Neuro Flashcards
Central cord lesion: UMN
Bilateral loss of pain and temp and motor function (UE)
Brown sequard syndrome: UMN
Hemisection
Ipsilateral loss of tactile discrimination, pressure, vibration and proprioception
Ipsilateral motor function and spastic paralysis below lesion
Contralateral loss of pain and temp below lesion
Anterior cord syndrome: UMN
Bilateral loss of motor function, pain and temperature
Posterior cord syndrome: UMN
Bilateral loss of proprioception, vibration, pressure and epicritic sensation
Cauda equina injury: LMN
Flaccid paralysis of bladder and bowel
No spinal reflec
Transient ischemic attack (TIA)
Disturbance in blood flow
Do not last long
Often warning sign for stroke
Middle cerebral artery
Contralateral hemiplegia
Hemianesthesia
Homonymous hemianopsia
Aphasia (left)
Apraxia (left)
Unilateral neglect (right)
Spatial dysfunction (right)
Anterior cerebral artery
Contralateral hemiplegia
Grasp reflex
Incontinence
Confusion
Apathy
Mutism
Posterior cerebral artery
Homonymous hemianopia
Thalamic pain
Hemisensory loss
Alexia- inability to read
Vertebrobasilar system
Pseudobulbar signs
Tetraplegia
Severe Glasgow
Below 8
Moderate Glasgow
9-12
Minor Glasgow
Greater than 13
GCS eye response
Open- 4 points
Spontaneous- spontaneous
Contact- command
Pain- pain
GCS verbal response
Mouth- 5 points
Our- oriented
Company?- confused (questions)
Inappropriate- inappropriate
Inc- incomprehensible
GCS motor
Muscle- 6 points
Obviously- obeys
Pretty- purposeful
With- withdraws
Flexible- flexion (decorticate)
Extensions- extension (decerebrate)
ASIA impairment scale: A
Complete
No sensory or motor function is preserved in sacral segments S4 and S5
ASIA: B
Incomplete
Sensory but no motor function is reserved below neurological level and extends through sacral segments
ASIA: C
Incomplete
Motor function is preserved below neurological level and majority of key muscle groups below neurological level have muscle grade <3/5
ASIA: D
Incomplete
Motor function is preserved below neurological level and majority of key muscle groups below neurological level have muscle group greater than 3/5
ASIA: E
Normal
sensory and motor functions are normal
Ataxia
Lack of coordination with voluntary movements
Clumsiness, inaccuracy, instability
Disjointed or jerky
Chorea
Brief, purposeless involuntary movements of distal extremities and face
Dyskinesia
Involuntary, erratic, withering movements of face, arms, legs and trunk
Dystonia
Sustained abnormal postures and disruptions of ongoing movements
Alterations of muscle tone
Hemiballismus
Involuntary flinging motions of extremities
Violent and wide amplitudes of motion
Continuous and random
Proximal and/ or distal muscles on 1 side of body
Myoclonus
Brief and rapid contraction of muscle or group of muscles
Tics
Brief, rapid, involuntary movements often resembling fragments of normal motor behavior
Stereotyped and repetitive but not rhythmic
Tremor
Rhythmic, alternating, oscillatory movement produced by repetitive pattern of muscle contraction and relaxation
Akinesia
Freezing
Bradykinesia
Slowed motor movwments
Dysmetria
Decreased coordination of movements
Rigidity
Muscle stiffness
Fasiculation
Involuntary muscle contraction and relaxation
Observed as muscle twitch
Festinating gait
Small rapid steps that result from a forward tilted head and trunk posture
Parasethesia
Numbness and tingling because of sensory nerve changes
What are the 4 primary symptoms of Parkinson’s
Tremor- pill rolling
Muscle rigidity
Bradykinesia
Postural instability
5 clinical states of Parkinson’s
1) unilateral symptoms
2) bilateral symptoms
3) postural instability
4) decrease postural instability, function, impaired mobility, need for assistance in ADLs
5) total dependence in ADLs and mobility
Spina Bifida occulta
Bony malformation with separation of vertebral arches
Occult spinal dysraphism
External manifestation as a red birthmark, patch of hair, dermal sinus, fatty benign tumor or dimple is present on site
Spina bifida with meningocele
Protrusion of sac through the spine containing CSF and meninges
