Neuro Flashcards
1
Q
Levels of Consciousness: Coma
A
a state of unconsciousness and a level of unresponsiveness to internal and external stimuli
2
Q
Levels of Consciousness: Stupor
A
a state of general unresponsiveness with arousal occurring from repeated stimuli
3
Q
Levels of Consciousness: Obtundity
A
characterized by a state of sleep, reduced alertness to arousal, delayed response to stimuli
4
Q
Levels of Consciousness: Delirium
A
characterized by disorientation, confusion, agitation, and loudness.
5
Q
Levels of Consciousness: Clouding
A
characterized by a quiet behavior, confusion, poor attention, and delayed responses.
6
Q
Level of Consciousness: Consciousness
A
a state of alertness, awareness, orientation, and memory.
7
Q
RLA: Level 1
A
No Response: deep sleep and completely unresponsive.
8
Q
RLA: Level 2
A
Generalized Response: reacts inconsistently and non-purposefully, responses limited and often the same regardless of stimulus presented. Responses include physiological changes, gross body movement, vocalization.
9
Q
RLA: Level 3
A
Localized Response: reacts specifically, but insconsistently. may follow simple commands such as close eyes or squeeze hand inconsistently, and delayed.
10
Q
RLA: Level 4
A
Confused-Agitated: heightened state of activity. bizarre and non purposeful. unable to cooperate with treatment efforts. verbalizations incoherent/inappropriate to environment. confabulation. attention to environment is brief. lacks short and long term recall.
11
Q
RLA: Level 5
A
Confused-Inappropriate: able to respond to simple commands consistently. needs simplicity and external striations or responses become non-purposeful. gross attention to environment. distractible. verbalization inappropriate and confabulatory. Memory impaired. Inappropriate use of objects. unlikely to learn new info.
12
Q
RLA: Level 6
A
Confused-Appropriate: Goal-directed behavior. dependent on external input/directions. simple directions consistently and shows carryover (for self-care). responses may be incorrect due to memory problems, but are appropriate. past memories show more depth.
13
Q
RLA: Level 7
A
Automatic-Appropriate: appropriate and oriented within hospital and home settings. goes through daily routine automatically/robot-like. minimal to no confusion and has shallow recall. shows carryover for new learning, but decreased rate. able to initiate social activities with structure. judgement is impaired
14
Q
RLA: Level 8
A
Purposeful-Appropriate: recall and integrate past and recent events. aware of and responsive to environment. carryover for new learning and needs no supervision. still has difficulty in emergency or unusual circumstances.
15
Q
Glasgow Coma Scale Categories
A
- Eye Opening
- Best Motor Response
- Verbal Response
16
Q
Glasgow Coma Scale: Eye Opening
A
1 - nil
2 - pain
3 - speech
4 - spontaneous
17
Q
Glasgow Coma Scale: Best Motor Response
A
1 - nil / 2 - extensor response
3 - abnormal flexion / 4 - withdraws
5 - localizes pain / 6 - obeys commands
18
Q
Glasgow Coma Scale: Verbal Response
A
1 - nil 2 - incomprehensible sounds 3 - inappropriate words 4- confused conversation 5- oriented
19
Q
Glasgow Coma Scale: Purpose and Norm Values
A
used initially after injury to determine arousal and cerebral cortex function.
20
Q
Abdominal Reflex
A
- T8-L1
- stroke from each quadrant in toward belly button
- deviation of belly button toward stimulus
21
Q
Corneal “blink” reflex
A
- trigeminal/facial nerves
- pt looks up and away, stroke cornea with cotton
- both eyes should blink
22
Q
Cremasteric reflex
A
- L1-L2
- scratch skin upper medial thigh
- elevation of testicle on same side
23
Q
Gag reflex
A
- glossopharyngeal and vagus nerves
- sim each side of back of throat
- gag
24
Q
plantar reflex
A
- L5-S1
- stroke lateral aspect of the sole of the foot from heel to ball, and medially toward great toe
- flexion of toes (babinski sign = positive response for CNS lesion)
25
Superficial Reflex
- response of stimulation of the receptors within the skin
- sensory response must reach spinal chord, ascend to reach the brain, and then motor music descend to reach motor neurons.
polysnaptic reflex
26
Deep Tendon Reflex
- muscle contraction after muscle's tendon is stimulated due to the reflex arc involving the spinal/brainstem segment that innervates the specific muscle.
