neuro rehab Flashcards
1
Q
where do the lowest level reflexes originate?
A
spinal cord (then brainstem, then midbrain/cortical areas)
2
Q
true or false, fast movements can be performed without sensory feedback
A
true (open loop control)
3
Q
open loop control systems
A
instructions for the action (motor programs) are prepared in advance and carried out without feedback
4
Q
feedforward control
A
“setting” of muscles prior to initiation of movement
5
Q
closed loop is used ____ (more/less) during learning
A
more because we need the feedback when we are learning a movement
6
Q
true or false, it is impossible for the brain to store motor programs for every movement
A
true, this is a limitation on this idea
7
Q
which theory talks about times of stability and instability
A
dynamic systems theory
8
Q
discrete tasks
A
have a beginning and end
9
Q
serial tasks
A
discrete movements strung together
10
Q
continuous movements
A
no recognizable beginning or end
11
Q
open environment
A
unpredictable
12
Q
closed environment
A
predictable
13
Q
intrinsic feedback
A
from sensory receptors
14
Q
extrinsic feedback
A
supplied from external sources
15
Q
which type of feedback schedule is most effective?
A
faded
16
Q
external focus of attention is better for learning (T/F)
A
true
17
Q
which type of task works better for massed practice?
A
discrete, or for a novel skill
fatigue can be an issue for continuous
18
Q
massed or distributed practice are about ….
A
the amount of time of practice vs. rest
massed is more practice than rest
19
Q
meissner’s corpuscle
A
fine, discriminative touch
20
Q
merkel’s disc
A
fine touch, superficial pressure
21
Q
pascinian corpuscle
A
deep pressure, vibration
22
Q
Ruffini corpuscles
A
stretch, vibrations
23
Q
which type of reflex is monosynaptic?
A
deep tendon reflex (stretch)
24
Q
function of the brainstem
A
receives and integrates somatosensory, vestibular, and visual inputs for postural control
regulate cardiovascular, respiratory and visceral activity
regulates arousal and awareness through ascending reticular system
25
basal ganglia goes with which cortical area?
supplementary motor
26
cerebellum goes with which cortical area?
premotor
27
vicarious function theory
assumes that functions can be learned or taken over by areas not previously done
28
CNS redundancy theory
CNS has back-up systems
29
functional substitution
areas of the brain become reprogrammed (increased sensitivity of hands as sensory information for the blind)
30
wallerian degeneration
the distal end that was separated (cut) will degenerate
31
recovery of synaptic effectiveness
edema resolves and function is restored
32
synaptic hyper effectiveness
when one presynaptic branch is destroyed, the rest release more NT
33
denervation super-sensitivity
increase in number of receptors on postsynaptic membrane
34
recruitment of silent synapses
unmasking, functional connections were silent before injury
35
axonal regeneration
sprouts from injured axons grow to form new synapses with other cell
36
collateral sprouting
presynaptic will sprout to synapse with a postsynaptic neuron that lost its presynaptic
37
angiogenesis and what substances promote it
formation of new blood vessels
| BDNF and TGFa
38
retentive memory
immediate recall
39
recent memory
recall immediate and then 5 min later
40
remote memory
chronological order of events
41
difference between non-equilibrium and equilibrium coordination
equilibrium requiers upright balance
42
what does a wide based gait and ataxic movement indicate?
cerebellar issue
43
what is the gait speed of a community ambulatory?
.8 m/s
44
what is the tinetti used for?
fall risk in the elderly
45
tests to determine risk...
```
TUG
functional reach
tinoetti
Berg
BESTest
```
46
floor effect
they will score too low
47
ceiling effect
they will score too high
48
SIRS
systemic inflammation response syndrome
| severe infection
49
risk for ICU acquired weakness goes up after how long
1 week
50
what is early mobility? how early?
within 24-48 hours after admission
51
PICS
post intensive care syndrome
52
who gets SCI?
young males, often preventable causes
53
what level are wedge compression fractures most common in?
thoracic
54
___ has regeneration, ___ has reorganization
PNS, CNS
55
spinal shock is caused by ... and is...