Spina bifida with myelomeningocele
Protrusion of sac through spine containing CSF, meninges and SC or nerve roots
Tethered cord syndrome
Tail end of SC when cord is stretched because of compression, trapped with fatty mass or scar tissue
Dev abnormality or injury
Akathisia
Inability to remain still
Early stage OT intervention for Huntington
Cognitive, emotional, motor disability and safety at home
Middle stage OT intervention of Huntington
Education
Final stages OT intervention Huntington
Posture
Splinting
Smooth transition to feeding tubes
Daily schedules and routines
T or F: ALS is progressive that moves distal to proximal
True
6 stages of ALS
1) can walk and have some weakness
2) can walk moderate weakness
3) can walk severe weakness
4) in wheelchair severe weakness in legs
5) in wheelchair arms and legs severe weakness
6) confined to bed and dependent
Erb’s palsy
Paralysis of upper brachial plexus including C5 and C6 and C7
Waiters tip position
Arm cannot be raised and elbow cannot be flexed
Klumpke’s
Paralysis of lower brachial plexus including C7 and C8 and T1
Hand and fingers don’t move
Guillain-Barré syndrome:
Onset and acute inflammatory phase
Acute weakness that occurs in 2 extremities
Max 2-4 weeks
Guillain-Barré syndrome:
Plateau phase
Symptoms are most disabling with little or no change over a few days or weeks
Guillain-Barré syndrome:
Progressive recovery phase
Recovery tends to start at head and neck and travel distally
Guillain-Barré syndrome: plateau phase interventions
Use of communication tools
Environmental mods
Adapt telephone for hands free use
Positioning
Educate client and fam about health condition and anxiety reduction
Guillain-Barré syndrome:
Recovery phase OT intervention
Dynamic splints
Safe mobility
Improve independence an safety functional transfers
Mod techniques for self care
Adaptive equipment
Energy conservation and fatigue management
Client centered fine motor program
Home assessment and recommend mods
Dysarthria/ dysphasia
Difficulty speaking
Visuospatial
Persons capacity to identify visual and spatial relationships between objects
Pseudo-bulbar effect
Sudden, uncontrollable episodes of inappropriate laughter or crying
MS
MS 4 categories of disease progression
1) relapse-remitting
2) secondary progressive
3) primary progressive
4) progressive relapsing
Relapse remitting category in MS
Clearly defined relapse of acute worsening of neurological function followed by partial or complete improvement and then stable periods of remission between attacks
Secondary progressive category in MS
Starts with a relapsing remitting course of up to 10-15 years and is usually diagnosed when there is continued neurological deterioration
Primary progressive category in MS
Continuous declining neurological function from onset
Progressive relapsing category in MS
Continued disease progression with super imposed relapses
Dysphagia
Trouble swallowing
Dyspraxia
Difficulties with motor skills and coordination
Tonic clonic/ grand mal seizures
Most common
Brief warning such as numbness, taste, smell or other sensations occur
Tonic phase in tonic-clonic seizure
Loss of consciousness, stiffening of body, bowel and bladder incontinence seconds before clonic phase
Clonic phase in tonic- clonic seizure
Alternating rigidity and relaxation of muscles
Postical state
Follows clonic phase
Period of drowsiness, disorientation or fatigue
Myoclonic- akinetic seizure
Brief, involuntary jerking of extremities with or without loss of consciousness
Petit mal/ absent seizure
4-12y
Loss of consciousness without loss of muscle tone
Rapid blinking, staring into space
Simple partial seizure
Involuntary, repetitive jerking of hand and arm
Child may experience visual or auditory hallucinations or olfactory senses
Infantile spasms or West syndrome, infantile myoclonic or jackknife
3-9mos
Dropping head and flexion of arms
Occur 100x per day
Lenox-Gaustat
First 3y of life
Hard to control- seizures if different types
Regression of dev status
Landau- kleffner syndrome/ acquired epileptic aphasia