- hyperreflexia = suprasegmental lesion (lesion above the level tested)
- hypo = injury in reflex arc
27
Superficial Sensation
- temperature
- light touch
- pain
28
Deep sensation
- proprioception
- kinesthesia
- vibration
29
cortical sensation
- bilateral simultaneous stim
- stereognosis
- two-point discrimination
- barognosis
- localization of touch
30
def: allodynia
the sensation of pain in response to a stimulus that would not typically produce pain
31
def: analgesia
the absence of pain while remaining consious
32
def: anesthesia
the absence of touch sensation
33
def: causalgia
constant, relentless burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury
34
def: dysesthesia
distortion of any of the senses, especially the sense of touch
35
def: hyperesthesia
heightened sensation
36
def: hyperpathia
an extreme exaggerated response to pain
37
def: hypesthesia
a diminished sensation of touch
38
def: neuralgia
severe and multiple shock-like pains that radiate from a specific nerve distribution
39
def: pallanesthesia
loss of vibration sensation
40
def: paresthesia
abnormal sensations such as tingling, pins and needles, or burning sensations
41
Classification of Acute Nerve Injury: Neurapraxia
- mildest
- nerve conduction preserved proximal an distal to the lesion
- nerve fibers are NOT damaged
- sx: pain, minimal atrophy, numbness or loss of motor and sensory function, diminished proprioception
- recover 4-6 weeks
- pressure injury most common
42
Classification of Acute Nerve Injury: Axonotmesis
- more severe
- reversible injury to fibers
- preservation of endoneurium, epineurium, scwann cells, and supporting structures
- distal wallerian degeneration
- recovery is spontaneous, may need surgery, heal 1mm/day
- traction, compression, crush injury most common
43
Classification of Acute Nerve Injury: Neurotmesis
- most severe
- axon, myelin, connective tissue all damaged
- irreversible
- flaccid paralysis/loss of sensation, distal to lesion impaired
- surgical reattachment may improve
- complete transection of the nerve trunk most common
44
Upper Motor Neuron Lesion: Location
- descending motor tracts within the:
- cerebral motor cortex
- internal capsule
- brainstem
- spinal chord
(Lat white column of spinal chord)
EX: CP, hydrocephalus, ALS, CVA, MS, Huntingtons, TBI, pseudobulbar palsy, brain tumor
45
Lower Motor Neuron Lesion: Location
lesion that affects nerves or their axons at or below the level of the brainstem.
- "final common pathway"
- ventral gray column of the spinal cord
EX: polio, ALS, Guillain-Barre, Tumors in spinal chord, Trauma, Bell's Palsy, Carpal Tunnel, MD, SMA
46
UMN Symptoms
- weakness of involved muscles
- hypertonicity
- hyperreflexia
- mid disuse atrophy
- abnormal reflexes
47
LMN Symptoms
- flaccidity/weakness
- decreased tone
- fasciculations
- muscle atrophy
- decreased/absent reflexes
48
Peripheral Nerve Lesion: Ant Horn
- sensory intact
- motor weakness/atrophy
- fasciculations
- decreased deep tendon reflex
- EX: ALS, polio
49
Peripheral Nerve Lesion: Muscle
- sensory intact
- motor weakness
- fasciculations are rare
- normal/decreased deep tendon reflexes
EX: muscular dystrophy
50
Peripheral Nerve Lesion: Neuromuscular Junction
- sensory intact
- motor fatigue
- NORMAL deep tendon reflex
- EX: myasthenia gravis
51
Peripheral Nerve Lesion: Peripheral Nerve (mononeuropathy)
- sensory loss
- motor weakness/atrophy along distribution/may have fasciculations
EX: Trama
52
Peripheral Nerve Lesion: Peripheral Polyneuropathy
- sensory (stocking glove)
- motor weakness/atrophy
- weaker distally, may have fasciculations
- decreased deep tendon reflex
EX: Diabetic peripheral polyneuropathy
53
Peripheral Nerve Lesion: Spinal Roots and Nerves
- sensory = dermatomal
- motor weakness = myotomal
- decreased deep tendon reflexes
EX: herniated disk
54
Def: Tremor
involuntary, rhythmic, oscillatory movement.
