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NPTE > Random Review NEUROMUSCULAR > Flashcards

Random Review NEUROMUSCULAR Flashcards

1
Q

To use visual system for balance…

A

eyes have to be open

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2
Q

To use proprioception for balance…

A

something like foam can’t be present because it makes the input info unreliable

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3
Q

To use the vestibular system for balance…

A

the neurological and mechanical aspects of this system can’t be compromised

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4
Q

How does the knowledge of results affect motor learning?

A
  • Knowledge of results should be kept minimal
  • Patients should be encouraged to engage in retrieval processes and maintain focus on performance
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5
Q

Function of the frontal lobe

A
  • Voluntary movement
  • Intellect
  • Orientation
  • Broca’s area (usually left hemisphere): speech, concentration
  • Personality, temper, judgement, reasoning, behavior, self-awareness, executive function
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6
Q

Function of parietal lobe

A
  • Sensation of touch, kinesthesia, vibration, temperature
  • Receives info from other areas of the brain about hearing, vision, motor, sensory, and memory
  • Provides meaning for objects
  • Interprets language and words
  • Spatial and visual perception
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7
Q

Function of temporal lobe

A
  • Primary auditory processing and olfaction
  • Wernicke’s area (usually left hemisphere): understand and produce meaningful speech
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8
Q

Function of occipital lobe

A
  • Process visual info
  • Process color, light, and shape
  • Judgement of distance
  • See in 3D
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9
Q

Impairments of frontal lobe

A
  • Contralateral weakness
  • Perseveration, inattention
  • Personality changes, antisocial behavior
  • Impaired concentration, apathy
  • Broca’s aphasia (expressive deficits)
  • Delayed or poor initiation
  • Emotional lability
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10
Q

Impairments of parietal lobe

A
  • Dominant hemisphere –> agraphia, alexia, agnosia
  • Non-dominant hemisphere –> dressing apraxia, constructional apraxia, anosognosia
  • Contralateral sensory deficits
  • Impaired language comprehension
  • Impaired taste
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11
Q

Impairments of temporal lobe

A
  • Learning deficits
  • Wernicke’s aphasia (receptive deficits)
  • Antisocial, agressive behaviors
  • Difficulty w/ facial recognition
  • Difficulty w/ memory, memory loss
  • Inability to categorize objects
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12
Q

Impairments of the occipital lobe

A
  • Homonymous hemianopsia
  • Impaired extraocular muscle movement and visual deficits
  • Impaired color recognition
  • Reading and writing impairment
  • Cortical blindness w/ bilateral lobe involvement
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13
Q

Function of hippocampus

A

Memory

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14
Q

Function of basal ganglia

A
  • Voluntary movement
  • Regulation of autonomic movement
  • Posture
  • Muscle tone
  • Control of motor responses
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15
Q

Function of amygdala

A

Emotional and social processing

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16
Q

Thalamus

A

Relay or processing station

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17
Q

Hypothalamus

A
  • Receives and integrates info from the ANS
  • Regulates hormones
  • Controls hunger, thirst, sexual behavior, and sleeping
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18
Q

Subthalamus

A

Regulating movements produced by skeletal muscles

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19
Q

Epithalamus

A
  • Pineal gland
  • Secretes melatonin
  • Controls internal clock
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20
Q

Blood supply of anterior cerebral arterey

A
  • Anterior frontal lobe
  • Medial surface of frontal and parietal lobe
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21
Q

Blood supply of middle cerebral artery

A
  • Most of outer cerebrum
  • Basal ganglia
  • Posterior and anterior internal capsule
  • Putamen
  • Pallidum
  • Lentiform nucleus
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22
Q

Blood supply of posterior cerebral artery

A
  • Portion of midbrain
  • Subthalamic nucleus
  • Basal nucleus
  • Thalamus
  • Inferior temporal lobe
  • Occipital and occipitoparietal cortices
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23
Q

Blood supply of vertebral-basilar artery

A
  • Lateral aspect of pons and midbrain together w/ superior cerebellum
  • Cerebellum
  • Medulla
  • Pons
  • Midbrain and thalamus
  • Occipital cortex
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24
Q

Expected impairments from injury to anterior cerebral artery

A
  • Contralateral LE motor and sensory involvement
  • Loss of bowel and bladder control
  • Loss of behavioral inhibition
  • Significant mental changes
  • Neglect
  • Aphasia
  • Apraxia and agraphia
  • Perseveration
  • Akinetic mutism w/ significant bilateral involvement
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25
Q

Expected impairments from injury to middle cerebral artery

A
  • Most common site of CVA
  • Wernicke’s aphasia in dominant hemispheere
  • Homonymous hemianopsia
  • Apraxia
  • Flat affect
  • Contralateral weakness and sensory loss of face and UE
  • Impaired spatial relations
  • Anosognosia in non-dominant hemisphere
  • Impaired body schema
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26
Q

Expected impairments from injury to posterior cerebral artery

A
  • Contralateral pain and temperature sensory loss
    Contralateral hemiplegia, mild hemiparesis
  • Ataxia, athetosis, or choreiform movement
  • Quality of movement is impaired
  • Thalamic pain syndrome
  • Prosopagnosia w/ occipital infarct
  • Hemiballismus
  • Visual agnosia
  • Homonymous hemianopsia
  • Memory impairment
  • Alexia, dyslexia
  • Cortical blindness from bilateral involvement
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27
Q

Expected impairments from injury to vertebral-basilar artery

A
  • Loss of consciousness
  • Hemiplegia or tetraplegia
  • Comatose or vegetative state
  • Inability to speak
  • Locked-in syndrome
  • Vertigo
  • Nystagmus
  • Dysphagia
  • Dysarthria
  • Syncope
  • Ataxia
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28
Q

Signs of a UMN injury

A
  • Weakness of involved muscles
  • Hypertonicity
  • Hyperreflexia
  • Mild disuse atrophy
  • Abnormal reflexes
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29
Q

Examples of a UMN injury

A
  • Cerebral palsy
  • Hydrocephalus
  • ALS (both lower and upper)
  • CVA
  • Birth injuries
  • MS
  • Huntington’s chorea
  • TBI
  • Pseudobulbar palsy
  • Brain tumors
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30
Q

Signs of a LMN injury

A
  • Flaccidity or weakness of involved muscles
  • Decreased tone
  • Fasciculations
  • Muscle atrophy
  • Decreased/absent reflexes
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31
Q

Examples of a LMN injury

A
  • Poliomyelitits
  • ALS (lower and upper)
  • Guillain-Barre syndrome
  • Tumors involving the spinal cord
  • Progressive muscular atrophy
  • Trauma
  • Infection
  • Bell’s palsy
  • Carpal tunnel syndrome
  • Muscular dystrophy
  • Spinal muscular atrophy
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32
Q

Pusher Syndrome

A
  • Term used to describe the behavior of individuals using their non-paretic limb to push themselves towards their paretic side.
  • Left unsupported, these patients demonstrate a loss in lateral posture, falling on to their paretic side
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33
Q

Cluster for cauda equina

A
  • Bilateral neurogenic pain
  • Reduced perineal sensation
  • Altered bladder function
  • Loss of anal tone
  • Loss of sexual function
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34
Q

Upper limb flexor synergy

A

SHOW OFF YOUR BICEP
- Scapula –> elevation and retraction
- Shoulder –> Abduction and ER
- Elbow –> Flexion
- Forearm –> Supination
- Wrist –> flexion
- Fingers –> flexion and adduction
- Thumb –> flexion and adduction

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35
Q

Upper limb extensor synergy

A
  • Scapula –> Depression and protraction
  • Shoulder –> IR and adduction
  • Elbow –> extension
  • Forearm –> pronation
  • Wrist –> extension
  • Fingers –> flexion w/ adduction
  • Thumb –> flexion and adduction
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36
Q

