Neuro Flashcards
Posterior portion of the Sylvian fissure separates the
Temporal and parietal lobes
What separates the frontal and parietal lobes laterally
Central sulcus
What separates the occipital lobe into superior and inferior halves
Calcarine sulcus
Lobe responsible for voluntary movement
Frontal
Lobe associated with sensation of touch, kinesthesia, perception of vibration, and temperature
Parietal
Lobe responsible for primary auditory processing and olfaction
Temporal
Lobe responsible for judgement of distance
Occipital
Broca area in what lobe
Frontal - expressive aphasia
Personality and temper what lobe
Frontal
Special and visual perception what lobe
Parietal
Injury to what lobe causes memory loss, antisocial behaviors, inability to categorize faces and objects
Temporal
Structure responsible for forming and storing new memories
Hippocampus
Which structure receives info from the cerebellum, basal ganglia, and all sensory pathways except olfactory tract
Thalamus- then relays the info to the appropriate association cortex
What structure regulates hunger thirst sleep sexual
Hypothalamus
Structure responsible for regulating movements produced by skeletal muscles. It is associated with basal ganglia and substantial nigra
Subthalamus
Internal clock, selected regulation of motor pathways and emotions
Epithalamus
Rapid alternating movements and muscle tone regulation
Cerebellum
MCA CVA characteristics (4)
Impaired body schema, impaired spatial relations, contralateral weakness and sensory loss mostly in face and UE, homonymous hemianopsia
ACA CVA characteristics (4)
Contralateral LE weakness and sensory deficits, significant mental changes, apraxia and agraphia, loss of bowel and bladder control
PCA CVA characteristics (4)
Thalamic pain syndrome, cortical blindness from bilateral involvement, visual agnosia, contralateral pain and temp loss
Vertebral-basilar artery CVA characteristics (4)
Coma, nystagmus, dysarthria, vertigo
Abnormal sensation of pain, temperature, touch, and proprioception which can be debilitating
Thalami can pain syndrome
Ipsilateral paralysis, ipsilateral loss of vibration sense and position sense, contralateral loss of pain and temp
Brown sequard syndrome
Dermatome-back, front of thigh to knee
L2
L2 myotome
Hip flexors and adductors
Dermatome - back, upper buttock, anterior thigh and knee, medial lower leg
L3
Myotome- psoas, quads
L3
Medial leg, dorsum of foot, big toe Dermatome
L4
Extensor hallucis longus, peroneals, df myotome
L5
Tibialis anterior(df, inv) and extensor hallucis myotome
L4
Dermatorme- dorsum of foot, first second and third toes, medial half of sole
L5
Dermatome- lateral and plantar aspect of foot
S1
Anterior tongue taste CNs
v and vii
Glut max innervation
Inferior gluteal nerve(1)
Obturator nerve innervation (5)
Adductor longus, brevis, and Magnus
Obturator externus
Gracilis
Superior gluteal nerve innervation (3)
Glut med, glut min, tfl
Tib anterior innervation
Deep peroneal (5)
Tib posterior innervation
Tibial nerve (7)
Extensor hallucis longus and extensor digitorum longus/brevis
Deep peroneal
Peroneus longus and brevis
Superficial peroneal nerve
Soleus and gastroc innervation
Tibial nerve
Abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis innervation
Medial plantar nerve
Flexor hallucis longus and flexor digitorum longus
Tibial nerve
Opponens digiti minimi, most lumbricals, adductor hallucis innervation
Lateral plantar nerve
Normal response for the abdominal reflex
Contraction of the abdominals and deviation of the embilicus in the direction of stimulus
Corneal blink reflex normal response
Both eyes blink with contact to one eye- asses trigeminal and facial nerves
Brisk and brief elevation of testicle on ipsilateral side is a normal response to which superficial reflex
Cremesteric reflex
3 superficial sensations
Temp, light touch, pain
Three deep sensations
Proprioception, kinesthesia, vibration
Three cortical sensations
Stereognosis, two point discrimination, barognosis
A deep sensation which is characterized by being able to identify the direction and extent of movement of a joint or body part
Kinesthesia
A deep sensation characterized by being able to identify a static position of an extremity or body part
Proprioception
Common cause for musculocutaneous nerve entrapment
Fracture of the clavicle
Ulnar nerve entrapment Etiologies
Compression in the cubital tunnel, entrapment in guyon’s canal
Type of fluent aphasia characterized by word finding difficulties but good comprehension
Conduction aphasia - where as wernicke’s which is characterized by impaired comprehension
Non fluent aphasia characterized by impairment in verbal expression secondary to deficits in motor learning
Verbal apraxia - pt is unable to initiate learned movement (talking) even though they understand the task
Slurred speech due to UMNL that affects the muscles that are used to articulate words and sounds
Dysarthria
This test is used for diagnosing potential CVA, brain tumor, aneurysm, or vascular malformation
Cerebral angiography
A test used to rule out cysts, tumors, epilepsy, hemorrhage, spinal stenosis, encephalitis
Ct scan
Test used to rule out seizure disorders, inflammation, etc by continuously measuring electrical activity of the brain
Electroencephalography eeg
Test used primarily to rule out hemorrhage, inflammation, infection , meningitis and Tumor
Spinal puncture
Pts taking cholinergic agents for dementia d/t Alzheimer’s disease may experience what side effects?
