Neuro Flashcards
1
Q
Dysdiadocokinesia
A
inability to perform rapid alternating movements
indicative of cerebellum involvement
2
Q
Dysmetria
A
decreased ability to judge distance
impaired with
3
Q
Dysarthria
A
motor deficit of muscles of speech and breathing
4
Q
WC management for high cervical tetraplegia
A
Dependent
5
Q
Anterior cord syndrome
A
Bilateral loss of lateral corticospinal tracts (motor) and spinothalamic tract (pain and temp)
Proprioception and vibration intact (DCML)
6
Q
Common MOI anterior cord syndrome
A
Cervical hyperflexion
7
Q
Brown Sequard Syndrome
A
Ipsilateral loss of motor (lateral corticospinal) and propricoception/vibration (DCML)
Contralateral loss of pain, temp (lateral spinothalamic) crude touch (anterior spinothalamic)
8
Q
MOI for central cord syndrome
A
Cervical hyperextension
9
Q
Posterior cord syndrome
A
Bilateral loss of DCML (proprioception, vibration, 2 point discrimination)
Motor function (lateral corticospinal) and pain/temp/light touch (lateral spinothalamic) preserved
10
Q
Dermatome C5
A
Anterolateral shoulder
11
Q
Dermatome C6
A
anterior arm, thumb, index finger
12
Q
Dermatome C7
A
Middle finger
13
Q
Dermatome C8
A
Medial arm and forearm + little finger
14
Q
Brachial plexus arises from
A
C5-T1
15
Q
With posteriorly herniated discs, the affected nerve root is above/below the vertebral segment
A
Below
ex. L4/L5 posterior herniation = L5 impairments
16
Q
With lateral/posterolateral herniated discs, the affected nerve root is above/below the vertebral segment
A
above
ex. L4/L5 disc = L4 impairments
17
Q
Thoracic dermatome landmarks:
T4
T6
T10
T12
A
T4- nipples
T6- xiphoid process
T10- umbillicus
T12- pubis
18
Q
Dermatome L1
A
greater trochanter, over inguinal/groin
19
Q
Dermatome L2
A
Anterior thigh to knee
20
Q
Dermatome L3
A
Anterior thigh to medial knee/lower leg
21
Q
Dermatome L4
A
Patella to medial malleolus to big toe
22
Q
Dermatome L5
A
Lateral leg (fibular head) and dorsum of foot (
23
Q
Dermatome S1
A
Lateral 5th digit and plantar aspect of foot
24
Q
C1/2 myotome
A
cervical flexion/extension/rotation
25
C3 myotome
cervical lateral flexion
26
C4 myotome
shoulder elevation (upper trap/levator)
27
C5 myotome
shoulder abduction (deltoid, supraspinatus)
elbow flexion (biceps)
28
C6 myotome
wrist extension (extensor carpi radialis)
29
C7 myotome
Elbow extension (triceps)
Wrist flexion (flexor carpi radialis)
30
C8 myotome
Thumb extension (EPL)
IP flexion (FDProfundus)
31
T1 myotome
Finger abduction (dorsal interossei)
32
L1-2 myotome
Hip flexion (iliopsoas)
33
L3 myotome
Knee extension (quads)
34
L4 myotome
Ankle dorsiflexion/inversion (TibA)
35
L5 myotome
Great toe extension (EHL)
36
S1 myotome
plantarflexion (gastroc)
eversion (peroneals)
37
S2 myotome
knee flexion (hamstrings)
38
S3-4 myotome
anal wink
39
SLR will test what myotomes
L1-4
(hip flexion + knee extension)
40
Walking on toes will test what myotomes
S1
41
Anterior spinothalamic tract
crude touch (general, non-discriminative touch) and pressure
42
Lateral spinothalamic tract
pain and temperature
43
Ascending sensory pathways
Spinothalamic tracts
DCML
44
Where is crude touch found vs fine touch
Crude (non-discriminative) - anterior spinothalamic
Fine (localization) - DCML
45
A delta fibers transmit ...
sharp pain
46
C fibers transmit ...
poor localized, dull pain
47
A-alpha fibers transmit ...