Lower limb flexor synergy

A
  • Hip –> abduction and ER
  • Knee –> flexion
  • Ankle –> DF and supination
  • Toes –> extension
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37
Q

Lower limb extensor synergy

A
  • Hip –> Extension, IR, and adduction
  • Knee –> extension
  • Ankle –> PF and inversion
  • Toes –> Flexion and adduction
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38
Q

Characteristics of a left hemisphere CVA

A
  • Weakness, paralysis of R side
  • Increased frustration
  • Decreased processing
  • Possible aphasia (expressive, receptive, global)
  • Possible dysphagia
  • Possible motor apraxia
  • Decreased discrimination b/t L and R
  • R hemianopsia
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39
Q

Characteristics of a right hemisphere CVA

A
  • Weakness, paralysis of the L side
  • Decreased attention span
  • Left hemianopsia
  • Decreased awareness and judgement
  • Memory deficits
  • Left inattention
  • Decreased abstract reasoning
  • Emotional lability
  • Impulsive behavior
  • Decreased spatial orientation
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40
Q

Characteristics of a brainstem CVA

A
  • Unstable vitals
  • Decreased consciousness
  • Decreased ability to swallow
  • Weakness on both sides of the body
  • Paralysis on both sides of the body
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41
Q

Characteristics of a cerebellum CVA

A
  • Decreased balance
  • Ataxia
  • Decreased coordination
  • Nausea
  • Decreased ability for postural adjustment
  • Nystagmus
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42
Q

Specific incomplete SCIs

A
  • Anterior Cord Syndrome
  • Brown-Sequard’s Syndrome
  • Cauda Equina Injury
  • Central Cord Syndrome
  • Posterior Cord Syndrome
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43
Q

Anterior Cord Syndrome

A
  • From compression and damage to anterior spinal cord or spinal artery
  • MOI –> cervical flexion
  • Loss of motor function, pain/temp sense below lesion
  • Damage to cotricospinal and spinothalamic tracts
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44
Q

Brown-Sequard’s Syndrome

A
  • Usually caused by a stab wound
  • Paralysis and loss of vibration and position sense on the same side as the lesion
  • Loss of pain and temp sense on opposite side
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45
Q

Cauda Equina Injury

A
  • Below L1
  • Flaccidity
  • Areflexia
  • Impairment of bowel and bladder function
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46
Q

Central Cord Syndrome

A
  • MOI –> cervical hypeerextension
  • Upper extremities are affected more than lower
  • Greater motor deficits than sensory
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47
Q

Posterior Cord Syndrome

A
  • Compression of posterior spinal artery
  • Loss of proprioception, 2-point discrimination, and stereognosis
  • Motor function preserved
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48
Q

Cluster for cervical myelopathy

A

3-4/5 of the following
- Gait deviation
- + Hoffmann’s test
- Inverted supinator sign
- + Babinski sign
- 45+ y/o

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49
Q

Chorea

A
  • a type of dyskinesia that is often observed as a side effect of antiparkinsonian medication
  • typically emerges with prolonged use of such medications.
  • characterized by involuntary, rapid, irregular, and jerky movements
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50
Q

Superficial reflexes

A
  • Abdominal
  • Corneal (“blink”)
  • Cremasteric
  • Gag
  • Plantar
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51
Q

Abdominal reflex

A
  • Spinal level –> T8-L1
  • Procedure –> stroke each quadrant in a diagonal toward the belly button
  • Normal response –> abdominal contraction and deviation of belly button toward stimulus
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52
Q

Corneal (“blink”) reflex

A
  • Spinal level –> trigeminal and facial nerves
  • Procedure –> pt looks up and away from you; stroke cornea w/ cotton
  • Normal response –> both eyes blink
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53
Q

Cremasteric reflex

A
  • Spinal level –> L1-L2
  • Procedure –> scratch skin of the upper medial thigh
  • Normal response –> elevation of testicle on ipsilateral side
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54
Q

Gag reflex

A
  • Spinal level –> glossopharyngeal and vagus nerves
  • Procedure –> stimulate side and back of throat
  • Normal response –> pt gags
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55
Q

Plantar reflex

A
  • Spinal level –> L5-S1
  • Procedure –> test for Babinski
  • Normal response –> toe flexion (Babinski sign indicates UMN lesion)
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56
Q

Stages of learning

A
  • Cognitive stage
  • Associative stage
  • Autonomous stage
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57
Q

Cognitive stage of learning

A
  • Initial stage
  • Conscious processing of info
  • Large amounts of error
  • Inconsistent attempts and performance
  • High degree of cognitive work
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58
Q

Associative stage of learning

A
  • Intermediate stage
  • More independently distinguish b/t correct vs incorrect performance
  • Can progress w/ less structure
  • Avoid excessive external feedback
  • Refining skill
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59
Q

Autonomous stage of learning

A
  • Final stage
  • Efficient w/o need for cognitive control
  • Can perform in variable environment
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60
Q

Categories for SCI functional outcomes

A
  • High tetraplegia (C1-C5)
  • Mid-level tetraplegia (C6)
  • Low tetraplegia (C7-C8)
  • Paraplegia
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61
Q

Summary for functional outcomes with high tetraplegia

A
  • Dependent bed mobility and transfers C1-C4
  • Mod-max A bed mobility and transfers C5
  • Mod I for powered weight shift, Dependent for manual weight shift
  • Dependent wheelchair management
  • Mod I powered wheelchair, MaA-dependent manual WC
  • No gait
  • Dependent positioning
  • Dependent feeding
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62
Q

Summary for functional outcomes with mid-level tetraplegia

A
  • MinA - modI w/ bed mobility, transfers, weight shift, WC (unless there is power), ROM, feeding
  • No gait
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63
Q

Summary for functional outcomes with low tetraplegia

A
  • ModI to independent bed mobility, weight shifts, WC, feeding
  • MinA-modI ROM/position
  • No gait
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64
Q

Summary for functional outcomes with paraplegia

A
  • IND bed mobility, transfer, WC, ROM, feeding.
  • ModI weight shift
  • Orthotics w/ gait
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65
Q

Which nerve is being tested in the cubital tunnel?

A

Ulnar nerve

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66
Q

Other than the carpal tunnel, what can compress the median nerve?

A

Pronator teres

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67
Q

How often should feedback of results for simple tasks be given?

A

every 15 reps

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68
Q

How often should feedback of results for complex tasks be given?

A

every 5 reps

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69
Q

Figure-ground discrimination

A

the inability to visually distinguish a figure from the background in which it is embedded

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70
Q

Touch localization

A

the ability to localize the area tested after a stimulus was provided with vision occluded

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71
Q

What is the best time to exercise for progressive MS?

A
  • when body temp is lowest and before fatigue.
  • Morning is the best time for this
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72
Q

Superficial reflexes

A
  • Abdominal
  • Corneal “blink”
  • Cremasteric
  • Gag
  • Plantar
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73
Q

Abdominal superficial reflex level

A

T8-L1

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74
Q

Abdominal superficial reflex procedure

A

Stroke each quadrant of the abdomen towards umbilicus

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75
Q

Abdominal superficial reflex normal response

A

Abdominal contraction, deviation of umbilicus in direction of the stimulus

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76
Q

Corneal “blink” superficial reflex level

A

Trigeminal and facial nerves

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77
Q

Corneal “blink” superficial reflex procedure

A
  • Ask patient to look up and away from you
  • Stroke the cornea using a piece of cotton
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78
Q

Corneal “blink” superficial reflex normal response

A

Both eyes will blink with contact to one eye

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79
Q

Cremasteric superficial reflex level

A

L1-L2

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80
Q

Cremasteric superficial reflex procedure

A

Scratch the skin of the upper medial thigh

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81
Q

Cremasteric superficial reflex normal response

A

Brisk and brief elevation of ipsilateral testicle

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82
Q

Gag superficial reflex level

A

glossopharyngeal and vagus nerves

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83
Q

Gag superficial reflex procedure

A

stimulate the back of the throat

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84
Q

Gag superficial reflex normal response

A

Pt gags, may be absent in subset of the population

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85
Q

Plantar superficial reflex level

A

L5-S1

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86
Q

Plantar superficial reflex procedure

A

stroke lateral aspect of foot from heel to ball of foot and move medially to big toe

