Neuro Flashcards
Cerebrospinal fluid
Shock absorber
- Provides: nutritive substances to CNS. Any interference with the absorption of the fluid will result in abnormal collection of fluid within the brain, termed hydrocephalus
- Contains: proteins - glucose - urea - salts - some WBC
Flow of cerebral spinal fluid
Lateral ventricles - 3/4 ventricles - subarachnoid space - blood - filtered in kidneys and liver
Meninges
Three layers of protective coverings that surround the brain and spinal cord
- dura mater
- arachnoid mater
- pia mater
Spinal cord
- contains nerve cell bodies
- major portion of spinal cord is nerve fibers in specific bundles extending from the cells fo the brain
- nerve fibers transmit into to/from the brain as electrical impulses carrying messages
- spinal cord is around the size of your little finger in circumference
Sensory nerves
- wide variety of sensory cells in the nervous system
- responsible for hearing, balance, vision, skin, muscles, joints, lungs, and other organs
- detect heat, cold, motion, pressure, pain, balance, light, taste, smell and other sensations
Motor nerves
- each muscles has its own motor nerve
- electrical impulses produced by the cell body in the spinal cord are transmitted along motor nerve to the mm and cause it to contract
- the cell body in the spinal cord is stimulated by an impulse produced in the motor strip of the cerebral cortex
Necrosis
Passive, more severe damage
- cell death
- inflammatory process
Apoptosis
Active
- programmed cell death
- no inflammation
- part of the normal maturation of nerve cells
Neuroplasticity
Reverse to changes in neural pathways and synapses due to changes in behavior, enrivonemnt, neural processes, thinking, emotions, as well as changes resulting from bodily injry
UMN lesion
Upper motor neuron lesion
- cerebral cortex
- sub-cortical white matter
- internal capsule
- brainstem
- spinal cord
LMN lesion
Lower motor neuron lesion
- damage to cell body, axons, motor end plate, muscles
Nerves vs ganglia
- Nerves: cordlike bundle of nerve fibers that transmits impulses to/from the brain and spinal cord to other parts of the body
- Ganglia: groups of nerve cell bodies located outside the CNS
Cerebro vascular accident
Stroke
- interruption of cerebral circulation that results in cerebral insufficiency, destruction of surrounding Brian tissue and neurological deficit
- infarction slowly progresses over one to two days
- most common site is middle cerebral artery
Ischemic vs hemorrahgic CVA
- Ischemic: thrombus - embolus - lacunae (artery damage)
2. Hemorrhagic: intracerebral - subdural 0 subarachnoid - AV malformation
S&S stroke and FAST
Sudden, severe head ache (no known cause) - weakness or numbness of the face, arm, leg on one side of the body (hemiplegia) - difficulty with speech - sudden loss or dimming of vision - unexplained dizziness - sudden falls - unsteadiness Face (uneven?) Arm (one arm hanging down?) Speech (slurrred) Time (call 911)
Tx stroke
- clot buster
- tPA: tissue plasminogen activator
- binds to fibrin in the clot
- only if CVA occurred in last 3 hours
Transient ischemic attack
- stroke symptoms that last 1-24hrs
- dure to sudden deficient supply of blood to the brain lasting a short time
- 1/3 have 2nd CVA
Transient ischemic attack S&S
- hemiplegia-paralysis
- hemiparesis- muscle weakness
- chagnes in mm tone (spasticity vs flaccid)
- sensory chagnes (n/t)
- visual changes
- perceptual chagnes
- balance abnormalities
- dysphasia (trouble swallowing)
- aphasia (communication disorder)
- cognitive deficits (decreased memory, problem-solving)
- incontinence of bowel or bladder
- emotional lability
Changes in mm tone CVA
- Spasticity (hypertonia)
- increased resistance to passive stretch
- clonus
- rigidity
- hypereflexia - Facility (hypotonia)
- low tone
- decreased or absent deep tendon reflexes
- ex drop foot
Sensation CVA
Ability to receive sensory input within and outside the body and transmit it through the peripheral nerves
- modes: visual, vestibular, tactile, proprioceptive
Perception CVA
Ability to integrate various sensory inputs and respond appropriately
Additional findings CVA
Coma and death are the most severe consequences
- common for pts post CVA to have residual complications and deficits that persist
- expressive aphasia: impaired ability to communicate by speech (broca’s)
- receptive aphasia: diminished ability to receive and interpret verbal and written communication (wernicke’s)
Modifiable risk factors CVA
- hypertension
- atherosclerosis
- heart disease
- diabetes
- elevated cholesterol
- smoking
- obesity
Non-modifiable risk factors CVA
- age
- race
- family history
- gender: male > female
- age constitutes the greates risk for strokes
- 73% are 65+ yo
CVA home care regimen
75% of patients return home at various levels of functional mobility
- PT in home:
- exercise program
- fall prevention
- control of spasticity
- endurance training
- functional mobility
- sensory stimulation
- motor re-education
injury patterens
- Hemiplegia (stroke) half of body
- Paraplegia (spinal cord) legs
- Terraplena (quad) arms and legs
Etiology of SCI
- MVA, violence, and falls
- over 50% occur 15-25 years of age
- higher ration of men and white ppl
- 10-15% also have TBI
