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S2 PTA 104 disease > Neuro > Flashcards

Neuro Flashcards

1
Q

Cerebrospinal fluid

A

Shock absorber

  1. 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
  2. Contains: proteins - glucose - urea - salts - some WBC
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2
Q

Flow of cerebral spinal fluid

A

Lateral ventricles - 3/4 ventricles - subarachnoid space - blood - filtered in kidneys and liver

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3
Q

Meninges

A

Three layers of protective coverings that surround the brain and spinal cord

  • dura mater
  • arachnoid mater
  • pia mater
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4
Q

Spinal cord

A
  • 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
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5
Q

Sensory nerves

A
  • 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
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6
Q

Motor nerves

A
  • 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
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7
Q

Necrosis

A

Passive, more severe damage

  • cell death
  • inflammatory process
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8
Q

Apoptosis

A

Active

  • programmed cell death
  • no inflammation
  • part of the normal maturation of nerve cells
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9
Q

Neuroplasticity

A

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

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10
Q

UMN lesion

A

Upper motor neuron lesion

  • cerebral cortex
  • sub-cortical white matter
  • internal capsule
  • brainstem
  • spinal cord
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11
Q

LMN lesion

A

Lower motor neuron lesion

- damage to cell body, axons, motor end plate, muscles

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12
Q

Nerves vs ganglia

A
  1. Nerves: cordlike bundle of nerve fibers that transmits impulses to/from the brain and spinal cord to other parts of the body
  2. Ganglia: groups of nerve cell bodies located outside the CNS
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13
Q

Cerebro vascular accident

A

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
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14
Q

Ischemic vs hemorrahgic CVA

A
  1. Ischemic: thrombus - embolus - lacunae (artery damage)

2. Hemorrhagic: intracerebral - subdural 0 subarachnoid - AV malformation

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15
Q

S&S stroke and FAST

A 
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)
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16
Q

Tx stroke

A
  • clot buster
  • tPA: tissue plasminogen activator
  • binds to fibrin in the clot
  • only if CVA occurred in last 3 hours
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17
Q

Transient ischemic attack

A
  • 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
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18
Q

Transient ischemic attack S&S

A
  • 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
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19
Q

Changes in mm tone CVA

A
  1. Spasticity (hypertonia)
    - increased resistance to passive stretch
    - clonus
    - rigidity
    - hypereflexia
  2. Facility (hypotonia)
    - low tone
    - decreased or absent deep tendon reflexes
    - ex drop foot
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20
Q

Sensation CVA

A

Ability to receive sensory input within and outside the body and transmit it through the peripheral nerves
- modes: visual, vestibular, tactile, proprioceptive

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21
Q

Perception CVA

A

Ability to integrate various sensory inputs and respond appropriately

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22
Q

Additional findings CVA

A

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)
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23
Q

Modifiable risk factors CVA

A
  • hypertension
  • atherosclerosis
  • heart disease
  • diabetes
  • elevated cholesterol
  • smoking
  • obesity
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24
Q

Non-modifiable risk factors CVA

A
  • age
  • race
  • family history
  • gender: male > female
  • age constitutes the greates risk for strokes
  • 73% are 65+ yo
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25
Q

CVA home care regimen

A

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
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26
Q

injury patterens

A
  1. Hemiplegia (stroke) half of body
  2. Paraplegia (spinal cord) legs
  3. Terraplena (quad) arms and legs
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27
Q

Etiology of SCI

A
  • 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
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28
Q

Phases of injury SCI

A
  1. Primary 1-2 days: damage to neurons at level of injry
  2. Secondary: apoptosis up to 4 spinal levels from injry
    - ischemia - hypoxia - edema
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29
Q

SCI

A

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)
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30
Q

SCIberg

A
  • 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
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31
Q

Brown sequared lesion

A
  1. Ipsilateral: touch, vibration, position

2. Contralateral: pain, temperature

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32
Q

PT intervention SCI

A
  • 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
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33
Q

ASIA scale

A
  • 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
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34
Q

Autonómica dysreflexia

A

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
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35
Q