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87
Q

Plantar superficial reflex normal response

A
  • Flexion of toes
  • Babinski indicates CNS leesion
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88
Q

DTR grade 0

A
  • No response
  • Always abnormal
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89
Q

DTR grade 1+

A
  • Diminished/depressed response
  • May or may not be normal
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90
Q

DTR grade 2+

A
  • Active normal response
  • Normal
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91
Q

DTR grade 3+

A
  • Brisk/exaggerated response
  • Moderate joint movement
  • May or may not be normal
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92
Q

DTR grade 4+

A
  • Very brisk/hyperactive
  • 1-3 beats of clonus
  • Reflex can spread to contralateral side
  • Always abnormal
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93
Q

DTR grade 5+

A
  • Strong muscle contraction
  • Sustained clonus
  • Reflex can spread to contralateral side
  • Always abnormal
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94
Q

DTRs

A
  • Biceps
  • Brachioradialis
  • Triceps
  • Patellar tendon
  • Achilles tendon
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95
Q

Biceps DTR spinal level

A

C5-C6

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96
Q

Biceps DTR procedure

A
  • Pt in sitting
  • Thumb over biceps tendon w/ elbow bent
  • Strike w/ hammer
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97
Q

Biceps DTR normal response

A

Contraction of biceps

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98
Q

Brachioradialis DTR spinal level

A

C5-C6

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99
Q

Brachioradialis DTR procedure

A
  • Hand resting in lap
  • Strike radius 1-2 inches superior to wrist
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100
Q

Brachioradialis DTR normal response

A
  • Contraction of brachioradialis
  • Elbow flexion +/or forearm supination
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101
Q

Triceps DTR spinal level

A

C6-C7

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102
Q

Triceps DTR procedure

A
  • Support UE through humerus
  • Lower portion hangs w/ elbow flexion
  • Strike tendon w/ hammer
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103
Q

Triceps DTR normal response

A

Contraction of triceps

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104
Q

Patellar tendon DTR spinal level

A

L3-L4

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105
Q

Patellar tendon DTR procedure

A
  • Supported knee flexion
  • Strike tendon w/ hammer inferior to patella
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106
Q

Patellar tendon DTR normal response

A

Quad contraction

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107
Q

Achilles tendon DTR spinal level

A

S1-S2

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108
Q

Achilles tendon DTR procedure

A
  • Stretch foot at the ankle while in sitting
  • Strike the Achilles tendon above the foot
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109
Q

Achilles tendon DTR normal response

A

Plantar flexion

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110
Q

Symptoms of a TIA

A
  • Temporary neurological deficits that resolve w/in 24 hours
  • Nothing shows up on MRI and CT
  • Strong predictor of future strokes
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111
Q

Dysmetria

A
  • Incoordination of movement w/ an inability to tell distance
  • Usually damage to the cerebellum
  • Overshooting = hypermetria
  • Undershooting hypometria
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112
Q

Apraxia

A

Inability to perform motor activities upon command while sensory and motor are intact

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113
Q

In which patients will you see apraxia?

A

Those w/ damage to the L cerebral cortex

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114
Q

Diplopia

A
  • Double vision
  • Often due to damage to brainstem
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115
Q

Dysdiadochokinesia

A
  • Inability to perform rapid alternating movements
  • Damage to cerebellum
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116
Q

Associated reaction

A
  • AKA motor overflow
  • Involuntary movement resulting from activity occurring in other parts of the body
  • Can be a sneeze, yawn, or movement of another extremity
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117
Q

Cogwheeling

A
  • Ratchet-like start/stop motion of a joint moved passively
  • Common in Parkinson’s
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118
Q

Athetosis

A
  • slow writhing movement
  • Usually cause by damage to the basal ganglia
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119
Q

Function of extrapyramidal system

A
  • Involuntary motor activity
  • Don’t pass through pyramids of the medulla
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120
Q

Symptoms of an extrapyramidal injury

A
  • Bradykinesia
  • Tremors
  • Involuntary movements
  • Impairments w/ movement initiation
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121
Q

Function of pyramidal system

A
  • Corticospinal tracts that connect the motor cortex to the spinal cord via the pyramids of the medulla
  • Damage here causes an UMN injury
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122
Q

Decorticate posturing

A
  • Found in patients w/ severe TBI
  • Causes patients to be positions w/ UE flexion, LE extension
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123
Q

Decerebrate posturing

A
  • Often caused by lesions to the midbrain below the red nucleus
  • UE + LE extension
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124
Q

Rancho Los Amigos Levels of Cognitive Functioning

A

1) No response
2) Generalized response
3) Localized response
4) Confused-agitated
5) Confused-inappropriate
6) Confused-appropriate
7) Automatic-appropriate
8) Purposeful-appropriate

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125
Q

1) No response (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Deep sleep
  • Unresponsive to any stimuli
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126
Q

2) Generalized response (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Inconsistent and non-purposeful response to stimuli
  • Nonspecific
  • Responses may be physiological changes, gross body movements, and/or vocalization
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127
Q

3) Localized response (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Specific but inconsistent response to stimuli
  • May follow simple commands
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128
Q

4) Confused-agitated (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Heightened state of activity
  • Bizarre and non-purposeful behavior
  • Does not discriminate among people or objects
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129
Q

5) Confused-inappropriate (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Can respond to simple commands
  • Gross attention to environment
  • Highly distractible
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130
Q

6) Confused-appropriate (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Goal-directed behavior, dependent on external input or direction
  • Follow simple directions consistently
  • Shows carryover for relearned tasks
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131
Q

7) Automatic-appropriate (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Appropriate and oriented w/in the hospital and home setting
  • Frequently robot-like
  • Shallow recall of activities
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132
Q

8) Purposeful-appropriate (Rancho Los Amigos Levels of Cognitive Functioning)

A
  • Aware of and responsive to environment
  • Can undergo job and driving evals
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133
Q

Which canal does the dix-hallpike test focus on?

A

Posterior semi-circular canal of the downside ear

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134
Q

When the posterior canal is affected, what is the initial response to the dix-hallpike test?

A

Upbeating and torsional toward the affected ear

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135
Q

Hoehn and Yahr Classification of Disability Scale

A

Used for the staging of the functional disability associated with Parkinson’s disease

  • Level 1: Little to no disability (unilateral if present)
  • Level 2: Minimal disability (bilateral or midline w/ no balance impairment)
  • Level 3: Activity restrictions, balance deficits, and decreased righting reflexes (typically able to live independently)
  • Level 4: Severe disability, able to stand and walk w/ assistance
  • Level 5: severe disability, confined to a wheelchair or bed bound
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136
Q

For a pt w/ GBS, what is the strongest indication and prognosis?

A

Need for a ventilator during hospital stay

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137
Q

Glasgow Coma Scale Scoring

A
  • </= 8 is severe brain injury or coma
  • 9-12 moderate brain injury
  • 13-15 mild brain injury
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138
Q

Outcome measure or vestibular patients

A

Dizziness handicap inventory (DHI)

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139
Q

Signs and symptoms of ankylosing spondylitis

A
  • Bilateral pain in the spine (SIJ primarily)
  • Stiffness in the spine results from ankylosing that often ascends
  • Leads to spinal mobility limitations and loss of chest expansion
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140
Q

Symptoms of meningitis

A
  • Severe headache
  • Neck stiffness
  • Sensitivity to light
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141
Q

Is the onset of symptoms for ALS sudden or indisious?

