Neuro Flashcards
Cheyne-stokes respiration
Period of apnea lasting 10-60sec followed by gradually increasing depth and frequency of respiration a (from frontal lobe and diencephalic dysfunction)
Hyperventilation :
Increased rate and depth, from lower midbrain and pons dysfunction
Apneustic breathing
Abnormal respiration marked by prolonged inspiration due to damage of upper pons
Kernig sign
Supine , flex hip and knee fully to chest then extend knee
Positive: pain and increased resistance to extending knee due to spasm of hamstring( if bilateral meningeal irritation )
Brudzinski sign
Supine flex neck to chest
Positive: causes Flexion of hips and knees (drawing up) suggests meningeal irritation
Anosognosia
Severe denial, neglect or lack of awareness of severity of condition
Mini mental scores
21-24 mild impairment
16-20 moderate
Less than 15 severe
Max score is 30
Opisthotonos
Prolonged severe spasm of muscles causing head back and heels to arch backward with arms/hands in rigid Flexion
Seen in severe meningitis, tetanus, epilepsy and strychnine poisoning
Flexion synergy pattern upper extremity
Scapular retraction/elevation, shoulder subduction and external rotation, elbow Flexion and forearm Supination, wrist and finger Flexion
Extension synergy pattern upper extremity
Scapular protraction, shoulder adduction and internal rotation, elbow extension and forearm pronation, wrist and finger Flexion
Flexion synergy pattern lower extremity
Hip Flexion and abduction, external rotation, knee Flexion, ankle dorsiflexion and inversion
Extension synergy lower extremity
Hip extension and adduction and internal rotation, knee extension and ankle plantarflexion/inversion
Pre central gyrus
Primary motor cortex for voluntary muscle action
Post central gyrus is primary sensory cortex for integration of sensation
Metabolic syndrome
Need three to diagnose:
1. Waist circumference >40”men, 35”women
- > = 150 triglycerides
- = 130/and or diastolic 85
- Fasting plasma glucose level of > 100
Performance oriented mobility assessment (poma, tinetti)
Balance: sitting, sit to stand, standing feet together, turn 360, sternal nudge, stand on one leg, tandem stand, reaching up, bending over, stand to sit, timed rising) and walking (gait initiation, path, turning times walk, step over obstacles)
Max score: 28
19-24 moderate fall risk
Berg balance
Max score 56
TUG
3 meters.
Normal intact adult: 20 sec
High fall risk: >30 sec
Functional reach
Forward only.
Above average >12.2 inches
Short physical performance battery (sppb)
Repeated 5 times sit to stands, semi tandem, tandem, side by side stands and timed 8 ft walk
Ordinal scale (0 worst performance to 12 best performance)
DGI
Changes in gait speed, head turns, pivot turns l, obstacles, stairs
Normal adults 21
Hx of fall: 11
Balance efficacy scale
Total score divided by 18 to yield mean bes score
cerebellum
regulates movement, postural control and muscle tone
if damaged = produces ataxia (difficulty initating movement), errors in rate/rhythm/timing of motor responses, also get dysarthria, disdiadochokinesia and nystagmus
basal ganglia
function - controls procedural learning, voluntary motor, routines
if damaged = produces hemiballismus, choreathetosis, hyperkinesis, rigidity, and bradykinesia
external intercostals
lit ribs up in deep inspiration
internal intercostals = pull ribs downward during forced expiration
Emg fibrillation
Spontaneous independent contraction of individual muscle fibers, evident with denervation for 1-3 weeks after losing nerve
Emg fasiculation
Spontaneous contraction of all or most of fibers in motor unit, muscle twitches that can be observed or palpated. Present in LMN disorders and denervation
**complete LMN lesion= fibrillation only
Partial= fibrillation and fasiculation
Ramiste phenomena
Involved lower extremity will abduct/adduct with applied resistance to uninvolved extremity in same direction
Souques phenomena
Raising involved upper extremity above 100 degrees with elbow extension will produce extension and abduction of fingers
Absolute contraindications for exercise testing in sci
Autonomic dysreflexia, severe or infected skin on weight hearing surfaces, symptomatic hypotension, uti, unstable fx, uncontrolled hot humid environment, insufficient rom to perform exercise task
Relapsing- remitting MS
Relapses with full recovery, lack of disease progression
Primary progressive MS
Disease progression from onset, without plateau or remission, or with occasional plateau and temporary minor improvements
Secondary progressive MS
Initial relapsing remitting course then progression at variable rate
Progressive relapsing MS
Progressive disease from onset but without clear acute relapse that may have Recovery or remission. Seen in those who develop after 40 years of age
Hohen and yahr classification for Parkinson’s
Stage 1 minimal or absent disability, unilateral symptoms
Stage 2 minimal bilateral or midline involvement, no balance involvement
Stage 3 impaired balance with some restriction to activity
Stage 4 all symptoms present and severe, stands and walks only with assistance
Stage 5 confinement to bed or wheelchair
Bradyphrenia
Slowing of thought processes
Neuropraxia
Class 1 injury to nerve causing conduction block ischemia, nerve dysfunction will readily reverse after few weeks ex compression
Axonotmesis
Class 2 injury to nerve interrupting axon and causing wallerian degeneration distal to lesion. No disruption to endoneurium, regeneration possible ex crush injury
Neurotmesis
Class 3 injury severance of all nerve structures, complete loss of function, axon cannot regenerate
Emg evidence of reinnervation
Low amplitude short duration polyphasic motor unit potentials
Vestibulospinal tract
Gross postural adjustments and subsequent head movements and acceleration
Recto spinal tract
Visual info related to spatial awareness, ends at cervical spine and controls musculature of neck and head position
Rubrospinal tract
Communicates with thalamus and cerebellum and plays important role in coordination of movement
Polyneuropathy
Bilateral symmetrical involvement of peripheral nerves, legs more than arms, distal earlier and more involved than proximal
Bulbar palsy
Weakness or paralysis of muscles innervated by motor nuclei of Lower brain stem of face tongue larynx pharynx
Stages of ALS (umn/LMN)
Stage 1 early disease, mild focal weakness, asymmetrical distribution , hand cramping and fasiculation man
Stage 2 moderate weakness, some atrophy of muscles, mod I c assistive device
Stage 3 severe weakness, increasing fatigue, mild to moderate functional limitations but still ambulatory
Stage 4 severe weakness and wasting of BLE, mild weakness of UEs, mod A, wheelchair user
Stage 5 progressive severe weakness of limbs and trunk, spasticity And hyperteflxia, loss of head control and max A
Stage 6 bedridden, dependent ADLs, progressive respiratory distress
Symmetrical tonic labyrinthine reflex
Occurs at birth, integrates by 6 months.
When in prone = body and extremities held in increased flexor tone (Flexion)
When in supine = body and extremities held in increased extensor tone (extension)
Crossed extension reflex
Occurs at 28 weeks gestation and integrates by 1-2 months
Noxious stimulation to ball of foot when lower extremity is fixed in extension causes other lower extremity to flex, adduct and then extend
