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DPT 509 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

why do we do a neurologic screen?

A

to ID red flags

to obtain data for differential dx

guidance for tool selection

to ID need for referral

to obtain baseline for the pt

to ID changes over time

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2
Q

what is a screening?

A

brief

determines need for detailed exam

screens for red flags

determines need for referral

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3
Q

what is an examination?

A

focused search for origins

ID system-related impairments that could contribute to activity and participation limitations

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4
Q

what belongs in a screen?

A

observation

reflex testing

motor assessment

sensation

coordination

balance

CN screen

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5
Q

what is a part of observation?

A

posture and general symmetry

muscle appearance

involuntary movements (tremors, bradykinesia, hypokinesia)

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6
Q

what is included in a mental status screen?

A

alert and oriented

memory screen

general behavior

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7
Q

what pathways are testing in UMN testing?

A

DCML pathway

corticospinal tracts

corticobulbar tracts

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8
Q

where does the DCML cross?

A

at the medulla

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9
Q

what sensations is the DCML responsible for?

A

proprioception, kinesthesia, discriminitive touch, stereognosis, tactile pressure, graphesthesia, recognition of texture, 2 point discrimination, vibration

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10
Q

where do the corticospinal tracts go to and from?

A

cortex to SC just proximal to the ant horn cell

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11
Q

where do the corticobulbar tracts go to and from?

A

cortex to CNS

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12
Q

what is the UMN presentation?

A

muscles paresis

hypertonicity (spasticity or rigidity)

hyperreflexia

abnormal reflexes

weakness not focal

(+) special/pathologic tests

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13
Q

what are the UMN pathologies?

A

TBI

stroke

SCI

any disorder affecting the cerebrum, BS, or SC

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14
Q

what is dystonia?

A

prolonged involuntary movement, twisting, or writhing repetitive movements

UMN

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15
Q

what is hypertonia?

A

increased resisitance to PROM

UMN

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16
Q

what is hypotonia?

A

decreased resistance to PROM

LMN

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17
Q

what is spasticity?

A

velocity-dependent increase in muscle tone

UMN

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18
Q

what is rigidity?

A

velocity-independent increase in muscle tone

increased resistance to movement throughout ROM in both directions

BG

UMN

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19
Q

how do we test for spasticity in flexors?

A

have pt in a comfortable relaxed position

begin by moving the jt slowly into flex, then ext, increasing speed gradually with repetition

quickly pull into extension

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20
Q

how do we test for spasticity in extensors?

A

pt in a comfortable relaxed position

begin by moving the jt slowly into ext, then flex, increasing speed gradually with repetition

quickly pull into flexion

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21
Q

what is a grade 0 in the modified ashworth scale of UMN testing?

A

no increased in muscle tone

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22
Q

what is a grade 1 in the modified ashworth scale of UMN testing?

A

slight increase in muscle tone, manifested by a catch and release or by min resistance at the end of the ROM when the affected part(s) is moved into flex/ext

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23
Q

what is a grade 1+ in the modified ashworth scale of UMN testing?

A

slight increase in muscle tone, manifested by a catch, followed by min resistance throughout the remainder of the ROM (<1/2)

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24
Q

what is a grade 2 in the modified ashworth scale of UMN testing?

A

more marked increase in muscle tone through most of the ROM, but affect part(s) moves easily

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25
Q

what is a grade 3 in the modified ashworth scale of UMN testing?

A

considerable increase in muscle tone, passive movement is difficult

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26
Q

what is a grade 4 in the modified ashworth scale of UMN testing?

A

affected part(s) rigid in flex/ext

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27
Q

what are the special/pathological tests for UMNs?

A

pronator drift test

clonus testing

Babinski sign

Hoffman sign

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28
Q

what is the pronator drift test?

A

stadnw with both arms flexed to 90 deg

palms up/forearms supinated

eyes closed

maintain position for 20-30 seconds

(+) test: downward drift of one arm

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29
Q

what is clonus testing of the LE?

A

tested at the ankle

knee should be slightly flexed

being slowly moving from DF to PF several times

then quickly jerk into DF with hold

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30
Q

what is clonus?

A

rapid, reflexive, back and forth motion that continues for multiple cycles

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31
Q

what is clonus testing of the UE?

A

tested at wrist

slowly move the wrist into flex/ext

then quickly jerk into ext

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32
Q

what is the test for the Babinski sign?

A

pt positioned in supine w/skin below the ankle exposed

using the end of the reflex hammer, firmly and quickly stroke the object upward along the palmar side of the foot

move up toward the toes from the calcaneus and move medially across the metatarsal region

(+) test: toe ext and abd (fanning of toes)

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33
Q

what is the test for the Hoffman sign?

