Neuro Flashcards
Frontal Lobe
Voluntary muscle action, attention, motivation, emotions, judgement, problem solving, sequencing, controls motor aspects of speech
Parietal Lobe
Primary cortex for sensory integration (touch, proprioception, spatial awareness, eye-hand coordination) Also affects academic skills, object naming, R/L organization, and visual attention
Temporal Lobe
Receives and processes auditory stimuli, receptive communication, short-term memory, facial recognition, visual memory behavior (aggressive), long term memory
Brain Lobes Locations
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Occipital Lobe
Perceives and processes visual stimuli. Important for reading.
Insula
Located deep within the lateral sulcus (under parietal and temporal lobes). Associated with visceral functions.
Limbic system
Concerned with instincts and raw emotions contributed to preservation of the individual. Basic functions include feeding, aggression, emotion, and endocrine aspects of sexual response. Also stores long term memories, particularly those with strong emotional components.
Basal Ganglia
Unconscious motor system involved in stereotypical or automatic motor plans, such as riding a bike, walking, or writing.
Thalamus
Part of the Diencephalon. VERY important. Relays sensory information (except for smell) to the cerebral cortex. Relays motor information from the cerebellum and glubus pallidus to the precentral motor cortex. Assists in integration of visceral and somatic functions. Acts as a filter for incoming information and helps to direct attention to the correct information.
Subthalamus
Controls several functional pathways for sensory, motor, and reticular function
Hypothalamus
Contols autonomic nervous system and neuroendocrine system. Maintains homeostasis.
Epithalamus
Integrates smell, visceral, and somatic afferent pathways. Pineal gland secretes hormones that influence pituitary gland and other organs and influences circadian rhythm.
Brain Stem Anatomy
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Cerebellum
Affects proprioception, equilibrium, and regulation of muscle tone. Also affects smooth coordination of voluntary movement (force, direction, etc.). Also responsible for the timing and fluidity of speech.
White matter
myelinated axons that convey information
Gray matter
Made up of cell bodies that integrate information. Known as ganglia in the PNS and nuclei or cortex in the CNS
Afferent axons
Carry info toward CNS
Efferent axons
Carry info to motor units
Cerebral arteriovenous malformation (AVM)
abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures
Middle cerebral artery (MCA) stroke
contralateral hemiplegia, hemianestesia, homonymous hemianopsia, aphasia, and/or apraxia
Internal carotid artery (ICA) stroke
same symptoms as MCA CVA
Anterior cerebral artery (ACA) stroke
Contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and/or mutism
Posterior cerebral artery (PCA) stroke
Homonymous hemianopsia, thalamic pain, hemi-sensory loss, and/or alexia
Vertebrobasilar system stroke
Pseudobulbar signs (dysarthia, dysphagia, emotional instability), tetraplegia
Left sided stroke effects
Movement and sensation on right side Visual reception from right field Bilateral coordination Verbal memory Bilateral auditory reception Speech receptive and expressive language deficits slow, cautious, and easily frustrated
Right sided stroke effects
Movement and sensation on left side Left neglect Visual reception from left field Visual spatial processing Nonverbal memory Attention to incoming stimuli Processing of nonverbal auditory information Interpretation of abstract information Interpretation of tonal inflections Swallowing difficulties and slurred speech Impulsive and inappropriate
Glasgow Coma Scale
Person’s level of consciousness is tested based on eye opening, verbal response, and motor response. GCS total of 3-8: Severe. GCS total of 9-12: Moderate. GSC total of 13-15: Mild.
