Neuro I Flashcards
1
Q
_ _ is the study of neural, physical, and behavioral aspects of movement
A
MOTOR CONTROL
2
Q
Name the stages of motor control.
A
5 stages
- stimulus presentation
- stimulus identification
- response selection
- response programming
- movement output
3
Q
During which stage of motor control do you develop a general plan? In which 2 association cortices does plan develop occur?
A
Stage 3- response selection
Pre-motor and supplemental motor association cortices (PMA/SMA)
4
Q
In which stage of motor control do you develop at detailed plan? What part of the brain does that occur?
A
Detailed plan- RESPONSE PROGRAMMING stage
Occurs in the PRIMARY MOTOR CORTEX (PMC)
5
Q
During which stage of motor control is the primary sensory cortex processing information?
A
Stimulus Identification phase
6
Q
_ _ is a set of internal processes associated with practice or experience leading to relatively permanent changes in skilled behavior ability. Dependent upon? (2)
A
MOTOR LEARNING is a set of internal processes. . .
Dependent upon:
- FAMILIARITY
- PAST EXPERIENCE
7
Q
Name the 4 feedback schedules.
A
BFD’S
- bandwidth
- faded
- delayed
- summed
8
Q
Giving feedback every few trials is known as?
A
Summed feedback
9
Q
Giving feedback after a several second delay, giving patient time to self correct is known as?
A
DELAYED FEEDBACK
10
Q
Giving less/ minimizing feedback as progress is made is known as?
A
Faded feedback
11
Q
Only giving feedback when patient goes outside of given error range is known as?
A
BANDWIDTH feedback
12
Q
Massed practice involves less _ and _ involves more.
A
Massed practice- LESS REST
DISTRIBUTED practice involves more rest
13
Q
Ordered, blocked, serial, and random are all examples of _ _. What type is most effective for permanent learning (if patient is appropriate)? What is another type that is used often by athletes and is shown to be effective in stroke patients?
A
Are all examples of PRACTICE SCHEDULES
RANDOM is most effective for permanent learning
MENTAL PRACTICE/ IMAGERY is used by athletes and effective for stroke patients.
14
Q
_ _ is the ability to maintain ones center of gravity within his/ her base of support both statically and dynamically.
A
POSTURE CONTROL is the ability . . .
15
Q
What 3 systems contribute to postural control?
A
Visual, vestibular, somatosensory
16
Q
Gastroc-Soleus, tibialis anterior, Iliopsoas, gluteus medius, TFL, erector spinae and abdominals are all active during?
A
All active during quiet standing
17
Q
How many functional balance grades are there? Name them.
A
0-4 scale
- absent 0
- poor 1
- fair 2
- good 3
- normal 4
18
Q
What functional balance grade is being described: unable to maintain balance?
A
0- absent
19
Q
What functional balance grade is being described: Requires handheld support and mod/ Max assistance to maintain static balance, unable to accept challenges
A
Poor-1
20
Q
What functional balance grade is being described: Maintains balance with handheld support, may require occasional minimal assistance with static balance, accepts minimal challenges and maintains balance while turning head and trunk (dynamic)
A
Fair
21
Q
What functional balance grades is being described: maintains balance without handheld support, limited postural sway with static balance, accepts moderate challenges and maintains balance while picking objects off of the floor (dynamic)
A
Good- 3
22
Q
What functional balance grade is being described: maintains steady balance without handheld support and accepts maximum challenges and shifts weight in all directions
A
Normal- 4
23
Q
Range of grading effectiveness of outcome measures for EDGE/ VEDGE and general description
A
1-4 range
- one being NOT RECOMMENDED, 4 being HIGHLY RECOMMENDED
24
Q
The BERG balance test looks at _ _ assessing static balance and fall risk. What is the total score? What is the cut-off for fall risk in older adults?
A
Looks at 14 ITEMS assessing static balance and fall risk
Total is 54 (0-4 points each)
Less than 45 is associated with higher fall risk in older adults
25
What distance is associated with an increased fall risk in older adults on the functional reach test?
Less than 7 inches
26
Which test looks at static balance in sensory manipulated environments ands tests all 3 systems that contribute to postural control?
Modified Clinical Test for Sensory Interaction in Balance (mCTSIB)
27
Which systems are tested during step 1 of the mCTSIB (feet together, arms crossed? Step 2 (feet together, arms crossed, eyes closed)?
Step 1- all 3 (vestibular, visual, somatosensory)
Step 2 - vestibular and somatosensory
28
Which systems are being tested in step 3 of the mCTSIB (feet together, arms crossed, on foam)? Step 4 (feet together, arms crossed, eyes closed, on foam)?
