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1
Q

Stages of ALS

Stage III

A
  • Severe weakness of specific muscles
  • Increasing fatigue
  • Mild to moderate functional limitations
  • Ambulatory
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2
Q

Neurotmesis

A
  • Class 3
  • Cutting of the nerve w/ severance of all structures and complete loss of function
  • Reinnervation typically fails w/o surgical intervention because of aberrant regeneration
  • Failure of regenerating axon to find its terminal end
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3
Q

LE Extension Synergy Components

A

Strong Components:

  • Hip Abduction
  • Knee Extension
  • Ankle Plantarflexion

Other Components:

  • Hip extension
  • IR
  • Ankle Inversion
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4
Q

Temororal Lobe Area

A
  • Contains:
    • Primary Auditory Cortex
    • Associative Auditory Cortex
    • Wernicke’s Area
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5
Q

Patients w/ T12-L3 Lesions

A
  • Can be independent ambulator on all surfaces/stairs
  • Swing-Through/Four-Point Gait
  • Bilateral KAFOs/Crutches
  • Household Ambulators
  • WC Community Ambulator
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6
Q

Fibrillation

A
  • Spontaneous independent contractions of individual muscle fibers
  • Evident w/ denervation for 1-3 weeks after losing nerve
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7
Q

Anterior Cord Syndrome: UMN Lesion

A

Loss of anterior cord:

  • Loss of Lateral Corticospinal Tracts
    • Bilateral loss of motor function, spastic paralysis below level of lesion
  • Loss of Spinothalamic Tracts
    • Bilateral loss of pain and temperature
  • Preservation of Dorsal Columns
    • Proprioception, kinesthesia, and vibratory sense
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8
Q

Glasgow Coma Scale

Score 13-15

A

Minor Brain Injury

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9
Q

Hoehn and Yahr Classification

Stage II

A
  • Minimal bilateral or midline involvement
  • No balance involvement
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10
Q

Stages of AD

Moderate AD

A
  • Noticable memory, thinking, and behavioral symptoms that impair a person’s ability to function in daily life
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11
Q

Spinothalamic Tracts

A
  • Lateral
    • Sensations of Pain and Temperature
  • Anterior
    • Crude Touch
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12
Q

Occipital Lobe Area

A
  • Primary Visual Cortex
  • Visual Association Cortex
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13
Q

Most Common Lumbar SCI Injury

A

Flexion

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14
Q

ACA Blood Supply

A

Anterior two-thirds of the medial cerebral cortex

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15
Q

Functional Balance Grade: Fair

A
  • Patient is able to maintain steady balance with hand-hold support; may require occasional minimal assistance (static).
  • Patient accepts minimal challenge; able to maintain balance while turning head/trunk (dynamic).
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16
Q

Stages of ALS

Stage II

A
  • Moderate weakness in groups of muscles
  • Some wasting (atrophy) of muscles
  • Modified independence w/ assistive devices
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17
Q

Fasciculations

A
  • Spontaneous contractions of all or most of the fiber in a motor unit
    • Muscle twitches that can be observed or palpated
  • Present w/ LMN disorders and denervation
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18
Q

Posterior Cord Syndrome: UMN Lesion

A

Loss of dorsal columns:

  • Bilateral Loss of Proprioception, Vibration, Pressure,
  • Epicritic Sensation (Stereognosis/Point Discrimination)
  • Preservation of Motor Function, Pain, and Light Touch
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19
Q

Reticulospinal System

A

Modifies Transmission of Sensation, Especially Pain

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20
Q

Brudzinski’s Sign

A
  • Patient is positioned in supine; flex neck to chest
  • Positive sign: causes flexion of hips and knees
    • Suggests meningeal irritation
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21
Q

Patients w/ C5 Lesions

A
  • Have Shoulder/Elbow Function
  • Can use manual chair w/ propulsion aids
    • Independent for short distances on smooth/flat surfaces
    • May choose electric WC for distances/energy conservation
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22
Q

