Neuro Final Exam Review Sheet Flashcards
- Describe status epilepticus
Continuous tonic-clonic attacks during which patient does not completely recover consciousness between attacks
What is the most common cause of status epilepticus?
abrupt withdrawal of anticonvulsant meds
why is status epilepticus a medical emergency.
b. This is a medical emergency because it risks permanent damage from hypoxia, hypoglycemia, lactic acidosis, cardiac arrhythmias, and respiratory depression – 25% mortality rate
What are the two types of partial seizures?
simple and complex
which type of partial seizure experiences loss of consciousness?
complex partial has consciousness impaired but not lost initially. When it spreads to both hemispheres is when we expereince LOC
describe the characteristics of a simple partial seizure
- Consciousness NOT impaired
- Only involves part of the brain
- May have aura
- Motor or sensory signs can spread to involve regions of motor cortex – spread through homunculus
describe the characteristics of complex partial seizure
- Consciousness is impaired but not lost initially, THEN lose consciousness
a. Spread to both hemispheres loss of consciousness - Most often begin as partial seizure
- 90% start in temporal lobe
- Aura is common
- Automatisms common
- lasts 1-2 min but can be longer
What are the common automatisms associated with complex partial seizures?
a. Orobuccolingual
b. Facial or Neck Movements
c. Sitting or standing up
d. Fumbling with objects
e. Walking
f. Talking
What are the types of generalized seizures?
absence tonic-clonic myoclonic tonic clonic atonic
What is another name for absence seizures?
petit mal
How long do absence (petit mal) seizures last?
less than 15 seconds
How are absence and tonic-clonic (grand mal) seizures different?
absence seizures have full orientation after
tonic-clonic seizures present with 10-30 minutes of confusion afterwards
what can petit-mal seizures be diagnosed as?
an intellectual disability or ADHD because someone can have hundreds of them per day with a brief period of LOC but full orientation afterwards
subtle motor manifestations such as eye blinking are common
how long do grand mal (tonic-clonic) seizures last?
3-5 minutes or less
what happens during the tonic phase of a grand mal seizure?
Tonic phase: unconscious and has tonic contractions for 10-30 seconds, extension of trunk and extremities, may have high pitched cry due to tonic contraction of muscles of respiration
what happens during the clonic phase of a grand mal seizure?
alternating muscle contraction and relaxation for 30-60 seconds or longer, gradually subsides, may become incontinent, may be unconscious for up to 30 minutes
What happens during a myoclonic seizure?
sudden brief shock like contractions
What 2 types of generalized seizures are rare?
tonic and clonic are rare
what happens during atonic seizure?
complete loss of tone in the body and LOC
occurs most commonly after brain damage
Describe the process of prescribing medications for the treatment of seizures.
a. Must establish a firm diagnosis before beginning anticonvulsants
b. Choose right drug for the type of seizure
c. Control symptoms – not looking for target serum level
i. Different for different patients
ii. Increase dose based on blood levels and patient response
iii. Evaluate one drug at a time
What should you do if a patient has a seizure?
a. Get others out of the room
b. Observe, time
c. Be the calm professional
d. Try to stay safe, stay away from mouth! (NO wallet in mouth… sorry!)
e. > 5 minutes, call 911
f. Second seizure right afterwards, call 911
What are the 7 types of spinal cord defects?
- Meningomyelocele
- Meningocele
- Spina bifida occulta
- Lipomeningocele
- Diastematomyelia
- Syringomyelia
- Chiari type II malformation
Which type of spinal cord defect has an abnormal tuft of hair over the arch that didn’t form right?
spina bifida occulta
What are the2 types of spinal cord defects that are considered closed neural tube defects?
diastematomyelia and lipomeningocele
What are the characteristics of syringomyelia?
hydrocephalus of the spinal cord caused by accumulation of CSF in the central canal
What is the most common type of spinal cord defect?
Myelomeningocele (meningomyelocele) make up about 95% of spinal cord defects
What part of the body is herniated with a meningomyelocele (myelomeningocele)?
the spinal cord and meninges herniates usually with the baby lacking skin over the site at birth
Which type of spinal cord defect has the spinal cord intact usually?
meningocele is less common with the spinal cord deeper inside and usually ok
In Lipomeningocele what is compressing the spinal cord?
fat deposits latch onto the spinal cord and can cause compression or even worse tethering which means the spinal cord will not migrate upwards and will be stuck
What can tethering/compression of the spinal cord cause?
may lead to bowel and bladder issues
What type of spinal cord defect has just the vertebrae affected with NO herniation?
spina bifida occulta has just the vertebra affected. they lack the spinous processes
What is occurring in diastematomyelia?
longitudinal splitting of the cord with each half having its own dorsal and ventral roots
What symptoms are possible in syringomyelia?
sensory loss and quadriplegia
what malformation has experiences elongation of the cerebellum and medulla?