Rancho Level I
No Response: Total Assistance
Rancho Level II
Generalized Response: Total assistance
Rancho Level III
Localized Response: Total Assistance
Rancho Level IV
Confused/Agitated: Max Assistance
Rancho Level V
Confused, Inappropriate Non-Agitated: Max Assistance
Rancho Level VI
Confused, Appropriate: Mod Assistance
Rancho Level VII
Automatic, Appropriate: Min Assist or ADLs
Rancho Level VIII
Purposeful, Appropriate: Stand-by Assistance
Rancho Level IX
Purposeful, Appropriate: Stand-by Assist on Request
Rancho Level X
Purposeful, Appropriate: Modified Independent
ASIA Impairment Scale - A
Complete, no sensory or motor function is preserved in the sacral segments S4-S5
ASIA Impairment Scale - B
Incomplete, sensory but no motor function is preserved below the neurological level and extends through the sacral segments
ASIA Impairment Scale - C
Incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade less than 3/5
ASIA Impairment Scale - D
Incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the level have a muscle grade greater than or equal to 3/5
ASIA Impairment Scale - E
Normal, sensory and motor function are normal
Central Cord Syndrome
Resulting from hyperextension injuries. Presents as more UE deficits vs. LE
Brown-Sequard Syndrome
Hemi-section of the cord resulting in ipsilateral spastic paralysis, ipsilateral loss of position sense, ipsilateral loss of discriminative, contralateral loss of pain, and contralateral loss of thermal sense
Anterior Cord Syndrome
Caused by flexion injuries. Motor function, pain, and temperature sensation are lost bilaterally below the lesion
Conus Medullaris Syndrome
Injury of the sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and a reflexive bowel and bladder
Cauda Equina Syndrome
Injury at the L1 level and below resulting in a lower motor neuron lesion; flaccid paralysis with no spinal reflex activity.
Autonomic Dysreflexia - What to do?
Check for bowel/bladder, pubic and skin irritation, or other irritation and relieve the issue immediately.
Spastic CP
Caused by motor cortex lesion. Results in spasticity with flexor and extensor imbalance. Increased tone in extremities with difficulty moving in the end ranges. Muscles may become permanently contracted. Decreased postural control and stability. May also experience hemiparetic tremors.
Athetoid CP
Caused by basal ganglia lesion. Characterized by uncontrolled, slow, writhing movements affecting hands, feet, arms, and legs and in some cases the face and tongue causing grimacing or drooling and dysarthia. Movement through end ranges with difficulty in mid-range. Movements increase during stress and disappear during sleep.
Ataxic CP
Caused by cerebellar lesion. Quadriplegic distribution. Affects the sense of balance and depth perception. Poor postural stability, decreased trunk tone, poor coordination, wide-based unsteady gait, intention tremor, and difficulty with precise movements.
Monoplegia
Involves one extremity
Hemiplegia
Involves the upper and lower extremity on the same side
Paraplegia
Involves the lower extremities
Quadriplegia
Involves all extremities
Diplegia
Involves less upper extremity involvement and greater lower extremity functional impairment
Dyskinesia
Involuntary, nonrepetitive, but occasionally stereotyped movements. Most often representative of basal ganglia disorders
Myoclonus
A brief and rapid contraction of a muscle or group of muscles
Tics
Brief, rapid, involuntary movements, often resembling fragments of normal motor behavior. They tend to be stereotyped and repetitive, but not rhythmic
Chorea
Brief, purposeless, involuntary movements, of the distal extremities and face. Usually considered to be a manifestation of dopaminergic overactivity in the basal ganglia
Dystonia
Results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone. May be generalized or focal.
Ataxia
Describes a lack of coordination while performing voluntary movements. It may appear as clumsiness, inaccuracy, or instability. Movements are not smooth and may appear disjointed or jerky.
Decerebrate rigidity
Abnormal rigid extension
Decorticate rigidity
Abnormal rigid flexion
Parkinson’s Disease Symptoms
A hypokinetic CNS disorder that is degenerative and slowly progressive. Begins with pill-rolling of one hand, then progresses to include tremor, rigidity, resistance to passive motion (cogwheel or lead pipe rigidity), akinesia, postural instability, festinating gait, retropulsion or propulsion, mask face, and micrographia. Medications tend to have an on-off effect and must be timed carefully.
Spina Bifida Occulta
A bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations. Typically does not cause symptoms. Occasionally, slight instability or bowl and bladder involvement may occur.
Occult Spinal Dysraphism (OSD)
When external manifestations such as a red birthmark, patch of hair, a dermal sinus, fatty benign tumor, or dimple covering the site are present. May result in the spinal cord being split (diplomyelia) or being tied down and tethered which may lead to neurological damage and developmental abnormalities.
Spina Bifida Cystica
An exposed pouch
Spina Bifida with Meningocele
Protrusion of a sac through the spine, containing CSF and meninges; but does not include the spinal cord. Does not present with symptoms other than occasional instability or bowel and bladder problems.
