Practice questions - Neuro rehab, ABI, degen disease Flashcards
A 55-year-old female presents with a spastic hemiparesis on the right side and a mild aphasia.
The MRI shows a stroke in the left hemisphere. Muscle strength in the arms/hands is decreased
and she cannot grasp items. However, she can actively (voluntary) extend her fingers already
two days after the stroke.
Which feature in her physical examination is an important predictor for recovery of hand/arm
function. Explain why
Voluntary finger extension because this is most closely related with the intactness of the corticospinal tract system.
A 55-year-old female presents with a spastic hemiparesis on the right side and a mild aphasia.
The MRI shows a stroke in the left hemisphere. Muscle strength in the arms/hands is decreased
and she cannot grasp items. However, she can actively (voluntary) extend her fingers already
two days after the stroke. She can’t play badminton and work as a receptionist anymore. She is motivated to follow rehab treatment.
Describe 2 aspects of functioning of the patient using ICF –> body function/structures and participation.
Body functions: spastic hemiparesis and mild aphasia
Restrictions in participation: can’t play badminton and work
A patient presents himself at the consultation hour with a dropped hand. Physical examination reveals an isolated inability to extend the wrist actively against gravity.
Furthermore muscle atrophy is observed. There is no resistance to fast passive extension.
No other abnormalities are found.
Is an upper or lower motor neuron disease suspected in this patient? (1 point) Explain why.
(2 points)
Lower motor neuron disease (1 point) bc atrophy (1 point), no spasticy (1
point) which is not seen in upper MND.
Paresis is not correct, can present in both.
Explain why spasticity and inactivity due to brain injury influence skeletal growth in children?
They disturb the balance between different muscles which causes deformity
during growth.
A 29-year-old woman diagnosed with MS three years ago is referred for rehabilitation, because
she needs appropriate aids and home adaptations. She is very severely fatigued and struggling
with accepting the diagnosis. She is wheelchair bound and makes only a very few transfers per day, and is therefore thinking that she has secondary progressive MS. She has had 2 relapses
with only minor impairments. Physical examination shows abnormal reflexes of the knee and Achilles tendons, but no paresis. There are no other neurological abnormalities. During examination she indicates that she cannot stand.
Does she indeed have secondary progressive MS? Please explain why.
Very unlikely that there is SPMS or no, because there only minimal
neurological symptoms and disease duration is short
Jasper is 10 years old and has bilateral spastic cerebal palsy. He learned how to walk with a
walking aid when he was 3 years old. He now walks with a walking aid, his condition is stable.
What is the goal of intrathecal baclofen treatment with regards to walking capacity for Jasper?
Jasper: preservation/improvement of walking because stable disease
John is 7 years old and has metachromatic leukodystrophia (MLD). He learned how to walk
when he was 1,5 years old. His walking capacity changed when he was 4 years old, starting
with tripping and falling more often. He now walks with a walking aid which is going more
difficult over time.
What is the goal of intrathecal baclofen treatment with regards to walking capacity for Jasper?
John: goal is not preservation of walking but comfort because he has a progressive disease
A 30-year-old male with a complete cervical spinal cord injury and a baclofen pump is presented
at the emergency department with a recurrence of his severe motor impairments for which he got his baclofen pump 5 years ago. Until two days ago his motor impairments were perfectly controlled.
Which radiographic examination is needed to find the cause of this recurrence of motor
impairments and why?
X-baclofen pump and catheter OR indium scan OR CT-pump/spinal cord after contrast
agent is needed to to look for system malfunction/catheter problemens.
Mike had a stroke 2 years ago. He has returned to work at the civil hall. When taking a walk during lunch time with his colleagues, John stops walking when one of his colleagues asks him a question about a complicated problem he is struggling with.
Why does Mike stop walking while thinking about his colleagues problem? Explain in max 5
sentences.
Dual task costs are larger in people with brain injury than in healthy age-matched groups.
They have deficits in executive functions, the ability to divide attention and an altered, less automatic walking pattern.
Both are attention demanding tasks and compete with each other
Explain why voluntary motion control of finger extension in the first days after a stroke is an
important predictor for recovery of arm dexterity.
Voluntary finger extension and finger individuation movements are most closely related with
the intactness of the corticospinal tract system.
Your patient with a stroke (on the acute stroke unit), is not able to perform finger extension in a
satisfactory way. What do you tell your patient about the prognosis for recovery of arm/hand
function at this moment?
Test is not conclusive eg prognosis is not clear since some people show later
recovery (low baseline recoveres) some don’t (non-recoverers).
Intrathecally administered baclofen (ITB) is used in selected patients with neurological
disorders. For which two types of motor impairment may ITB be considered?
Spasticity (including spasms) and dystonia
Children with mild traumatic brain injury can develop behavioral/neuropsychiatric problems such as anxiety and depression. Name 2 other common behavioral/neuropsychiatric problems after traumatic brain injury.
- Personality changes
- Agressive behavior
- Attention deficit
Name 4 elements/symptoms which are needed to make the clinical diagnosis of Parkinson’s Disease Which of these is essential for the diagnosis?
- Bradykinesia is essential
- Rigidity
- Tremor
- Postural instability
What are two main drivers of functional recovery after a stroke?
- Salvation of punumbral tissue
- Alleviation of diaschisis (anatomical supression at distance)
- Brain plasticity
- Using behavioral compensation strategies