- also caused by diseases
- 190,000-230,000 in US
Phases of injury SCI
- Primary 1-2 days: damage to neurons at level of injry
- Secondary: apoptosis up to 4 spinal levels from injry
- ischemia - hypoxia - edema
SCI
Early goal: preservation of live and prevention of further damage to neural tissue
- stabilization by means of fusiong vertebrae with bone grafts, rods, wires, and external devices such as body jackets or casts
- medications are used to enhance repair and recover (steroids for inflammation control)
SCIberg
- inability to walk
- loss of touch sensation
- loss of sexual function
- loss of voluntary bladder and bowl control
- inability to feel hot and cold
- loss of body temperature regulation
- cardiovascular risk
- compromised digestion system
- breathing difficulties
- constant neuropathic pain
- psychological battles
- pressure sores
- spasms
Brown sequared lesion
- Ipsilateral: touch, vibration, position
2. Contralateral: pain, temperature
PT intervention SCI
- maintain mobility of joints, extremities, strength of unaffected mm, cardiorespiratory capacity, and endurance
- once medical stability and orthopedic clearance is obtained, a more vigorous functional training is begun
- home regime: W/C accessible with ramps, other modifications, family edu
ASIA scale
- A: complete- no sensory or motor
- B: incomplete- sensory but no motor below injry level
- C: incomplete- most key muscle groups below injry level and <3/5 strength
- D: incomplete- most key muscle groups below injury have >3/5 strength
- E: normal- sensory and motor intact
Autonómica dysreflexia
Acture emergency
- who: T5 and above
- signs: increased BP, HA, diaphoresis, vision changes, arrhythmia, anxiety
- triggers: full bladder or bowels, kidney stones, gastritis, onset of menses, DVT or PE, pressure injry, bruises, tight clothing
Parkinson’s
Progressive condition first described by James parkinson in 1817
- etiology: unknown
- substantia nigra in the midbrain deteriorates
- decreased dopamine
- chronic degeneration disease of the CNS that usually occurs after 50 yo
- shaking palsy
- presentation: rigidity and trembling of head, forward tilt of trunk, redacted arm swinging, shuffling gait with short steps, regidity and trembling of extremities
S&S Parkinson’s
- tremor: affects hands and feet, alternating contractions of opposing mm groups and tends to occur at rest
- rigidity: a disturbance of mm tone, resistance when the limbs are passively moved (2 types o frigidity are cogwheel and leadpipe)
- bradykinesia: slowness of movement
- akinesia: a poverty of movements
Impact on pt Parkinson’s
- decreased ability to maintain balance, walking, stair climbing, reaching
- some days worse than others
- condition results in deficiency in dopamine
- no cure
- prognosis: symptoms will continue to worsen over time due to the effectiveness of medication diminish
Medical tx and PT role Parkinson’s
- levodopa to replace dopamine
- transplantation: a controversial option for a more permanent treatment or cure
- stem cell research
- edu pt, family
- teach pt compensatory strategies to maintain fucntion and decrease further problems
- stretching, PNF patterning incorporatied into 3D movement
- timing is everything (time of day, after meds)
- strength training
- ambulatory training
MS
- slow debilitating degenerative disease
- can last up to 20+ years
- most pts become w/c bound and dependent on other for personal care
- affects brain and spinal cord
- fatigues easily, good/bad days, hard to recover from over exercising
- 400,00 in US, 2.5 mil ww
- chronic demyelination of myelin sheaths surrounding the nerves in brain and spinal cord
- myelin breakdown results in plaque development, decreased nerve conduction velocity and eventual failure of impulse transmission
- lesions are scattered through the CNS and do not follow a pattern
Contributing factors in development of MS
- idiopathic
- genetics, viral infections, and environment all have a role in MS
- theory: a slow acting virus initiates the autoimmune response in individuals that have environmental and genetic factors for the disease
- higher incidence of MS in temperate climates, white ppl, 20-35 yo, women
S&S ms
- vision problems
- paresthesias and sensory changes
- spasticity
- weakness
- ataxia (defective mm coordination)
- balance dysfunction
- fatigue
- bowel and bladder dysfunction
Patterns for MS
Frequency and intensity of exacerbation and remission may indicate speed/course
- Relapsing-remitting (85%) landscape
- Primary-progressive - normal graph
- Secondary-progressive - solo house
- Progressive-relapsing - city on a hill
Diagnosing MS
- there is no single test to diagnose MS early in the disease
- MRI may assist with observation and establishing baseline for lesions
- EMG may demonstrate slowed nerve conduction
- cerebral spinal fluid can be analyzed fro elevated concentration of gamma globulin and protein levels
PT interventions MS
- relaxation and energy conservation techniques
- normalization of tone
- balance activities
- gait training
- core stabilization
- adaptive/assistive device training
- patient caregiver education regarding safety
- patterens of fatigue
Long term effects of MS
may live for many years and die from