A

Insidious

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142
Q

Presentation with anterior cord syndrome

A

Loss of motor function, pain, and temperature sensation below the level of injury

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143
Q

Symptoms of damage to the brainstem

A
  • Double vision (diplopia)
  • Slurred speech (dysarthria)
  • Difficulty swallowing (dysphagia)
  • Inconsistent pattern of motor weakness
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144
Q

What test differentiates b/t intermittent claudication and spinal stenosis?

A

Bike test of van Gelderen

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145
Q

What testing is used to diagnose seizures?

A

Electroencephalogram

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146
Q

Modified Ashworth Scale for spasticity

A

0 = no increased tone
1 = slight increase in tone (catch and release/min resistance felt at end range)
1+ = slight increase in tone (catch is followed by min resistance through less than half the range)
2 = Increased tone through most of the range, limb moved easily
3 = increased tone that makes PROM difficulty
4 = Rigid/fixed

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147
Q

Non-fatigable nystagmus suggests what problem, and what should be done about it?

A
  • Suggests a central NS or central vestibular system dysfunction
  • Refer to neurologist
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148
Q

Heterotopic ossification

A
  • Abnormal bone growth in soft tissue, usually near joints
  • Trauma is thought to be a causative factor
  • Warmth and swelling can be a sign
  • Stop PROM treatment and contact physician
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149
Q

What percentage of SCI pts experience heterotopic ossification?

A
  • ~20%, usually below the level of the lesion
  • Most often in the hips
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150
Q

Summed feedback

A

Feedback is given after a set number of trials (i.e. every 3rd attempt)

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151
Q

Constant feedback

A

Feedback is given after every trial

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152
Q

Faded feedback

A

Feedback is given initially after every trial and then less often (i.e. move from every trial to every 2nd, then every 4th, and so on)

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153
Q

Bandwith feedback

A

Feedback is given only when the patient makes an error that is outside the acceptable performance

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154
Q

Signs and symptoms of a concussion

A
  • Nausea
  • Light sensitivity
  • Dizziness
  • Difficulty w/ balance
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155
Q

Post-concussion syndrome

A
  • Can develop 1-3 months after recovery from concussion
  • Dizziness and difficulty paying attention
  • Balance Error Scoring System (BESS) can be used to assess
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156
Q

Ataxia

A
  • Characterized by incoordination of movement
  • Indicates damage to cerebellum
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157
Q

Cutoff score for fall risk on TUG for community dwelling adults

A

13.5 s

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158
Q

Cutoff score for fall risk on TUG for older adults w/ stroke

A

> 14 s

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159
Q

Cutoff score for fall risk on TUG for adults w/ hip OA

A

> 10 s

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160
Q

Typical TUG score for frail elderly adults

A

11-20 seconds

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161
Q

Cutoff score for fall risk on TUG for frail elderly adults

A

> 32.6 s

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162
Q

Cutoff score for fall risk on TUG for pts w/ vestibular disorders

A

> 11.1 s

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163
Q

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

A
  • Covers fine and gross motor skills
  • 6 composite scores; 1 comprehensive measure
  • Includes higher-level gross motor skills like running and jumping
164
Q

Functional Independence Measure for children (WeeFIM)

A
  • Minimal data set of 18 items
  • Measures functional performance in 3 domains:
    = Self-care
    = Mobility
    = Cognition

*no higher level skills

165
Q

Gross Motor Function Measure (GMFM)

A
  • Evaluates change in gross motor function for kids 0-18 years old w/ cerebral palsy
  • Describes a child’s current abilities, not able to predict future progress or function
  • Not validated in kids w/ TBI
166
Q

Peabody Developmental Motor Scales- Second Edition (PDMS-2)

A
  • Norm-referenced
  • Assesses kids’ motor development from birth to 5 years
  • Score converted to a quotient (mean = 100, SD = 15)
167
Q

Role of biofeedback an spasticity

A
  • Can be used to both increase or decrease muscle activity
  • Feedback from the machine is given to the pt, and they are given instruction to increase or decrease activity depending on the goal
168
Q

Myasthenia gravis

A
  • Autoimmune disorder that causes weakness in the skeletal muscles
  • Action potentials are unable to be transmitted across the NM junction
  • Cause by formation of autoantibodies to ACh
169
Q

Symptoms of myasthenia gravis

A
  • Fluctuating muscle weakness
  • Varies in severity
  • Improves w/ rest
170
Q

Muscles most commonly affected by myasthenia gravis

A
  • Extraocular eye muscles
  • Facial muscles
  • Throat muscles
  • Proximal muscles of the extremities
171
Q

When performing the straight leg raise test, how do you bias the sural nerve?

A

Hip flexion + knee extention + ankle DF + ankle inversion

172
Q

When performing the straight leg raise test, how do you bias the tibial nerve?

A

Hip flexion + knee extention + ankle DF + ankle eversion

173
Q

When performing the straight leg raise test, how do you bias the common peroneal nerve?

A

Hip flexion + knee extention + ankle PF

174
Q

Conditions that may cause flaccid paralysis

A
  • Guillan-Barre syndrome
  • Brainstem stroke
  • Spinal cord injury
  • ALS
  • NOT MULTIPLE SCLEROSIS
175
Q

What is the Apgar score?

A

A standardized assessment of a newborn in the first minutes after birth and the response to resuscitation efforts, if needed

176
Q

Criteria for Apgar score

A
  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respiratory
177
Q

Apgar Score Appearance

A
  • 0 points –> Pallor or blue all over
  • 1 points –> Body pink, extremities blue (acrocyanosis)
  • 2 points –> Body and extremities all pink
178
Q

Apgar Score Pulse

A
  • 0 points –> absent pulse
  • 1 points –> <100 bpm
  • 2 points –> >100 bpm
179
Q

Apgar Score Grimace

A
  • 0 points –> no response to stimulation
  • 1 point –> grimace to stimulation, no cry
  • 2 points –> cry and active movement to stimulation
180
Q

Apgar Score Activity

A
  • 0 points –> none, flaccid
  • 1 point –> Some flexion of arms and legs
  • 2 points –> arms and legs flexed
181
Q

Apgar Score Respiratory

A
  • 0 points –> absent cry
  • 1 point –> weak cry, irregular
  • 2 points –> strong cry
182
Q

Apgar score interpretation

A
  • 7-10 –> no intervention, routine care
  • 4-6 –> some resuscitation assistance required (oxygen, suction, stimulate the baby (rub the back))
  • 0-3 –> full resusitation
183
Q

Fibrillation activity w/ an EMG is consistent with which neuro-based problems?

A
  • Neuropathy
  • Myopathy
  • Or both
  • NOT TYPICALLY ASSOCIATED W/ CNS PROBLEMS
184
Q

Irradiation

A
  • PNF technique
  • Overflow of neuronal excitation from strong motor units flows to weak/inhibited motor units
  • Can occur in any direction and across any body segment
185
Q

Joint approximation

A

Compression of the joint to facilitate muscle responses in the extensor patterns or during stabilization

186
Q

Quick stretch PNF

A

Uses the stretch reflex to initiate dynamic movements and facilitate contraction through increased motor unit recruitment

187
Q

Dynamic reversals PNF

A
  • Use isotonic concentric contractions of the agonists and then antagonists
  • Improves intramuscular and intermuscular coordination
188
Q

Significance of clonus

A
  • Indicates upper motor neuron lesion
  • Refer to physician for imaging
189
Q

What symptom of Parkinson’s does levodopa/carbidopa (Sinemet) primarily address?

A

Bradykinesia and rigidity

190
Q

When will Parkinson’s patients demonstrate improvement after a dose of levodopa?

