Neurology W2 Flashcards
SCI, neurodegenerative disorders
What type of tract is the lateral spinothalamic tract and what does it carry?
Ascending tract (sensory)
Responsible for pain and temperature sensation.
What does the anterior spinothalamic tract primarily sense?
Crude touch and pressure
It is an ascending sensory tract.
Where does the dorsal columns (medial lemniscus) tract cross and what does it carry?
At the pyramid motor (medulla) in the brain stem
It is responsible for proprioception, deep touch, 2-point discrimination, and vibration.
What is the main function of the lateral corticospinal tract?
Motor function of limbs and digit musculature
It is the main motor pathway, comprising 90% of the corticospinal tract.
What is the consequence of an injury to the lateral corticospinal tract?
is it UMN or LMN?
loss of CL mvmt below the level of the lesion, spasticity will also present due to damage of UMN, 10% will not cross so some function remains
This indicates upper motor neuron lesions.
What are the common traumatic causes of spinal cord injury?
Hyperflexion, hyperextension, axial load, rotation, penetrating injury, falls, transportation
40% are cervical incomplete; tetraplegic & paraplegic are common.
Describe the interpretation of each asia grade
A = complete, no motor or sensory function is preserved in the sacral segments (S4-5)
B= sensory incomplete
C= motor incomplete (1/2 below 3)
D= motor incomplete (1/2 above 3)
E= normal
What immediate treatment can prevent secondary injury in spinal cord injuries?
prevention of edema through: Direct application of ice
It helps prevent edema, ischemia, hypoxia, and necrosis.
What causes decreased blood pressure in individuals with spinal cord injuries?
Decreased heart rate and limited cardiac output because parasympathetic system is no unapposed (sympathetic located between T1-L1)
autonomic dysfunction can result from injuries to level T6 and above.
What does the ASIA scale measure?
Neurological classification of spinal cord injury
It assesses sensory and motor function.
What is indicated by the presence of Deep Anal Pressure (DAP)?
if present, indicates Sensory incomplete injury (ASIA B)
If present, it indicates some sensory function below the neurological level.
What defines the Zone of Partial Preservation (ZPP)?
Dermatomes below the sensory level and myotomes below the motor level that remain partially innervated (only referenced in ASIA A)
It is referenced only in complete (ASIA A) injuries.
What characterizes Central Cord Syndrome?
Greater loss of upper extremity function compared to lower extremity function (bc it often occurs in Cspine)
Common in elderly individuals due to hyperextension injuries.
What is the main feature of Brown-Sequard Syndrome?
Ipsilateral loss of proprioception/vibration sense and motor control, contralateral loss of pain and temperature sensation
Results from compression of one side of the spinal cord.
What are the symptoms of Anterior Cord Syndrome?
Bilateral loss of motor function, pain, and temperature below injury level
Light touch and proprioception are preserved.
What distinguishes Conus Medullaris Syndrome?
Combined upper motor neuron and lower motor neuron features
Injury occurs at L1-L2.
What is characteristic of Cauda Equina Syndrome?
Lower motor neuron type injury with variable loss and areflexic bowel and bladder
It is a surgical emergency.
What actions does the Sympathetic Nervous System prepare the body for?
Fight or flight response
Increases heart rate and blood pressure, dilates arteries to skeletal muscle.
What is the primary interest of the Parasympathetic Nervous System?
Rest and digest functions
It conserves energy and maintains bodily functions.
What is autonomic dysreflexia?
A noxious stimulus below the level of lesion causing a reflexive sympathetic response leading to hypertension
It occurs in lesions above or equal to T6.
What are the signs of neurogenic shock?
Bradycardia, hypotension, hypothermia
Occurs due to loss of sympathetic vascular tone.
What is a typical treatment for hypotension in spinal cord injury patients?
Volume resuscitation and vasopressors
This counters loss of sympathetic tone.
What are common health risks associated with spinal cord injuries?
Pressure sores, poor secretion clearance, DVT & PE
DVT signs include sudden lower extremity pain, redness, swelling.
