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Neuro > Sensory > Flashcards

Sensory Flashcards

1
Q

semicircular canals

A
  • receptors detect mvmt of the head by sensing the motion of endolymph
    – 3 hollow rings perpendicular to each other – opens into utricle – swelling called ampulla, containing a crista which consists of supporting cells & sensory hair cells – embedded in gelatinous mass (cupula) & bending of cupula & hair cells sensitive to rotational acceleration/decel
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2
Q

Otolith organs

A

– utricle & saccule – membranous sacs within the vestibular apparatus
– respond to head position relative to gravity & to linear acceleration/deceleration
- Inside is membranous labyrinth – endolymph – bending of hair cells determines signals – CN 8

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3
Q

Hair cells

A

sensitive to rotation

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4
Q

Semicircular canals

A

– acceleration/deceleration – linear

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5
Q

Cochlea

A

– organ of hearing

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6
Q

Lateral Vestibulospinal Tract

A

Activate postural muscles

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7
Q

Medial Vestibulospinal Tract

A
  • To lower motor neurons – influence posture

- Positioning of head, neck, eyes in response to postural changes

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8
Q

Medial Longitudinal Fasciculus

A
  • Bilateral connections w/ the extraocular nuclei (CN III, IV, & VI) & superior colliculus, influencing eye & head mvmts
  • Descending from vestibular nuclei out ot motor neurons
  • Ascending to vestibular nuclei & cranial nerves
  • Eyes positioning – CN 3,4,6
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9
Q

Benign Paroxysmal Positional Vertigo

A
  • Rapid head change results in vertigo and nystagmus which subsides in approx. 2 minutes
  • Caused by Otoconia (crystals) from the macula getting into semicircular canals and disrupting endolymph flow
  • inner ear disorder – acute speed of onset - <2 min – if untreated, improves in weeks or months; if treated w/ particle repositioning maneuver, often cured immediately – elicited by change of head position – getting out of bed quickly – displacement of otoconia (crystals of calcium carbonate in ear) – confuses brain, start feeling dizzy
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10
Q

Vestibular neuritis

A
  • Inflammation of vestibular nerve
  • Loss of balance, nystagmus, nausea, and vertigo
    – infection – acute onset – severe symptoms 2-3 days, gradual improvement over 2 weeks – clears as virus clears – no unique signs
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11
Q

Meniere’s Disease

A
  • Abnormal fluid pressure in inner ear
  • Sensation of full ear, tinnitus, vertigo, nausea, vomiting, and hearing loss
    – unknown etiology – chronic – duration of typical incident is 0.5 – 24 hours – some pts have only mild hearing loss & few episodes of vertigo. Most have multiple episodes of vertigo & progressive loss of hearing. – associated with hearing loss, tinnitus, & feeling of fullness in ear. (pop ears when yawn or swallow to relieve pressure)
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12
Q

Bilateral lesions of vestibular nerve (CN 8)

A
  • Oscillopsia (visual objects bouncing when moving)
    – interfere with reflexive eye mvmts in response to head mvmt – oscillopsia – over time, adapts & less difficulty w/ visual field – certain antibiotics/strept may damage both the cochlea & vestibular apparatus – hearing loss, disequilibrium, oscillopsia – vertigo infrequent
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13
Q

Ataxia - tremor

A 
-Voluntary, normal-strength, jerky, & inaccurate movements
Three types
-Sensory
-Vestibular
-Cerebellar
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14
Q

Peripheral Neuropathy

A
  • Destruction of myelination of large sensory fibers carrying proprioceptive information
  • Guillian-Barre, autioimmune disorders
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15
Q

Multiple Sclerosis

A
  • Impaired sensory transmission due to plaques and demyelination of CNS (brain & spinal cord)
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16
Q

Nystagmus testing

A 
Post-rotary
Caloric
Optokinetic
Electronystagmography
Nystagmus is normal response to rotary movement
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17
Q

Romberg test

A
  • Stand feet together arms in front flexed to 90 degrees
  • Close eyes
  • Observe postural sway and maintenance of arm position
  • CAUTION – client may fall to affected side
  • Arms may drift to affected side
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18
Q

Functional Reach Test

A

-Measure of balance
the difference, in inches, between arm’s length & maximal forward reach, using fixed base of support.
-Used to detect balance impairment, change in balance performance over time
-Test utilizes a force platform (electronic system for measuring functional reach) or a 48-inch measuring device or “yardstick”.
-Reach of < or = 6 inches predict fall risk

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19
Q

Treatment of body awareness and balance issues

A

Activities that:

  • increase proprioceptive input
  • increase vestibular input
  • require utilization of proprioceptive information
  • challenge balance
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20
Q

Olfaction

A
  • CN 1
  • Sickness decreases smell
  • Smoking decreases smell
  • Terminate in olfactory cortex
  • Cingulate gyrus – emotional response to smells
  • Memory also associated with smells
  • Can’t smell, can’t taste
  • Brain injury, strokes also can affect
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21
Q

Gustation

A
  • CN 7, 9, & 10
  • Food restrictions, swallowing problems
  • Precautions
  • Sitting up
  • Taste buds –
  • Sensory nerve fibers – CN 7, 9. 10 – project to solitary nucleus (gustatory nucleus) – to thalamus, through cortex into frontal lobe – insular cortex (autnomic responses)
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22
Q