A

flick the distal phalynx of the middle finger into flexion

(+) test: flex of 1st/2nd DIPs

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34
Q

what is a (+) Hoffman sign suggestive of?

A

CNS lesion

cord compression

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35
Q

should the Hoffman sign be viewed in isolation?

A

no!

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36
Q

when should UMN testing be on the front burner?

A

when we need to add evidence for suspected CNS lesion

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37
Q

when should UMN testing be on the back burner?

A

if there’s no clinical evidence pointing to UMN

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38
Q

what is the purpose of deep tendon reflex testing?

A

testing for sensory-neuromotor integrity by stimulating a monosynaptic stretch reflex (response)

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39
Q

what is the procedure for DTR testing?

A

place extremity in a relaxed position

locate the tendon of the muscles being tested

loosely grip the reflex hammer

strike the tendon directly or protect the tendon with your thumb and strike the thumb

observe/record response

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40
Q

what are common DTR testing locations?

A

tendon of biceps, brachioradialis, triceps, quads, and Achilles tendon

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41
Q

what is a 0 in DTR reflex testing?

A

no reflex

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42
Q

what is a 1+ in DTR reflex testing?

A

min/depressed reflex

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43
Q

what is a 2+ in DTR reflex testing?

A

normal response

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44
Q

what is a 3+ in DTR reflex testing?

A

overly brisk response

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45
Q

what is a 4+ in DTR reflex testing?

A

extremely brisk response w/clonus

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46
Q

what is a 5+ in DTR reflex testing?

A

sustained clonus

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47
Q

t/f: DTR testing should be compared bilaterally

A

true

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48
Q

t/f: DTR grades of 1+ through 3+ are normal unless assymetric

A

true

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49
Q

what is the nerve root of the biceps?

A

C 5-6

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50
Q

how is the biceps DTR tested?

A

sitting, arm ext, palpate biceps tendon and tap with thumb over tendon

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51
Q

what is the response for biceps DTR testing?

A

elbow flex

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52
Q

what is the nerve root of the brachioradialis?

A

C6-7

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53
Q

how is the brachioradialis DTR tested?

A

sitting, arm at the side, palpate the brachioradialis, tap the muscles belly or tendon at the radial tub

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54
Q

what is the response of brachioradialis DTR testing?

A

elbow flex w/slight supination

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55
Q

what is the nerve root of the triceps?

A

C6-8

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56
Q

how is the triceps DTR tested?

A

sitting with arm supported in abduction, hit at the triceps tendon, proximal to the elbow

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57
Q

what is the response of triceps DTR testing?

A

elbow extension

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58
Q

what is the nerve root of the patellar tendon?

A

L3-4

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59
Q

how is the patellar tendon DTR tested?

A

sitting with leg bent over the edge of the chair, tap the patellar tendon

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60
Q

what is the response of patellar tendon DTR testing?

A

knee extension

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61
Q

what is the nerve root of the hamstrings?

A

L5, S1-2

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62
Q

how are the hamstrings DTRs tested?

A

prone with knee semiflexed and supported, tap on finger directly over tendon at knee

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63
Q

what is the response of hamstring DTR testing?

A

slight contraction of knee flexors

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64
Q

what is the nerve root of the Achilles tendon?

A

S1-2

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65
Q

how is the Achilles tendon DTR testing?

A

sitting with leg bent over edge of chair, ankle in DF, tap Achilles tendon

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66
Q

what is the response of Achilles tendon DTR testing?

A

ankle PF

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67
Q

when is DTR testing on the front burner?

A

when s/s suggest UMN/LMN involvement

if pt’s symptoms are worsening

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68
Q

when is DTR testing on the back burner?

A

with conditions unrelated to the NS

post op tendon/lig repair, ankle sprain, etc

if dx is already present and well established, DTR won’t give any new info

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69
Q

what is an example of documenting DTR testing?

A

patellar (L4) R 1+, L 2+; Achilles (S1) R 2+, L 2+

3+ B for patellar and Achilles tendons (2+ for all UE DTRs B)

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70
Q

what are the LMN pathologies?

A

peripheral nerve injury

radiculopathy

peripheral neuropathy

polio

GBS

ALS

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71
Q

what is the presentation of a pt with a LMN lesion?

A

paralysis

hypotonia

hyporeflexia

fasciculations

ipsi weakness
- segmental/focal pattern
- atrophy from denervation

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72
Q

what is the order of clinical return of sensory nerve fxn?

A

1) pain and temp
2) moving touch, 2-point discrimination
3) constant touch and static 2-point discrimination
4) 256 hz vibration

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73
Q

what are the sedden classifications of nerve injury and their corresponding Sunderland classification?