Parkinson’s

A

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
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36
Q

S&S Parkinson’s

A
  • 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
37
Q

Impact on pt Parkinson’s

A
  • 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
38
Q

Medical tx and PT role Parkinson’s

A
  • 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
39
Q

MS

A
  • 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
40
Q

Contributing factors in development of MS

A
  • 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
41
Q

S&S ms

A
  • vision problems
  • paresthesias and sensory changes
  • spasticity
  • weakness
  • ataxia (defective mm coordination)
  • balance dysfunction
  • fatigue
  • bowel and bladder dysfunction
42
Q

Patterns for MS

A

Frequency and intensity of exacerbation and remission may indicate speed/course

  1. Relapsing-remitting (85%) landscape
  2. Primary-progressive - normal graph
  3. Secondary-progressive - solo house
  4. Progressive-relapsing - city on a hill
43
Q

Diagnosing MS

A
  • 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
44
Q

PT interventions MS

A
  • 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
45
Q

Long term effects of MS

A

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
46
Q

Amyotrophic lateral sclerosis

A

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
47
Q

PT intervention for ALS

A
  • 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
48
Q

Traumatic Brain injury

A

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
49
Q

Concussion

A

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
50
Q

Delayed effects of concussion

A
  • 7-10 days after injry
  • resolves in 3 months
  • epilepsy
  • cumulative effects of multiple brain injuries
  • post-concussion syndrome
  • recommnedations for pediatric mTBI
51
Q

Coup-contrecoup

A

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

52
Q

TBI/concussion pathophysiology and S&S

A

Patho:

  1. Traumatic force
  2. 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

53
Q

Glasgow coma score

A 
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
54
Q

Hydrocephalus

A

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
55
Q

Epilepsy

A

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
56
Q

Bell’s palsy

A

(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
57
Q

Margaret Rood

A

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
58
Q

Brunnstrom

A

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
59
Q

Neurodevelopmental treatment

A

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
60
Q

Proprioceptive neuromuscular facilitation

A

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
61
Q

Neurotomy

A

Incision of a nerve

62
Q

Radicotomy

A

Incision into a nerve root

63
Q

Neuroplasty

A

Surgical repair of a nerve

64
Q

CAT scan

A

Rule out brain lesions

65
Q

MRI

A

Gives best assist immediately after the onset of ischemia within the Brian

66
Q

Positron emission tomography

A

PET

- to determine cerebral perfusion and cell function

67
Q

Ultrasonography

A

Indetifies areas of diminished blood flow

68
Q

Angiography

A

May identify a clot and determine if surgical intervention is necessary

69
Q

Electroencephalogram

A

EEG

- record of the electrical impulses. Brain placing electrodes on scalp

70
Q

Electromyography

A

EMG

- records electrical activity in mm during rest and mm contraction

71
Q

Myelogram

A

X ray image of spinal cord (dye injected)

72
Q

Lumbar puncture

A

Insertion of needle to remove spinal fluid fro diagnostic purposes and other reasons

73
Q

Cerebral angiography

A

X-ray image of blood vessels

74
Q

Shunt

A

Tube implanted to redirect the flow of fluid

75
Q

Syncope

A

Fainting caused by a lack of blood supply to the cerebrum

76
Q

Dementia

A

Mental decline

77
Q

Cognitive

A

Mental processes of comprehension

78
Q

Ataxia

A

Lack of mm coordination

79
Q

Afferent

A

Toward the center

80
Q

Efferent

A

Away from center

81
Q

Aphasia

A

Loss of speaking

82
Q

Cráneo cerebral

A

Pertaining to cranium/cerebrum

83
Q

Dysphasia

A

Difficulty speaking

84
Q

Dysphagia

A

Difficulty swallowing

85
Q

Hyperesthesia

A

Excessive sensitivity to stimuli

86
Q

Interictal

A

Between seizures or attacks

87
Q

Monoparesis

A

Weakness of one limb

88
Q

Cephalalgia

A

Pain in the head (HA)

89
Q

Subdural

A

Below the dura mater

S2 PTA 104 disease (15 decks)

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