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PCE > Neurology > Flashcards

Neurology Flashcards

1
Q

Klumke Palsy

A
  • claw hand
  • C8, T1

MM effects: intrinsic hand mm, flex/ext of wrist and fingers

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2
Q

Median nerve Palsy

A
  • Ape hand

C6-8, T1

  • thenar mm: no thumb abduction/opposition
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3
Q

Impairments associated with Alzheimers, & what is preserved

A
  • impaired: memory, language, videos palatial skills, cognition, personality.
  • preserved: implicit skills ( piano playing?)
  • dx: via neurotic plaques at autopsy
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4
Q

What is vascular cognitive dementia?

  • how do we measure it?
A
  • multiple small lesions due to poor blood flow (high bp)
  • degeneration of medial temporal lobes (staircase pattern of functional loss)
  • htn, small hemorrhage, atherosclerotic plaque
  • outcome measure: mini mental state exam

PT concerns:
- falls, motor activities, sleep support

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5
Q

Types of seizures

A

1) primary Generalized seizure:
- bilateral and symmetrical
* * tonic-clinic = dramatic whole body
* * Absence seizure = brief, imperceptible 100x/day

2) Partial Seizures
* * Simple Partial = focal motor, focal motor with March, temporal lobe seizure (change in behavior)
* * complex partial = simple seizure followed by impaired consciousness

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6
Q

Erbs palsy

A

C5, C6 injury to infants –> birthing injury

  • waiters tip position

MM effects: rhomboids, lev scap, SA, delts, supra + infra spinatus, biceps, brachioradialis, brachialis, supinator, long ext of wrist, fingers thumb

Rx:

  • immobilize initially
  • gentle rom + play exercises
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7
Q

CVA & TIA defined.

A

Strokes
Cerebral vascular accident

Transient ischemic attack

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8
Q

Stroke s/s?

A
  • Sudden numbness or weakness of face, arm or leg
  • confusion, dizziness
  • trouble speaking or understanding words
  • trouble seeing out of one or both eyes
  • trouble walking
  • loss of balance and coordination
  • headache with no known cause
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9
Q

Stroke: risk factors (non/ modifiable)

A

Non modifiable:
- age (risk doubles after 55), M>F, FMHx, previous TIA

Modifiable:
- HTN, CAD, DM, cholesterol, smoking, obesity, drugs, birth control??

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10
Q

2 Stoke classifications?

A

Ischemic stroke:
- 80%, caused by thrombosis, embolic lacunar infarct (deep area of brain, commonly related to DM and HTN)

Hemorrhagic stroke:
- 20%: Aneurysm and AV malformation, often occurs in younger ppl, majority occur in cerebral cortex.

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11
Q

Ischemic stroke: response after injury + Rx

A

Response:

  • death of tissue where there is no blood (core death)
  • possible preservation of area surrounding core that is supplied by collaterals (ischemic penumbra)
  • release of glutamate, Ca2+, edema, O2 free radicals, degeneration

Rx:

  • TISSUE PLASMINOGEN ACTIVATOR (TPA) within 3 hrs (dissolves clot)
  • Sx to remove clot

** cerebellum and hippocampus are ++sensitive to ischemia

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12
Q

Hemorrhagic stroke: Rx

A

Rx:

  • Surgery to stop the bleed
  • Better long term prognosis for recovery of function than ischemic
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13
Q

What type of stroke has better long term recovery?

A
  • hemorrhagic
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14
Q

Tool used to predict progression and risk of reoccurrence of stroke?

A

ABCD score:

A = age
B = blood pressure
C = Clinical features (hemiplegia, speech problems)
D = duration
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15
Q

4 common way to prevent reoccurrence of stroke

A
  • anticoagulant (ASA)
  • lipid lowering agent
  • lifestyle change
  • exercise
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16
Q

Stroke: prognostic indicators?

A
  • location, extent, duration
  • ability to move fingers (pyramidal motor output intact [white tracts are not plastic])
  • cortical (mostly grey matter) vs. Subcortical (white and grey) [grey matter is capable of functional reorganization
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17
Q

Features of a TIA

A

Transient ischemic blockage of circulation

  • mild s/s,
  • resolves usually within 24 hrs
  • high recurrence (80%) within a year
  • can have lasting damage
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18
Q

Brainstem stoke consequences

A

Very disabling; takes out ascending and descending tracts

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19
Q

What is a TBI? + accompanied by?