Spina Bifida Myelomeningocele
Protrusion of a sac through the spine, containing CSF and meninges as well as the spinal cord or nerve root. Results in sensory and motor deficits occurring below the level of the lesion. May result in LE paralysis and/or deformities and bowel and bladder incontinence.
Arnold-Chiari Syndrome
A condition in which a portion of the cerebellum and medulla oblongata slip down through the foramen magnum to the cervical spinal cord.
Tethered Cord Syndrome
Occurs in the tail end of the spinal cord when it is stretched as a result of compression, being trapped with a fatty mass, or a developmental abnormality.
Brainstem
Consists of the midbrain, pons, and medulla. Controls vegetative functions: respiration, cough and gag reflex, pupillary responses, swallowing reflex.
Midbrain
Sits on top of the pons and inferior to the thalamus. Has a role in automatic reflexive behaviors dealing with vision and audition.
Pons
Inferior to midbrain and superior to medulla. Mediates motor information on an unconscious level. For example, shifting weight to maintain balance or making fine adjustments in muscles to perform precise limb movements.
Medulla
Inferior to the pons. Carries descending motor messages from the cerebrum to the spinal cord. Carries ascending sensory messages from the spinal cord to the cerebrum.
Duchenne’s Muscular Dystrophy
Most common. Only in boys and detected between 2 and 6 years of age. Symptoms include enlarged calf muscles and sometimes forearm and thigh muscles, giving appearance that the child is healthy. Causes weakness in all voluntary muscles, including heart and diaphragm. Rarely survive beyond early 20s.
Gower’s Sign
In Duchenne’s MD, weakness of proximal joints progresses to the point that the child has to crawl up his thighs with his hands to stand from a kneeling position
Limb-girdle muscular dystrophy
Onset between 10 and 30 years, proximal muscles of the pelvis and shoulders are initially affected. Progresses slowly.
Facioscapulohumeral muscular dystrophy
Occurs in early adolescence, involves the face, upper arms, and scapular region, causing masking and decreased mobility of the face and inability to lift the arms above the shoulders.
Spinal muscular atrophy
The infantile form (Werdnig-Hoffman disease) has a life expectancy of 2 years. Intermediate form is detected 6 months to 3 years of age and progresses rapidly with a life expectancy of early childhood.
Congenital myasthenia gravis
Involves transmission of impulses in the neuromuscular junction. Onset starting near beth and occurring more frequently in males.
Charcot-Marie-Tooth disease
Involves the peripheral nerves marked by progressive weakness, primarily in fibular and distal leg muscles.
Myopathies
Similar to dystrophies, but progress more slowly resulting in a better prognosis. Weakness of face, neck, and limbs is characteristic.
Muscular Dystrophy Symptoms
Low muscle tone and weakness causing abnormal movement patterns and developmental delay. Difficulty with oral motor feeding. Deformity of spine and extremities due to weakness. Difficulty breathing.
Progressive Supranuclear Palsy
Manifested by loss of voluntary, but preservation of reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudo bulbar palsy, and dementia
Pseudobulbar Palsy
Difficulty with chewing, swallowing, and speech, as well as emotional outbursts caused by dysfunction of cranial nerves.
Huntington’s Chorea
An autosomal dominant disorder beginning in middle-age. Characterized by coreiform movement and intellectual deterioration. Psychiatric disturbance may come before movement disorder.
Cerebellar/Spinocerebellar Disorder
Characterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movement composition tremor, dysarthia, and nystagmus
Frieddrich’s Ataxia
Autosomal recessive inheritance, onset in childhood or early adolescent. Characterized by unsteady gait, UE ataxia, and dysarthia.
Cauda Equina
Begins at L1-L2. Spinal nerves that have not yet exited the vertebral column
Spinal Nerves
Part of the PNS. Consist of ascending sensory pathways (from the dorsal root) and descending motor pathways (from the ventral horn).
Dorsal root ganglion
contain the cell bodies of sensory nerves. Part of the PNS
Dorsal horn
Part of the CNS. Sends sensory messages from the dorsal root to the brain.
Ventral Root
Part of the PNS. Receive motor messages from the brain and send them out into the motor spinal nerves. Cell bodies for the motor spinal nerves that innervate proximal muscle groups are located in the medial ventral horn. Distal muscle groups are located in the lateral ventral horn.
