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NBCOT Exam > Neuro > Flashcards

Neuro Flashcards

1
Q

Frontal Lobe

A

Voluntary muscle action, attention, motivation, emotions, judgement, problem solving, sequencing, controls motor aspects of speech

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2
Q

Parietal Lobe

A

Primary cortex for sensory integration (touch, proprioception, spatial awareness, eye-hand coordination) Also affects academic skills, object naming, R/L organization, and visual attention

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3
Q

Temporal Lobe

A

Receives and processes auditory stimuli, receptive communication, short-term memory, facial recognition, visual memory behavior (aggressive), long term memory

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4
Q

Brain Lobes Locations

A

.

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5
Q

Occipital Lobe

A

Perceives and processes visual stimuli. Important for reading.

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6
Q

Insula

A

Located deep within the lateral sulcus (under parietal and temporal lobes). Associated with visceral functions.

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7
Q

Limbic system

A

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.

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8
Q

Basal Ganglia

A

Unconscious motor system involved in stereotypical or automatic motor plans, such as riding a bike, walking, or writing.

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9
Q

Thalamus

A

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.

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10
Q

Subthalamus

A

Controls several functional pathways for sensory, motor, and reticular function

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11
Q

Hypothalamus

A

Contols autonomic nervous system and neuroendocrine system. Maintains homeostasis.

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12
Q

Epithalamus

A

Integrates smell, visceral, and somatic afferent pathways. Pineal gland secretes hormones that influence pituitary gland and other organs and influences circadian rhythm.

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13
Q

Brain Stem Anatomy

A

.

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14
Q

Cerebellum

A

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.

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15
Q

White matter

A

myelinated axons that convey information

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16
Q

Gray matter

A

Made up of cell bodies that integrate information. Known as ganglia in the PNS and nuclei or cortex in the CNS

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17
Q

Afferent axons

A

Carry info toward CNS

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18
Q

Efferent axons

A

Carry info to motor units

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19
Q

Cerebral arteriovenous malformation (AVM)

A

abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures

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20
Q

Middle cerebral artery (MCA) stroke

A

contralateral hemiplegia, hemianestesia, homonymous hemianopsia, aphasia, and/or apraxia

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21
Q

Internal carotid artery (ICA) stroke

A

same symptoms as MCA CVA

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22
Q

Anterior cerebral artery (ACA) stroke

A

Contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and/or mutism

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23
Q

Posterior cerebral artery (PCA) stroke

A

Homonymous hemianopsia, thalamic pain, hemi-sensory loss, and/or alexia

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24
Q

Vertebrobasilar system stroke

A

Pseudobulbar signs (dysarthia, dysphagia, emotional instability), tetraplegia

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25
Q

Left sided stroke effects

A 
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
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26
Q

Right sided stroke effects

A 
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
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27
Q

Glasgow Coma Scale

A

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.

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28
Q

Rancho Level I

A

No Response: Total Assistance

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29
Q

Rancho Level II

A

Generalized Response: Total assistance

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30
Q

Rancho Level III

A

Localized Response: Total Assistance

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31
Q

Rancho Level IV

A

Confused/Agitated: Max Assistance

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32
Q

Rancho Level V

A

Confused, Inappropriate Non-Agitated: Max Assistance

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33
Q

Rancho Level VI

A

Confused, Appropriate: Mod Assistance

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34
Q

Rancho Level VII

A

Automatic, Appropriate: Min Assist or ADLs

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35
Q

Rancho Level VIII

A

Purposeful, Appropriate: Stand-by Assistance

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36
Q

Rancho Level IX

A

Purposeful, Appropriate: Stand-by Assist on Request

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37
Q

Rancho Level X

A

Purposeful, Appropriate: Modified Independent

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38
Q

ASIA Impairment Scale - A

A

Complete, no sensory or motor function is preserved in the sacral segments S4-S5

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39
Q

ASIA Impairment Scale - B

A

Incomplete, sensory but no motor function is preserved below the neurological level and extends through the sacral segments