What are contraindications for heterotopic ossification in spinal cord injury patients?
Forced PROM and serial casting are contraindicated
Symptoms include pain, increased spasticity, warmth, low-grade fever.
What is a common sign of DVT?
Increased temperature and positive Homan’s sign
Homan’s sign is used to assess for deep vein thrombosis (DVT) by eliciting pain in the calf upon dorsiflexion of the foot.
What are the primary prevention methods for DVT?
- Anticoagulation meds
- Compression stockings
- Sequential compression devices
- PROM/AROM
- Early mobilization
These methods help reduce the risk of DVT in patients, especially after surgeries or injuries.
What is a significant consequence of osteoporosis following spinal cord injury?
Rapid increase in calcium excretion leading to a high incidence of fractures, especially in lower extremities
Osteoporosis is a common complication after spinal cord injury due to decreased bone loading.
What is post-traumatic syringomyelia?
Formation of an abnormal tubular cavity in the spinal cord
This condition can occur years after the initial spinal cord injury and leads to various neurological symptoms.
What are the signs and symptoms of heterotopic ossification?
- Pain (if sensory sparing)
- Increased spasticity
- Warmth
- Low grade fever
- Erythema
- Local swelling
- Sudden decreased ROM with an abnormal firm or hard end-feel
These symptoms can indicate the presence of heterotopic ossification.
What are the signs and symptoms of post-traumatic syringomyelia?
- Differences or increase in presentation of the injury
- Pain at level and spreading upwards
- Sensory changes
- Motor weakness
- Increased spasticity
- Bladder & bowel dysfunction
- Increased episodes of autonomic dysreflexia
- Hyperhidrosis (excessive sweating)
These symptoms are indicative of syringomyelia and may require surgical intervention.
What is a major cause of death in people surviving more than 30 years post spinal cord injury?
Cardiovascular disease (CVD)
CVD is a significant long-term health concern for individuals with spinal cord injuries.
What is the recommended frequency and intensity for aerobic exercise in SCI patients?
Minimum 2 days/week at moderate to high intensity; 60-80% HR using Karvonen formula
This exercise regimen is necessary for improving cardiovascular fitness in SCI patients.
What are the benefits of exercise for patients with spinal cord injury?
- Improved muscle strength/endurance
- Improved exercise tolerance
- Improved cardiovascular fitness
- Improved overall functional capacity in terms of self-care and mobility
Regular exercise is crucial for maintaining health and improving quality of life in SCI patients.
What is the role of aquatic exercises in managing muscle tone?
Aquatic exercises help reduce tone through slow passive movements
The buoyancy of water allows for easier movement and can aid in relaxation of spastic muscles.
What is the respiratory status of a patient with a C1-C3 spinal cord injury?
Ventilator dependent with vital capacity of 5-10%
Patients at this level of injury are unable to breathe independently due to paralysis of respiratory muscles.
What functional outcomes are expected for a patient with a C5 spinal cord injury?
- Independent use of power wheelchair with modified hand controls
- Potential for independent use of manual wheelchair on flat surfaces
- Able to maintain propped sitting position (locked elbows)
- Independent hand to mouth for feeding with adapted gripping aids
This level of injury presents significant challenges, but some independence can be achieved with adaptations.
What is the primary treatment for spasticity?
- Medications
- Intrathecal baclofen
- Botox for specific muscles
- Therapeutic exercise
These treatments aim to manage symptoms and improve function in individuals with spasticity.
What are the signs of upper motor neuron lesions (UMNL)?
- Limited and delayed atrophy
- Increased muscle tone
- Spasticity
- Hyperreflexia
These signs are indicative of UMNL and differ from lower motor neuron lesions.
What is amyotrophic lateral sclerosis (ALS)?
A progressive motor neuron degeneratio and death that affects both upper and lower motor neurons
ALS leads to muscle weakness and atrophy as the disease progresses.
what are some demographic and survival statistics of ALS?