motor and proprioception
LARGEST AND FASTEST
48
A-beta fibers transmit ...
touch
these are faster than A delta which is why you rub your toe after you stump it
49
A-gamma fibers transmit
muscle spindles
50
Deep sensory receptors
posture, position sense, proprioception, muscle tone, and speed and direction of movement
51
Mechanoreceptors
detect touch such as vibration and pressure
52
Chemoreceptors
detect changes in chemical composition to regulate cardiovascular and respiratory functions
ex. taste buds, aortic buds
53
Thermoreceptors
nerve cell endings that regulate changes in body temperature
54
Dorsal horn =
sensory
55
Ventral horn =
motor
56
To be classified as a stroke, how long do symptoms have to last?
24 hours
57
Characteristics of L-sided stroke
cautious, careful
speech and language impairments including motor of speech or expressing (Brocas) and difficulty comprehending/utilizing cues (Wernickes area)
58
Characteristics of R-sided stroke
quick, impulsive, poor judgement
visual perceptual deficits (pushers)
difficulty with perception of emotions
59
Patient with L sided stroke will have difficulty with visual or verbal cues
verbal
60
Patient with right-sided stroke will have difficulty with visual or verbal cues
visual
due to visual-spatial deficits
best to approach with direct verbal cues
61
What is the best approach/cues for a patient with R R-sided stroke
direct verbal cues
62
What is the best approach/cues for a patient with L-sided stroke
body language, hand gestures, facial expressions
63
MCA stroke deficits
UE>LE
contralateral motor and sensory loss
aphasia if dominant hemisphere impacted
64
ACA stroke deficits
LE>UE
contralateral motor and sensory loss
65
PCA stroke deficits
contralateral homonymous hemianopsia (loss of visual field of each eye)
contralateral sensory loss
involuntary movements (chorea, athetosis, hemiballism, tremor) - PCA affects more the cerebellum
66
Bells Palsy vs Trigeminal neuralgia differential
Trigeminal neuralgia
-painful
-decreased sensation in CN V distribution (forehead, cheek, maxilla)
-weakness of temporalis and masseter muscles
?
-exacerbated with stress or cold, better with relaxation
Bells palsy
-compression of the facial nerve in temporal bone
- deficits include anterior taste 2/3 tongue, ipsilateral weakness of facial muscles (frontalis, inability to smile, puff cheeks, raise eyebrows, close eye (orbicularis oculi))
-no pain, just paralysis
-Excessive tearing due to dry eye, loss of salivation control
-no sensory deficits
67
Triggers for trigeminal neuralgia
stress or cold
68
CVA vs Bells Palsy
CVA is quicker onset, typically only lower part of face is affected vs Bells palsy which is entire hemi paralysis
69
Brunnstrum stages of recovery
Stage 1- flaccidity, no volitional movement
Stage 2- emerging spasticity
Stage 3- peak spasticity, voluntary movement within synergy**
Stage 4- decreased spasticity, voluntary movement outside of synergy** or partial synergies
Stage 5- movement out of synergy and individual joints, but no coordination
Stage 6- near normal control, full spectrum of movements
Stage 7- normal
70
Stage 1 Brunnstrum
Flaccidity - initial phase of shock w/ no active movement or tone
71
Stage 2 Brunnstrum
Emergence of Spasticity - small involuntary movements occur + development of basic limb synergy pattern
72
Stage 3 Brunnstrum
peak spasticity, peak synergy
Voluntary movement within the synergy
basically the worst phase
73
Flexor synergy pattern UE
