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(3) Neurological Evaluation & Intervention > S3_L1: Movement Disorders > Flashcards

S3_L1: Movement Disorders Flashcards

1
Q

Lesions in the cerebellum leads to problems with what? (1-2).

A

balance and coordination

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2
Q

_______ is the loss of coordination that may be central or peripheral

A

Ataxia

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3
Q

TURE OR FALSE: Since the cerebellum contains both motor and sensory representations of the body, lesions to the cerebellum produces either paralysis or significant muscle weakness

A

False

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4
Q

Determine which which condition is part of what kind of ataxia.

  1. Alcohol Abuse
  2. Tabes Dorsalis
  3. Cerebellar Atrophy
  4. (+) DM

A. Sensory Ataxia
B. Cerebellar Ataxia

A
  1. B
  2. A
  3. B
  4. A
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5
Q

Determine which which condition is part of what kind of ataxia.

  1. Decreased Proprioception
  2. Peripheral Vascular Disease
  3. Stroke
  4. TBI

A. Sensory Ataxia
B. Cerebellar Ataxia

A
  1. A
  2. A
  3. B
  4. B
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6
Q

Determine the condition.

  1. Has difficulty stopping a movement
  2. Associated with cognitive disorders, emotional lability, &depression
  3. Definite decomposition of movement
  4. (+) Uthoff’s phenomenon
  5. Progress visual feedback from narrow/small to wide (~1 ft)

A. Parkinson’s Disease
B. Multiple Sclerosis

A
  1. B
  2. B
  3. A
  4. B
  5. A
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7
Q

Determine the condition.

  1. Basal ganglia affectation
  2. Cerebellum affectation
  3. Has difficulty starting a movement
  4. Cognitive affectation may not be present
  5. Increase in amplitude of the movement, wide BoS

A. Parkinson’s Disease
B. Multiple Sclerosis

A
  1. A
  2. B
  3. A
  4. A
  5. B
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8
Q

TRUE OR FALSE: Pts c PD walk with decreased velocity, cadence, & stride length. The ideal feedback to give pts c Parkinson’s disease is both visual and verbal cues

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

D. Only the 2nd statement is true

Cadence increases in PD

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9
Q

TRUE OR FALSE: Lesions of the central regions of the cerebellum are accompanied by movement incoordination related to the intent of movement and reflect problems with preparation for movement.
Lesions of the lateral region result in problems reflecting the loss of ‘updating’ afferent information.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are false

NOTE: The regions must be interchanged

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10
Q

TRUE OR FALSE: Lesions of the vestibulo-cerebellum, with its connections to the vestibular system, are associated with disturbances of balance. It also results in nystagmus.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

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11
Q

TRUE OR FALSE: Cerebellum contributes to engram formation or motor memory. Cerebellum dictates how big and small movements should be.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

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12
Q

TRUE OR FALSE: Alcohol is a stimulant.

A

False

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13
Q

Determine whether the following impairments are primary or secondary

  1. Dysmetria
  2. Rebound Phenomenon
  3. Sequencing Problems

A. Primary
B. Secondary

A
  1. B
  2. B
  3. A
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14
Q

Determine whether the following impairments are primary or secondary

  1. Decomposition of Movement
  2. Scaling Problems
  3. Timing Problems
  4. Dysdiadochokinesia

A. Primary
B. Secondary

A
  1. B
  2. A
  3. A
  4. B
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15
Q

Identify the clinical signs of cerebellar affectation.

Decreased coordination of rapid alternating movements

A

Dysdiadochokinesia

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16
Q

Identify the clinical signs of cerebellar affectation.

Abnormal coordination affecting speed, amplitude of displacement, directional accuracy, and force of movement

A

Ataxia

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17
Q

Identify the clinical signs of cerebellar affectation.

Unable to terminate the movement soon enough

A

Hypermetria

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18
Q

Identify the clinical signs of cerebellar affectation.

Decomposition of movement

A

Dyssynergia

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19
Q

Identify the clinical signs of cerebellar affectation.

Abnormal coordination of muscles for speech production

A

Dysarthria

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20
Q

This is one of the hallmarks of a cerebellar disorder. It presents with widened base, unsteadiness, irregularity of stepping both in direction and distance, and reduced stride length with a trend to reduced cadence.

A

Ataxic Gait

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21
Q

Answer the following questions:

  1. How often does fatigue occur in MS?
  2. In what time of day do fatigue most common occur in MS patients?
A
  1. daily
  2. afternoon
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22
Q

Fill in the blanks: Role of the cerebellum in movement.