edema,
temporary suppression of SC ruction at and below level
first to come back are sacral reflexes
56
spinal precautions
No BLT
bending
lifting more than 10 lbs
no twisting
57
who would you expect to have issues with generating a forceful cough (SCI level)?
above C6
58
level of autonomic dysreflexia
above T6
59
what to do for autonomic dysreflexia
raise HOB to decrease BP
look for noxious stimuli
keep checking vitals
ER immediately if BP does not come down
60
spasticity is ___ dependent
velocity
61
neuropathic pain therapies
anticonvulsants
| tricyclic antidepressants
62
Brown-sequard syndrome
SC hemisection
ipsilateral: motor at that level and below, DCML below, AL at the level
contralateral: AL at level and below
63
anterior cord syndrome
AL loss at and below level, motor at and below
64
central cord syndrome
loss of motor pools at the level, loss of AL at the level (crossing fibers)
65
posterior cord syndrome
loss of DCML below lesion
likely have antalgic gait as a result
66
cauda equina
LMN
| sensory impairment and flaccid paralysis
67
conus medularis
UMNs and LMNs
| maybe see spasticity, hyperreflexia
68
root escape
preservation or return of function of nerve roots at, or near, level of lesion
69
neurologic level of inury
loest segment w/ normal sensory and or motor function (3/5) on both sides of the body
70
ASIA levels
```
A = complete
B = sensory only
C = less than 1/2 motor normal
D = more than 1/2 motor normal
E = normal
```
71
how much HS length does an SCI patient need for functional long-sit?
110-120
72
secondary complications of SCI (think bone)
heterotrophic ossification
| osteoporosis
73
sympathetic affects on bladder
hypogastric nerve --> relaxes bladder muscles and contracts internal urethral sphincter
74
parasympathetic effects on bladder
pelvic nerve --> contracts detrusor muscle --> voiding
75
somatic effects on bladder
pudendal nerve --> contracts external urethral sphincter (voluntary control)
76
location of lesion for spastic bladder
above conus medullar is because micturition reflex is still intact
77
location of lesion for flaccid bladder
lesion of conus medlars or cauda equina (the reflex is disrupted)
78
failure to store urine can be from 2 causes
```
detrusor hyperreflexia
sphincter incompetence (corticospinal tract damage or sympathetic denervation)
```
79
failure to empty bladder
hyporeflexia of detrusor
outlet obstruction
spastic external sphincter
80
location of lesion for spastic bowel
lesion within SC above conus medullaris
intact defecation reflex
81
bowel program success
```
SELF
Schedule
exercise
liquids
food
```
82
reflexogenic erections happen from
direct stimulation to the genital area
83
psychogenic erection happen from
result of audiovisual stimuli or fantasy (from brain)
84
NIHSS score is for what?
```
stroke severity
0 = no symptoms
1-4 = minor stroke
5-15 = mod stroke
16-20 = mod to severe
21-42 = severe stroke
```
85
ASTRAL score is for what?
```
stroke
Age
Severity (NIHSS)
Time delay
pResence of visual field deficit
glucose at Admission
Level of consciousness
```
86
an embolism is a clot that comes from...
the heart normally
87
intracerebral hemorrhage
blood vessels within brain rupture
88
subarachnoid hemorrhage
blood vessels outside of the brain ruptures, filling subarachnoid space with blood
89
Arteriovenous malformation
congenital defect consisting of abnormal tangle of blood vessels that pass blood directly from arteries to veins
CAN RUPTURE
common stroke seen in young people
90
watershed strokes
affect areas of the brain supplied by the most distal branches of major cerebral arteries
-proximal arm and leg weakness (man in a barrel)
91
warning signs of stroke
```
FAST
Face
Arms
Speech
Time
```
worst headache of their life
92
what type of drugs do you give someone with a TIA of cardiac origin?
anticoagulants (warfarin, heparin)
93
what type of drug is aspirin?
platelet antiaggregant (antiplatelet, antithrombotic)
94
When do you use thrombolytic therapy?
tPA, altaplase... within 4.5 hours of an ischemic stroke
95
what is a cryptogenic stroke?
