Neuromuscular: Study Set 1 Flashcards
Which cervical levels are most likely to be affected if a SCI occurs while in a flexed position
C5 -C6
Which cervical levels are most likely to be affected if a SCI occurs while in an extended position
C4 - C5
Which of the following incomplete SCI lesions are a result of compression and/or MOI of cervical flexion. This lesion results in a loss of motor function, pain and temperature sensation below the lesion due to damage of the corticospinal and spinothalamic tracts
Anterior Cord Syndrome
Brown-Sequard’s Syndrome
Cauda Equina Injury
Central Cord Syndrome
Posterior Cord Syndrome
Anterior Cord
If a patient presents with anterior cord syndrome, what are the typical signs and symptoms you would find
Compression to the anterior spinal cord with a MOI of cervical flexion
Loss of motor function, pain, and temperature sensation below the level bilaterally
Which of the following incomplete SCI lesions are a result of hemisection of the spinal cord typically due to a stab wound. This will result in a loss of vibratory and position sense ipsilateral to the lesion, and a loss of pain and temperature sense on the contralateral side of the lesion
Anterior Cord Syndrome
Brown-Sequard’s Syndrome
Cauda Equina Injury
Central Cord Syndrome
Posterior Cord Syndrome
Brown-Sequard’s Sydrome
If a patient presents with Brown-Sequard’s Syndrome, what are the typical signs and symptoms you would find
Hemisection of the spinal cord most likely due to a stab wound.
Loss of vibratory and position sense on the same side as the lesion, but a loss of pain and temperature sense are found on the opposite side of the lesion
Which of the following incomplete SCI lesions occur below the L1 spinal level and are not expected to make a full recovery. A patient with this injury will experience flaccidity, areflexia, and impairment of the bowel and bladder.
Anterior Cord Syndrome
Brown-Sequard’s Syndrome
Cauda Equina Injury
Central Cord Syndrome
Posterior Cord Syndrome
Cauda Equina Syndrome
Is Cauda Equina considered a CNS or PNS injury
PNS
If a patient presents with a cauda equina injury, what signs and symptoms will they demonstrate
Flaccidity, areflexia, and impaired bowel and bladder function
Which of the following incomplete SCI lesions results from compression and/or hyperextension that will cause the UE to have greater impairments than the LE, and motor deficits will be greater than sensory deficits
Anterior Cord Syndrome
Brown-Sequard’s Syndrome
Cauda Equina Injury
Central Cord Syndrome
Posterior Cord Syndrome
Central cord syndrome
If a patient presents with central cord syndrome, what signs and symptoms might they demonstrate
Compression and damage to the central spinal cord with a MOI of hyperextension
More UE involvement with greater motor deficits than sensory deficits
Which of the following SCI lesions results from compression of the spinal cord and is characterized by loss of proprioception, two point discrimination, and stereognosis; but motor function is preserved
Anterior Cord Syndrome
Brown-Sequard’s Syndrome
Cauda Equina Injury
Central Cord Syndrome
Posterior Cord Syndrome
Posterior cord syndrome
What is stereognosis
The ability to recognize an object with tactile senses without vision.
Ex: Being able to tell I’m holding an apple vs a banana
List the levels of the ASIA impairment scale and their definitions
Level A: Complete - no motor or sensory function is preserved
Level B: Sensory incomplete - Sensory is preserved, but no motor function is preserved more than three levels below the lesion
Level C: Motor incomplete - Sensory is preserved, but no motor function is preserved less than three levels below the lesion and less than half of the motor function that is preserved scores 3 or greater for MMT
Level D: Motor incomplete - Sensory is preserved, but no motor function is preserved less than three levels below the lesion, but more than half of the motor function that is preserved scores 3 or greater for MMT
Level E: Normal
State the muscle group to be tested in relation to the following myotomes in a patient with a SCI
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
C5 - elbow flexors
C6 - wrist extensors
C7 - elbow extensors
C8 - finger flexors
T1 - small finger abductors
L2 - hip flexors
L3 - Knee extensors
L4 - ankle DFs
L5 - great toe extensors
S1 - ankle PFs
State the specific muscle to be tested in relation to the following myotomes in a patient with a SCI
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
C5 - biceps, brachialis
C6 - extensor carpi radialis longus and brevis
C7 - triceps
C8 - flexor digitorum profundus
T1 - abductor digiti minimi
L2 - iliopsoas
L3 - quadriceps
L4 - tibialis anterior
L5 - extensor hallucis longus
S1 - gastrocnemius, soleus
State the site for sensory testing in relation to the dermatomes C2-C8
C2 - Just lateral to the occipital protuberance
C3 - Supraclavicular fossa
C4 - Top of AC joint
C5 - lateral antecubital fossa
C6 - Dorsal thumb, proximal phalanx
C7 - Dorsal middle finger, proximal phalanx
C8 - Dorsal little finger, proximal phalanx
State the site for sensory testing in relation to the dermatomes T1-T12
T1 - medial antecubital fossa
T2 - apex of axilla
T3 - Third intercostal space
T4 - fourth intercostal space
T5 - fifth intercostal space
T6 - xiphoid process
T7 - T7
T8 - T8
T9 - T9
T10 - level of umbilicus
T11 - T11
T12 - midpoint of inguinal ligament
State the site for sensory testing in relation to the dermatomes L1-S4/5
L1 - L1
L2 - anteromedial thigh
L3 - medial femoral condyle
L4 - medial malleolus
L5 - dorsal surface of third toe; (great toe per SBU)
S1 - lateral heel; (lateral side of pinky toe per SBU)
S2 - popliteal surface; (soleus per soleus)
S3 - ischial tuberosity
S4/5 - perianal area
True or False:
Balance relies on a combination of somatosensory input, visual input, and vestibular input.