Figure-Ground Discrimination

A

Ability to pick out an object from an array of objects

Ex: brakes from a WC

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23
Q

Typical Neurological Gait Deficits

Ankle

A
  • Equinus Gait
  • Varus Foot
  • Equinovarus Position
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24
Q

Medial Medullary Syndrome

A

Ipsilateral to lesion:

  • Paralysis of Half of Tongue

Contralateral to lesion:

  • Hemiplegia UE/LE
  • Impaired Sensation
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25
Stages of ALS Stage IV
* Severe weakness and wasting of LEs * Mild weakness of UEs * Moderate assistance and assistive devices required * Uses WC
26
Segmental Demyelination
* Axons are preserved (no wallerian degeneration) * Remyelination restores function * ex: Guillain-Barre
27
Cheyne-Stoke Respiration
* A period of apnea lasting 10-60 seconds * Gradually increasing depth/frequency of respirations * Accompanies depression of frontal lobe/diencephalic dysfunction
28
Depth and Distance Imperceptions
Determine whether a patient can judge depth and distance
29
Stages of ALS Stage V
* Progressive weakness w/ deterioration of mobility/endurance * Increased fatigue * Moderate to severe weakness of whole limbs/trunk * Spasticity * Hyperreflexia * Loss of head control * Max assist
30
Opisthotonos
* Prolonged, severe spasm of muscles, causing head, back, andheels to arch backward * Arms and hands are held regidly flexed * Seen in severe meningitis, tetanus, epilepsy, and strychnine poisoning
31
Patients w/ C8-T1 Lesions
* Have Hand Function * Manual WC w/ standard hand rims
32
Midbrain Lesion
* Contralateral Hemiplegia * Contralateral CN III palsy
33
Stages of AD Mild AD
* Mild by measurable changes in cofnitive abilities noticeable to person affected and family members * Able to carry out everyday activities
34
Spinoreticular Tracts
Convey Deep and Chronic Pain
35
Stages of AD Preclincal AD
* Individuals have measureable changes in brain CSF/blood biomarkers w/out noticeable symptoms
36
Axonal Degeneration
* Degeneration of axon cylinder and myelin * Progressing from distal to proximal * Dying back of nerves * ex: peripheral neuropathy
37
Typical Neurological Gait Deficits Hip
* Retracted/Flexed * Trendeleburg Limp (Weak Abductors) * Scisoring (Spastic Adductors) * Insufficient Pelvic Rotation during Swing
38
Lesions of Neocerebellum (Hemisphere, Posterior Lobe)
* Intention Tremor * Irregular/Oscillatory Voluntary Movements * Dysdiadochokinesia * Dysmetria * Hypermetria * Errors or Force, Direction, Amplitude, Rebound Phenonmenon * Dyssynergia
39
Rancho Los Amigos Levels of Cognitive Function Level IV, V, and VI
Confused
40
Parietal Lobe Area
* Contains: * Postcentral Gyrus (Primary Sensory Cortex)
41
Neck Mobility Test for Meningeal Irritation
* Patient is positioned in supine, flex neck to check * Positive sign: neck pain w/ limitation/guarding of head flexion due to spasm of posterior neck muscles * Can result from meningeal inflammation, arthritis, or neck injury
42
Guidelines to Promote Learning W/ Right Hemisphere Lesions
* Use verbal cues * Demonstrations or gestures may confuse patients w/ visuospatial deficits * Give frequent feedback * focus on slowing down and controlling movement * Focus on safety * Avoid environmental (spatial) clutter * Do not overestimate ability to learn
43
MCA Bloody Supply
Lateral cerebral cortex, basal ganglia, and large portions of the internal capsule
44
UE Extension Synergy Components
Strong Components: * Shoulder Adduction Other Components: * Scapular Protraction * IR, * Elbow Extension, * Forearm Pronation * Wrist and Finger Flexion
