Neuromuscular System Flashcards
Define Vestibuloocular Reflex (VOR)
Allows for head/ eye movement coordination.
- this reflex supports gaze stabilization through eye movement that counters movements of the head
- this maintains a stable image on the retina during movement.
Define Vestibulospinal Reflex (VSR).
Attempts to stabilize the body and control movement.
- the reflex assists with stability while the head is moving as well as coordination of the trunk during upright postures.
Define the ankle strategy.
The first strategy to be elicited by a SMALL range and SLOW velocity perturbation when when the feet are on the ground.
- muscle groups contract in a distal to proximal fashion to control postural sway from the ankle joint.
Define Hip Strategy.
Elicited by a greater force, challenge or perturbation through the pelvis and hips.
- the hips will move (in the opposite direction from the head) in order to maintain balance.
- muscle groups contract in a proximal to distal fashion in order to counteract the loss of balance.
Define SUSPENSORY Strategy.
Is used to LOWER the center of gravity during standing or ambulation in order to better control the center of gravity.
EXAMPLES:
- knee flexion
- crouching
- squatting
This strategy is often used when both mobility and stability are required during a task (such as surfing).
Define Stepping Strategy.
Is elicited through unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the center of gravity is beyond the base of support.
- the lower extremities step and/ or upper extremities reach to regain a new base of support.
Define the BERG BALANCE Scale.
Tool designed to assess a patient’s risk for falling.
- there are 14 tasks, each scored on an ordinal scale from 0-4.
- these tasks include:
Static activities
Transitional movements
Dynamic activities in sitting and standing positions
Define the FUGL- MEYER Sensorimotor Assessment of Balance Performance Battery.
This tool is designed as a subset of the FUGL- Meyer Physical Performance Battery and is designed to assess balance specifically for patients with Hemiplegia.
- each of the seven items assess is scored from 0- 2.
Define Functional Reach Test
A single task screening tool used to assess standing balance and risk of falling.
- a person is required to stand upright with a static base of support.
- a yardstick is positioned to measure the forward distance that a patient can reach without moving the feet.
Define the Romberg Test.
An assessment tool of balance and ataxia that initially positions the patient in unsupported standing, feet together, upper extremities folded, looking at a fixed point straight ahead with eyes open.
- next, the patient maintains the same standing posture, but closes the eyes.
- a patient receives a grade of “normal” if they are able to maintain the position for 30 seconds.
Define Timed Get Up and Go Test.
Assess a person’s level of mobility and balance.
- the patient initially sits in a chair, then stands and walks 10 feet, then turns around and walks back to the chair to sit back down.
- the patient is scored based on amount of postural sway, excessive movements or other signs of loss of balance.
- the rating scale designates a score of one as normal and a score of five as severely abnormal.
- in an attempt to increase overall reliability, the use of time was implemented.
Define Tinetti Performance Oriented Mobility Assessment.
Used to screen patients for an increased risk for falling.
- the first section assess balance sit- stand transfers, immediate standing balance with eyes open and closed, tolerating a slight push in the standing position, and turning 360 degrees.
- a patient is scored from 0-2 in most categories.
- the second section assess gait variable at normal and rapid speeds, including step length, height, step asymmetry and continuity, path, stand during gait, and trunk motion.
- a patient is scored 0-2 for each.
Define Fluent Aphasia
General category of aphasia characterized by empty speech that lacks substance, though word output and speech production are still functional.
Define Non- fluent Aphasia
General category of aphasia characterized by poor word output, dysprosodic speech, poor articulation and an increased effort for speech.
Define Wernicke’s Aphasia.
A type of fluent aphasia that is also known as receptive aphasia and is characterized by impaired reading an auditory comprehension of speech
Define Broca’s Aphasia.
A type of NON- FLUENT aphasia that is also known as expressive aphasia and is characterized by impaired naming and repetition skills and frustration with language skill errors.
Define Global Aphasia.
A type of NON- FLUENT aphasia characterized by both comprehension impairments and impairments with naming, writing, and repetition skills.
Define Verbal Apraxia.
A non- dysarthric and non- aphasis impairment of prosody and articulation of speech.
- verbal expression is impaired secondary to deficits in motor planning.
Define Dysarthria.
A motor disorder of speech that is caused by an UMN lesion that affects the muscles that are used to articulate words and sounds.
- speech is often noted as “slurred” and there may also be an effect on respiratory or phonatory systems due to the weakness.
Cranial Nerve 1- Olfactory: Testing Procedure & Positive Test
TESTING PROCEDURE: patient is positioned in sitting with the eyes closed or blindfolded.
- the therapist places an item with a familiar odor under the patient’s nostril and the patient is asked to identify the odor.
POSITIVE TEST: indicated by an INABILITY to identify familiar odors.
Cranial Nerve 2- OPTIC: Testing Procedure & Positive Test
TESTING PROCEDURE: patient is positioned in standing a selected distance from a chart or diagram.
- the therapist asks the patient to identify objects or read selected items from the chart or diagram
POSITIVE TEST: indicated by an inability to identify objects at a reasonable distance.
Cranial Nerve 3- OCULOMOTOR: Testing Procedure & Positive Test
TESTING PROCEDURES: patient is positioned in sitting and is asked to follow an object such as a writing utensil with their eyes as it is moved VERTICALLY, HORIZONTALLY and DIAGONALLY.
- therapist should make sure the patient does not rotate their head during the testing and should inspect the patient’s eyes for asymmetry or ptosis.
POSITIVE TEST: indicated by an identified tracking deficit, asymmetry or ptosis
Cranial Nerve 4- TROCHLEAR: Testing Procedure & Positive Test
TESTING PROCEDURE: patient is positioned in sitting and asked to follow an object such as a writing utensil with their eyes as it is moved in an inferior direction.
- the therapist should make sure the patient does not move their head downward.
POSITIVE TEST: indicated by an inability to depress the eyes and/ or complaints of diplopia.
Cranial Nerve 5- TRIGEMINAL (sensory): Testing Procedure & Positive Test
TESTING PROCEDURE (sensory): patient is positioned in sitting and is asked to close their eyes.
- the therapist uses a piece of cotton and a safety pin to alternately touch the patient’s face.
- the patient is asked to classify each contact with the face as “sharp” or “dull”.
POSITIVE TEST: identified by impaired or absent sensation or the inability to differentiate between “sharp” or “dull”.
Cranial Nerve 5- TRIGEMINAL (motor): Testing Procedure & Positive Test
TESTING PROCEDURE (motor): is tested by asking the patient to perform mandibular protrusion, retrusion and lateral deviation.
POSITIVE TEST: indicated by an impaired ability to move the mandible through the specified motions.
Cranial Nerve 6- ABDUCENS: Testing Procedure & Positive Test
TESTING PROCEDURE: patient is positioned in sitting.
- the therapist asks the patient to abduct their eyes without rotating the head
POSITIVE TEST: indicated by an inability to abduct the eyes.
Cranial Nerve 7- FACIAL (sensory): Testing Procedure & Positive Test
TESTING PROCEDURE (sensory): patient is positioned in sitting and is asked to distinguish between sweet and salty substances placed on the anterior portion of the tongue.
POSITIVE TEST: identified by an inability to accurately identify sweet and salty substances.
Cranial Nerve 7- FACIAL (motor) Testing Procedure & Positive Test
TESTING PROCEDURE (motor): therapist performs a manual muscle test of selected muscles involved in facial expression.
POSITIVE TEST: indicated by an inability to mimic selected facial expressions due to muscle impairment.