A

20-60 minutes after taking the dose

191
Q

Distributed practice

A
  • Rest time >/= practice time
  • Results in better learning
192
Q

Massed practice

A

Practice time > rest time

193
Q

Blocked order practice

A
  • AAA BBB CCC
  • May be preferred for early learning
194
Q

Serial order practice

A
  • ABC ABC ABC
195
Q

Random order practice

A
  • CBA ABC BAC
  • Most preferred for long-term retention
196
Q

PNF UE D1

A

Back-handed slap <> shut the car door

197
Q

PNF UE D2

A

Drawing a sword

198
Q

PNF LE D1

A

Fig 4 <> “stanky leg”

199
Q

PNF LE D2

A

Karate side kick <> Rabona soccer kick

200
Q

Morton’s Neuroma

A

A thickening of the tissue around a nerve leading to the toes

201
Q

Purpose of the Gross Motor Function Classification System (GMFCS)

A
  • 5-level system
  • Used to describe the functional abilities of children w/ cerebral palsy
202
Q

Gross Motor Function Classification System (GMFCS) Level 1

A
  • Ambulation w/o restriction
  • Difficulty w/ advanced balance and coordination activities
203
Q

Gross Motor Function Classification System (GMFCS) Level 2

A
  • No AD needed for ambulation
  • Limited in the community and outdoors for ambulation
204
Q

Gross Motor Function Classification System (GMFCS) Level 3

A
  • Uses AD for ambulation
  • Limited outdoors and in community
  • May require WC
205
Q

Gross Motor Function Classification System (GMFCS) Level 4

A
  • Limited self-mobility
  • May use powered mobility
206
Q

Gross Motor Function Classification System (GMFCS) Level 5

A
  • Severely limited self-mobility
  • Transported in manual WC
207
Q

What is a dorsal rhizotomy?

A
  • a neurosurgical procedure that is used to treat children with cerebral palsy who have severe lower extremity spasticity
  • consists of cutting the dorsal rootlets of the spinal cord that are related to the spastic muscles of the lower extremities
208
Q

Normal femoral neck shaft angle

A

120-135

209
Q

Coxa vara femoral neck shaft angle

A

<120

210
Q

Coxa valga femoral neck shaft angle

A
  • > 135
  • Can result in femoral head being less in contact w/ the acetabulum, causing instability
  • Can lengthen the leg
211
Q

Order for sensory testing as part of the neuro exam

A

1) Light touch –> wisp of cotton
2) Superficial pain –> small, sharp object
3) Temperature/vibration
4) Deep pressure pain
5) Proprioception

212
Q

Strategies for managing a seizure

A
  • Place pt on the floor
  • Turn pt’s head to one side
  • Monitor pt’s respirations
  • Time seizure activity
  • Do not restrict movement, nor place objects in pt’s outh
213
Q

Why is restraining a patient experiencing a seizure a bad idea?

A
  • Typically not enough time
  • Restricting movements manually could result in injury to the pt or therapist
214
Q

Pt’s w/ Parkinsons will present with a __ gait?

A

shuffling pattern

215
Q

Pt’s w/ damage to the cerebellum will presetn w/ a __ gait?

A

Ataxic gait

216
Q

Pt’s w/ cerebral palsy and spina bifida will present with a __ gait?

A
  • Crouched gait with weakness of knee extensors or plantarflexors
  • CP can also result in toe walking
217
Q

Exercise strategies for managing CRPS

A
  • Interventions should focus on active movement without symptom exacerbation
  • Passive motion does not provide enough benefit for treatment
218
Q

Other strategies for managing CRPS

A
  • Mirror therapy
  • Graded motor imagery
  • Desensitization techniques
  • Modalities
219
Q

Independent (levels of assistance)

A

Patient completes w/o need for cues or manual assistance

220
Q

Standby assistance

A
  • Therapist is close to the pt
  • Provides any necessary cues or instructions
  • No contact w/ the pt
221
Q

Contact guard assistance

A
  • Therapist is close to the pt
  • Hand is touching the pt or the gait belt
222
Q

Minimal assistance

A

Pt completes at least 75% of the task

223
Q

Moderate assistance

A

Pt completes 50-74% of the task

224
Q

Maximal assistance

A

Pt completes 25-49% of the task

225
Q

Dependent (level of assistance)

A

Total physical assistance is provided

226
Q

Reaction of patients w/ MS to heat

A
  • Overwhelming majority of pt’s w/ MS have an adverse reaction to heat
  • AKA Uhthoff syndrome
  • Raising body temperature could lead to exacerbation or temporary worsening of symptoms
227
Q

Presentation of Bell’s palsy

A
  • Weakness of facial expression muscles on the affected side
  • Pain location behind the ear
  • Inability to close the eyelid on affected side
  • Loss of taste on the anterior aspect of the tongue
228
Q

Symptoms of trigeminal neuralgia

A
  • Inflammation of CN 5
  • Intense electric shock-like pain in the face
  • Symptoms usually provoked by touching the affected area
  • Usually unilateral
229
Q

At which SCI level can patients be expected to demonstrate independent rolling in bed?

A

C6

230
Q

At which SCI level can patients demonstrate the ability to cough?

A

C5, due to the clavicular portion of the pec major depressing the sternum and upper ribs

231
Q

At which SCI level can patients use a powered WC?

A

C4

232
Q

At which SCI level can a patient be expected to achieve independent transfers?

A

C6

233
Q

Berg Balance Scale

A
  • Predictor of fall risk
  • 14 balance tasks, each is scored 0-4
  • Max score = 56
  • Higher is better
234
Q

Berg Balance Scale high fall risk

A

45 or lower

235
Q

What is Meniere disease?

A
  • Vestibular disorder
  • Presents with vertigo, tinnitus, low-frequency hearing loss, and aural fullness
  • Idiopathic, but related to the amount of fluid in the ear
236
Q

aural fullness

A

a sensation of blockage in the ear

237
Q

How is Meniere disease managed?

A
  • No cure
  • Symptoms managed w/ a controlled diet, especially by restricting sodium intake
238
Q

Acoustic neuroma

A
  • Benign tumor
  • Causes dysequilibrium
  • Can cause vertigo, but not episodic
  • B/c it is slow growing, tinnitus and hearing loss are later in progression
239
Q

Ramsay-Hunt Syndrome

A
  • Viral inflammation of CN VII (facial nerve)
  • Causes unilateral vertigo, hearing loss, Bell’s palsy
240
Q

Potential muscle weaknesses w/ C1 myotome

A

NONE

241
Q

Potential muscle weaknesses w/ C2 myotome

A
  • Longus colli
  • SCM
  • Rectus capitis
242
Q

Potential muscle weaknesses w/ C3 myotome

A
  • Trapezius
  • Splenius capitis
243
Q

Potential muscle weaknesses w/ C4 myotome

A
  • Trapezius
  • Levator scapulae
244
Q

Potential muscle weaknesses w/ C5 myotome

A
  • Supraspinatus
  • Infraspinatus
  • Deltoid
  • Biceps brachii
245
Q

Potential muscle weaknesses w/ C6 myotome

A
  • Elbow flexors
  • Supinator
  • Wrist extensors
246
Q

Potential muscle weaknesses w/ C7 myotome

A
  • Elbow extensors
  • Wrist flexors
247
Q

Potential muscle weaknesses w/ C8 myotome

A
  • Ulnar deviators
  • Thumb extensors
  • Thumb adductors
248
Q

Clinical Test of Sensory Integration on Balance (CTSIB)

A
  • AKA “foam and dome” test
  • Measures a patient’s postural control under different conditions
249
Q

Conditions in the Clinical Test of Sensory Integration on Balance (CTSIB)

A

For all six conditions, the patient stands with their feet parallel and arms at their side or hands on hips for a minimum of 3 trials of 30 seconds for each condition.