A

neuropraxia (1)

axonotmesis (2)

neurotmesis (5)

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74
Q

what is involved in Sunderland grade 1 nerve injury?

A

conduction block

myelin sheath damage

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75
Q

what is involved in Sunderland grade 2 nerve injury?

A

axonal discontinuity

myelin sheath and axon damage

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76
Q

what is involved in Sunderland grade 3 nerve injury?

A

myelin, axonal and endoneural disruption

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77
Q

what is involved in Sunderland grade 4 nerve injury?

A

perineural rupture and fascicle disruption

myelin, axon, endo, and peri damage

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78
Q

what is involved in Sunderland grade 5 nerve injury?

A

nerve trunk discontinuity

myelin, axon, endo, peri, and epi damage

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79
Q

when is the Wallerian degeneration in nerve injury?

A

axonotmesis and neurotmesis

2nd-5th degree

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80
Q

what are myotomes?

A

defined group of muscles supplied by a single nerve root

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81
Q

what is the muscle action of the C1 myotome?

A

capital flexion

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82
Q

what is the muscle action of the C2 myotome?

A

cervical flexion

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83
Q

what is the muscle action of the C3 myotome?

A

cervical lateral flexion

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84
Q

what is the muscle action of the C4 myotome?

A

scap elevation

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85
Q

what is the muscle action of the C5 myotome?

A

shoulder abd, elbow flex

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86
Q

what is the muscle action of the C6 myotome?

A

wrist ext

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87
Q

what is the muscle action of the C7 myotome?

A

elbow ext

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88
Q

what is the muscle action of the C8 myotome?

A

thumb ext, finger flex

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89
Q

what is the muscle action of the T1 myotome?

A

finger abd

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90
Q

what is the muscle action of the L2 myotome?

A

hip flex

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91
Q

what is the muscle action of the L3 myotome?

A

knee ext

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92
Q

what is the muscle action of the L4 myotome?

A

ankle DF

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93
Q

what is the muscle action of the L5 myotome?

A

great toe ext

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94
Q

what is the muscle action of the S1 myotome?

A

ankle PF

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95
Q

what is the muscle action of the S2 myotome?

A

knee flex

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96
Q

what muscle does the long thoracic nerve innervate?

A

serratus anterior

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97
Q

what muscle does the suprascapular nerves innervate?

A

supraspinatus and infraspinatus

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98
Q

what muscle does the axillary nerve innervate?

A

deltoids

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99
Q

what muscle does the musculocutaneous nerve innervate?

A

biceps

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100
Q

what muscle does the radial nerve innervate?

A

high: triceps

mid humerus: wrist extensors, MCP extensors, thumb retropulsion

distal: sensory only

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101
Q

what does the proximal median nerve innervate?

A

wrist flexors

ape hand

benedictine sign

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102
Q

what does the distal median nerve innervate?

A

thenar eminence

ape hand

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103
Q

what does the proximal ulnar nerve innervate?

A

claw hand

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104
Q

what are the peripheral nerve deformities?

A

ulnar claw deformity

benedictine sign

ape hand deformity

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105
Q

what does the obturator nerve innervate?

A

obturator externus

adductor compartment

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106
Q

what does the femoral nerve innervate?

A

illiacus

pectineus

sartorius

quads

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107
Q

what does the tibial nerve innervate?

A

muscles of posterior calf

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108
Q

what does the common fibular nerve innervate?

A

anterior leg muscles

lateral leg muscles

intrinsic muscles

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109
Q

what does the superior gluteal nerve innervate?

A

glut med

glut min

TFL

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110
Q

what does the inferior gluteal nerve innervate?

A

glut max

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111
Q

what does the sciatic nerve innervate?

A

posterior thigh muscles

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112
Q

when should motor assessment be on the front burner?

A

if suspected nerve root pathology is present

used to differentaite bw nerve root dysfxn and injury to peripheral nerve

determine involvement of SCI

can be done for quick screen

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113
Q

when should motor assessment be on the back burner?

A

in conditions unrelated to spinal nerve root pathology

not a priority in orthopedic cases where nerve root pathology is low/absent

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Perfectly
114
Q

what is an example of a motor exam documentation?

A

weakness (4-/5) in R ankle DF (L4) an great toes extension (L5); no pain upon resistance. R L2, L3, S1 myotomes all 5/5; L L2-S1 5/5

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115
Q

what is an example of a motor exam assessment in documentation?

A

pt’s s/s consistent w/R L4-5 nerve root dysfxn based on reported pain and paresthesia pattern and determined strength in L4-5

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116
Q

t/f: peripheral nerve injuries generally present w/impairments that parallel the distribution of the involved nerve

A

true

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117
Q

what is the pattern of sensory loss in DM?

