Neuromuscular and Nervous Systems Flashcards
What is Somatosensory Input.
It is the proprioceptive input you receive from your joints. muscles, ligaments, and skin regarding length, tension, pressure, pain, and joint position in order to keep you balanced.
How do you challenge the Somatosensory System?
You change the surface the patient is standing on: slopes, uneven surfaces, standing on foam…
How do you challenge the Visual System in terms of balance?
Examine the patient balancing with eyes open and closed.
What is Vestibular Input?
Input regarding the position and movement of the head in relation to gravity.
In regards to the vestibular system, what do the Semicircular Canals do?
They respond to the movement of fluid with head motion.
In regards to the vestibular system, what do the Otoliths do?
They measure the affects of gravity and movement with regard to acceleration and deceleration.
How do you challenge the Vestibular System?
By examining balance with different head movements.
What are some examples of Vestibular Tests?
-Dix-Hallpike Test: The patient is quickly lowered to supine with their neck extended to approximately 30 degrees, then their eye movements are examined
-Bithermal Caloric Testing: The patients ear canals are irrigated with water at different temperatures, then their eye movements are examined.
-Nystagmus Assessment: Different tests to analyze the type of nystagmus the patient has.
-Head Thrust Sign: The patent’s head is quickly thrusted in multiple directions while they try to maintain their gaze on a fixed object; the patient should be able to maintain a fixed gaze.
What is the Vestibuloocular Reflex (VOR)?
A reflex that supports gaze stabilization through eye movement that counters movements of the head. E.g. a dancer spotting while she spins.
What is the Vestibulospinal Reflex (VSR)?
A reflex that assists with stability while the head is moving as coordination of the trunk during upright postures.
What is the Suspensory Strategy?
It is used in conjunction with the ankle, hip, and stepping strategies. It is when you lower your center of gravity to maintain balance. This strategy is often used when both mobility and stability are required during a task (such as surfing).
Describe the Berg Balance Scale
It is a test to access the patient’s risk for falling. It includes 14 tasks with a maximum score of 56. A score less than 45 indicates an increased risk for falling.
Describe the Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery
It is designed to assess balance specifically for patients with hemiplegia. It includes 7 items to be assessed and the highest score you can get is a 14.
Describe the Functional Reach Test
It is just like the reaching portion of the Berg, but it utilizes age related reaching norms (20-40, 41-69, 70-87). If the patient falls below the age appropriate range for functional reach, they are at an increased risk of falling.
Describe the Romberg/Sharpened Romberg Tests
-Romberg: the patient stands with their arms across their chest and their feet together and holds for 30 seconds with eyes open and then again with eyes closed
-Sharpened Romberg: same as the Romberg, but with feet in tandem stance
What does it mean if a patient has a positive Romberg test?
Either the somatosensory or vestibular system is affected.
What does it mean if a patient exhibits Ataxia and also receives a positive Romberg test?
The patient is affected by Sensory Ataxia and not Cerebellar Ataxia
Describe the Timed Up and Go Test
It test the patients balance by having them quickly stand up from a chair, walk approximately 10 feet, turn around, walk back, and sit back down. A patient who can do it in 10 seconds or less is considered independent, over 20 seconds is considered increased risk for falling, and over 30 seconds is considered high risk for falling.
Describe the Tinetti Performance Oriented Mobility Assessment.
It assesses balance through a STS section and a gait section. The first section has a maximum score of 16 and the second section has a maximum score of 12, with a total max score of 28. A total score less than 19 indicates a high risk for falls.
What is Aphasia?
Impairment of processing for receptive and/or expressive language.
What is Paraphasia?
When someone makes an unintentional sound(s) when saying a word or phrase.
What are the type(s) of Fluent Aphasia?
Wernicke’s Aphasia
What is Wernicke’s Aphasia?
A lesion in the temporal lobe which affects the patient’s comprehension of language, writing, and naming ability.
What are the type(s) of Non-fluent Aphasia?
-Broca’s Aphasia
-Global Aphasia
What is Broca’s Aphasia?
A lesion to the frontal lobe causes expressive aphasia (the most common type of aphasia), impaired repetition and naming skills, and paraphasias.
What is Global Aphasia?
A lesion to the frontal, temporal, and parietal lobes which results in receptive and expressive aphasia. The patient may involuntarily verbalize (usually without correct context), and may use nonverbal skills for communication.`
What are some tips for treating a patient with Aphasia?
-Try to limit verbal cueing; instead, use tactile and visual cues
-Try to limit background noise and multiple voices; this is distracting
-Use concise sentences and yes or no questions
-Allow the patient plenty of time to process and respond
-Account for extra time needed during session for communication needs. Rushing communication will increase frustration.
-Try to limit repetitive feedback
What is Apraxia?
It is an impairment to motor planning which affects verbalization. (similar to expressive aphasia, but stems from impaired motor planning abilities).
What is Dysarthria?
It is an impairment to motor function which affects verbalization. (similar to expressive aphasia, but stems from impaired motor control)
What are the Cranial Nerves and what do they do?
