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PNE > Neuro > Flashcards

Neuro Flashcards

1
Q

What is chronic spasticity associated with?

A

Abnormal posturing and deformity, contractures, functional limitations and disability

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2
Q

What are the 2 types of rigidity?

A

Leadpipe: constant uniform rigidity throughout entire ROM
Cogwheel: hypertonic state with rachet like jerkiness during muscle elongation

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3
Q

What is rigidity associated with?

A

Contractures, stiffness, inflexibility, functional limitations and disability

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4
Q

Describe the Modified Ashworth Scale?

A

0 - no increase in tone
1 - slight increase in tone - minimal resistance at end of ROM
1+ - slight increase - minimal resistance through less than half ROM
2 - noticeable increase - mod resistance through most of ROM
3 - considerable increase throughout - PROM difficult
4 - max rigidity through entire ROM (passive and active)

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5
Q

What is the order of testing sensation?

A

Superficial - light touch, pain, temp, pressure
Deep - proprio, kinaesthesia, vibration
Combined - stereognosis, graphasthesia, etc.

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6
Q

What are the cortical sensation tests and what do they assess?

A

Stereognosis - tactile object recognition
Tactile localization - ability to localize touch sensation
2 point discrimination - ability to perceive 2 separate points on the skin simultaneously
Double simultaneous stimulation - ability to perceive simultaneous touch stimulation (identical spots on both sides, proximal and distal on one extremity, prox and distal on one side of the body)
Graphesthesia - ability to identify numbers, letters, etc that have been traced on the skin
Texture recognition - differentiate between textures
Barognosis - recognition of weight

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7
Q

What are coordination tests? What are you looking for with each one?

A

Nose to finger - intention tremor, dysmetria, postural control, speed
Pro/Sup RAM - dysdiadochokinesia
Finger Opposition RAM - dysdiadochokinesia
Rebound test - inability to adapt to removal of resistance causing jerky response
Heel to Shin - speed of movement, dysmetria, postural control with movement
Tapping RAM - dysdiadochokinesia
Toe to finger - intention tremor, speed of movement, dysmetria, postural control

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8
Q

What is the progression of positions to assess balance in?

A

Most supported –> least supported

4 point kneeling –> kneeling –> sitting –> standing –> walking

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9
Q

How do you progress the balance assessment in each position? What are other ways to increase difficulty?

A

Internal perturbations - pt generated movements
External perturbations - expected and unexpected
Ways to increase difficulty: BOS, speed of movement/perturbation, expected vs. unexpected, amount of sensory input

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10
Q

What are the 3 strategies used to maintain balance?

A

Ankle - small perturbations
Hip - large or fast perturbations where ankle isn’t enough
Equilibrium restoring - pivoting, movement of extremities, changing BOS

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11
Q

Romberg Test/Sharpened Romberg Test

A

Measures balance
In standing (barefoot), feet together, eyes closed, arms at sides. Count seconds pt can maintain balance
Opening eyes, using arms or stepping ends the test
Sharpened = same but in tandem

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12
Q

Sensory Organization Test

A

Tests function of 3 senses needed for balance (vision, vestibular and somatosensory)
6 test conditions Firm - eyes open, closed, dome; Foam - eyes open, closed, dome
Pt must keep hands at sides and are timed for 30s
Test ends if pt’s arms or feet change position or eyes open when should be closed
3 attempts per condition if fail

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13
Q

Berg Balance Scale (General Interpretation)

A

Static and dynamic balance
0-20 - high fall risk
21-40 - medium fall risk
41-56 - low fall risk

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14
Q

Functional Reach Test

A

How far pt is able to reach without moving feet
Standing beside wall but not touching, can’t use wall to lean or for support
3 trials, avg of last 2
< 7 in (18cm) = limited functional balance, restricted in ADLs
>10 in (26cm) = mostly independent, low risk of falls

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15
Q

TUG

A

Assess mobility, balance, walking ability and fall risk in older adults
Use regular shoes and gait aid if needed
Sitting, line 3m away
>12s = fall risk

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16
Q

Describe ALS and its impairments

A

Loss of brainstem nuclei and anterior horn cells in spinal cord. Affects UMN and LMN.
Impairments: muscle atrophy, cramps, problems breathing, difficulty with walking/tripping, fatigue, fasciculations, hyperreflexia, spasticity, pain (from spasticity, cramps, joint hypomobility), resp dysfunction, no pattern of muscle loss, dysphagia, dysarthria, sensation unaffected

17
Q

Describe myasthena gravis and its impairments

A

Autoimmune neuromuscular junction dysfunction due to blocking of ACH receptors
Impairments: problems chewing, difficulty with speech, swallowing and breathing, symmetrical muscle weakness in proximal limbs, neck muscle weakness, loss of control in eye and eyelid muscles

18
Q

Describe GBS and its impairments

A

Autoimmune, demyelination of peripheral nerves and nerve roots, progressive muscle weakness and respiratory paralysis (LMN).
Impairments: progressive symmetrical weakness in arms and legs (distal to proximal), sensory loss/parasthesia, absent reflex or hypo, resp dysfunction in 2-3 weeks (vent), dysarthria, dysphagia, diploplia, facial weakness, autonomic dysfunction (arrythmia, tachycardia, etc.)