  • Standing on a firm surface with eyes open
  • Standing on a firm surface with eyes closed
  • Standing on a firm surface with a dome made from a modified Japanese lantern
  • Standing on a foam cushion with eyes open
  • Standing on a foam cushion with eyes closed
  • Standing on a foam cushion with a dome made from a modified Japanese lantern.
250
Q

Charcot-Marie-Tooth disease

A
  • Hereditary neurological disorder
  • Causes peripheral neuropathies
  • Results in decreased DTR’s
251
Q

PNF technique used for facilitating rolling from supine to prone

A

Scapular anterior depression and pelvic anterior elevation

252
Q

PNF technique used for facilitating rolling from prone to supine

A

Scapular posterior elevation and pelvic anterior depression

253
Q

ABC Scale

A
  • Activities-specific Balance Confidence Scale
  • 16-item self-reported measure on balance confidence during different activities
  • 0-100 scale (0 = no confidence, 100 = complete confidence)
254
Q

Normative data for ABC scale with community-dwelling older adults

A

79.89 +/- 20.59

255
Q

Tinetti falls efficacy scale (FES)

A
  • 10-item self-reported measure
  • Rates confidence of pt’s to perform 10 daily tasks w/o falling
  • 1 (very confident) - 10 (not confident at all)
256
Q

Cut-off score for FES

A
  • > 70 = fear of falling
  • > 80 = risk of falling
257
Q

Ataxia

A
  • Incoordination of movement
  • Errors of force, speed, or trajectory
258
Q

Role of cuff weights in patients w/ ataxia

A

Can slow limb movements, which reduces ataxia in patients w/ cerebellar injuries

259
Q

Role of balcofen in managing spasticity

A
  • Agonist of GABA (inhibitory neurotransmitter)
  • Inhibits alpha motor activity in spinal cord
  • Reduces spasticity
260
Q

Clinical signs of meningitis

A
  • Severe headache
  • Fever
  • Pain w/ stressing meninges (Brudzinski and Kernig signs)
  • Nuchal rigidity (stiff neck)
261
Q

Brudzinski sign

A
  • Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
  • Indicates meningeal irritation
262
Q

Kernig sign

A

Step 1. The patient is positioned in supine with hip and knee flexed to 90 degrees

Step 2. The knee is then slowly extended by the examiner (Repeat on both legs)

Step 3. Resistance or pain and the inability to extend the patient’s knee beyond 135 degrees, because of pain, bilaterally indicates a positive Kernig’s sign

  • Indicates meningeal irritation
263
Q

Distance for TUG

A

3 meters

264
Q

WC independence level expected w/ C6 complete SCI

A
  • Independent on all indoor surface
  • Some-total assist on outdoor surfaces
265
Q

Which measure is the most thorough for high functioning patients post-TBI?

A
  • High-Level Mobility Assessment Tool (HiMAT)
  • Used for patients who are anticipated to return to sport or vocation
266
Q

How can use of a body-weight supported treadmill facilitate a patient’s recovery from stroke?

A
  • The set up allows the therapist to manually guide the limbs
  • The rhythmic input and manual guidance facilitates a reciprocal gait pattern
267
Q

Impact of CVA in the posterior limb of the internal capsule

A
  • The corticospinal tracts pass through here
  • Stroke here will result in pure motor loss, w/ no loss of cognition, sensation, perception, or language
268
Q

Potential adverse effect of cholinergic agonists

A

Bradycardia

269
Q

Return to sport post-concussion

A
  • Initial rest period (24 hours often appropriate)
  • Light aerobic exercise (increase HR w/o symptom provocation)
  • Sport-specific exercise –> noncontact training drills –> full-contact practice
270
Q

How long does return to sport post-concussion usually last?

A

About a week

271
Q

What should be watched for during the process of return to sport post-concussion?

A
  • Monitor symptoms
  • If symptoms worsen or reappear, decrease activity intensity
272
Q

How to test for a Lhermitte sign

A
  • Have the patient in long sitting position
  • passively flexing the head and one hip while keeping the knee in position
  • positive test is pain down the spine and into the UE or LE
273
Q

Purpose of testing for the Lhermitte sign

A

ID dysfunction in the spinal cord and/or UMN lesions

274
Q

Straight leg raise test AKA

A

Lasegue test

275
Q

What is being tested when the examiner holds their finger out and has the patient point to it with their great toe

A

Dyssynergia

276
Q

Dyssynergia

A

movements of specific segments are not properly sequenced or are of an inappropriate amplitude or direction

277
Q

What is being tested when the patient slides their heel up the shin from the ankle to the knee and back down again

A

Dysmetria

278
Q

What is being tested when the patient is asked to draw a circle on the floor with the great toe during this test

A

Dysmetria

279
Q

What is being tested when the patient performs rapidly alternating pronating and supinating the forearms?

A

dysdiadochokinesia

280
Q

Gait speed predictive of poor clinical outcomes

A

<0.8 m/s

281
Q

Normative values for gait speed at 70 y/o

A
  • Men: 1.2 m/s
  • Women 1.1 m/s
282
Q

Dynamic Gait Index

A
  • tests the ability of the participant to maintain walking balance while responding to different task demands, through various dynamic conditions.
  • Used w/ individuals with vestibular and balance problems and those at risk of falls.
  • 8 items scores 0-3 (0 = bad, 3 = best)
283
Q

Dynamic gait index score indicating fall risk

A

</= 19/24

284
Q

Autonomic Hyperreflexia

A
  • Autonomic dysreflexia
  • Emergency situation when a noxious stimulus below the level of SCI causes a sympathetic system response
  • Cervical and thoracic spinal cord (above T6)
285
Q

Signs and Symptoms of Autonomic Hyperreflexia

A
  • Hypertension
  • Sweating
  • Headache
  • Difficulty breathing
  • Possible loss of consciousness
286
Q

What are examples of a noxious stimuli that can lead to autonomic hyperreflexia?

A
  • restrictive clothing
  • pressure ulcer
  • fecal impaction
  • blocked catheter
287
Q

What should be done with a patient who is experiencing autonomic hyperreflexia?

A
  • Sit them upright to decrease BP
  • Relieve the noxious stimulus
288
Q

If the radial nerve is severed at the radial groove, which muscles would be impacted by this injury?

A

Wrist and finger extensors

289
Q

How does vestibular habituation work?

A
  • It is suggested repeated exposure to the provoking stimulus will cause the CNS to habituate so that the tolerance of motion improves
  • DGI can be used not just as an assessment, but as a treatment as well for visual vertigo
290
Q

What sign/symptoms may be present after taking a dose of Sinemet (carbidopa/levodopa)?

A
  • Orthostatic hypotension
  • Nausea
  • Dry mouth
  • Dizziness
  • Dyskinesias
291
Q

Dopamine agonists vs levadopa

A

While levodopa is converted in the brain into dopamine, dopamine agonists mimic the effects of dopamine without having to be converted

292
Q

Common side effect of dopamine agonists

A

Leg swelling

293
Q

How do anticholinergics work?

A

Reduce the excessive ACh due to the decrease in dopamine

294
Q

Why are anticholinergics less commonly used to treat Parkinson’s disease?

A

They can cause central toxicity

295
Q

Use of MAO-B inhibitors like Azliect (rasagiline)

A
  • They block enzymes in the brain that break down levodopa
  • Primarily used in the early stages of Parkinson’s
296
Q

Common side effect of MAO-B inhibitors

A

Insomnia

297
Q

Steps for contract-relax PNF technique

A
  • Position the arm at the end of the available shoulder PROM
  • Instruct patient to perform an isotonic contraction of 5-8 s of the antagonist
  • Then the arm can be passively or actively moved further into the limited direction
  • Activation of the antagonist results in GTO activation, which assists in relaxation of the limiting muscle
298
Q

Bayley Scale of Infant and Toddler Development

A
  • Norm-referenced test of motor development
  • Used to assess kids from 1-42 months
299
Q

Post-polio syndrome

A
  • Occurs in many w/ hx of polio
  • Loss of motor units and deterioration of motor neurons
  • Increased difficulty w/ ADLs due to increased fatigue, pain, and endurance
  • Strength training not advised b/c if can result in overuse weakness
300
Q

neuropraxia

A
  • a disturbance in the function of a peripheral nerve usually caused by compression
  • characterized by slowing and in some cases blockage of nerve conduction.
  • There is no damage to the nerve fibers except at the site of compression
301
Q

How will a neuropraxia appear on an electrophysiologic study?

