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NPTE > Neuromuscular system > Flashcards

Neuromuscular system Flashcards

1
Q

The Frontal lobe is responsible for

A

Judgement, problem solving, creativity, logic, understanding consequences, Emotions,
Memory and learning
Brocas area - Non-fluent expressive aphasia
Motor cortex

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2
Q

Parietal lobe

A

Object recognition, sense of taste

Somatosensory cortex

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3
Q

Occipital lobe

A

Visual cortex

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4
Q

Temporal lobe

A

Hearing, smell, memory

(L) hemisphere - wernikes area, fluent, receptive aphsia

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5
Q

Hippocampus

A

Short to long term memory

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6
Q

Reticular activating system

A

Regulates alertness,

Deep sleep, drowsy, low alert, high alert

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7
Q

Anterior spinal artery

A

Supplies middle medulla including ant spinal cord

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8
Q

Posterior inferior cerebellar artery

A

Supplies cerebellum

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9
Q

Vertebral artery

A

supplies the post part of the circle of willis

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10
Q

Ascending pathways are also called and carry which information?

A

Afferent pathways - carry sensory information to the brain

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11
Q

Decending pathways are also called what and carry which information?

A

Efferent pathways - control motor function and muscle tone,

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12
Q

The Dorsal column medial lemniscal tract carries which information on which side?

A

Crosses in the medulla, travels ipsilaterally
Proprioception, vibration, tactile discrimination
Separated into fasiculus cunatus: upper extremity
Fasciculus gracilis: lower extremity

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13
Q

The spinothalamic tract carries which information on which side?

A

Pain and temperature (lateral) Crude touch (anterior) on the contralateral side. Decussation at the level.

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14
Q

The corticospinal tract is responsible for what?

A

Voluntary motor control

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15
Q

Vestibulospinal tract is responsible for what?

A

Muscle tone, antigravity muscles, Postural reflexes, head on trunk stabilisation, VOR

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16
Q

Rubrospinal tract

A

Proximal limb flexors - causes flexion in the upper extremities.

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17
Q

Reticulospinal tract

A

Excitatory to extensors and axial muscles (medial) inhibitory to extensors (lateral)

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18
Q

What is usually the cause of decreased DTR? and Increased?

A

Peripheral issue for decreased and a central issue for exaggerated

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19
Q

CN I

A

Olfactory - smell, sensory only

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20
Q

CNII

A

Optic - Vision, sensory only

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21
Q

CNIII

A

Oculomotor - Eye movements, depress, elevate, adduct

Motor only

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22
Q

CNIV

A

Trochlear - Eye movement - depress and adduct

Motor only

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23
Q

CN V

A

Trigeminal - sensation of face, scalp, eyeball and tongue
- masseter and temporalis jaw closing
Mixed

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24
Q

CNVI

A

Abducens - eye movement - abduction,

Motor only

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25
Q

CNVII

A

Facial - eye closing, facial expression, taste on ant 1/3 tongue
Mixed

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26
Q

CNVIII

A

Vestibulococlear - hearing and balance

Sensory only

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27
Q

CNIX

A

Glossopharyngeal - taste to post 2/3 tongue, Gag reflex

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28
Q

CNX

A

Vagus - sensation and motor to heart and lungs

Mixed

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29
Q

CNXI

A

Accessory - SCM and trap function. shoulder shrug

Motor oNly

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30
Q

CNXII

A

Hypoglossal - tongue movements Motor only

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31
Q

Dermatomes: C1

A

Top of skull

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32
Q

Dermatomes: C2

A

Temple, forehead, occuiput

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33
Q

Dermatomes: C3

A

Neck, post cheek, temporal area, under mandible

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34
Q

Dermatomes: C4

A

Tip of shoulder, upper scap, clavicle

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35
Q

Dermatomes: C5

A

Deltoid, ant arm to base of thumb

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36
Q

Dermatomes: C6

A

Ant arm - radial hand thumb and index finger

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37
Q

Dermatomes: C7

A

Medial arm and forearm to middle finger

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38
Q

Dermatomes: C8

A

Ring and pinky finger, ulnar forearm

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39
Q

Dermatomes: T1

A

Medial forearm

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40
Q

Dermatomes: T2

A

Axilla

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41
Q

Dermatomes: T3-6

A

Upper thoracic (T4 nipple)