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40
Q

ASIA Impairment Scale - C

A

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

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41
Q

ASIA Impairment Scale - D

A

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

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42
Q

ASIA Impairment Scale - E

A

Normal, sensory and motor function are normal

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43
Q

Central Cord Syndrome

A

Resulting from hyperextension injuries. Presents as more UE deficits vs. LE

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44
Q

Brown-Sequard Syndrome

A

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

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45
Q

Anterior Cord Syndrome

A

Caused by flexion injuries. Motor function, pain, and temperature sensation are lost bilaterally below the lesion

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46
Q

Conus Medullaris Syndrome

A

Injury of the sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and a reflexive bowel and bladder

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47
Q

Cauda Equina Syndrome

A

Injury at the L1 level and below resulting in a lower motor neuron lesion; flaccid paralysis with no spinal reflex activity.

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48
Q

Autonomic Dysreflexia - What to do?

A

Check for bowel/bladder, pubic and skin irritation, or other irritation and relieve the issue immediately.

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49
Q

Spastic CP

A

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.

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50
Q

Athetoid CP

A

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.

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51
Q

Ataxic CP

A

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.

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52
Q

Monoplegia

A

Involves one extremity

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53
Q

Hemiplegia

A

Involves the upper and lower extremity on the same side

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54
Q

Paraplegia

A

Involves the lower extremities

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55
Q

Quadriplegia

A

Involves all extremities

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56
Q

Diplegia

A

Involves less upper extremity involvement and greater lower extremity functional impairment

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57
Q

Dyskinesia

A

Involuntary, nonrepetitive, but occasionally stereotyped movements. Most often representative of basal ganglia disorders

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58
Q

Myoclonus

A

A brief and rapid contraction of a muscle or group of muscles

59
Q

Tics

A

Brief, rapid, involuntary movements, often resembling fragments of normal motor behavior. They tend to be stereotyped and repetitive, but not rhythmic

60
Q

Chorea

A

Brief, purposeless, involuntary movements, of the distal extremities and face. Usually considered to be a manifestation of dopaminergic overactivity in the basal ganglia

61
Q

Dystonia

A

Results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone. May be generalized or focal.

62
Q

Ataxia

A

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.

63
Q

Decerebrate rigidity

A

Abnormal rigid extension

64
Q

Decorticate rigidity

A

Abnormal rigid flexion

65
Q

Parkinson’s Disease Symptoms

A

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.

66
Q

Spina Bifida Occulta

A

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.

67
Q

Occult Spinal Dysraphism (OSD)

A

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.

68
Q

Spina Bifida Cystica

A

An exposed pouch

69
Q

Spina Bifida with Meningocele

A

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.

70
Q

Spina Bifida Myelomeningocele

A

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.

71
Q

Arnold-Chiari Syndrome

A

A condition in which a portion of the cerebellum and medulla oblongata slip down through the foramen magnum to the cervical spinal cord.

72
Q

Tethered Cord Syndrome

A

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.

73
Q

Brainstem

A

Consists of the midbrain, pons, and medulla. Controls vegetative functions: respiration, cough and gag reflex, pupillary responses, swallowing reflex.

74
Q

Midbrain

A

Sits on top of the pons and inferior to the thalamus. Has a role in automatic reflexive behaviors dealing with vision and audition.

75
Q

Pons

A

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.

76
Q

Medulla

A

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.

77
Q

Duchenne’s Muscular Dystrophy

A

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.

78
Q

Gower’s Sign

A

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

79
Q

Limb-girdle muscular dystrophy

A

Onset between 10 and 30 years, proximal muscles of the pelvis and shoulders are initially affected. Progresses slowly.

80
Q

Facioscapulohumeral muscular dystrophy

A

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.

81
Q

Spinal muscular atrophy

A

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.

