Neuro Flashcards
1
Q
3 parts of cognition
A
- Memory
- Judgement
- Attention span
2
Q
3 parts of mental status
A
- Orientation
- Attention
- State of consciousness
3
Q
2 screenings for mental status
A
MiniMental State Exam
Mini-cog
4
Q
What does the mini-cog include?
A
Have pt repeat 3 items, clock drawing, recall 3 items
5
Q
Which is a better mental status exam - MMSE or minicog?
A
Minicog
6
Q
What does the MoCA screen for?
A
Mild cognitive impairment (MCI)
7
Q
7 components of MoCA
A
- Attention and concentration
- Executive function
- Language
- Visio-constructional skills
- Conceptual thinking
- Calculations
- Orientation
8
Q
What disorder is the MoCA very sensitive for?
A
Alzheimers
9
Q
What is the MMSE very specific for?
A
Normals
10
Q
4 reasons to sensory test
A
- Directed by recommended interventions
- Safety
- Baseline
- Determine need to educate pt in compensatory techniques
11
Q
5 tests for protective sensation
A
- Pain via sharp/dull
- Light touch
- Deep pressure
- Temp
- Monofilaments
12
Q
3 tests for deep sensation
A
- Vibration
- Kinesthesia
- Proprioception
13
Q
What is the only test that we test on the affected side first?
A
Vibration
14
Q
7 cortical sensation tests
A
- Tactile localization
- Stereognosis
- 2 pt discrimination
- Double simultaneous touch
- Barognosis
- Graphesthesia
- Texture
15
Q
Test for regrowth of peripheral nerve?
A
Tinel’s sign
16
Q
Functional test for assessing sensation
A
Modified Moberg’s pick up test
17
Q
8 types of neuro lesions
A
- Peripheral nerve
- Nerve root
- Spinal cord
- Diabetic peripheral neuropathy
- Anterior cord syndrome
- Posterior cord syndrome
- Brain stem
- Cerebral cortex
18
Q
Tingling signifies that nerve has been _________
A
Bumped
19
Q
Loss of sensation signifies that nerve has been _____________
A
Severed
20
Q
Type of neuro lesion that will present with bilateral sensation loss
A
Diabetic peripheral neuropathy
21
Q
Progression of sensation loss in peripheral neuropathy
A
Early = loss of vibration/temp Prolonged = loss of protective sensation
22
Q
If there is an injury to the brainstem, there will be sensory loss on the __________ side of the body. What is an exception to this?
A
Contralateral
Cranial nerve deficits will occur on ipsilateral side
23
Q
This part of the brain is injured during a stroke
A
Cerebral cortex
24
Q
2 ways sensation is lost from a lesion to cerebral cortex
A
- Atopognosia - ability to localize stimulation site
2. Parietal lobe - loss of discriminative sensation
25
If your pt has a lesion in their cerebral cortex, which side of the body will experience sensory loss?
Contralateral
26
When there is pressure on a nerve, do you lose sensory or motor first?
Sensory ----- then both if prolonged
27
If an injury caused denervation there will be a loss of ______________
Sensibility
28
How many mm can a nerve grow a day?
1-2 mm
29
When nerves are regrowing, they may be ___________
Hypersensitive
30
_______ fibers are more susceptible to a compression injury
Sensory
31
In a compression injury, these two things happen sequentially:
1. Diminished vibratory perception
| 2. Intermittent numbness and paresthesia
32
What is the intervention for a moderate-severe nerve injury?
Surgery
33
5 general principles of sensory testing
1. Pt positioned comfortably
2. Explain procedure
3. Establish area of normal sensation
4. Vision obscured
5. Distal --> proximal
34
5 variables of sensory testing
1. Environment
2. Pt emotions
3. Callus vs non callus
4. Instrumental related variables
5. Method related variables
35
4 variables to document after sensation testing
1. Status
2. Type
3. Location of testing
4. Sensory mapping
36
6 conditions for foam and dome test
1. Eyes open, stable surface
2. Eyes closed, stable surface
3. Visual conflict w moving surround/dome, stable surface
4. Eyes open, foam
5. Eyes closed, foam
6. Foam and dome
37
3 systems tested in foam and dome
1. Vision
2. Somatosensory
3. Vestibular
38
Describe flexion synergy of LE
Hip flexion, abduction, ER; knee flexion; ankle DF
39
3 things to observe in the appearance of tone
1. Atrophy
2. Pseudohypertrophy
3. Fasciculations
40
4 ways to test muscle tone
1. Passive movement
2. Pendulum test
3. Drop arm test
4. DTRs
41
Pendulum test is used to assess...
Spasticity
42
Drop arm test is used to test integrity of....
