Neurological System Disorders Flashcards
Precentral Gyrus Frontal Lobe
primary motor cortex for voluntary muscle control
Prefrontal Cortex Frontal Lobe
controls emotions, judgments, higher-order cognitive functions such as ideation and abstraction
Premotor Cortex Frontal Lobe
related to planning movements includes Broca’s area, which controls motor aspects of speech
Postcentral Gyrus Parietal Lobe
Receives fibers conveying touch, proprioceptive, pain, and temp sensations
Temporal Lobe
receives/processes auditory stimuli Wernicke’s area- language comprehension
Occipital Lobe
receives/processes visual stimuli
Limbic System
concerned with instincts and emotions contributing to preservation of the individual
basic functions include feeding, aggression, emotions, endocrine aspects of sexual response, and long-term memory
Controllable CVA Risk Factors
Hypertension
Cardiac Disease
Diabetes Mellitus
Obesity
Diet; High Cholesterol
Use of oral contraceptives with high dose of estrogen
Cigarette smoking; Alcohol abuse
Uncontrollable CVA Risk Factors
Age
Gender (male)
Race (African American and Hispanic)
Genetic predisposition
CVA Warning Signs
Numbness or weakness of the face, arm, or leg, especially on one side of the body
Confusion
Difficulty speaking or understanding, slurred speech
Blurred vision
Difficulty walking, dizziness, loss of balance or coordination
Severe headache with no known cause
Transient Ischemic Attack (TIA)
Temporary interruptions in blood supply to the brain Mini-Strokes Symptoms generally last 24 hours
Cerebral Infarction
due to either embolism or thrombosis of intra or extracranial arteries
Cerebral Hemorrhage
bleed secondary to hypertension or aneurysm
Cerebral Arteriovenous Malformation AVM
abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures
Right CVA
Left sided weakness and sensory loss
Visual-spatial and perceptual deficits
Left sided neglect
Swallowing deficits, slurred speech
Difficulty with abstract thinking
Short attention span
Behavior: impulsivity, denial of deficits, inappropriate comments, excessive talking
Left CVA
Right sided hemiplegia and sensory loss
Global Aphasia
Difficulty reading and writing
Decreased analytical thinking, impaired time concepts, impaired memory
Difficulties in learning new info
Apraxia, left/right confusion
Behavior: slow, cautious, easily frustrated, decreased motivation
Flexion Synergy Patterns
Scapular adduction and elevation; Humeral abduction and external rotation; Elbow flexion; Forearm supination; Wrist flexion; Digit flexion
Extension Synergy Patterns
Scapular abduction and depression; Humeral adduction and internal rotation; Elbow extension; Forearm pronation and wrist and finger flexion or extension
Open vs Close Head Injury TBI
Open Injury Injury results from an object penetrating the skull
Closed Injury Injury tends to be more diffuse Injury can be due to compression, expansion, acceleration, deceleration, or rotation of the brain inside of the skull
Glasgow Coma Scale Eye Opening
1- Never
2- To Pain
3- To Sound
4- Spnotaneous
Glasgow Coma Scale Motor Response
1- No Movement
2- Extension
3- Flexion Abnormal
4- Flexion Normal
5- Localizes Stimulus
6- Obeys Commands
Glasgow Coma Scale Verbal Response
1- None
2- Incomprehensible
3- Inappropriate
4- Confused
5- Oriented
Rancho Los Amigos Scale
I. No Response
II. Generalized Response
III. Localized Response
IV. Confused-Agitated
V. Confused-Inappropriate, Non-Agitated
VI. Confused-Appropriate
VII. Automatic-Appropriate
VIII. Purposeful-Appropriate
Generalized Response RLAS 2
inconsistent, non-purposeful. delayed response
Localized Response RLAS 3
