PPT Slides Flashcards
Allows for smooth eye movements, Coordinates responses to balance reaction
Vestibulocerebellum
Coordinates postural adjustments,automatic movements such as gait.
Spinocerebellum
Coordinates Voluntary fine motor movement extremities, planning of movements, timing
Cerebrocerebellum
Cerebellar connections with lower structures are_____. Unlike connections with the cortex and other structures which are____.
ipsilateral, C/L
The cerebellum affects the ____side of the body?
Ipsilateral
What is inflammation of the parenchyma of the brain and the surrounding meninges.
Encephalitis
What is the difference between Meningitis, Ecephalitis, and Cerebritis?
- inflammation of the meninges. Viral more common than bacterial. Caused by other viruses. Spread by coughing or sneezing or poor hygiene.
- parenchyma of the brain and meninges. Most often is due to a viral infection with parenchymal damage.
- Abscess formation and implies a highly destructive bacterial infection of the brain tissue.
Which form of meningitis is thought to be rare and fatal?
bacterial
How does bacteria meningitis manifest itself?
through the exchange of respiratory and throat secrections, such as coughing and kissing, but cannot live outside the body for long. They cannot be picked up from water supplies, pools, and buildings.
The peak incidence of intracranial tumors occurs in 2 age ranges. which are?
2 to 12 and 50 to 70
What are the associated symptoms and lobe function with Frontal Lobe brain tumors?
Associated Symptoms: C/L hemiparesis, execessive aphasia, poor centration, loss of insight and judgement, impulsiveness, personality changes.
Function: Voluntary motor function, speech-broca’s area, abstract thinking, judgement, insight, tact/inhibition.
What are the associated symptoms and lobe function with Parietal Lobe brain tumors?
Associated Symptoms: C/L sensory disturbance (touch, pressure, and proprioception) Tactile Agnosia.
Function: Sensory Interpretation
What are the associated symptoms and lobe function with Occipital Lobe brain tumors?
Associated Symptoms: Visual Field Deficits, Visual Agnosia.
Function: Primary visual reception, Interpretation of vision.
What are the associated symptoms and lobe function with Temporal Lobe brain tumors?
Associated Symptoms: Receptive Aphasia, Impairment of Intellect.
Function: Primary Auditory Reception, Werinicke’s Area, Integration of somatic, auditory and visuospatial association areas.
Recent epidemilogic reviews have determined about ____% of primary intracranial tumors are glimoas?
50%
What is the normal ICP pressure range?
4 or 5 to 10-15mmHg
ICP at rest is normally____mmHG in supine (adult)?
7-15mmhg
ICP depends on the position the patient is in, when you lie someone down what happens to blood pressure?
goes up due to the vagovasal response.
What happens to the ICP in a the vertical position?
becomes negative (averaging -10mmHG)
Since the skull is ____ and ___vessel, swelling results in increased pressure that can occlude _______?
rigid, closed vessel, occlude cerebral circulation.
T/F a mild increase in ICP can increase morbidity?
true
Severe increases in ICP (>40mmhg) can cause what?
deformation of the brain and herniation of cerebral matter: uncal, central, tonsillar.
According to the Glasgow Coma scale, a mild brain injury, frequently w/o residual deficits s/p 3 months is considered to be a score of-____
> 12
According to the Glasgow Coma Scale the cut off range for “comatose” is?
9-12
A score of ______for greater than 6 hours indicates a severe brain injury, 90% are considered comatose and 50% die.
</= 8
Post-Tramuatic Amensia following a brain injury that lasts less than 10 minutes is considered to be_______injury?
very mild.
Post-Tramuatic Amensia following a brain injury that lasts less than 1 hour is considered to be_______injury?
mild
Post-Tramuatic Amensia following a brain injury that lasts 1-24 hours is considered to be_______injury?
moderate
Post-Tramuatic Amensia following a brain injury that lasts 1-7 days is considered to be_______injury?
severe
Post-Tramuatic Amensia following a brain injury that lasts more than 7 (1-4 weeks) days is considered to be_______injury?
very severe
Anything over 4 weeks is considered “extremely severe”
Glasgow Coma Scale has 3 components (EYES OPEN, BEST MOTOR, BEST VERBAL): What are the ratings 1-4 for EYES OPEN?
1-no response
2-eyes open to painful stimuli
3-eyes open to verbal command
4-eyes open spontaneously
Glasgow Coma Scale has 3 components (EYES OPEN, BEST MOTOR, BEST VERBAL): What are the ratings 1-6 for BEST MOTOR?