Automatic proprioceptive reactions
43
DTR corresponding nerve:
Jaw
Trigeminal nerve
44
DTR corresponding nerve:
Biceps
C5
45
DTR corresponding nerve:
Brachioradialis
C6
46
DTR corresponding nerve:
Triceps
C7, 8
47
DTR corresponding nerve:
Patellar
L2-4
48
DTR corresponding nerve:
Ankle
S1-2
49
Define muscle tone
Resistance of muscle to passive stretch
50
3 causes for muscle tone
1. Physical inertia
2. Intrinsic stiffness of muscle/CT
3. Reflex muscle contraction
51
3 ways to categorize muscle tone
1. Hypertonia
2. Hypotonia
3. Dystonia
52
4 components of hypertonia
1. Spasticity
2. Clasp-knife reflex
3. Clonus
4. Rigidity
53
If a pt has hypertonia, the spasticity will ____________ at increased speeds
Increase
54
In hypertonia, rigidity is ___________
Similar at all speeds
55
Decerebrate rigidity
Extension of all exremities
56
Decorticate rigidity
UE flexed, LE extended
57
Sustained muscle contractions that result in twisted and abnormal posture
Dystonic posturing
58
Tonal grading scale
```
0 = no response
1 = decreased response (hypo)
2 = normal response
3 = exaggerated response (mild-mod hyper)
4 = sustained response (severe hyper)
```
59
MAS scale for spasticity
0 = no increase in tone
1 = slight increase (catch and release)
1+ =slight increase (initial catch followed by min resistance thru partial range)
2 = increased tone thru most of range
3 = increased tone, passive mvmt difficult
4 = rigid in ext/flx
60
Scale for spasticity tested at three speeds
Tardieu scale
61
Three speeds of tardieu scale
1. Slow
2. Speed at which gravity would drop the limb
3. Fast
62
2 factors graded on tardieu scale
```
X = quality
Y = angle of catch
```
63
How many levels in the Barry Albright Dystonic Scale?
5
64
BADS measures ______________
% of time that dystonia is occuring
65
Scoring for DTRs
```
0 = no response
1+ = decreased response
2+ = normal response
3+ = exaggerated response
4+ = clonus (1-3 beats)
5+ = sustained clonus
```
66
7 factors that influence tone
1. Position and interaction w tonic reflexes
2. Stress/anxiety
3. Volitional effort/movement
4. Meds
5. State of CNS arousal
6. Temperature of environment
7. General health
67
Ability to execute smooth, accurate, controlled movements
Coordination
68
Deficits in coordination are often related to...
CNS disorders of cerebellum, basal ganglia, dorsal
69
Inability to make smooth, accurate movements
Ataxia
70
Disturbance in distance or ROM
Dysmetria
71
Involuntary slow, twisting, writhing continuous movements esp seen in distal parts of extremities and perioral area
Athetosis
72
Involuntary abrupt, rapid, brief, unsustained, arrhythmical, random mvmts
Chorea
73
Chorea is seen most often at ________ joints
Proximal
74
Chorea is worse at _______ and sometimes improved by ________
Rest; movement
75
Rhythmical oscillating movements
Tremor
76
3 types of tremors and what they indicate
Intention - cerebellar diseases
Resting - parkinsons (disappears or slows w movement)
Postural - seen when body part is held against gravity
77
Repetitive, stereotyped, involuntary movements
Tics
78
Slowness of movement
Bradykinesia
79
Inability to perform rapidly alternating movements
Dysdiadochokinesis
80
5 main areas of coordination assessment
1. Alternate or reciprocal movement
2. Movement synergy
3. Movement accuracy
4. Fixation or limb holding
5. Equilibrium or posture holding
81
Defined as the stability produced on each side of the vertical axis
Balance
82
How is balance achieved?
Via multiple CNS inputs/outputs
83
How is balance assessed?
Standardized tools OR observation of functional activities
84
3 types of reactions
1. Righting
2. Protective
3. Equilibrium
85
Serve to maintain body alignment and/or orientation to the environment
Righting reactions
86
When COM moves too far beyond BOS
Protective reactions
87
Attempt to maintain COM over BOS
Equilibrium reactions
88
6 things to note when recording results for equilibrium testing
1. Number of extremities involved
2. Distribution
3. Situations that alter coordination/balance
4. Amount of time to perform
5. Level of safety
6. History of falls
89
Community balance and mobility scale is for ________________
Higher level pts
90
2 types of reflexes
1. Superficial cutaneous reflexes
| 2. Primitive reflexes
91
Dermatomes tested for abdominal reflexes
T7-T12
92
Normal response of abdominal reflexes
Contractions of abs w umbilical deviation toward the stimulus
93
Another name for plantar reflex
Babinski reflex
94
Normal response of plantar reflex
Flexion and adduction of toes
95
Abnormal response (babinski sign)
Extension of great toe along with abduction or fanning of lateral four toes
96
2 developmental reflexes
Tonic labyrinthine
| Tonic neck
