Neurological Workbook Flashcards
1
Q
Pain
A
VAS
2
Q
Rom
A
Goniometer
3
Q
Strength
A
Oxford scale
4
Q
Sensation
A
Fuegal Mayer- also assesses- , Nottingham sensory assessment
5
Q
Coordination- fine motor skills
A
9 hole peg test- putting pegs from one box into another
6
Q
Tone
A
Ash worth scale
7
Q
What is the standing balance outcome measure?
A
Timed unsupported stand, 180 degree turn, functional reach test, Rombergs, GUAG, star excursion test, Y balance test, Berg balance test, POMA
8
Q
Gait
A
10,6,3m, Incremental shuttle walk test
9
Q
UL function
A
9 hole peg test, MAS, timed or videoed PADLs or DADLs
10
Q
Trunk stability
A
PASS, timed Unsupported Sit
11
Q
What is postural hypotension?
A
Sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10mmHg within 3 minutes of standing, usually accompanied by symptoms of dizziness/loss of balance/ Pale complexion/ sweating/ lack of verbal communication/ vacant episode
12
Q
What is autonomic dysreflexia?
A
A serious, acute medical event whereby noxious stimuli cause an increase in blood pressure which the autonomic nervous system is unable to control or regulate leading to cardiovascular response of further increase of blood pressure and increase heart rate.
Affects t6 and above
13
Q
What is a tenodesis grip?
A
The ability to passively utilise the natural propensity to create a finger flexion through wrist extension due to tension in long finger flexors in the a sense of motor activity in fingers/ wrist flexion
14
Q
Ranges
A
Normal BP- 80/120
Normal HR- 60/100
Normal RR- 12-16
15
Q
How can you reduce High tone?
A
Meds, positioning management, stretching, prom, increasing BOS- supportiny muscles warm and calm environment using voice,change environment.
16
Q
How can you activate low tone?
A
Strengthening, reducing base of support, sitting/ standing position to increase alertness
17
Q
How long would you stretch a neurological patient to see elastic changes?
A
30-60 seconds
Why? Improve range of movement and sensory feedback to prime joint/ muscle for functional practice/ further therapy
18
Q
Explain the concave/convex rule for joint mobilisations
A
If the moving joint surface is convex, sliding is in the opposite direction of the angular movement of the bone.
If the moving joint surface is concave, sliding is in the same direction as the angular movement of the bone.
19
Q
Explain neuroplasticity in your own words
A
The ability of the brain to recover from injury or disease through a restorative change process through the means of re-growth, repair, restoration and rewiring of neuronal pathways alongside the neuroplastic reorganisation of partially spared pathways . This natural ability to adapt is based on experience and development.
The adaptation of the CNS and PNS to functional demand
3 stages of learning motor skills- cognitive, associative and autonomous
20
Q
How would you progress trunk stability and trunk mobility in a patient post CVA/TBI?
A
Sitting balance (static/dynamic), sit out in appropriate chair- increasing time gradually as able, trunk mobilisation and facilitation of pelvic movement in sitting, strengthening of core muscles, trunk muscles, perch sitting.
How does this differ with a SCI patient?
Awareness of what level injury is at/ total or partial paralysis- which trunk muscles are innovated, ensuring no hinging as injury especially for thoracic injury, may be more appropriate to ensure correct supported seating depending on injury level and full spinal cord injury.
21
Q
What are the benefits of standing?
A
Increase weight baring Increases confidence Visual stimulation Increase bone density Increase strength and motor recruitment High centre of gravity/ small base of support- balance/ postural muscles working
22
Q
How would you stand an early stroke or TBI patient?
How does this differ with a SCI patient?
A
If level of deficit lost stroke/ TBI allows can attempt standing with support/ assistance- block knee and support affected arm.
SCI may need to commence upright stance position with use of tilt table, electric standing frame in order to accommodate for BP changes/ regulation
23
Q
What provides stability in the GH joint?
A
Direction of glenoid fossa
Glenoid labrum
Capsule-superior
Rotator cuff
24
Q
Post stroke and tbi treatments
A
Mirror box Mental practice Sensory retraining Strengthening FES Care of shoulder- education, positioning and supportive devices
25
What is mirror box therapy?
Patient sits with the affected arm behind the mirror
Focuses on the reflex ion and imagines it is the affected limb
Recommended to exercise for 10 minutes every day
26
week 3- balance
As long as the centre of mass remains over the base of support, balance is maintained.