Step 3- vestibular, and visual (somatosensory is eliminated by standing on foam)
Step 4- just vestibular
29
What test is a 14 item test used to assess static and dynamic balance of multiple systems using a 0-2 ordinal scale with 28 point max score?
Mini BEST test
30
Which 2 tests have a 2-4 VEDGE score for vestibular rehab?
FD
- functional gait assessment (FGA)
- dynamic gait index (DGI)
31
Which 2 tests have a VEDGE 3 score?
Activities-specific Balance confidence scale (ABC)
Four step square test
32
Other than the DGI, FGA, ABC, and Four step square test all other tests have what level of VEDGE score?
2
33
The Romberg and Sharpened Romberg (tandem) both assess? Are scored?
Both assess static balance, both are scored by negative or positive
34
Which do the TUG, DGI, FGA, and the 10 meter walk test assess?
Dynamic balance during gait
35
Which 2 tests look at LE strength?
30 second chair stand test/ 30 second sit to stand test
5X sit to stand test
36
What are the 6 steps of clinical decision making>
```
Examination
Evaluation
Diagnosis
Prognosis/ Plan of care/ Expected outcomes
Intervention
Outcomes
```
37
During which clinical decision making step do you analyze data using ICF terminology, develop a problem list and assign FIM scores?
EVALUATION
38
The plan of care includes _ and _ _.
Includes GOALS and EXPECTED OUTCOMES
39
What 4 essential elements does each goal/ outcome need to include?
BIC Time
- behavior/ activity
- individual/ patient
- condition
- time
40
What are the 3 intervention catagories?
RESTORATIVE
COMPENSATORY
PREVENTATIVE
41
What part of the clinical decision making process includes home evaluation, patient/ caregiver education, plans for follow up care, and HEP?
Outcomes
42
Which 2 neurological pathways are involved with visual input?
MD
- medial longitudinal fasciculus (MLF)
- Dieters tract
Vision= Maryland
43
Where is sensory information processed? (2)
Vestibular Nuclear Complex (VNC)
| Cerebellum
44
Which 3 CN's are involved with eye movements?
CN III- Oculomotor nerve
CN IV- Trochlear nerve
CN VI- Abducens nerve
45
Which sensory system is the fastest? Involves _, _ and _ awareness.
Somatosensory systems is faster than the visual and vestibular systems.
Involves TACTILE, KINESTHETIC, AND PROPRIOCEPTIVE awareness.
46
The DCML and Spinothalamic tract are the neurological pathways that supply/ process _ input.
The DCML and the Spinothalamic tract are the neurological pathways that supply/ process SOMATOSENSORY input
San Diego- Somatosensory
47
The _ _ is a strong inhibitor of the other sensory systems.
The VISUAL SYSTEM is a strong inhibitor of the other systems
48
Which system is the conflict resolver if there is mixed input coming in from the other two sensory systems?
VESTIBULAR system is the conflict resolver of the the 3 input systems
49
What is the nerve supply to the vestibular system? What is the vascular supply?
Nerve supply: CN VIII- vestibulocochlear nerve
Vascular supply: labyrinthine artery
50
The _ _ is a series of holes located in the temporal bone which contains _ and supports the _ _.
The BONY LABYRINTH is a series of holes located in the temporal bone which contains PERILYMPH and supports the MEMBRANOUS LABYRINTH.
51
The membranous labyrinth includes the _ _ _ and the _ _ (_ and _). Contains _.
Membranous labyrinth includes the 3 SEMICIRCULAR CANALS and the OTOLITHIC ORGANS (UTRICLE and SACCULE).
Contains ENDOLYMPH
52
Endolymph has a high _ concentration, perilymph has a high _ concentration.
Endolymph- potassium
Perilymph- sodium
53
The _ have the greatest sensitivity to angular motion (flexion, rotation, extension, lateral tilt). The _ _ have the greatest sensitivity to linear motion.
The SCC (SEMI CIRCULAR CANALS) have the greatest sensitivity to angular motion
The OTOLITHIC ORGANS have the greatest sensitivity to linear motion
54
The _ is best at detecting up/ down movement, the _ is the best at backward/ forward motion.
Saccule is best at UP/ DOWN (SUD)
Utricle is best at BACKWARD/ FORWARD (BUF)
55
Each end of the SCC has a single enlarged end called the _ which contains the _
Each end of the SCC has a single enlarged end called the AMPULLA which contains the CUPULA
56
The _ or _ are _ _ crystals which increase the otolithic organs sensitivity to linear motion.
