Neuro Pathology Pt. 2 Flashcards
Vestibular disorders, SCI
1
Q
Define vertigo
A
- Sensation that the visual surrounding is spinning or flowing; can be spontaneous or triggered; if severe accompanied by nausea & vomiting
2
Q
Define unsteadiness
A
- Occurs when the brain receives inadequate info about the body’s position from the somatosensory, visual, & vestibular systems, may result from peripheral neuropathy, eye disease, or peripheral vestibular disorders
3
Q
Define presyncope
A
- Caused by cardiovascular disorders reducing cerebral perfusion
4
Q
Define lightheadedness
A
- Nonspecific & hard to diagnose
- It may result from panic attacks with hyperventilation
5
Q
Difference between internal and external vertigo
A
- Internal: sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during on otherwise normal head movement
- External: the false sensation that the visual surround is spinning or flowing
6
Q
What are some causes of an unilateral peripheral vestibular hypofunction (PVH)
A
- Trauma
- Vestibular neuritis/labyrinthitis: acute infection with prolonged attack of sx
- Meniere’s disease
- BPPV
- Tumor: acoustic neuroma (vestibular schwannoma)
7
Q
Define Meniere’s disease
A
- Episodic vertigo syndrome associated with low/medium frequency sensorineural hearing loss & fluctuating aural sx (tinnitus/ear fullness) in affected ear
- Duration of vertigo sx is between 20 min and 12 hrs
8
Q
What are some causes of bilateral PVH
A
- Otoxic drugs or certain chemotherapy drugs
- Bilateral Meniere’s disease
- Meningitis
- Tumors
- Autoimmune diseases
9
Q
Characteristics of a central nervous system lesion when looking at nystagmus
A
- Direction changing
- Pure down-beating
- Pure torsional with inability to walk even short distances
10
Q
Describe how to assess for vestibulospinal reflex function
A
- Examine posture & balance
- Examine for instability in sitting, standing, during functional activities, and gait
11
Q
Outcome measures for vestibular patients
A
- Dizziness Handicap Inventory (DHI)
- Activities Specific Balance Confidence Scale (ABC)
- Postural stability/balance tests
- Functional gait tests
- Vestibular disorders activities of daily living scale (VADL)
12
Q
Define habituation training
A
- Repetition of movements & positions that provoke dizziness & vertigo
13
Q
Difference between VOR x1 and VOR x2
A
- VOR x1: head moves horizontally while eyes remain stationary
- VOR x2: moving target while head is stationary
14
Q
What are the 3 intervention types for BPPV
A
- Canalith repositioning maneuver: for debris that is free-floating in the semicircular canal
- Liberatory maneuver: for debris that is adherent to the cupula (cupulolithiasis)
- Brandt-Daroff exercises: for residual or mild vertigo
15
Q
Spinala read of greatest frequency of injury
A
- C5
- C7
- T12
- L1
16
Q
Define a tetraplegia (quadriplegia)
A
- Injury occurs between C1 and C8
- Involves all four extremities & trunk
17
Q
Define a paraplegia
A
- Injury occurs between T1 and T12-L1
- Involves both lower extremities & trunk (varying levels)
18
Q
Complete versus incomplete SCI
A
- Complete: no sensory or motor function below level of lesion
- Incomplete: preservation of sensory or motor function below level of injury; spotty sensation, some muscle function
19
Q
Describe the ASIA SCI impairment scale
A
- A = Complete, no motor/sensory function preserved in sacral segments S4-S5
- B = Incomplete, sensory but no motor function preserved below the neurological level & includes the sacral segments S4-S5
- C = Incomplete, motor function preserved below neurological level; most key muscles below lesion level have a muscle grade less than 3
- D = Incomplete, motor function is preserved below neurological level & most key muscles below level have a muscle grade of 3 or more
- E = Normal motor & sensory function
20
Q
Describe central cord syndrome
A
- Loss of spinothalamic tracts with bilateral loss of pain/temperature
- Loss of ventral horn with bilateral loss of motor function (primarily upper extremities)
- Preservation of proprioception & discriminatory sensation
- Typically caused by hyperextension injuries to the cervical spine
21
Q
Describe Brown-Sequard syndrome
A
- Ipsilateral loss of DCML with loss of tactile discrimination, pressure, vibration, & proprioception
- Ipsilateral loss of corticospinal tracts with loss of motor function & spastic paralysis below level of lesion
- Contralateral loss of spinothalamic tract with loss of pain/temperature below level of lesion (at level of lesion is bilateral loss)