A

early symptoms w/stocking-glove distribution in peripheral neuropathy

118
Q

t/f: with CNS involvement, there is generally a more diffuse pattern of sensory involvement

A

true

119
Q

the following indicates a lesion to what tract(s)? :

contra loss of pain and temp

A

lesion of the antero-lateral tracts

120
Q

the following indicates a lesion to what tract(s)? :

loss of vibration or 2 point discrimination

A

lesion of DCML

121
Q

t/f: sensory and motor loss is usually indicative of nerve root involvement

A

true

122
Q

what structures are involved in sensory exam?

A

primary sensory cortex

secondary sensory cortex

homunculus

123
Q

what is the sequencing of the sensory exam?

A

superficial senses examined first

then deep senses

then cortical senses

if there is no superficial sense of touch, usually don’t proceed to proprioceptive and kinesthetic assessments or cortical assessments

distal to proximal

124
Q

what needs to be documented in a sensory exam?

A

modality of testing

quantity of involvement or body surfaces assessed

deg of severity (absent, impaired, delayed)

localization of sensory impairment

impact of sensory loss of fxn

125
Q

what is the C3 dermatome?

A

lateral neck

126
Q

what is the C4 dermatome?

A

over the clavicle

127
Q

what is the C5 dermatome?

A

lateral upper arm

128
Q

what is the C6 dermatome?

A

thumb

129
Q

what is the C7 dermatome?

A

middle finger

130
Q

what is the C8 dermatome?

A

medial border of the hand

131
Q

what is the T1 dermatome?

A

medial forearm

132
Q

what is the T2 dermatome?

A

medial upper arm close to the axilla

133
Q

what is the L1 dermatome?

A

anterior groin

134
Q

what is the L2 dermatome?

A

middle to upper anterior thigh

135
Q

what is the L3 dermatome?

A

middle to lower medial thigh

136
Q

what is the L4 dermatome?

A

medial aspect of the foot to great toe and proximal lateral thigh to medial tibia

137
Q

what is the L5 dermatome?

A

central dorsum of foot and ankle

138
Q

what is the S1 dermatome?

A

lateral aspect of the foot and ankle

139
Q

what is the S2 dermatome?

A

middle posterior thigh

140
Q

what are the superficial sensations testing?

A

pain

temp

touch awareness (light touch)

141
Q

what are deep sensations testing?

A

kinesthesia

proprioception

vibration

142
Q

what are combined cortical sensations testing?

A

stereognosis

tactile localization (performed w/touch awareness)

2 point discrimination

143
Q

what is involved in the sensory exam of pain?

A

sharp vs dull discrimination (protective sensation)

toothpick and q tip or paperclip

apply randomly

apply light pressure, not a swiping motion

144
Q

what is involved in the sensory exam of temp?

A

using test tubes of water (warm and cold)

use the side of the test tubes, not the tip

randomly apply and assess perception of sensation

pt will reply verbally “cold” or “hot” after each stim application

145
Q

what is involved in the sensory exam of touch awareness?

A

light touch:
- cotton swab, camal hairbrush, tissue, fingers gently rub across an area
- ask pt if they recognize the stim saying “yes” or “now”

pressure perception:
- use fingertip or double tip cotton swab
- apply firm pressure on skin enough to indent the skin, but no enough to cause pain
- pt asked to ID when they feel the response

146
Q

what is sensory extinction?

A

feeling only one side when both sides are stimulated (unilateral neglect in CVA)

touching 2 points and the pt only feels one

147
Q

what is involved in the sensory exam of kinesthesia?

A

small amounts of passive motions are performed

larger jt motions will be more discernable than smaller

therapist should maintain loose grip

PT demonstrates movements to pt with eyes open

pt asked to ID the direction of the movement

pt can also duplicate the motion w/the opposite limb

148
Q

why shouldn’t you grip the plantar and dorsal side of the foot in kinesthesia testing? how should you grip the foot?

A

bc the pt can still sense pressure on the foot and can possibly descern the movement from the pressure

instead, grip the sides of the hand, toes, fingers, wrist, or foot

149
Q

what is involved in the sensory exam of proprioception?

A

the jt is moved through a portion of ROM and held static

pt asked to ID ROM previously described by the therapist (initial, mid, terminal)

therapist hold jt in static position

pt asked to describe the position

pt can also be asked to duplicate the position
‘
pt can also duplicate position with contra limb

150
Q

what is kinesthesia?

A

awareness of movement

151
Q

what is proprioception?