Cranial Nerve 8- VESTIBULOCOCHLEAR: Testing Procedure & Positive Test
TESTING PROCEDURE: patient is positioned in sitting in a quiet location. The therapist, positioned behind the patient and to one side, slowly brings a ticking watch toward the patient’s ear. The therapist records the distance from the ear when the patient is able to identify the ticking sound. The therapist repeats the procedure on the contralateral ear and compares the measurements.
POSITIVE TEST: indicated by an inability to hear the ticking sound at 18- 24 inches or a significant bilateral difference.
Cranial Nerve 9- GLOSSOPHARYNGEAL (sensory): Testing Procedure & Positive Test
TESTING PROCEDURE (sensory): the therapist assess the patient’s ability to distinguish objects by taste after they are placed on the posterior portion of the tongue.
POSITIVE TEST: indicated by an inability to accurately identify tasted substances, especially sour and bitter substances, placed on the posterior third of the tongue.
Cranial Nerve 9 GLOSSOPHARYNGEAL (motor): Testing Procedure & Positive Test
TESTING PROCEDURE (motor): the therapist touched the pharynx with a tongue depressor with the patient positioned in sitting
POSITIVE TEST: indicated by lack of gagging or an inability to feel the tongue depressor touch the back of the throat.
Cranial Nerve 10 VAGUS (sensory): Testing Procedure & Positive Test
Testing Procedure (sensory): the therapist touches the pharynx with a tongue depressor with the patient positioned in sitting
POSITIVE TEST: indicated by an inability to feel the tongue depressor touch the back of the throat.
Cranial Nerve 10- VAGUS (motor): Testing Procedure & Positive Test
Testing Procedure (motor): therapist touches the pharynx with a tongue depressor with the patient positioned in sitting
Positive Test: indicated by a lack of gagging
Cranial Nerve 11- ACCESSORY: Testing Procedure & Positive Test
TESTING PROCEDURE: the patient is positioned in sitting with the arms at the side. The therapist asks the patient to shrug their shoulders and maintain the position while the therapist applies resistance through the shoulders in the direction of shoulder depression.
POSITIVE TEST: indicated by an inability to maintain the test position against resistance.
Cranial Nerve 12- HYPOGLOSSAL: Testing Procedure & Positive Test
TESTING PROCEDURE: the patient is positioned in sitting. The therapist asks the patient to protrude the tongue.
POSITIVE TEST: indicated by an inability to fully protrude the tongue or the tongue deviating to one side during protrusion.
What muscles are innervated by the AXILLARY NERVE:
Deltoid
Teres Minor
What muscles are innervated by the DORSAL SCAPULAR NERVE;
Rhomboids
Levator Scapulae
What muscles are innervated by the LATERAL PECTORAL NERVE:
Pectoralis major- clavicular head
What muscles are innervated by the LONG THORACIC NERVE:
Serratus Anterior
What muscles are innervated by the LOWER SUBSCAPULAR NERVE:
Subscapularis
Teres Major
What muscles are innervated by the MEDIAN NERVE:
Flexor muscles in the forearm, except flexor carpi ulnaris.
Five muscles of the hand
What muscles are innervated by the MEDIAL PECTORAL NERVE:
Pectoralis Major & minor
What muscles are innervated by the MUSCULOCUTANEOUS NERVE:
Coracobrachialis
Biceps brachii
Brachialis
What muscles are innervated by the nerve to SUBCLAVIUS:
Subclavius
What muscles are innervated by the RADIAL NERVE:
Brachioradialis
Triceps
Supinator
Wrist Extensors
Anconeus
What muscles are innervated by the SUPRASCAPULAR NERVE:
Infraspinatus
Supraspinatus
What muscles are innervated by the THORACODORSAL NERVE:
Latissimus Dorsi
What muscles are innervated by the ULNAR NERVE:
Flexor carpi ulnaris
Flexor digitorum profundus
Most small muscles of the hand
What muscles are innervated by the UPPER SUBSCAPULAR NERVE:
Subscapularis
What muscles are innervated by the DEEP PERONEAL NERVE:
Tibialis Anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
Extensor digitorum brevis
What muscles are innervated by the FEMORAL NERVE:
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Iliacus
Sartorius
Pectineus
What muscles are innervated by the INFERIOR GLUTEAL NERVE:
Gluteus Maximus
What muscles are innervated by the LATERAL PLANTAR NERVE:
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
Dorsal interossei
Quadratus plantae
Adductor hallucis
Lumbricals II, III, IV
Plantar interossei
What muscles are innervated by the LUMBAR PLEXUS:
Psoas Major & minor
Quadratus lumborum
What muscles are innervated by the MEDIAL PLANTAR NERVE:
Abductor hallucis
Lumbricals I
Flexor digitorum brevis
Flexor hallucis brevis
What muscles are innervated by the OBTURATOR NERVE:
Adductor longus, brevis, and magnus
Obturator Externus Gracilis
What muscles are innervated by the SACRAL PLEXUS:
Piriformis
Superior gemelli
Inferior gemelli
Obturator internus
Quadratus femoris
What muscles are innervated by the SCIATIC NERVE- Common Peroneal Division:
Biceps femoris (short head)
What muscles are innervated by the SCIATIC NERVE- Tibial Division:
Semitendinosus
Semimembranosus
Biceps femoris (long head)
What muscles are innervated by the SUPERFICIAL PERONEAL NERVE:
Peroneus longus & brevis
What muscles are innervated by the SUPERIOR GLUTEAL NERVE:
Gluteus medius & minimus
Tensor fasciae latae
What muscles are innervated by the TIBIAL NERVE:
Soleus
Popliteus
Plantaris
Tibialis Posterior
Gastrocnemius
Flexor hallucis longus
Flexor digitorum longus
Define Motor Control.
The study of the nature of movement, or the ability to regulate or direct essential movement
Define Motor Learning.
The study of the acquisition or modification of movement
Define Cognitive Stage of Motor Learning.
The INITIAL stage of learning where there is a high concentration of conscious processing of information.
The person will acquire information regarding the goal of the activity and begin to problem solve as to how to attain the goal.
Define Associative Stage of Motor Learning.
The INTERMEDIATE stage of learning where a person is able to more independently distinguish correct versus incorrect performance.
The person is linking the feedback that has been received with the movement that has been performed and the ultimate goal.
Define the Autonomous Stage of Motor Learning.
The FINAL stage of learning where a person improves the efficiency of the activity without a great need for cognitive control.
The person can also perform the task with interference from a variable environment.
Define Intrinsic (Inherent) Feedback.
Represents all feedback that comes to the person through sensory systems as a result of the movement, including visual, vestibular, proprioceptive, and somatosensory inputs.
Define Extrinsic (augmented) Feedback.
Represents the information that can be provided while a task or movement is in progress or subsequent to the movement.
This is typically in the form of verbal feedback or manual contacts.
Define Knowledge of Results:
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.
Define Knowledge of Performance:
Extrinsic feedback that relates to the actual movement pattern that someone used to achieve their goal of movement.
Define Massed Practice:
Occurs when the practice time in a trial is greater than the amount of rest between trials.
Define Distributed Practice:
Occurs when the amount of rest time between trials is equal to or greater than the amount of practice time for each trial.
Define Constant Practice:
Characterized by practice of a given task that occurs under a uniform condition.
Define Variable Practice.
Characterized by practice of a given task that occurs under differing conditions.
Define Random Practice:
Occurs when practice is varied amongst different tasks.
Define Blocked Practice.
Is characterized by consistent practice of a single task.
Define Whole Training.
Characterized by practice of an entire task.
Define Part Training.
Characterized by practice of an individual component or selected components of a task.
Define Closed System Model.
Is characterized by transfer of information that incorporates multiple feedback loops and a larger distribution of control.
In this model, the nervous system is seen as an active participant with the ability to enable the initiation of movement as opposed to solely reacting to stimuli.
