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Reminders! > Neuro > Flashcards

Neuro Flashcards

1
Q

UMN lesion s/s

A 
Spasticity
Increased DTR
Babinski
Clonus
Hyperreflexia
Atrophy
Associated rxns
Synergistic mvmnts
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2
Q

Medial tracts

A 
Medial corticospinal
Tectospinal
Medial reticulospinal
Medial vestibulospinal
Lateral vestibulospinal
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3
Q

Lateral tracts

A

Lateral corticospinal
Lateral reticulospinal
Rubrospinal

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4
Q

Medial corticospinal tract

A

Controls neck, shoulder, and trunk mm

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5
Q

Tectospinal tract

A

Reflexive head movement toward sound/visual object

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6
Q

Medial reticulospinal tract

A

Postural mm, limb extensors, APAs

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7
Q

Medial vestibulospinal tract

A

Neck and upper back extensors

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8
Q

Lateral vestibulospinal tract

A

Ipsilaterally facilitates LMN extensors, inhibits flexors

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9
Q

Only tracts that innervate LEs

A

Medial reticulospinal

Lateral vestibulospinal

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10
Q

Lateral corticospinal tract

A

Contralateral fractionation of the hand

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11
Q

Rubrospinal tract

A

Contralateral upper limb flexors

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12
Q

Lateral reticulospinal

A

Facilitates flexors and inhibits extensors

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13
Q

Lesion to frontal lobe

A 
Contralateral weakness
Inattention
Personality changes
Brocas aphasia
Emotional liability
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14
Q

Lesion to parietal lobe

A 
Contralateral sensory deficits 
Impaired language comprehension
Visuospatial prob (poor body awareness)
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15
Q

Lesion to temporal lobe

A 
Learning deficits
Wenickes aphasia
Aggressive bx
Difficulty recognizing emotions
Hearing loss
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16
Q

Lesion to occipital lobe

A

Homonymous hemianopsia
Extra ocular dysfunction
Reading/writing impairments
Blindness

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17
Q

LMN lesion s.s

A 
flaccidity
dec DTR
hyporeflexia
atrophy
fasciculations
weakness
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18
Q

PMA

A

Involved in visually guided movement
Contains mirror neurons that are activated during observation of others performing a task
Shows that demonstration of task is important! - helps prime the PMA

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19
Q

SMA

A

Activated during execution of learned tasks and bimanual tasks
Sequential movements

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20
Q

CBM

A

Error detection and correction center
Compares actual movement to intended movement and helps make corrections
3 parts - spino, vestibulo, cerebro
Involves PMA more than SMA
Loop =
M1 - PMA - Prefrontal - pons - CBM - thalamas - M1 - PMA - Prefrontal (and feedback to vestibular/RF for posture)

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21
Q

Main output of CBM

A

Inhibitory via purkinje fibers - Resets

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22
Q

Romberg Test

A

CBM ataxia will NOT be able to maintain balance with either EC or EO!

Romberg - sensory ataxia - usually only unable to balance with EC

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23
Q

CBM lesion

A

Ataxia - jerky, inaccurate movements
Dysdiadochokinesia (RAMs), Dysmetria, Action tremor

IPSILATERAL SIDE OF BODY

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24
Q

BG

A

Involved in selection of intended movement
Direct is excitatory (gas - glutamate and DA) - facilitate mvmnt
Indirect is inhibitory (brake - GABA) - inhibit movement

Globus pallidus is a natural inhibitor

FINISH

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25
Q

Function of BG

A

Monitoring and optimizing the pattern of mm activity so goal is reached efficiently

Selection/optimization/fine tune movement
Does not determine basic parameters of the movement though (that is the PMA)

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26
Q

Hypokinetic disorders (PD)

A

The lack of DA - cannot inhibit the globus pallidus

Direct is not facilitated
Indirect is not inhibited

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27
Q

Hyperkinetic disorders (Huntingtons)

A

Lack of inhibition by globus pallidus

Just going off direct pathway
Lose the indirect (inhib) pathway

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28
Q

BG are activated during what movement

A

Coordination and skilled movements
So when you tx someone with brain injruy who has poor coord, don’t just work on gait - need to activate the BG
Add reward based action , dual tasking

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29
Q

Motor input nuclei of BG

A

Putamen

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30
Q

Sensory input of BG

A

Caudate

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31
Q

Substantia nigra =

A

Produces DA

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32
Q

Semicircular canals

A

Angular acceleration
SC canals = 3 rings with receptors that sense motion of endolymph
Each ring opens at end to utricle - that expands into ampulla - ampulla has crista in it - has hair cells imbedded in cupula

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33
Q

Semicircular canals - each canal in pair produces

A

reciprocal signals - inc in one canal lead to dec from its partner

So rotate R - depolarize R and hyperpolarize L

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34
Q

Otolithic Organs

A

Saccule and Uttricle
Sense liner acceleration of head and head position relative to gravity

Saccule - vertical
Uttricle - horizontal

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35
Q

Saccule and Utricle contain

A

Macula inside with hair cells in a gel topped by otoconia

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36
Q

Two major roles of vestibular system in motor control

A

Gaze stabilization

Postural adjustments

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37
Q

Vision - R visual field is processed in the

A

L visual cortex!