A

Traumatic brain injury:
- change in brain function due to external force

Accompanied by:
- dec or LOC, impaired cognition, physical function, emotional or behaviour changes

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20
Q

TBI classification

A

1) Closed: no skull# or laceration of the brain, meninges not breached (does not require hitting head)
2) Open: Meninges breached, exposed brain or laceration

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21
Q

TBI mechanisms

A
  • Coup (primary mechanical injury)
  • Contracoup (secondary mechanical injury): ischemia + edema
  • DIA (diffuse axonal injury): sheering from rotary forces in areas of density change (white and grey matter)
  • Contusion
  • Anoxic injury forces
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22
Q

Differentiate between primary and secondary brain injury

A

Primary:
- direct damage from mechanical forces, focal or diffuse

Secondary:
- circulation deficits (bloodflow

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23
Q

4 type of brain hematomas

A

Epidural:

  • Arterial bleed outside the dura
  • temporal or tempoparietal most often
  • 90% with skull#

Sub-dural:

  • Venous bleed b/w arachnoid and dura mater
  • Rx: surgery (burr holes/ craniotomy)

Sub-arachnoid:
- fatal b/w arachnoid and pia mater

Intra-cranial:
- most common, blood within the brain under the pia mater

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24
Q

ICP: values + how to monitor

A

Normal = 0-10mm Hg, >20 for 5 mins is very bad

How to Monitor:

  • extra ventricular drain ( need stop cock to avoid back flow)
  • sub-arachnoid/dura bolt
  • intraparenchymal monitor
  • epidural sensor
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25
Q

Cerebral perfusion pressure (CPP): how to calc + normal value + strategy to maintain it.

A

CPP = MAP - ICP / cerebral vascular resistance

Goal: 70-100 mm Hg

Maintain by keeping HOB at 30 degree to keep MAP above 80
- also helps with ventilator acquire pneumonia

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26
Q

Basal skull # s/s?

A
  • blood or CSF out of nose or ears
  • raccoon eyes
  • bruising over mastoid (battle sign)
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27
Q

Frontal lobe injury s/s?

A
  • poor planning, judgement, disinhibition
  • brocas aphasia (poor language production)
  • altered manners, morals, emotions
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28
Q

Parietal lobe injury s/s

A
  • somatosensory function alterations in touch, temp, positional awareness
  • language comprehension (wernickes)
  • motor planning issues (apraxia)
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29
Q

Temporal lobe injury s/s?

A
  • Comprehensive receptive aphasia (Wernicke’s + Broca’s)
  • memory impairment
  • auditory processing issues
  • integration and regulation of emotion, motivation and behaviours
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30
Q

Occipital lobe injury s/s

A
  • visual problems + visual field deficit

- Contracoup injury more so than coup

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31
Q

Traumatic brain injury: PT related issues

A
  • Respiratory issues
  • ICP control
  • abnormal posturing
  • decreased mobility
  • Contracture’s
  • confusion/ agitation
  • fatigue
  • family stress
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32
Q

Respiratory issues post TBI + Rx

A
  • Decreased LOC, comprimised respiratory centre, ++ oral secretion
    Rx:
  • manual tech/ suctioning (O2 always 100%, only suction for 10secs)
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33
Q

ICP control post TBI: Rx

A
  • maintain neural head positioning at all times
  • keep Rx short
  • Head down posture for drainage is CONTRAINDICATED
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34
Q

Abnormal posturing post TBI: types + Rx

A
  • Decerebrate posturing: UE + LE in extension = Brainstem damage (mid brain) and cerebellum lesions
  • Decorticate posturing: Arms flexed, legs extended = cerebral, thalamus, cord, CST damage.

Rx: ICP

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35
Q

Decreased mobility post TBI: Rx,

A
  • Sit and dangle when medically stable
  • tube feed off 20 mins prior to mobilizing
  • early mobilization to prevent heterotrophic ossification

Caution: DVT, PE, hyper metabolism

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36
Q

Contractures post TBI: Rx

A
  • place muscles in lengthened position 20 mins - 12 hours a day
  • resting splints, casting, PROM
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37
Q

Concussion definition + s/s?

A
  • Complex pathological process affecting the brain, induced by traumatic biomechanical forces
  • mild form of brain injury (TBI)

S/s:

  • loss of consciousness maybe
  • behavioural change (emotions)
  • cognitive impairment (thinking/ planning ahead)
  • sleep disturbance, dizziness, irritability, memory, visual change
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38
Q

What is 2nd impact syndrome?

A
  • Rare/ fatal uncontrolled swelling of brain

- minor 2nd blow before initial symptoms are resolved

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39
Q

Glasgow come scale: categories, score

A

3 categories: eye opening, verbal response, motor response

Total score out of 15, usually done in acute injury

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40
Q

Rancho Levels of Cognition details

A

Good predictor of functional outcome after injury (1-10)

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41
Q

Causes of ‘traumatic’ and ‘non-traumatic’ SCI?

A

Traumatic:

  • Falls (40%), transport, sport
  • M>F, 15-35
  • 18% are T-spine, Lspine complete, 40% C-spine incomplete

Non:

  • cancer, infection and inflammation (TB), motor neurone disorders, vascular disease, congenital
  • M>F, 50-60yr
  • most are paraplegia
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42
Q

SCI early management focus:

A
  • spinal stability
  • limiting neurological deficit and promote recovery
  • minimize complications
  • create environment for spinal column to heal
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43
Q

Definition of myelopathy

A

Refers to pathology of the SC… When due to trauma its SCI

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44
Q

What is spinal shock? + s/s?

A
  • temporary suppression of all reflex activity below level of injury, can last months

S/s:

  • Areflexia
  • flaccid paralysis
  • ** thought that return of the sacral reflexes mark beginning of spinal resolution
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45
Q

Neurological shock: details + s/s

A
  • body’s reaction to sudden loss of sympathetic control
  • injuries above T6

S/s:

  • decreased vasomotor tone = hypotension and hypothermia despite normal blood volume
  • bradycardia (because of unopposed vagaries stimulation of heart)
  • can lead to metabolic issues
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46
Q

What do the doctors mobility orders mean?