3 different pathways involve - sensory reception-central processing- motor output
27
Where does the process of balance co-ordinated in the brain?
Cerebellum
28
What 4 things do we need for balance?
Intact sensory receptors
Intact PNS and CNS to transmit, receive and process sensory information
Intact CNS and PNS to initiate, transmit and produce motor output
Intact MSK system to produce movement
29
What can you do in clinical practice to challenge balance?
```
Take away senses
Reduce BOS
Raise COG
Encourage automatic reactions
Add reactive or proactive elements and add dual tasking
```
30
Revision of how you would address these deficits as part of gait-re education
Muscle weakness- progressive strengthening work, FES, splinting
Muscle tightness and high tone - meds, soft tissue mobs, stretches, splinting and positioning
Low tone- strengthening and sensory feedback
Ataxia- coordination and core stability
Sensory deficit- sensory stimulation
Apraxia- meaningful activity practice, repetition, may need to consider cognitive strategy training
Initiation problems- cueing
Speed of movement- repetition of movemenr/ progressing speed/ treadmill
Quality of movement- repetition of specific movemenr/ facilitation of movement
Efficiency of movement- analysis of movement
Cardiovascular fitness- cardiovascular training on treadmill
Joint stiffness- joint mobilisations
Confidence/ anxiety- repetition and reassurance
31
Why should you use a walking aid, short or long term?
1. To enable mobility and facilitated increased independence, social interaction, weight ageing, return to function- short term
2. To reduce risk of falls, to enable continued mobility and independence, for fatigue management- long term
32
What should be considered when issuing walking aids?
Compensations
Reliance on walking aids
Changes to gait cycle
Cognition, require carryover to learn how to use
Falls risk/ trip hazard if used incorrectly/ inappropriately issued
33
How would you measure for a stick/elbow crutch?
Handle should measure from ulnar process (hand by side) to floor
34
How would you teach the stairs using crutches?
Leave spare crutch at bottom/ top of stairs so use one hand on rail if possible
Technique is same with/ without rail
Descending: crutch (es) and hand down first, the affected leg down, followed by unaffected leg
Ascending: weight through crutches/
hand rail- step unaffected foot up stair/ step first, followed by affected leg (weight through hand rail/ crutches)
35
What safety checks when issuing walking aids in a hospital/ clinical environment are needed?
```
Ferrules
Handles
Adjustable equipment
Frame/stick no wear and tear/dents
Appropriate footwear
Environment- check no trip hazards/ busy environment/ wet floors etc
```
36
What problems may neuro patients have with their upper limb?
```
Weakness/low tone
High tone or rigidity
Contractures
Loss of function
Pain
Change of sensation
Loss of coordination
Tremors
```
37
Why may upper limb recovery be limited following CVA and TBI?
```
Cognition
Severity of paresis
Low mood/depression/ anxiety limiting rehab engagement
Poor sensation/limiting sensory recovery
Visual inattention
Flaccidity and spasticity
```
38
What is the use of electrical stimulation?
Foot drop
Hemiplegic shoulder
Paraplegia- standing, cycling and walking
Exercising- decrease spasticity, increase circulation and decreased adhesions
Prepare for active exercise
39
What is FES (functional Electrical stimulation)
Process of pairing the stimulation simultaneously or intermittently with a functional task
40
What is constraint induced movement therapy?
Consider for people with stroke who have 10 degrees of wrist extension and 10 degrees finger extension
How and why would the affected limb be constrained?
To encourage the use of the affected arm, to give sensory stimulation to affected arm, to stop compensations in affected arm, with a glove
41
Therapy considerations and specific task training that is patient orientated and specific
Non affected limb is recommended to be constrained for 90% of waking hours. The purpose is to fascinate tasks and adaptive task practice with the affected limb. More than 7 hours of specific training of the affected limb is required.
Specific task training that is patient orientated is referred to as functional task practice;
Strength tasks- picking up a jug with increasing amounts of water in it as appropriate
Dexterity tasks- opening the door, picking up money
Activity training tasks- getting dressed, eating,drinking and showering
Pen and paper skills tasks- straight line drawing (horizontal, vertical), writing/letter practice, etc
42
What techniques can be used to manage increased tone?
```
Passive and active stretching
Massage- including soft tissue mobilisations
Passive movements
Positioning
Active movement/strengthening/function
Heat therapy
Medication
Hydrotherapy
Discourage activities which strongly provoke
Prevention of secondary complications
```
43
What are the principles of strength training?