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42
Q

Dermatomes: T5-7

A

Costal margin

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43
Q

Dermatomes: T7-12

A

Lower abdomen (T10 belly button, T12 ASIS)

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44
Q

Dermatomes: L1

A

Upper groin, lower back

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45
Q

Dermatomes: L2

A

Lower groin, ant thigh and knees

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46
Q

Dermatomes: L3

A

Sacral area, medial knee, ant lower leg

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47
Q

Dermatomes: L4

A

Med lower leg - medial calf and ankle

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48
Q

Dermatomes: L5

A

ant tibia, toes

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49
Q

Dermatomes: S1

A

Lat foot, plantar foot, Gastroc/soleus

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50
Q

Dermatomes: S2

A

Post thigh, lateral leg

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51
Q

Dermatomes: S3

A

Buttock

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52
Q

Dermatomes: S4

A

Rectum, anal area, saddle

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53
Q

Myotomes: C5

A

Deltoid, shoulder abduction

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54
Q

Myotomes: C5/6

A

Elbow flexion, wrist extension

55
Q

Myotomes: C7

A

Elbow extension wrist flexion

56
Q

Myotomes: C8

A

Ulnar deviation, FCU, ECU

57
Q

Myotomes: T1

A

digit abd/add interossei

58
Q

Myotomes: L2/3

A

Hip F

59
Q

Myotomes: L3/4

A

Knee extension

60
Q

Myotomes: L4/5

A

Ankle DF, toe ext

61
Q

Myotomes: S1

A

Plantar flexion, Gastroc

62
Q

ASIA impairment Scale - ASIA A

A

Complete, no sensory or motor function preserved

63
Q

ASIA impairment Scale - ASIA B

A

Sensory incomplete: sensory preserved but not motor

64
Q

ASIA impairment scale ASIA C

A

Motor incomplete, motor preserved but muscle grade <3/5

65
Q

ASIA impairment scale ASIA D

A

Motor incomplete, motor preserved, muscle grade >3/5

66
Q

ASIA impairment scale ASIA E

A

Normal - sensory and motor function normal

67
Q

Rancho Los Amigos level of cognitive function

A 
I: No response
II: Generalised response
III: Localised response
IV: Confused agitated
V: Confused inappropriate
VI: Confused appropriate
VII: Automatic
VIII: Purposeful
68
Q

Glasgow Coma Scale stages of severity

A

8 or less; severe
9-12 moderate
13-15 mild

69
Q 
Deep Tendon Reflexes: 
Biceps:
Brachioradialis:
Triceps:
Patellar:
Achilles:
A 
Biceps: C5,C6
Brachioradialis: C5/6
Triceps: C7
Patellar: L3/4
Achilles: S1/2
70
Q

Grades of DTR

A 
0 - no response
1+ - diminished response
2+ normal response
3+ brisk/exaggerated response
4+ Hyperactive - always abnormal
71
Q

Superficial reflexes include;

A

Abdominal T8-L1
Corneal Blink CN V and VII
Gag reflex CN IX and X
Cremasteric Reflex L1-2

72
Q

Wheelchair measurements should be

A

Seat height +2
Seat depth -2
Seat width +2
Back height -4

73
Q

Functional independence measure (FIM)

A

Score 18-126 with each item scored 1-7

1 total assistance, 2 max assist, 3 mod assist, 4 min assist, 5 supervision. 6 modified independent (device), 7 complete independence.

Self care, bladder bowel, transfers, locomotion, communication, social cognition

74
Q

Tinetti Balance test

A

Sit, sit to stand, attempt to rise, first 5 sec standing, standing nudged, eyes closed, 360 degree turn, sit

75
Q

Dynamic Gait index

A 
Level surface
change in speed
horizontal head turns
Vertical head movement
gait pivot and turn
Step over obstacle
Step around obstacles
Stiars. 
<19/24 fall risk
>22 safe ambulator
76
Q

Brunnstroms stages

A
  1. No spasticity - flaccid, no synergy no function
  2. Spasticity onset + weak associated movements
  3. Peak spasticity, voluntarily perform synergy
  4. Spasticity decreasing, partial limb synergy
  5. Spasticity decreasing, independent of synergy, almost clear
  6. Minimal spasticity, free of synergy, isolated joint movements with co-ordination
  7. Normal
77
Q

Alzheimers

A

progressive mental deterioration, deterioration of cerebral cortex and subcortical areas. Low neurotransmitters and high aluminum.