True
When working with a balance patient, what are some general ways to challenge somatosensory input
Changing the surface they are standing on; foam; slopes; uneven surfaces
Anything that will challenge joint position and proprioception
When working with a balance patient, what are some general way to challenge visual input
eyes open; eyes close;
test for visual pursuits, saccades, and gaze control
When working with a balance patient, what are some ways to challenge vestibular input
Moving the head left/right or up/down. Walking faster/slower
Which of the following input systems have receptors located in the joints, muscles, and ligaments to provide proprioceptive information.
Somatosensory input
Visual input
Vestibular input
somatosensory input
Which of the following input systems have receptors that allow for perceptual acuity regarding verticality motion of objects and self, environmental orientation, postural sway, and movements of the head/neck.
Somatosensory input
Visual input
Vestibular input system
visual input
Which of the following input systems provides the NCS with feedback regarding the position and movement of the head with relation to gravity
Somatosensory input
Visual input
Vestibular input
vestibular input
Which of the following allows for head/eye movement coordination and gaze stabilization through eye movement that counters head movement?
VOR - vestibuloocular reflex
VSR - Vestibulospinal reflex
VOR
Which of the following allows for head and neck movement in relation to the body for postural control and stability during upright postures
VOR - vestibuloocular reflex
VSR - Vestibulospinal reflex
VSR
Which of the automatic postural strategies is the first strategy to be elicited by a small range and slow velocity perturbation if the feet are on the ground?
Ankle strategy
Hip strategy
Suspensory strategy
Stepping strategy
Ankle strategy
During an ankle strategy, do muscles contract from distal to proximal or proximal to distal?
distal to proximal
Which of the automatic postural strategies is elicited by a greater force in which the hips will move in an opposite direction than the head moves in order to maintain balance?
Ankle strategy
Hip strategy
Suspensory strategy
Stepping strategy
hip strategy
During a hip strategy, do muscles contract from distal to proximal or proximal to distal
proximal to distal
Which of the automatic postural strategies is used to lower the center of gravity during standing or ambulation to better control the center of gravity?
Hint: This strategy is often used when both mobility and stability are required of a task?
Ankle strategy
Hip strategy
Suspensory strategy
Stepping strategy
suspensory strategy
What would be a good example of using a suspensory strategy
surfing or skateboarding
Which of the following automatic postural strategies is elicited through unexpected perturbations during static standing or when a perturbation occurs beyond the base of support?
Ankle strategy
Hip strategy
Suspensory strategy
Stepping strategy
Stepping strategy
True or False:
If a patient reaches out with his/her upper extremities in attempt to regain balance, they are using an automatic stepping postural strategy
True, the use of UE reaching out or the use of LE stepping out to regain balance are both examples of stepping strategy
Vertigo can either have a PNS or CNS etiology. If the origin of vertigo is the PNS, what are the characteristics that a patient might experience?
Episodic, short duration
Precipitating factors
Pallor, sweating
Nausea, vomiting
Fullness or tinnitus
Vertigo can either have a PNS or CNS etiology. If the origin of vertigo is the CNS, what are the characteristics that a patient might experience?