82
Q

Congenital myasthenia gravis

A

Involves transmission of impulses in the neuromuscular junction. Onset starting near beth and occurring more frequently in males.

83
Q

Charcot-Marie-Tooth disease

A

Involves the peripheral nerves marked by progressive weakness, primarily in fibular and distal leg muscles.

84
Q

Myopathies

A

Similar to dystrophies, but progress more slowly resulting in a better prognosis. Weakness of face, neck, and limbs is characteristic.

85
Q

Muscular Dystrophy Symptoms

A

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.

86
Q

Progressive Supranuclear Palsy

A

Manifested by loss of voluntary, but preservation of reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudo bulbar palsy, and dementia

87
Q

Pseudobulbar Palsy

A

Difficulty with chewing, swallowing, and speech, as well as emotional outbursts caused by dysfunction of cranial nerves.

88
Q

Huntington’s Chorea

A

An autosomal dominant disorder beginning in middle-age. Characterized by coreiform movement and intellectual deterioration. Psychiatric disturbance may come before movement disorder.

89
Q

Cerebellar/Spinocerebellar Disorder

A

Characterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movement composition tremor, dysarthia, and nystagmus

90
Q

Frieddrich’s Ataxia

A

Autosomal recessive inheritance, onset in childhood or early adolescent. Characterized by unsteady gait, UE ataxia, and dysarthia.

91
Q

Cauda Equina

A

Begins at L1-L2. Spinal nerves that have not yet exited the vertebral column

92
Q

Spinal Nerves

A

Part of the PNS. Consist of ascending sensory pathways (from the dorsal root) and descending motor pathways (from the ventral horn).

93
Q

Dorsal root ganglion

A

contain the cell bodies of sensory nerves. Part of the PNS

94
Q

Dorsal horn

A

Part of the CNS. Sends sensory messages from the dorsal root to the brain.

95
Q

Ventral Root

A

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.

96
Q

Dura Mater

A

Most superficial and thickest membrane

97
Q

Arachnoid Mater

A

The middle meningeal membrane. Contains the CSF.

98
Q

Pia Mater

A

The deepest and thinnest membrane that adheres to the spinal cord.

99
Q

ALS

A

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.

100
Q

Erb’s palsy

A

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.

101
Q

Klumpke’s Palsy

A

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.

102
Q

Peripheral Neuropathy

A

Can be caused by trauma, pressure, disease, or infection. Symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve.

103
Q

Guillain-Barre Syndrome

A

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.

104
Q

Myasthenia Gravis

A

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.

105
Q

Post-Polio Syndrome

A

New muscle weakness approximately 15 years after stability following polio. Treatment includes bracing with orthoses and stretching and exercise programs.

106
Q

Multiple Sclerosis

A

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.

107
Q

Upper motor neuron

A

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.

108
Q

Lower motor neuron

A

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.

109
Q

CN 1

A

Olfactory Nerve. Smell

110
Q

CN 2

A

Optic nerve. Visual acuity, pupillary reflexes, orientation of head and eye movements.

111
Q

CN 3

A

Oculomotor nerve. Extraocular eye movements.

112
Q

CN 4

A

Torch leave nerve. Extra ocular eye movements

113
Q

Thalamic Pain

A

Continuous, intense pain occurring on the contralateral hemiplegic side. Result of a stroke involving the ventral posterolateral thalamus. Poor rehab potential.

114
Q

Radiculalgia

A

Neuralgia of nerve roots

115
Q

Herpes Zoster

A

Shingles. Acute, painful mononeuropathy characterized by inflammation if the posterior root ganglion of the affected spinal nerve. Can last 10 days to 5 weeks.

116
Q

Psychosomatic pain

A

The origin of the pain is due to mental or emotional disorders

117
Q

Dyspraxia

A

Difficulty with planning movements, particularly those that are complex or new

118
Q

Tonic-clonic/grand mal seizures

A

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

119
Q

Myoclonic-akinetic seizure

A

Myoclonic seizures are brief, involuntary jerking of the extremities, with or without loss of consciousness. Akinetic seizures include a loss of tone.