Define Habituation.
Is the decrease in response that will occur as a result of consistent exposure to non- painful stimuli.
Define Non- Associative Learning.
Is learning that occurs via a single repeated stimulus (e.g., habituation, sensitization)
Define Associative Learning.
Is learning that occurs through the understanding of the relationship between two stimuli, causal relationships or stimulus and consequence (e.g., classical conditioning, operant conditioning).
Define Procedural Learning.
Is the learning of tasks that can be performed without attention or concentration to the task.
A task is learned by forming movement habits (e.g., developing a habit through repetitive practice).
Define Declarative Learning.
Is learning that requires attention, awareness, and reflection in order to attain knowledge that can be consciously recalled (e.g., mental practice).
define Motor Program.
Is a concept of a central motor pattern that can be activated by sensory stimuli or central processes.
Motor programs are seen as containing the rules for creating spatial and temporal patterns of motor activity needed to carry out a given motor task.
Define Open System Model.
Is characterized by a single transfer of information without any feedback loop (reflexive hierarchical theory).
In this theory, the nervous system is seen as awaiting stimuli in order to react.
Define Sensitization.
Is the increase in response that will occur as a result of a noxious stimulus.
Myotome Testing- Shoulder Elevation: Innervation Level
C3- C4
Myotome Testing- Shoulder Abduction: Innervation Level
C5
Myotome Testing- Elbow Flexion: Innervation Level
C5- C6
Myotome Testing- Wrist Extension: Innervation Level
C6
Myotome Testing- Elbow Extension: Innervation Level
C7
Myotome Testing- Wrist Flexion: Innervation Level
C7
Myotome Testing- Thumb Extension: Innervation Level
C8
Myotome Testing- Finger Abduction: Innervation Level
T1
Myotome Testing- Hip Flexion: Innervation Level
L2- L3
Myotome Testing- Knee Extension: Innervation Level
L3- L4
Myotome Testing- ANKLE DORSIFLEXION: Innervation Level
L4- L5
Myotome Testing- Great Toe Extension: Innervation Level
L5
Myotome Testing- Ankle Plantar Flexion: Innervation Level
S1
Reflex Testing- Biceps: Innervation Level
C5
Reflex Testing- Brachioradialis: Innervation Level
C6
Reflex Testing- Triceps: Innervation Level
C7
Reflex Testing- Patella: Innervation Level
L3- L4
Reflex Testing- Achilles: Innervation Level
S1- S2
Dermatome Testing- Posterior Head: Innervation Level
C2
Dermatome Testing- Posterior- Lateral Neck: Innervation Level
C3
Dermatome Testing- Acromioclavicular Joint: Innervation Level
C4
Dermatome Testing- Lateral arm: Innervation Level
C5
Dermatome Testing- Lateral Forearm and Thumb: Innervation Level
C6
Dermatome Testing- Palmar Distal Phalanx Middle Finger: Innervation Level
C7
Dermatome Testing- Little Finger and Ulnar Border of the Head: Innervation Level
C8
Dermatome Testing- Medial Forearm: Innervation Level
T1
Dermatome Testing- Middle third of anterior Thigh: Innervation Level
L3
Dermatome Testing- Patella and Medial Malleolus: Innervation Level
L4
Dermatome Testing- Fibular Head and Dorsum of Foot: Innervation Level
L5
Dermatome Testing- Lateral and Plantar Aspect of Foot: Innervation Level
S1
Dermatome Testing- Medial Aspect of Posterior Thigh: Innervation Level
S2
Dermatome Testing- Perianal Area: Innervation Level
S3- S5
Functional Testing: Heel Walking- Innervation Level
L4
Functional Testing: Toe Walking- Innervation Level
S1
Components of Metencephalon.
Cerebellum
Pons
Components of Myelencephalon.
Medulla Oblongata
Number of Paired Spinal Nerves: Cervical
8
Number of Paired Spinal Nerves: Thoracic
12
Number of Paired Spinal Nerves: Lumbar
5
Number of Paired Spinal Nerves: Sacral
5
Functions of the Autonomic Nervous System.
Is concerned with innervation for INVOLUNTARY processes, glands, internal organs, and smooth muscle.
Functions of Sympathetic Nervous System.
Prepares the body for emergency response;
- it generally results in a stimulating response
Function of the Parasympathetic Nervous System.
Is concerned with conserving and restoring energy;
- it generally results in an inhibitory response.
Function of the Corpus Callosum.
relays information from one side of the brain to the other.
Function of the Hippocampus.
Is responsible for the process of forming and storing new memories of one’s personal history and other declarative memory, as well as assisting in learning language.
Function of Basal Ganglia
Responsible for VOLUNTARY movement, regulation of autonomic movement, regulation of autonomic movement, posture, muscle tone, and control of motor response.
Function of Amygdala.
Involved in emotional and social processing, such as fear and pleasure responses, arousal, processing of memory, and the formation of emotional memories.
Function of Thalamus.
Relay or processing station for the majority of information that goes to the cerebral cortex.
- it coordinates sensory perception and movement with other parts of the brain and spinal cord that also have a role in SENSATION and MOVEMENT.
- it receives information from the cerebellum, basal ganglia, and all sensory pathways except for the olfactory tract.
- the thalamus then relays the information to the appropriate association cortex.
Function of Hypothalamus.
Receives and integrates information from the autonomic nervous system and assists in regulating hormones.
- controls functions:
Hunger
Thirst
Sexual behavior
Sleeping
- regulates:
Body temperature
Adrenal glands
Pituitary gland
Function of Subthalamus:
Primarily represented by the subthalamic nucleus and is important for regulating movements produced by skeletal muscles.
- it has association with the basal ganglia and substantia nigra
Function of the Epithalamus.
Primarily represented by the pineal gland.
- this gland secretes melatonin and is involved in CIRCADIAN RHYTHMS, the internal clock, selected regulation of motor pathways, and emotions.
- it’s associated with the limbic system & basal ganglia.
Function of the Cerebellum.
Is responsible for FINE TUNING of movement, and assists with maintaining posture and balance by controlling muscle tone and positioning of the extremities in space.
- controls the the ability to perform rapid alternating movements.
Function of the PONS.
Assists with regulation of RESPIRATION RATE and is associated with the orientation of the head in relation to visual and auditory stimuli.
- Cranial nerves V- VIII originate from the pons
Function of the Medulla Oblongata.
Influences AUTONOMIC nervous activity and regulation of RESPIRATION and HEART RATE.
- reflex centers for vomiting, coughing, and sneezing are found within the medulla.
- responsible for relaying SOMATIC sensory information from internal organs and for the control of arousal & sleep.
- Cranial nerves IX- XII originate from the medulla oblongata.
Function of the Brainstem.
Three structures: midbrain, pons and medulla oblongata.
- works as a relay station, sending messages between various parts of the body and the cerebral cortex
- many of the primitive functions that are essential for survival are located within the brainstem:
Regulation of heart rate & respiratory rate.
Identify the Dominant Hemisphere for: LANGUAGE
Left
Identify the Dominant Hemisphere for EXPRESS POSITIVE EMOTIONS.
Left
Identify the Dominant Hemisphere for ARTISTIC ABILITIES.
Right
Identify the Dominant Hemisphere for ANALYTICAL.
Left
Identify the Dominant Hemisphere for LOGICAL, RATIONAL.
LEFT
Identify the Dominant Hemisphere for KINESTHETIC AWARENESS.
Right
Identify the Dominant Hemisphere for UNDERSTAND MUSIC
Right
Identify the Dominant Hemisphere for NONVERBAL PROCESSING:
Right
Identify the Dominant Hemisphere for MATHEMATICAL CALCULATIONS.