Scapula elevation and retraction
Shoulder abduction and ER
Elbow flexion
Wrist flexion and supination
Finger flexion/adduction
think about trying to scratch your own armpit
74
Stage 4 Brunnstrum
decline in spasticity, decline in synergy
Voluntary movement out of synergy
75
Stage 5 Brunnstrum
movement out of synergy , lack of coordination
76
Stage 6 Brunnstrum
near normal function
77
Stage 7 Brunnstrum
normal
78
Extensor synergy pattern UE
Scapula depression and protraction
Shoulder IR and adduction
Elbow extension
Wrist pronation and extension
Finger flexion/adduction
79
Intervention techniques for spasticity/synergistic patterns
Low load resistance out of synergy
WB for extended period of time out of synergy
PNF out of synergy
Overall, early mobilization through stretching and ROM
80
CNS vs PNS
CNS - brain and spinal cord
PNS - connects CNA to limbs; consists of all other peripheral nerves
81
ANS
Technically part of the PNS
controls breathing, HR, digestion, salivation, etc
82
Sympathetic nervous system neurotransmitter
norepinephrine and epinephrine
83
Parasympathetic NS neurotransmitter
mostly AcH
84
Lateral fissure
separates frontal from temporal and parietal lobes
85
Dermatome C1
apex of skull
86
Dermatome C2
back of head to temple to under chin
87
Dermatome C3
upper shoulder, clavicle
88
ASIA levels
A - full
B - motor paralysis, sensory intact
C - motor intact (less than 50% muscles 3/5)
D - motor intact (more than 50% muscles 3/5)
E - normal
89
Pt displays smooth forehead on the L when smiling: is this stroke or Bells palsy
Bells palsy on the L
90
PT treatment for Bells Palsy
In addition to corticosteriods (prednisone)
face sling
estim to increase muscle tone
functional retaining of other side of face
protect cornea
91
Flexor synergy pattern LE
hip flexion, abduction and ER
knee flexion
ankle dorsiflexion and inversion
toe extension
92
Extensor synergy pattern LE
hip extension, adduction, IR
knee extension
ankle plantarflexion and inversion
toe flexion
93
Strongest component of UE extension synergy
shoulder adduction
94
Strongest component of UE flexion synergy
elbow flexion
95
Central cord syndrome
motor affected more than sensory
Distal components of UE > LE
hyperextension MOI
96
Impairments with frontal lobe damage
decreased motor
contralateral paralysis
brocas aphasia
unstable emotions, decreased problem solving
inability to discriminate odors
97
Impairments with parietal lobe damage
somatosensory impairments (asterognosis, agraphesthesia, extinction)
visual spatial
hearing impairments
taste impairments
98
Grapesthesia
ability to understand/feel letters written on hand
99
Red flags for concussion
different pupil size
N&V
loss of conciousness more than 30 seconds
headache worse over time
speech, numbness, decreased coordination
Change in behavior
100
Common causes of seizures
drug withdrawal
degenerative brain diseases
electrolyte imbalances
infections
101
Grand mal/generalized seizure
impacts all areas of the brain
loss of consciousness with stiffening followed by rhythmic movements of arms and legs
incontinence
eyes open
2-5 mins
102
Petit mal/absense seizure
posture is normal -- repetitive blinking or small movements may occur for a few seconds but may occur multiple x a day
103
Status epilepticus
prolonged seizure or multiple seizures in a row with little recovery time for > 30 minutes requiring immediate medical attention as it is life threatening
104
If you notice a patient start to have a seizure, what do you do?
