Neuromuscular: Study Set 1 Flashcards by Madelynn Kahl

Which cervical levels are most likely to be affected if a SCI occurs while in a flexed position

C5 -C6

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Which cervical levels are most likely to be affected if a SCI occurs while in an extended position

C4 - C5

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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

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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

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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

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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

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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

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Is Cauda Equina considered a CNS or PNS injury

PNS

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If a patient presents with a cauda equina injury, what signs and symptoms will they demonstrate

Flaccidity, areflexia, and impaired bowel and bladder function

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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True or False:

Balance relies on a combination of somatosensory input, visual input, and vestibular input.

True

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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

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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

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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

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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

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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