Progressive encephalopathy
Loss of language skills
Auditory agnosia
Behavioral disturbances
Simple febrile seizure
Most common in children under 5y
Loss of consciousness and involuntary, generalized jerking of ground mal seizures
Status epilepticus seizure
Prolonged seizure in rapid succession
Life threatening
Occurs with tonic clonic
Thrombangiitis obliterus/ Buergers disease results in
Diminished temp sense
Paresthesias
Pain
Cold extremeties
Motor learning theory
Importance of practice and repetition
Transfer of learning
Provides visual and verbal feedback to give person input they needed to make postural and limb adjustments
Brunnstorms movement therapy
Focus on facilitating recovery through specific treatment
Treatment focuses on on promotion of movement from reflexive to volitional
Margaret Rood Approach 4 sequential phases of motor control
1) reciprocal inhibition/ innervation
2) co-contraction
3) heavy work
4) skill
Reciprocal inhibition/ innervation
Early mobility pattern is a primarily reflex governed by spinal and supraspinal centers
Co-contraction
Simultaneous contraction of agonist and antagonist that provide stability in static position
Heavy work
Proximal muscles contract and move and distal deferments are fixed
Skill
Considered highest level of control and combines stability and mobility
Consists of stabilized proximal segments while distal move in space
Dyssynergia
Breakdown in movement
Joints move separately to reach desired movements
Dysdiadochokinesia
Impaired ability to perform rapid alternating movements
Athetosis
Inadequate timing, force, and accuracy of movements in trunk/ limbs
Ayres sensory integration
Based on principles of inner drive and active involvement of child
Individualizing activities used in therapy based on child’s interests
Sensory integration and praxis test (SIPT)
4-8.11y
Relationship among tactile, vestibular-prop processing, visual perception and practicability
DeGangi-Berk test of sensory integration (TSI)
3-5y
Measures SI function with focus on vestibular system
Test of sensory functions in infants
1-18mos
Assess level of infants sensory responsiveness to variety of stimuli
Sensory processing measure (SPM)
Elementary school aged
Measures sensory processing, praxis and social participation
4 types of practice
1) random/ variable
2) blocked
3) variable conditions
4) mental practice
Random/ variable practice
Involves practice of several tasks that are presented in a random order encouraging reformulation of the solution to the presented motor problem
Blocked practice
Involves repeated performance of same motor skill
Variable conditions practice
Involves practice of skills in various contexts to improve transfer of learning and retention of skills
Mental practice
Involves cognitive reversal of a skill without actually moving object
Alcalculia
Inability to perform calculations
Agraphia
Inability to write
Alexia
Inability to read
Anomia
Loss of ability to name objects or retrieve names of people
Anosognosia
Unawareness of motor deficits
Lack of insight or disability
What side of brain damage is Aphasia and apraxia
Left
Brocas/ expressive aphasia
Non fluent speech
Broken speech
Wernickes/ receptive aphasia
Words spoken are meaningless
Cannot follow verbal commands
Global aphasia
All language deficits
Ideational apraxia
Lack of knowledge of object, what to do with it and sequence
Motor/ ideomotor apraxia
Cannot perform task when asked but can spontaneously
Loss of access of kinesthetic memory so purposeful movement cannot be achieved
Astergnosis/ tactile agnosia
Inability to recognize object by touch alone
Somatoagnosia
Body scheme disorder
diminished awareness of body structure and failure to recognize body parts as own
Arnadottir OT Neurobehavioral Eval (A-ONE)
Structured observations of BADL and mobility skills
Assessment of motor and process skills (AMPS)
Functional competence in 2 or 3 familiar and chosen BADL or IADL tasks
Behavioral inattention task
Examines presence of unilateral neglect and impact on functional performance
Catherine Bergego Scale