*M>F
*onset 55-65
*only 10% survive 10yrs
what is Leu Gehrigs disease?
another name for Amyotrophic Lateral Sclerosis
What characterizes Parkinson’s disease?
Degeneration of dopaminergic neurons in the substantia nigra leading to decreased dopamine
This results in motor symptoms such as tremors and rigidity due to an imbalance with acetylcholine.
What is multiple sclerosis?
A chronic, progressive demyelinating disease of the CNS that is autoimmune in nature
MS leads to impaired neural transmission due to damage to myelin sheaths.
describe the gait pattern of a person with Parkinsons
loss of reciprocal arm swing, shuffle/festination, narrow BOS, freezing episodes
What are the effects of low levels of dopamine?
Low levels of dopamine result in Akinesia & Bradykinesia.
What is the consequence of high levels of acetylcholine?
High levels of acetylcholine create an excessive excitatory output, making movement difficult, resulting in tremor and rigidity.
what is Huntintons disease/chorea?
hereditary disorder that causes atrophy to the basal ganglia, personality disorder and dementia
what is the key difference between huntington’s disease and parkinson’s disease?
cognitive involvement, personality disorders in Huntingtons (can be dementia in both)
name a few different types of muscular dystrophies
- Beckers
- congenital
- facioscapulohumeral
- myotonic MD
- Emery-Dreifus
- spinal muscle atrophy
what are the key markers of duchenne’s muscular dystrophy?
*gowers sign
*calf pseudohypertrophy
what are s/s of DMD and when is it usually Dx?
*waddling gait
*toe walking
*inc lordosis
*frequent falls
*dec IQ
* visible sings present at 3-6 years
what is Friedrich’s ataxia?
progressive neurodegenerative disease affectig dorsal root ganglia, dentate nuclei and spinal cord - autosomal recessive.
*onset around 15yrs
What are cardinal features of Fredrichs Ataxia?
*progressive ataxia of gait and limbs
*dysarthria
*babinski
*peripheral neuropathy
*dec proprioception/vibration
*muscle weakness
what is werdnig-hoffman disease?
Is it fatal?
severe, inherited disease that leads to rapid motor neuron death in anterior horn, CN are also affected.
;eads to death before the age of 2 if not on breahting support
What type of disease is Multiple Sclerosis (MS)?
A chronic, progressive demyelinating disease of the CNS.
What causes damage to the myelin sheaths in Multiple Sclerosis?
Damage is due to autoimmune processes leading to demyelination and scarring.
What is a typical age of onset for Multiple Sclerosis?
Typical onset is between 20-40 years old.
What are the possible causes of ALS?
- Viral
- Autoimmune
- Toxic
- Genetic (5-10%, autosomal dominant)
- Drug induced
- Idiopathic
What is the average lifespan after a diagnosis of ALS?
Death typically occurs within 2-5 years.
What are the hallmark characteristics of Parkinson’s Disease?
- Resting tremor
- Rigidity
- Bradykinesia/Akinesia
- Postural instability
What are non-motor disturbances associated with Parkinson’s Disease?
- Pain
- Visual/spatial issues
- Sleep disturbance
- Depression
- Fatigue
- Dementia
What is the pattern of progression in ALS?
Weakness starts peripherally and moves centrally, with muscle groups affected asymmetrically.
What are the four types of Multiple Sclerosis?
- Relapsing Remitting
- Primary Progressive
- Secondary Progressive
- Progressive Relapsing
What are some exacerbating factors for Multiple Sclerosis symptoms?
- Heat
- Stress
- Pregnancy
- Infections
What is the importance of timing Parkinson’s Disease medications with exercise?
Timing is important to maximize beneficial outcomes.
What is Levodopa (Sinemet) used for in Parkinson’s Disease?
It converts into dopamine.
What are the adverse effects of prolonged use of Levodopa?
- Dyskinesias
- GI disturbances
- Restlessness
- Anxiety
- Depression
What is the ALS Functional Rating Scale (ALSFRS) used for?
It assesses disease progression and function.