Left
Identify the Dominant Hemisphere for SPATIAL RELATIONSHIPS.
Right
Identify the Dominant Hemisphere for SEQUENCE AND PERFORM MOVEMENTS.
Left
Identify the Dominant Hemisphere for Hand- Eye Coordination.
Right
Identify the Dominant Hemisphere for Express Negative Emotions.
Right
Identify the Dominant Hemisphere for Express Negative Emotions.
Right
Identify the cerebral lobe for VOLUNTARY MOVEMENT.
Frontal
Identify the cerebral lobe for Sensation of Touch.
Parietal
Identify the cerebral lobe for Main Processing Center for Visual Information.
Occipital
Identify the cerebral lobe for Broca’s Area.
Frontal
Identify the cerebral lobe for Main Processing Center for Auditory Information.
Temporal
Identify the cerebral lobe for Spatial and Visual Perception.
Parietal
Identify the cerebral lobe for Executive Functions.
Frontal
Identify the cerebral lobe for Wernicke’s Area.
Temporal
Identify the cerebral lobe for Sensation of Kinesthesia.
Parietal
Identify the cerebral lobe for Judgement of Distance
Occipital
Identify the cerebral lobe for Personality and Behavior
Frontal
Define the Dura Mater
The outermost meninx.
- it lines the periosteum of the skull and protects the brain.
define Arachnoid Mater.
The middle meninx.
- it surrounds the brain in a loose manner.
Define Pia Mater.
The innermost meninx.
- it covers the contours of the brain and forms the choroid plexus in the ventricular system.
Define the Epidural Space.
An area between the skull and dura mater that can be abnormally occupied.
Define Subdural Space.
Is the space that exists between the dura mater and arachnoid mater.
Define the subarachnoid space.
The space that exists between the arachnoid mater and pia mater that contains cerebrospinal fluid and the circulatory system for the cerebral cortex.
Define the Ventricular System,
Is designed to protect and nourish the brain.
- compromised of 4 fluid- filled cavities called VENTRICLES and multiple foramina that allow the passage of cerebrospinal fluid.
Define Choroid Plexus.
Is specialized tissue within the ventricles that makes the cerebrospinal fluid.
Define the Cerebrospinal Fluid.
Is a clear, fluid- like substance that cushions the brain and sprains cord from injury and provides mechanical buoyancy and support.
- CSF provides nutrition to the CNS and serves as a conduit for removal of metabolites.
Define Blood- Brain Barrier.
Consists of meninges, protective glial cells, & capillary beds of the brain.
- it’s responsible for exchange of nutrient between the CNS and vascular system.
- provides protection for the CNS by restricting certain molecules from crossing the barrier while others are able to do so freely.
Define Axon
A projection of a nerve away from the cell body that conducts impulses.
Define Dendrite.
An extension of the cell body that receives signals from other neurons
Define Motor Unit.
A single motor neuron and all of the muscle fibers that it innervates.
Define Myelin.
Proteins and lipids that form to create a sheath around particular nerves;
- it increases conductivity of the nerve impulse.
Define Nerve Conduction Velocity.
Measures the speed of a nerve impulse along the axon of a nerve.
Define Neurons.
Nerve cells that receive and send signals to other nerve cells;
- it is comprised of a cell body, an axon, and dendrites.
Define Nodes of Ranvier.
Brief gaps in myelination of an axon;
- they serve to facilitate rapid conduction of a nerve impulse via jumping from gap node to gap node.
Define Saltatory Conduction.
An action potential moving along an axon in a jumping fashion from node to node;
- it decreases the use of sodium- potassium pumps and increase speed of conduction.
Define Schwann Cell.
Cells that cover the nerve fibers within the peripheral nervous system and form the myelin sheath.
Pathology of Alzheimer’s Disease.
- progressive neurological disorder that results in deterioration and irreversible damage within the cerebral cortex and subcortical areas of the brain.
- noted by a change in a higher cortical functions characterized by subtle changes in memory, impaired concentration, and difficulty with new learning.
- typical course of the disease averages between 7 to 11 years with death resulting from infection or dehydration.
Pathology of Amyotrophic Lateral Sclerosis.
- risk is higher in males than females and usually occurs between 40- 70 years of age
- clinical presentation may include both upper and lower motor neuron involvement with weakness occurring in a distal to proximal progression.
- average course of the diagnosis to 2 to 5 years with roughly a quarter of patients surviving longer than 5 years.
Pathology of Anterior Cord Syndrome;
- an incomplete spinal cord lesion in which the anterior 2/ 3 of the spinal cord is damaged.
- occurs through a traumatic incident that causes compression or damage to the anterior spinal artery, most often associated with fracture or dislocation.
- typically presents with complete loss of motor function and loss of pain and temperature sensation bilaterally below the level of the lesion due to the damage to the costicospinal and spinothalamic tracts
Pathology of Arthrogryposis Multiplex Congenita:
- non- progressive neuromuscular disorder that is estimated to occur during the first trimester in utero.
- causative factors include poor movement during early development due to myopathic, neuropathic or joint abnormalities.
- clinical signs include cylinder- like extremities with minimal definition, significant and multiple contractures, dislocation of joints, and muscle atrophy.
Pathology of Autism Spectrum Disorder:
- group of complex brain development disorders that are characterized by difficulties with social interaction, communication and repetitive behaviors.
- initial signs & symptoms generally become apparent around the age of 2 or 3.
- treatment tends to focus on improving social communication and decreasing non-purposeful movements & vocalizations.
Pathology of Bell’s Palsy.
- refers to an acute onset of sensory and motor deficits in structures supplied by the facial nerve.
- primarily affects the muscles associated with facial expression, however, it can also impact saliva and tear production.
- is a self- limiting condition that is not life- threatening with majority of patients experiencing a spontaneous recovery that occurs within weeks to months.
Pathology of Carpal Tunnel Syndrome.
- incidence is higher in females than males with the most common age being from 35- 55 years of age
- muscle atrophy is often noted in the abductor pollicis brevis muscle and later in the thenar muscles.
- electromyography studies, Tinel’s sign, and Phalen’s test can be used to assist with confirming the diagnosis.
Pathology of the Central Cord Syndrome.
- incomplete spinal cord lesion that most often results from a cervical hyperextension
- clinical presentation involves motor loss that is greater in the UE than the LE
- most common incomplete spinal cord lesion accounting for approximately 30% of all incomplete forms of tetraplegia.
Pathology of Cerebellar Disorders.
- presents differently based on etiology and location of the lesion within the cerebellum.
- various causes include genetic, congenital malformations, and hereditary ataxias.
- treatment is diagnosis dependent and typically supportive unless it is acquired and/ or reversible.
Pathology of Cerebral Palsy.
- spastic cerebral palsy involves UMN damage; athetoid cerebral palsy involves damage to the basal ganglia.
- clinical presentation includes motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance impairments.
- intellectual disability and epilepsy are present in 50- 60% of children diagnosed with cerebral palsy.
Pathology of Cerebrovascular Accident:
- types of CVA include ischemic stroke (thrombus, embolus, Lacunar) and hemorrhagic stroke (intracerebral, subdural, subarachnoid)
- Left CVA: weakness or paralysis to the right side, impaired processing, heightened frustration, aphasia, dysphagia, an motor apraxia
- Right CVA: weakness or paralysis to the left side, poor attention span, impaired awareness and judgement, spatial deficits, memory deficits, emotional lability, and impulsive behavior
Pathology of Diabetic Neuropathy.
- nerve ischemia results from microvascular disease combined with the direct effects of hyperglycemia on neurons resulting in the impairment of nerve function.