the underlying cause is unknown after extensive testing
96
what to do for intracerebral hemorrhagic stroke
stop antithrombotics, debased BP, decrease ICP
97
dorsolateral prefrontal cortex deficit
```
executive functioning(memory retrieval)
perseveration, disinhibition
```
98
ventromedial prefrontal cortex deficit
motivational aspect of decision making
impulsive, risk-taking
inability to interpret emotions or act appropriately
99
anterior cingulate cortex is important for
connected with VMPC and DLPFC and limbic system
shifting attention, awareness of emotion
(considered part of limbic system)
100
posterior cingulate cortex is important for
working memory, comparing, evaluating info, orienting objects in space mentally
101
declarative memory
facts and events
102
nondeclarative memory
procedural and emotional learning
103
non-associative learning
habituation and sensitization
104
associative learning
```
classical and operant conditioning
cellular mechanisms (LTP and LTD)
```
105
where does long term potentiation happen?
hippocampus and neocortex
106
where does long term depression happen?
cerebellum and hippocampus
107
bottleneck theory
two tasks with similar neural network requirements create a bottleneck during dual tasking (decreasing performance in one or both tasks)
108
capacity sharing model
processing capacity for an individual is limited... multiple tasks could require more capacity
109
at the areas of broca's and wernicke's on opposite hemisphere, what do they do?
nonverbal planning (broca's) and nonverbal interpretation (wernicke's)
110
verbal dorsal stream processing...
transforms what we want to say to sentences
111
verbal ventral stream processing...
converts what is said into its meaning and plans what we want to say
112
anomic aphasia
inability to retrieve words an individual wants to say
| most common after stroke
113
conduction aphasia
thought to be due to damage to arcuate fibers connecting broca's and wernicke's
speak in gibberish
114
wernicke's allows for repeating words (T/F)
true
115
transcortical motor aphasia
disconnected broca from BG or premotor... non-fluent aphasia, but can repeat words
116
transcortical sensory aphasia
fluent aphasia, but can repeat words, often echolalia
117
mixed transcortical aphasia
least common (isolation aphasia)
all areas intact, but isolated
can repeat
can't comprehend or produce spontaneous speech
118
global aphasia
most severe, large left hemisphere lesion
can improve sometimes
no speech made or understood
119
dysarthria types
spastic (UMN)
| flaccid (cranial nerves)
120
diaschisis
loss of function in a remote area, but neuronally connected
121
On day 2 post stroke, if the following are present, predicts independent gait at 6 months with 98% chance
independent sitting for 30s
25 degree motion of DF, Knee extension, hip flexion
palpable contraction of DF, KE, AND HF
fair+ strength in DF, KE, HF
122
3 stages of stroke recovery according to Bobath
1: flaccidity
2: spasticity
3: relative recovery
(recovery continues for 1 year)
123
muscles not included in the synergy patterns
```
lats
teres major
serrates anterior
finger extensors
ankle evertors
HARD TO ACTIVATE
```
124
UE movement is in ___ direction as other for unmasked reflexes post stroke
SAME
125
LE movement is in the _____ direction as other for unmasked reflexes post stroke... except
OPPOSITE
| except for ABD and ADD
126
sougue's phenomenon
raise arm above horizontal and get finger extension and abduction
127
raimiste's phenomenon
resisted abduction elicits abduction in the contralateral limb (same for add)
128
perceptual deficits usually occur in the ____ lobe
right parietal
129
asonognosia
denial of presence or severity of disability
130
agnosia
dont know what to do with an object
131
dysphagia
delayed triggering of the swallowing reflex
| posture and head control can contribute
132
which type of hemiplegics tend to be more impulsive?
L
133
thalamic syndrome
severe burning pain in the area weeks or months after thalamic stroke
134
Gordon's Investment Principle
performance will degrade during learning process, then it will improve as it becomes integrated
135
shoulder problems associated with hemiplegia
pain and subluxation
136
body scheme
postural model of body, relationships between body parts
137
body awareness
integration of tactile, proprioceptive and interoceptive sensation, in addition to feelings
(these legs are mine)
138
somatognosia
failure to recognize a part of their body (maybe think dead person in bed), includes naming a body part
139
where does a lesion causing unilateral neglect happen?