- Postural: hyperthyroidism, fatigue, anxiety
- Resting: Parkinson's
- Intention: cerebellum (or its efferent pathways) - MS
55
Def: Tics
- sudden, brief, repetitive coordinated movements, occur at irregular intervals. (myoclonic jerks)
EX: tourette syndrom (needs verbal and motor tic)
56
Def: Chorea
- brief, irregular contractions; rapid
- secondary to damage of the caudate nucleus
- Ballism = choreic jerks of large amplitude, flailing; typically secondary to damage subthalmic nucleus.
EX: Huntingtons
57
Def: Dystonia
- sustained muscle contractions, cause twisting, abnormal postures, repetitive movements.
EX: parkinson's, CP, encephalitis.
58
Def: Athetosis
- slow, twisting and writhing, large amplitude.
- primarily seen in face, tongue, trunk, and extremities
- associated with spasticity
EX: forms of CP, secondary to basal ganglia pathology
59
Def: Akinesia
inability to initiate movement. seen in parkinson patients
60
Def: asthenia
generalized weakness, secondary to cerebellar pathology
61
Def: ataxia
inability to perform coordinated movements
62
Def: Athetosis
involuntary movements combined with postural instability.
63
Def: clasp-knife response
form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessons with movement through the range.
64
Def: cogwheel rigidity
resistance to movement has a phasic quality: parkinsons
65
Def: dystonia
postural/central muscle weakness
66
Def: Lead pipe rigidity
a form of rigidity where there is uniform and constant resistance to range of motion. Basal ganglia
67
Vistibular Input: Semicircular Canals VS Otolith Organs
Semicircular: responds to movement of fluid with head motion.
Otolith Organs: measure the effects of gravity and movement with regard to acceleration/deceleration.
68
Def: Vestibuloocular Reflex (VOR)
- allows for head/eye movement coordination
| - supports gaze stabilization, eye movement that counters movements of the head.
69
Def: Vestibulospinal Reflex (VSR)
- attempts to stabilize the body and control movement.
- assists with stability while the head is moving
- coordination of the trunk during upright postures.
70
Peripheral Vertigo Symptoms
- episodic and short duration
- autonomic symptoms
- precipitating factor
- pallor, sweating
- nausea and vomiting
- auditory fullness
- tinnitus
71
Central Vertigo
- less severe autonomic symptoms
- loss of consciousness can occur
- neurological symtoms including:
- diplopia, hemianopsia, weakness, numbness
ataxia, dysarthria
72
Peripheral Vertigo Etiology
- BPPV
- Meniere's disease
- infection
- trauma/tumor
- metablic disorders (DB)
- acute alcohol intoxication
73
Central Vertigo Etiology
- Meningitis
- Migraine headache
- complications of neurologic origin post ear infections
- trauma/tumor
- cerebellar degeneration (ie alcoholism)
- MS
74
Characteristics Associated with aphasia that equate to poor prognosis (4)
- perseveration of speech
- severe auditory comprehension impairments
- unreliable yes/no answers
- use of empty speech without recognition of impairments
75
Def: Fluent Aphasia
- lesions frequently involve temporal lobe, wrenches' area, parietal lobe
- empty speech/jargon
- use of neologisms (makes a word unrecognizable)
76
Def: Non Fluent Aphasia
- frontal lobe (ant. speech center) of dominant hemisphere
- poor word output
- dysprosodic speech (impairment in rhythm/inflection)
- content is present, impaired syntactical words
77
Types of Fluent Aphasia
1. Wernicke's Aphasia: post region of the superior temporal gyrus. (receptive aphasia). comprehension impaired, impaired writing, poor naming, no motor impairment
2. Conduction Aphasia: supramarginal gyrus/arcuate fasciculus. impairment with repetition. good comprehension. word-finding difficulties. reading intact/writing impaired.
