Question Bank Flashcards
T/F: Somatotopic organization exists only in M1
False: is throughout the cortex, basal ganglia, cerebellum, and SC
Where is the majority of the corticospinal pathways located?
M1 - Primary Motor Cortex
What are the 4 Motor Areas in the Cortex associated with Voluntary Movements?
- M1 - Primary Motor Cortex (joint movement)
- Premotor Cortex (ventral and dorsal)
- Supplementary Motor Area (SMA)
- Cingulate Motor Area (we don’t know much about it)
What is the Broadmann’s Area for the Frontal Cortex?
46
T/F: The PMA receives input from M1
True
In ability to coordination hand movement would be caused by a deficit in what area?
SMA
Why do we see syngery in those with M1 damage?
Because tracts originating in the brain stem are still intact
What is a potential major alternative route for mediation of voluntary movement?
Reticulospinal
What type of reflex does not involve interneurons?
Stretch reflexes
Modulation by substantia nigra is lost in what disease?
Parkinson’s Disease
T/F: The basal ganglia can output can only facilitate movement
False, can also inhibit movement
When do clinical sx become apparent in PD?
When 85-90% of dompamine is lost from the substantia nigra
Putamen affected first (motor sx.) followed by the caudate (cognitive sx.)
Dystonia can be distributed in 1 of 3 ways:
focal, segmental, or generalized
Basal Ganglia Loop: Input to puamen if ___________ _________, to caudate if ______________ ____________.
motor, activity, cognitive, component
What is the incidence of PD?
Higher in men
1 in 3 over the age of 85
What is the etiology of PD?
A combination of genetic and environmental (pesticides/insecticides) factors
Which PD sx is most disabling?
Bradykinesia
What is the fall risk in those with PD?
At 9x greater risk of fall compared with age matched normal individuals
> 2/3 wil. fall
More than 10% fall >1x/wk
Dementia occurs in what proportion of those with PD?
1/3
includes loss of executive functions (thinking, judgement) and memory impairments
Pharmological Management for PD:
- In early stages
- reduces oxidative stress on neurons
- delays the use of L-dopa
Seligiline
Pharmological Management for PD:
- Antiviral medicaiton
- Facilitates release of catecholamines (dopamine)
- Demonstrates modest improvement w/tremor, rigidity, bradykinesia
- Often used in conjunction w/L-dopa
Amantadine
Describe how L-dopa works as a pharmacological tx for PD
Is a precursor of dopamine that can cross the blood brain barrier, is converted to dompamine once across the barrier
Reduces bradykinesisa and rigidity
Less effective in reducing tremor and postrual instability
Pharmological Management for PD: Often given with L-dopa to prevent it from converting to dopamine before corssing the blood brain barrier
Carbidopa
List the 3 dopamine agonists
Bromocriptine and pergolide
List the surgical options for PD
- Thalamotomy: destructive lesion w/in thalamus (reduce tremor)
- Pallidotomy: destructive lesion w/in basal ganglia (reduce tremor/dyskinesia)
- Deep brain stimulation
- Neural transplantation
What is the ratio of fibers in to out of the cerebellum and what does this tell us about it’s function:
40 in: 1 out
Function: does a lot of data collection/processing; sensory and adjustment
T/F: The cerebelllum talks directly to motor neurons.
False: must go through deep nuclei
Additionally: perkinje fibers don’t tlk to motor neurons, also go through deep nuclei
Purkinje cell output to cerebellar nuclei is _____________.
Inhibitory
_________ ___________ not limited to motor events but also involves subjective timing and speed judgements
Timing function
T/F: The cerebellum is a storage site fo motor memories
False: not likely, can still perform previoulsy learned tasks with dentate nuclei lesion
What % of people are L hemisphere dominant?
94%
What is the cause of prosopagnosia?
bilateral damage to inferior visual secondary sensory area
KL is a 72 yo male who was transferred to rehabilitation after sustaining a CVA on the left side. He c/o weakness of his R limbs and of being unable to button his clothing or tie his shoes. R hand movements are clumsy. On the R side of his body, KL is unable to localize tactile stimuli or distinguish between passive flexion and extension of his joints.
Where is the lesion?
L primary motor and somatosensory cortices (best answer)
Might also be localized to L somatosensory cortex; being unable to button clothing or tie shoes could be do to loss of sense of touch and proprioception; weakness in R limbs would be less likely a sign of localized lesion in L S1, but because ~20% of corticospinal fibers start in S1, it’s possible
Critchley (1953) reported a patient who seemed normal but put a tea bag in the teapot, set the pot on the stove, and poured cold water into a cup. She lit a match, put the match to the gas burner, blew out the match, and turned on the gas.
