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Term 3 > Neuromuscular Unit 1 Vids > Flashcards

Neuromuscular Unit 1 Vids Flashcards

1
Q

What are the impairments following Neurologic Injury?

A
  • Motor Impairments
  • Sensory Impairments
  • Perceptual and Cognitive Impairments
  • Speech and Language Impairments
  • Composite Impairments
  • CN Impairments (Lower Motor Neuron)

All of these impairments are going to be important on how we relate them to enablement and disablement model and ICF. So we must understand how these will affect activity limitations and participation restrictions

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2
Q

What are potential impairments with Motor Impairments?

A
  • Muscle weakness
  • Abnormalities of muscle tone (Spasticity or rigidity)
  • Coordination problems (Non-equilibrium)
  • Involuntary movements
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3
Q

What are potential impairments with Sensory Impairments?

A
  • Somatosensory Deficits
  • Visual Defects
  • Vestibular Defects
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4
Q

What are potential impairments with Perceptual and Cognitive Impairments?

A
  • Perceptual: Agnosia, Neglect, Apraxia
  • Cognitive: Orientation, Memory, Arousal
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5
Q

What are potential impairments with Speech and Language Impairments?

A
  • Aphasia
  • Dysarthria
  • Dysphagia
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6
Q

What are potential impairments with Composite Impairments?

A

This is both Motor and Sensory Impairments

  • Postural control/balance (equilibrium coordination)
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7
Q

With Motor Impairments, what is muscle weakness?

A

(From Upper Motor Neuron Pathology)
Muscle weakness results from the inability to generate normal levels of muscle force
- This amount of force a muscle can produce is due to both mechanical muscle properties and neural input

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8
Q

If a patient has a Upper Motor Neuron pathology, where would the patient be affected?

A
  • The clinical presentation will be contralateral to the side of the deficit
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9
Q

If a patient has a Lower Motor Neuron pathology, where would the patient be affected?

A
  • The clinical presentation will be on the ipsilateral side of the deficit
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10
Q

If a patient has Motor impairments from an upper motor neuron pathology, what would determine the weakness of the muscle?

A

The distribution and amount of resulting weakness will depend on the size of the lesion in the brain as well as the location.

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11
Q

What are common terms used to associate weakness associated with UMN lesions?

A
  • Paralysis
  • Plegia
  • Paresis
  • Hemiplegia/Hemiparesis
  • Paraplegia
  • Tetraplegia
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12
Q

In terms of muscle weakness associated with UMN lesions, what is the def. of paralysis?

A

Complete absence of muscle strength or the inability to voluntarily recruit motor units.

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13
Q

In terms of muscle weakness associated with UMN lesions, what is the def. of Plegia?

A

The same as Paralysis:

  • Complete absence of muscle strength or the inability to voluntarily recruit motor units.
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14
Q

In terms of muscle weakness associated with UMN lesions, what is the def. of Paresis?

A

Muscle Weakness

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15
Q

In terms of muscle weakness associated with UMN lesions, what is the def. of Hemiplegia/Hemiparesis?

A

Hemiplegia: One-sided paralysis

Hemiparesis: One-sided Weakness

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16
Q

In terms of muscle weakness associated with UMN lesions, what is the def. of Paraplegia?

A

Lower Extremity Paralysis

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17
Q

In terms of muscle weakness associated with UMN lesions, what is the def. of Tetraplegia?

A

Both upper and lower extremity paralysis to include the trunk

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18
Q

Why would a patient have one sided weakness versus bilateral weakness?

A

This depends on where the damage is in the motor area.

(For ex:
- If there is damage to the R. side of the brain, there would be weakness in the L side of the body.
- If there is damage in both sides of the brain like TBI, the patient may experience weakness in both sides of the body)

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19
Q

Why would an individual have more upper extremity than lower extremity weakness, consider vascular distribution-coronal view and the homunculus?

A
  • For ex. if a Pt. had a middle cerebral artery (MCA) infarct or stroke, they are likely to have more upper body involvement or upper extremity weakness as compared to lower extremity.
  • However if a Pt. had an Anterior cerebral artery (ACA) stoke, they’re likely to exhibit more lower extremity weakness than upper extremity
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20
Q

How do we examine Muscle Weakness?

A
  1. MMT
  2. Hand-held or extremity dynamometers
  3. Isokinetic dynamometry
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21
Q

With patients with UMN lesions, they will have limitations when examining for weakness, what are some considerations that must be taken place when performing an MMT?

A
  • The patient has to be able to attain the standardized testing positions
  • The patient has to be able to have adequate comprehension and understand basic commands
  • The patient has to exhibit isolated movements

Pt. may have trouble moving in an isolated fashion, also they may move in abnormal synergistic patterns and also may have alterations in muscle tone

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22
Q

How may patients with abnormal synergy patterns exhibit when they have significant weakness?

A

When joint movement cannot be isolated to an inability to activate or coordinate muscle contractions and abnormal muscle mass pattern of movement occurs

When a patient with a stroke attempts to flex their shoulder, their elbow, wrist, fingers flex and this cannot be stopped or controlled

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23
Q

Abnormal synergy patterns are usually associated with what?