Loss of consciousness
Neurological symptoms such as
-diplopia
-hemianopsia
-weakness
-numbness
-ataxia
-dysarthria
(red flags)
-
State whether the following etiology of vertigo is caused from the PNS or CNS
BPPV
PNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Meniere’s disease
PNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Meningitis
CNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Infection
PNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Migraine headache
CNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Complications of neurologic origin post ear infection
CNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Trauma/tumor
CNS or PNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Metabolic disorders such as diabetes mellitus
PNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Cerebellar degeneration disorders such as alcoholism
CNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Acute alcohol intoxication
PNS
State whether the following etiology of vertigo is caused from the PNS or CNS
Multiple sclerosis
CNS
What is Meniere’s disease?
A build up of fluid in the inner ear causing vertigo.
A PNS issue.
What is meningitis?
Inflammation and infection of the fluid/membrane surrounding the brain and spinal cord that could cause vertigo like symptoms.
A CNS issue.
What is multiple sclerosis?
A disease in which the immune system attacks the myelin sheath in the CNS that disrupts the connection between the brain and body which cause vertigo like symptoms.
A CNS issue.
Which canal does BPPV most commonly affect?
posterior semicircular canal
Which of the following balance tests and measures is used to assess fall risk and is scored out of 56
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Berg balance scale
True or False:
A patient who scores a 48 on the berg balance scale is at an increased risk of falling
False; Lower than 45 is an increased risk
Which of the following balance tests and measures is used to assess balance in patients with a higher level of motor skills
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Fregley-Graybiel Ataxia Test
Which of the following balance tests and measures is used to assess balance in patients with hemiplegia
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Fugly-Meyer
Which of the following balance tests and measures is used to assess standing balance and risk of falling
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Functional reach test
Which of the following balance tests and measures is used to assess balance and ataxia
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Romberg test
Which of the following balance tests and measures is used to assess a patient’s level of mobility and balance
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Timed up and go
Which of the following balance tests and measures is used to assess fall risk and is out of 28
Berg Balance Scale
Fregley-Graybiel Ataxia Test
Fugyl-Meyer Test
Function Reach Test
Romberg Test
Timed up and Go
Tinetti Balance Test
Tinetti Balance test
True or False:
A patient who scores 18 on the Tinetti balance test is at an increased risk of falling
True, anything less than 19/28 is at an increased risk of falling
Briefly describe the Fregley-Graybiel Ataxia Test
This test is used to assess balance in patients with high level of motor skills.
There’s 8 tests with 5 trials of each
The trials include standing/walking on a balance beam, standing SLS and in romberg, and walking with eyes closed
Briefly describe the fugly meyer
This test is used for patients with hemiplegia.
7 items total with a total score of 14, 14 being the best/least deficits
Briefly describe the functional reach test
Testing standing balance and risk of falling by a patient standing and reaching as far as they can next to a yard stick.
Average of three trials
Briefly describe the romberg test
This test assess sensory ataxia and balance. Patient stands in romberg with eyes open then closed.
30 sec is normal.
A positive romberg is positive for sensory ataxia, not cerebral ataxia.
The sharpened romberg test is standing in tandem with eyes open and closed.
Briefly describe the timed up and go test
This tests the level of mobility and and balance a patient has.
A patient starts in an armless chair, stands up and walks 10 feet, turns around and sits back down.
Out of 5 points, a score of 5 is severe risk.
A time 10 sec in normal
20 sec is an increased risk for falls
30 sec is a high risk for falls
Briefly describe the tinetti balance test
used to assess risk of falling
Out of 28, a score of less than 19 is an increased risk of falling
Briefly describe the balance berg scale
Used to assess risk of falling
Out of 56, a score of less than 45 is an increased fall risk
Which region of the brain plays an important role in maintaining motor control and balance
cerebellum
What is cranial nerve I
Is this an efferent or afferent nerve?
olfactory; sensory
What is cranial nerve II
Is this an efferent or afferent nerve?
optic; sensory
What is cranial nerve III
Is this an efferent or afferent nerve?
oculomotor; motor
What is cranial nerve IV
Is this an efferent or afferent nerve?
