Neuromuscular system Flashcards
(134 cards)
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
2
Q
Parietal lobe
A
Object recognition, sense of taste
Somatosensory cortex
3
Q
Occipital lobe
A
Visual cortex
4
Q
Temporal lobe
A
Hearing, smell, memory
(L) hemisphere - wernikes area, fluent, receptive aphsia
5
Q
Hippocampus
A
Short to long term memory
6
Q
Reticular activating system
A
Regulates alertness,
Deep sleep, drowsy, low alert, high alert
7
Q
Anterior spinal artery
A
Supplies middle medulla including ant spinal cord
8
Q
Posterior inferior cerebellar artery
A
Supplies cerebellum
9
Q
Vertebral artery
A
supplies the post part of the circle of willis
10
Q
Ascending pathways are also called and carry which information?
A
Afferent pathways - carry sensory information to the brain
11
Q
Decending pathways are also called what and carry which information?
A
Efferent pathways - control motor function and muscle tone,
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
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.
14
Q
The corticospinal tract is responsible for what?
A
Voluntary motor control
15
Q
Vestibulospinal tract is responsible for what?
A
Muscle tone, antigravity muscles, Postural reflexes, head on trunk stabilisation, VOR
16
Q
Rubrospinal tract
A
Proximal limb flexors - causes flexion in the upper extremities.
17
Q
Reticulospinal tract
A
Excitatory to extensors and axial muscles (medial) inhibitory to extensors (lateral)
18
Q
What is usually the cause of decreased DTR? and Increased?
A
Peripheral issue for decreased and a central issue for exaggerated
19
Q
CN I
A
Olfactory - smell, sensory only
20
Q
CNII
A
Optic - Vision, sensory only
21
Q
CNIII
A
Oculomotor - Eye movements, depress, elevate, adduct
Motor only
22
Q
CNIV
A
Trochlear - Eye movement - depress and adduct
Motor only
23
Q
CN V
A
Trigeminal - sensation of face, scalp, eyeball and tongue
- masseter and temporalis jaw closing
Mixed
24
Q
CNVI
A
Abducens - eye movement - abduction,
Motor only
25
CNVII
Facial - eye closing, facial expression, taste on ant 1/3 tongue
Mixed
26
CNVIII
Vestibulococlear - hearing and balance
| Sensory only
27
CNIX
Glossopharyngeal - taste to post 2/3 tongue, Gag reflex
28
CNX
Vagus - sensation and motor to heart and lungs
| Mixed
29
CNXI
Accessory - SCM and trap function. shoulder shrug
| Motor oNly
30
CNXII
Hypoglossal - tongue movements Motor only
31
Dermatomes: C1
Top of skull
32
Dermatomes: C2
Temple, forehead, occuiput
33
Dermatomes: C3
Neck, post cheek, temporal area, under mandible
34
Dermatomes: C4
Tip of shoulder, upper scap, clavicle
35
Dermatomes: C5
Deltoid, ant arm to base of thumb
36
Dermatomes: C6
Ant arm - radial hand thumb and index finger
37
Dermatomes: C7
Medial arm and forearm to middle finger
38
Dermatomes: C8
Ring and pinky finger, ulnar forearm
39
Dermatomes: T1
Medial forearm
40
Dermatomes: T2
Axilla
41
Dermatomes: T3-6
Upper thoracic (T4 nipple)
42
Dermatomes: T5-7
Costal margin
43
Dermatomes: T7-12
Lower abdomen (T10 belly button, T12 ASIS)
44
Dermatomes: L1
Upper groin, lower back
45
Dermatomes: L2
Lower groin, ant thigh and knees
46
Dermatomes: L3
Sacral area, medial knee, ant lower leg
47
Dermatomes: L4
Med lower leg - medial calf and ankle
48
Dermatomes: L5
ant tibia, toes
49
Dermatomes: S1
Lat foot, plantar foot, Gastroc/soleus
50
Dermatomes: S2
Post thigh, lateral leg
51
Dermatomes: S3
Buttock
52
Dermatomes: S4
Rectum, anal area, saddle
53
Myotomes: C5
Deltoid, shoulder abduction
54
Myotomes: C5/6
Elbow flexion, wrist extension
55
Myotomes: C7
Elbow extension wrist flexion
56
Myotomes: C8
Ulnar deviation, FCU, ECU
57
Myotomes: T1
digit abd/add interossei
58
Myotomes: L2/3
Hip F
59
Myotomes: L3/4
Knee extension
60
Myotomes: L4/5
Ankle DF, toe ext
61
Myotomes: S1
Plantar flexion, Gastroc
62
ASIA impairment Scale - ASIA A
Complete, no sensory or motor function preserved
63
ASIA impairment Scale - ASIA B
Sensory incomplete: sensory preserved but not motor
64
ASIA impairment scale ASIA C
Motor incomplete, motor preserved but muscle grade <3/5
65
ASIA impairment scale ASIA D
Motor incomplete, motor preserved, muscle grade >3/5