What is the Unified Rating Scale for Parkinson’s (UPDRS) used to assess?
It assesses the severity and progression of Parkinson’s Disease.
Fill in the blank: The average life expectancy of individuals with Multiple sclerosis is around _______ years less than a healthy adult.
5-10
What are some typical symptoms of Multiple Sclerosis?
- Fatigue
*vertigo - Muscle weakness
- Spasticity
- Balance issues
- Optic neuritis or diplopia
what are some Rx recommendations for MS?
*vestibular rehab
*posture
*compensatory strategies for balance and safety
*gait and gait aids
how can you set up PT sessions to avoid fatigue for MS patients?
*late morning sessions
*control room temp
Define chorea.
Quick, jerky, involuntary, random, purposeless, uncontrolled movements
Often seen in conditions like Huntington’s chorea.
What are the effects of Huntington’s chorea on speech?
Swallowing and speech are affected, making the person sound drunk
This is due to neurological deterioration.
What causes the symptoms of Huntington’s chorea?
Loss of neurotransmitters and GABA
GABA is an important inhibitory neurotransmitter in the brain.
What is the primary focus of physical therapy treatment for Huntington’s chorea?
Symptom management, patient safety, and maintaining enough nutrition
What is essential tremor?
A common neurological disorder usually seen as shaking hands evoked by voluntary movements
No other neurologic signs are present.
What factors can exacerbate essential tremor?
Fatigue and nervousness
Define hemiballism.
A very rare movement disorder characterized by exhausting violent movements
It is due to damage within various areas of the basal ganglia.
What is tardive dyskinesia?
A difficult to treat and often incurable form of dyskinesia secondary to the use of anti-psychotics
It involves random movements in the tongue, lips, jaw, and may affect limbs.
What characterizes Tourette’s syndrome?
Repetitive, involuntary, stereotypical movements and utterances known as tics
It is influenced by a combination of genetic and environmental factors.
What is meningitis?
An infectious disease that causes inflammation of the meninges (pia, arachnoid, dura)
What are the cardinal signs of meningitis?
Headache, fever, vomiting, rigidity of the neck
What are the types of meningitis?
1) Aseptic: Fungus, virus, parasite
* 2) Tuberculosis: Abscess or edema
* 3) Bacterial: Medical emergency in children or infants
What is encephalitis?
An infection of the brain and spinal cord caused by viral or bacterial infections
Symptoms include headache, nausea, vomiting, decreased consciousness, and coma.
What is Lyme disease caused by?
Bacteria, Borrelia burgdorferi, transmitted through ticks
What are the stages of Lyme disease? how long does each last
1) Local presentation: rash, erythema, flu-like symptoms 1-30days
* 2) Infection spreads through bloodstream (neuro, MSK, cardiac) 3-10weeks
* 3) Long term neurological issues, arthritis, cognitive deficits (months-years)
Define myasthenia gravis.
A rare, chronic, autoimmune disease where antibodies block acetylcholine receptors at the neuromuscular junction
What is the primary symptom of myasthenia gravis?
Weakness and increased fatigue with repeated contraction, improved with rest
what is an important component when planning an exercise program for person with myasthenia gravis?
rest; want to do strengthening after medications (AChesterase inhibitors) have been taken to maximize ACH in the terminals and allow lots of rest breaks.
What is Guillain–Barré syndrome?
An autoimmune disease affecting cranial and peripheral nerves, characterized by acute demyelination
Symptoms often follow a viral infection.
What is the typical progression of symptoms in Guillain–Barré syndrome?
Symmetrical weakness and paresthesias begin in hands and feet and progress proximally
What is Charcot Marie Tooth Disease?
A hereditary motor and sensory neuropathology characterized by extensive demyelination of motor and sensory nerves
what is the difference between Charcot Marie Tooth disease and GBS?