A

jt position sense and awareness of jts at rest

152
Q

what is involved in the sensory exam of vibration?

A

place the tuning fork (128 hz) on a bony prominence

alternate bw vibration/non-vibration

pt should perceive the vibration by verbally telling the PT if there is vibration or not

best to use headphones if available bc the auditory cue of the tuning fork can cue the pt to the correct response

153
Q

t/f: deep sensations and combined cortical sensations are not check at the dermatomal level, but at bony prominences

A

true

154
Q

t/f; you need at least 2 of the following sensations to maintain static balance: vision, somatosensation, and vestibular systems

A

true

155
Q

what is involved in the sensory exam of stereognosis?

A

small objects used that are easily obtainable, cultural, and familiar (keys, coins, combs, paper clips, pencils, etc)

place an object in the pt’s hand for manipulation and identification

allow the pt to handle several samples prior to starting the test

modification for speech impairment using blinding and pics

156
Q

what is stereognosis?

A

ability to recognize the form of an object by touch

157
Q

what is involved in the sensory exam of 2 point discrimination?

A

2 points are applied simultaneously w/ equal pressure and gradually moved closer together to determine the smallest distance they can differentiate

varies bw individuals and body parts

an aesthesiometer and circular 2 point discriminator can be used or 2 paper clips

apply gradually reducing distances bw 2 points

alternate w/occasional single point

have pt verbally respond “one” or “two”

158
Q

what is 2 point discrimination?

A

ability to perceive 2 points applied simultaneously

measures the smallest distance b/w 2 stimuli

159
Q

what is involved in quantitative sensory threshold testing?

A

using monofilaments

pressures vary from 0.026 g to 100g

apply filament perpendicular to skin until it bends

apply 3x at each side

apply gradually thicker filament until the pt can perceives pressure w/vision occluded

160
Q

what is involved in the sensory exam of peripheral neuropathy?

A

sensory testing for tactile sensation and proprioception

apply stim for light touch, dull, temp, vibration, pressure

test pressure sensation in specific areas of the foot using force applied through monofilaments

determine pt awareness of pressure (protective sensation)

161
Q

how many sensory sites are there on the dorsum of the foot?

A

3

162
Q

how many sensory sites are there on the plantar side of the foot?

A

9

163
Q

what is meant by “loss of protective sensation”?

A

inability to detect 10g of force applied through a 5.07 monofilament

164
Q

when should sensory testing be on the front burner?

A

any pt w/NS involvement should include both sensory items from posterior columns and spinothalamic tracts

pt with DM or any other disease that could affect distal sensation

suspected nerve root involvement (LBP)

165
Q

when should sensory testing be on the back burner?

A

should rarely be on the back burner

should be screened frequently

166
Q

what is the fxn of CN 1(olfactory nerve)?

A

smell

167
Q

how is CN 1 tested?

A

2-3 very distinct smelling items waved under pt’s nose with their eyes closed under each nostril separately

strength of scent should be the same bilaterally

168
Q

what items can be used for testing CN 1?

A

coffee beans, peppermint, lemon, cinnamon, cloves

169
Q

what would be an abnormal finding with CN 1 testing?

A

anosmia (inability to detect smells)

170
Q

what is the fxn of CN 2?

A

afferent

light detection and red saturation

vision

171
Q

how is CN 2 tested?

A

Snellen eye chart for visual acuity

have PT read from largest to smallest 20 feet away

perform each eye separately

peripheral vision screen (look at your nose while bringing your finger into from the side and ask when they see it w/o looking away from finger)

172
Q

what would be abnormal findings in CN 2 testing?

A

field deficits

blindness, impaired near vision

173
Q

what does 20/20 vision mean?

A

subject at 20 feet is equal to visual acuity of a person with normal vision at 20 feet

174
Q

what does 20/40 vision mean?

A

visual acuity of subject at a 20 foot distance is equal to visual acuity of a person w/normal vision at 40 feet

175
Q

what is the fxn of CN 3?

A

efferent

sup rectus muscle (elevation and adb)

inf rectus (depression and abd)

pupillary constriction

176
Q

how is CN 3 tested?

A

have PT follow your finger in an H pattern w/o moving their head

use a pen light to shine in the eyes, contra and ipsi pupil should constrict

177
Q

what would be abnormal findings in CN 3 testing?

A

absence of pupillary constriction

lateral strabismus

diploplia pr nystagmus

impaired eye movements

178
Q

what 3 CNs are tested together?

A

3, 4, 6

179
Q

what is the fxn of CN 4?

A

efferent input to sup oblique muscle (depression and add)

180
Q

how is CN 4 tested?