  1. Initiates and control _______
  2. ______ of movement/muscle action
  3. Compares ______ with _______
  4. _______ and adaptive adjustments
  5. Compensating for lesions of the ______
A
  1. voluntary movement
  2. Timing
  3. intended movement (IM) ; motor performance (MP)
  4. Motor learning (ML)
  5. cerebral cortex
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23
Q

TRUE OR FALSE: The cerebellum regulates movement and posture directly by adjusting the output of major descending motor systems

A

False

It is indirect.

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24
Q

The cerebellum acts as a (1)_____ to detect the difference between an intended movement and the actual movement, and, through its projections to the upper motor neurons, to reduce the ______.

A
  1. comparator
  2. error
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25
Q

Enumerate the 2 mechanisms in which the cerebellum acts.

A
  1. Moment to moment error correction
  2. Feed-forward mode of control
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26
Q

TRUE OR FALSE: When the cerebellum has a lesion, the moment to moment error correction becomes disrupted. Movement is not corrected while the individual is doing it; thus presenting with hypo- or hypermetria.

A

True

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27
Q

Anticipatory response of the body to prevent an error or pain

A. Moment to moment error correction
B. Feed-forward mode of control

A

B. Feed-forward mode of control

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28
Q

TRUE OR FALSE: Motor learning requires a transition from non-specific responses to highly selective associations

A

True

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29
Q

People with diabetes mellitus can have ataxia because of the loss of what? and on where?

A

proprioception on the LE

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30
Q

Tabes Dorsalis affects what spinal cord tract?

A

DCML

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31
Q

Tabes Dorsalis results in what?

A

Wide BOS

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32
Q

TRUE OR FALSE: The capacity to generate force in an isolated muscle predicts the ability of that muscle to work in concert with others in a task-specific way

A

False

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33
Q

TRUE OR FALSE: If muscle is strong, it means that a person has good coordination. If muscle is weak, it means that a person has poor coordination.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

D. Only the 2nd statement is true

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34
Q

Problems with coordination involve problems in what? Enumerate all 4.

A
  1. Activation
  2. Sequencing of movement
  3. Timing
  4. Scaling
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35
Q

Determine which condition or action falls under what category.

  1. Coactivation of the muscle
  2. Slowed Execution
  3. Difficulty terminating or changing a movement
  4. Problems judging distance or range
  5. Loss of fractionation

A. Activation
B. Sequencing of movement
C. Timing
D. Scaling

A
  1. B
  2. C
  3. C
  4. D
  5. A
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36
Q

Determine which condition or action falls under what category.

  1. Decomposition of movement
  2. Cannot dictate how big the joint ROM body needs to do
  3. Inability to break down a task
  4. Compensation by doing smaller movements
  5. Slowed Initiation

A. Activation
B. Sequencing of movement
C. Timing
D. Scaling

A
  1. B
  2. D
  3. A
  4. B
  5. C
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37
Q

Identify the clinical signs of cerebellar affectation.

Disorder of movement termination

A

Dysmetria

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38
Q

Identify the clinical signs of cerebellar affectation.

alternating contractions of agonists and antagonists

A

Tremor

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39
Q

Identify the clinical signs of cerebellar affectation.

Oscillatory eye movements

A

Nystagmus

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40
Q

Identify the clinical signs of cerebellar affectation.

delay in the antagonistic response that is demonstrated by asking the individual to flex the elbow isometrically against the examiner’s resistance.

A

Rebound Phenomenon

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41
Q

The following are adaptive motor behavior seen in pts with cerebellar affectations, EXCEPT:

A. Increased variability in performance
B. Wide base of support
C. Excessive preshaping of the hand
D. Lack of yield at the knee in midswing
E. None

A

D. Lack of yield at the knee in midswing

it happens in midstance

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42
Q

The following are adaptive motor behavior seen in pts with cerebellar affectations, EXCEPT:

A. Excessive use of arms
B. Excessive stepping
C. Supporting arms while doing hand activities
D. Fast walking with large, uncontrolled steps
E. None

A

E. None

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43
Q

Multiple Sclerosis affects what structures?

A

white matter tracts and cerebellum

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44
Q

Arrange the progression of MS in sequence.

