Quiz 2 Flashcards
What is dystonia?
co-contraction of agonist + antagonist causing abnormal + distorted positions of body parts
What is secondary dystonia?
caused by another disorder/disease
What are some characteristics of dystonia?
can cause twisting, repetitive movements, or abnormal posture
local/focal or generalized
What are some types of dystonia?
torticollis -> cervical dystonia
blepharospasm -> eye lid control
limb dystonia (ex. writer’s cramp)
What is the cause of primary dystonia?
basal ganglia dysfunction
How is dystonia diagnosed?
mostly observation - MRI can detect BG localization
What causes early onset dystonia?
gene deletion
What is dopa-responsive dystonia?
childhood onset that responds well to levodopa
What are some causes of secondary dystonia?
disorders that affect the BG - tumors, Huntington’s, Parkinson’s, infarct, abscess, carbon monoxide poisoning, neonatal hyperbilirubinemia, Wilson’s disease
How is dystonia treated?
anticholinergic medication (block ACh), botox + OT
What are some OT interventions for dystonia?
exercise, stretching, biofeedback, orthoses, relaxation techniques, sensory training
What is Huntington’s disease?
genetic condition of CNS
What are some characteristics of Huntington’s?
onset = 30-50 yo
slow progression
15-20 yr life expectancy
What causes Huntington’s?
degeneration of UMNs, BG atrophy + cortex degeneration
What are movement symptoms of Huntington’s
clumsiness, fidgety, tics, athetosis (wiggly), dystonia, bradykinesia (slowness), rigidity, chorea (jerky), decreased walking, speech + swallowing
What are eye symptoms of Huntington’s?
slow saccades (orientation to look), difficultly initiating saccades w/o head movement or blinking, impaired smooth tracking
What are the cognitive symptoms of Huntington’s?
decreased concentration + memory, impaired EF, dementia
What are the psychosocial/behavior symptoms of Huntington’s?
delusions, psychosis, impulsivity, depression, anxiety, OCD
How is Huntington’s diagnosed?
symptom review, family history, genetic testing
What occupations does Huntington’s affect?
social participation, ADLs, IADLs, leisure, health management, work
How is Huntington’s managed?
no cure - OT, medication, counseling
What are the functions of the cerebellum?
integrate sensory info from SC + brain, helps w/ cognition, coordinate movement + motor planning
What are the regions of the cerebellum?
inferior vermis + flocculonodular lobe -> balance + eye movement
vermis + flocculonodular lobe -> controls trunk
lateral cerebellum -> controls limbs, cognition + motor planning
What are the symptoms of a cerebellar artery infarct?
vertigo, nausea, vomiting, nystagmus, limb ataxia, unsteady gait, headache
What causes a cerebellar hemorrhage?
high BP, arteriovenous malformation (tangle of blood vessels to cause bypass of capillaries), metastases
What are the symptoms of a cerebellar hemorrhage?
headache, nausea, vomiting, ataxia, nystagmus, hydrocephalus (too much CSF)
What is the most significant symptoms of a cerebellar lesion?
ataxia - irregular + uncoordinated movements (can be ipsilateral)
What are the symptoms of a midline lesion to the cerebellum?
truncal ataxia - unsteady gait, eye movement difficulties, vertigo, nausea + vomiting
What are the symptoms of a lesion lateral to the vermis?
appendicular ataxia
What are some characteristics of ataxia?
dysrhythmia -> abnormal timing
dysmetria -> decreased control of distance, ROM + speed of movement
What is the result of a lesion in the lateral motor systems?
same side ataxia
What is the result of a lesion in the medial motor systems?
bilateral ataxia
What are some other causes of ataxia?
lesion to cerebellar peduncles, prefrontal cortex, or pons; hydrocephalous, SC disorder, damage to midbrain, frontal lobe, internal capsule, parietal lobe, or sensorimotor cortex
What causes sensory ataxia?
damage to DC/ML pathway (ipsilateral, loss of sense of joint position), nerves (ipsilateral), thalamus, or somatosensory cortex (contralateral)
What are the symptoms of sensory ataxia?
overshooting limb movement, unsteady gait, impaired joint sense
What are the signs and symptoms of cerebellar damage?
nausea, vomiting, vertigo, slurred speech, unsteady gait, ataxia, headache, decreased consciousness, head tilt, hydrocephalus
What are other types of brain damage that can affect ataxia?