A

“Spine unstable”: column is assumed unstable, +/- neuro deficits
PT must:
- Maintain neutral spine, bed rest, HOB at zero, 2-3 person turns

“Spine Stable”: but needs protection
PT: maintain neutral spine, pt can turn independently, mob + rehab ok

“Spine stable- no restrictions”

  • all movements okay within comfort limits
  • watch for BP changes
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47
Q

ASIA impairment scale:

A 
A = Complete: No motor or sensory function in the sacral segments S4-5
B = Incomplete: Sensory but not motor function is preserved below the neurological level and includes S4-5
C = Incomplete: motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade LESS than 3
D = Incomplete: motor function is preserved below the neurological level, atleast  than half of key muscles below the neurological level have a muscle grade of 3 or MORE 
E = Normal: motor and sensory functions are normal
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48
Q

5 common clinical SCI syndromes

A 
Central cord
Brown squared
Anterior cord
Conus medulla ribs
Cauda equina
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49
Q

ASIA UE myotomes

A 
C5: abd, elbow extensor
C6: wrist extension
C7: elbow extn
C8: thumb ext
T1: finger abd

Sacral function:
- voluntary anal contraction: if present indicated MOTOR INCOMPLETE (ASIA C)

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50
Q

Level of lesion defined….

A

Defined as the most caudal segment with normal sensory and motor function on both sides of body

  • sensory level: most caudal segment w/ bilateral score of 2 for both pin prick and light touch
  • Motor level: most caudal segment with a grade 3 or more provided all segments above are level 5.
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51
Q

Anterior cord syndrome

A

Loss of anterior 2/3 of cord:

  • Loss of motor, pain and temp below injury level
  • preservation of dorsal column ( proprioception, vibration)
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52
Q

Central cord syndrome

A

Most common SCI syndrome

  • UE motor and sensory function more impaired than LE
  • often associated with spinal canal stenosis
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53
Q

Brown sequard syndrome:

A

One side cord more damaged than the other

  • ipsilateral loss of motor function and dorsal column (proprioception, vibration) [ they cross in medulla]
  • Contralateral loss of P and temp sensation a few levels below lesion
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54
Q

Caudal equina syndrome

A

Spinal cord terminates at L1-2

LMN lesion s/s
- Areflexia, and flaccid bladder and bowel

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55
Q

SC tracts:

A

Lateral spinothalamic: Pain + temp
Anterior spinothalamic: Crude touch + pressure
Dorsal columns: Fine touch, stereogenesis, vibration
Lateral corticospinal: 90% cross in the pyramid
Anterior corticospinal: the 10% that crosses at the level of innervations

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56
Q

SCI effects on respiratory function:

  • coughing
  • Independent breathing
A

Cough function:
- C1-C3 = absent, C4-T1 = non functional, T2-T4 = poor, T5-T10 = weak, T11 and below = normal

Independent breathing: Need C4 intact

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57
Q

SCI effects on respiratory function:

What innervations are needed for normal vital capacity?

A

T11 and below

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58
Q

SCI effects on respiratory function:

- mm innervations for breathing

A

C2-C7: accessory mm of breathing
C3-5: Diaphragm
T1-T11: intercostals
T6- L1: abdominals

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59
Q

C1-C4 SCI:

  • pattern of weakness
  • possible movements
  • mm innervated
A
  • paralysis of trunk and UE, probably diaphragm
  • neck movements, slight shoulder retraction + abduction
Full:
- C1-C3: SCM, neck extensors + flexors
- C2-C4: traps
Partial:
- C3-C5: Lev scap, diaphragm, supra/infraspinatus
- C4-C5: Rhomboids
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60
Q

C1-C4 SCI: PT management

A
  • ROM
  • Spasticity management
  • neck strengthening
  • chest physio
  • prevent contractures
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61
Q

C5 SCI:

  • pattern of weakness
  • possible movements
  • major mm innervated
A
  • significant imbalance around the shoulder girdle + no elbow extension, wrist pronation/flex/extn or any hand movement
  • possible: shoulder abd/flex/extn, elbow flex/supination, scap add/abd

Full:
- All of the C4 mm + diaphragm, Rhomboids, lev scap
Partial:
- deltoid, biceps, brachioradialis, teres minor,

62
Q

C5 SCI:

- hand function details

A

Rx: splints and universal cuffs (no antagonist to flexion)

  • possibly tenodesis grip with forearm supination and pronation to achieve wrist flexion and extension
63
Q

innervations:

  • lev scap
  • Rhomboids
A

C3-C4 Dorsal scapular

C4-C5 dorsal scapular

64
Q

What level of SCI does a patient have a chance to live in the community?