- initial symptoms: tingling, numbness or pain, especially in the feet
- patients require strict monitoring of blood glucose levels to prevent further nerve pathology.
pathology of Down Syndrome:
- clinical manifestations: hypotonia, flattened nasal bridge, Simian line (palmar crease), epicanthic folds, enlargement of the tongue, and developmental delay.
- medical management: team approach that requires lifelong intervention and should be directed toward achieving maximum potential and level of function.
- exercise is essential for a child with Down Syndrome in order to avoid inactivity and obesity.
Pathology for Duchenne Muscular Dystrophy:
- X- linked recessive trait manifesting in only male offspring while female offspring become carriers.
- clinical presentation:
Waddling gait
Pseudohypertrophy of the calf
Difficulty climbing stairs - there is usually rapid progression of this disease with the inability to ambulate by 10 to 12 years of age with death occurring as a teenager or less frequently in the 20s
Pathology for Erb’s Palsy.
- muscles affected are supplied by cervical roots C5 & C6 which result in a loss of function of the rotator cuff, deltoid, Brachialis, Coracobrachialis, & biceps brachii.
- Brachial plexus injury in a newborn usually occurs during a difficult deliver, due to a large baby, a breech presentation with a prolonged labor or with the use of forceps.
- results in flaccid paralysis nicknamed the “waiter’s tip deformity” characterized by:
Loss of shoulder function
Loss loss of elbow flexion
Loss of forearm supination
Hand positioned in a pinch grip manner
Pathology for Epilepsy
- injury to the brain can cause abnormal activity of the brain’s nerve cells in which the electrical discharge of the neurons becomes hypersynchronous, resulting in epileptic seizures.
- symptoms vary widely depending on the type of seizure (e.g., tonic, clonic) and may include:
Mood disturbances
Staring
Loss of consciousness
Uncontrollable jerking of the arms & legs
Stiffening of muscles
Loss of muscle control - an electroencephalogram measures electrical activity of the brain and is the most common test used to confirm the diagnosis of epilepsy.
Pathology for Guillain- Barre Syndrome
- results in motor weakness in a distal to proximal progression, sensory impairment, & possible respiratory paralysis.
- etiology: unknown, HOWEVER, it is hypothesized to be an autoimmune response to a previous respiratory infection, influenza, immunization or surgery.
- majority of patients experience full recovery, 20% have remaining neurologic deficits, & 3-5% of patients die from respiratory complications.
Pathology for Huntington’s Disease:
- chronic progressive genetic disorder that is fatal within 15 to 20 years after clinical manifestation.
- characterized by degeneration and atrophy of the basal ganglia (specifically the striatum) and cerebral cortex within the brain
- clinical presentation includes enlarged ventricles secondary to atrophy of the basal ganglia, mental deterioration, speech disturbances, and ataxic gait.
Pathology for Multiple Sclerosis.
- characterized by demyelination of the myelin sheaths that surround nerves within the brain & spinal cord resulting in plaque development, decreased nerve conduction velocity, and eventual failure of impulse transmission.
- clinical symptoms may include:
Visual problems
Paresthesias
Sensory changes
Clumsiness
Weakness
Ataxia
Balance dysfunction
Fatigue - intervention includes:
Regulation of activity level
Relaxation & energy conservation Techniques
Normalization of tone
Balance activities
Gait training
Core Stabilization
Pathology for Myasthenia Gravis:
- an autoimmune disorder that affects the transmission of neuromuscular signals
- primary feature is muscle weakness within the skeletal muscles, with other neurologic findings being normal (e.g., reflexes, sensation)
- muscles affected commonly include the ocular muscles and limb musculature (proximal greater than distal)
Pathology for Parkinson’s Disease
- degenerative disorder characterized by a decrease in production of dopamine (neurotransmitter) within the substantia nigra of the basal ganglia.
- clinical presentation may include:
Hypokinesia
Difficulty initiating & stopping movement
Festinating & shuffle gait
Bradykinesia
Poor posture
“Cogwheel” & “lead pipe” rigidity. - medical management includes dopamine replacement therapy (Levodopa, Sinemet, Madopar) which is designed to minimize bradykinesia, rigidity, & tremor
Pathology for Polyneuropathy.
- characterized by damage or disease that affects multiple peripheral nerves, which is most commonly caused by diabetes mellitus
- polyneuropathy often starts in the distal lower extremities, generally symmetrically, & may progress to include the hands & more proximal portions of the limbs
- electromyography & nerve conduction testing are often used to determine the location and extent of nerve damage
Pathology for Post- Polio Syndrome.
- 25- 50% of patients with poliomyelitis will eventually develop post- polio syndrome.
- symptoms of post- polio syndrome include muscle weakness, atrophy, fatigue, and sometimes muscular or joint pain
- treatment is generally multidisciplinary & aimed at controlling symptoms and improving daily function.
Pathology for Prader-Willi Syndrome.
- genetic condition that is diagnosed by physical attributes & patterns of behavior rather than genetic testing
- causative factor is a partial deletion of chromosomes 15
- clinical presentation includes coordination impairments and intellectual disability
Pathology for Sciatica Secondary to a Herniated Disk.
- the sciatic nerve experiences an inflammatory response and subsequent damage secondary to compression from the herniated disk
- sciatica is characterized by low back and gluteal pain that typically radiates down the back of the thigh along the sciatic nerve distribution
- pain will increase in a sitting position or when lifting, forward bending or twisting.
Pathology for Spina Bifida Myelomeningocele.
- classifications include:
OCCULTA (incomplete fusion of the posterior vertebral arch with no neural tissue protruding)
MENINGOCELE (incomplete fusion of the posterior vertebral arch with neural tissue/ meninges protruding outside the neural arch)
MYELOMENINGOCELE (incomplete fusion of the posterior vertebral arch with both meninges and spinal cord protruding outside the neural arch) - approximately 75% of vertebral defects are found in the lumbar/ sacral region most often at L5- S1
- prenatal testing of alpha- fetoprotein (AFP) in the blood will show an elevation in levels that indicate a probable neutral tube defect at approximately week 16 of gestation.
Pathology for Spinal Cord Injury- Complete C7 Tetraplegia
- clinical presentation includes impaired cough & ability to clear secretions, altered breathing pattern, and poor endurance
- outcomes at this level include independence with feeding, grooming, dressing, self- range of motion, independent manual WC mobility, independent transfers and independent driving with an adapted automobile.
- the triceps, extensor pollicis longus & brevis, extrinsic finger extensors, and flexor carpi radialis will remain the lowest innervated muscles.
Pathology for Spinal Cord Injury- Complete L3 Paraplegia.
- Patients possess at least partial innervation of the gracilis, iliopsoas, Quadratus lumborum, Rectus femoris, and sartorius with full upper extremity use.
- additional findings that can exist include sexual dysfunction, a non reflexive bladder, the need for bowel program, urinary tract infections, muscle contractures and pressure sores
- patients with L3 paraplegia should be able to live independently with education regarding the management of their disability.
Pathology for Spinal Muscular Atrophy.
- characterized by progressive degeneration of the anterior horn cell
- clinical signs include progressive muscle weakness and atrophy, diminished or absent deep tendon reflexes, normal intelligence, intact sensation, and end- stage respiratory compromise.
- treatment includes positioning, vestibular and visual stimulation and access to play.
Pathology for Thoracic Outlet Syndrome.
- results from compression and damage to the brachial plexus nerve trunks, subclavian vascular supply, and/or the axillary artery.
- contributing factors in the development of the condition include the presence of a cervical rib, an abnormal first rib, postural deviations, hypertrophy or spasms of the scalene muscles, and an elongated cervical transverse process.
- females are at a greater risk than males, with the most common age ranging from 30- 40 years of age.
