Neuromuscular System Flashcards
autonomic nervous system
(automatic) responsible for involuntary muscle movement
somatic nervous system
responsible for voluntary muscle movement
CNS
brain and spinal cord
structural components of a neuron
- soma
- dendrites: receive signals
- axons: send signals Away
white vs gray matter
myelinated vs unmyelinated
basal ganglia
responsible for muscle control and muscle tone
-Parkinson’s Disease
medulla oblongata
responsible for life centers
-maintains consciousness and arousal
pons
regulates respiration
hypothalamus
maintains homeostasis
thalamus
relay station
corpus callosum
allows communications between left and right hemispheres
primary functions: frontal lobe
PRIMARY MOTOR CORTEX: contralateral, voluntary movements
-Broca’s area: motor component of speech
-cognition, judgement, attention, emotional control
dysfunction pattern: frontal lobe
-contralateral weakness
-personality changes
-ataxia
-Broca’s aphasia
-delayed/poor initiation
primary functions: parietal lobe
PRIMARY SENSORY CORTEX: contralateral
-short term memory
-perception of touch, proprioception, pain, and temperature sensations
dysfunction pattern: parietal lobe
-constructional apraxia
-anosognosia
-Wernicke’s aphasia
-homonymous visual deficits
-impaired language comprehension
primary functions: occipital lobe
VISUAL ASSOCIATION CORTEX
-processes and applies meaning
dysfunction pattern: occipital lobe
variety of visual deficits
primary functions: temporal lobe
PRIMARY AUDITORY CORTEX
-Wernicke’s area: comprehension of spoken word
-long term memory
+ PRIMARY VISUAL CORTEX
dysfunction pattern: temporal lobe
-hearing impairments
-memory/learning deficits
-Wernicke’s aphasia
-antisocial behaviors
primary functions: cerebellum
-regulates muscle tone: posture, smooth voluntary movements
-motor learning: sequencing of movements
dysfunction pattern: cerebellum
-ataxia
-lack of coordination: dysdiadochokinesia, dysmetria
-intention tremors
-balance deficits
dysfunction pattern: basal ganglia
(Parkinson’s Disease)
-bradykinesia
-resting tremors
-rigidity
-athetosis
-chorea
dysfunction pattern: thalamus
-thalamic pain syndrome
-altered relay of sensory information
dysfunction pattern: hypothalamus
-poor autonomic NS functioning
-altered basic life functions
dysfunction pattern: brain stem
-altered consciousness
-contralateral hemiparesis/plegia
-cranial nerve palsy
-altered respiratory patterns
-attention deficits
R hemisphere injury deficits
-LEFT sensory/motor deficits
-QUICK AND IMPULSIVE, overestimation of abilities
-unable to understand nonverbal communication
-difficulty sustaining movements
-poor coordination and kinesthetic awareness
L hemisphere injury deficits
-RIGHT sensory/motor deficits
-SLOW, CAUTIOUS, ANXIOUS, self-deprecating
-difficulty understanding/producing language
-difficulty sequencing movements
-poor logical, rational thought
circle of willis
blood supply to the brain
meninges
protective layers of the brain
-dura mater
-arachnoid
-pia mater
CSF
protects the brain and circulates nutrients/disposes waste
-produced by choroid plexuses
SAME DAVE
-sensory afferent
-motor efferent
-dorsal afferent
-ventral efferent
cauda equina
(horse’s tail) nerves arising from the distal tip (L1/L2) of the spinal cord
GTO
(golgi tendon organ) sensitive to muscle tension
muscle spindle
sensitive to muscle length
cerebral angiography
shows vascularity
computed tomography
shows tissue density
EEG
records electrical activity
-seizures
EMG
records muscle-nerve communication
level of arousal: alert
responds fully and appropriately
level of arousal: lethargic
appears drowsy, can respond but falls asleep easily
level of arousal: obtunded
confused, responds slowly, decreased interest in environment
level of arousal: stupor
only aroused from sleep with painful stimuli, minimal awareness
level of arousal: coma
cannot be aroused, no response to stimuli
glasgow coma scale
measured by degree of eye opening, motor response, and verbal response (15 point total + )
sustained attention
ability to attend to task without redirection
divided attention
ability to shift attention from one task to another
focused attention
ability to stay on task in the presence of distractors
mini mental exam
brief screening for cognitive dysfunction (30 point total + )
OH
BP drop d/t change in position
-20 mmHg systolic
-10 mmHg diastolic
-lightheadedness, syncope
stereognosis
ability to identify objects placed in hand
two-point discrimination
ability to discern between two points or one
tactile localization
ability to identify point on body where stimulus is applied without looking
graphesthesia
ability to recognize #/letter drawn on skin without looking
barognosis
ability to assess object according to weight
kinesthesia
ability to identify direction of joint MOVEMENT
proprioception