A

C6 = chance to live w/o care

65
Q

C6 SCI:

  • pattern of weakness
  • possible movements
A
  • no wrist flexion, elbow ext, hand mov’t

Possible:

  • radial wrist ext, horizontal adduction
  • elbow ext via shoulder ER
  • TENODESIS grip permitting a weak grasp without hand movements
66
Q

C6 SCI:

  • mobility and transfers ability
  • PT role
A
  • slide board transfer possible, manual w/c possible

PT: functional strength, movement tricks, ROM, equipment,
- Lats, serratus and pecs allow weight bearing through extremity and hamstring length will allow them to sit upright and free up their hands

67
Q

C7- C8 SCI:

  • pattern of weakness
  • possible movements
  • Hand function
A
  • limited grasp/release/ dexterity due to lack of intrinsic mm of hand
  • possible: elbow extn (C7), wrist extn, DIP/PIP flex, MP Flex (C8)

Hand:
Descent hand function but no fine motor control
- C7: need to use more tenodesis grip
- C8: more finger flexors, some thumb flexion (no lumbricals)

68
Q

Having an intact tricep will impact a SCI patient in what way?

A

Triceps allow independent transfers, manual w/c, independent in most ADL’s

69
Q

T1-9 SCI (thoracic paraplegia)

- presentation

A
  • Lives in community using a w/c
  • has intact UE function
  • Respiratory function compromised above T6
  • Can stand in a standing frame
  • possible trunk spasticity
70
Q

T10-L1 SCI:

  • respiratory function?
  • living and mobility status
A
  • normal cough, respiratory fxn intact
  • independent community dweller
  • limited ambulation may be possible with bracing
71
Q

L2-L5 SCI:

A
  • intact trunk
  • sparing of LE muscles allows for potential of functional walking
  • need brace and grade 3 quads to walk w/o KAFO
  • cauda equina = hidden disability = Areflexia bladder and bowel and flaccid paralysis
72
Q

Autonomic effects of SCI on heart and lungs:

- sympathetic NS: location + effects

A

” fight of flight”
- Chain T1-T11

Effects:

  • increase HR, BP, blood flow to skeletal mm
  • relaxes bronchial mm (allowing an increase in O2 supply)
73
Q

Autonomic effects of SCI on heart and lungs:

- Parasympathetic NS: location + effects

A

“Craniosacral”
- mainly interested in the Vagus nerve

Effects:

  • Decrease HR and contractility
  • Increases blood flow to smooth mm (rest and digest)
  • contracts bronchial mm
74
Q

General effects of injury of T6 and above:

  • Sympathetic effect
  • parasympathetic
  • effects on heart
A

Sympathetic:
- very dependent on level of injury (T1-L1 chain)
Parasympathetic:
- remains intact and UNOPPOSED via the vagus nerve in SCI T6 and up. = valgus nerve withdrawal rather than sympathetic drive (normally sympathetic increase HR bit it is no longer intact ,so u must rely on removing parasympathetic)

Heart:

  • limited CO + shunting of blood
  • Blunting of HR 110-120
75
Q

Autonomic dysreflexia:

A
  • caused by a massive sympathetic discharge from a noxious stimuli below the level of SCI (with injuries T6 and up)
S/S:
- BP increase 20-30 mmHg, bradycardia, severe headache, blurred vision, anxiety, dilated pupils, cool/dry pale skin (vasoconstriction) below injury, sweating
Causes:
- bladder/ bowel irritation
- wound, etc

Rx/ prevention:

  • position upright
  • remove stimuli, use drugs
  • good bowel and bladder routines
  • skin and nail care
76
Q

Orthostatic hypotension: definition + s/s + Rx:

A
  • SUDDEN drop of 20mmHg of SBP, or 10 of DBP

S/S:
- asymptomatic, Dizziness, fainting, lightheaded, headache

Rx:

  • mobilize slowly with therapy
  • use compression stockings etc
77
Q

List of common health risks associated with SCI

A
  • DVT and PE
  • Heterotrophic ossification
  • osteoporosis
  • post traumatic syringomyelia
78
Q

SCI injury and DVT/PE: why + s/s + prevention

A
  • due to venous stasis, transient hypercoagulable state

S/s: sudden LE swelling + increase temp

Prevention:

  • anticoagulation meds
  • compression stockings
  • Sequencial compression devices
  • AROM
  • early mobilizations

PE tachycardia may be masked by parasympathetic dominance

79
Q

SCI and heterotrophic ossification:

  • 2 Rx contraindications:
  • s/s
  • Rx
A

Contraindications:
- Forced PROM or serial casting

S/s: 
- pain, increased spasticity, warmth/ fever, erythema, swelling, sudden decrease in ROM with abnormal hard end-feel
Rx:
- PROM within tolerable range + mobility
- meds
- surgery
80
Q

SCI and Osteoporosis:

  • why
  • consequence
A

Due to Rapid increase in calcium excretion within a few days of SCI
- large incidence of #, especially LE

81
Q

SCI and post traumatic syringomyelia:

  • pathology
  • s/s
  • Rx:
A

Formation of an abnormal tubular cavity in the spinal cord

  • dura tethers/scars to the arachnoid blocking CSF flow
  • CSF is forced into the spinal cord, progressively enlarging the cyst
  • leads to compression of cord + vascular supply

S/s: pain, sensory/motor changes, increase spasticity, B & B dysfunction, increased AD, hyperhydrosis

Rx: surgery

82
Q

What are the two tests for spasticity?