78
Types of Non-Fluent Aphasia
1. Brocas Aphasia: 3rd convolution of frontal lobe. (expressive aphasia). most common. motor impaired. intact comprehension.
2. Global Aphasia: frontal, temporal, parietal lobes. comprehension SEVERELY impaired. uses non verbal skills.
3. Verbal Apraxia: non-dysarthric/non-aphasic impairment of prosody and articulation of speech. problems with motor planning. left frontal lobe adjacent to Brocas.
4. Dysarthria: UMN affects muscles to articulate words. slurred speech.
79
PNF: Agonistic Reversals (AR)
- controlled mobility and skill (proximal dynamic stability)
- isotonic concentric contraction performed against resistance followed by alternating concentric and eccentric contractions with resistance.
80
PNF: Alternating Isometrics (AI)
- stability/strength and endurance
| - isometric contractions alternating from one side of joint to other without rest.
81
PNF: Contract-Relax (CR)
- Increase ROM/Mobility
| - at end of range, patient performs a maximal contraction of the antagonistic muscle group.
82
PNF: Hold-Relax (HR)
- Mobility/ increased ROM
- Isometric contraction, facilitated for all muscle groups at the limiting point, then relax. often used for patients who present with pain.
83
PNF: Hold Relax Active Movement (HRAM)
- Mobility/ initiate movement
- used with MMT 1/5 or less. place extremity in shortened range, then isometric contraction is performed. relax-and extremity is moved into a lengthened position with a quick stretch. pt is then asked to return the extremity to the shortened position through an isotonic contraction.
84
PNF: Joint distraction
- Mobility/increased ROM and initiation
- proprioceptive component. manual traction slowly and usually combined with mobs. also can be combined with quick stretch to initiate movement.
85
PNF: Normal Timing (NT)
- Skill/ Distal Functional Movement
- improve coordination. distal to proximal sequence. proximal components are restricted until the distal components are activated and initiate movement. repetition.
86
PNF: Repeated Contractions (RC)
- Mobility/ initiation of movement / strength
- quick stretch followed by isometric or isotonic contractions. used to initiate movement, throughout a weak movement pattern or at a joint of weakness.
87
PNF: Resisted Progression (RP)
- Skill / proximal dynamic stability / strength
- Gait! resistance applied to an area such as the pelvis, hips, or extremity during the gait cycle in order to enhance coordination, strength, or endurance.
88
PNF: Rhythmic Initiation (RI)
- Mobility / initiation of movement
| - hypertonia. passive, active assistive, slightly resistive. slow and rhythmical
89
PNF: Rhythmic Rotation (RR)
- Mobility / increase ROM and initiate movement
| - passive technique to decrease hypertonia, slowly rotate an extremity around the longitudinal axis. relaxation.
90
PNF: Rhythmic Stabilization (RS)
- mobility / stability / increase ROM
- isometric contractions of all muscles around a joint against progressive resistance. relax, move into newly acquired range, then repeat. a progression of alternating isometrics.
91
PNF: Slow Reversal (SR)
- Stability, controlled mobility, skill / distal functional movement.
- a technique of slow and resisted concentric contractions of agonist and antagonists around a joint without rest. improve control of movement and posture.
92
PNF: Slow Reversal Hold (SRH)
- stability, controlled mobility, skill / distal functional movement
- slow reversal with addition of an isometric contraction performed at the end of each movement, gain more stability.
93
PNF: Timing for Emphasis
- skill / strength / distal functional movement
| - strengthen weak component of movement pattern. isotonic/isometric contractions produce overflow to weak muscles.