ability to identify POSITION of joint
homonymous hemianopsia
loss of contralateral half of visual field in EACH eye
somatognosia
inability to identify body parts and their relationship to one another
anosognosia
severe denial/neglect, lack of awareness of dysfunction
figure-ground discrimination disorder
inability to pick an object from the background
form constancy disorder
inability to pick an objects in an array of similar shaped items
position in space deficit
inability recognize up/down, in/out, under/over
topographical disorientation
inability to navigate familiar route on own
agnosia
inability to recognize familiar objects with one sensory modality
apraxia
inability to perform purposeful movements when there is no loss in physical ability (ideomotor/ideational)
ideomotor apraxia
cannot perform the task on command but can do the task when left
ideational apraxia
cannot perform the task at all
clonus
when quick stimulus produces a cyclical, sustained contraction
flaccidity
lack of resistance to PROM, occurs during period of spinal shock immediately after injury and LMN injuries
spasticity
increased resistance to PROM following spinal shock as function begins to return and UMN injury
Modified Ashworth Scale
measures spasticity (1-4 scale)
0 - no increase in tone
1 - slight increase
2 - moderate increase
3 - PROM is difficult
4 - nonmovable
decorticate rigidity
sign of severe impairment of the diencephalon
-sustained FLEX posture in UE
-sustained EXT in LE
decerebrate rigidity
sign of severe impairment of the brain stem
-sustained EXT posture in UE/LE
rigidity
resistance to PROM in agonist and antagonist
cogwheel rigidity
ratchet-like response (catches then releases)
leadpipe rigidity
constant rigidity
Jendrassik’s maneuver
pt hooks fingers together and attempts to pull them apart to increase sensitivity to DTRs in LE
Babinski reflex
quick stroke of the lateral border of the sole of the foot produces flexion of the first toe
-abnormal: EXT of first toe
-reintegrates at 2 years
DTR grading scale
(0-4+ scale)
0 - absent
1+ hyporeflexia
2+ NORMAL
3+ hyperreflexia
4+ clonus
DTR nerve root: biceps
C5-C6
DTR nerve root: triceps
C7-C8
DTR nerve root: quadriceps
L3-L4
DTR nerve root: Achilles
S1-S2
DTR pneumonic
1,2 buckle my shoes
3,4 kick the door
5,6 pick up sticks
7,8 lay them straight
:))
ramiste’s phenomenon
resisted hip ABD/ADD of uninvolved extremity causes the same reaction in the involved extremity
homolateral limb synkinesis
FLEX of UE causes FLEX of ipsilateral LE
ataxia
uncoordinated movement
dysmetria
inability to accurately judge the distance to a reach a goal or target
dysarthria
slurring of speech due to impaired motor control of speech structure
intention tremor
involuntary, oscillatory movement that appears with voluntary movement
postural tremor
involuntary, oscillatory movement that appears while holding limb still
akinesia
unable to initiate movement
chorea
involuntary “dancing” movements
athetosis
involuntary, twisting movements
equilibrium vs nonequilibrium coordination tests
coordination tests done while sitting vs standing
rhomberg progression
rhomberg: stand with feet together
sharpened/tandem rhomberg: heel-to-toe position
Berg Balance Scale
examines functional balance
-56 total points, <45 high risk of falls
neuroplasticity
mechanism in which the brain reorganizes its’ structures, functions, or connections in response to rehab
contract relax
stretch, isometric contraction of antagonist, relax, PT BRINGS THEMSELVES into new rangeAZXZ X<?>
hold relax
stretch, isometric contraction of antagonist, relax, PROM into new range
UE - D1 PNF
movement across face and downward to the side
UE - D2 PNF
movement across the body and upwards toward the head
Brunnstrom’s stages of motor recovery
stages 1-6
1-flaccid
2-spasticity
3-synergies
4-decline in synergies
5-increasing voluntary control
6-near normal
stages of motor control
mobility, stability, controlled mobility, skill
meningitis
inflammation of the meninges (protective coverings of the CNS)
encephalitis
inflammation of the brain
ALS
(amyotrophic lateral sclerosis) UMN and LMN
MS
(multiple sclerosis) chronic, progressive demyelination of the CNS with fluctuating periods
relapsing-remitting MS
presents with cycles of exacerbation/remission with long periods of stability
secondary-progressive MS
presents as relapsing-remitting and turns into a progressive course
primary-progressive
progresses from onset with no or occasional plateaus
Lhermitte’s sign
electric shock-like sensation throughout body produced by neck FLEX
considerations for pts with MS
-work better in the mornings
-many sensory deficits
-avoid factors that worsen condition: heat, hyperventilation, dehydration, fatigue
-during acute relapse, exercise should be avoided
Parkinson’s Disease