```
Overload
Specificity
Motivation
Learning
Reversibility
Diminishing returns
Age and gender
```
44
How could you make task specific exercises throughout the day?
Vary environment, whole practice or part practice, vary timing of exercise practice (within sessions), use it with family, friends, group practice, use of music to motivate or could encourage independent practice throughout the day in function if possible.
45
What types of resisted exercise can you think of?
Subjects own body weight
Manual resistance
Free weights
Mechanical resistance- westminister pulley system, springs, theraband, gym equipment , hydrotherapy
46
What are the central causes of Fatigue?
1. CNS (primary in MS, Stroke, TBI, PD)
2. Endocrine dysfunction
3. Immunological
4. Autonomic nervous system
47
List some fatigue management strategies
```
Balance and pacing
Prioritise
Rest and relaxation
Sleep
Food and nutrition
Emotional health
Cognition
Leisure time
Pain management
Physical activity and exercise
```
48
What is discharge planning?
A process that aims to improve the coordination of services after discharge from hospital by considering the patients needs within the community
Full MDT is involved
Patient is the most important
49
What do you need to know for a safe discharge to happen?
Physical and cognitive ability of the patient
| Home environment regarding equipment and carers
50
What is perception?
The process that transforms sensory information into meaningful representations
51
What are the types of perceptual disorders?
Agnosia
Neglect
Apraxia
52
What is agnosia
Inability to interpret sensations and hence to recognise things, typically as a result of brain damage
53
What is visual spatial neglect?
Failure to report, respond to or orient to stimuli in the space contralateral to the site of the brain lesion
54
What is Apraxia or dyspraxia?
Disorder of movement not characterised by problems with tone/ co-ordination, but by an inability to combine simple movements into a sequence to achieve a goal
55
What is cognition?
All the mental processes that allow us to recognise, learn, remember and attend to changing information in the environment
Learning and memory- frontal lobe and cerebellum
Attention and concentration- frontal lobe and brain stem
Language and communication - frontal and temporal lobe
56
What are the 3 types of amnesia?
Post traumatic amnesia- period of confusion following brain injury, no memory of events preceding trauma, memory post injury is missing or confused
Retrograde amnesia- no memory of events preceding episode
Anterograde amnesia- inability to incorporate new information
57
Name outcome measures for cognition and explain how they work
MoCA- Montreal cognitive assessment
MMSE- mini mental state examination
ACE-R - Addenbrookes cognitive examination revised
58
What is a gross motor skill?
Gross motor skills are the bugger movements such as rolling over and sitting- that use the large muscles in the arms, legs, torso and feet.
59
What is a fine motor skill?
Fine motor skills are small movements such as picking up small objects and holding a spoon- that uses the small muscles of the fingers, toes, wrists, lips and tongue
60
What is cerebral palsy?
A permanent impairment of movement and posture resulting from a non progressive brain disorder due to hereditary factors or events during pregnancy, delivery, neonatal period and the first 2-3/5 years of life
What are the 3 descriptions of CP dependent on the area of the body affected?
Hemiplegia
Diplegia
Quadriplegia
Hypotonicity- athetoid, ataxic
Hypertonic- dystonic ans spastic
Spasticity is abnormal muscle tightness due to prolonged muscle contraction - rigidity is when the muscle can’t relax well
61
What are the different types of hypertonicity?
Spastic
| Dystonic- involuntary muscle movements- twitch
62
What are the different types of hypotonicity?
Athetoid
| Ataxic
63
What is spina bifida? What are the 3 main types of spina bifida?
Congenital abnormality in the formation of spinal vertebrae
1. Cystica myelomeningocele
2. Cystica meningocele
3. Occulta
64
What is hydrocephalus?
Increased CSF in ventricles of the brain
| It is treated by using shunt
65
What is muscular dystrophy?
They are a group of inherited genetic conditions that gradually cause the muscles to weaken, leading to an increased level of disability
Duchenne motors disease is one of the most common and severe forms, it usually affects boys in early childhood- people with this condition will usually only live into their 20s-30s
66
What is epilepsy?
A chronic disorder that causes unprovoked, recurrent seizures. A seizure is a sudden rush of electrical activity in the brain .
It is considered a disease of the brain defined by any of the following:
At least two unprovoked seizures occurring more than 24 hours apart
One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures
Diagnosis of an epilepsy syndrome
67
What are the two main types of epilepsy?
Generalised (affecting the whole brain)
Focal/partial (affecting just one part of the brain)
68
What are the two main causes of epilepsy?