Where is the lesion?
What is this disorder?
Lesion
- Premotor area (do to issue with sequencing these motor actions)
- Could also be impaired dorsolateral prefrontal cortex with resultant impaired executive functioning
Disorder
- apraxia
VM, a 72 yo female, was admitted to the hospital with R hemisensory loss, hemiplegia, and communication problems. She greeted visitors with a halting, effortful, and garbled “Hello, how you?” She was able to easily follow simple verbal or written commands.
Where is the lesion?
What is this communication disorder?
Which artery involved?
Lesion: L hemisphere affecting motor, sensory, and Broca’s
Disorder: Broca’s aphasia
Artery: MCA
T/F: All aging is pathological.
False
T/F: Age related disease of the brain are a direct result of our increasing life span.
True: We had to overcome other life span limiting disease i.e. infection, heart disease, before we lived long enough that brain health became the limiting factor to life span
T/F: Older adults are unable to learn.
False: able, will take more practice
T/F: Older adults have difficulty learning complex new skills.
True: will be slower to learn and will develop new skill to a lesser degrees – will take more practice/time to increase skill
T/F: Cognitive delcine is absolute in aging.
False: keeping mind and body active is critial to maintaining cognitive performance
What type of exercise is best to support and improve executive cognitive control?
Aerobic
T/F: Exercise benefits reaction time and alters brain activity.
True: with exercise there is a decrease in reaction time as well as brain activation
T/F: Functional decline is a part of AD
True.
Describe the functional declines related to AD
- Cognitive decline: executive function, sense of self, coordination
- Physical decline: lean mass and bone loss, sedentary,
Describe the physical function changes with AD
Gait: slower, variable stride length, wider BOS
Falls: worse balance, greater sway, poor mobility, poor safety awareness
Apraxia
Paratonia
What are a PT’s best tools to fight aging?
Exercise and Practice
What % of those who survive a stroke will have a second stroke?
10-20%
What is the rate of the following stroke recovery categories?
Almost complete recovery
Minor impairment
Mod-Sev impairment
Requires nursing home
almost complete = 10%
minor = 25%
mod-sev = 40%
nursing home = 10%
What is the leading cause of disability and the 3rd leading cause of death?
Stroke
Distruption of what artery presents with lack of function in the face, hand, and arm?
MCA
Distruption of what artery presents with lack of function in the legs?
ACA
A CVA to which artery is most common?
MCA
What type of CVA presents as “wake, rise, fall”
Thrombotic CVA
Where does an embolic CVA typically lodge itself?
In medium sized vessels, i.e. MCA, vertebral, basilar branches
What is the effect of immediate impact with a emoblic CVA?
No collateral blood flow
Then sx vary if the clot moves
What is the window the TPA?
3 hours
What is prourokinase and it’s window of effectiveness?
It’s a microcatheter inserted by a neurosurgeon to remove the clot
6 hours
With what type of CVA might you want high BP and why?
With an ischemic CVA, High BP may be useful to reperfuse the ischemic tissue
When would you decrease BP in a pt. s/p CVA?
If their SBP > 220 or DBP > 120
If they’re on TPA
High BP can result in damage to other organ systems
What is normal ICP?
12-15 mmHg
Who is at the highest risk for TBI?
Males from 14-24 yo (take more risks)
How does cryotherapy work?
It decreaes the body temp to slow metabolism to protect tissue from damage and resulting death
What type of dx procedures can be used on the brain?
MRI or CT to assess structures
EEG to assess function
EMG to assess peripheral nerve
What facility requires 3 hours of PT/OT/SLP per day?
Rehabilitation hospital
What things can be used for spasticity management?
Botox (lasts 3-4 months)
Baclofen
Nerve blocks
Serial Casting
What type of brain matter has a greater capacity for recovery?
Gray matter
For what amount of time s/p TBI is spontaneous functional recovery possible?
3-6 months
This spontaneous recovery can be facilitated by PT
T/F: Consistency is key when learning to communicate in an altered manner
True
Who is ALS most common in?
Men (1.5x more than women), 40-60 yo
What percent of those experience cognitive changes? dementa?
up to 50%; 15%
What is the survival rate for ALS?
5 year survival = 20%
10 year survival = 10%
What is the average survival from time of ALS dx?
3-5 yrs
An multi-disciplinary team approach an increase the survival of ALS by how many months?
7.5 mo
What FVC % indicates respiratory failure and LE < 6 mo w/o invasive ventilation?
30%
What can be said about the progression of ALS and pain?
Pain is directly proportional to disease course
70% report pain at some point