19
Q

Describe Parkinson’s and its impairments. What are some outcome measures for PD?

A

Loss of dopaminergic neurons in the substantia nigra.
Impairments: tremor, rigidity, akinesia, postural dysfunction, shuffling gait, masked face, stooped posture, dysphonia, dysphagia, weakness, decreased ROM
Outcome Measures: Unified Parkinson’s Disease Rating Scale (UPDRS), Short Parkinson’s Evaluation Scale (SPES), Scales for Outcomes in Parkinson’s Disease (SCOPA)

20
Q

Describe TBI and its impairments

A

Leads to axonal damage due to excessive force, diffuse axonal injury
Impairments: spasticity, weakness, ataxia, poor balance, hypokinesia, cognitive deficits, pain

21
Q

Describe Post polio syndrome and its impairments

A

Development of new muscle weakness and fatigue in skeletal and bulbar muscles that begins 25-30 years after poliomyelitis.
Impairments: 2 new symptoms among - excessive fatigue, muscle or joint pain, muscle atrophy, cold intolerance, no other medical explanation + fasciculations, cramping, sensation intact

22
Q

Describe MS and its impairments. What are the subtypes?

A

Chronic and progressive autoimmune demyelination of CNS neurons.
Impairments: symptoms vary depending on location and extent, sensory and motor impairment, fatigue, heat sensitivity, ataxia/balance, poor bladder control, slurred speech, visual deficits, sexual, cognitive, pain, Lhermitte’s sign - intense burst of pain that runs down back into arms and legs when flex neck
Sub types: relapsing remitting, primary progressive, secondary progressive, progressive relapsing

23
Q

What are the signs and symptoms of a hemiplegic shoulder?

A

Pain, subluxation (from supraspinatus flaccidity), loss of ROM

24
Q

MCA Stroke

A

C/L sensory and/or motor in UE/face mostly
Left - may have language deficits (Wernicke’s)
Right - may have spatial perception deficitis (neglect)

25
Q

ACA Stroke

A

C/L sensory and/or motor in LE

Frontal lobe cognitive and behavioural abnormalities

26
Q

PCA Stroke

A

Visual deficits

May also have C/L sensory and/or motor impairment

27
Q

What are 3 common impairments associated with CVA?

A

Fluent/Sensory Aphasia (Wernicke’s)
Non-fluent Aphasia (Broca’s)
Dysarthria

28
Q

What are 2 common assessment methods for CVA?

A

Fugl-Meyer Assessment Scale - evaluates recovery of motor function, balance, sensation and joint functioning
3 point scale (0-no perform, 1-partial, 2-fully)
5 domains - motor functioning, sensory, balance, joint ROM, joint pain
CMSA - used to stage motor recovery, predict rehab outcomes and measure clinically important change in physical function
Impairment inventory and disability inventory

29
Q

What are possible causes of SCI?

A

In utero, fractures, dislocations, disease, spinal stroke or trauma

30
Q

What are primary and secondary problems of SCI?

A

Primary - paralysis, spinal shock

Secondary - resp, GI, urinary, circulatory

31
Q

What is autonomic dysreflexia? What are the signs and symptoms?

A

Above T6 injury. Noxious stimuli below level of injury causes body to go into sympathetic over activity. Inc BP and dec HR cause seizures, renal damage, death
Signs and Symptoms: bradycardia, hypertension, cold peripheries, seizures, piloerection, pupillary dilation, headache, chest pain, nasal congestion, blurred vision, flushing or sweating or goosebumps above injury level

32
Q

NLI C1-C4 Capabilities

A

Paralysis of arms, hands, trunk, legs
Requires assistance with breathing, secretion clearance, bowel and bladder clearing assistance
Dependent in all ADLs
Power w/c with head or chin control
Little to no voluntary control of bladder

33
Q

NLI C5

A

Breathe independently but may be laboured (abdominal binder may improve)
Dependent in transfers
Can raise arms (have biceps and deltoids) and bend elbows
Some or total paralysis of wrists, hands, trunk and legs
Power w/c with adapted joystick
Very few may use sliding board transfer by locking elbows

34
Q

NLI C6

A

Everything as C5 (raise arms, bend elbows)
Limited self care with tenodesis grip
Sliding board transfer
Small distance w/c propulsion with hand rim projections

35
Q

NLI C7

A

Everything as C6 (raise arms, bend elbows, tenodesis grip, sliding board transfer, w/c propulsion small distance)
Extend elbows (easy sliding board transfer)
Most ADLs independent
Drive an adapted vehicle
Independent in w/c propulsion

36
Q

NLI C8

A

As C7

Flex fingers, grasping much easier

37
Q

NLI T1-T12

A

Full function and sensation of UE
Lower level injury = better trunk control
Little to no voluntary control of bladder

38
Q

Describe the ASIA Scale

A 
A = complete
B = sensory incomplete (sensory but not motor preserved below level)
C = motor incomplete (more than half of key muscles have less than grade 3)
D = motor incomplete (more than half of key muscles have grade 3 or more)
E = normal
39
Q

What are the steps in ASIA classification?

A 
Determine sensory level
Determine motor level
Determine NLI - most caudal segment with intact sensation and antigravity muscle function
Determine whether complete or incomplete
Determine ASIA level

PNE (17 decks)

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