Genetics
| Structural brain change
69
What are the triggers of a seizure?
```
Stress
Trauma
Overexertion
Pregnancy, periods
Sleep loss
```
70
What is the underlying pathology of GBS?
The underlying pathology is usually multi focal inflammation and de-myelination throughout the peripheral nervous system, (peripheral polyneuropathy) with secondary axonal degeneration in the most severely affected.
71
How does GBS differe from MS?
GBS affects the peripheral nervous system (able to repair)
| Ms affects the Central Nervous system (inability to repair)
72
What is the common course of the disease of GBS?
Disease is ascending
Max s and s reached between 2-4 weeks
Plateau period lasts approx 4-6 weeks but can be up to a year
15% require ventilation
Recovery can start from week 4 over several months
73
Explain the medical management of GBS
Steroids alone are ineffective
| Plasma exchange occurs through a cell separator machine.
74
What is motor neurons disease?
Progressive degenerative disorder of cortical, brain stem and spinal motor neurones both upper motor neuron and lower motor neuron
75
What are the 4 main types of motor neuron disease?
Amyotrophic lateral sclerosis
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis
76
What is ME?
Myalgic Encephalomyelitis- inflammation of the brain and muscles
Defining symptoms- post exertional malaise, fatigue, cognitive dysfunction or brain fog, muscle pain
77
What is the best treatment for people with ME?
```
Pacing
Prioritising
Planning
Hr monitoring
Mindfulness
Trigger points
```
78
What is ms
A chronic demyelination disease of the CNS characterised by an inflammatory process and causing widespread degeneration of the CNS, gradually resulting in severe neurological deficit.
4 main types-
1. silent/benign
2. Relapsing/remitting gradually worsens
3. Secondary progressive gradually worsens that gets chronically bad
4. Primary progressive gets bad quickly
79
What is ataxia?
```
Disorder/ confusion of movement
3 different types
1. Cerebellar- core stability and coordination exercises
2. Sensory- cooksey cawthorne exercises
3. Vestibular - sensory stimulation
```
80
What is PD?
Parkinson’s disease is a chronic, progressive neuro degenerative disorder resulting from the degeneration of dopamine producing neurones in the substantia nigra of the basal ganglia
81
Pathophysiology of PD
Substantia nigra is the main source of dopamine. Dopamine is a neurotransmitter. Basal ganglia is part of a series of parallel loops involving the thalamus and cerebral cortex. There is two main pathways…
Direct pathway- promotes movements
Indirect pathway- inhibits movement
Dopamine excites the direct and inhibits the indirect pathway ie inhibits inhibition
82
What are the 3 cardinal signs of PD?
Bradykinesia/akinesia
Resting tremor
Rigidity
83
Name 3 meds for PD AND 2 side effects of the PD medication
Levodopa- madopar and sinemet
Anticholinergics (arpicoline)
COMT- inhibitors (entacapone)
84
What are the 3 types of cueing?
Kinesthetic
Visual
Auditory
85
How does cueing work?
Executing movement- primary motor cortex
Executing and planning movement- Premotor area (PMA) and supplementary motor area (SMA)
In PD, the SMA system is impaired, but the PMA system remains intact
86
What are the two types of rigidity?
Cogwheel- rigidity is intermittent throughout the movement
| Leadpipe- rigidity is constant throughout the movement
87
What is neuroplasticity?
How the nervous system changes and adapts to functional demands, new pathways are created in the brain
88
What is bolvarian degeneration
Degeneration of the peripheral nervous system
89
What is agnosia?
A condition where a person is unable to identify a person or object using their sensory reception
90
What are the different types of tone
Hypertonic- Dystonic- twisting, twitching and involuntary movements
Spasticity
Hypotonicity- athetoid- slow riding movements
Ataxic- uncoordinated movement and jerking movements
91
What is spina bifida
Congenital abnormality resulting in abnormality in the formation of the vertebral bodies
3 types - occulta- no protrusion
Meningocele- doesn’t affect the spinal cord so protuberance but no neurological affect
Myelomeningocele- protrusion and bulges into the spinal cord
92
What is the outcome measure for SCI
ASIA scale
93
What is the outcome measure for tbi?
Glasgow coma scale (GCS)
94
What is backwards kinetic chaining?
It is when the movement is broken down into smaller movements from a more stable source (being on the ground) to a less stable source (the process of standing up)
95
Why is backward chaining good
It prevents a long lay
It helps you get up from the floor
It helps them protect themselves if they feel like they are going to fall
They are able to fall better