A

Usually associated but not limited to those patients that have had a stroke

24
Q

What is Muscle Tone?

A

The resistance felt in the muscle during passive elongation

25
Q

What is Hypotonia as it relates to Muscle Tone? What is a specific type of Hypotonia? These are a result of what?

A

Hypotonia is low muscle tone, where there is a decrease in the resistance to passive movement when compared to normal
- A very specific type of hypotonia is flaccidity (Complete lack of resistance)
- Hypotonia and flaccidity are the result of weakness due to the lack of voluntary muscle activation, also associated with lower motor neuron, spinal nerve or peripheral nerve lesions

26
Q

How does a person with Hypotonia result with Hypertonia?

A

Generally when a person with an upper motor neuron pathology is going through their immediate phase of recovery, its referred to as cerebral or spinal shock.
- During that first 24-48 hrs after UMN pathology, the descending motor tracts are not communicating to the muscle they will exhibit hypotonia.
- Over time their tone will then start to move into a hypertonic state as their cerebral or spinal shock resolves

27
Q

What is Hypertonia? What are different forms of this?

A

Elevated muscle tone, so their is going to be an increase of resistance to passive movement
- Spasticity, stiffness and rigidity are all forms of hypertonia associated with UMN pathology

28
Q

When does Spasticity occur? What is a key sign of spasticity?

A

Occurs when there’s damage to the descending motor system, namely, the corticospinal tract.
- A key sign of spasticity is that its velocity dependent, meaning the faster you passively elongate the muscle, the muscle being assesses is going to offer much more resistance, this is due to hyper-excitability leading to an increase in the UMN activity of the same agonist muscle

29
Q

Hypertonia in the form of muscle stiffness is an example of a Direct or Indirect impairment?

A

This will be an indirect impairment

A lot of times muscle stiffness will occur the longer the patient becomes chronic with their condition, ideally because they’ve become more sedentary

30
Q

What is Rigidity?

A

This is not velocity dependent, this may affect both agonist and antagonist, this is associated with lesions of the basal ganglia, namely with conditions like Parkinson’s and Huntington’s Chorea.

31
Q

If a patient has an UMN lesion and normal, smooth, coordinated and efficient movement is affected what parts of their brain are affected that contribute to these movements? What can this lead to in terms of movement?

A

Motor Cortex, Basal Ganglia, Cerebellum, and Dorsal Columns

  • This leads to very awkward, very inaccurate, very delayed and inefficient movement patterns
32
Q

Non-equilibrium coordination problems may be manifested by what?

A
  • Timing; reaction time
  • intralimb/interlimb coordination: What do the movement look like at the shoulder or elbow, what are the movements of gait
  • Accuracy
  • Scaling force and amplitude: do their muscles respond accordingly with the right amount of muscle force
33
Q

With motor impairments a patient may experience involuntary movements and they are typically named for what they look like. What are different types of involuntary movements patients will experience? (5)

A
  • Dystonia
  • Chorea
  • Athetosis
  • Resting Tremor
  • Action Tremor
34
Q

With involuntary movements, what is Dystonia?

A

Excessive twisting and bizarre repetitive movements caused by axial and proximal limb musculature, typical with basal ganglion lesions (Parkinson’s). Often exhibited in patients that have been using long term parkinson’s medications as a side effect.

35
Q

With involuntary movements, what is Chorea?

A

Rapid and jerky movements, associated with basal ganglion lesions, hence the term Huntington’s Chorea

36
Q

With involuntary movements , what is Athetosis?

A

Slow twisting, snakelike movements, often associated with Cerebral Palsy

37
Q

With involuntary movements, what are Resting Tremors?

A

The tremor that occurs when the muscles and the patients body are at rest. Very common in patients with parkinson’s, especially with the upper extremity. Sometimes referred to as the “Pill Rolling Tremor”

38
Q

With involuntary movements, what are Action Tremors?What is the difference between Postural Tremors and Kinetic/Intention tremors?

A

Tremors that occurs with movements. So it occurs when muscles of the involved body part are contracted, such as tremor that occurs when your holding your body or body part in a posture against gravity (Postural tremor),
or a tremor that occurs during voluntary movement such as reaching for a target (kinetic or intention tremor) generally associated with cerebellar lesions

39
Q

What type of sensation is associated with the Spinothalamic System?

A

This is the protective sensation
- Pain
- Temperature
- Crude Touch
- Pressure

40
Q

What are the Dorsal Column-Medial Lemniscal System- Discriminative Sensations?

A
  • Vibration
  • Proprioception
  • Discriminative touch
41
Q

With the Dorsal Column-Medial Lemniscal System, what are the Combined Cortical Sensations?

A
  • Barognosis: loss of ability to perceive weight of object
  • Stereognosis: ability to identify objects in hand
  • Graphesthesia: ability to recognize letters/numbers on skin by touch
  • Tactile Location
  • Texture recognition
  • 2 point discrimination
42
Q

Why is it necessary to understand and recognize visual impairments in the neurologically impaired?