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38
Q

Nasal retina processes infor from

A

Lateral visual fields

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39
Q

Nasal retina info - cross or no?

A

Yes! Cross at optic chiasm and goes to contralateral primary visual cortex

Lateral R/L fields

40
Q

Temporal retina info - cross or no?

A

No!
Go ipsilateral

Medial R/L fields

41
Q

L optic nerve processes info of the

A

L eye!

42
Q

The left optic tract processes info of the

A

L temporal retina
R nasal retina

Makes up the R visual field!

43
Q

The right optic tract processes info of the

A

R temporal retina
L nasal retina

Makes up the L visual field

44
Q

Lesion at chiasm =

A

Both peripherals out

Tunnel vision

45
Q

Lesion at optic nerve =

A

Ipsilateral vision loss (cross hasn’t happened yet)

46
Q

Lesion at optic tract =

A

Contralateral homonymous hemianopsia
If L tract cut - lose R visual field in both eyes
So cut L optic tract = lesion to L visual cortex = lose R visual field

47
Q

VOR

A

Stabilize visual images during head movements
Eyes move in opp direction of head movement

Exercises specific for VOR = vestibular adaptation exercises

48
Q

Role of vision in motor control

A

Allows for feedforward (anticipatory control)

49
Q

Primary visual cortex - streams

A 
Dorsal = the where
Ventral = the what
50
Q

After being processed by the visual cortex, visual information flows where

A

Dorsally to the posterior parietal lobe
Central to the temporal lobe

Dorsal and ventral streams!!!

51
Q

Tau is what

A

Time to contract info
Involves object getting larger on retina as it approaches the individual
Makes you aware things are getting closer to you

52
Q

Optical flow is what

A

Stoplight effect
Visual info that is streaming past you as you move through an environment that gives you a sense of how you environment/you are moving

53
Q

Sleep stages

A

1 = transition btw sleep and awake
2 = firest sleep stage, dec arousal, temp, RR
3, 4 = slow wave sleep, deepest stage
STAGE 2 = MOST MOTOR LEARNING!

1 to 4 = NREM
4 to 1 = NREM
REM
Continues like this - but depth of NREM decreases and duration spent in REM increases throughout the night

54
Q

Hippocampus

A

Memory storage and consolidation!
HM epilepsy case study - showed hippocampus specific for laying down new memory - Took out hippcampus, part of temporal, and amyG

He had normal LTM (could remember before accident) Working memory (seconds, minutes)
Couldn’t do transfer from STM to LTM though
PROCEDURAL MEMORY was there though - his hand would “remember” drawing the star - but his brain would not

55
Q

Hippocampus injury - leads to loss of

A

memory in recent events

Can still remember how to ride a bike and tie shoe laces - these are procedural memories

56
Q

Declarative memory =

A

Conscious/explicit
Facts, events

Declarative is split into:
1 episodic (events, experiences) - special to you
2 semantic (facts, concepts) - more common knowledge
57
Q

Procedural memory

A

Unconcious/implicit
Skills, tasks

Motor learning falls here!

58
Q

STM is defined how

A

Working memory
Less than 1 min

Prefrontal lobe!

59
Q

LTM - Declarative = things you

A

can TELL others

60
Q

LTM - procedural = things you ____

A

KNOW that you can SHOW by DOING

Skill learning - ride bike
Priming - more likely to use recently heard word
Conditioning - salivate when see food

61
Q

Visuospatial working memory

A

Specific part of the prefrontal cortex that is dedicated to it!
heavily connected to parietal and visual input - takes that info to premotor areas to plan appropriate motor response

62
Q

LTM - 4 operations

A

Encoding - new info is attended to and linked with existing info

Storage = neural mechanisms by which memory is retained overtime

Consolidation = makes temporarily stored info more stable

Retrieval = when stored info is recalled

63
Q

Motor learning =

A

set of processes associated with experience or practice leading to relatively permanent change in ability to perform skilled action

Change in capability to perform a skill inferred from permanent improvement in performance as a result of practice
(infer learning based on performance)

64
Q

Requirements for motor learning

A 
Improvement
Consistency
Stability (dec variability) 
Persistence
Adaptability
65
Q

Motor behavior =

A

Motor control
Motor learning
Motor development

66
Q

Stages of motor learning - Vereijken

A

Initial/Cognitive stage
Intermediate/Associative stage
Advanced/Automatic stage

67
Q

Stages of motor learning - Vereijken - Initiative/Cognitive

A

CBM signaling motor error
Prefrontal/DLPFC/ACC - involved in concious/cognitive recognition of error

BG inc activity in caudate with early learning (caudate connects with DLPFC) - this is how BG learns which action to select

68
Q

Stages of motor learning - Vereijken - Intermediate/Associative

A

Less PFC/DLPFC with more practice
CBM stays active but is less active than initial stage
BG - shifts from caudate/DLPFC loop to putamen/SMA loop

