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Neuro Diff Dx Flashcards

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1
Q

UMN vs LMN vs Basal Ganglia vs Cerebellum: tone

A

UMN: increased, spasticity (velocity dependent).
LMN: hypotonia.
BG: increased, rigidity (not velocity dependent).
Cerebellum: decreased or normal.

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2
Q

UMN vs LMN vs Basal Ganglia vs Cerebellum: reflexes

A

UMN: hyperreflexia, Clonus, Babinski.
LMN: hyporeflexia or absent.
BG: decreased or normal.
Cerebellum: decreased or normal.

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3
Q

UMN vs LMN vs Basal Ganglia vs Cerebellum: sensation

A

UMN: decreased
LMN: decreased
BG: normal
Cerebellum: normal

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4
Q

UMN vs LMN vs Basal Ganglia vs Cerebellum: involuntary movements

A

UMN: muscle spasms
LMN: fasciculations (twitching)
BG: resting tremor
Cerebellum: none

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5
Q

Voluntary movements in UMN lesions

A

Synergy patterns

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6
Q

Voluntary movements in LMN lesions

A

Weak or absent

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7
Q

Voluntary movements in BG lesions

A

Bradykinesia
Akinesia

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8
Q

Voluntary movements in Cerebellum lesions

A

Ataxia
Intention tremor
Dysdiadochokinesia
Dysmetria
Nystagmus

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9
Q

What is Dysdiadochokinesia? How do we assess it?

A

Difficulty performing rapid alternating movements.
Seen w/ cerebellar involvement.
Assess: flip hands over, tap foot.

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10
Q

What is Dysmetria? How do we assess it?

A

Difficulty controlling movement speed & distance.
Seen w/ cerebellar involvement.
Assess: finger nose finger, heel to shin.

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11
Q

Parkinsons: cardinal signs

A

*TRAP:
Tremor (resting)
Rigidity
Akinesia
Postural instability

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12
Q

Parkinsons: define rigidity & what are the common types?

A

Involuntary increase in mm tone when moving thru ROM.
Lead Pipe = resistance is smooth & consistent throughout ROM.
Cogwheel = jerky, basically lead pipe + tremor.

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13
Q

Define akinesia vs bradykinesia vs hypokinesia

A

Akinesia: difficulty initiating movement, freezing.
Bradykinesia: difficulty with automatic movements (e.g., arm swing while walking).
Hypokinesia: slow or small amplitude of movement.

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14
Q

Parkinsons: early sxs

A

Loss of smell (olfactory N affected)
Constipation
Sleep disorders

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15
Q

Parkinsons: other sxs (not the 4 cardinal signs)

A

-Hypophonia (breathy, monotone voice).
-Mask-like face.
-Micrographia (handwriting gets smaller & smaller).
-Orthostatic hypotension.
-Restrictive lung disease.
-Difficulty dual-tasking.

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16
Q

Parkinsons: gait characteristics

A

-Freezing: sudden inability to initiate.
-Festinating: short steps, shuffling, increasing speed.
-Decreased step width.
-Decreased step length.
-Decreased trunk rotation.
-Decreased arm swing.
-En bloc turning.

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17
Q

Parkinsons: interventions for festinating gait

A

Toe wedge or declined heel (moves COM posteriorly).

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18
Q

Hoehn & Yahr Stage 1

A

Minimal or absent disability.
Unilateral symptoms.

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19
Q

Hoehn & Yahr Stage 2

A

Minimal bilateral or midline symptoms.
Balance intact.

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20
Q

Hoehn & Yahr Stage 3

A

Impaired righting reflexes, unsteadiness.

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21
Q

Hoehn & Yahr Stage 4

A

Severe symptoms.
Standing/walking require assistance.

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22
Q

Hoehn & Yahr Stage 5

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A

Confined to bed or WC.

23
Q

Parkinsons: gait training considerations

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A

Simple commands when freezing or frozen.
Metronomes, music, visual cues.

24
Q

Parkinsons: posture interventions

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A

Prone lying.
Rotational movements, crossing midline.