loosen restrictive clothing
remove harmful hazards
do not restrain limbs
Establish airway - lay on side
wait for it to stop
105
distributed or massed practice for patients with cerebellar damage (could prob translate to other brain injuries)
distributed since
106
DTR for MS
hyperreflexic
107
Symptoms of MS
double vision
fatigue
hypereflexia and spasticity/hypertonicity
decreased balance and coordination
decreased aerobic capacity and endurance
108
Medical management of MS
immunosuppressant drugs sucha s adrenocorticotrophic hormone and corticosteroids such as prednisone, dexamethasone, methyprednisone
109
Exercise considerations with MS
breaks for fatigue
when progressing, think about increasing duration before intensity
110
Optimal scheduling for MS
mid morning or mid afternoon
111
Hoehn and Yahr Scale
1-Unilateral disease with minimal to no dysfunction
2-Bilateral or midline impairment without balance dysfunction
3-Bilateral, impaired balance
4-all symptoms present, walk & stand with assistance
5-Confined to bed and wheelchair
112
Hoehn and Yahr Scale 1
1-Unilateral disease with minimal to no dysfunction, some tremors or bradykinesia may be present
113
Hoehn and Yahr Scale 2
2-Bilateral or midline impairment WITHOUT balance dysfunction
114
Hoehn and Yahr Scale 3
3-Bilateral, impaired balance
115
Hoehn and Yahr Scale 4
4-all symptoms present, walk & stand with assistance
116
Hoehn and Yahr Scale 5
5-Confined to bed and wheelchair
117
Pathophysiology of PD
loss of dopamine (inhbitory) results in excessive Ach (excitatory) output from the basal ganglia = tremors, festinating
118
Whats the importance of Hoehn and Yahr Scale 3
this is where BALANCE issues start
119
Whats the importance of Hoehn and Yahr Scale 2
bilateral involment NO BALANCE
120
Whats the importance of Hoehn and Yahr Scale 1
unilateral involvement
121
"Off" time - parkinsons
when symptoms return between medication doses
think meds are wearing off
122
Guillan Barre
caused by acute demyelination of peripheral nerves
distal to proximal weakness causing incoordination
diminished DTR (hyporeflexia)
motor>sensory loss
123
Meineres disease
excess endolymph fluid causing hearing loss, tinnitus, increased pressure, vertigo
124
Horizontal roll test
tests horizontal canal
125
Habituation exercises
repetition of movements and positions that provoke dizziness with idea that graded exposure will increase tolerance
126
Flaccid bladder vs spastic bladder
flaccid - failure to empty due to LMN injury - no messages between spine and bladder because nerves are damaged - bladder keeps filling because it is not getting signals to empty - thus leaking
spastic - unpredictable emptying due to overactive bladder secondary to lesion of SC at T12 or above - voluntary nerves do not work but reflexive ones do - thus unwanted voiding
127
Above T12 spinal cord injury = spastic or flaccid bladder
spastic
128
Below T12 spinal cord injury = spastic or flaccid bladder
flaccid
129
Good starting weight unloading with BWSTT
35%
130
What is more severe with GBS: Motor or sensory loss
Motor
most return to community ambulation within 6 months - 2 years
131
Post polio
gradual onset
myalgias, hypersensitivity, fatigue, cold intolerance
132
Labile HTN Post polio
Blood pressure fluctuates dramatically from normal to high
133
Post polio affects motor or sensory
only motor
134
Common symptoms with NMJ disorders (myasthenia gravis, botulinum toxin)
fatigue and weakness
135
What is a muscle characteristic consistent with MG
fatigue
muscular strength worse w repeated contraction
136
Etiology of MG
damage to post synaptic Ach receptors at NMJ
137
MG patient population
females 20-30
men and women 60-80
138
Generalized MG impacts what muscles
Extra-occular
Facial
muscle of mastication
proximal limb/girdle muscles
139
Ice pack test
Application of an ice pack to eyelid for 2 minutes
reduction in ptosis (eye lid drooping) = myasthenia gravis
MG = post synaptic Ach disorder
140
What is ptosis
eye lid drooping
141
Are proximal or distal muscles more involved with MG
proximal
142
Lambert Eaton vs MG
MG = proximal muscle weakness (post synaptic Ach disorder)
Lambert eaton = distal muscle weakness (pre synaptic Ach disorder)
143
What is botulinum toxin?
binding presynaptically to Ach receptors to decrease muscle tone
144
Are there reflex changes with MG?
no
145
Myopathies affect on muscles
prox to distal weakness
146
Non equilibrium coordination tests
usually performed in sitting
finger nose finger
heel shin
finger opposition
alternating pronation/supination
147
Equilibrium coordination tests
in standing
romberg
walking
standing marching
148
External intercostals innervation and importance
T1-T11
act to lift the ribs during inspiration
importance is that unless patient has a high thoracic injury - these muscles will always show partial innervation; unlike rectus which is innervated lower by T7-T12
149
Rectus abdominus innervation
T7-T12
150
Frenkels exercises
gradual progressive activities designed to increase coordination
151
Chorea vs athetosis vs hemiballism
Chorea - nonrhythmic, rapid, jerking movements that typically impact the distal musculature and the face
Athetosis - nonrythmic, slow, constant writhing movements affecting distal muscles - basal ganglia lesion
Hemiballism - nonrhythmic, rapid, violent, flinging movement that typically occurs unilaterally involving the upper extremity - contralateral lesion in the area of the subthalamic nucleus.