A

Modified ashworth + Tardieu

83
Q

spasticity: defined + clinical presentation

A
  • velocity dependent resistance to passive stretch

Characteristics:

  • increase mm tone
  • increase stretch reflex
  • uncontrolled movements

Rx:

  • Meds: intra thermal baclofen, Botox
  • therapeutic exercises
84
Q

Spasticity: pros and cons

A

Pro:

  • maintain mm bulk, venous return,
  • possible reflex erection

Cons:
- Contracture’s, pain, positioning issues, fatigue

85
Q

Spastic bladder:

  • Location of injury
  • presentation
  • management
A

Injury is above the conus
Msg will continue to travel btw bladder and spinal cord since reflex arc is still intact

Bladder can be trained to empty on its own
Rx: intermittent catheter or condom/foley drainage

86
Q

Flaccid bladder:

  • injury location
  • pathology
  • consequences
  • Rx
A

Injury above T12 in conus and cauda equina injuries

  • messages don’t travel btw SC and bladder because the reflex centre is damages
  • bladder looses ability to empty reflexively

Rx: must be catheterized b/c bladder will continue to fill

87
Q

Difference between spastic and flaccid bowel:

-

A

Spastic = functioning peristalsis and reflex propulsion, reflex contraction of sphincter can lead to stool retention.
- Rx: suppository or digital stim for voiding

Flaccid:
- slow stool retention, incontinence, no reflex

88
Q

UMN vs LMN lesions and sexual health

A

UMN lesion = reflex and spontaneous erection but no ejaculation (reduced fertility)

LMN = psychogenic erection possible, but reflex and ejeculation not possible

89
Q

3 types of pain experienced by SCI patients?

A

Neuropathic:
- stabbing/burning pain not changed by position or activity- Rx: medication

Nociceptive:
- dull, crampy ache, altered by position and activity - Rx: modalities, exercise, STR, education, posture, positioning

Chronic:
- 2/3 of SCI have chronic pain - Rx: education, exercise, interdisciplinary team

90
Q

SCI and exercise precautions

A

Decreased sympathetic impact:
- HR and BP will not have normal response (expect level similar pre and post)

  • Use RPE and Borg
  • watch for orthostatic hypotension
91
Q

SCI and respiration:

  • what position is ideal diaphragm length/tension curve
  • how does sitting affect VC
  • effect of the injury on lung volumes
A
  • diaphragm best when lying
  • decreased VC in sitting compared to supine
  • all lung volumes decrease except residual volume
92
Q

Tumours: types of Rx

A

Surgery, radiation, chemotherapy, bio therapy, antiangiogenic, hormone therapy

93
Q

6 common types of tumours

A

Epithelial = carcinoma

  • Mesenchymal = sarcoma (loose connective tissue from mesoderm)
  • Glial = glioma (most common brain tumour)
  • lymphoid = lymphoma
  • hematopoietic = leukemia
  • Melanocytic = melanoma
94
Q

Common lung carcinomas

A
  • Squamous metaplasia
  • squamous diplasia
  • carcinoma in situ
  • invasive carcinoma
95
Q

Rate of death with colon cancer

A

2nd highest cause of death

96
Q

Breast Ca risk factors + sx side effect

A
  • hormonal and genetic risk factors

- Axillary node dissection common

97
Q

Prostate Ca Tx?

A

Sx, radiation, brachytherapy, androgen deprivation therapy

98
Q

Common Cancers in kids

A
  • Acute lymphocytic leukemia
  • non-hodgkins + Hodgkin’s lymphoma
  • brain Ca
  • sarcoma: osteosarcoma, Ewing’s sarcoma
99
Q

Skin cancer: types + risks

A

Basal cell carcinoma (BCC)
- most common skin Ca, low risk of spreading, translucent and red

Squamous cell carcinoma (SCC)
- solid skin tumor (volcano shape), high risk of metastasis

Malignant melanoma:
- most dangerous skin Ca, high risk of metastasis, ABCD rule (>6mm)

100
Q

Duchenne’s muscular dystrophy:

  • pathology
  • effects
  • Dx
A

X-link mutation on chr 21, M>F, maternal carrier
- dystrophin protein is not produced (structural component within mm) causing tissue to be prone to damage and necrosis.

Effects:

  • mm is replaced by fat and connective tissue
  • progressive symmetrical wasting
  • w/c by 12… RIP by ~ 20

Dx: genetic testing, physical exam, CK levels

101
Q

Duchenne’s muscular dystrophy:

  • classic signs
  • s/s
  • Rx
A
  • Gowers sign: pushing through thighs to stand from floor
  • Calf pseudohypertrophy: Defined calves by fat and CT

S/s: mm wasting, waddling gait, toe walking, lordosis, difficulty getting getting up and doing stairs, falls, low IQ

Rx:

  • maintain strength and balance (no eccentrics)
  • respiratory therapy
  • prevention of contractures, seating, equipment
102
Q

types of muscular dystrophy other than duchennes

A
  • Beckers = slower and progressive form of DMD
  • Congenital
  • myotonic
  • spinal mm atrophy: skeletal mm weakness due to anterior horn degeneration. S/s = hypotonia, dec fxn, weakness, fatigue
103
Q