A

H movement

bring your finger towards the pt’s nose - both eyes should converge (move downward and inward)

181
Q

what would be abnormal finding in CN 4 testing?

A

lateral strabismus

medial strabismus

diploplia or nystagmus

impaired eye movements

182
Q

what is the fxn of CN 6?

A

efferent lateral rectus (abd)

183
Q

how is CN 6 tested?

A

H movement

observe specifically for abduction

184
Q

what is the double H movement assessing?

A

smooth pursuits

185
Q

what would be abnormal findings in CN 6 testing?

A

lat strabismus

med strabismus

diploplia or nystagmus

impaired eye movements

186
Q

how far should you be from the pt when testing CN 3, 4, 6?

A

2 feet

187
Q

what eye muscles in CN 3 responsible for?

A

sup rectus

med rectus

inf rectus

inf oblique

188
Q

what eye movements is CN 3 responsible for?

A

moves eye up, down, and medially

189
Q

what muscle is CN 4 responsible for?

A

sup oblique

190
Q

what eye movement is CN 4 responsible for?

A

moves the adducted eye downward

191
Q

what muscle is CN 6 responsible for?

A

lateral rectus

192
Q

what eye movements is CN 6 responsible for?

A

eye abduction

193
Q

what is the fxn of CN 5?

A

efferent: muscles of mastication

afferent: facial sensation

194
Q

how is CN 5 tested?

A

w/eyes closed, perform light touch of the pt’s face (forehead, cheeks, and lateral jaw

palpate the masseter and temporalis muscles bilaterally with the pt clenches their jaw

direct pt to open jaw slightly and provide resistance to mandibular closing and/or lateral motion (w/tongue depressor)

195
Q

what would be abnormal findings in CN 5 testing?

A

loss of facial sensation

trigeminal neuralgia

weakness, wasting of muscles

deviation of the jaw to the ipsi side

assymetry of jaw strength

196
Q

what is the fxn of CN 7?

A

afferent: taste (ant 2/3 of tongue)

efferent: facial muscles (facial expression)

197
Q

how is CN 7 tested?

A

assess motor fxn of the facial muscles by asking pt to elevate eyebrows, puff out cheeks, smile, and frown

assess taste by having pt close their eyes and stick out their tongue while you place something sweet on the tongue

198
Q

what would be abnormal findings of CN 7 testing?

A

paralysis

inability to close eyes

difficulty w/speech articulation

decreased taste

199
Q

what could unilateral LMN lesion be indicative of?

A

Bell’s palsy

200
Q

what could bilateral LMN lesion be indicative of?

A

GBS

201
Q

what could unilateral UMN lesion be indicative of?

A

stroke

202
Q

what is the fxn of CN 8?

A

afferent hearing, detection of head movement, balance

203
Q

how is the cochlear branch of CN 8 tested?

A

have PT close their eyes and rub the pads of your thumb and forefinger together next to one ear and ask for indication of when sound is heard

204
Q

how is the vestibular branch of CN 8 tested?

A

stand unsupported w/eyes closed for 30 sec (Romberg test)

205
Q

what would be abnormal findings of a CN 8 test?

A

vertigo

decreased balance

gaze instability

deafness/impaired hearing

206
Q

is CN 9 assessed frequently?

A

not really

207
Q

what is the fxn of CN 9?

A

afferent: taste (post 1/3 of tongue)

efferent: salivation

208
Q

how is CN 9 tested?

A

place something sour/bitter on the posterior 1/3 on the pt’s tongue

have PT open their mouth and say “ahhhh” and observe the uvula (should be centered)

ask pt to swallow

test gag reflex w/tongue depressor

209
Q

what is the fxn of CN 10?

A

afferent and efferent pharynx and larynx

viscera

efferent for one extrinsic tongue muscle

210
Q

how is CN 10 tested?

A

same as CN 9

211
Q

what would be abnormal findings for CN 10 testing?

A

dysphonia (hoarse voice)

dysphagia (difficulty swallowing)

dysarthria (difficulty articulating words)

212
Q

what is the fxn of CN 11?

A

efferent upper trap and SCM

213
Q

how is CN 11 tested?

A

ask pt to shrug their shoulders and then rotate their head applying resistance and asking the pt to hold the position

214
Q

what would be abnormal findings in CN 11 testing?

A

LMN = atrophy, fasciculation

weakness

215
Q

what is the fxn of CN 12?

A

efferent tongue movements

216
Q

how is CN 12 tested?

A

have the pt stick out their tongue

observe for side to side deviation or atrophy

have PT move tongue side to side and observe for smooth movements

217
Q

if a pt can’t stick out their tongue straight, what is this indicative of?