152
Chorea is common with what conditions
huntingtons disease and wilsons disease
153
Wilsons disease
copper accumulation within liver
154
Non fluent aphasia
Motor - Brocas - Expressive - frontal lobe
155
Fluent aphasia
Comprehension - wernikes - parietal lobe
156
What would you see with AIN lesion
patient not able to make "a ok" sign with their hand - DIP will extend and create a pulp to pulp grip instead of tip to tip
157
Progression for NDT
work on tone first
then stability
then mobility
indicated for stroke or CP
158
Progression for PNF
mobility
stability
controlled mobility
skill
159
Branches of trigeminal nerve most commonly affected
maxillary and mandibular
160
Jaw jerk reflex
tests trigeminal nerve
161
CANS pneumonic Webers Test
Conductive loss
Affected ear
Normal ear
Sensironeural loss
162
AC>BC w/ bilateral Weber
normal
163
AC>BC w/ lateralized Weber
sensironeural to side of lateralization
164
Possible causes of conductive loss
ear wax
otitis (ear infection)
foreign body in ear canal
trauma to ear drum
165
Anosogonia
brain doesnt understand your consition
Do you know what condition you have?
Ahhh no
166
somatoagnosia
do not recognize your own body parts
167
Grade 2 concussion
longer than 15 mins - some amnesia - no LOC
168
Grade 1 concussion
symptoms resolve in 15 mins - no LOC
169
Grade 3 concussion
any LOC
170
C1-C4 SCI outcomes
sip and puff for mobilty/power WC
dependent ADLs
if above C4 - ventilator
171
C5 expected movements
3BIRDS
Biceps
Brachioradialis
Brachialis
Infraspinatus
Rhomboids
Delt
Supinator
172
C5 transfer
assistance with slide board
173
C5 mobility
power WC with joystick
manual - handrim projection or grip adaptation
174
C6 muscles SCI
PET SLIP
Pec major
Extensors
Teres minor
Serratus
Lat
Infraspinatus
Pronator
175
C6 SCI AD
Manual WC with friction or projection handrims
may require power for community d/t decreased stamina
176
C6 transfer
IND with slide board
this contrasts from C5 which is maxA w/ slide board
177
C7 muscles
FEET
Flexor carpi radialis
EPB
EPL
Extrinsic finger extensors
178
C7 SCI AD
manual WC with normal handrims
179
Modified ashworth scale 1
catch at end of ROM
180
Modified ashworth scale 1+
catch through 1/2 ROM
181
Modified ashworth scale 2
increase in tone through full ROM, still moved easily
182
Modified ashworth scale 3
passive movement difficult
183
Modified ashworth scale 4
rigid
184
Visual agnosia
inability to recognize once familiar objects
185
Nitrogycerin side effects/considerations
increases dizziness and fall risk d/t postural hypotenion
186
ASIA designates what as the C5 myotome
elbow flexor
187
Sensation scoring with ASIA scale
2 normal
1 dim
0 absent
188
Best treatment approach with fluent aphasia
wernickes - struggle with comprehension so visual/tactile cues along with word repetition are most beneficial
189
Best treatment approach with nonfluent aphasia
verbal cues since comprehension is intact and they just cant speak well
190
PICA stroke
associated with wallenburg syndrome
balance/dizziness
facial numbness and pain/temp lack of sensaiton (trigeminal nerve)
hoarseness (CN IX) and trouble swallowing (CN X)
contralateral pain and temp loss (spinothalamic tract)
191
How to read brain CT
looking from top down
cerebrum on top
cerebellem on bottom of image
192
Pushers syndrome pushes to which side
weak side
193
If pt had a stroke - which LE are they more likely to WB through
less involved
194
Dominant hemisphere
Language and logical skills
195
Non dominant hemisphere
Perception, arts
196
Myasthenia gravis