  • loss of orientation, word finding difficulty, depression, poor judgment, rigidity, slow movement, shuffling gait
78
Q

ALS

A

Chronic degenerative UMN and LMN impairment

79
Q

Ant cord syndrome

A

Hyperflexion injury.
Loss of spinothalamic tracts with bilateral loss of pain and temperature.
DCML pathway preserved.
Bilateral loss of motor function, spastic paralysis below level of the lesion

Motor function, pain and temp.

80
Q

Arthrogryposis multiplex congenita

A

Occurs during first trimester, fibrosis of muscles and joint structures. Non-progressive.
Multiple contractures, joint dislocation, atrophy, cylindershaped limbs with no definition/tone

81
Q

Autonomic dysreflexia

A

Occurs with SCI above T6

Reaction of the ANS to overstimulation

  • Pounding headache
  • flushed skin
  • red blotches on head and neck
  • sweating above injury level
  • nausea
  • slow heat rate
  • goosebumps below level
  • blurred vision
82
Q

Bells Palsy

A

Temporary unilateral facial paralysis due to trauma with demyelination of the facial nerve.
CNVII. - facial paralysis unilateraly
Inability to taste
Inability to smile, puff cheeks, close eye
Drooping eye, drooping mouth, tearing eye, loss of saliva control
Exacerbated by use of muscles

83
Q

Brown sequard syndrome

A

Loss of contralateral pain and temperature and ipsilateral, motor, proprioception, vibration, deep pressure and discrimination.

Contralateral spinothalamic tract
Ipsilateral: DCML tract and corticospinal tract

84
Q

Bulbar palsy

A

Weakness/paralysis of muscles innervated by motor nuclei of the lower brainstem
Dysphageia, nasal regurgitations, slurred speech, choking, dysphonia, dysarthria, dysphasia

85
Q

Cauda equina

A

LMN lesion caused by injury below L1

Flaccidity, areflexia, incontinence bladder/bowel

86
Q

Central cord syndrome

A

Compression to central SC due to hyperextension injury

Motor more than sensory, upper limb more than lower
Loss of spinothalamic tract bilateral, preservation of DCML
Bilateral loss of motor function.

87
Q

Cerebral palsy

A

Non progressive brain injury sustained during birth, in utero or in infancy.
Abnormal tone, reflexes and mobility

88
Q

Dysautonomia

A

Any disease or malfunction of the ANS

Abnormal HR, breathing, sweating, pupil size, bladder function, fatigue

89
Q

Guillian Barre

A

Polyneuritis with progressive muscle weakness that develops rapidly. Often lasts 4 weeks. Most patients heal completely within a year.
Acute inflammatory demyelinating polyneuropathy
Peripheral nerves
Lower extremity weakness progressing to upper extrem
Sensory loss less than motor

90
Q

Huntingtons disease

A

Inherited - causes degeneration and atrophy of basal ganglia and cerebral cortex (chromosome 4)
Choreic movement, dystonia, atheoid movement, ataxia, impaired gait, posture and balance. Difficulty with speech and swallowing, incontinence, tongue protrusion

91
Q

Polio myelitis

A

Viral disease inflames the grey matter of the spinal cord. Infection.

92
Q

Post cord syndrome -

A

Posterior SCI - Compression due to hyperflexion of csp. Rare - only affects DCML tract (prop, vib, deep pressure, sensory discrim)

93
Q

Post polio syndrome

A

LMN pathology affects ant horn cells of people who have had poliomyelitis. Progressive weakness, fatiuge, atrophy, pain, swallowing issues.

94
Q

Trigeminal Neuralgia

A

Degeneration or compression of the Trigeminal nerve. Harder to reverse if left a long time.