A

a unilateral lesion of CN 12

218
Q

if there is an UMN lesion of CN 12, what would you see?

A

deviation do the tongue away from the lesion

219
Q

if there is a LMN lesion of CN 12, what would you see?

A

deviation do the tongue towards the lesion

220
Q

what would be abnormal findings of CN 12 testing?

A

atrophy or fasciculation of the tongue

impaired movement and deviation of the tongue towards the weak side

221
Q

when should CN testing be on the front burner?

A

in the presence of known/suspected brain injury

in known or suspected progressive NM disease that affects BS or brain (ALS)

if there are any changes in facial expression

222
Q

when should CN testing be on the back burner?

A

if typical s/s aren’t observed

223
Q

what is an example of documentation for CN testing?

A

dysfxn noted B with CN 2 and 3 (pupillary constriction), CN 5(decr masseter and temporalis muscle strength), CN 6 (ocular abduction), CN 8 (decr hearing), and CN 9 and 10 (swallowing)

224
Q

b4 doing an in depth exam of sensory fxn, we must determine what 2 things?

A

1) ability to concentrate
2) ability to respond to stimuli

225
Q

what 5 things are measured in cognition testing?

A

1) arousal
2) attention span
3) memory
4) orientation
5) cognition

226
Q

what is arousal?

A

pt’s ability to respond

responsiveness to sensory stim

227
Q

what does alert mean?

A

awake and attentive to normal stimuli

228
Q

what does lethargic mean?

A

sleepy, have to redirect to keep on track

229
Q

what does obtunded mean?

A

difficult to arouse from a solemn state and confused when awake

230
Q

what does stupor mean?

A

semi-comatose state responding only to strong and noxious stim

231
Q

what does coma mean?

A

no arousal regardless of stim

232
Q

what is attention?

A

selective awareness of the environment

responsiveness to stim/task w/ being distracted by other stim

233
Q

what is orientation?

A

a person’s awareness of time, person, place (or space)

234
Q

how would you document a pt who is alert and oriented to person and time, but not place?

A

AAO x2 (place)

235
Q

what is cognition?

A

method of CNS to process info

236
Q

the process of cognition includes…

A

knowledge

understanding

awareness

judgement

decision making

237
Q

t/f: cognitive and perceptual capacity are pre-requisits for learning

A

true

238
Q

what are the components of an exam of cognitive fxn?

A

orientation

comprehension

memory

executive fxn

problem-solving

cognition and task completion

motor planning

239
Q

what is the purpose of the mini cog assessment?

A

cognition SCREENING tool consisting of multiple domains

240
Q

what are the components of the mini cog assessment?

A

combo of 3 word recall and clock drawing test

paper and pencil instrument completed by therapist with pt

241
Q

who is the mini cog assessment used for?

A

pts with stroke, progressive dementia, and older adults

242
Q

what is the purpose of the mini mental state exam (MMSE)?

A

screening cognitive impairment an recording cognitive changes over time

243
Q

how long does it take to complete the MMSE?

A

<10 minutes

244
Q

what population do we use the MMSE on?

A

adults 18-64 and 65+

245
Q

what is the MMSE composed of?

A

paper and pencil instrument scored by the examiner

246
Q

is the mini cog or MMSE more robust?

A

the MMSE

247
Q

how many items are included in the MMSE?

A

11 items assessing 7 cognitive domains

orientation to time and place

registration and recall of 3 words

attention and calculation

language

visual construction

30 possible points

248
Q

what are the psychometrics for the MMSE?

A

for subjects with mild cog impairment-low sensitivity and unable to detect change

adequate interrater reliability

MDC=3 points

249
Q

what are the considerations for the MMSE?

A

limited detection of dementia

best to use in conjunction w/other cog testing

criticized for low reliability and “too many easy items”

prone to ceiling effect in pts w/minimal cog impairments

250
Q

what is the cutoff score for the MMSE?

A

<24

251
Q

what does a MMSE score of 24-30 mean?

A

no cognitive impairment

252
Q

what does a MMSE score of 18-23 mean?

A

mild cognitive impairment

253
Q

what does a MMSE score of 0-17 mean?

A

severe cognitive impairment

254
Q

what is the Montreal cognitive assessment (MoCA)?

A

quick cog assessment of memory, language, attention, visuospatial skills, orientation and abstraction to detect mild cog dysfxn

255
Q

what is the population for the MoCA?

A

18-65+

validated for large population

256
Q

which covers more domains, the MoCA or mini cog?

A

MoCA

257
Q

what is the max score of the MoCA?

A

30

258
Q

how long does it take to administer the MoCA?

A

10 minutes

259
Q

which cognitive assessment requires a training course and certification?