66
ASIA impairment scale ASIA E
Normal - sensory and motor function normal
67
Rancho Los Amigos level of cognitive function
```
I: No response
II: Generalised response
III: Localised response
IV: Confused agitated
V: Confused inappropriate
VI: Confused appropriate
VII: Automatic
VIII: Purposeful
```
68
Glasgow Coma Scale stages of severity
8 or less; severe
9-12 moderate
13-15 mild
69
```
Deep Tendon Reflexes:
Biceps:
Brachioradialis:
Triceps:
Patellar:
Achilles:
```
```
Biceps: C5,C6
Brachioradialis: C5/6
Triceps: C7
Patellar: L3/4
Achilles: S1/2
```
70
Grades of DTR
```
0 - no response
1+ - diminished response
2+ normal response
3+ brisk/exaggerated response
4+ Hyperactive - always abnormal
```
71
Superficial reflexes include;
Abdominal T8-L1
Corneal Blink CN V and VII
Gag reflex CN IX and X
Cremasteric Reflex L1-2
72
Wheelchair measurements should be
Seat height +2
Seat depth -2
Seat width +2
Back height -4
73
Functional independence measure (FIM)
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
Tinetti Balance test
Sit, sit to stand, attempt to rise, first 5 sec standing, standing nudged, eyes closed, 360 degree turn, sit
75
Dynamic Gait index
```
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
Brunnstroms stages
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
Alzheimers
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
ALS
Chronic degenerative UMN and LMN impairment
79
Ant cord syndrome
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
Arthrogryposis multiplex congenita
Occurs during first trimester, fibrosis of muscles and joint structures. Non-progressive.
Multiple contractures, joint dislocation, atrophy, cylindershaped limbs with no definition/tone
81
Autonomic dysreflexia
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
Bells Palsy
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
Brown sequard syndrome
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
Bulbar palsy
Weakness/paralysis of muscles innervated by motor nuclei of the lower brainstem
Dysphageia, nasal regurgitations, slurred speech, choking, dysphonia, dysarthria, dysphasia
85
Cauda equina
LMN lesion caused by injury below L1
| Flaccidity, areflexia, incontinence bladder/bowel
86
Central cord syndrome
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
Cerebral palsy
Non progressive brain injury sustained during birth, in utero or in infancy.
Abnormal tone, reflexes and mobility
88
Dysautonomia
Any disease or malfunction of the ANS
| Abnormal HR, breathing, sweating, pupil size, bladder function, fatigue
89
Guillian Barre
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
Huntingtons disease
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
Polio myelitis
Viral disease inflames the grey matter of the spinal cord. Infection.
92
Post cord syndrome -
Posterior SCI - Compression due to hyperflexion of csp. Rare - only affects DCML tract (prop, vib, deep pressure, sensory discrim)
93
Post polio syndrome
LMN pathology affects ant horn cells of people who have had poliomyelitis. Progressive weakness, fatiuge, atrophy, pain, swallowing issues.
94
Trigeminal Neuralgia
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
```
Upper motor neuron lesion:
Location:
Structures:
Disorders:
Tone:
Reflexes:
Involuntary Movements:
Strength:
Muscle bulk:
Voluntary movements:
```
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
```
Lower motor neuron lesion:
Location:
Structures:
Disorders:
Tone:
Reflexes:
Involuntary Movements:
Strength:
Muscle bulk:
Voluntary movements:
```
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
Archicerebellum
Vestibular: ocular dysmetria, poor eye pursuit, dysfunctional VOR, Impaired hand eye co-ordingation
Gait and trunk ataxia, with BOS gait
98
Paleocerebellum
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
Neocerebellum
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
Types of MS
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
Nonfluent aphasia
Brocas motor aphasia
Expressive
speech is awkward, restricted, interrupted and produced with effort. (L) hemisphere frontal lobe.