UMN or LMN damage, sensory issues, movement disorders (Parkinson’s)
What are some tests for appendicular ataxia?
precision finger tap, dysdiadochokinesia (rapid alternating movement), tremor, note myoclonus (rapid movement disorder)
What are some tests for truncal ataxia?
wide base + unsteady gait,tandem walking, Rhomberg test, titubation (head or trunk tremor)
What are some eye movement abnormalities?
ocular dysmetria -> over/undershoot eye gaze
slow or jerky saccades
nystagmus
suppressed vestibulo-ocular reflex
What are some speech abnormalities and other findings?
fluctuations in rate + volume, slurred speech, difficult to understand, decreased muscle tone, cognitive deficits
What is a stroke?
decreased blood flow to brain leading to decrease O2 + tissue damage
hemorrhagic or ischemic
What are some characteristics of a stroke?
cerebral vascular accident (CVA), 5th leading cause of death, major cause of disability
What are some causes and risk factors of a stroke?
cardiac disease, high BP, high cholesterol, diabetes
smoking, obesity, physical inactivity, alcohol, drugs
What is a hemorrhagic stroke?
ruptured blood vessel causing increase pressure in brain (aneurysm)
What is a ischemic stroke?
blockage of blood vessel (infarction -> death of brain tissue due to blockage)
What are the types of blockages in the brain?
thrombosis -> blood clot
embolism -> clot that breaks away
from another body part
transient ischemic attack -> mini
stroke w/ no tissue death
What are the major structures that supply blood to the cerebral hemisphere?
anterior circulation -> internal carotid
posterior circulation -> vertebral
arteries
circle of Willis -> internal + vertebral
arteries meet
What are the symptoms of MCA clinical syndrome?
most common - aphasia, hemineglect, hemianopia, face, arm, or leg sensorimotor loss, gaze preference towards side of lesion
What are the symptoms of ACA clinical syndrome?
sensory loss, contralateral leg, hemiparesis, motor aphasia, contralateral neglect, frontal lobe - grasp reflex, judgment, flat affect, apraxia, incontinence, alien hand syndrome (semiautomatic contralateral arm movements)
What are the symptoms of PCA clinical syndrome?
contralateral homonymous hemianopsia (visual field deficits
thalamus or internal capsule - contralateral sensory + hemiparesis, aphasia
occipital lobe - alexia (reading deficits) w/o agraphia (writing deficits)
What are the impairments caused by stroke?
varies by side of brain affected, damage to specific area of brain + amount of damage - may not know full effects until wks or months
What are the motor impairments caused by stroke?
contralateral weakness + paralysis, ataxia, apraxia (coordination + motor planning), spasticity, contractures, dysphasia (swallowing), bowel + bladder control
What are the sensory impairments caused by stroke?
decreased tactile sensation + depth perception, paresthesia ( tingling, burning or pain), hemianopsia (1/2 visual field), difficulty recognizing objects
What are the cognitive impairments caused by stroke?
decreased memory, shorten attention span, difficulty w/ retention, EF, reading, writing or recognizing objects
What are the communication impairments caused by stroke?
dysarthria (speech motor), articulation, Broca’s aphasia, Wernicke’s aphasia, global aphasia (language)
*on left side of brain
What are the emotional impairments caused by stroke?
partial loss of emotional control + depression
What is the difference between right vs. left side stroke?
right -> left side paralysis, visual + spatial difficulties, impulsivity, decreased memory
life -> right side paralysis, slow behavior, language deficits, problem-solving
What are the treatments to support stroke?
motor -> exercise, PROM, stretching, splinting, muscle relaxers
psychosocial + ADLs
What is a TBI?
acquired injury to brain from bump, blow, or jolt
What type of damage is caused by close head injuries?
focal or diffuse
What is the primary phase of damage?
caused by impact
What is the secondary phase of damage?
monitored after injury - swelling or bleeding
What are the types of injury from a blast TBI?
primary -> blast
secondary -> flying debris
tertiary -> blast throwing individual against object
How are TBIs categoried?
Glasgow Coma Scale - eye opening, verbal + motor response
What is a mild Glasgow score?
13+, concussion, inattention, decreased memory, headache, vertigo, tinnitus
What is a moderate Glasgow score?
9-12, loss of consciousness, confusion
What is a severe Glasgow score?
8-, coma, vegetative
What is the Los Amigos Scale of Cognitive Functioning?
determines level of independence + care needed
What are the physical effects of TBI?
decreased movement, balance, coordination + endurance
What are the physical treatments of TBI?
exercise, massage, orthotics, AE, medication, sleep support, etc.
What is cerebral palsy?
group of permeant disorders that effect movement + posture
non-progressive, developed at birth
What are the causes of CP?
prenatal -> toxin, lack of O2, blood incompatibility
perinatal -> birth trauma
postnatal -> TBI, infection
What is the neuroscience of CP?
cerebral cortex, subcortical structures, axons next to lateral ventricles
spastic diplegia -> BG + thalamus
dyskinetic -> BG
ataxic -> thalamus + cerebellum
What is spastic CP?
exaggerated muscle tone = stiffness, pain, contractures
What is hypotonic CP?
low muscle tone, inadequate contraction
What is dyskinetic CP?
jerk, fluctuating muscle tone, involuntary
What is ataxic CP?
clumsy, does not involve muscle tone
What are some complications from CP?
contractures, scoliosis, dental, osteoporosis, respiratory infection
How is CP identified?
observation, history + neuro exam