right posterior inferior parietal lobe (they think right said is dominant in choosing what to pay attention too)
140
anosognosia
deny symptoms such as paralysis, safety problem, they will say it's not their arm
141
pusher syndrome
uses non paretic extremities to push away
142
prosopagnosia
inability to recognize familiar faces
143
perceptual disorder classifications (4)
body image/scheme
spatial relations
agnosias
apraxia
144
screening is more than a test, it is a program (T/F)
true
145
orientation
adjustment of the body and head to vertical
146
stability
ability to maintain the center of mass within the base of support
147
anterior canals detect
nodding your head
148
posterior canals detect
side bend
149
saccule detects
motion in the sagittal plane
150
superior vestibular nucleus
VOR (semicircular)
151
lateral vestibular nucleus
LVST (Utricle and saccule)
152
medial vestibular nucleus
MVST (semicircular)
153
inferior vestibular nucleus
RF, cerebellum, SC
154
when learning new motor skills you rely more on (visual/somatosensory) input
visual (same with children)
155
suspensory strategy for balance
lower the COG towards BOS, crouch down
156
acoustic neuroma
tumor of vestibulocochlear nerve
157
vestibular hypofunction (unilateral)
feels like you are moving toward uninvolved side (more activity)
158
cupulolithiasis
dislodged otoconia adhere to cupula
159
canalithiasis
dislodged otoconia are free-floating (more common)
160
Meniere's Disease
fluctuations in fluid and electrolyte control in inner ear
161
stupor
barely conscious state, can only be aroused briefly
162
obtunded
sleeps often, and when aroused has decreased alertness
163
post-traumatic amnesia
period of both retrograde and anterograde amnesia after mod/severe TBI
164
Glascow Coma Score
```
13-15 = mild concussion
9-12 = moderate
3-8 = severe
```
165
Ranchos Level 1
no response
166
Ranchos Level 2
general response (inconsistent, nonpurposeful)
167
Ranchos Level 3
localized response (specifically, but inconsistently)
168
Ranchos Level 4
confused - agitated (bizarre, nonpurposeful)
169
Ranchos Level 5
confused - inappropriate
170
Ranchos Level 6
confused - appropriate (dependent on external input or direction)
171
Ranchos Level 7
automatic - appropriate (shows carryover for NEW learning, impaired judgement)
172
Ranchos Level 8
purposeful - appropriate (needs no supervision once activity is learned)
173
key to manage agitation
prevent escalation, modify environment
174
key to manage confusion
external structure
175
key to manage impulsivity
consistency across caregivers, verbal rehearsal
176
key to manage disinhibition
calm, provide concrete feedback
177
key to manage perseveration
curing and pacing to interrupt repetitive behavior, stimulus to move onto next step
178
key to manage confabulation
may be serving a purpose like reducing anxiety... ignore it if low functioning, nonthreatening feedback of inaccuracy in higher functioning, redirection
179
key to manage inability to self-reflect
use concrete goals
180
key to manage apathy
treatment should target choices and acknowledge accomplishment
181
key to mange lack of initiation
cueing to start activity
182
anoxic brain injury
incidents that alter the amount of oxygen in the blood (poor prognosis)
183
most adult tumors are ___(supra/infra)tentorial
supra, children are more likely infra (cerebellum, brainstem)
184
adenoma
gland (usually benign)
185
blastoma
malignant tumor whose cells have underdeveloped characteristics
186
glioma
any tumor that arises from supportive tissue of the brain (can be benign or malignant)
187
most common type of glioma
astrocytoma
188
most common malignant primary CNS tumor in children
medulloblastoma
189
most common benign CNS tumor
meningioma
190
craniotomy
resection of skull overlying tumor and replacement of bone flap
191
normal ICP
0-15, emergency is over 20
192
ALS
most common form of adult-onset progressive motor neuron disease, UMN and LMN, spreads from one focal region to another adjacent area, axonal degeneration distal to proximal
193
ALS on EMG
spontaneous potentials at rest (acute denervation)
reduced motor recruitment (reduced number of motor units)