69
Q

Stages of motor learning - Vereijken - Advanced/Autonomous

A

Overall brain change from multiple brain areas to high activity of a focused smaller set
BG - inc skeletal motor SMA/putamen loop
Allows for voluntary movement sequences to be run off automatically - like sit to stand

70
Q

NDT - key points

A 
Symmetry
Posture 
Weight shift  (after get equal WB in midline)
71
Q

CIMT

A

Restrain uninvolved to force pt to use involved

Constrained 90% of awake time for 2 wks

72
Q

Locomotor training improves ___

Average for norm

A

GAIT SPEED

1.2 m/s

73
Q

Muscle spindles

A

Monitor change in length
If mm lengthened a lot - will cause contraction at some point to prevent from getting too long
Like stretch reflex

74
Q

GTOs

A

Monitor mm tension
When cx too much will eventually lead to relax
Autogenic inhibition

75
Q

Spasticity

A

VELOCITY DEP
with inc in velocity = inc in resistance
Corticospinal damage or UMN
CLASP KNIFE

76
Q

Rigidity

A

Lead pipe - rigid in both directions
Cog wheel - series of catching and jerks with passive stretch
Due to BG damage, loss of direct pathway

DTR normal, no clonus

77
Q

Drugs for spasticity

A 
Baclofen - mimic GABA
Dantrolene - prevent Ca release
Tizanidine - inhibits alpha motor neurons
Phenol - inject to block nerves
Botox - prevents release Ach 
Rhizotomy - cut spinal nn root
78
Q

LE flex synergy

A

hip.knee flex
abd.er
DF/INV

79
Q

Associated reactions - Homolateral Synkinesis

A

Resisted elbow flex causes ipsilateral hip flexion

80
Q

Associative reactions - Raimiste’s Phenomenon

A

Resist good side abd or add and get that same movement (abd or add) on the affected side

81
Q

Associative reactions - Soques finger phenomenon

A

Shoulder flexion facilitates finger extension

82
Q

Brunstrom stages of CVA recovery

A 
1 - flaccid
2 - spasticity starts, weak synergy
3 - spasticity severe, some volitional mv
4 - dec spasticity, some isolated mvmnt
5 - more complete isolated mvmnt
6 - normal tone
83
Q

Modified ashworth scale

A

Measures spasticity on scale 0-4
0 = no inc in mm tone
1 = slight inc catch/release or min resistance at end of ROM
1+ = throughout remainder of ROM (less than half)
2 = more marked inc in mm tone throughout most ROM
3 = inc in mm tone, PROM hard to do
4 = affected parts rigid in flex or ext

84
Q

Tardieu scale

A

Measures angle of clasp knife

85
Q

Pendulum

A

Measures rigidity

86
Q

3 components of postural control system

A

Sensory detection (visual, vestibular, somatosensory) - vis dominates

Integration

Execution of msk responses

87
Q

Ankle strategy

If perturbation causes displacement forward =

If perturbation causes displacement back =

A

Distal to prx activation (gastroc - hams - paraspinals)
Small perturb with firm surface

If perturbation causes displacement forward = gastroc, hams, ps

If perturbation causes displacement back = DFs, hip flex, abs

88
Q

Hip strategy

A

Proximal to distal activation
Pulls COM in direction of recovery
Larger, faster perturbations on smaller or compliant surface

Falling forwards, recover with = ab and hip flex cx

Falling backwards, recover with = hams and ps

89
Q

Stepping strategies

A

Rapid step in direction of displacing force

Can be changed!!

90
Q

APAs

A

Anticipatory postural control!
Medial reticulospinal!

Activation of mm to stabilize body prior to voluntary movement
APAs are context dependent - this is why important to NOT always supply with ad or hand on gait belt when working balance

91
Q

Static balance tests

A 
Romberg
SLS
Perturbations
Functional reach
CTSIB
92
Q

Dynamic balance tests

A 
FSST
Ambulation
Reaching
Berg
TUG
Mini Best
ABC
93
Q

Locomotion - strength?

A

Walking does NOT require a lot of strength (2+) - what you need is mm to fire/burst and the timing of the bursts is most important

94
Q

Essential requirements for gait

A

Progression - CPGs, BG
Postural control - CBM
Adaptation - V1

95
Q

Locomotor region of brain

A

midbrain locomotor region (MLR)
peduncle pontine nucleus (PPN)

Both initiate locomotion and control speed

Can bypass BG and get to these with visual and auditory cueing (using the SMA)

96
Q

A 50 yr old pt with recent stroke impacting hippocampus would have all these deficits EXCEPT what:

Difficulty learning new facts
Difficulty describing a recent event
Difficulty learning a new vocab word
Difficulty recalling a childhood memory

A

Deficits in all listed! EXCEPT recalling a childhood memory

They can do this because long term memory is stored all over the brain

97
Q

A pt has a confired diagnosis of unilateral vestibular hypofunction - the chief complaint of the patient is dizziness and blurred vision with head movements
What type of exercise would be MOST appropriate to target the patient’s chief complaint?

A

Vestibular Adaptation!!!

Reminders! (22 decks)

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