ALS:

  • defined
  • etiology + disease course
A

“Amyotrophic lateral sclerosis”
- motor neurone diseas with gradual deterioration of both UMN and LMN. Presents with both flaccid and spastic paresis

  • M > F, etiology is unknown
  • 2-5 yrs post Dx (only 10% survive 10 years)
104
Q

ALS:

- s/s

A

S/s:

  • Paresis in a single muscle group
  • mm groups are assymetric ally affected
  • fasciculations (twitch)
  • metabolic issue of skin (papery, fragile, cold)
  • gradual involvement of striated mm
  • flaccid + spastic can co-exist
  • “selective sparing” no ocular, cardiac, urethral, and anal sphincter
105
Q

ALS:

  • Dx
  • Rx
A

Dx: physical exam, medical Hx, mm biopsy

Rx: meds, rehab for mobility, symptom relief (spasticity, secretions)

106
Q

Essential tremor:

  • defined
  • causes
A
  • evoked by voluntary movement

Causes = genetic / increase thalamus activity

107
Q

What is dystonia? + what is it linked to? + causes?

A
  • Involuntary, sustained muscle contraction, writhing
  • linked to a single repetitive action (musicians)

Causes: genetic, different brain origins.

108
Q

Parkinson’s: defined/ pathology

A

Chronic neurodegenerative disease in the basal ganglia

  • Decreased dopamine produced by Substantia nigra
  • dopamine normally inhibits Ach but without dopamine = excessive excitatory output
109
Q

Parkinson’s: Classic s/s? + others

A
  • Bradykinesia = slowness, can result in freezing
  • Resting tremor
  • Rigidity (velocity independent resistance to passive stretch)
  • Postural instability

+ mask face, loss of automatic movement, micrographia, hypokinesia, depression, dementia, postural hypotension, pain, sleep disturbances, fatigue, fine motor control

110
Q

Parkinson’s: Rx + outcome measures

A
  • Drugs: L-dopa + anticholinergic (cause mov’t tremor)
  • education: exercise as protection
  • functional mobility: BIG movements (cueing, posture, cardioresp, falls prevention)
  • prevent secondary sequelae
  • equipment
  • environment safety

Outcome measures: UPDRS + Hoens and Yar

111
Q

Huntington’s Chorea: defined

A

Hereditary disorder of atrophy of basal ganglia + personality + dementia

  • can’t stop moving + abnormal movements

Rx: symptom management + antipsychotic drugs, safety, nutrition

112
Q

Multiple Sclerosis: defined + etiology and onset

A
  • inflammatory disease: fatty myelin sheaths around brain + SC axons are damaged. Leads to demyelination + scarring
  • etiology is unknown, onset 20-40’s F>M
113
Q

Multiple sclerosis: types

A 
Relapsing Remitting:
- new/old symptoms resurface or worsen
- full/partial recovery relapse, each flare up may cause more loss of fxn
Primary Progressive:
- Gradual worsening of symptoms overtime
- no remission but may stabilize
Secondary Progressive:
- Begins as "relapsing remitting" but steadily worsens
- does not remyelinate
Progressive Relapsing:
- steady progression with attacks
114
Q

Multiple Sclerosis: symptoms (early)

A
  • mm weakness
  • optic neuritis + diplopia
  • sensory changes (paraesthesia)
  • b/b incontinence
  • vertigo
  • fatigue
  • impaired cognition
  • pain
  • depression
115
Q

Multiple Sclerosis: Rx + contraindications

A

Pharmaceuticals:
- anti-inflammatories + immunosuppressant (heat intolerance side effect)

PT:
- Vestibular dysfunction, proprioception, exercise (pool?)

Avoid: Heat, fatigue, pregnancy

116
Q

Lyme disease: defined

A

Bacterial infection “borrelia burgdoferi”, via Ticks
- mimics: MS, GB, fibromyalgia, chronic fatigue syndrome

Stages:

  • localized erythema + flu-like s/s
  • neuro (headache + neck stiff), msk + cardiac issues
  • Bell’s palsy?
  • final stage = long term neuro + arthritis + cognitive deficits

Rx: antibiotics
- PT: relieve pain + exercise to increase strength without exacerbating symptoms

117
Q

Guillain-Barré syndrome:

A

Antibody mediated demyelination of Schwann cells in PNS from spinal nerves to terminating fibers

Cause: immune disorder, 2/3 ppl had recent illness in last 30 days

S/s:

  • onset to peak = 4 weeks
  • rapid ascending motor weakness and distal sensory loss (arms, trunk, face)
  • absent DTR
  • may require ventilation

Rx: meds = immunoglobin, Plasmaphoresis
PT: joint protection, chest tx, mobilize, strength, ROM

118
Q

Meningitis: defined + potential results + types

A

Infectious disease causing inflammation of meninges (pia,arachnoid, dura)
- Can lead to thrombosis, infarction, scars, edema

Types:

  • Aseptic (fungus, virus, parasite,herpes simplex2, Epstein Barr, lupus)
  • Tuberculosis: abscess or edema
  • Bacterial: in child its an emergency
119
Q