- disuse atrophy - pressure sores - contractures - pathological fractures - renal infection - pneumonia
- if untreated, 50% of pts will require a wheelchair within 15 years of diagnosis
- suicide is 7x higher
Amyotrophic lateral sclerosis
ALS (Lou Gehrig’s)
- rapidly progressive neurological disorder
- degeneration of motor nerve cells
- idiopathic
- onset at 50
- difficulty in speech, swallowing, breathing, movements involving all mm
- prognosis: no cure, survival is about 4 years
PT intervention for ALS
- provide preventive and supportive care for secondary problems of weakness
- recommend appropriate devices and equipment to minimalist dependence on others
- educate family/caregivers patient management
Traumatic Brain injury
TBI
- caused by falls, MVAs, or violence
- 50% falls are ETOH related
- refers to either open or closed head injry
- varying deficits: motor and sensory capabilities, cognitive and intellect unreal functions, emotional and psychological functions
Concussion
Minor TBI
- HA
- temporary LOC
- confusion
- amnesia surrounding the traumatic event
- dizziness
- ringing in the ears
- nausea/vomiting
- slurred speech
- delayed response to questions
- appearing dazed
- fatigue
Delayed effects of concussion
- 7-10 days after injry
- resolves in 3 months
- epilepsy
- cumulative effects of multiple brain injuries
- post-concussion syndrome
- recommnedations for pediatric mTBI
Coup-contrecoup
Damage is located at the site of impact (often less marked) and on the opposite side of the head to the point of maximum external trauma
- may occur with whiplash
TBI/concussion pathophysiology and S&S
Patho:
- Traumatic force
- Brain swelling, decreased perfusion, atonal injry, hypoxia, edema, bleeding
S&S
- depends on injured area - visual changes - perceptual changes - mm tone changes - distractibility - memory loss - seizures - HA - anxiety - depression
Glasgow coma score
Measure altered levels of consciousness due to diffuse damage and brainstem injry Max score of 15 1. Eye opening 4 2. Verbal response 5 3. Motor response 6
Hydrocephalus
Increased amount of cerebrospinal fluid in the ventricles of the brain, which causes enlargement of the cranium
- water in the head
- treated with a shunt to move fluid to abdomen
Epilepsy
Disorder in which the main symptom is recurring seizures
- sudden, brief attacks of altered consciousness, motor activity, or sensory phenomena
- convulsive seizures are the most common form of attacks
Bell’s palsy
(7th cranial nerve)
- paralysis of mm on one side of the face, usually temporary
- pt may drool, have a sagging mouth and non-closure of the eyelid on the affected side
Margaret Rood
Stress the imporantce of sensory stimuli in arousing, calming, and modifying motor responses
- variety of stimuli to influence motor behavior (cold, vibration)
- autonomic (involuntary) nervous system modifying motor responses
Brunnstrom
Worked primarily with CVA pts
- used movement patterns that these pts exhibited as they recovered
- sequencing of movements and actitudes that would facilitate recovery and fucntion
Neurodevelopmental treatment
NDT
- Berta and Karen bobath
- focus on cerebral palsy and adult CVA
- after CVA pt cant direct nerve impulses appropriately causing abnormal patterens of coordination in posture, movement, and abnormal mm tone
- tx: promote functional patterns, integrated automatic reactions, voluntary functional activity, improved motor control
Proprioceptive neuromuscular facilitation
PNF
- most activities require multidimensional movements using various mm at various joints complement and enhance one another’s activities
- uses sensory stimuli at specific locations and ties within a movement
- emphasizes joint and position sense, proprioceptive stimuli, tactile and visual and auditory stimuli
- used with pts with MSK and neuromuscular problems
Neurotomy
Incision of a nerve
Radicotomy
Incision into a nerve root
Neuroplasty
Surgical repair of a nerve
CAT scan
Rule out brain lesions
MRI
Gives best assist immediately after the onset of ischemia within the Brian
Positron emission tomography
PET
- to determine cerebral perfusion and cell function
Ultrasonography
Indetifies areas of diminished blood flow
Angiography
May identify a clot and determine if surgical intervention is necessary
Electroencephalogram
EEG
- record of the electrical impulses. Brain placing electrodes on scalp
Electromyography
EMG
- records electrical activity in mm during rest and mm contraction
Myelogram
X ray image of spinal cord (dye injected)
Lumbar puncture
Insertion of needle to remove spinal fluid fro diagnostic purposes and other reasons
Cerebral angiography
X-ray image of blood vessels
Shunt
Tube implanted to redirect the flow of fluid
Syncope
Fainting caused by a lack of blood supply to the cerebrum
Dementia
Mental decline
Cognitive
Mental processes of comprehension
Ataxia
Lack of mm coordination
Afferent
Toward the center
Efferent
Away from center
Aphasia
Loss of speaking
Cráneo cerebral
Pertaining to cranium/cerebrum
Dysphasia
Difficulty speaking
Dysphagia
Difficulty swallowing
Hyperesthesia
Excessive sensitivity to stimuli
Interictal
Between seizures or attacks
Monoparesis
Weakness of one limb
Cephalalgia
Pain in the head (HA)
Subdural
Below the dura mater