- Hemisection of spinal cord typically caused by penetration wounds (gunshot/knife) with asymmetrical symptoms
22
Q
Describe Anterior cord syndrome
A
- Loss of lateral corticospinal tracts with bilateral loss of motor function, spastic paralysis below level of lesion
- Loss of spinothalamic tracts with bilateral loss of pain/temperature
- Preservation of DCML: proprioception, kinesthesia, & vibratory sense (light touch)
- Typically caused by flexion injuries of the cervical spine
23
Q
Describe posterior cord syndrome
A
- Loss of DCML bilaterally
- Bilateral loss of proprioception, vibration, pressure, & epicritic sensations (stereognosis, 2-point discrimination)
- Preservation of motor function, pain, & light touch
- Extremely rare
24
Q
Describe Cauda Equina syndrome
A
- Injury below L1 resulting in LMN lesions
- Flaccid paralysis with no spinal reflex activity
- Flaccid paralysis of bladder & bowel
- Potential for nerve regeneration; regeneration often incomplete, slows & stops after about 1 yr
25
Q
Define sacral sparing in SCI
A
- Sparing of tracts to sacral segments with preservation of perianal sensation, rectal sphincter tone, or active toe flexion
26
Q
Action of diaphragm, respiratory muscles, intercostals; chest expansion, breathing pattern, cough, vital capacity; respiratory insufficiency or failure occurs in lesions above what spinal level
A
- Above C4
- Phrenic nerve, C3-C5 innervates diaphragm
27
Q
How to determine the spinal cord level of injury
A
- Lowest segmental level of innovation includes muscle strength present at a grade 3+/5
28
Q
Define spinal shock
A
- Transient period of reflex depression & flaccidity
- May last several hours or up to 24 wks
29
Q
Signs and symptoms of autonomic dysreflexia
A
- HTN
- Bradycardia
- Severe HA
- Feeling of anxiety
- Constricted pupils
- Blurred vision
- Flushing and piloerection (goosebumps)
- Increased spasticity
30
Q
What should you do if patient is experiencing autonomic dysreflexia
A
- Bring to an upright position
- Loosen any tight clothing or restrictive devices
- Examine/reduce blockage of urinary drainage
- Monitor BP and HR
- Notify medical and/or nursing staff ASAP
31
Q
Signs and symptoms of orthostatic hypotension
A
- Drop in 20 SBP or drop in 10 DBP or both and an increase in HR of 10 bpm
- Lightheadedness
- Syncope
- Mental or visual blurring
- Sense of weakness
32
Q
Describe locomotor training for T6-T9 complete SCI
A
- Supervised ambulation for short distances
- Requires bilateral KAFOs and crutches
- Swing to gait pattern; requires assistance
- May prefer standing devices/standing wheelchairs for physiological standing
33
Q
Describe locomotor training for T12-L3 complete SCI
A
- Can be independent with ambulation on all surfaces & stairs
- Using a swing through or 4 point gait pattern & bilateral KAFOs and crutches
- May also use reciprocating gait orthoses with walker with or without FES system
- Typically independent household ambulators; wheelchair use for community ambulation
34
Q
Describe locomotor training for L4-L5 complete SCI
A
- Can be independent with bilateral AFOs & crutches or canes
- Typically independent community ambulators
- May still use wheelchair for activities with high-endurance requirements
- High rejection of orthoses/ambulation in favor of wheelchair mobility & energy conservation
35
Q
Define neuromodulation
A
- Use of electrical stimulation to replace or improve function of a paralyzed or paretic limb
- Includes FES and robotic assisted walking
36
Q
Parameters and progression of body weight support treadmill training for SCI
A
- High intensity, high frequency training: 4-5 days/wk, 20-30mins, typically for 8-12 weeks
- Progression: decrease BWS, increase treadmill speed, eliminate manual assistance
- Can progress further to overground gait training for community ambulation
37
Q
What are some exercise precautions for tetraplegia/high lesion paraplegia SCI patients
A
- Pts may experience blunted tachycardia, lack of pressor response, very low VO2 peak, & substantially higher variability of most responses
- Monitor HR and BP closely during exercise & activity training
38
Q
Absolute contraindications to exercise testing & training of individuals with SCI
A
- Autonomic dysreflexia
- Severe or infected skin on weight bearing surfaces
- Symptomatic hypotension
- urinary tract infection (UTI)
- Unstable fracture
- Uncontrolled hot & humid environments
- Insufficient ROM to perform exercise task