45
Gross Motor Classification for CP Level II
* Walks w/o assistive devices * Limitations walking outdoors/community
46
Dorsal Columns/Medial Lemniscal System
* Convey sensations of: * Proprioception * Vibration * Tactile Discrimination
47
Functional Balance Grade: Poor
* Patient requires hand-hold support and moder to maximal assistance to maintain position (static). * Patient unable to accept challenge or move without loss of balance (dynamic).
48
Functional Balance Grade: Good
* Patient is able to maintain steady balance without hand-hold support, limited postural sway (static). * Patient accepts moderate challenge; able to maintain balance while picking object off floor (dynamic).
49
Tectospinal Tract
Assists in Head-Turning Responses to Visual Stimuli
50
LE Flexion Synergy Components
* Hip flexion * Abduction * ER * Knee Flexion * Ankle Dorsiflexion/Inversion
51
Agnosia
* Inability to recognize familar objects w/ one sensory modality * Retain ability to recognize same object w/ other sensory modalities * Ex: Subject doesn't recognize a clock by sight but can recognize by ticking
52
Vertebrobasilar Artery Blood Supply
Ventral surface of the medulla and the posterior inferior aspect of the cerebellum
53
Rancho Los Amigos Levels of Cognitive Function Level II-III
Decreased Response
54
Vertical Disorientation
Determine whether patient can accurately identify when something is upright
55
Patients w/ L4-L5 Lesions
* Bilateral AFOs w/ Crutches or Canes * Independent Community Ambulators * May still use WC for high-endurance activities
56
Lateral Inferior Pontine Syndrome
Ipsilateral to lesion: * Cerebellar: Ataxia, Nystagmus, Vertigo * Facial Paralysis/Impaired Facial Sensation * Paralysis of Conjugate Gaze * Deafness * Tinnitus Contralateral to lesion: * Impaired Pain and Temperature Sensation
57
Vestibulospinal Tracts
Controls: * Muscle Tone * Antigravity Muscles * Postural Reflexes
58
Spatial Relations
Ability to duplicate a pattern of two or three blocks
59
Patients w/ T6-T9 Lesions
* Require KAFOs, Crutches, Swing-to Gait Pattern * Supervised ambulation for short distances * May prefer standing devices/standing WC
60
Lesions of Paleocerebellum (Spinocerebellum; Rostral Cerebellum/Anterior Lobe)
* Hypotonia * Truncal Ataxia * Dysequilibruim * Static Postural Tremor * Increased Sway * Wide BOS * High Guard Arm Position * Posture worse w/ EO * Ataxic Gait * Unsteady/Increased Falls * Uneven/Decreased Step Length * Increased Step Width
61
CRPS: Dystrophic or Middle Stage
* Think/Pale/Cynotic Skin * Cessation of Hair/Nail Growth * Hyperhidrosis * Muscle Astrophy * Osteoporosis
62
Most Common Cervical SCI Injuries
Flexion-Rotation
63
CRPS: Acute or Early Stage
* Diffuse/Severe Burning/Aching Pain * Increases w/ Emotional Stress * Allodynia * Hyperpathia * Increased sensitivity to normal stimuli * Vasomotor Instability * Dusky Molting/Cool Sking * Swelling * Edema
64
CATSIB Patients Unstable in Conditions 4, 5, and 6
Dependent on Surface/Somatosensory Inputs
65
Anterior Cerebral Artery (ACA) Syndrome
* UE more spared * Apraxia * Akinetic Mutism
66
Basilar Artery Blood Supply
Ventral portion of the pons
67
Gross Motor Classification for CP Level III
* Walks w/ assistive mobility device * Limitations walking outdoors/community
68
CATSIB Patients Unstable in Conditions 3, 4, 5, and 6
Patients with Sensory Selection Problems
69
Lateral Medullary (Wallenberg's) Syndrome
Ipsilateral to lesion: * Cerebellar: Ataxia, Nystagmus, Vertigo * Loss of Pain and Temperature to Face * Sensory Loss UE, Trunk, or LE Contralateral to lesion: * Impaired Pain and Temperature Sensation to Body/Face * Horner's Syndrome (Miosis, Ptosis, Decreased Sweating) * Dysphagia * Impaired Speech