The OTOLITHS or OTOCONIA are CALCIUM CARBONATE crystals which increase . . .
57
The _-_ _ of the Cupula allows us to figure out if we are static or dynamic and which direction we are moving.
The PUSH-PULL SYSTEM of the Cupula allows us to. . . .
58
What is the normal/ resting neural firing rate for the cilia? 2 types of cilia?
Normal/ resting rate is 60-100 pulses per second
Stereocilia (small cilia) and Kinocilia (large cilia)
59
When sterocilia is pushed toward the Kinocilium small openings _ _ and _ _ enters the cell. When the sterocilia is pulled away the openings _ and _ _ enters the cell.
PUSHED toward Kinocilium small openings OPEN MORE and MORE POTASSIUM enters the cell (push in=more)
PULLED away from Kinocilium openings CLOSE and NO POTASSIUM enters the cell (pull out=less)
60
On the side of the pushing, _ occurs and action potentials _. Pushing occurs on the _ side of the head as rotation occurs.
On the side of the pushing DEPOLARIZATION occurs and action potentials INCREASE
Pushing occurs on the SAME side of the head as rotation occurs.
61
On the side of pulling, _ occurs and action potentials _.
On the side of pulling, HYPERPOLARIZATION occurs and action potentials DECREASE
62
Primary processing occurs in the _ which is located between the pons and the _.
Primary processing occurs in the VNC (vestibular nuclear complex) which is located between the pons and the CEREBELLUM.
63
Adaptive processing occurs in the _ and has a largely dampening or inhibitory effect on the vestibular system.
Adaptive process occurs in the CEREBELLUM and has a largely . . . .
64
The _ maintains gaze stablity. Normal _ _ is 1:1, meaning for each degree the head turns one direction the eyes will turn one degree in the opposite direction.
The VOR (vestibular occular reflex) maintains gaze stability.
The normal VOR GAIN is 1:1
65
The _ maintains postural stability and can be _/ _ with _.
The VSR (vestibular spinal reflex) and can be DELAYED/ DECLINE with AGE.
66
_ is not a diagnosis it is a symptom.
DIZZINESS
67
Acute dizziness is defined as _ _ (Or equal too) _ _. What are the 2 subtypes of chronic dizziness.
Acute dizziness is defined as LESS THAN (or equal too) 3 DAYS
Chronic dizziness: CONSTANT, SPELLS (lasting seconds, minutes, hours)
68
Why is it considered chronic dizziness if it lasts for greater than 3 days?
Because the vestibular system is quick to recover/ reset
69
_ is a false sense of moving or spinning. _ is faintness.
VERTIGO is a false sense of moving or spinning
LIGHTHEADEDNESS is faintness
70
_ is feeling off balance. _ is blurry vision.
DISEQUILIBRIUM is feeling off balance.
OSCILLOPSIA is blurry vision
71
What is the mVAS? When should you get this information?
Modified visual analog scale for dizziness (similar to pain), ask patient range of 0-10 with 0 being no dizziness and 10 being most dizzy
Get the information on initial evaluation and reassessment (in the last 48-72 hours what is the worst and best, how do you feel right now), during each phase of treatment (CRM, Casani, liberatory) and before/ after treatment.
72
The _ _ _ is a 25 item subjective questionnaire that assess the psychological impact of dizziness on the patient. How is it scored? Total? Ranges (3).
The DIZZINESS HANDICAP INVENTORY (DHI) is a . . . .
Each question is scored 4=yes, 2=sometimes, 0=no for a total of 100
Mild: 0-30
Moderate: 31-60
Severe: 61-100
73
Gentamycin (aminoglycoside antibiotics), cisplatin (antineoplastics), and mannitol (diuretic) are all examples of _ _. _ _ is an environmental toxin that has the same effect.
. . . .all examples of OTOTOXIC DRUGS
CARBON MONOXIDE is an environmental toxin that has the same effect.
74
3 types of drugs that are prescribed to treat symptoms of dizziness include: _ (to decrease fluid in ears), _ (to inhibit CNS response) and _ (to inhibit acetylcholine).
ANTIHISTAMINES (to decrease fluid in ears)
BENZODIAZEPINES (to inhibit CNS response)
ANTICHOLINERGICS (to inhibit ACH)
75
CNS (disease/ tumor/ bleeding), labyrinthitis, vestibular neuritis, and BPPV are all possible causes of _ _.