Chiari type II presents with elongation of the cerebellum and medulla which protrude through the foramen magnum
What symptoms can occur in chiari type II malformation?
we can have lower brainstem symptoms because of the compression of the hindbrain
the medulla and pons are also small and deformed
there is also blockage of CSF flow resulting in hyrdocephalus
What are some possible causes of spina bifida?
a. multifactorial
b. folate deficiency
c. polygenetic
d. other: maternal diabetes, exposure to chemicals, extreme alcoholism, thalidomide-valporic acid/ antiseizure med
What are some common S&S of tethered cord?
Increased new spasticity, changes in bowel and bladder, changes in foot position, back pain, development of hamstring contracture, rapid scoliosis
What are some common S&S of a shunt dysfunction?
increasing head size, vomiting, sweating, swelling of head, headache, irritability, seizures, rapid scoliosis, lethargy
Why is VP shunting used for patients with SB?
It is used to relieve the pressure on the brain caused by accumulation of fluid
What are the 4 types of CP?
Spastic (most common; >80% of cases)
Athetoid
Mixed
Ataxic
What are the 3 subcategories of spastic CP?
spastic hemiplegia
spastic diplegia
spastic quadriplegia
Describe spastic CP
overactivity which leads to hypertonicity and involves the UMN
what is affected in spastic hemiplegia?
1/2 of the body is affected
ex: L UE and L LE
What is affected is spastic quadriplegia?
all 4 extremities are affected
What is affected is spastic diplegia?
bilateral LE are affected
What is involved in athetoid CP?
also known as dyskinetic CP, the basal ganlia is involved which is why we see rapid/slow dystonia with this type of cerebral palsy
there are patterns of involuntary movement esp. in the distal muscles when the pt. goes to move
What is the second most common type of CP?
mixed spastic and athetoid
which type of CP involves the cerebellum?
ataxia CP which is very rare because the cerebellum in not vulnerable for a long time throughout the development
What is associated but NOT a cause of CP?
prematurity has a large association
What are some prenatal factors related to CP?
- low socioeconomic status
- not good prenatal care
- maternal infection such as herpes, rubella, toxoplasmosis (kitty litter), measels, anemia, Rh incompatibility, severe maternal diabetes
- genetics
What are some perinatal factors related to CP?
intraventricular hemorrhage
fetal anoxia from wrapping of the umbilical cord around the baby
What are some postnatal factors related to CP?
trauma infection near drowning anoxia toxic conditions such as lead poisoning shaken baby syndrome cardiac arrest
signs and symptoms you would see in a child diagnosed with CP?
a. Prolonged fisting
b. early handedness
c. scissoring of legs
d. inability to bring hands and feet together
e. delay/slowing of developmental milestones
f. abnormal postures/reflexes
g. low tone
Do all children with CP have an intellectual disability?
No, IQ involvement is more likely the more severe the CP is. ⅓ have normal intelligence
What are some common medical treatment options for children with CP?
a. Surgery- tendon releases, osteotomy, etc
b. bracing of foot ankle
c. selective dorsal rhizotomy- just cut the 1a axons
(to be a good candidate they must not be using the spasticity for their function because this surgery elimates the spasticity)
d. Meds: baclofen, botox
What are the physiological events that occur distal to the site of an injury to a peripheral nerve?
Wallerian degeneration with myelin sheath breakdown-damaged Schwann cells release factors that attract macrophages
↓
Macrophages invade and proteases and IL-1 are produced - stimulates Schwann cell proliferation
↓
Schwann cells fill up connective tissue tube
↓
Schwann cells produce neurotropic and neurotrophic factors that guide and support axonal regrowth to targets
↓
Once the axon contacts a Schwann cell, the above factors fall in present levels
↓
Axon is attracted down tubule until target is reached
Does the CNS exhibit axonal regeneration in the same way the PNS does?
No, the CNS has minimal capability for axonal regeneration because the adult CNS environment is not conducive to axonal regeneration
Why is the CNS environment not conducive to axonal regeneration?