25
Parkinsons: what are BIG interventions most helpful for?
Hypokinesia
26
Parkinsons: considerations with levidopa/carbidopa?
PT 1hr after dose. On/off phenomenon: random fluctuations in motor performance. On = Dyskinesia Off = Dystonia
27
Parkinsons: dyskinesia vs dystonia?
Dyskinesia (ON): involuntary repetitive, smooth movements. Affects large mm groups. Dystonia (OFF): prolonged involuntary mm spasms. Affects specific mm or mm group.
28
MS definition
Demyelination of neurons in brain & spinal cord. UMN condition.
29
MS: motor sxs
-Spasticity (esp. LE ext). -Scissoring gait. -Ataxia. -Dysphagia. -Dysphonia.
30
MS: non-motor sxs
-Numbness, paresthesia. -Flaccid or spastic bladder. -Poor attention/concentration. -Fatigue.
31
MS: common early symptom
Optic Neuritis: -Inflammation of CN 2. -Vision loss, eventual blindness. -Marcus Gunn Pupil: abnormal pupillary light reflex (dilate w/ light).
32
MS: which cranial nerves are often affected?
CN 2 (Optic Neuritis) CN 5 (Trigeminal Neuralgia)
33
Lhermitte's Sign
Unique symptom of MS. Neck flexion = electric shock sensation down the spine.
34
Uhthoff's Phenomenon
Unique symptom of MS. Excessive heat = temporary worsening of symptoms.
35
Charcot's Triad
When MS affects cerebellum. 1. Scanning speech 2. Intention tremor 3. Nystagmus *Mnemonic SIN
36
Pseudobulbar affect
Unique symptom of MS. Inappropriate laughing or crying.
37
Intention tremor vs resting tremor
Intention = tremor when reaching for objects (cerebellum). Resting = tremor at rest (BG, PD).
38
MS Classifications (1996)
1. Relapsing Remitting (most common): short duration exacerbations w/ full or partial recovery. Steady symptoms btwn exacerbations. 2. Primary Progressive: steady increase, no exacerbations. 3. Secondary Progressive: when RRMS turns into progressive. 4. Progressive Relapsing (removed in 2013): like RRMS, but increasing/unsteady symptoms in periods btwn exacerbations.
39
MS Clinically Isolated Syndrome
-Pt has only had ONE attack of symptoms. -May or may not have lesions on MRI. -May eventually turn into MS, but also could stay as CIS forever.
40
MS diagnostic criteria
Disseminated in time: at least 2 separate episodes of symptoms. Disseminated in space: at least 2 lesions on MRI.
41
MS intervention considerations
-Do not over fatigue. -Manage temperature, avoid overheating. -Morning is best time to exercise. -Include energy conservation, coordination, & balance.
42
MS FITT
F: 3-5x/wk (alternating days). I: Low, submax (3-5 METs or 50-70% VO2). T: 30min T: Circuit training best. Cycling, walking, swimming are good options for aerobic.
43
ALS definition
Progressive destruction of motor neurons. UMN + LMN condition, but sensation intact (bc motor neurons ONLY).
44
ALS common sxs
-UMN: spasticity & hyperreflexia. -LMN: mm atrophy & fasciculations. -Bulbar: dysphagia & dysarthria. -Cognitive/Emotional: pseudobulbar affect, dementia, attention deficits.
45
ALS: which mm are most often affected?
-Cervical extensor weakness (neck gets stuck in flexion). -Respiratory mm weakness (eventual death).
46
ALS: focus of PT intervention
-Energy conservation!!! -Functional, ADLs. -Respiratory function, breathing exercises. -ROM & positioning, slow prolonged stretches. -Avoid over fatiguing, take frequent breaks.
47
ALS: equipment & devices?
-Soft foam collar GOOD for cervical extensor weakness. -Avoid heavy orthotics like HKAFO (too much energy expenditure).
48
GBS definition
-Demyelinating polyradiculoneuropathy: loss of myelin in N roots, peripheral Ns, and CNs. -Autoimmune, occurs after infection.
49
GBS: motor sxs
-Paralysis: distal to proximal. -Decreased reflexes or areflexia.
50
GBS: sensory sxs
-Glove & stocking. -Burning, tingling, numbness.
51
GBS: cranial nerves affected
7 Facial (Bell's Palsy) 9 Glossopharyngeal (dysphagia) 10 Vagus (autonomic dysfunction) 11 Spinal Accessory 12 Hypoglossal (dysphagia, dysarthria)
52
GBS: focus of PT interventions
-Respiratory function. -Energy conservation. -Avoid overuse & fatigue (can prolong recovery timeline).
53
GBS: expected recovery timeline
6-12 months

NPTE (28 decks)

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