Neuro Exam II Flashcards
definition: interprets observed behaviors/movement and compares them to normative behaviors
qualitative analysis
(true/false) Qualitative analysis does not assist in developing a plan of care.
false (it does)
definition: muscles working in appropriate sequence with adequate timing and directional components
functional synergy
(true/false) For a patient with an orthotic, assess movement with and without the orthotic.
true
definition: moving the system from a stable to unstable state
variability of movements
definition: a means to determine
the optimal challenge point for motor learning.
- Interactions between nominal task difficulty of
the to-be-learned task and the learner’s skill level togetherwith the specific conditions of practice create a level of functional task difficulty that determines how much information will be available for motor learning
challenge point framework
definition: an element(s) that causes change and controls the environment, the task, etc
control parameter
(true/false) The more variability there is, the closer to normalcy the movement is.
true
The key to assessment and intervention lies in ______.
variability of movement
definition: the preferred movement pattern that the patient goes to
attractor state
Attractor state is from the ____ theory.
dynamic systems theory
definition: the metabolic cost of an individual’s preferred movement pattern
efficiency of movement
Using _____ theories, the patient is no longer viewed as a passive recipient since they are actively engaged in examination
contemporary theories
What are some examples of secondary impairments?
physical deconditioning
biomechanical factors
definition: movement that avoids breaks within the motion being performed.
ex: sit to stand from a chair
momentum strategy
definition: movement that has frequent stops within the motion being performed
force-control strategy
A patient is more prone to lose balance posteriorly when they attempt to bring their trunk into EXT (before/after) their weight is over their feet.
before
What is the purpose of a transfer?
To permit patients to function in different environments
(true/false) some skills learned for one transfer can be used for other transfers
true (generalizability)
What are the 3 levels of transfers?
- independent
- assisted
- dependent
definition: Patient is able to perform at least 75% of the activity (the majority of the activity)
minimal assistance
definition: Patient is able to perform at least 50% of the activity (able to complete part of the activity without assistance)
moderate assistance
definition: Patient is able to perform less than 25% of the activity (generally unable to perform the activity)
maximum assistance
definition: brief, involuntary twitching of a muscle or a group of muscles. It describes a medical sign and, generally, is NOT a diagnosis of a disease.
Cause: peripheral nerve lesions- although most caused by a disturbance in the CNS. May also be referred to as fasciculation
myoclonus
definition: involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements (oscillations or twitching) of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal cords, trunk, and legs.
tremor
Where do tremors most commonly occur?
hands
(true/false) essential tremors are not associated with pathology.
true
What is another name for a cerebellar tremor?
intention tremor
definition: slow, broad tremor of the extremities that occurs at the end of a purposeful movement, such as trying to press a button or touching a finger to the tip of one’s nose
cerebellar tremor
definition: tremor is caused by damage to structures within the brain that control movement. This resting tremor, which can occur as an isolated symptom or be seen in other disorders, is often a precursor to Parkinson’s disease (more than 25 percent of patients with Parkinson’s disease have an associated action tremor). The tremor, which is classically seen as a “pill-rolling” action of the hands that may also affect the chin, lips, legs, and trunk, can be markedly increased by stress or emotions
parkinsonian tremor
definition: Hands go from supination to pronation while the patient’s eyes are close
drift (pronator drift)
With myopathies, weakness is more (proximal/distal)
proximal
With axonal neuropathies, sensory loss and weakness is normally more (proximal/distal)
distal
What special reflex is tested when there is suspicion of frontal lobe pathology?
Frontal Release signs
definition: stroking of the check will cause the patient to turn their head toward the stimulation.
rooting
definition: reflex is brought about by tapping the upper lip lightly. The contraction of the muscles causes the mouth to resemble a snout.
snout
definition: occurs when a disagreeable stimulus is drawn from the thenar eminence at the wrist up to the base of the thumb. There is ipsilateral contraction of the orbicularis oris and mentalis muscles. The skin over the chin wrinkles, and the corner of the mouth elevates slightly.
palmomental reflex
(true/false) frontal release signs are found in both children and adults.
False (only found when they are infants)
definition: Abnormal rapidly alternating movements (RAMs)
Dysdiadochokinesia
definition: decomposition of movement (no longer smooth)
ataxia
What are signs of cerebellar dysfunction?
ataxia, overshooting, dysdiadochokinesia
Truncal ataxia would be expected to have a disturbance in _____ stability. Patients will have a (narrow/wide) base of support- this will most likely worsen with attempts to bring feet together.
gait stability, wide BOS
How far apart should a person’s stance be?
2 inches
What are the sensory functions of the dorsal columns and posterolateral tract of lissauer?
Conscious Proprioception
Vibration
Discriminative (Light) Touch
What are the sensory functions of the anterolateral system?
pain and temperature
What is the first test for the anterolateral system?
sharp and dull sensation
What is the second test for the anterolateral system?
temperature sensation
What is the sensory function of the parietal cortex?
higher somatosensory analysis
What is the first test for the parietal cortex?
dual simultaneous stimulation
What is the second test for the parietal cortex?
graphesthesia
What is the third test for the parietal cortex?
stereognosis (recognizing objects)
Is decerebrate or decorticate posturing an indication for worse prognosis?
decerebrate posturing
definition: a problem with how the brain receives and sends information to the rest of the body
functional neurologic disorders (FND)
- formerly known as somatoform psychiatric disorders (conversion disorder)
What are characteristics of a comatose state?
- eyes closed
- unresponsive to stimuli
- unarousable
What is considered as one of the most important aspects of an examination when performed on a patient in a coma?
pupillary responses
What is normally seen in a person’s eyes if they have midbrain damage?
asymmetrical/bilateral dilated, unresponsive blown pupils
How do you test CN II on a patient in a coma?
blink to threat, pupillary responses
How do you test CN III, IV, VI, and VIII on a patient in a coma?
Extraocular movements and vestibulo-ocular reflex
spontaneous movements
nystagmus
dysconjugate gaze
oculocephalic maneuver (doll’s eye test)
caloric testing
–> cotton whisp test
definition: an attempt to induce nystagmus (compensatory eye movement in the absence of head motion) by pouring cold or warm water into the ear.
caloric testing (VOR response)
If a person has “doll’s eyes,” is their brainstem damaged?
No… it is an indication that there is no brainstem damage
definition: can be performed by turning the head to one side. If the brainstem is intact, the eyes will move conjugately away from the direction of turning (as if still looking at the examiner rather than fixed straight ahead).
oculocephalic maneuver (VOR test)
How does one test CN V and VII on a patient in a comatose state?
corneal reflex
facial asymmetry
not able to close eyes
grimace response
How does one test CN IX and X on a patient in a comatose state?
gag reflex
What is a sensory exam for a patient in a coma?
flexor withdrawal from a painful stimulus (nail-bed pressure or trap pinch)