Invading macrophage response much slower
Clean up is delayed because macrophages have trouble crossing the blood brain barrier
Astrocytes are produced that create a “walling off” of the injury
No new glial matrix is formed
Oligodendrocytes do not multiply and produce a hostile environment
They produce Nogo factor that is an inhibiting protein of axonal elongation
**Keep in mind that the the axons themselves DO have the ability to regenerate
What are the SIMILARITIES between axonal regeneration in the PNS and CNS
both have a growth cone
both have the capability for axonal regeneration
both have initial axon sprouting
both have a macrophage response but the PNS is much better
both have chormatolysis ( change seen in the cell body of a neuron, where the chromatin and cell nucleus are pushed to the cell periphery, in response to axonal injury) occurring
What are the DIFFERENCES between axonal regeneration in the PNS and CNS
The PNS has a much better macrophage response which starts Schwann cell proliferation
The CNS has decreased macrophage response due to their limited ability to cross the blood brain barrier. These macrophages produce astrocytes that form an astrocytic scar that “walls off” the injury therefore reducing clean up
for the CNS there is minimal axon regeneration therefore minimal function is restored (1-2 mm growth)
In the CNS we have limited microglia response
What does the CNS contain that produces a hostile environment?
oligodendrocytes that produce Nogo factor which is a protein that inhibits axonal elongation by destroying the growth cone therefore a hostile environment is produced
How does recovery of function occur after CNS damage?
a. reduced effects of ischemia
b. elimination of edema
c. behavioral compensations
d. recovery from diashcisis
What are some examples of behavioral compensations?
i. learned use of an unaffected extremity for a task previously performed by an affected extremity
ii. restricting/modifying functional activities
iii. reading Braille after losing vision
what are the parts of recovery from neuronal shock (diashcisis)?
i. neural sprouting
ii. denervation supersensitivity
iii. silent synapses
When the loss of one structure influences other nearby structures that have the same innervation and results in physiological imbalance
System returns to normal with gradual recovery of structures or from reorganization (PLASTICITY)
We exhibit more obvious and pronounced diaschisis with sudden loss
A series of small lesions have the ability to recover much better than one large lesion
Better recovery is also seen from a bilateral (symmetrical) lesion
What is denervation supersensitivity?
a decreased frequency of inputs leads to an increase in post-synaptic receptor number which leads to greater response/sensitivity to neurotransmitters within a synapse
What are silent synapses?
synapses that are not normally functional due to competition among other neural pathways may become active in the presence of CNS damage
What are the 2 types of neuronal sprouting?
i. regenerative synaptogenesis - injured axons re-sprout
ii. reactive synaptogenesis - neighboring axons sprout to innervate injured regions
How do we promote plasticity?
a. We encourage exploration (of the environment, of the task, etc.).
b. We make a task/intervention meaningful (functional).
c. We encourage active problem solving and promote novelty.
d. We make the task challenging “enough” (not too hard, but of sufficient challenge to the individual).
e. The patient practices.
What is the difference between learning, performance and skill?
a. Learning is a relatively permanent change that occurs as a result of synaptic plasticity.
b. Performance is a temporary change seen during practice session. (short term learning)
c. Skill is the ability to be flexible with multiple outcomes that are efficient and effective. (long term learning)
Explain what happens in short term learning versus long term learning
short-term= simple forms of learning that lead to changes in effectiveness of synaptic transmission (NT level changes).
long-term= synthesis of new proteins and growth and elimination of new synaptic connections
-involves structural changes in organization and number of connections among neurons takes place with long-term learning
explain habituation
Form of nonassociative learning; there is no temporal relationship with the stimulus that is given
With repeated stimulus, the responses become progressively smaller
Fewer NT are released
What happens with short term learning and habituation?
Homosynaptic depression occurs in short-term learning and habituation
Activation of interneurons and motor neurons is decreased
what happens with long term learning and habituation?
With habituation and long-term learning there are structural changes
The number of directs sensory to motor connections is decreased
This demonstrates that spaced (intermittent) training and distributing learning produce the best results
explain sensitization
enhanced response to a stimuli
Involves second messenger G proteins and metabotropic receptors
What is classical conditioning?
Pavlovs dog
: learning to associate two stimuli.