A. Depletion of oligodendrocytes; Axons denuded are seen within the lesion
B. Active destruction of oligodendrocytes and their myelin sheath due to contact with macrophages and microglia
C. Scar formation from astrocytic
reactivity; hardened patches/plaques
D. Accumulation of inflammatory cells, lymphocytes and monocytes around CNS venules

A

DBAC

45
Q

The following are the most commonly affected areas in MS, EXCEPT:

A. Brainstem
B. Cerebellar white matter
C. Thoracic Spinal Cord
D. Periventricular regions
E. Optic Nerves

A

C. Thoracic Spinal Cord

46
Q

Determine what pattern of MS is being described.

Steady increase in disability without attacks

A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive

A

D. Chronic Progressive

47
Q

Determine what pattern of MS is being described.

Never new disability between attacks

A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive

A

B. Relapsing-remitting

48
Q

Determine what pattern of MS is being described.

No disability, returns to normal in between attacks

A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive

A

A. Benign

49
Q

Determine what pattern of MS is being described.

No new disability between attacks followed by steady increase of disability

A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive

A

C. Relapsing-
progressive

50
Q

TRUE OR FALSE: Depression is unrelated to severity of MS

A

True

51
Q

What may be used in patients with nystagmus, diplopia, and double vision?

A

Eye patches on one eye

52
Q

This is a MS sx that increases with use and is progressive if the spinal cord is involved

A

Weakness

53
Q

TRUE OR FALSE: MS patients cannot be given an HMP as it will produce Uthoff’s Symptoms. MS patients may receive aquatic therapy as long as the water is not too warm.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

D. Only the 2nd statement is true

54
Q

What treatment time must be avoided in treating MS patients?

A

10am-2pm

NOTE: More prone to fatigue when the environment is warm. Advised to do exercises in the early morning or late afternoon only.

55
Q

TRUE OR FALSE: UE and LE Ergometer can be done simultaneously to maximize treatment time for MS patients.

A

False

56
Q

Rhythmic, mechanical oscillation of a body part that is suppressed by willed (voluntary) activity, sleep, and complete relaxation.

In what movement disorder is this seen?

A

Parkinson’s

NOTE: The sx was resting tremor

57
Q

Sinemet takes how many minutes before it peaks?

A

50-60 mins

58
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Confined to bed or wheelchair

A

5

59
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Imparied righting reflexes. Unsteadiness when turning or rising from chair.

A

3

60
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Minimal or absent; unilateral if present

A

1

61
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Some activities are restricted, but patient can live independently and continue some forms of employment.

A

3

62
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

All symptoms present and severe.

A

4

63
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Balance not impaired.

A

2

64
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Minimal bilateral or midline involvement.

A

2

65
Q

Determine the Hoehn-Yahr Stage based on the descriptions below.

Standing and walking possible only with assistance.

A

4

66
Q

TRUE OR FALSE: In treating PD pts, instructions must be detailed and thorough. It is best to elaborate every instruction so patient can understands it better.

A

False

Emphasis on “getting the idea of the movement” is needed, but SIMPLIFIED instructions are preferred.

67
Q

TRUE OR FALSE: Exercise capacity of persons with mild to moderate Parkinson’s (Hoehn and Yahr Stage I-III) is similar to their age-matched peers even without medications

A

False

68
Q

In PD, the aim of walking practice is to increase speed by increasing what?

A

stride length

69
Q

Answer the following questions:

  1. When teaching a PD patient to turn while walking, in what manner should the PT teach the pt to turn?
  2. What strategy will be used for small spaces?
A
  1. Turning in a large arc using big steps
  2. Clock turning strategy
70
Q

In PD pts, to which direction do their CoG deviates?

A

anteriorly

NOTE: This is due to a relatively flexed posture

71
Q

TRUE OR FALSE: In PD, it is important to increase in cadence & decrease stride length.

A

False

72
Q

The following are gait manifestations of PD pts:

A. Decrease in stride length
B. Increase cadence
C. Decrease in velocity
D. All
E. None

A

D. All

73
Q

TRUE OR FALSE: The cerebellum regulates vestibular, spinal and cortical mechanisms by means of reciprocal neuronal connections

A

True

74
Q

Differentiate intended movement (IM) with motor performance (MP)

A

IM: movement that you have in mind before the actual movement

MP: actual motor output

75
Q

This is the inability to reach for a certain object d/t cerebellar affectation

A

Hypometria

76
Q

This manifests with overreach for a certain target

A

Hypermetria

77
Q

Avoid a mistake or error first

A. Moment-to-moment error correction
B. Feed-forward mode of control

A

B. Feed-forward mode of control

78
Q

TRUE OR FALSE: The cerebrum plays a major role in motor coordination to adapt to the requirements of the task as conditions change.