specific but inconsistent
Confused-Agitated RLAS 4
respond to internal stimulant, maybe combative because of confusion
Confused-Inappropriate, Non-Aggitated RLAS 5
appears alert.responds to very simple commands. reacts to external stimuli but out of proportion
Confused-Appropriate RLAS 6
Goal directed behavior, needs a lot of guidance
Automatic-Appropriate RLAS 7
increased awareness. follow simple directions consistently. can relearn old task
Purposeful-Appropriate RLAS 8
Appropriate and oriented. complete ADLs. requires supervision for decreased insight
Spinal Cord Etiology
Trauma to the spinal cord as a result of compression, shearing force, contusion secondary to motor vehicle accident, diving accident, gunshot/knife wound, sports injury, or fall
Non-traumatic cord injuries may be a result of tumor, progressive degenerative disease
ASIA Impairment Scale
A= complete, no sensory or motor func in the sacral segments S4-S5
B= incomplete, sensory but no moter func below neurological lvl and extends thru sacral segments
C= incomplete, motor func below neurological lvl and majority of key muscle groups muscle grade 3/5
D= incomplete, motor func below neurological lvl and majority of key muscle groups muscle grade >/= 3/5
E= normal, sensory and motor func are normal
SCI Symptoms
Spinal shock- 4-8wks
Cessation of all reflex activity below the level of injury
Sensory deficits- partial or complete
Loss of bladder/bowel control
Loss of temp control below lesion
Decreased respiratory func
Sexual dysfunction
Changes in muscle tone- spasticity/flacciidty
Loss of motor func- quadraplegia/paraplegia complete/incomplete
SCI Complications
Respiratory
Decubitus ulcer
Orthostatic Hypotension
DVT
Autonomic Dysreflexia
UTI
Heterotopic Ossification
Heterotopic Ossification
Abnormal bone development in soft tissue in or around a joint Symptoms: Swelling Painful extremity Decreased range of motion with boney end feel
Autonomic Dysreflexia
A syndrome occuring in patients with spinal cord lesions above T6. Sudden and significant increase in blood pressure above their usual levels in response to a noxious stimuli
C1-C3 Spinal Injury
FO: Neck flx/ext, and rot; shrug shoulders (C3 only) ROM is WFL and painfree. Patient is able to direct PROM program
RE: Mechanical ventilator, commun mouth sticks or env. control units, w/c sip/puff tech
C4 Spinal Injury
FO: Neck flexion, ext, rot; scap. elevation (shoulder shrug) and inspiration May breathe w/o ventilator
RE: Power W/C, keyboard, mounted smartphone,commun mouth sticks or env. control units
C5 Spinal Injury
FO: Shoulder flx/ext, abd; elbow flx and sup; scap. add/abd
Bed mobility w/assist. UED/UEB: Min-ModA. Feed s/u and Indp w/ae.
RE: Power W/C, suspension sling, dorsal wrist w/universal cuff, wash mitt, scoop dish, angled utensils
C6 Spinal Injury
FO: Scap. protractor, some horiz. Add, forearm pron, wrist ext., tenodesis
Bed mobility w/assist, indp eating, indp LED (maxA w/shoes and socks),assist grooming (Indp w/tenodesis grasp or splint), Trns w/assist-indp, MinA bathing w/handheld shower, tub bench
RE: Power or manual W/C, move from universal cuff to built-up utensils, adapted cups/mugs, AE for dressing and eating, hydraulic standing frame, transfer board
C7-C8 Spinal Injury
FO: Elbow ext, wrist flex/ext, finger flex/ext, thumb use.
Ind-assist bladder and bed mob, ind transfers and press relief, ind eating and UED/UEB, ind-assist LED/LEB
RE: Manual W/C, padded tub bench or shower commode chair, handheld shower,button hook, modified vehicle
T1-T9 Spinal Injury
FO: UEs fully intact, ltd. upper trunk stability, endur.