Involves facilitation of synaptic transmission
There must be pairing with the unconditioned stimulus to undergo conditioning effects
Cellular mechanisms are similar to sensitization
NMDA channels involved
What is operant conditioning?
learning to associate a specific behavior with a reinforcing event: trial and error learning.Similar mechanisms to classical conditioning
What are the 4 intrinsic principles of motor learning
a. Arousal
b. Attention
c. Motivation
d. Memory
elements of arousal
No learning is occurring
Can be an issue with patients who have neurological problems
As arousal increases you get stronger muscle contractions and increased co-activation
There is difficulty seen at both ends of the spectrum of arousal (not aroused enough in a coma → too agitated to cooperate)
elements of attention
Ability to focus and attend to what one is doing
Reading a book and walking at the same time
Can be improved with training
elements of memory
Many ways to compensate for memory deficits
Slow pace
One-step instructions
Reminders
Cognitive therapy
Can improve motor learning even without explicit learning
elements of motivation
Inner urge to prompt a person to action with purpose
Infants have inner urge to explore
Reinforcers can increase motivation BUT they must be meaningful
What is intrinsic feedback?
Comes to the person through various sensory systems as a result of movement (proprioception, kinesthesia)
Can have concurrent and terminal
What is extrinsic feedback?
Supplements intrinsic Concurrent Continuous, small steps (hands all over when getting pt. up) Terminal One step given at the end Enhances learning
What is the difference between knowledge of performance and knowledge of results?
Knowledge of Results
WHAT they did → “Good, you got your arm up!!”
Knowledge of Performance
HOW they did it → “Do you know how you climbed the step?”
KP is better!!!!!!
When should feedback be given?
before a new task is given
What are the 3 types of models for practicing? Which is the best
Expert models
Demonstrator has mastered the task
Worst way to learn
Coping models
Demonstrator is only slightly better at the task
PT can turn themselves into a coping model
Peer models
Demonstrator is someone just as good/bad as you
Watching themselves in the mirror
Best way to learn
a. whole vs part
i. whole: doing the entire task at once
ii. part: breaking the task down and doing each section of the task at a time
WHOLE IS BETTER
b. variable vs consistent
i. variable: performing the task with different scenarios to have the ability to perform the task in a variety of ways
ii. consistent: performing the task exactly the same way over and over
VARIABLE IS BETTER; NONREPITIOUS REPETITION
c. random vs blocked
i. random: alternating between tasks, switching back and forth between tasks
ii. blocked: only focusing on one task at a time, performing many repetitions of the same task over and over before switching to a new task completely
RANDOM IS BETTER
d. massed vs distributed
i. massed: practice time > rest time (resting or performing a different task)
ii. distributed: rest time > practice time
DISTRIBUTED IS BETTER
what is manual guidance?
This is considered concurrent feedback
Extrinsic because you are doing it to them
Use this when it is the only way you can convey the task
Explain reflex hierarchy Theory
motor control emerges from reflexes that are nested within hierarchically organized levels of the CNS. Normal development is a process of increasing corticalization in the CNS. The cortex is the supreme commander.
explain dynamic systems theory
a system that changes over time and has a set of orderly and persisting interrelationships between parts of a whole that all work together to perform a given function. Function is the result of how the various parts of the nervous system interact as well as nervous system interacting with other systems.
involves the concept of synergy
what is a control parameter?
a. A factor which serves as a catalyst to change behavior (ex. the speed on the treadmill changed the horse’s behavior).
Pregnant woman tying her shoes differently
Patients with hemiplegia losing and relearning balance control
Speed of treadmill to go from walk to run
Walking on ice
Increasing ROM can change movement pattern
Stimulus is not the same as cause
Can change with time in the same individual
difference between hierarchy and heterarchy
hierarchy has the cortex as the control
heterarchy is non-hierarchical; No strict order of command therefore no complex rules
what is a phase shift?
a. Changes in behaviors that are often non-linear even when the change to the system was linear (the phase shifts were when the horse changed from walk to trot to canter, the speed of the treadmill was increased linearly).
What is the difference between creative and stable phase?
a. Creative phase: the system is unstable and new behaviors can emerge.
b. Stable phase: the system is maintaining a specific form of behavior.
we are drawn towards efficiency
what are constraints?
a. Characteristics of an element in a system that limits, confines, retains or restricts behavior.
what are affordances?
a. Possibilities that an object invites, supports, provides or affords for a particular behavior.
A chair can afford sitting, kneeling, standing on the seat, hiding under it