Dura Mater
Most superficial and thickest membrane
Arachnoid Mater
The middle meningeal membrane. Contains the CSF.
Pia Mater
The deepest and thinnest membrane that adheres to the spinal cord.
ALS
Motor neuron disease of unknown etiology characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar involvement. Death usually occurs in 2-5 years. Symptoms include muscle weakness and atrophy, cramps and muscle twitches, spasticity, hyperactive deep tendon reflexes, and corticospinal tract involvement. Dysarthia and dysphagia are also evident. Signs usually begin in the hands.
Erb’s palsy
Paralysis of the upper brachial plexus including the fifth and sixth cervical nerves, and possibly C7. Most often paralyzed: supraspinatus, infraspinatus, deltoid, biceps, brachialis, and subscapularis. Arm can’t be raised and elbow flexion is weak. Typically presents in waiter’s tip position. Treatment includes positioning and ROM to retain ER, abduction, and flexion at shoulder.
Klumpke’s Palsy
Paralysis of the lower brachial plexus including the seventh and eighth cervical and first thoracic nerves. Paralysis of the hand and wrist resulting in limp hand and fingers that don’t move.
Peripheral Neuropathy
Can be caused by trauma, pressure, disease, or infection. Symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve.
Guillain-Barre Syndrome
Recovery begins 2-4 weeks after first symptoms. Symptoms include acute, rapidly progressive form of polyneuropathy characterized by symmetric muscular weakness and mild distal sensory loss/paresthesias. Weakness is always more apparent and more prominent distally at first. Plasmapheresis may be utilized.
Myasthenia Gravis
Caused by autoimmune attack on the acetylcholine receptor of the postsynaptic neuromuscular junction. Progressively disabling. Symptoms include ptosis, diplopia, muscle fatigue after exercise, dysarthia, dysphagia, and progressive limb weakness. Sensation is intact. Quadriparesis may develop.
Post-Polio Syndrome
New muscle weakness approximately 15 years after stability following polio. Treatment includes bracing with orthoses and stretching and exercise programs.
Multiple Sclerosis
Slowly progressive CNS disease characterized by patches of demyelination in the brain and spinal cord. Causes paresthesias, weakness or clumsiness in the leg or hand, visual disturbances, vertigo, emotional disturbances, bladder dysfunction, cognitive decline, spasticity, gait instability, and possibly hemiplegia/quadriplegia.
Upper motor neuron
Carries motor messages from the primary motor cortex to the cranial nerve nuclei and ventral horn. In an UMN lesion, spasticity occurs below the lesion and flaccidity occurs at the lesion level.
Lower motor neuron
Carries motor messages from the motor cell bodies in the ventral horn to the skeletal muscles. In LMN lesion, flaccidity occurs at and below the lesion level.
CN 1
Olfactory Nerve. Smell
CN 2
Optic nerve. Visual acuity, pupillary reflexes, orientation of head and eye movements.
CN 3
Oculomotor nerve. Extraocular eye movements.
CN 4
Torch leave nerve. Extra ocular eye movements
Thalamic Pain
Continuous, intense pain occurring on the contralateral hemiplegic side. Result of a stroke involving the ventral posterolateral thalamus. Poor rehab potential.
Radiculalgia
Neuralgia of nerve roots
Herpes Zoster
Shingles. Acute, painful mononeuropathy characterized by inflammation if the posterior root ganglion of the affected spinal nerve. Can last 10 days to 5 weeks.
Psychosomatic pain
The origin of the pain is due to mental or emotional disorders
Dyspraxia
Difficulty with planning movements, particularly those that are complex or new
Tonic-clonic/grand mal seizures
Tonic phase - includes a loss of consciousness, stiffening, heavy and irregular breathing, drooling, skin pallor, and occasional incontinence for a few seconds
Clonic phase - alternating rigidity and relaxation of muscles
Postictal state - a period of drowsiness, disorientation, or fatigue
Myoclonic-akinetic seizure
Myoclonic seizures are brief, involuntary jerking of the extremities, with or without loss of consciousness. Akinetic seizures include a loss of tone.
First aid for seizures
Remove dangerous objects and protect the individual, but do not interfere with movements. Gently guide to floor and loosen clothing. Turn on side to prevent choking. Allow to rest or sleep afterward and notify emergency contact.