120
Q

First aid for seizures

A

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.

121
Q

Carr and Shepherd’s Motor Relearning Program

A

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.

122
Q

Contemporary Task-Oriented Approach

A

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.

123
Q

Stages of Motor Learning

A
  1. Skill acquisition (cognitive stage) - initial learning and practice of a skill
  2. Skill retention (associated stage) - involves carry-over, as clients are asked to demonstrate newly acquired skill after initial practice
  3. Skill transfer stage (autonomous stage) - individual demonstrates the skill in a new context
124
Q

Motor Learning

A

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.

125
Q

Principles of NDT

A

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

126
Q

Associated Reactions

A

NDT. Nonfunctional and involuntary changes in the limb position and tone. Example: flexor pattern of upper limb during demanding tasks.

127
Q

NDT Handling Techniques

A
  1. Provide external stability during movement
  2. Normalize movement patterns
  3. Facilitate or inhibit specific muscle groups
  4. Inhibit abnormal patterns of control
  5. Provide sensory input
  6. Increase ROM
  7. Dissociate body segments
  8. Normalize tone
128
Q

NDT techniques to normalize tone

A
  1. Weightbearing
  2. Trunk rotation
  3. Scapular mobilization
  4. Pelvic alignment and weight shifts
  5. Slow controlled movements
  6. Proper positioning in bed, chair, etc.
129
Q

PNF Principles

A

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.

130
Q

PNF D2 flexion and extension

A

Arm down and across body with fist > open hand > arm up and out > fist > back down to start (watch hand)

131
Q

PNF D1 flexion and extension

A

Arm starts down and to the side with open palm > fist > up and across body > open hand > back down to start (watch hand)

132
Q

PNF body movement development

A
  1. prone on elbows
  2. supine to sidelying
  3. sidelying to side sitting
  4. supine to long sitting
  5. prone to hands and knees
  6. kneeling
  7. hands and knees to plantigrade
133
Q

Specific PNF techniques

A

placement of hands over agonist to facilitate, quick stretch to elicit contraction, traction of the joint, joint compressions

134
Q

Rood’s four sequential phases of motor control

A
  1. Reciprocal inhibition/innervation - primarily a reflex
  2. Co-contraction - of agonist and antagonist to provide stability in a static pattern
  3. Heavy Work - proximal muscles contract and move and the distal segments are fixes
  4. Skill - highest level of control. combines stability and mobility.
135
Q

Rood facilitation techniques

A

fast brushing, tendon tapping, vibration, quick icing, heavy joint compression in weight bearing position, resistance utilizing gravity or the therapist’s hands

136
Q

Rood inhibition techniques

A

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

137
Q

Brunnstrom’s levels of motor recovery

A
  1. flaccidity
  2. minimal voluntary movement
  3. marked spasticity
  4. deviation from synergy on a volitional basis
  5. movements differ greatly from basic synergies
  6. no spasticity, isolated muscles move freely
  7. normal motor function
138
Q

Modified Ashworth Scale

A

Measures spasticity. 0= No increase in muscle tone. 4= part is rigid in flexion or extension

139
Q

Stage 1 Parkinson’s Disease

A

Unilateral tremor, rigidity, akinesia, minimal or no functional impairment

140
Q

Stage 2 Parkinson’s Disease

A

Bilateral tremor, rigidity or akinesia, independent with ADL, no balance impairment

141
Q

Stage 3 Parkinson’s Disease

A

Worsening of symptoms, first signs of impaired righting reflexes, onset of disability in ADL, can lead an independent life

142
Q

Stage 5 Parkinson’s Disease

A

Confined to a wheelchair or bed, maximally assisted

143
Q

Stage 4 Parkinson’s Disease

A

Requires help with some or all ADLs, unable to live alone without some assistance, able to walk and stand unaided

NBCOT Exam (19 decks)

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