re-innervation changes (chronic denervation with re-innervation)
194
ALS on nerve conduction study
```
reduction combined motor AP (fewer functioning motor axons)
normal latency and velocity (myelin unaffected)
normal sensory (unaffected)
```
195
ALS on muscle biopsy
grouping of fiber types (checkerboard)
196
ALS disease modifying drugs
Rilutek and Radicava
197
exercise guidelines for ALS
concentric
moderate intensity
energy conservation
198
post-polio syndrome
overwork weakness of giant motor units 20-40 years after resolution, energy conservation is big for this group
199
GBS
autoimmune disease, progressive muscle weakness and respiratory paralysis (PNS)
200
types of GBS
AIDP: demyelination, better prognosis
AMAN: axon, nodes of ranvier
201
medical treatment of GBS
plasmapheresis
intravenous human immunoglobulin
NOT COTRICOSTEROIDS
202
PT for acute GBS
pain management
ROM
positioning
gentle stretching
203
peripheral nerve injury seddon classification
neurapraxia
axonotmesis
neurotmesis
204
peripheral nerve sunderland classification
1-5
205
mononeuropathy multiplex
asymmetrical involvement of several nerves
206
polyneuropathy
distal and symmetrical involvement of many nerves
207
MS
most common inflammatory demyelinating disease of CNS
early symptom: optic neuritis (cellophane in one eye)
HEAT INTOLERANCE, fatigue, ANS dysfunction
208
Diagnosis of MS
```
dissemination in space (2 sites) and time (1 month apart)
periventricular
juxtacortical
infratentorial
spinal cord
```
209
primary vs. secondary progressive MS
secondary is when you start out with relapsing-remitting and then start just progressing over time
210
treatment of relapse in MS
corticosteroids
211
risk factors in MS
living far from equator (Vit. D)
| epstein barr
212
types of MS
clinically isolated syndrome
RRMS
PPMS
SPMS
213
how many drugs are there to treat MS
22
214
uthoff's sign
worsening of neuro symptoms in MS due to heat intolerance
215
which drug is used for PPMS
ocrevus
216
when is PT contraindicated for MS?
acute exacerbation + corticosteroids
217
cardinal motor signs of PD
```
TRAP
tremor at rest
rigidity
akinesia/bradykinesia
postural instability
```
218
types of PD
primary
secondary (from brain injury)
parkinson-plus
219
parkinson-plus syndromes
progressive supranuclear palsy
multiple system atrophy
corticobasal ganglionic degeneration
Lewy body dementia
220
which circuits are involved in PD
```
motor
associative (DLPFC = executive functioning)
limbic = emotional regulation effects
```
221
where are lewy bodies first seen?
low in brainstem, work their way up, see symptoms in midbrain,
more cognition problems towards end due to cortical areas
222
cogwheel vs. lead pipe rigidity
```
cogwheel = jerky
leadpipe = constant, uniform resistance
```
223
microgrpahia
writing starts out big but gets smaller
224
hypophonia
voice amplitude is smaller
225
PD prodromal symptoms that occur before motor
OH, bladder dysfunction, constipation, anosmia (loss of smell), excessive daytime somnolence, rapid eye movement
226
progresive supranuclear palsy
```
most common PP
supranuclear ophthalmoplegia (cant look down), postural instability
```
227
multiple system atrophy
dont respond to levodopa, hyperkinetic dysarthria (6 years survival)
228
corticobasal ganglionic degeneration
cortical atrophy of frontal and parietal + loss of D in SN
| early cognitive dysfunction
229
dementia with lewy bodies
early cognitive symptoms
visual hallucinations
really exaggerated responses to antipsychotics
230
diagnosis of PD
must have bradykinesia w/ tremor and/or rigidity, absence of secondary cause, definite dx made w/ autopsy
231
HD
HD gene, more than 40 repeats will causes disease
more repeats = younger onset
early: loss of GABA pathway neurons (D2) --> more movement
late: loss of D1 and D2 --> less movement
can have movement, cognitive, and psychiatric issues
age of onset 30-50
232
how does HD present in kids (less than 20 y.o.)
more like PD
233
HD dx
family history, presence of extrapyramidal movement disorder
234
medical treatment for HD
chorea: DA blockers and DA-depleting drugs
depression: tricyclic antidepressants
irritability/aggressive behaviors: atypical antipsychotics