Trochlear; motor
What is cranial nerve V
Is this an efferent or afferent nerve?
trigeminal; both sensory and motor
What is cranial nerve VI
Is this an efferent or afferent nerve?
abducens; motor
What is cranial nerve VII
Is this an efferent or afferent nerve?
facial; both
What is cranial nerve VIII
Is this an efferent or afferent nerve?
vestibulocochlear; sensory
What is cranial nerve IX
Is this an efferent or afferent nerve?
glossopharyngeal; both sensory and motor
What is cranial nerve X
Is this an efferent or afferent nerve?
vagus; both sensory and motor
What is cranial nerve XI
Is this an efferent or afferent nerve?
accessory; motor
What is cranial nerve XII
Is this an efferent or afferent nerve?
hypoglossal; motor
How is cranial nerve I tested
identify familiar orders
How is cranial nerve II tested
test visual fields and acuity
Ex: identify objects/letters from a chart
How is cranial nerve III tested
The H test
Ex: having a pt follow an object with their eyes without moving their head in the shape of an H
How is cranial nerve IV tested
moving eyes downward and inward without moving head
How is cranial nerve V tested
Trigeminal Nerve
S: sharp or dull sensation
M: Clenching teeth; mastication
protruding, retracting, and lateral deviation of the mandible
How is cranial nerve VI tested
Lateral glaze of the eyes without moving the head
How is cranial nerve VII tested
S: Tasting on the anterior portion of the tongue
M: Mimicking facial expressions
How is cranial nerve VIII tested
Identifying nose
Ex: rubbing fingers together next to ear; Weber and Rinne test
How is cranial nerve IX tested
S: Depressing the tongue to stimulate a gag reflex
M: Tasting on the posterior portion of the tongue
How is cranial nerve X tested
S: Depressing the tongue for a gag reflex; saying “ahh”
M: The ability to swallow
How is cranial nerve XI tested
Accessory nerve; motor
Resisted shoulder shrug
How is cranial nerve XII tested
Sticking out tongue
Which muscle is innervated by the oculomotor nerve
Superior oblique
Upper trapezius
Lateral rectus
Medial rectus
Medial rectus
Which muscle is innervated by the abducens nerve
Superior oblique
Upper trapezius
Lateral rectus
Medial rectus
lateral rectus
What muscle is innervated by the trochlear nerve
Superior oblique
Upper trapezius
Lateral rectus
Medial rectus
superior oblique
What muscle is innervated by the accessory nerve
Superior oblique
Upper trapezius
Lateral rectus
Medial rectus
upper trapezius
True or False:
Bell’s palsy is a result of damage to cranial nerve VII
True; the facial nerve
True or False:
Taste on the anterior tongue is the sensory component of the glossopharyngeal nerve
False; facial nerve
True or False:
Autonomic innervation of the abdominal viscera is innervated by the vagus nerve
True
True or False:
The superior oblique muscle of the eyeball is innervated by the trochlear nerve
true
True or False:
An inability to protrude the mandible may be indicative of hypoglossal nerve damage
False; trigeminal
True or False:
Anosmia may result due to damage to the olfactory nerve
True; anosmia is the inability to smell
True or False:
Diplopia may result due to damage of the facial nerve
False; trochlear
True or False:
The inability to clench the teeth may be indicative of damage to the trigeminal nerve
true
Which two cranial nerves are not responsible for movement of the eyes
abducens
optic
oculomotor
trigeminal
trochlear
optic and trigeminal
Which two cranial nerve pathways are associated with the corneal reflex
afferent trigeminal
efferent optic
afferent oculomotor
efferent facial
afferent trigeminal and efferent facial
Which two cranial nerves originate from the midbrain
oculomotor and trochlear
Autonomic innervation to the lacrimal gland is via the ______ nerve
smallest branch of the trigeminal nerve, the lacrimal nerve
Testing pupillary reaction to light would assess the function of the ________ nerve
Oculomotor
What is aphasia
impairment of processing expressive or receptive language
what are the two categories of aphasia
fluent or non-fluent
what is the definition of prosody
the use of rhythm and sounds when talking
what is paraphasia
sentences are jumbled and don’t make sense
what are the two types of fluent aphasia
Wernicke’s aphasia and conduction aphasia
what are the characteristics of Wernicke’s aphasia
known as receptive aphasia
comprehension is impaired
poor writing and naming skills
no motor impairments typically
what are the characteristics of conduction aphasia
good comprehension
impairment with repetition
hard to find words mid speech
reading is intact but writing is impaired
what are the two types of non-influent aphasia
broca’s aphasia and global aphasia
what are the characteristics of broca’s aphasia
expressive aphasia, most common form of aphasia
good comprehensive but impaired motor impairment
what are the characteristics of global aphasia
comprehension impaired
impaired writing and naming
uses non verbal skills to communicate