Decrease hr and dizziness
Levodopa should be administered when
Max benefit from scheduling therapy one hour after administration of dopamine replacement agents for PD. Side effect is OH
What disease is caused by deterioration of neurons within the cerebral cortex that are involved in acetylcholine transmission. Results in development of amyloid plaques and neurofibrillary tangles
Alzheimer’s disease
Pt’s with ALS will experience weakness which spreads in what path?
Distal to proximal ie asymmetrical df weakness first sign
Bell’s palsy may be caused by ?
Herpes- causes inflammation of the nerve within the auditory canal producing subsequent demyelination of cn vii
PT should be ready to call 911 if seizure lasts longer than ?
5 min
After seizure is over, the PT should place the person on their _____ side until they are fully alert
left side - in case pt vomits
What is the hypothesized etiology of GBS
Autoimmune response to a previous respiratory infection, surgery, or immunization causing an acute polyneuropathy
What is the initial presentation of GBS
Distal Symmetrical motor weakness, mild distal sensory impairment
Autosomal dominant Disease characterized by degeneration of the basal ganglia and cerebral cortex within the brain, causing neurotransmitters become deficient and unable to modulate movement
Huntingtons disease - ataxia with choreoathetoid movements, rigid
Extreme fatiguability and skeletal muscle weakness. Ocular muscles are affected first and approximately half the pts experience ptosis and diplopia. Also CN weakness
Myasthenia gravis
Myasthenia gravis focus
Energy conservation techniques and strengthening using isometrics while avoiding fatigue
Since pt use long term corticosteroids focus on secondary osteoporosis prevention
Decrease in production of dopamine by basal ganglia
PD- sluggish movement(hypokinesia), difficulty initiating movement ( akinesia) , festering gait, rigidity, freezing during ambulation
With myasthenia gravis, are proximal or distal muscles affected more ?
Proximal more affected. Also CN involvement. Myasthenia gravis crisis is a medical emergency
What are some signs of myasthenia crisis
Respiratory difficulty, swallowing issues, labored talking and chewing
Five primary risk factors for CVA
TIA, smoking, arrhythmias, hypertension, DM
Common cardiac disorders that can lead to embolism include?
Valvular disease, ischemic heart disease, acute MI, arrhythmias ( a fib), patent foreamen ovale, post cardiac catheterization
Plaque formation in cerebral artery causing CVA
Thrombus CVA
Hemorrhagic stroke precipitating factor
Hypertension.
Assessment of acute CVA relative to impairment
national institute of health stroke scale NIH
Provides a level of burden through assessment of mobility and ADL management
Functional independence measure FIM
Assessment of physical and social disability due to CVA
Stroke impact scale
Motor, sensory, balance, pain, rom impairment assessment due to stroke
Fugl-Meyer assessment of physical performance
Which motor learning theory puts a high emphasis on the concept of practice
Adams closed loop theory
Which motor learning theory puts a high emphasis on feedback and importance of variation with practice
Schmidts schema theory
Practice of a given task under a uniform condition
Constant practice
Practice of a given task under differing conditions
Variable practice
Varying practice amongst different tasks
Random practice
Consistent practice of a single task
Blocked practice
An approach that targets normal movement and how it is relearned after neurological insult
Carr and Shepard - centered around PT observation during examination in order to identify the variations in normal movement, also feedback, knowledge of results
Technique focusing on inhibiting abnormal patterns of movement with simultaneous facilitation of normal patterns, emphasizing rotation during treatment activities and providing orientation to midline by moving in and out of midline with dynamic activity
Bobath Neuromuscular developmental treatment NDT
Movement combinations that deviate from basic limb synergies should be introduced in what brunnstrom stage ?
Stage 4
Approach based on the premise that stronger parts of the body are used to stimulate and strengthen the weaker parts
Pnf
Developmental sequence of agonistic reversals (2)
Controlled mobility and skill
Developmental sequence of alternating isometrics (1)
Stability- AI emphasizes endurance and strengthening
Developmental sequence of contract relax and or relax? Which one contracts the agonist? Antagonist?
