Neuro Diff Dx Flashcards
UMN vs LMN vs Basal Ganglia vs Cerebellum: tone
UMN: increased, spasticity (velocity dependent).
LMN: hypotonia.
BG: increased, rigidity (not velocity dependent).
Cerebellum: decreased or normal.
UMN vs LMN vs Basal Ganglia vs Cerebellum: reflexes
UMN: hyperreflexia, Clonus, Babinski.
LMN: hyporeflexia or absent.
BG: decreased or normal.
Cerebellum: decreased or normal.
UMN vs LMN vs Basal Ganglia vs Cerebellum: sensation
UMN: decreased
LMN: decreased
BG: normal
Cerebellum: normal
UMN vs LMN vs Basal Ganglia vs Cerebellum: involuntary movements
UMN: muscle spasms
LMN: fasciculations (twitching)
BG: resting tremor
Cerebellum: none
Voluntary movements in UMN lesions
Synergy patterns
Voluntary movements in LMN lesions
Weak or absent
Voluntary movements in BG lesions
Bradykinesia
Akinesia
Voluntary movements in Cerebellum lesions
Ataxia
Intention tremor
Dysdiadochokinesia
Dysmetria
Nystagmus
What is Dysdiadochokinesia? How do we assess it?
Difficulty performing rapid alternating movements.
Seen w/ cerebellar involvement.
Assess: flip hands over, tap foot.
What is Dysmetria? How do we assess it?
Difficulty controlling movement speed & distance.
Seen w/ cerebellar involvement.
Assess: finger nose finger, heel to shin.
Parkinsons: cardinal signs
*TRAP:
Tremor (resting)
Rigidity
Akinesia
Postural instability
Parkinsons: define rigidity & what are the common types?
Involuntary increase in mm tone when moving thru ROM.
Lead Pipe = resistance is smooth & consistent throughout ROM.
Cogwheel = jerky, basically lead pipe + tremor.
Define akinesia vs bradykinesia vs hypokinesia
Akinesia: difficulty initiating movement, freezing.
Bradykinesia: difficulty with automatic movements (e.g., arm swing while walking).
Hypokinesia: slow or small amplitude of movement.
Parkinsons: early sxs
Loss of smell (olfactory N affected)
Constipation
Sleep disorders
Parkinsons: other sxs (not the 4 cardinal signs)
-Hypophonia (breathy, monotone voice).
-Mask-like face.
-Micrographia (handwriting gets smaller & smaller).
-Orthostatic hypotension.
-Restrictive lung disease.
-Difficulty dual-tasking.
Parkinsons: gait characteristics
-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.
Parkinsons: interventions for festinating gait
Toe wedge or declined heel (moves COM posteriorly).
Hoehn & Yahr Stage 1
Minimal or absent disability.
Unilateral symptoms.
Hoehn & Yahr Stage 2
Minimal bilateral or midline symptoms.
Balance intact.
Hoehn & Yahr Stage 3
Impaired righting reflexes, unsteadiness.
Hoehn & Yahr Stage 4
Severe symptoms.
Standing/walking require assistance.
Hoehn & Yahr Stage 5
Confined to bed or WC.
Parkinsons: gait training considerations
Simple commands when freezing or frozen.
Metronomes, music, visual cues.
Parkinsons: posture interventions
Prone lying.
Rotational movements, crossing midline.
Parkinsons: what are BIG interventions most helpful for?
Hypokinesia
Parkinsons: considerations with levidopa/carbidopa?
PT 1hr after dose.
On/off phenomenon: random fluctuations in motor performance.
On = Dyskinesia
Off = Dystonia
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.
MS definition
Demyelination of neurons in brain & spinal cord.
UMN condition.
MS: motor sxs
-Spasticity (esp. LE ext).
-Scissoring gait.
-Ataxia.
-Dysphagia.
-Dysphonia.
MS: non-motor sxs
-Numbness, paresthesia.
-Flaccid or spastic bladder.
-Poor attention/concentration.
-Fatigue.
MS: common early symptom
Optic Neuritis:
-Inflammation of CN 2.
-Vision loss, eventual blindness.
-Marcus Gunn Pupil: abnormal pupillary light reflex (dilate w/ light).
MS: which cranial nerves are often affected?
CN 2 (Optic Neuritis)
CN 5 (Trigeminal Neuralgia)
Lhermitte’s Sign
Unique symptom of MS.
Neck flexion = electric shock sensation down the spine.
Uhthoff’s Phenomenon
Unique symptom of MS.
Excessive heat = temporary worsening of symptoms.
Charcot’s Triad
When MS affects cerebellum.
1. Scanning speech
2. Intention tremor
3. Nystagmus
*Mnemonic SIN
Pseudobulbar affect
Unique symptom of MS.
Inappropriate laughing or crying.
Intention tremor vs resting tremor
Intention = tremor when reaching for objects (cerebellum).
Resting = tremor at rest (BG, PD).
MS Classifications (1996)
- Relapsing Remitting (most common): short duration exacerbations w/ full or partial recovery. Steady symptoms btwn exacerbations.
- Primary Progressive: steady increase, no exacerbations.
- Secondary Progressive: when RRMS turns into progressive.
- Progressive Relapsing (removed in 2013): like RRMS, but increasing/unsteady symptoms in periods btwn exacerbations.
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.
MS diagnostic criteria
Disseminated in time: at least 2 separate episodes of symptoms.
Disseminated in space: at least 2 lesions on MRI.
MS intervention considerations
-Do not over fatigue.
-Manage temperature, avoid overheating.
-Morning is best time to exercise.
-Include energy conservation, coordination, & balance.
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.
ALS definition
Progressive destruction of motor neurons.
UMN + LMN condition, but sensation intact (bc motor neurons ONLY).
ALS common sxs
-UMN: spasticity & hyperreflexia.
-LMN: mm atrophy & fasciculations.
-Bulbar: dysphagia & dysarthria.
-Cognitive/Emotional: pseudobulbar affect, dementia, attention deficits.
ALS: which mm are most often affected?
-Cervical extensor weakness (neck gets stuck in flexion).
-Respiratory mm weakness (eventual death).
ALS: focus of PT intervention
-Energy conservation!!!
-Functional, ADLs.
-Respiratory function, breathing exercises.
-ROM & positioning, slow prolonged stretches.
-Avoid over fatiguing, take frequent breaks.
ALS: equipment & devices?
-Soft foam collar GOOD for cervical extensor weakness.
-Avoid heavy orthotics like HKAFO (too much energy expenditure).
GBS definition
-Demyelinating polyradiculoneuropathy: loss of myelin in N roots, peripheral Ns, and CNs.
-Autoimmune, occurs after infection.
GBS: motor sxs
-Paralysis: distal to proximal.
-Decreased reflexes or areflexia.
GBS: sensory sxs
-Glove & stocking.
-Burning, tingling, numbness.
GBS: cranial nerves affected
7 Facial (Bell’s Palsy)
9 Glossopharyngeal (dysphagia)
10 Vagus (autonomic dysfunction)
11 Spinal Accessory
12 Hypoglossal (dysphagia, dysarthria)
GBS: focus of PT interventions
-Respiratory function.
-Energy conservation.
-Avoid overuse & fatigue (can prolong recovery timeline).
GBS: expected recovery timeline
6-12 months