1: Olfactory (sense of smell)
2: Optic (sense of sight)
3: Oculomotor (motor for vision in upward, downward, and medial directions)
4: Trochlear (motor for vision in downward/medial direction)
5: Trigeminal (senses of the face AND motor for chewing
6: Abducens (motor for vision in the lateral directions)
7: Facial (sense of anterior tongue taste AND motor for facial expressions)
8: Acoustic/Vestibulocochlear (sense of hearing and balance)
9: Glossopharyngeal (sense of taste for posterior tongue and motor for swallowing)
10: Vagus (regulates internal organ function and reflexes such as coughing, sneezing, swallowing, and vomiting)
11: Accessory (motor for shrugging)
12: Hypoglossal (motor for tongue)
Which Cranial Nerves are responsible for Motor Function of the Eyes?
3: Oculomotor
4: Trochlear
6: Abducens
What is ptosis?
When the upper eyelid droops over the eye.
What is the Brachial Plexus?
It is a main nerve that passes from the neck to the axilla and supplies the UE with nerves.
Which nerve roots does the Brachial Plexus stem from?
C5-T1
What is the Brachial Plexus Divided into and what are their Sub-divisions?
-Nerve Roots
-C5-T1
-Trunks
-Superior, Middle, Inferior
-Divisions
-Anterior, Posterior
-Cords
-Lateral, Medial, Posterior
-Branches
What are the Main Nerves of the Upper Extremities?
-Axillary Nerve
-Musculocutaneous Nerve
-Radial Nerve
-Ulnar Nerve
-Median Nerve
What is a good acronym to remember UE nerve pathology?
ARM-U
NAMe SOME
-Axillary nerve (C5-C6) and surgical Neck Fracture
-Radial nerve (C5-T1) and Axillary compression, Midshaft fracture
-Median nerve (C5-T1) and Supracondylar fracture
-Ulnar nerve (C8-T1) and Outstretched fall, Medial epicondyle fracture
Abduction
Rist drop
Monkey hand
Ulnar claw
What term is used to describe the study of the nature of movement, or the ability to regulate or direct essential movement?
Motor Control
What term is used to describe the study of the acquisition or modification of movement?
Motor Learning
What are the 3 stages of Motor Learning and what differentiates them?
-Cognitive Stage: the initial stage of learning where there is a high concentration of conscious processing of information.
-Associative Stage: the intermediate stage of learning where a person is able to more independently distinguish correct versus incorrect performance.
-Autonomous Stage: the final stage of learning or skilled learning where a person improves the efficiency of the activity without a great need for cognitive control.
What term represents all feedback that comes to the person through sensory systems as a result of the movement including visual, vestibular, proprioceptive, and somatosensory inputs?
Intrinsic (inherent) Feedback
What term represents the information that can be provided while a task or movement is in progress or subsequent to the movement; and is typically in the form of verbal feedback or manual contacts?
Extrinsic (augmented) Feedback
What term is an important form of extrinsic feedback and includes terminal feedback regarding the outcome of a movement that has been performed in relation to the movement’s goals?
Knowledge of Results
What term is extrinsic feedback that relates to the actual movement pattern that someone used to achieve their goal of movement?
Knowledge of Performance
What term refers to repeated performance of an activity in order to learn or perfect a skill?
Practice
Which type of Practice results in time in trial being greater than the amount of rest between trials?
Massed Practice
Which type of Practice results in the amount of rest time between trials being equal to or greater than the amount of practice time for each trial?
Distributed Practice
Which type of Practice results in performing a given task under a uniform condition?
Constant Practice
Which type of Practice results in performing a given task under differing conditions?
Variable Practice
Which type of Practice results in varying practices amongst different tasks?
Random Practice
Which type of Practice results in consistent practice of a single task?
Blocked Practice
Which type of Practice results in practice of an entire task?
Whole Training
Which type of Practice results in practice of an individual component or selected components of a task?
Part Training
C1-C4 injury symptoms may present the following effects or limitations:
-Most severe of the spinal cord injury levels
-Paralysis in arms, hands, trunk and legs
-Potential inability to breath independently, cough or control bowel movements or bladder
-Impaired or reduced ability to speak
-Tetraplegia or quadriplegia, meaning all four limbs are affected
-Inability to independently drive a car
-Potential need for complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
-May be able to use powered wheelchairs with special controls to move around
-Requirement for 24-hour-a-day personal care
An injured person may experience the following effects or C-5 vertebrae injury symptoms:
-Person can raise his or her arms and bend elbows
-Can speak and use diaphragm, but breathing is weakened
-Need for assistance with most ADLs, but power wheelchair can enable independent movement from one place to another
An injured person with C-6 vertebrae symptoms may experience the following effects:
-Person can extend wrist
-Can speak and use diaphragm, but breathing is weakened
-Can do transfers with adaptive equipment
A person with C-7 injury symptoms may present the following effects or limitations:
-Person can extend elbow and has some finger extension
-No longer has trouble breathing
-Can do most ADLs independently
C-8 injury symptoms may present the following effects or limitations:
-Patients should be able to grasp and release objects
General Effects of Injury to Thoracic Spinal Cord Nerves – T-1 to T-5
-Injuries usually affect the abdominal, lower back muscles, and legs
-Arm and hand function is usually normal
General Effects of Injury to Thoracic Spinal Cord Nerves – T-6 to T-12
-Injuries usually result in affected legs