Mobility
Contract-relax- antagonist
Hold-relax- agonist
Developmental sequence of hold relax active movement (1)
Mobility- improves initiation of movement for muscle groups tested at 1/5 or less
Developmental sequence of joint distraction
Mobility- inc ROM and initiate movement if used c quick stretch technique
Developmental sequence of normal timing (1)
Skill- repetition of the pattern produces a coordinated movement of all components
Developmental sequence of repeated contraction
Mobility- a technique used to initiate movement and sustain a contraction – quick stretch applied at Point of weakness followed by contraction
Developmental sequence of resisted progression
Skill- used to emphasize coordination of proximal components during gait
Developmental sequence of rhythmic initiation
Mobility- assist initiation of movement in the presence of hypertonia
Developmental sequence of rhythmic stabilization (2)
Mobility, Stability- isometric contraction of ALL muscles around a joint. Progression of alternating isometrics which just focuses on flex/ext
Developmental sequence of Rhythmic rotation
Mobility- passive technique to improve ROM by slowly rotation around longitudinal axis to decrease hypertonia
Developmental sequence of slow reversal
Stability, controlled mobility, skill- improve control of movement and posture
Developmental sequence of slow reversal hold
Stability, controlled mobility, and skill- using Slow reversal with the addition of an isometric contraction that is performed in the end of each movement in order to gain stability
Developmental sequence of timing for emphasis
Skill- used to strengthen weak component of a motor pattern by using muscle contraction to produce overflow
8 facilitation techniques
Quick stretch, taping, icing, resistance, approximation, traction, light touch, joint compression
4 inhibitory techniques
Prolonged ice, warmth, sustained stretch, deep pressure
Hemiplegia vs hemiparesis
Hemiparesis is weakness - hemiplegia is paralysis
Inability to formulate an initial motor plan and sequence tasks
Ideational apraxia
Motor function is preserved below the neurological level, and most key muscles below the neurological level have a muscle grade of less than 3
Asia c
Which Asia grade represents normal sensory and motor function
Asia E
Sensory but not motor function is preserved below the neurological level and extends through the sacral segment of s4 and S5
Asia B
Motor function is preserved below the neurological level and most key muscles below that level have a muscle grade greater than or equal to 3
Asia D
How to determine sensory level
Most caudal dermatome with 2/2 normal score for pin prick and light touch
Midanterior thigh dermatome
L2
L3 dermatome
Medial femoral condyle
Dorsum of the foot at third MTP joint dermatome
L5
Medial malleolus dermatome
L4
Lateral heel dermatome
S1
Popliteal fossa in the midline dermatome
S2
Ischial tub dermatome
S3
Perianal area dermatome
S4-5
A drop of ____ mmhg of SBP after moving from a supine to sitting position
20 mm hg
Sacral sparing characteristics
Sensation of the saddle Area, movement of toe flexors, and rectal sphincter contraction -‘incomplete lesion
Total flaccidity and loss of all reflexes below the level of the lesion
Spinal shock- can last 30 min and can last up to several weeks
A term used to describe trace of poor motor or sensory function for up to 3 levels below the lesion
Zone of preservation
An injury that results on the opposite side of the brain due to a rebound effect
Contrecoup lesion
In terms of TBI what are some examples of secondary injury
Inc ICP, hematoma, ischemia, post traumatic epilepsy
Concussion grade - no loss of consciousness, some confusion typically resolving within 15 mins
Grade 1
Concussion grade- transient confusion lasting longer than 15 mins c poor concentration, retrograde and antegrade amnesia
Grade 2 - RTP after two weeks asymptomatic
Concussion grade- any LOC, Emergency room, a min of one month symptoms free
Grade 3
Independent sitting achieved when?
6-7 months
What is Cruising ? And when is it achieved?
Walks along furniture, 8-9 months
When is walking unsupported achieved?
12-15 months
Rides tricycle, walks stairs reciprocally, hops on one foot- These are typically achieved by?
Two years
Skipping, throws and catches ball, jumps over obstacles up to 12 inches
3-4 years
Jumps rope, gallops, bounces large ball
5-8 years
Caused by lack of gene that produces the muscle proteins required for production of dystrophin and nebulin
Duchenne muscular distrophy
Etiology of DMD
X linked recessive trait- mother is a silent carrier
Small hands feet, almond shaped eyes, obesity, coordination impairment
Prader-Willi syndrome - focus on postural control, exercise, fine motor
Spinal muscular atrophy is
Progressive degeneration of anterior horn cell due to mutation of chromosome 5
Type 2 sma onset
@6-12 months : can survive into adult hood
Type 1 sma onset
Birth to 2 months - life expectancy less than one year
Type 3 sma onset
4-17 year and typically survive into adulthood
Anterior portion of the Sylvian fissure separates ?
Temporal and frontal lobes