Pathology for Traumatic Brain Injury.
- occurs due to an open head injury where there is penetration through the skull or closed head injury where the brain makes contact with the skull secondary to a sudden, violent acceleration of deceleration.
- brain injury may include swelling, axonal injury, hypoxia, hematoma, hemorrhage, and changes in intracranial pressure.
- high risk groups include ages 0-4, 15-19, and greater than 65 (males at greater risk in each category)
Pathology for Trigeminal Neuralgia.
Typically the result of abnormal pressure on or irritation of the Trigeminal nerve.
- symptoms are typically unilateral and may be either episodic or constant; sudden pain described as sharp, jolting, stabbing or shock- like or persistent aching or burning sensations
- diagnostic testing is often inconclusive with a diagnosis typically made based on the patient’s reported symptoms.
Pathology for Vestibular Disorders.
- occurs when there is disruption of the sensory information processed by the inner ear and brain with respect to the body’s control of balance and eye movements.
- classified as either peripheral or central, with the majority of cases diagnosed as peripheral.
- effects can be quite diverse ranging from spontaneous recovery to permanent disability.
Pharmacology- ANTIEPILEPTIC AGENTS: Action & Indication
ACTION: reduce or eliminate seizure activity within the brain.
- inhibit firing of certain cerebral neurons through various effects on the CNS.
- chemical classifications include:
Barbiturates
Benzodiazepines
Carboxylic acids
Hydantoins
Iminostilbenes
Succinimides
Second generation drugs
INDICATION: seizure activity (partial seizures, generalized seizures, unclassified seizures)
Pharmacology- ANTIEPILEPTIC AGENTS: Side Effects & Implications for PT.
SIDE EFFECTS: vary considerably based on the specific anti-epileptic agent; may include:
- ataxia
- skin issues
- behavioral changes
- gastrointestinal distress
- headache
- blurred vision
- weight gain
IMPLICATIONS FOR PT: therapists must have adequate knowledge of established protocols for responding to a seizure as well as potential side effects of anti-epileptic medications.
- Pts with epilepsy may show greater sensitivity to environmental surroundings such as light or noise level.
Pharmacology- ANTISPASTICITY AGENTS: Action & Indications.
ACTION: promote relaxation in a spastic muscle
Spasticity: an exaggerated stretch reflex of the muscle that can occur after injury to the CNS
- spasticity is not a primary condition, but a secondary effects from CNS damage.
- agents bind selectively within the CNS or within the skeletal muscle cells to reduce spasticity
INDICATIONS:
- increased tone
- spasticity
- spinal cord injury
- CVA
- multiple sclerosis
Pharmacology- ANTISPASTICITY AGENTS: Side Effects & Implications for PT
SIDE EFFECTS: drowsiness, confusion, headache, dizziness, generalized muscle weakness, hepatotoxicity potential with Dantrium, tolerance, dependence
IMPLICATIONS FOR PT: Therapists must balance the need to decrease spastic muscles with the loss of function that a patient may experience with the reduction of hypertonicity.
- once spasticity is reduced, therapists should focus on therapeutic handling techniques, facilitation, and strengthening to promote overall mobility.
- sedation may also alter the scheduling of therapy to allow for maximal participation.
Pharmacology- DOPAMINE REPLACEMENT AGENTS: Action & Indications
ACTION: assist to relieve the symptoms of Parkinson’s disease secondary to the decrease in endogenous dopamine.
- these agents are able to cross the blood- brain barrier through active transport and transform to dopamine within the brain.
INDICATIONS; Parkinson’s disease, Parkinsonism
Pharmacology- DOPAMINE REPLACEMENT AGENTS: Side Effects & Implications for PT
SIDE EFFECTS: Arrhythmias (levodopa), gastrointestinal distress, orthostatic hypotension, dyskinesias, mood and behavioral changes, tolerance
IMPLICATIONS FOR PT: therapist & patients attain maximal benefit from scheduling therapy one hour after administration of levodopa.
- therapists must understand the debilitating effects of drug holidays and should monitor the patient’s blood pressure frequently due to the potential for orthostatic hypotension.
Pharmacology- MUSCLE RELAXANT AGENTS: Action & Indications
ACTION: promote relaxation in muscles that typically present with spasm that is a continuous, tonic contraction.
- spasm typically occur secondary to a musculoskeletal or peripheral nerve injury rather than CNS injury.
INDICATIONS: muscle spasm
Pharmacology- MUSCLE RELAXANT AGENTS: Side Effects & Implications
SIDE EFFECTS: vary considerably based on the specific muscle relaxant agent;
- sedation
- drowsiness
- dizziness
- nausea
- vomiting
- headache
- tolerance
- dependence
IMPLICATIONS for PT: therapists must be aware of potential side effects, however, maximize the potential for relaxation through therapeutic techniques and the use of modalities during treatment
-prevention of reinjury through stretching, posture retraining, and education should assist the patient to achieve desired outcomes.
Infant Reflexes: Asymmetrical Tonic Neck Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: head position, turned to one side
RESPONSE: arm & leg on face side are extended, arm & leg on scalp side are flexed, spine curved with convexity toward face side.
NORMAL AGE OF RESPONSE: Birth to 6 months
Infant Reflexes: Symmetrical Tonic Neck Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: head position, head or extension
RESPONSE: when head is in flexion, arms are flexed, legs extended; when head is in extension, arms are extended, legs are flexed
Normal Age of Response: 6 to 12 months
Infant Reflexes: Tonic Labyrinthine Reflex (TLR)- Stimulus, Response & Normal Age of Response.
STIMULUS: position of labyrinth in inner ear- reflected in head position
RESPONSE: in supine position, body and extremities are held in extension;
In prone position, body and extremities are held in flexion
Normal Age of Response: Birth to 6 months
Infant Reflexes: Galant Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: touch to skin along spine from shoulder to hip
RESPONSE: lateral flexion of trunk to side of stimulus
Normal Age of Response: 30 weeks of gestation to 2 months
Infant Reflexes: Palmar Grasp Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: Pressure in palm on ulnar side of hand
RESPONSE: Flexion of fingers causing strong grip
Normal Age of Response: Birth to 4 months
Infant Reflexes: Plantar Grasp Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: pressure to base of toes
RESPONSE: Toe flexion
Normal Age of Response: 28 weeks of gestation to 9 months
Infant Reflexes: Rooting Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: Touch on cheek
RESPONSE: turning head to same side with mouth open
Normal Age of Response: 28 weeks of gestation to 3 months
Infant Reflexes: MORO Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: head dropping into extension suddenly for a few inches
RESPONSE: arms abduct with fingers open, then cross trunk into adduction; cry
Normal Age of Response: 28 weeks of gestation to 5 months
Infant Reflexes: STARTLE Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: loud, sudden noise
RESPONSE: arms abduct with fingers open, then cross trunk with elbows remaining flexed and hands closed
Normal Age of Response: 28 weeks of gestation to 5 months
Infant Reflexes: POSITIVE SUPPORT Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: weight placed on balls of feet when upright
RESPONSE: stiffening of legs and trunk into extension
Normal Age Of Response: 35 weeks of gestation to 2 months
Infant Reflexes: WALKING (STEPPING) Reflex- Stimulus, Response & Normal Age of Response.
STIMULUS: supported upright position with soles of feet on firm surface
RESPONSE: reciprocal flexion/ extension of legs
Normal Age Of Response: 38 weeks of gestation to 2 months
UE PNF PATTERNS: D1 Extension
Pattern begins with the pt positioned in shoulder FLEX, ADD, & Lateral Rotation
- “open your hand and push down and away from your body”
UE PNF PATTERN: D1 Flexion
Pattern begins with the pt positioned in shoulder extension, abduction, and medial rotation.