102
Fluent aphasia
```
Wernikes aphasia
Receptive
Spontaneous speech preserved and flows smoothly
Auditory comprehension is impaired
Temporal lobe - (L) hemisphere
```
103
Ideomotor apraxia
Cannot perform task on command but can do if left on own
104
Ideational Apraxia
Cannot perform task at all
105
Spastic Cerebral palsy
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
Athetoid Cerebral Palsy
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
Ataxic Cerebral Palsy
```
Low tone
Poor balance
Unco-ordinated movements hand tremor
Poor visual tracking, nystagmus
Wide stance gait
```
108
Myasthenia Gravis
Progressive muscular disorder
Autoimmune
Strength worse with continuing contraction
109
Traumatic Brain injury - frontal lobe
```
Non-fluent Aphasia (brocas)
Apraxia
Motor planning difficulties
difficulty concentrating
unpredictable, unstable emotions
Difficulty discriminating odours
```
110
Traumatic Brain injury - Parietal lobe
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
Traumatic Brain injury - Temporal lobe
Fluent Aphasia
Decrease in hearing, localise sounds
impaired learning and memory
Difficulty learning new tasks
112
Traumatic Brain injury - occipital lobe
visual agnosia (can see but cannot recognise or interpret visual information
Homonymous hemianopsia
perceptual impairment
113
Primary brain damage -
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
Secondary brain damage:
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
Anterior Cerebral Artery Strokes affect which areas of the brain and cause which deficits?
Ant and med frontal lobe, medial parietal lobe
Agraphia, aphasia. apraxia, akinetic mutism
Lower limb more affected than UL
Bladder and bowel problems
116
Medial Cerebral Artery Strokes affect which areas of the brain and cause which deficits?
```
Cerebrum and basal ganglia
UL more affected than LL
Facial paralysis
Wernikes aphasia
Homonymous hemianopia
Asognosia
```
117
Posterior Cerebral Artery Strokes affect which areas of the brain and cause which deficits?
Occipital lobe. thalamus, midbrain
prosopagnosia
LL and UL contralat hemiplegia
CL pain and temp loss
118
Lacunar strokes
internal capsule lesion
pure motor loss
contralateral hemi
no aphasia, no visual field loss
119
Mid brain lesion
CNIII - ptosis, strabismus
| C/L Hemi
120
Medial inferior pontine lesion
paramedian branch of the basilar artery
Ipsilateral - diplopia, ataxia, nystagmus, paralysis of conjugate gaze
Contralateral - hemiparesis UL/LL, impaired sensation
121
Lateral inferior pontine lesion
Ipsilateral - tinitus, deafness, ataxia, nystagmus, vertigo, paralysis of conjugate gaze, facial paralysis, impaired facial sensation
Contralateral - pain and temp sensation impaired
122
Locked in syndrome
Anterior inferior cerebellar artery
Lower bulbar paralysis CN V - XII
Can move eyes vertically and blink, cannot talk
123
Medial medullary Syndrome
Ipsilateral tongue paralysis 1/2 tongue
Contalateral hemiplegia UL and LL
Impaired sensation
124
Lateral medullary syndrome
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
Left brain CVA
```
Speech and language
Slow cautious behaviour
difficulty expressing positive emotion
difficulty with verbal cues/commands
Apraxia - movement planning
```
126
Right brain CVA
```
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
Neuro-developmental treatment
Controls initiation and sequencing
128
Rood method
Reflex stimulus model - treatment based on sensorimotor learning consider movement as autonomic and non-cognitive - result of sensory input
129
Hierarchial reflex theory
higher centers control or inhibit lower centres
130
Bobath Approach
Neurodevelopmental treatment - patients learn to control movement through normal activities that promote normal movement patterns.
131
Kabat Knott Voss
Stronger parts stimulate and strengthen weaker parts
132
Horners syndrome is characterised by
Anhydrosis
Ptosis
Myosis
133
Fugl-meyer Sensorimotor Assessment of Balance
| Performance Battery
Specific balance ax for hemiplegia
134
Fregley-Graybreil Ataxia Test Battery
High level motor skill only