Independent all self-care, ind stand w/frame, ind homemaking, driving
RE: Manual W/C, standing frame, hand controls (vehicle), elevated padded toilet seat or padded tub bench, shower/commode chair, handheld shower
T10-L1 Spinal Injury
FO: Good trunk stability. Paralysis of LEs
Independent all self-care, assit-ind walk w crutches, ind homemaking, driving
RE: Manual W/C, standing frame, forearm crutches or walker, KAFO, hand controls (vehicle), padded std or raised padded toilet seat, padded tub transfer bench, hand-held shower
L2-S5 Spinal Injury
FO: Good trunk stability, partial to full control of LEs. Partial paralysis of LEs, hips, knees, ankle, foot
Independent all self-care, assit-ind walk w crutches, ind stand w frame, ind homemaking, driving
RE: Padded toilet seat, padded tub bench, handheld shower, forearm crutches or cane, KAFO or AFO
Cerebral Palsy
Caused by an injury and/or disease prior to, during, or shortly after birth resulting in brain damage and secondary neurological and muscular deficits
Types include Spastic CP, Dyskinetc CP, and Ataxic CP Classifications are Monoplegia, Hemiplegia, Paraplegia, Quadriplegia, Diplegia
Complications include language and intellectual deficits, seizures, visual impairments, and feeding disturbances
Spastic CP
Lesion of the motor cortex resulting in spasticity with flexor and extensor imbalance. Spasticity can express itself as:
- Hypertonia- increased tone
- Hyperreflexia- increased intensity of reflexes
Dyskinetic CP
Lesion in the basal ganglia results in fluctuations in muscle tone. The lesion expresses itself as:
- Dystonia- excessive or inadequate muscle tone
- Athetosis- writhing involuntary movements
- Chorea- spasdomic involuntary movements
Ataxia CP
Lesion in the cerebellum results in hypotonia and ataxic movements; characterized by lack of stability resulting in more primitive total patterns of movement.
Classified according to ability by the GMFCS and MACS
Gross Motor Function Classification System (GMFCS) for Children w/CP
1- Walks w/o restrictions
2- Walks w/o ae
3- Walks w/ae
4- Self-mobility w/limitations (manual/power w/c)
5- Self-mobility severely limited, even w/ae
Manual Ability Classification System (MACS) for Children w/CP
1- Handles objects easily and sucessfully
2- Handles most objects but with somewhat reduced quality/speed
3- Handles objects with difficulty, needs help to prepare and/or modify activities
4- Handles a limited selection of easily managed objects in adapted situations
5- Does not handle objects and has severely limited ability to perform even simple actions
Dyskinesias
involuntary, non-repetitive movements affecting distal, proximal, and axial musculature
Myoclonus
brief and rapid, involuntary contractions of a muscle or muscle group
Chorea
brief, purposeless, involuntary movements of the distal extremities and face
Dystonia
Involuntary muscle contractions that cause repetitive or twisting movements
Ataxia
lack of coordination while performing voluntary movements
Hemiballismus
involuntary flinging motions of the extremities. continuous and random
CP Treatment Focus for Infants
Positioning Feeding orally Play positions Handling during feeding, holding, dressing, play
CP Treatment Focus for Toddler/Pre-School Age
Positioning
Handling
Fine motor skills/pre-K skills
Self feeding and dressing
Visual motor/visual perceptual skills mobility
CP Treatment Focus for School Aged
Positioning
Fine motor activities to support performance in the classroom
Handwriting
Visual motor/visual perceptual skills
Classroom adaptations
Adaptive PE
CP Treatment Focus for Young Adult
Monitor positioning equipment, splints
Pre-vocational activities and skills
Readiness for a group home
Hypertonic Abnormal Muscle Development
hyper-ext of neck; retraction of shoulder; pelvis extended; legs add, maybe crossed
Positioning
On tummy, elbows underneath them; highly motivating toy in front for neck ext
Side-lying Sitting; bolster (car seat if small); have child straddle for abd of legs; support hips; slowly rotate shoulders forward.