A

Vision is a main component of the Postural Control system

43
Q

With Visual defects, what are terms associated with UMN lesions?

A
  • Blurred vision: loss of visual acuity
  • Diplopia: double vision
  • Strabismus: Eyes aren’t parallel, have altered visual axis
  • Nystagmus: Rapid, rhythmic, repetitive involuntary eye movements
  • Homonymous Hemianopsia: Partial blindness resulting in loss of vision in the same visual fields of both eyes
  • Occipital Blindness: Legally blind, loss or absence of the ability to perceive images
44
Q

What are the Vestibular Deficits? What CN is utilized and where is the information sent?

A
  • Peripheral Sensory Apparatus: (aka End Organ)
    —Is the semicircular canals (this structure is for angular acceleration) , utricle, and saccule (These two are for linear acceleration).
    —Then you have the Cochlea for hearing,
  • Both of these utilize CN VIII that sends info to the CNS at the level of the brainstem and cerebellum to then help execute the appropriate motor plan
45
Q

What is Perception?

A

Processing of sensation into meaningful information about the body and the surrounding environment

46
Q

What are Perceptual Deficits?

A
  • Agnosia: The inability to process and recognize incoming information(Generally right-sided brain damage)
  • Unilateral Neglect: Considered a body scheme agnosia, really common when they have right-sided brain damage. The inability to perceive and integrate stimuli on one side of the body (They ignore the left side of the environment and/or body)
  • Apraxia: Inability to perform a movement, despite the patient having normal sensation and normal strength, more common for patients with left-sided brain damage. Inability to execute upon command
47
Q

What is Cognition?

A

The ability to sort, retrieve and manipulate information

48
Q

What are some questions you would ask your patient to examine their orientation status?

A
  • Who are you?
  • Where are you? etc.
49
Q

What are Cognitive deficits?

A

Very common in patients after UMN pathology, impaired cognition impacts the patients ability to learn

  • Orientation: the understanding of who you are, where you are and the time (Orientation to yourself or to the person is usually the last thing lost, orientation to time is usually the first thing to be lost following a brain injury)
  • Memory: Ability to store and retrieve information in past experiences (involves limbic system)
    Subdivisions:
    –Short term; Immediate Recall; Long term memory
  • Arousal & Lvl of consciousness
50
Q

What are some questions you would ask your patient to examine their memory?

A

What did you eat for breakfast this morning? (For short-term memory)

Can you tell me your date of birth? (Long-term memory)

51
Q

What are some Speech and Language Impairments?

A
  • Aphasia (Language disorder): Associated with left-sided or dominant hemisphere brain damage
  • Dysarthria (Speech disorder): “Slurred Speech”, the patient lacks the coordination of the muscles that are used for articulation. Can occur due to right or left sided brain damage. They will have weakness and lack of coordination of both speech and respiratory muscles.
    (Common with Cerebral Palsy, TBI, Stroke, MS, PD, etc.)
  • Dysphagia: Impaired swallowing
52
Q

What are the subcategories of Aphasia?

A
  • Expressive Aphasia: (aka Broca’s or non-fluent/motor aphasia, occur when there is damage to broca’s area (Frontal lobe on left or dominant hemisphere) Have intact auditory comprehension. They have a hard time expressing what they want to say.
  • Receptive Aphasia: (aka Wernicke’s or Fluent/Sensory Aphasia, occurs when there’s damage to Wernicke’s area (Association cortex in Temporal Lobe on left or dominate hemisphere). They have auditory comprehension that is impaired, they dont understand whats being said to them
  • Global Aphasia: When patients have elements of both Expressive and Receptive Aphasia, there is going to be widespread, significant damage to the left or dominant hemisphere
53
Q

Why does dysphagia have the potential to be life threatening?

A
  • This can lead to aspiration, pneumonia which can cause the death of a patient. Occurs when food or food particles inadvertently enters the trachea and finds its way into the lungs and causes an infection which will lead to sepsis and they will die.
  • Dysphagia is considered a red flag, referral is needed
54
Q

What are Composite impairments?

A

Composite impairments occur because of the interaction of direct and indirect impairment or the interaction of more than one system.

  • Postural Control/Balance (this is the ability to keep the COM within your BOS, whether in rest or in motion).
55
Q

With Composite Impairments, what are the main systems for Posture Control/Balance?

A

Somatosensory System (Dorsal Column-Median Lemniscal tract), Vestibular System (Peripheral sensory apparatus in inner ear), and Visual system

  • All these systems will bring information to the CNS where both the brain, brainstem and cerebellum are going to integrate and understand for an appropriate motor plan
56
Q

What re the two Postural Control systems/Loops?

A
  • Reactive Postural Control: Works in response to an external force or a perturbation, this system works heavily on feedback mechanisms to prevent you from falling over
  • Anticipatory Postural Control: Works in anticipation of potentially losing your balance, referred to as the feed forward response. Used in advanced of you losing your balance
57
Q

What are Cranial Nerve Impairments?

A
  • LMN lesion
  • Resulting deficit will be ipsilateral to the lesion

Term 3 (42 decks)

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