A

False

It is the cerebellum

79
Q

This is the breaking down of a certain task into smaller steps

A

Fractionation

80
Q

What secondary impairment is shown by a pt who has Sequencing Problems? You may choose a maximum of 4 letters.

A. Decomposition of Movement
B. Rebound Phenomenon
C. Dysdiadochokinesia
D. Dysmetria

A

A. Decomposition of Movement

81
Q

What secondary impairment is shown by a pt who has Scaling Problems?

A. Decomposition of Movement
B. Rebound Phenomenon
C. Dysdiadochokinesia
D. Dysmetria

A

D. Dysmetria

82
Q

What secondary impairment is shown by a pt who has Timing Problems? You may choose a maximum of 4 letters.

A. Decomposition of Movement
B. Rebound Phenomenon
C. Dysdiadochokinesia
D. Dysmetria

A

B & C

83
Q

TRUE OR FALSE: Primary impairments are the direct impairments. Secondary impairment are the manifestations of the abstract impairments.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

D. Only the 2nd statement is true

84
Q

This is referred to as the early termination of movement

A

Hypometria

85
Q

TRUE OR FALSE: In cerebellar lesions, antagonist contraction is delayed.

A

True

This is the reason why rebound phenomenon occurs

86
Q

This manifests as decreased coordination of timing of onset and offset of agonists and antagonists and loss of smoothness of the movement

A

Dyssynergia

87
Q

Cerebellar tremor is most marked at the ______ of the movement, for which reason it is frequently called a _____ tremor.

A
  1. end
  2. terminal
88
Q

This occurs due to abnormal coordination of speech and respiration

A

Dysarthria

89
Q

TRUE OR FALSE: Pts c cerebellar lesions restrict the amplitude or degrees of freedom of motion, but they often overestimate this.

A

True

90
Q

TRUE OR FALSE: Ataxia and balance problems may be more clearly observed when the person is asked to walk fast

A

False

91
Q

This is similar to a circuit training for the UE, where a bombardment of movement & activities occurs.

A

Hammering

92
Q

Hammering is used to train what?

A

smooth movements at various amplitudes and speed

93
Q

TRUE OR FALSE: In cerebellar stroke, tremors can be minimized by using cuff weights. In PD, weights cannot be used to stop tremors.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

94
Q

To increase task complexity, the following may be done, EXCEPT:

A. Reduce external constraints (EC)
B. Reduce possibilities for Upper Limb support
C. Encourage increase amplitude of movement
D. Encourage increase in cadence
E. Increase cognitive challenge

A

D. Encourage increase in cadence

95
Q

To increase task complexity, the following may be done:

  1. Standing on trampoline
  2. Talking to the patient while stacking cones
  3. Giving a cane
  4. Giving 2 tasks at once
  5. Encouraging small movements

A. I & IV
B. III & V
C. II, III, IV
D. I, II, IV
E. I, II, III, IV, & V

A

D. I, II, IV

96
Q

TRUE OR FALSE: Frenkel exercise may be used as a tx strategy for ataxic patients.

A

True

These are stabilization exercises and platform exercises that improve balance

97
Q

TRUE OR FALSE: Inflammation in MS is sufficient to cause a functional block in conduction through myelinated axons.

A

True

98
Q

TRUE OR FALSE: The inflammation response in MS has both destructive and beneficial effects.

A

True

99
Q

When do eye patches in MS become a restorative treatment, rather than an adaptive treatment?

A

if nystagmus was addressed by extra ocular muscle strengthening

100
Q

YES OR NO: Can eye patches be applied to blurring vision?

A

NO

101
Q

Described as a feeling of heaviness or clumsiness

A

Weakness

102
Q

TRUE OR FALSE: In MS, fatigue worsens with heat, humidity, stress, strenuous exercises, sleep deprivation

A

True

103
Q

What are the 2 positive features of PD?

A

Resting Tremor & Rigidity

104
Q

Difficulty initiating movement

A

Akinesia

105
Q

Reduced movement speed

A

Bradykinesia

106
Q

Reduced excursion of movement more pronounced in sequential and simultaneous movements

A

Hypokinesia

107
Q

Difficulty starting or continuing rhythmic repetitive movements

A

Freezing Phenomenon

108
Q

Increased resistance throughout the range of passive movement at a joint that is of the same intensity in both extensor and flexor muscles

A

Rigidity

(3) Neurological Evaluation & Intervention (12 decks)

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