Slow rocking motions to help break up tone
Hypotonic Abnormal Muscle Development
Needs lots of flx
Positioning
Facilitate tone prone in a platform swing
Side-lying to bring head, legs, and arms into midline
Sitting with lots of support in hips and trunk “W” sit for core strength
Prone with pillow underneath (so face not on flr)
Multiple Sclerosis MS
chronic, inflammatory disease of the CNS in which most patients incur disability over time
Pain
Sensorimotor Changes- spasticity, ataxia, weakness, gait instability, hemi/quadriplegia
Balance Disturbance- dizziness/vertigo
Visual Changes
Bowel and Bladder Disturbance
Cognitive Changes- apathy, memory loss, lack of judgement, inattention
Dysarthria and Dysphagia
Tremor
Sexual Dysfunction
Depression
Treatment- assist w/managing symptoms, maintain func, optimize QOL declining- adaptive approach; recovery- remedial approach
Types of MS
Relapsing Remitting- acute attack, recovery. another attack may or may not happen
Secondary Progressive- relapse/remit, then progressive decline
Primary Progressive- progressive w/o remitting
Progressive Relapsing- progressive w/acute decline
Parkinson’s Disease
Slow progressive disease of the nervous system
Symptoms
Bradykinesia; Muscle Rigidity; Resting Tremor; Cog-wheel Rigidity; Micrographia; Dementia; Memory Deficits; Voice softens-becomes monotone; Reduced facial expression; Shuffling Gait; Freezing
Parkinson’s Disease Stages
I- Unilateral symptoms, no or minimal functional implications, usually a resting tremor
II- Bilateral symptom involvement, no balance difficulty, mild problems with trunk mobility and postural reflexes
III- Postural instability, mild to moderate functional disability
IV- Postural instability increasing, though able to walk; functional disability increases, interfering with ADL; decreased manipulation and dexterity
V- Confined to wheelchair or bed
Shunt Precautions
Blockage- headache, vomiting, irritability
Infection- vomiting, lethargy, fever; seizures and deterioration of physical/cognitive functioning
Muscular Dystrophies/Atrophies
a group of degenerative disorders due to a hereditary disease process; can begin in infancy, childhood, or adulthood
Includes Duchenne’s MD, arthrogryposis multiplex congenita, limb-girdle MD, spinal muscular atrophy, congenital myasthenia gravis, and myopathies
Symptoms: Low muscle tone and weakness Difficulty w/oral feeding Breathing difficulties
Amyotrophic Lateral Sclerosis ALS
Degenerative motor neuron disease of unknown etiology; more prevalent in men; avg onset 57yrs; life expectancy 2-5yrs Symptoms
Affects Voluntary Muscles
Spasticity and Stiffness Weakness, low tone and atrophy
Speech deficits, swallowing and respiratory involvement
Eye Muscles; external sphincters controlling bowel and bladder management; five senses; heart, liver, and kidneys are spared.
Stages of ALS
I: Independent in walking and ADLs, some weakness
II: Can walk; mod weakness
III: Can walk; severe weakness
IV: Req w/c for mobility; some assist w/ADLs; severe weakness in legs
V: Req w/c for mob; dependent for ADLs; severe weakness in arms and legs
VI: Confinded to bed; req assist for ADLs and most self-care
Peripheral Neuropathies
Result of trauma, pressure paralysis, forcible over-ext of a joint, hemorrhage into a nerve, exposure to cold or radiation, or ischemic paralysis.
Symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve
Guillain-Barre Syndrome
a disorder in which the body’s immune system attacks part of the peripheral nervous system. Inflammatory disease that causes demyelination of axons in peripheral nerves
Etiology unknown; may occur after an infectious disorder, surgery, or immunization
Three Phases
Onset and Acute: acute weakness occurs in at least two extremeties and advances (20-30% req mechanical ventilation)
Plateau: sypmtoms most disabling with little/no change for days-weeks
Recovery: starts head/neck moves distally; sig-complete return of func, may have residual fatigue
Guillain-Barre Syndrome Symptoms
Rapid progression
Pain, fatigue, edema
Prickling, “pins and needles” sensations in your fingers, toes, ankles or wrists
LE weakness that spreads to UE, can evolve into paralysis
Unsteady walking
Difficulty with eye or facial movements, including speaking, chewing or swallowing
Severe pain that may feel achy or cramp-like and may be worse at night
Difficulty with bladder/bowel function
Rapid heart rate
Low or high blood pressure
Difficulty breathing
OT TBI Acute Treatment Focus
Sensory stimulation
ROM
Positioning
Splinting
OT TBI Rehab Treatment Focus
Regaining func in ADLs, IADLs, executive func skills, and community reintegration