Decreased sensation to forehead, cheek, jaw. Jaw and corneal reflex absent.
Facial pain or numbness from mouth, nostrils eye, ear One side or bilateral
Exacerbated by stress/cold

95
Q 
Upper motor neuron lesion:
Location:
Structures:
Disorders:
Tone:
Reflexes:
Involuntary Movements:
Strength: 
Muscle bulk:
Voluntary movements:
A

Location: CNS
Structures: Brainstem, cortex, corticospinal tracts, SC
Disorders: CVA, TBI, SCI
Tone: Increased
Reflexes: Increased
Involuntary Movements: muscle spasm
Strength: SCI: bilat loss below, CVA: contralateral loss
Muscle bulk: Variable, atrophy from disuse
Voluntary movements: Impaired or absent

96
Q 
Lower motor neuron lesion:
Location:
Structures:
Disorders:
Tone:
Reflexes:
Involuntary Movements:
Strength: 
Muscle bulk:
Voluntary movements:
A

Location: PNS
Structures: Ant horn cell, spinal roots, peripheral nerves, cranial nerves
Disorders: Polio, GBS, PNI, peripheral neuropathy, radiculopathy
Tone: Decreased/absent
Reflexes: Decreased / absent
Involuntary Movements: Fasciculation (with denervation)
Strength: Severe atrophy, limited distribution
Muscle bulk: atrophy from neurogenic causes, rapid and focal wasting
Voluntary movements: weak or absent

97
Q

Archicerebellum

A

Vestibular: ocular dysmetria, poor eye pursuit, dysfunctional VOR, Impaired hand eye co-ordingation
Gait and trunk ataxia, with BOS gait

98
Q

Paleocerebellum

A

Hypotonia
Truncal ataxia - disequilibrium, posture worse with eyes closed, static postural tremor, increased sway.
High guard arm position, wide BOS
Ataxic gait: unsteady increased falls, uneven/decreased step length, increased step width

99
Q

Neocerebellum

A

Intention tremor
Dysdiadochokinesia
Dysmetria: overshooting, errors of direction, amplitude, rebound phenomenon
Dyssynergia - abnormal timing, impairment of multijoint co-ordination, movement sequences and complex motor tasks

100
Q

Types of MS

A

Relapsing- remitting: relapses with full recovery, some residual deficit between relapses
Primary progressive - no plateaus or remissions, occasional plateaus.
Secondary progressive - Initial relapsing remitting then progression at different rates
Progressive relapsing - some remission or recovery but progressive disease from onset.

101
Q

Nonfluent aphasia

A

Brocas motor aphasia
Expressive
speech is awkward, restricted, interrupted and produced with effort. (L) hemisphere frontal lobe.

102
Q

Fluent aphasia

A 
Wernikes aphasia
Receptive 
Spontaneous speech preserved and flows smoothly
Auditory comprehension is impaired
Temporal lobe - (L) hemisphere
103
Q

Ideomotor apraxia

A

Cannot perform task on command but can do if left on own

104
Q

Ideational Apraxia

A

Cannot perform task at all

105
Q

Spastic Cerebral palsy

A

High muscle tone in AG muscles
mass patterns of F/E
Imbalance of tone across joints - contractures
hip F/adductors/ internal rotators / knee flexors/ ankle PF
Crouched gait hip F/knee F

106
Q

Athetoid Cerebral Palsy

A

Tonic reflexes ATNR, STNR, TLR block functional postures and movement.
Poor proximal stability
Ataxia and inco-ordination
Poor visual tracking, speech delay, oral motor problems

107
Q

Ataxic Cerebral Palsy

A 
Low tone
Poor balance
Unco-ordinated movements hand tremor
Poor visual tracking, nystagmus
Wide stance gait
108
Q

Myasthenia Gravis

A

Progressive muscular disorder
Autoimmune
Strength worse with continuing contraction

109
Q

Traumatic Brain injury - frontal lobe

A 
Non-fluent Aphasia (brocas)
Apraxia
Motor planning difficulties
difficulty concentrating
unpredictable, unstable emotions
Difficulty discriminating odours
110
Q

Traumatic Brain injury - Parietal lobe

A

Asterognosis (tactile agnosia)
Loss of two point discrim
(R) side - apraxia, impaired body scheme, visual spatial, autitory perceptual disorders
Taste impaired in tongue on contalat side.