70
CATSIB Patients Unstable in Conditions 2, 3, 5, and 6
Dependent on Vision
71
Ideomotor Apraxia
Patient cannot perform task on command but can do task when left alone
72
Lacunar (pure motor) Stroke
* Contralateral Hemiplegia * UE/LE * No Aphasia * Visual Field Deficit Rare
73
Hoehn and Yahr Classification Stage V
* Confined to bed or WC
74
Rancho Los Amigos Levels of Cognitive Function Level VII and VIII
Appropriate (Automatic and Purposeful)
75
Stages of ALS Stage I
* Early disease * Mild focal weakness * Asymmetrical distribution * Symptoms of hand cramping and fasciculations
76
Medial Inferior Pontine Syndrome
Ipsilateral to lesion: * Cerebellar Ataxia * Nystagmus * Paralysis of Conjugate Gaze * Diplopia Contralateral to lesion: * UE/LE Hemiparesis * Impaired Sensation
77
Glasgow Coma Scale Score 1-8
Severe Brain Injury
78
Topographical Disorientation
Determine whether patient can navigate a familiar route on their own Ex: travel from room to clinic
79
Middle Cerebral Artery (MCA) Syndrome
* LE more spared * Nonfluent Aphasia * Perceptual Deficit * Loss of Conjugate Gaze to Opposite Side * Sensory Ataxia
80
Hoehn and Yahr Classification Stage III
* Impaired Balance * Some restrictions in activities
81
Apraxia
Inability to perform voluntary, learned movements in the absence of loss of sensation, strength, coordination, attention, or comprehension
82
Stages of ALS Stage VI
* Bedridden * Dependent ADS/FMS * Progressive respiratory distress
83
Locked-in Syndrome
* Tetraplegia * Lower Bulbar Paralysis (CN V-XII) * Mutism (Anarthria) * Preserved Consciousness * Preserved Vertical Eye Movements/Blinking
84
Glasgow Coma Scale Score 9-12
Moderate Brain Injury
85
Ideational Apraxia
Patient cannot perform the task at all
86
Functional Balance Grade: Absent
* Patient unable to maintain balance.
87
CATSIB Patients Unstable in Conditions 5 and 6
Patients with Vestibular Loss
88
Hoehn and Yahr Classification Stage IV
* All symptoms present and severe * Stand and walks only w/ assistance
89
Guidelines to Promote Learning W/ Left Hemisphere Lesions
* Develop an appropriate communication base * Words, Gestures, Pantomimes * Assess Level of Understanding * Give frequent feedback and support * Do not underestimate ability to learn
90
Gross Motor Classification for CP Level V
* Self-mobility is severely limited, even w/ assistive technology
91
Typical Neurological Gait Deficits Knee
* Weak Knee Extensors * Knee Flexes during Stance * Compensatory Locking of Knee in Hyperextension * Spastic Quadriceps * May Also Hyperextend Knee
92
Patients w/ Left Hemisphere Lesions
Typically slow, cautious, hesitant, and insecure
93
Cauda Equina Injury: LMN Lesion
* Loss of long nerve roots at or below L1 * Variable nerve root damage (motor and sensory signs) * Incomplete lesions common * Flaccid paralysis with no spinal reflex activitiy * Flaccid paralysis of bladder and bowel * Potential for nerve regeneration * Regeneration often incomplete, slows and stops after about 1 year
94
Neurapraxia
* Class 1 * Injury to nerve that causes transient loss of function (conduction block ischemia) * Nerve dysfunction may be rapidly reserves or persist a few weeks * ex: compression
95
Wallerian Degeneration
* Transection (neurotmesis) results in degeneration of the axon/myelin sheath distal to site of axonal interuption
96
Posterior Cerebral Artery (PCA) Syndrome
* Contralateral Sensory Loss * Choreoathetosis, Tremor, Hemiballismus * Transient Contralateral Hemiparesis * Homonymous Hemianopsia * Visual Agnosia * Memory Defect * Dyslexia * Central Pain * Weber's Syndrome * Oculomotor N. palsy