1-no response 2- Extension (decrebrate) 3-Flexion-abnormal (decorticate) 4-Flexion withdrawal 5-Localize pain (above are to painful stimulus)
6-Obeys to command, to verbal stimulus.
Glasgow Coma Scale has 3 components (EYES OPEN, BEST MOTOR, BEST VERBAL): What are the ratings 1-5, BEST VERBAL?
1-no response 2-incomprehensible sounds 3-inappropriate words 4-disoriented and converses 5-oriented and converses
What are the highest and lowest scores you can rank someone on the GCS and when should you use a more advance scale?
3-lowest
15-highest
score 9-10 use more advance scales.
T/F there appears to be a relationship between length of time in a coma (LOC, or loss of consciousness) and length of PTA (post-traumatic Amnesia).
TRUE
An injury to descending pathways between the superior colliculus and pons; upper extremity extension and lower extremity extension results in what type of posture?
Decerebrate posture
Brats extend
An injury to descending pathways between the cerebrum and red nuclei; upper extremity flexion, lower extremity extension, results in what type of posturing?
Decorticate
Cort Flexes
Which apraxia results in the inability to correctly imitate hand gestures and voluntarily mime tool use, e.g. pretend to brush one’s hair?
Ideomotor
Which apraxia results in loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects in everyday life.[
Ideational
The Inability to execute learned purposeful movements is known as?
motor apraxia
Motor Deficits: When a person is considered “like a stone” stuck in movement, no large speed or ROM. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. almost appears as if the person is “cramping up” is called ______?
Dystonia
Name the Motor Deficit: Smaller ROM, Smaller speed of movement, writhing, is called?
Athetosis
Name the Motor Deficit: larger than anthetoids. brief, semi-directed, irregular movements that are not repetitive or rhythmic, but appear to flow from one muscle to the next. “DANCE LIKE”
Chorea
Name the Motor Deficit: Really fast movements, really large movements.
Ballismus
Name the Motor Deficit from
Slow to Rapid Movement and
None to Large ROM
Dystonia, Athetosis, Chorea, Ballismus (DACB)
Flow of Visual Signals from Retina–>Lateral geniculate–>visual cortex:
Once at input is received by the Visual Cortex, it is sent to other areas of the cerebral cortex, where directions for movement are created and where objects are recognized visually. Located Dorsally and receives input from the “Action Stream” the Posterior Parietal Cortex does what?
specifies how to move (visual guidance)
Visual Flow: Retina–>Lateral Geniculate–>Visual Cortex. Once at input is received by the Visual Cortex, it is sent to other areas of the cerebral cortex, where directions for movement are created and where objects are recognized visually. Located Ventrally and receives input from the Perception Stream the Occipitotemporal region does what?
Visually identifies an object
Flow of Visual Signals from Retina–>Tectum
-Sensory Receptors of the tectum detect ortientation. The tectum also sends outputs for visually guided eye movements.
Flow of Visual Signals: Retina–>Pretectal Area:
Pupillary Reflexes
The Inner Ear has two sets of sensory receptors:
The first are Semicircular Canals, what do they sense and what are the “receptors”?
3 canals (anterior, horizontal, posterior), sense rotation of the head in all planes, receptors are called cristae.
The Second set of sensory receptors in the inner ear are the Utricle and Saccule, they sense what?
sense linear acceleration and deceleration of the head, sensitive to the force of gravity. Receptors are called maculae.
Vestibular Nerve Firing, when the head is not moving the resting discharge rate for both right and left hair cells is about 90 spikes/sec, as the head turns (R), hair cells on the side away from the direction of turn (L)______?
Hyperpolarize, decreasing vestibular nerve signals on the left side. At the same time, hair cells toward the direction of the turn depolarize, increasing vestibular nerve signals on the right (side toward the turn).
How far you can lean in any direction without changing your BOS is known as____?
limits of Stability
Normal LOS:
A-P?
Laterally?
12 deg.-AP
16 deg-laterally
In People with impaired balance a ______exists, a path of the body’s movement (sway) within the LOS.
sway envelope
Forward Sway: Ankle Strategy (name the order of muscle recruitment)
gastro, hams, paraspinals
Backward Sway: Ankle Strategy (name the order of muscle recruitment)
ant tib, quad, abs
Forward Sway: Hip Strategy (name the order of muscle recruitment)
abdominals, quadriceps
Backward Sway: Hip Strategy (name the order of muscle recruitment)
paraspinals, hams
BPPV: Benign Paroxysmal Positional Vertigo. How long does it last, describe symptoms?
