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NPTE > Neuro Diff Dx > Flashcards

Neuro Diff Dx Flashcards

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

A

Confined to bed or WC.

23
Q

Parkinsons: gait training considerations

A

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

24
Q

Parkinsons: posture interventions

A

Prone lying.
Rotational movements, crossing midline.

25
Q

Parkinsons: what are BIG interventions most helpful for?

A

Hypokinesia

26
Q

Parkinsons: considerations with levidopa/carbidopa?

A

PT 1hr after dose.
On/off phenomenon: random fluctuations in motor performance.
On = Dyskinesia
Off = Dystonia

27
Q

Parkinsons: dyskinesia vs dystonia?

A

Dyskinesia (ON): involuntary repetitive, smooth movements. Affects large mm groups.
Dystonia (OFF): prolonged involuntary mm spasms. Affects specific mm or mm group.

28
Q

MS definition

A

Demyelination of neurons in brain & spinal cord.
UMN condition.

29
Q

MS: motor sxs

A

-Spasticity (esp. LE ext).
-Scissoring gait.
-Ataxia.
-Dysphagia.
-Dysphonia.

30
Q

MS: non-motor sxs

A

-Numbness, paresthesia.
-Flaccid or spastic bladder.
-Poor attention/concentration.
-Fatigue.

31
Q

MS: common early symptom

A

Optic Neuritis:
-Inflammation of CN 2.
-Vision loss, eventual blindness.
-Marcus Gunn Pupil: abnormal pupillary light reflex (dilate w/ light).

32
Q

MS: which cranial nerves are often affected?

A

CN 2 (Optic Neuritis)
CN 5 (Trigeminal Neuralgia)

33
Q

Lhermitte’s Sign

A

Unique symptom of MS.
Neck flexion = electric shock sensation down the spine.

34
Q

Uhthoff’s Phenomenon

A

Unique symptom of MS.
Excessive heat = temporary worsening of symptoms.

35
Q

Charcot’s Triad

A

When MS affects cerebellum.
1. Scanning speech
2. Intention tremor
3. Nystagmus
*Mnemonic SIN

36
Q

Pseudobulbar affect

A

Unique symptom of MS.
Inappropriate laughing or crying.

37
Q

Intention tremor vs resting tremor

A

Intention = tremor when reaching for objects (cerebellum).
Resting = tremor at rest (BG, PD).

38
Q

MS Classifications (1996)

A
  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
Q

MS Clinically Isolated Syndrome

A

-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
Q

MS diagnostic criteria

A

Disseminated in time: at least 2 separate episodes of symptoms.
Disseminated in space: at least 2 lesions on MRI.

41
Q

MS intervention considerations

A

-Do not over fatigue.
-Manage temperature, avoid overheating.
-Morning is best time to exercise.
-Include energy conservation, coordination, & balance.

42
Q

MS FITT

A

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
Q

ALS definition

A

Progressive destruction of motor neurons.
UMN + LMN condition, but sensation intact (bc motor neurons ONLY).

44
Q

ALS common sxs

A

-UMN: spasticity & hyperreflexia.
-LMN: mm atrophy & fasciculations.
-Bulbar: dysphagia & dysarthria.
-Cognitive/Emotional: pseudobulbar affect, dementia, attention deficits.

45
Q

ALS: which mm are most often affected?

A

-Cervical extensor weakness (neck gets stuck in flexion).
-Respiratory mm weakness (eventual death).

46
Q

ALS: focus of PT intervention

A

-Energy conservation!!!
-Functional, ADLs.
-Respiratory function, breathing exercises.
-ROM & positioning, slow prolonged stretches.
-Avoid over fatiguing, take frequent breaks.

47
Q

ALS: equipment & devices?

A

-Soft foam collar GOOD for cervical extensor weakness.
-Avoid heavy orthotics like HKAFO (too much energy expenditure).

48
Q

GBS definition

A

-Demyelinating polyradiculoneuropathy: loss of myelin in N roots, peripheral Ns, and CNs.
-Autoimmune, occurs after infection.

49
Q

GBS: motor sxs

A

-Paralysis: distal to proximal.
-Decreased reflexes or areflexia.

50
Q

GBS: sensory sxs

A

-Glove & stocking.
-Burning, tingling, numbness.

51
Q

GBS: cranial nerves affected

A

7 Facial (Bell’s Palsy)
9 Glossopharyngeal (dysphagia)
10 Vagus (autonomic dysfunction)
11 Spinal Accessory
12 Hypoglossal (dysphagia, dysarthria)

52
Q

GBS: focus of PT interventions

A

-Respiratory function.
-Energy conservation.
-Avoid overuse & fatigue (can prolong recovery timeline).

53
Q

GBS: expected recovery timeline

A

6-12 months

NPTE (28 decks)

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