- “close your hand and pull up & across your body”
UPPER EXTREMITY PNF PATTERNS: D2 Extension
Pattern begins with the pt positioned in shoulder FLEX, ABD, and Lateral Rotation.
- “close your hand and pull down and across your body”
UPPER EXTREMITY PNF PATTERNS: D2 Flexion
Pattern begins with the patient positioned in shoulder EXT, ADD, and Medial Rotation.
“Open your hand and pull up and away from your body”
PNF Terminology- CHOPPING.
A combination of BUE asymmetrical patterns performed as a closed- chain activity.
PNF Terminology- DEVELOPMENTAL SEQUENCE.
A progression of motor skill acquisition.
The stages of motor control include:
- mobility
- stability
- controlled mobility
- skill
Define Mass Movement Patterns:
Hip, knee and ankle move into flexion or extension simultaneously.
Define Overflow.
Muscle activation of an involved extremity due to intense action of an uninvolved muscle of group of muscles.
Rancho Los Amigos Cognitive Functioning Scale: Level 1- No Response
Pt appears to be in a deep sleep and is completely unresponsive to any stimuli
Rancho Los Amigos Cognitive Functioning Scale: Level II- Generalized Response
Pt reacts inconsistently and non purposefully to stimuli in a nonspecific manner.
Responses are limited and often the same regardless of stimulus presented.
Responses may be physiological changes, gross body movements, and/ or vocalization.
Rancho Los Amigos Cognitive Functioning Scale: Level III- Localized Response
Pt reacts specifically, but INCONSISTENTLY to stimuli.
Responses are directly related to the type of stimulus presented.
May follow simple commands such as closing the eyes or squeezing the hand in an inconsistent, delayed manner.
Rancho Los Amigos Cognitive Functioning Scale: Level IV- Confused- Agitated
Pt is in a HEIGHTENED state of activity.
Behavior is bizarre and non- purposeful relative to the immediate environment.
Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts.
Verbalizations frequently are incoherent and/ or inappropriate to the environment; confabulation may be present.
Gross attention to environment is very brief; selective attention is often nonexistent.
Patient lacks short and long- term recall.
Rancho Los Amigos Cognitive Functioning Scale: Level V- Confused- Inappropriate
Pt is able to respond to simple commands fairly consistently.
However, with increased complexity of commands, responses are non- purposeful, random, or fragmented.
The patient is highly distractible and lacks the ability to focus attention on a specific task.
Verbalization is often inappropriate and confabulatory.
Memory is severely impaired; may perform previously learned tasks with structure, but is unable to learn new information.
Rancho Los Amigos Cognitive Functioning Scale: Level VI- Confused- Appropriate
Pt shows goal- directed behavior, but is dependent on external input or direction.
Follows simple directions consistently and shows carryover for relearned tasks such as self- care.
Responses may be incorrect due to memory problems but they are appropriate to the situation.
Past memories show more depth and detail than recent memory.
Rancho Los Amigos Cognitive Functioning Scale: Level VII- Automatic Appropriate
Pt appears appropriate and oriented within the hospital and home setting.
Goes through daily routine automatically, but frequently robot- like.
Pt shows minimal to no confusion and has shallow recall of activities.
Shows carryover for new learning, but at a decreased rate.
With structure is able to initiate social or recreational activities; judgement remains impaired.
Rancho Los Amigos Cognitive Functioning Scale: Level VIII- Purposeful- Appropriate
Pt is able to recall and integrate past and recent events and is aware of and responsive to environment.
Shows carryover for new learning and needs no supervision once activities are learned.
May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgement in emergencies or unusual circumstances.
Deep Tendon Reflexes: Biceps Tendon- Innervation, Procedure, Normal Response
Innervation: C5- C6
Procedure: support the elbow in partial flexion in sitting or supine; place the thumb firmly over the biceps tendon at the elbow and strike the hammer through the thumb.
Normal Response: Contraction of the biceps muscle; flexion of the elbow
Deep Tendon Reflexes: Brachioradialis Tendon- Innervation, Procedure, and Normal Response.
Innervation: C5- C6
Procedure: Rest the hand on the lap in sitting with the forearm supported and in neutral; strike the radius one to two inches superior to the wrist
Normal Response: Contraction of the brachioradialis muscle; elbow FLEX and/ or Forearm SUP
Deep Tendon Reflexes: Triceps Tendon- Innervation, Procedure, Normal Response
Innervation: C6- C7
Procedure: Support the UE through the humerus and allow the lower portion to hang with elbow flexion; strike the triceps tendon directly above the elbow
Normal Response: Contraction of the triceps muscle; elbow extension
Deep Tendon Reflexes: Patellar Tendon- Innervation, Procedure, Normal Response
Innervation: L3- L4
Procedure: Supported knee flexion with the patient in sitting or supine; strike the tendon directly inferior to the patella
Normal Response: Contraction of the quadriceps; knee extension
Deep Tendon Reflexes: Achilles Tendon- Innervation, Procedure, and Normal Response
Innervation: S1- S2
Procedure: In sitting, flex the foot at the ankle putting the Achilles on stretch; strike the Achilles tendon above the foot.
Normal Response: Plantar flexion of the foot.
Type of Sensation: Temperature
Superficial
Type of Sensation: Stereognosis
Cortical
Type of Sensation: Barognosis
Cortical
Type of Sensation: Pain
Superficial
Type of Sensation: Vibration
Deep
Type of Sensation: Bilateral Simultaneous Stimulation
Cortical
Type of Sensation: Kinesthesia
Deep
Type of Sensation: Two- Point Discrimination
Cortical
Type of Sensation: Light Touch
Superficial
Type of Sensation: Localization of Touch
Cortical
Type of Sensation: Proprioception
Deep
Testing Procedure: Barognosis
Perceive the weight of different objects in the hand
Testing Procedure: Deep Pain
Squeeze the forearm or calf muscle
Testing Procedure: Graphesthesia
Identify a number or letter drawn on the skin without visual input
Testing Procedure: Kinesthesia
Identify the direction and extend of movement of a joint or body part
Testing Procedure: Light Touch
Perceive touch through light pressure or use of a cotton ball
Testing Procedure: Localization
identify the exact location of light touch on the body using a verbal response or gesturing
Testing Procedure: Proprioception
Identify a static position of an extremity or body part
Testing Procedure: Stereognosis
Identify an object without sight
Testing Procedure: Superficial Pain
Perceive a noxious stimulus using a pen cap, paper clip end or pin.
Testing Procedure: Temperature
Perceive warm and cold test tubes
Testing Procedure: Two- Point Discrimination
Identify one or two points without visual input using a two- point caliper on the skin.
Testing Procedure: Vibration
Perceive vibration or pain through a tuning fork
Level of Assistance for Bed mobility for C3 Lesion
Dependent
Level of Assistance for Bed mobility for L3 Lesion
Independent
Level of Assistance for Bed mobility for C8 Lesion
Independent
Level of Assistance for Weight Shifting for T3 Lesion
Independent
Level of Assistance for Range of Motion for C4 Lesion
Dependent
Level of Assistance for Range of Motion for L4 Lesion
Independent
Level of Assistance for Slide Board Transfers for C4 Lesion
Dependent
Level of Assistance for Slide Board Transfers for C8 Lesion
Independent
Level of Assistance for Feeding for T1 Lesion
Independent
Define Akinesia
The inability to initiate movement; commonly seen in patients with Parkinson’s disease
Define Asthenia
Generalized weakness, typically secondary to Cerebellar pathology
Define Ataxia
The inability to perform coordinated movements,
Define Athetosis
A condition that presents with involuntary movements combined with instability of posture.