Calcium Carbonate/otoconia can fall loose and get into semicircular canals=
NOT A CENTRAL LESION
BBPV Nystagmus 2 components:
- Torsional
- Vertical
Paroxysmal=sudden recurrence
episodic and last less than 60 seconds.
The room is spinning sensation.
Other symptoms can include nausea, instability, neck, stiffness.
A patient presents to the clinic with diplopia, dysarthria, facial numbness and says that the room is spinning, the most likely diagnosis is?
CENTRAL POSITIONAL VERTIGO, (vertebrobasilar insufficiency)
An Ablative lesion of cranial nerve 8 or labyrinth can cause what type of vertigo?
Continous
A perilympatic fistula can cause ______?
hearing loss
T/F people with central positional vertigo can have PERIPHERAL problems along with diplopia, dysarthria, facial numbness?
true
Patient present with Tinnitis (ringing of ears), hearing loss, and vertigo lasting minutes to HOURS, this patient most likely has what diagnosis?
Meniere’s Disease
Vertigo that is highly variable in Duration can be do to ?
Migraine-associated dizziness
Acute Vestibular Loss, Panic disorder, motion sensitivity, cervical vertigo and vertebral artery blockage can all cause what symptom?
vertigo
BPPV–>Canal Identification with Hallpike-Dix:
During a Right Hallpike-Dix assessment you see a Upbeat R Torsional Nystagmus. When you return the patient to a seated position the patient demonstrates a Downbeat, left torsional Nystagmus. Which Semicircular Canal is impaired?
Right Posterior CANAL
BPPV–>Canal Identification with Hallpike-Dix:
During a Right Hallpike-Dix assessment you see a Downbeat R Torsional Nystagmus. When you return the patient to a seated position the patient demonstrates an Upbeat, left torsional Nystagmus. Which Semicircular Canal is impaired?
Right Anterior
BPPV–>Canal Identification with Hallpike-Dix:
During a Right Hallpike-Dix assessment you see a Downbeat L Torsional Nystagmus. When you return the patient to a seated position the patient demonstrates an Upbeat, right torsional Nystagmus. Which Semicircular Canal is impaired?
Left Anterior
What is the difference between Canalithiasis and Cupulolithiasis?
Cup: Debris adheres to the cupula resulting in increasaed density of the cupula and causes an inappropiate deflection with movement toward the affected ear.
Cana: Debris is free floating in the endolymph of the canal and the otoconia floats to the most dependent position of the canal resulting in movement of the endolymph and deflection of the cupula.
Researched “best treatment option/First choice” for Canalithiasis (SEVERE) in the:
Posterior Canal (BPPV).
Anterior Canal (BPPV)
Horizontal (BPPV)
- CRT (canal re-positioning treatment or epley)-p
- CRT
- Brandt-Daroff/CRT
Upbeating Nystagmus usually indicates that _____canal is involved. and is usually noted during what two assessment tests?
posterior, Hallpike-Dix and Sidelying
Downbeating Nystagmus usually indicates ____ semicircular canal is involved? and is usually noted during what two assessment tests
anterior,Hallpike-Dix and Sidelying
Exception to the upbeat/downbeat rule: if horizontal nystagmus occurs what canal is involved? and is usually noted during what assessment test?
horizontal, roll test
Researched “best treatment option/First choice” Canalithiasis (MILD)
Posterior Canal BPPV.
Anterior Canal BPPV
Horizontal BPPV
- Brandt-Daroff-posterior
- Brandt-Daroff
- Appiani/Brandt-Darroff
Keep in mind Bradnt Darroff treatment is usually given as a home exercise treatment, once the patient is symptom free for 3 consecutive days, they can stop the exercise.
Researched “best treatment option/First choice” Cupulolithiasis Posterior Canal BPPV.
Anterior Canal BPPV
Horizontal BPPV
- Liberatory-p
- Liberatory
- Brandt-Daroff (slide), packet dr. brewer gave us says (modified liberatory maneuver)
Name 3 post treatment BPPV instructions that you would tell your patient?
- Do not sleep on affected side for 2 nights.
- Do not hang your head back while lying down such as at the dentist or beauty shop.
- Do not hang your head down such as tying you shoes or picking an object up from the floor.
When measuring Visual Acuity using the Snellen’s chart, your patient’s vision is noted to be worse than 20/400. Name 3 other ways to assess your patient’s vision.
- Count fingers at a certain number of feet away (scale is 1 foot-10feet (20/8000 to 20/800).
- Hand Motion at a certain number of feet
- Light perception or no light perception
Name the 4 components int he Modified CTSIB?