A
  • nerve signals originating from sites proximal to the lesion would be slowed or blocked
  • stimulation of the nerve distal to the lesion would produce normal responses
302
Q

axonotmesis

A
  • loss of axonal continuity
  • reduces the number of axons available for conduction
303
Q

How will an axonotmesis appear on an electrophysiologic study?

A

The amplitude of compound muscle action potentials produced would be smaller

304
Q

University of California Biomechanics Laboratory (UCBL) orthosis

A
  • Controls excessive movement at the subtalar joint
  • Corrects hindfoot valgus
  • Prevents forefoot adduction
  • Wraps around the medial and lateral sides of the foot while supporting the plantar surface of the foot
305
Q

Tinetti Performance-Oriented Mobility Assessment (POMA)

A
  • 16 item test (9 for balance, 7 for gait)
    Balance
  • Sitting balance
  • Arises
  • Attemps to arise
  • Immediate standing balance
  • Standing balance
  • Sternal nudge
  • Eyes closed
  • Turning 360 degrees
  • Sitting down
    Gait
  • Initiation of gait
  • Step length and height
  • Step symmetry
  • Step continuity
  • Path
  • Trunk
  • Walking stance
306
Q

Scoring for POMA

A
  • 0-2 scale
  • Higher = better
307
Q

What causes steppage gait?

A
  • Hip and knee flexion greater than normal
  • Compensation for the inability to dorsiflex
308
Q

Steps for hold-relax PNF technique

A
  • the extremity is moved through an agonistic pattern until resistance is felt
  • the antagonist muscle groups perform an isometric contracted (the extremity does not move as the therapist resists the antagonistic movement pattern)
  • the patient relaxes, and the extremity is moved through an agonistic pattern again
309
Q

Steps for slow-reversal PNF technique

A
  • Place the agonist in a lengthened position
  • apply maximum resistance to an isotonic contraction of the agonist
  • immediately follow that by isotonic contraction of the antagonist
310
Q

Steps for rhythmic-stabilization PNF technique

A
  • Place the agonist in a lengthened position
  • have the patient perform an isometric contraction of the antagonist, then immediately follow that by an isometric contraction of the hamstrings
311
Q

Differential diagnosis for migraine vs BPPV

A
  • Pts w/ a migraine will not display nystagmus or instability while ambulating
  • Negative Dix-Hallpike
  • Migraine may have light sensitivity
312
Q

How to apply tension to the obturator nerve

A

Slump test + hip abduction

313
Q

How to apply tension to the femoral nerve

A

Flexing the hip to 20°, flexing the knee, and plantar flexing the ankle while pt is in sidelying

314
Q

Festination

A
  • a classic parkinsonian symptom
  • noted as progressive increase in speed with shortened stride length
  • can occur throughout the medication cycle.
315
Q

Freezing

A
  • the inability to initiate movement, found in patients w/ Parkinsons
  • often as a result of a real or perceived barrier such as a doorway
  • not related to medication cycles
316
Q

2 main categories of tremors

A
  • Resting tremors
  • Action tremors
317
Q

Resting tremors

A
  • Seen in patients w/ Parkinsons
  • Seen when observing the pt at rest and affected limb not activated or supported against gravity
318
Q

Types of action tremors

A
  • Postural tremors
  • Kinetic tremors
319
Q

Postural tremors

A

occur if a body part is held against gravity for a period of time

320
Q

Kinetic tremors

A

occur during any voluntary movement

321
Q

lesions associated with action tremors

A

Cerebellar lesions

322
Q

Types of Kinetic tremors

A
  • Intention tremor
  • Non-specified kinetic tremor
323
Q

Intention tremor

A
  • occurs during goal-directed movements
  • I.E. pressing a target
324
Q

Non-specified kinetic tremor

A

occurs during non-goal oriented movements

325
Q

Ideomotor apraxia

A

Patients are unable to perform activities upon command, but these motions can be performed spontaneously

326
Q

Normal memory test

A
  • List of numbers or words given
  • Pt repeats list immediately to demonstrate comprehension
  • Total recall after 5 minutes
  • Recall 2+ items after 30 minutes
327
Q

What is the rate for axonal regeneration?

A

1 inch/month

328
Q

Outcome and Assessment Information Set

A
  • Measures patient outcomes in the home
  • Includes 13 items to measure instrumental ADLs
  • Collected by providers of home care services funded by Medicare
329
Q

instrumental ADLs

A
  • More complex than ADLs, better measure for independent living
  • Can include items such as preparing meals, shopping, etc (require more planning and thinking)
330
Q

Barthel Index

A
  • General measure of functional ability and ADLs
  • Measure degree of assistance on 10 items (feeding, ambulation, stair climbing, toileting, etc)
331
Q

Fugl-Meyer Assessment

A
  • Assessment of motor function, sensation, and balance
  • Specifically examines volitional movement w/in and outside common extremity synergistic patterns
  • Designed for pts who had a stroke
332
Q

Functional Independence Measurement

A
  • Measures physical, psychological, and social function
  • No instrumental activities of daily living
333
Q

Signs and symptoms of tarsal tunnel syndrome

A
  • Burning pain or tingling at sole of foot
  • Pain with prolonged walking
  • Pain during ankle eversion from stretching irritate neural tissue
  • Intrinsic muscle weakness (in long-standing cases)
334
Q

Role of deep or firm pressure in treating kids w/ autism

A
  • Commonly used for kids who are hypersensitive
  • Therapeutic touch (hands on child’s shoulders and firm downward pressure), Hug Machine, wearable garments (pressure or weighted)
335
Q

effect of natural light for kids w/ autism

A

Excitatory

336
Q

Most appropriate time to administer the Glasgow Coma Scale

A

As soon as possible after onset of impaired consciousness

337
Q

Time for post-traumatic amnesia (PTA) of a mild TBI

A

0-1 day

338
Q

Time for post-traumatic amnesia (PTA) of a moderate TBI

A

> 1, <7 days

339
Q

Time for post-traumatic amnesia (PTA) of a severe TBI

A

> 7 days

340
Q

Test for CN I

A

Ask the patient to identify a particular smell, such as coffee

341
Q

Test for CN II

A

Have the patient read from an eye chart

342
Q

Test for CN III

A

Assess the patient’s ability to visually track a moving object
- Upward
- Downward
- Medial gaze

Reaction to light

343
Q

Test for CN IV

A

Assess the patient’s ability to visually track a moving object
- Downward and inward gaze

344
Q

Test for CN V

A
  • Test sensation of the face
  • test strength of the muscles of mastication
  • assess the jaw jerk reflex
345
Q

Test for CN VI

A

Assess the patient’s ability to visually track a moving object
- Lateral gaze

346
Q

Test for CN VII

A

Assess taste on the anterior tongue, ask the patient to make particular facial expressions

347
Q

Test for CN VIII

A

Assess the patient’s hearing acuity with the use of a tuning fork

348
Q

Test for CN IX

A

Assess taste on the posterior tongue or assess the patient’s gag reflex

349
Q

Test for CN X

A

Observe the patient swallowing

350
Q

Test for CN XI

A

Assess the strength of the sternocleidomastoid and trapezius

351
Q

Test for CN XII

A

Ask the patient to stick out the tongue and move it side to side

352
Q

Best intensity AND amplitude for exercises given to patients w/ Parkinsons

A

High intensity, high amplitude

353
Q

Canadian Occupational Performance Measure

A
  • Uses client- or family-generated goals to rate satisfaction and performance
  • Used to track the perception of the child’s performance in the area of participation
354
Q

Clasp knife phenomenon

A
  • increased resistance to passive stretch is initially present
  • suddenly decreases back to normal resistance
355
Q

Proper procedure after a patient experiences a TIA

A

Due to increased risk for stroke, they should receive immediate medical attention