CMT is a hereditary, chronic, progressive neuropathy GBS is an acute, autoimmune-mediated neuropathy that can often follow an infection
what are the Rx for early stage GBS?
mechanical ventilation
*chest physio
*breathing exercises
*educate on proper positioning
*maintain PROM
what are some Rx for late stage GBS?
functional muscle strengthening
*endurance training
*gait retraining
What are the clinical manifestations of post-polio syndrome?
New asymmetrical muscle weakness, atrophy, abnormal fatigue, and decreased endurance
Sensory system is not affected.
when are you more likely to get the best results on strength testing for individuals with post-polio syndrome?
early morning; often more fatigued in afternoon. Will also fatigue with repeated testing
What are the signs of cerebellar disorders?
Dysmetria, nystagmus, dysdiadochokinesia
These symptoms indicate issues with precision, timing, and accuracy of motor output.
What is the Romberg test used for?
To determine the cause of loss of motor coordination (ataxia)
It differentiates between sensory and cerebellar issues.
What is dysdiadochokinesia?
Inability to perform rapid alternating movements
It is a common test for coordination issues.
What are the functions of the archicerebellum (vestibulocerebellum)?
Maintaining balance and spatial orientation, control of head and body position, and eye movements
What is the consequence of lesions in the paleocerebellum (spinocerebellum)?
Hypotonia, trunk ataxia, and ataxic gait
What are the effects of lesions in the neocerebellum (cerebrocerebellum)?
Intention tremor, dysdiadochokinesia, dysmetria, and loss of fine coordination
what are some therapeutic goals for individuals with cerebellar disorders?
improve coordination
*improve postural stability
*improve functional mobility
*improve vestibular functioning
*cardiovascular endurance
How can you test for dysdiadochokinesia?
rapid alternating supination/pronation, toe taps
How can you test for dysmetria?
finger to nose, opposition, heel slide on shin
What is Posterior Cord Syndrome?
A condition caused by posterior impact or hyperextension trauma leading to loss of vibration/touch and proprioception below the level of the lesion
Can also be caused by vitamin B12 deficiency or infection.
What movements are associated with C5 spinal cord injury?
Shoulder ABD/elbow flexion
Major muscles innervated include full SCM, neck extensors, neck flexors, and partial diaphragm.
What movements are associated with C6 spinal cord injury?
Wrist extension, shoulder abduction, flexion, extension, elbow flexion, and supination
Hand function may involve wrist splints and universal cuffs.
What are the major muscles innervated at the C7 level?
Triceps, allowing for elbow extension and independent transfers
C7 also allows wrist extension and flexion of the PIP/DIP joints.
What movements can be performed by an individual with a C8 spinal cord injury?
Finger flexion, thumb flexion, and some hand function
Fine motor control remains difficult due to weak intrinsic hand muscles.
What is the significance of sacral motor function in spinal cord injury?
Voluntary anal contraction indicates motor incomplete (ASIA C)
Presence of sacral motor function suggests some preservation of function.
What is the expected function at T1-9 (Thoracic Paraplegia)?
Intact upper extremity function, primarily using a wheelchair for community living
Respiratory function is compromised above T6.
What are the characteristics of L2-L5 spinal cord injuries?
Intact trunk, sparing of lower extremity muscles, potential for functional walking with braces
Requires grade 3 quads to walk without a knee-ankle-foot orthosis (KAFO).
Fill in the blank: The first level of spinal cord injury to have potential to live in the community without care is _______.
C6
True or False: Individuals with T10-L1 spinal cord injuries have compromised respiratory function.
False
Respiratory function is intact and cough is normal.
What is the role of physical therapy for C1-C4 spinal cord injury patients?
ROM, spasticity management, neck strengthening, chest physiotherapy, and prevention of contractures.
What is the potential for ambulation in individuals with T10-L1 spinal cord injuries?
Limited ambulation may be possible with bracing.
What are the characteristics of cauda equina injuries?
Hidden disability, areflexive bladder and bowel, and flaccid paralysis.
What movements can individuals with C7 spinal cord injuries perform?
Elbow extension, wrist extension, and finger flexion
They may also utilize a tenodesis grip for grasping.