Carr and Shepherd’s Motor Relearning Program
Person is an active participant with a goal to relearn effective strategies for performing functional movement. Intervention is focused on learning general strategies for solving motor problems, not learning specific movements.
Contemporary Task-Oriented Approach
Functional Tasks help organize motor behavior. Therapist first works to identify most important role and occupational limitations, then uses task analysis to identify limiting factors.
Stages of Motor Learning
- Skill acquisition (cognitive stage) - initial learning and practice of a skill
- Skill retention (associated stage) - involves carry-over, as clients are asked to demonstrate newly acquired skill after initial practice
- Skill transfer stage (autonomous stage) - individual demonstrates the skill in a new context
Motor Learning
The acquisition of functional skills that can be generalized to multiple situations and environments. Uses random and blocked practice in variable, and eventually naturalistic, conditions to encourage generalization.
Principles of NDT
You must normalize posture and limb tone before there can be normal movement. Primitive reflexes and abnormal postures/movements are inhibited. Appropriate postural reactions are the basis for controlled movement and focus is on improving quality of movement. Utilizes bilateral movement patterns to integrate both sides of the body
Associated Reactions
NDT. Nonfunctional and involuntary changes in the limb position and tone. Example: flexor pattern of upper limb during demanding tasks.
NDT Handling Techniques
- Provide external stability during movement
- Normalize movement patterns
- Facilitate or inhibit specific muscle groups
- Inhibit abnormal patterns of control
- Provide sensory input
- Increase ROM
- Dissociate body segments
- Normalize tone
NDT techniques to normalize tone
- Weightbearing
- Trunk rotation
- Scapular mobilization
- Pelvic alignment and weight shifts
- Slow controlled movements
- Proper positioning in bed, chair, etc.
PNF Principles
The response of neuromuscular mechanisms can be hastened through stimulation of the proprioceptors. Pairing goal directed activities with facilitation techniques can hasten the learning process.
PNF D2 flexion and extension
Arm down and across body with fist > open hand > arm up and out > fist > back down to start (watch hand)
PNF D1 flexion and extension
Arm starts down and to the side with open palm > fist > up and across body > open hand > back down to start (watch hand)
PNF body movement development
- prone on elbows
- supine to sidelying
- sidelying to side sitting
- supine to long sitting
- prone to hands and knees
- kneeling
- hands and knees to plantigrade
Specific PNF techniques
placement of hands over agonist to facilitate, quick stretch to elicit contraction, traction of the joint, joint compressions
Rood’s four sequential phases of motor control
- Reciprocal inhibition/innervation - primarily a reflex
- Co-contraction - of agonist and antagonist to provide stability in a static pattern
- Heavy Work - proximal muscles contract and move and the distal segments are fixes
- Skill - highest level of control. combines stability and mobility.
Rood facilitation techniques
fast brushing, tendon tapping, vibration, quick icing, heavy joint compression in weight bearing position, resistance utilizing gravity or the therapist’s hands
Rood inhibition techniques
gentle rocking for generalized relaxation response, slow stroking over the spine, slow rolling from supine to sidelying and back in rhythmical pattern, tendinous pressure over the muscle insertion, maintained stretch to an overactive muscle, neutral warmth, prolonged icing
Brunnstrom’s levels of motor recovery
- flaccidity
- minimal voluntary movement
- marked spasticity
- deviation from synergy on a volitional basis
- movements differ greatly from basic synergies
- no spasticity, isolated muscles move freely
- normal motor function
Modified Ashworth Scale
Measures spasticity. 0= No increase in muscle tone. 4= part is rigid in flexion or extension
Stage 1 Parkinson’s Disease
Unilateral tremor, rigidity, akinesia, minimal or no functional impairment
Stage 2 Parkinson’s Disease
Bilateral tremor, rigidity or akinesia, independent with ADL, no balance impairment
Stage 3 Parkinson’s Disease
Worsening of symptoms, first signs of impaired righting reflexes, onset of disability in ADL, can lead an independent life
Stage 5 Parkinson’s Disease
Confined to a wheelchair or bed, maximally assisted
Stage 4 Parkinson’s Disease
Requires help with some or all ADLs, unable to live alone without some assistance, able to walk and stand unaided
