motor neuron disease
Progressive paralysis due to loss of motor neurons with no sensory involvement
Name MND area of degeneration
Anterior horn cells = LMN
Corticospinal tracts = UMN
Motor nuclei of brainstem = Bulbar palsy
Corticobulbar tracts = Pseudobulbar palsy
List the types of MND
Progressive muscle atrophy - LMN
Amyotrophic lateral sclerosis - UMN and LMN
Pseudobulbar palsy- UMN
Progressive Bulbar Palsy - LMN
Mixed bulbar palsy