Direct prescience of unilateral neglect and self awareness of it
Cognistat neurobehavioral cognitive status exam
Brain behavior relations
Executive function performance test
Executive function deficits
Loustein ot cognitive assessment (LOTA)
For stroke, TBI or tumor
Managing everyday tasks
Mini-mental state exam (NMSE) if folstein test
Cognitive impairment
Montreal cognitive assessment (MoCA)
MILD cognitive dysfunction
Rivermead behavioral memory test
MEMORY dysfunction
Rivermead perceptual assessment battery
VISUAL- PERCEPTUAL deficits
Remedial/ restorative/ transfer of training approach
RESTORATION of components to increase skills
Compensatory/ adaptive/ functional approach
Compensatory strategies
Neurofunctional approach
Focus on re training real world skills
Cognitive disabilities model
Focus placed on adaptive approaches and strengthening residual activities
Barthel index
Independence in ADL and functional mobility
Cognitive performance test (CPT)
Assessment of functional task that require cognitive processing skills based on Allen Cognitive Disabilities model
FIM and WeeFIM system
Assessment of severity of a disability as determined by what the individual actually does and the amount of assistance needed to complete task
Katz index of ADL
Assessment level of independent functioning and type of assistance required in ADL
Kitchen tool assessment (TKA)
Measurement of the judgement, planning, organizational skills used to perform a simple cooking task
Klein bell activities of daily living scale (K-B Scale)
Assessment of independent functioning in ADLs
Kohlmans eval of living skills (KELS)
Determination of individual knowledge and/ or performance of basic living skills needed to live independently
Milwaukee eval of daily living skills (MEDLS)
Assessment if actual or stimulated performance of basic living skills needed to function in individual expected environment
Routine task inventory (RTI)
Measurement of individual level of impairment in ADLs according to Allen model of cognitive disabilities
PLISSIT model
P- permission
LI- limited info
SS- specific suggestions
IT- intense therapy
Stages of Alzheimer’s
1) early stage mild
2) middle state mod
3) late stage severe
Early stage of Alzheimer’s
Individual may function largely independently and engage in occupations of daily life without assistance
Individuals may be aware of having memory lapses or forgetting words
Middle stage Alzheimer’s
Expletive frequent forgetfulness, mood changes, poor decision making in selecting clothes for weather, personality changes, disorientation and risk for wandering or becoming lost
Late stage Alzheimer’s
Unable to engage with the environment, cannot carry on conversations, and require significant levels of assistance for daily activities
Vascular dementia
Cerebrovascular disease that leads to focal lesions on the brain and neurotransmitter disruption
Reisberg stage 1
No cognitive decline
Reisberg stage 2
Very mild cognitive decline
No memory deficits evident
Person notices and complains about forgetfulness
Reisberg stage 3
Mild cognitive decline
Family and friends begin to notice memory and recall deficits
Increase forgetfulness
Decrease performance with work and social environment
Reisberg stage 4
Moderate cognitive decline
Mild dementia
Oriented to time and place
Can recognize familiar faces
Assistance at home
Noted in IADL
Reisberg stage 5
Moderate severe cognitive decline
Moderate dementia
Individual cannot live alone
Needs cues and assistance to perform ADL and IADL
Forget major relevant facts of life
Disoriented to time and place
Reisberg stage 6
Severe cognitive decline
Moderately severe dementia
No longer speaking in full sentences
Trouble following 2 step directions
Personal and emotional changes
Obsessive/ delusional behaviors
Bladder and bowel incontinence
Reisberg stage 7
Very severe cognitive decline
Severe dementia
Can no longer sit, stand or walk
Bed bound
What Allen cognitive level can a person do 3 running stitches
Level 3
What Allen cognitive level can a person do a whipstitch
Level 4