chronic, progressive disease of the basal ganglia d/t deficiency of dopamine and degeneration of the substancia nigra
festinating gait
-found in PD pts
shortened stride, decreased speed, increased cadence, decreased arm swing and trunk rotation
s/s of PD
-festinating gait
-akinesia
-bradykinesia
-kyphotic posture
-resting tremors
CVA
(cerebrovascular accident aka stroke) sudden, focal neurological deficit resulting from ischemic or hemorrhagic lesions in the brain
thrombus
blood clot
embolus
traveling matter that can occlude and cause infarction of cerebral arteries
TIA
(transient ischemic attack) brief warning episodes of dysfunction lasting less than 24 hours
pusher syndrome
condition where pt forcefully pushes towards paretic side
L vs R hemisphere lesions
L: slow, cautious, hesitant
R: impulsive, quick, overestimate their ability, SAFETY CONCERNS
Wernicke’s aphasia
(receptive /fluent aphasia) impaired speech comprehension, however pt speaks in “word salad”
Broca’s aphasia
(expressive/motor/nonfluent aphasia) difficulty speaking but comprehension is intact
constraint-induced movement therapy
“forced” use of the paretic extremity
TBI
(traumatic brain injury) brain damage due to contact forces or acceleration forces
coup-contrecoup injury
injury occurring at point of impact and opposite
diffuse axonal injury
tearing of axons and vessels
Rancho Los Amigos level of cognitive functioning
outlines predictable sequence of cognitive and behavioral recovery (8 levels)
I-III no to decreased response levels
IV-VI confused levels
VII-VIII appropriate levels
retrograde amnesia
inability to remember events preceding the injury
SCI
(spinal cord injury) partial or complete disruption of the spinal cord
naming of SCI level
named according to last INTACT nerve root segment
SCI level that causes tetraplegia/quadriplegia
C1-C8
SCI level that causes paraplegia
T1-L1
central cord syndrome
loss of centrally located tracts with more intact peripheral tracts caused by hyperEXT of the C-spine
Brown-Sequard syndrome
hemisection of the spinal cord presenting with asymmetrical s/s
anterior cord syndrome
loss of anterior cord caused of FLEX resulting in loss of motor function, pain, and temp but preservation of light touch, proprioception, and position sense
cauda equina syndrome
SCI below L1, considered a LMN injury
C3, 4, and 5…
keep the diaphragm alive :))
autonomic dysreflexia
EMERGENCY!! when noxious stimu elicit vasoconstriction and raises BP to dangerous levels occurring in SCI T6 and above
s/s: hypertension, headache, diaphoresis
response: red raise their head, empty catheter
epilepsy
recurrent seizures (repetitive abnormal electrical discharges of the brain)
grand mal seizures
generalized; all areas of the brain are involved
focal seizures
only one part of the brain is involved, s/s present in specific area of body
neurapraxia
(nerve compression)
axonotmesis
injury to the nerve interrupting the axon, causes degeneration distal to lesion, regeneration possible
neurotmesis
severance of the entire nerve, requires surgical intervention
Bell’s Palsy
unilateral facial paralysis d/t LMN lesion to the facial nerve (CN VII)
Guillan Barre Syndrome
acute demyelination of both cranial and peripheral nerves resulting in progressive muscular weakness (LE>UE, distal to proximal)
myasthenia gravis `
decreased acetylcholine receptors resulting in fluctuating weakness
myasthenic crisis
EMERGENCY!! weakness of the respiratory muscles
postpolio syndrome
new onset of weakness and fatigue occurring after recovery from acute poliomyelitis
considerations with pt with nerve disorders
avoid fatigue, overuse
trigeminal neuralgia
neuralgia resulting from degeneration or compression of trigeminal nerve (CN V)
complex regional pain syndrome
overreaction of the NS following trauma to a nerve resulting in pain out of proportion to injury
allodynia
touch that is typically nonpainful (ie. light touch) is interpreted as pain
hyperalgesia
increased level of pain sensitivity, lower pain threshold
tenodesis grasp
passive hand grasp that occurs when the wrist is EXT
locked in syndrome
pt is awake and aware of environment however is unable to control muscles beyond the eyes
ACA CVA syndrome
-impacts medial frontal/parietal lobes (motor/sensory), BG (motor, corpus collosum)
-LE>UE
-urinary incontinence
-apraxias
-abulia: lack of desire to carry out action
MCA CVA syndrome
-impacts lateral frontal/parietal/temporal lobes
-face+UE
-(L) language~aphasias
-(R) perception~agnosias
ICA CVA syndrome
-supplies ACA and MCA
-incomplete: presents similar to ACA/MCA
-complete: inc cerebral edema, coma, death
PCA CVA syndrome
-impacts occipital lobe (visual), temporal lobe, thalamus (relay station), brain stem (life centers)
-oculomotor nerve palsy: inferior, out eye position
-cortical blindness: blindness but structure is normal
-thalamic pain syndrome
-pusher syndrome