. . . All possible causes of ACUTE DIZZINESS
76
With _ the hearing will be affected. With _ _ the hearing is spared, complains of just dizziness.
With LABYRINTHITIS the hearing is affected
With VESTIBULAR NEURITIS hearing is spare, complains of just dizziness.
77
What is the chief complaint associated with: BPPV? UVH? BVH?
BPPV- vertigo
UVH- blurry vision/ Oscillopsia
BVH- disequilibrium/ off balance
78
UVH usually takes about _-_ _ to resolve. BVH takes _ _ to resolve.
UVH: 6-8 weeks to resolve
BVH: 6- 24 months
79
UVH, BVH, Mal debarquement (slow to recalibrate vestibular system after getting off boat) and psychological disorders such as anxiety are all causes of _ _ dizziness.
. . . All causes of CHRONIC CONSTANT dizziness.
80
What are 3 causes of chronic episodic dizzy spell lasting seconds?
BOP
- BPPV
- OH
- peri lymphatic fistula (mixing of endo and perilymph)
81
3 causes of chronic episodic dizzy spells lasting minutes?
TeMPo
- TIA
- Migraine
- panic attack
82
2 examples of chronic dizzy spells lasting hours (many hours, days, several days)?
M and M
- motion sickness/ sensitivity
- Meneire's disease (rapid accumulation of fluid in one or more ears)
83
If a patient has a history of trauma coupled with dizziness and/ or pain what should you do?
Refer patient to MD for medical evaluation
84
Alar ligament tests, lateral shear, and sharp-purser tests can all be performed with caution at the discretion of the clinician to test for? What happens if you get a positive test?
. . To test for CERVICAL STABILITY/ INSTABILITY
If you get a positive test: STOP AND REFER TO MD AND/ OR FOR IMAGING
85
What are the 5 D's/ symptoms in addition to vertigo, headache, nausea and/ or paresthesia that suggest possible VBI during mVAT test?
```
Dizziness
Disequilibrium
Drop attacks (fainting)
Diplopia
Dysarthria
```
86
If the mVAT is tested before a Dix hall pike or roll test it can help you differentiate between?
Help you differentiate between BPPV and arterial occlusion
87
Which 3 tests look at tonic vestibular input to the eye muscles? With all 3 tests symptoms usually occur in the acute stage and resolve within 7 days, if they don't it suggests?
SOG
- spontaneous nystagmus test
- ocular alignment test
- gaze evoked nystagmus test
If symptoms don't resolve within 7 days suggests CNS INOLVEMENT
88
If a patient is positive for the spontaneous nystagmus test then you should expect a _ _ result on the gaze evoked nystagmus test (GEN). _ _ is rare in the GEN without CNS involvement.
. . . You should expect a 2 DEGREE result on the GEN. 3 DEGREE is rare in the GEN without CNS involvement.
89
Which test looks at the integrity of the CN III, IV, and VI? Positive tests suggests?
SMOOTH PURSUIT TEST
Suggests possible CNS problem
90
Which test is being described: patient sits upright and looks back and forth between stationary horizontal and vertical targets (chin and pen) without moving their head. What is a positive result? What does it suggest?
Saccadic eye movement test
Positive result would be eyes stop/ interrupt movement 2 or more times
Suggest possible CNS problem (should retest again after re-explaining to eliminate possible of patient misunderstanding test)
91
Which test is being described: patient tracks moving pen tip while moving both their head and eyes? Purpose is to examine patients' ability to cancel out the _ via the _.
VOR CANCELLATION TEST
Examines patients ability to cancel out the VOR via the CEREBELLUM (head movement)
92
If CNS problem is suspected you could test the _ _ _ integrity (babinski, clonus, DTR's) and the _ integrity (open/ close eyes, heel to shin, hand flipping) to help rule out other pathologies.
You could test the UPPER MOTOR NEURON integrity (babinski, clonus, DTRs') and the CEREBELLAR integrity (open close eyes, heel to shin, hand flipping, dysdiadochokinesia) to help rule out other pathologies.
93
Which test is used to assess the anterior and posterior vertical semi circular canals? Horizontal canals?
Dix Hallpike- anterior/ posterior vertical SCC's
Roll Test- horizontal SCC's
94
If during the Dix Hallpike exam you see torsional jerk nystagmus with the fast phase beating toward the right SCC in an upbeat direction which canal is involved? Why? What happens if it beats downward? Vertically?
Right posterior vertical canal
-fast phase beats towards involved side= right, up beat direction = posterior canal involvement
If it was downward beating nystagmus= right anterior vertical canal
If it beats VERTICALLY- SUGGEST CNS PROBLEM
95
Which is the easiest canal to become affected by BPPV? Often occurs during? Which is more common canalithiasis or cupulothiasis?