356
Q

Implications of the Romberg test

A

indicative of a loss of proprioception that occurs with lesions of the spinal cord in the posterior columns

357
Q

pronator drift

A
  • completed by asking a patient to extend their arms, fully supinated, in front of them.
  • They are then asked to close their eyes.
  • If there is any drifting of either hand toward a pronated position, the test is considered positive.
  • It is an indication of damage to the corticospinal tracts
358
Q

Fukuda step test

A
  • completed by asking the patient to step in place with their eyes closed.
  • The test is negative when they are able to stay in place while stepping
  • the test is positive when the patient is noted to rotate during the stepping toward the side where there is a unilateral vestibular loss
359
Q

Hoffmann sign

A
  • suggestive of corticospinal tract dysfunction
  • present when there is observed movement of the thumb or index finger following the forceful flick of the patient’s middle finger with the examiner’s thumb
360
Q

ASIA A

A
  • Complete
  • No sensory OR motor below S4-S5
361
Q

ASIA B

A
  • Sensory incomplete
  • Motor complete below level of injury
362
Q

ASIA C

A
  • Sensory intact
  • <1/2 muscles 3/5

OR

  • Sensory incomplete
  • Motor function 3+ levels below injury
363
Q

ASIA D

A
  • Sensory intact
  • > /= 1/2 muscles 3/5
364
Q

ASIA E

A

Normal (in patient that had prior deficits)

365
Q

Function of CN I

A
  • Olfactory
  • Sensory: smell
  • Motor:
366
Q

Function of CN II

A
  • Optic
  • Sensory: Sight
  • Motor:
367
Q

Function of CN III

A
  • Oculomotor
  • Sensory:
  • Motor: eye movement, smooth muscle of eyes
368
Q

Function of CN IV

A
  • Trochlear
  • Sensory:
  • Motor: eye movement
369
Q

Function of CN V

A
  • Trigeminal
  • Sensory: Touch, pain of face, nose membranes, sinuses, mouth, anterior tongue
  • Motor: Mastication
370
Q

Function of CN VI

A
  • Abducens
  • Sensory:
  • Motor: eye movement
371
Q

Function of CN VII

A
  • Facial
  • Sensory: taste anterior tongue
  • Motor: Facial muscles
372
Q

Function of CN VIII

A
  • Vestibulocochlear
  • Sensory: hearing and balance
  • Motor:
373
Q

Function of CN IX

A
  • Glossopharyngeal
  • Sensory: touch, pain for posterior tongue/pharynx; taste of posterior tongue
  • Motor: Swallow
374
Q

Function of CN X

A
  • Vagus
  • Sensory: touch, pain pharynx, larynx, bronchi; taste for tongue, epiglottis
  • Motor: Muscles of palate, pharynx, and larynx; thoracic and abdominal viscera (autonomic)
375
Q

Function of CN XI

A
  • Accessory
  • Sensory:
  • Motor: SCM and traps
376
Q

Function of CN XII

A
  • Hypoglossal
  • Sensory:
  • Motor: Tongue
377
Q

Mnemonic for name of CN

A

On Occasion Our Trusty Truck Acts Funny, Very Good Vehicle Any How

378
Q

Mnemonic for CN type

A

Some Say Marry Money, But My Brother Says Big Brains Matter Most

379
Q

Ascending spinal tracts

A
  • Cuneocerebellar tract
  • Fasciulus cuneatus/gracilis (DCML)
  • Spinocerebellar tract
  • Spino-olivary tract
  • Spinoreticular tract
  • Spinotectal tract
  • Spinothalamic tract (anterior/lateral)
380
Q

Descending spinal tracts

A
  • Corticospinal tract (anterior/lateral)
  • Reticulospinal tract
  • Rubrospinal tract
  • Tectospinal tract
  • Vestibulospinal tract
381
Q

Cuneocerebellar tract

A
  • Ipsilateral subconscious proprioception
  • Neck and UE
382
Q

Fasciulus cuneatus/gracilis (DCML)

A
  • Conscious proprioception
  • 2-point discrimination
  • Vibration
  • Graphesthesia
383
Q

Spinocerebellar tract

A
  • Ipsilateral subconscious proprioception
  • Muscle tension
  • Joint sense
  • Posture of trunk/LE
384
Q

Spino-olivary tract

A
  • Goes to cerebellum
  • Info about cutaneous and proprioceptive organs
385
Q

Spinoreticular tract

A

Levels of consciousness

386
Q

Spinotectal tract

A
  • Info for spinovisual reflexes
  • Movement of eyes and head toward a stimulus
387
Q

Spinothalamic tract (anterior)

A
  • Crude touch
  • Pressure
388
Q

Spinothalamic tract (lateral)

A

Pain and temperature

389
Q

Corticospinal tract (anterior)

A
  • Pyramidal
  • Ipsilateral voluntary, discrete, and skilled movements
390
Q

Corticospinal tract (lateral)

A
  • Pyramidal
  • Contralateral voluntary find movement
391
Q

Reticulospinal tract

A
  • Extrapyramidal
  • Facilitation or inhibition of voluntary and reflex activity
392
Q

Rubrospinal tract

A
  • Extrapyramidal
  • Motor input of gross postural tone
  • Flexor muscles (+)
  • Extensor muscle (-)
393
Q

Tectospinal tract

A
  • Extrapyramidal
  • Contralateral postural muscle tone
  • Associated w/ auditory/visual stimuli
394
Q

Vestibulospinal tract

A
  • Extrapyramidal
  • Gross postural adjustments (ipsilateral) in response to head movements
  • Extensors (+)
  • Flexors (-)
395
Q

Asymmetrical Tonic Neck Reflex (ATNR)

A
  • Stimulus: head position, turned to one side
  • Response: Arm and leg on face side extended; arm and leg on other side flexed, spine curved w/ convexity toward face side
  • Normal age of response: 0-6 months
396
Q

Symmetrical Tonic Neck Reflex (STNR)

A
  • Stimulus: head position, flexion or extension
  • Response: flexion –> arms flexed, legs extended; extension –> arms are extended, legs flexed
  • Normal age of response: 6-12 months
397
Q

Tonic Labyrinthine Reflex (TLR)

A
  • Stimulus: head position determines labyrinth position in ear
  • Response: supine –> body and extremities are in extension; prone –> body and extremities are in flexion
  • Normal age of response: 0-6 months
398
Q

Galant reflex

A
  • Stimulus: touch skin along spine from shoulder to hip
  • Response: lateral flexion of trunk to side of stimulus
  • Normal age of response: 30 wks gestation - 2 months
399
Q

Palmar grasp reflex

A
  • Stimulus: pressure in palm on ulnar side of hand
  • Response: flexion of fingers
  • Normal age of response: 0-4 months
400
Q

Plantar grasp reflex

A
  • Stimulus: Pressure to base of toes
  • Response: toe flexion
  • Normal age of response: 28 wks gestation - 9 months
401
Q

Rooting reflex

A
  • Stimulus: touch on cheek
  • Response: turn head to same side w/ mouth open
  • Normal age of response: 28 wks gestation - 3 months
402
Q

Moro reflex

A
  • Stimulus: head dropping into extension suddenly
  • Response: arms abduct, fingers open, followed by crossing arms across chest and crying
  • Normal age of response: 28 wks gestation - 5 months
403
Q

Startle reflex

A
  • Stimulus: Loud, sudden noise
  • Response: similar to Moro, elbow remain flexed and hands closed
  • Normal age of response: 28 wks gestation - 5 months
404
Q

Positive support reflex

A
  • Stimulus: weight placed on balls of feet when upright
  • Response: stiffening of legs and trunk into extension
  • Normal age of response: 35 wks gestation - 2 months
405
Q

Walking (stepping) reflex

A
  • Stimulus: Supported upright position w/ soles of feet on firm surface
  • Response: reciprocal flexion/extension of legs
  • Normal age of response: 38 wks gestation - 2 months

NPTE (75 decks)

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