111
Q

Traumatic Brain injury - Temporal lobe

A

Fluent Aphasia
Decrease in hearing, localise sounds
impaired learning and memory
Difficulty learning new tasks

112
Q

Traumatic Brain injury - occipital lobe

A

visual agnosia (can see but cannot recognise or interpret visual information
Homonymous hemianopsia
perceptual impairment

113
Q

Primary brain damage -

A

Diffuse axonal injury - disruption or tearing caused by shear strain on small blood vessels
Focal injury: Contusion, laceration, mass effect from hemorrhage and edema
Coup-countercoup: point of impact and opposite point of impact
Closed or open injury with fractured skull

114
Q

Secondary brain damage:

A

Hypoxic-ischemia injury from systemic problems, reps or cardiovascular that compromise cerebral circulation
Swelling/edema - increased cranial pressures, brain herniation. Elecrolyte imbalance and release of damaging neurotransmitters.

115
Q

Anterior Cerebral Artery Strokes affect which areas of the brain and cause which deficits?

A

Ant and med frontal lobe, medial parietal lobe
Agraphia, aphasia. apraxia, akinetic mutism
Lower limb more affected than UL
Bladder and bowel problems

116
Q

Medial Cerebral Artery Strokes affect which areas of the brain and cause which deficits?

A 
Cerebrum and basal ganglia
UL more affected than LL
Facial paralysis
Wernikes aphasia
Homonymous hemianopia
Asognosia
117
Q

Posterior Cerebral Artery Strokes affect which areas of the brain and cause which deficits?

A

Occipital lobe. thalamus, midbrain
prosopagnosia
LL and UL contralat hemiplegia
CL pain and temp loss

118
Q

Lacunar strokes

A

internal capsule lesion
pure motor loss
contralateral hemi
no aphasia, no visual field loss

119
Q

Mid brain lesion

A

CNIII - ptosis, strabismus

C/L Hemi

120
Q

Medial inferior pontine lesion

A

paramedian branch of the basilar artery
Ipsilateral - diplopia, ataxia, nystagmus, paralysis of conjugate gaze
Contralateral - hemiparesis UL/LL, impaired sensation

121
Q

Lateral inferior pontine lesion

A

Ipsilateral - tinitus, deafness, ataxia, nystagmus, vertigo, paralysis of conjugate gaze, facial paralysis, impaired facial sensation
Contralateral - pain and temp sensation impaired

122
Q

Locked in syndrome

A

Anterior inferior cerebellar artery
Lower bulbar paralysis CN V - XII
Can move eyes vertically and blink, cannot talk

123
Q

Medial medullary Syndrome

A

Ipsilateral tongue paralysis 1/2 tongue
Contalateral hemiplegia UL and LL
Impaired sensation

124
Q

Lateral medullary syndrome

A

PICA - Wallenbergs
Ipsilateral - cerebellar ataxia, vertigo, nystagmus
Loss of pain and temp to face
Sensory loss in Upper or Lower extrem or trunk
Contralat pain and temp to body and face

125
Q

Left brain CVA

A 
Speech and language
Slow cautious behaviour
difficulty expressing positive emotion
difficulty with verbal cues/commands
Apraxia - movement planning
126
Q

Right brain CVA

A 
Visual perceptual impairment
quick impulsive behaviour
poor judgement, can't self correct
difficulty with perception of emotions
difficulty with visual cues
difficulty sustaining movement
127
Q

Neuro-developmental treatment

A

Controls initiation and sequencing

128
Q

Rood method

A

Reflex stimulus model - treatment based on sensorimotor learning consider movement as autonomic and non-cognitive - result of sensory input

129
Q

Hierarchial reflex theory

A

higher centers control or inhibit lower centres

130
Q

Bobath Approach

A

Neurodevelopmental treatment - patients learn to control movement through normal activities that promote normal movement patterns.

131
Q

Kabat Knott Voss

A

Stronger parts stimulate and strengthen weaker parts

132
Q

Horners syndrome is characterised by

A

Anhydrosis
Ptosis
Myosis

133
Q

Fugl-meyer Sensorimotor Assessment of Balance

Performance Battery

A

Specific balance ax for hemiplegia

134
Q

Fregley-Graybreil Ataxia Test Battery

A

High level motor skill only

NPTE (19 decks)

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