- Eyes open firm surface
- eyes closed firm surface
- eyes open compliant surface
- eyes closed compliant surface
timed each position–>30sec
T/F the M-CTSIB has good test-retest and inter-rater reliability, Sensitivity at 95%, specificity at 90% and foot position or use of shoes DO NOT affect the test findings.
true
What is a considered a positive test for romberg or sharpened romberg and the what is the position of the patient’s upper extermities?
+=increase sway or begin to fall
–slide says arms folded across chest and feet together first with eyes open then closed.
Time how long they can hold position.
T/F The sharpened romberg can differentiate between active and sedentary older adults, but not necessarily between fallers and nonfallers?
true
Most community-dwelling older adults can complete the TUG in ____sec. What is considered a “severe impairment” and “Function dependence”
<12 sec
greater than 20 sec = severe impairment, needs an AD
Greater than 30 sec=functional depend.
What outcome measure has a cutoff score of 19, assess gait under 8 conditions including, normal pace on level surface, changing speed, walking while head turning (h and v) stopping and turning and around obstacles and a max score of 24?
DGI
What outcome measure differentiates between individuals who do and do not have vestibular dysfunctions?
DGI
What is considered the modified version of the DGI and what components of the DGI does it remove or add?
Functional gait assessment. Walking around obstacles and adds tandem walking, backward walking and walking with eyes closed.
Berg Balance Scale has 14 positional movements and a max score of 56, what score indicates an increase in falls risk and requires the patient to have an A.D. for safe ambulation? Also what is considered a meaningful score change?
less than 45, 6 points is meaningful
POMA (tinetii) has 9 balance and 7 gait components, if a patient has a decreased balance score what does that tend to reflect (balance is out of 16 points) ?
reflects less stability.
POMA (tinetii) has 9 balance and 7 gait components, if a patient has a decreased gait score what does that tend to reflect?
indicates more dysfunctional and inefficient ambulation.
A patient scores a 19/28 on the tinetti what does that indicate?
high falls risk
That same patient that scored a 19/28 on the tinetii was reassessed two weeks later their score is now a 24/28. Interpret this patient’s score, is there a meaningful change are they still at risk for falls?
There is a meaningful change in the patient’s score (meaningful change is 5 points) the patient is still at a moderate falls risk. score of: (19-24 mod falls risk)
Although PTs are primarily concerned with improving neuromuscular function, the ______and ______changes associated with TBI are usually the MOST disabling in the long run.
Cognitive and Behavioral
Glasgow Outcome Scale (GOS) that is usually used at discharge and 6 month to a year after injury. What are levels 1-5
1-Dead
2-Vegetative State (unaware of self and environment)
3-Severe Disability (unable to live independently)
4- Moderate Disability (Able to live independently)
5-Mild Disability (able to return to work/school)
What are the 9 indirect impairments associated with TBI?
- DVT
- Decreased Bone Density
- Decreased Endurance
- Heterotopic Ossification
- Muscle Atrophy
- Pneumonia
- Infection
- Skin Breakdown, decubitus ulcers
- Soft Tissue Contractures
RACHO LOS AMINGOS SCALE and levels of Assistance
TOTAL ASSIST (1-3), no response, generalized response, localized response MAX Assist (4-5), confused agitated, confused inappropriate MOD ASSIST (6), confused appropriate MIN ASSIST (7), automatic appropriate SBA (8) purposeful appropriate response
CENTRAL LESION VS. BPPV (What would you expect to see in ROMBERG/TANDEM ROMBERG, SLS, GAIT, TURN HEAD WHILE WALKING TEST)?
Central Lesion: negative romberg, positive tandem, unable to perform SLS, may have pronounced ataxia, turning head will increase ataxia.
BPPV: slight positive test while turning their head they may feel slightly unsteady. everything else would be negative.
What are the common motor Deficits in TBI patients?
- Dyskinesias: Dystonia, Chorea, Athetosis, Ballism
- Ataxia: Sensory, Cerebellar, Labyrinthine
- Paralysis/paresis
- Tremor
- Apraxia: motor, ideomotor, ideational
MILD TBI will score
____GCS
_____min loss of consciousness
_____days posttraumatic amnesia
13-15, less than 30 minutes, 0-1 days
MODERATE TBI will score
____GCS
_____min loss of consciousness
_____days posttraumatic amnesia
9-12, 30min-24hr, 2-7 days
SEVERE TBI will score
____GCS
_____min loss of consciousness
_____days posttraumatic amnesia
3-8, greater than 24 hours, greater than 7 days