A

MoCA

260
Q

what are the psychometrics for the MoCA?

A

for subjects with mild cog impairements-high sensitivity and able to detect cog change

excellent interrater reliability

261
Q

what are the considerations for the MoCA?

A

able to detect mild cog impairments

greater emphasis on attention and executive fxn than MMSE

no ceiling effect

262
Q

what is the cutoff score of the MoCA?

A

> 26 is considered normal

263
Q

what do you do to the MoCA score if a pt has less than 12 years of formal education?

A

add 1 point to the overall score

264
Q

t/f: the MoCA has more reliable change when compared to the MMSE

A

true

265
Q

what is agnosia?

A

inability to recognize an object and interpret it (visually or tactilely)

266
Q

what is apraxia?

A

impairment of voluntary skilled movements not as a result of impairment of strength, coordination, and attention

267
Q

when should cognitive assessments be on the front burner?

A

when the pt or family are reporting “forgetfulness”

there is a hx of or suspected dementia

there is a change in mental status bw days or visits

268
Q

when should cognitive assessments be on the back burner?

A

when the pt is young and healthy

when pt has no hx of brain injury or CNS lesions

269
Q

what is coordination?

A

ability to execute smooth, accurate, and controlled movements

270
Q

what NS structures are involved in coordination?

A

cerebellum, BG, and DMCL pathway

271
Q

what is the typical progression of difficulty and order of testing for coordination and balance?

A

unilateral testing–> bilateral symmetrical tasks–> bilateral asymmetrical tasks–> multi limb tasks

272
Q

what are the 4 keys areas of coordination testing?

A

1) reciprocal motion
2) movement composition (synergy)
3) movement accuracy
4) fixation or limb holding

273
Q

what are the UE tests for coordination?

A

rapid alternating movement (pro/sup)

finger tapping/finger opposition

finger to nose (or chin)

finger to clinician finger (tapping finger as it moves around)

274
Q

what are the LE tests for coordination?

A

heel to shin (most common LE coordination test)

toe tapping (something heel to toe)

275
Q

what are you looking for with coordination testing?

A

gross and fine motor coordination of specific skills

how long it takes to complete the tasks

eyes open vs closed

accuracy

if speed affects quality

276
Q

what would an ataxic pt show in heel to shin testing?

A

inaccurate movements

277
Q

what would a hyperkinetic pt show in heel to shin testing?

A

fast movements (increased amplitude)

278
Q

t/f: documentation of coordination lacks standardization and reliability

A

true

279
Q

what should be included in the documentation of coordination testing?

A

length of time to complete

narrative of impairment (dysmetria, tremor, etc)

280
Q

what are the types of balance?

A

static (steady state0 postural control

reactive postural control

proactive (anticipatory) postural control

281
Q

what are the sensory systems for balance?

A

vision, somatosensory, and vestibular (need 2/3)

282
Q

what are the tests for static balance?

A

Romberg test (feet together EO and EC)

sharpened Romberg position (tendem EO and EC)

single limb stance test (EO and EC)

283
Q

how do we exam sensory strategies?

A

Romberg test

sensory organization test

MCTSIB

284
Q

how should all coordination and balance testing start in terms of positioning?

A

arms crossed over the chest with EO

time and quality should be measured and documented

285
Q

what are the reactive balance tests?

A

nudge/push test

mini best

FIST

functional reach test

286
Q

what is the procedure for the nudge/push test?

A

guard the pt

ask pt to stand quietly and comfortably with eyes open

tell pt you will nudge them in various directions and they must maintain upright stance

quickly but gently nudge the pt at random intervals from the front, back, and side (push at sternum, pelvis, or shoulders)

287
Q

what is the mini BEST test?

A

lean hard into PT and randomly let go to test the reactive balance

288
Q

what is the FIST test?

A

non ambulatory option for reactive sitting balance

289
Q

what is the fxnal reach test?

A

screens/assesses pt’s stabil;ity by measuring max distance they can reach while standing/sitting without stepping out of lifting heels (if standing)

fair psychometrics

cutoff score of <18.5 cm (indicates fall risk)

2 practice trials and 3 test trials

290
Q

how do you document for balance?

A

Norma, good, fair, poor, absent

291
Q

when should coordination and balance testing be on the front burner?

A

hx of falls/episodes of instability

reports of “dizziness”

CNS disorder that affects postural instability

general deconditioning/weakness

recurrent LE injuries (ankle sprains)

use of AD for ambulation

anyone over 65 yo

292
Q

when should coordination and balance testing be on the back burner?

A

no known balance difficulties

no hx of falls/FOF

visual, vestibular, somatosensory systems are all perfect

DPT 509 (7 decks)

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