97
Stages of AD Severe AD
* Loss of ability to communicate, recognize others, and complete dependence
98
Position in Space
Have patient demonstrate different limb positions
99
Spinocerebellar Tracts
Convey proprioception information from: * Muscle Spindles * Golgi Tendon Organs * Touch/Pressure Receptors
100
Frontal Lobe Area
* Contains: * Precentral Gyrus * Prefrontal Cortex * Broca's Area
101
Rubrospinal Tracts
Assists Motor Function
102
Gross Motor Classification for CP Level I
* Walks w/o restrictions * Limitations in more advanced gross motor skills
103
Kernig's Sign
* Patient is positioned in supine, flex hip and knee fully to chest, and then extend knee. * Positive sign: causes pain and increased resistance to extending the knee due to spasm of hamstring * When bilateral, suggests meningeal irritation
104
Corticospinal Tracts
Arise from Primary Motor Cortex
105
Hoehn and Yahr Classification Stage I
* Minimal or absent disability * Unilateral symptoms
106
Brown-Sequard Syndrome: UMN Lesion
Hemisection of Spinal Cord: * Ipsilateral Loss of Dorsal Columns * Loss of tactile discrimination, pressure, vibration, and proprioception * Ipsilateral Loss of Corticospinal Tracts * Loss of motor function and spastic paralysis below lesion * Contralateral Loss of Spinothalamic Tract * Loss of pain and temperature below level of lesion * Bilateral loss of pain and temperature at level of lesion
107
Patients w/ C7 Lesions
* Have Triceps Function * Same as C6 but w/ increased propulsion
108
Patients w/ C6 Lesions
* Have Radial Wrist Extensors * Manual WC w/ friction surface hand rims * Independent
109
Patients w/ Right Hemisphere Lesions
* Typically impulsive, quick, indefferent * Often exhibit poor judgement/safety * Overestimate their abilities while underestimating their problems
110
UE Flexion Synergy Components
Strong Components: * Elbow, Wrist, Finger Flexion Other Components: * Scapular Retraction/Elevation * Shoulder Abduction, ER, * Supination
111
Form Constancy
Ability to pick out an object from an array of similarly shaped but different sized objects
112
Axonotmesis
* Class 2 * Injury to nerve interrupting the axon and causing loss of function and wallerian degeneration distal to lesion * No disruption of the endoneurium * Regeneration is possible * ex: crush injury
113
Gross Motor Classification for CP Level IV
* Self-mobility w/ limitations * Children are transported or use power mobility outdoors/community
114
Most Common SCI Injury Levels
* C5 * C7 * T12 * L1
115
Lisions of the Archicerebellum (Flocculonodular Lobe)
* Central vestibular symptoms * Ocular Dysmetria * Poor Eye Pursuit * Dysfunctional VOR * Impaired Hand-Eye * Gait/Trunk Ataxia * Poor Postural Control/Orientation * Wide-Based Gait * Little change in tone or dyssenergia of extremities
116
Rancho Los Amigos Levels of Cognitive Function Level I
No Response
117
Functional Balance Grade: Normal
* Patient is able to maintain steady balance without hand-hold support (static). * Patient accepts maximal challenge and can shift weight easily at full range in all directions (dynamic).
118
CRPS: Atrophic or Late Stage
* Decreased Hypersensitivity * Normal Blood Flow/Temperature * Smooth/Glossy Skin * Severe Muscle Atrophy * Periscapular Fibrosis * Diffuse Osteoporosis * Development of Claw Hand
119
Central Cord Lesion: UMN Lesion
Cavitation of central cord in cervical section: * Loss of Spinothalamic Tracts * Bilateral loss of pain/temperature * Loss of Ventral Horn * Bilateral loss of motor function: primarily UE * Preservation of proprioception and discriminatory sensation

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