Peripheral movements occur without central stability
Define Bradykinesia.
Movement that is very slow
Define Chorea
Movements that are sudden, random, and involuntary.
Define Clasp- knife response
A form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement though the range of motion.
Define Clonus
A characteristic of an upper motor neuron lesion; involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex.
Define Cogwheel Rigidity.
A form of rigidity where resistance to movement has a physical quality to it; often seen with Parkinson’s disease
Define Dysdiadochokinesia
The inability to perform rapidly alternating movements
Define Dysmetria
The inability to control the range of a movement and the force of muscular activity
Define Fasciculation
A muscular twitch that is caused by random discharge of a LMN and its muscle fibers; suggests LMN disease, however, can be benign.
Define Hemiballism
An involuntary and violent movement of a large body part.
Define Kinesthesia
The ability to perceive the direction and extent of movement of a joint or body part.
Define Lead Pipe Rigidity.
A form of rigidity where there is uniform and constant resistant to range of motion; often associated with lesions of the basal ganglia.
Define Rigidity
A state of severe hypertonicity where a sustained muscle contraction does not allow for any movement at a specified joint.
Define Tremor.
Involuntary, rhythmic, oscillatory movements secondary to a basal ganglia lesion.
There are various classifications secondary to specific etiology.
Define Agnosia.
The inability to interpret information.
Define Agraphesthesia.
The inability to recognize symbols, letters or numbers traced on the skin.
Define Agraphia.
The inability to write due to a lesion within the brain and is typically found in combination with aphasia.
Define Alexia
The inability to read or comprehend written language secondary to a lesion within the dominant lobe of the brain.
Define Anosognosia.
The denial or unawareness of one’s illness; often associated with unilateral neglect.
define Aphasia.
The inability to communicate or comprehend due to damage to specific areas of the brain.
Define Apraxia
The inability to perform purposeful learned movements or activities even though there is no sensory or motor impairment that would hinder completion of the task.
Define Astereognosis,
The inability to recognize objects by sense of touch.
Define Body Schema,
Having an understanding of the body as a whole and the relationship of its parts to the whole
Define Constructional Apraxia.
The inability to reproduce geometric figures and designs.
A person is often unable to visually analyze how to perform a task.
Define Decerebrate Rigidity.
A characteristic of a corticospinal lesion at the level of the brainstem that results in extension of the trunk and all extremities,
Define Decorticate Rigidity.
A characteristic of a corticospinal lesion at the level of the diencephalon where the trunk and lower extremities are positioned in extension and the upper extremities are positioned in flexion.
Define Diplopia.
Double vision
Define Dysarthria.
Slurred and impaired speech due to a motor deficit of the tongue or other muscles essential for speech.
Define Dysphagia.
The inability to properly swallow.
Define Dysprosody.
Impairment in the rhythm and inflection of speech.
Define Emotional Lability.
A characteristic of a right hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation.
Define Fluent Aphasia.
Characteristic of receptive aphasia where speech produces functional output regarding articulation, but lacks content and is typically dysprosodic using neologistic jargon.
Define Hemiparesis.
A condition of weakness on one side of the body.
Define Hemiplegia.
A condition of paralysis on one side of the body.
Define Homonymous Hemianopsia.
The loss of the right or left half of the field of vision in both eyes.
Define Ideational Apraxia.
The inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for movement is impaired.
Ideomotor Apraxia
A condition where a person plans a movement or task, but cannot volitionally perform it.
Automatic movement may occur, however, a person cannot impose additional movement on command.
Define Non- Fluent Aphasia.
Characteristic of expressive aphasia where speech is non- functional, effortful, and contains paraphasias.
Writing is also impaired.
Define Perseveration
The state of repeatedly performing the same segment of a task or repeatedly saying the same word/ phase without purpose.
Define Synergy.
Mass movement patterns that are primitive in nature and coupled with spasticity due to brain damage.
Define Unilateral Neglect.
The inability to interpret stimuli and events on the contralateral side of a hemispheric lesion.
Left sided neglect is most common with a lesion to the right inferior parietal or superior temporal lobes.
Define Cauda Equina Injury.
A term used to describe injuries that occur below the L1 level of the spine.
A cauda equina injury is considered to be a lower motor neuron lesion.
Define Dermatome.
Designated sensory areas based on spinal segment innervation.
Define Myelotomy.
A surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function.
Define Myotome.
Designated motor areas based on spinal segment innervation.
Define Neurectomy.
A surgical removal of a segment of a nerve in order to decrease spasticity and improve function.
Define Neurogenic Nonreflexive Bladder.
The bladder is flaccid as a result of a cauda equina or conus medullaris lesion.
The sacral reflex arc is damaged.
Define Neurogenic Reflexive Bladder.
The bladder empties reflexively for a patient with an injury above the level of T12.
The sacral reflex arc remains tact.
Define Neurologic Level.
The lowest segment (most caudal) of the spinal cord with intact strength and sensation.
Muscle groups at this level must receive a grade of fair
Define Paradoxical Breathing.
A form of abnormal breathing that is common in tetraplegia where the abdomen rises and the chest is pulled inward during inspiration.
On expiration the abdomen falls and the chest expands.
Define Paraplegia.
A term used to describe injuries that occur at the level of the thoracic, lumbar, or sacral spine.
Define Rhizotomy.
A surgical resection of the sensory component of a spinal nerve in order to decrease spasticity and improve function.
Define Sacral Sparing.
An incomplete lesion where some of the innermost tracts remain innervated,
Characteristics include sensation of the saddle area, movement of the toe flexors, and rectal sphincter contraction.
Define Spinal Shock.
A physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks.
Presents with total flaccid paralysis and loss of all reflexes below the level of injury.
Define Tenodesis.
Patients with tetraplegia that do not possess motor control for grasp can utilize the tight finger flexors in combination with wrist extension to produce a form of grasp.
Define Tenotomy.
A surgical release of a tendon in order to decrease spasticity and improve function.
Define Tetraplegia (Quadriplegia)
A term adopted by the American Spinal Injury Association to describe injuries that occur at the level of the cervical spine.
Define Zone of Partial Preservation.
A term used to describe the area below the neurologic level of injury that contains partial sensory or motor innervation.
Upper Motor Neuron Disease: Expectation for Reflexes.
Hyperactive
Upper Motor Neuron Disease: Expectation for Atrophy
Mild from disuse
Upper Motor Neuron Disease: Expectation for Fasciculations.
Absent
Upper Motor Neuron Disease: Expectation for Tone
Hypertonic
Lower Motor Neuron Disease: Expectation for Reflexes
Diminished or absent
Lower Motor Neuron Disease: Expectation for Atrophy
Present
Lower Motor Neuron Disease: Expectation for Fasciculations
Present
Lower Motor Neuron Disease: Expectation for Tone
Hypotonic to flaccid
Progressive Muscular Atrophy: UMND or LMND
LMND
Cerebral Palsy: UMND or LMND
UMND
Hydrocephalus: UMND or LMND
UMND
Poliomyelitis: UMND or LMND
LMND
Guillain- Barre Syndrome: UMND or LMND
LMND
Cerebrovascular Accident: UMND or LMND
UMND
Multiple Sclerosis: UMND or LMND
UMND
Huntington’s Chorea: UMND or LMND
UMND
Bell’s Palsy: UMND or LMND
LMND
Carpal Tunnel Syndrome: UMND or LMND
LMND
Muscular Dystrophy: UMND or LMND
LMND
Traumatic Brain Injury: UMND or LMND
UMND
Pseudobulbar Palsy: UMND or LMND
UMND
Brain Tumors: UMND or LMND
UMND
Spinal Muscular Atrophy: UMND or LMND
LMND