Meningitis: s/s + Rx

A

S/s:

  • Brudzinski sign: flexed hip + knees causes neck to involuntarily flex
  • fever, headache, seizure, vomiting
  • focal CNS signs: nerve palsy, deafness, pain w/ hip or knee flexion

Rx:
Antibiotics/vitals

120
Q

Encephalitis: Defined + s/s + result

A

Infection of the brain, SC, brain parenchyma

S/s:

  • headache, LOC, Coma
  • nausea, vomiting
  • agitation
  • meninges like irritation
  • stiffness

Result: necrosis, hemorrhagic necrosis, scaring

121
Q

Creutzeldt Jakob disease: presentation + pathology

A

Movement disorder/dementia: progressive and fatal

Pathology:

  • caused by prions (misfolded proteins) = mad cow disease = bovine spongiform encephalopathy
  • contracted by ingestion or via the nose
  • incubates 5-8 years
122
Q

Post-Polio Syndrome: defined + initial/later effect

A

Attacks neurons in the Brainstem + anterior horn cell of SC

Initial effect: death of motor neurons controlling skeletal mm
- some survive, if so there is some recovery via larger motor units

Later effect: high metabolic stress on larger motor units
- gradual deterioration of sprouted fibres = mm weakness and paralysis

123
Q

Vestibular function + causes of dizziness

A
  • gaze stability
  • postural stabilization: balance and equilibrium
  • resolve sensory motor mismatch

Causes of dizziness:
- cardiovascular, neurological, visual, psychogenic, cervicogenic, meds, vestibular

124
Q

Common vestibular s/s + what medication affects vestibular system frequently

A

Vertigo = subjective experience of nystagmus (room spinning): occurs with BPPV

  • Dizziness = discrepancy between R and L side, patient can’t work out where they are in space: may not be vestibular in orgin
  • Oscillopsia: blurred vision

Med that effects vestibular = Gentomycin

125
Q

Differentiate b/w semicircular canal vs Otoliths

A

Semicircular Canals X 3 = horizontal, anterior, post

  • fx: gaze/angular displacement of head
  • movement of endolymph will deflect hair cells and excite or inhibit CN VII neurons

Otoliths X 2 = Utricle (horizontal plane), Saccule (sagittal plane motion)
- together detect acceleration and deceleration + pull of gravity, important for posture

126
Q

BPPV: common presentation, s/s + Ax + Rx?

A

90% present with crystals in posterior SSC, 80% canalithiasis (free floating in canal)
S/s:
-brief (

127
Q

Menieres Disease: defined + s/s

A

Over accumulation of endolymph

S/s: episodic vertigo, tinnitus, fullness of ears, hearing loss

128
Q

What is VOR?

A

Vestibulo-occuluar reflex:
- moves your eyes in the opposite direction that your head is turning: allows visual fixation

  • deficient in UVL and BVL
129
Q

UVL: causes + s/s + tests + Rx

A

Causes: infection, trauma, disease (menieres), sx

S/s acute:
- spontaneous nystagmus away from the affected ear, reduce VOR, vertigo (resolves in a few days), dizziness, Oscillopsia, imbalance
S/s Chronic:
- dizziness, Oscillopsia, imbalance (symptoms worse after rapid head movements)

Tests: head thrust, dynamic visual acuity, balance and gait assessment + Dix hall pike
Rx: conflict resolution exercises (balance, walking etc), education, falls, fitness

130
Q

BVL: features + s/s + Ax

A
  • no dizziness or vertigo and usually caused by toxic drugs (GENTIMICIN)

S/s: poor balance with eyes closed + increased Oscillopsia

Ax: balance = static, dynamic, composite
Gait Ax: DGI style

131
Q

Central vestibular loss: causes, Redflags, Rx

A

Causes: stroke, TBI, MS, tumor, neurodegenerative, etcetera

Redflags: direction changing nystagmus

Dx: collection of oculomotor tests
Rx: based on neuroplasticity (exercise, habits, balance, walking, functional tasks)

132
Q

Cervicogenic dizziness: Rx

A
  • Manage vestibular dysfunction
  • proprioception of neck symptoms
  • motor control + endurance (DNF)
133
Q

Acoustic Neuroma: features

A

Aka “ vestibular Schewannoma”

  • intracranial tumor of Merlin around CN VIII
  • causes central vestibular loss
134
Q

Peripheral neuropathy: defined + causes

A

Injury to peripheral N due to damage or illness

Causes:

  • Lyme disease
  • Diabetes
  • HIV
  • Shingles
  • Guillain-Barre
135
Q

Diabetic neuropathy: presentation + causes

A

Symmetrical distal polyneuropathy

Causes:

  • hyperglycaemia leading to abnormal micro-circulation
  • change in insulin levels alter gene regulation
  • lose of myelinated + non-myelinated fibres
  • vascular changes
  • nerve growth reduced
136
Q

Diabetic Neuropathy: s/s + Rx

A

S/s:
Burning pain, symmetrical sensory changes, paraesthesia (impaired proprioception/touch/pressure), minimal motor weakness

Rx:

  • control hyperglycaemia
  • skin care
  • exercise: strength (ankles + hips to prevent falling), balance, injury prevention
137
Q

Complex regional pain syndrome: cause + s/s

A

Result of dysfunction in central or peripheral nervous system usually post immobilization or trauma

S/s:

  • change in color/temp of the skin over the affected limb
  • intense burning pain
  • skin sensitivity
  • sweating
  • swelling
  • stiffness
138
Q

CRPS: stages + Rx

A
  1. Puffy swelling, red, warm, stiff, allodynia, +ve bone scan
  2. Inc pain + stiffness, firm edema, cyanosis, atrophy, osteopenia on xray
  3. Tight, smooth, glossy, cool, pale skin + stiff contractures, nail and hair changes + severe osteoporosis

Rx: early ROM, pain + edema management, education, desensitize

139
Q

Cerebral palsy: co-morbidities + Risk factors

A

Co-morbidities:

  • hearing and speech
  • hydroencephaly
  • scoliosis
  • hip dislocation
  • mental retardation

Risk factors:

  • pre-natal infection, malnutrition, maternal seizures
  • perinatal prematurity, breech/complicated birth
  • low birth weight, low APGAR score,
  • post natal infection, toxins, tumor, CVA, anoxia
140
Q

Cerebral palsy classifications + features

A

1) Spastic:
-mono,di,hemi,quadri-plegia.
Classified by physiology type: stiffness, dec ROM, movement limited to synergies. Primitive movement patterns- trouble start/stopping
2)Ataxic:
- Rate, range, force duration of movements
- difficulty with rapid movements, coordinated gait, fine motor or balance
3) Dystonic:
- Increased tone, long sustained involuntary movements and postures
- full ROM but tend to lock joints at end range (no mid control)
4) Hypotonia:
- low tone and weakness
5) Athetoid:
- writhe ring movements/ snake like

141
Q

CP: pathology

A

“Not consistent”

  • intra ventricular hemorrhage = below lining of ventricles
  • peri ventricular leukomalacia = common ischemic injury
  • small holes surrounding ventricles = death of small brain areas
142
Q

CP hip dislocation warning signs + features

A

Query if cannot abduct legs more than 45 degrees

Features:

  • Pain ++, hard to stand/walk
  • spasticity of adductor long us and iliopsoas
  • dislocated posteriorly, pelvic obliquity and scoliolis
143
Q

Cerebral palsy: Rx

A

Med Rx:
- bacolfen pump, dorsal rhizotomy (cut dorsal roots of SC),Botox to adductors, serial casting, tendon release, osteotomy

PT Rx:

  • manage atypical mm: ROM + orthotics
  • “habituation not rehab”
  • positioning, sitting modifications: pummel between legs
144
Q

Spina bifida: defined + types + risk factor

A

Neural tube defect resulting in vertebral and/or SC malformation

  • Spina Bifida Occulta = no SC involvement, may be indicated by hairy tuft
  • Spina Bifida Cystica = visible open lesion
  • Meningocele = tumor/cyst includes CSF, cord intact
  • Myelomenigingcele = cyst includes CSF and herniated cord tissue

Link b/w maternal folic acid + infection + exposure to teratogens

145
Q

Spina Bifida: s/s + Rx:

A

S/s:
- flaccid or spastic mm, muscle weakness, contractures, mm wasting, dec/ absent DTR, incontinence, hydrocephalus (chiari malformation), osteoporosis, lordosis, scoliosis, foot deformities (club foot)

Rx:

  • ROM, strnegth, functional exercises
  • teach transfers
  • equipment
  • encourage awareness of sensory deficits
  • limb protection
146
Q

Erb’s Palsy:

A

C5, C6 injury in infants, usually from coming out of birth

Mm affected:
- rhomboidal, lev scap, SA, delts, supra/infra spinatus, biceps, brachioradialis, brachialis, supinator, long extensors or wrist, fingers, thumb

Rx:

  • immobilization early
  • gentle ROM and play exercises
147
Q

Klumke palsy: nerves affected + mm

A

C8, T1

Mm affected:
- intrinsic hand mm, flex/ extensors of wrist and fingers

148
Q

Ape hand: nerves affected + mm

A

Ape hand = median nerve palsy = C6, C8-T1

mm affected:
- the air mm of thumb = no thumb abduction and opposition

149
Q

Alzheimer’s:

  • risks + etiology
  • impairments
  • preserved fxn
A
  • increased age + genetic link with unknown etiology

Impairments: “slow steady decline”

  • memory, language, visuospatial skills
  • cognition, personality

Preserved: implicit skills ( piano playing,etc)

Dx: autopsy via neurotic plaque formation

150
Q

Vascular Cognitive Dementia:

  • pathology
  • risk factors?
  • cause of death
  • outcome measure
  • Rx
A
  • multiple small lesions 2nd to poor blood flow (high BP), leading to degeneration of medial temporal lobes = “staircase pattern of functional losses”
  • related to: HTN, small hemorrhages, atherosclerotic plaque.
  • death usually from Pneumonia

Outcome measures: Mini mental state exam (MMSE)

PT concerns: Falls, retaining motor skills, reduce restlessness, increase sleep support for care givers.

PCE (9 decks)

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