Posterior, often occurs during sleep
Canalithiasis is MORE COMMON
96
During a Dix Hallpike test: If it takes seconds for nystagmus to begin once in position and symptoms fatigue in less than 60 seconds it is? Caused by?
It is CANALITHIASIS
Caused by FREE-FLOATING OTOCONIA
97
If a patient has cupulothiasis there will be no _ _ and symptoms will _ _ _ _. This occurs when otoconia become _ to the _ in the SCC.
There will be no LATENCY PERIOD (symptoms start immediately) and symptoms will PERSIST BEYOND 60 SECONDS.
This occurs when otoconia become ADHERED to the CUPULA in the SCC.
98
How can the Dix Hallpike be altered for patients with spinal issues or who have difficulty lying on the their backs?
Side lying test
99
If you suspect the _ _ are affected you should perform the Roll test.
If you suspect the HORIZONTAL CANALS are affected you should perform the roll test
100
If during the Roll test there is a latency period, symptoms fatigue is less than 60 seconds and the fast phase is geotrophic (beats towards the ground) what should you suspect? Why? Typically you will get a positive result _, how should you treat?
You should suspect canalithiasis
- because geotrophic nystagmus is indicative of canalithiasis
Typically you will get a positive result BILATERALLY, therefore you should treat THE SIDE WITH THE STRONGEST NYSTAGMUS
101
If you perform the roll test and you see apogeotrophic (toward the ceiling) nystagmus that starts immediately and persists for more than 60 seconds what should you suspect? Which side do you treat? Why?
You should suspect HORIZONTAL CUPULOLITHIASIS (due to presence of apogeotrophic nystagmus)
Treat side with WEAKEST NYSTAGMUS as the involved side
WHY: because you typically get positive result on both sides
102
Which test is used to test for UVH and BVH? What is a positive test?
HIT- head impulse test
Positive test is presence of a corrective saccade(s)
- UVH, positive to the side that provoked the saccade (left turn- left UVH)
- BVH, positive for saccades in both directions
103
What type of saccade occurs when a patient knows that they should be looking at certain spot and then corrects? What is the definition of the other?
Corrective/ voluntary saccade- when patient recognizes error and corrects
Reflexive saccade is when the body thinks it's moving so it automatically corrects
104
What is the intervention for BPPV canalithiasis in either the horizontal or vertical canals? What is the difference between the two?
CRM- Canalith repositioning manuever (AKA epley manuever)
Vertical canals: start in + Dix Hallpike, turn to opposite Dix Hallpike, roll to side maintaining head position, return to sitting on EOM/ neutral head
Horizontal canals/ BBQ roll: start in + roll test, head rotated to neutral, rotated to opposite roll test position, roll into prone with head still flexed, roll to supine in + roll test position (same as starting), return to long sit position
105
Which treatment approach should be used for horizontal cupulolithiasis? Describe. _ is important!
Casani manuever
Pt sitting with head in neutral, laid down onto involved side, head rotated 45 degrees towards the floor, pt returned to sitting with head in neutral
VELOCITY is important (needs to be quick passive rotation to dislodge otoconia)
106
The liberatory manuever is used to treat vertical cupulolithiasis, if you want to treat the Right posterior vertical SCC you need to turn your head the _ side, go down to involved side (side lying), move through sitting position to opposite side lying position while maintaining head position.
Turn your head to the OPPOSITE (left) SIDE, go down onto the involved side (right side), move through sitting to opposite side. . .
107
If you are treating the Right anterior vertical canal with the liberatory manuever, turn your head to the _, lay down on your _ side, move through to side lying on the opposite side maintaining head position and then return to sitting.
Turn your head to the RIGHT (same), lay down on your RIGHT (INVOLVED) side, move through . . .
108
What exercises can be given to patients to help with BPPV? Should only perform at a speed that? Symptoms should return to baseline within? Frequency recommended?
Brand-Daroff (move from side lying position to sitting to opposite side to sitting- in each position for 60 seconds)
Should be performed at a speed with increases mVAT 1-2 levels
Symptoms should return to baseline within 1-5 minutes
Performed once daily.
109
What is the name of exercises used to help treat UVH and BVH? Which one is indicated for which condition? What is the purpose of the exercises
Adaptation exercises
- X1: indicated for UVH AND BVH
- X2 (both card and head/ eyes moving): indicated for UVH ONLY
Purpose: to improve VOR gain