Dysphagia

A
  • difficulty swallowing
  • Enzymes in saliva breakdown food
  • Bolus – what end up swallowing
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23
Q

Stages of Swallowing

A
  • Preoral stage
  • Oral Preparatory stage
  • Oral Stage
  • Pharyngeal Stage
  • Esophageal Stage
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24
Q

Preoral stage

A

-See food, smell food = salivate & grab spoon

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25
Q

Oral Preparatory Stage

A
  • Food enters mouth and is mixed w/ saliva

- Chewed, contained by cheeks, and retrieved by tongue cupped by the tongue to form bolus in center of tongue

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26
Q

Oral Stage

A

-Tongue squeezes bolus against hard palate moving it back

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27
Q

Pharyngeal Stage

A
  • Soft palate elevates and retracts minimizing the opening to the esophagus and the epiglottis tips back to cover the opening
  • Vocal cords close
  • Pharyngeal constrictor muscles contract to propel bolus past the pharynx
  • Elevation of larynx causes the upper esophageal sphincter to relax so bolus can go through
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28
Q

Esophageal Stage

A
  • Upper esophageal sphincter returns to normal
  • Bolus passes through esophagus with peristalsis and gravity
  • Lower esophageal sphincter relaxes to allow bolus to pass into stomach
29
Q

Effects of Dysphagia

A
  • Choking
  • Aspiration
  • Dehydration
  • Weight loss
  • Pulmonary complications
  • Drooling
  • Social exclusion
30
Q

TBI (dysphagia)

A

– Pseudobubar, Paralytic

  • Behavioral and cognitive problems
  • Abnormal pathological reflexes
  • Increased muscle tone
  • Open mouth and poor lip closure
  • Drooling
  • Decreased tongue control
  • Pocketing of bolus in cheek
  • Delayed swallow
  • Nasal regurgitation
  • Decreased base of tongue movement and laryngeal elevation
  • Takes longer to eat
31
Q

Pseudobulbar

A

– UMN – neurological – poorly coordinated swallow

32
Q

Paralytic

A

– LMN – neurologic – decreased swallow reflex

33
Q

CVA (dysphagia)

A

– Pseudobulbar Paralytic

  • Occur in R and L hemisphere and subcortical
  • R HEMISPHERE
    • Oral transit delays
    • Delay in pharyngeal trigger and laryngeal elevation
    • Pharyngeal stage lasts longer resulting in aspiration
    • May be neglect or denial of swallowing problems
    • May be apraxic for eating and swallowing
  • SUBCORTICAL
    • Oral transit delays and delay in triggering swallow
    • Overall weakness in swallow
    • May be reduced upper esophageal sphincter opening
34
Q

Cerebral Palsy

A
  • Pseudobulbar, Paralytic
  • Difficulty with bolus formation and transit
  • Delayed swallow reflex
  • Pharyngeal dysmotility
  • Diseases of the esophagus
  • Aspiration
  • Abnormal oral reflexes
  • Hypo or hypersensitivity of oral structures
  • Decreased laryngeal elevation
  • Proper positioning important
35
Q

Head and Neck Cancer

A

– Mechanical

  • Depends on size and location of lesion
  • Removal of parts create unique problems
36
Q

Psychiatric Disorders

A

– Pseudobulbar

  • Tardive dyskinesia (neuroleptic drugs)
  • Dystonia of tongue and larynx
  • Hyperkinesis of face jaw, tongue and UES
  • Difficulty pacing eating
37
Q

Alzheimer’s

A

– Pseudobulbar

  • Decreased attention span and apraxia
  • Need cueing
38
Q

Multiple Sclerosis

A

– Pseudobulbar, Paralytic

  • Weakness of oral structures and neck muscles
  • Delayed pharyngeal swallow
  • Weak pharyngeal contractions
39
Q

Parkinson’s Disease

A

– Pseudobulbar

  • Impulsiveness and poor judgment (late stages)
  • Jaw rigidity
  • Abnormal head and neck posture
  • Impaired coordination of tongue and chewing
  • Retention of food in mouth
  • Delayed oral transit
  • Impaired pharyngeal motility aspiration
40
Q

Assessment of Dysphagia

A
  • Observation of controlled feeding
  • Technological tests
  • Electromyography
  • Fiberoptic Endoscopic Swallowing Study
  • Manometry
  • Scintigraphy
  • Ultrasonography
  • Videofluoroscopy
  • Box 48-3, p. 1333, Radomski & Trombly Latham (2008)
  • Treatment: p. 1335-1342 Radomski & Trombly Latham (2008)
41
Q

Auditory Receptor

A
  • Transmits soundwaves into energy
  • Unit of measurement = decibel
  • Outer, inner & middle ear
42
Q

Soundwaves

A
  • pass through ear canal & cause to vibrate

- Transmit into electrical impulses & travel along nerve fibers

43
Q

Tempanic membrane

A

eardrum

44
Q

Osicles

A

– mallous, incus & stapes

45
Q

Auditory Pathway

A
  • Vestibular cochlear nerve (CN 8) – 2 branches – vestibular branch & cochlear branch
  • Tubes connect inner ear to pharynx – closed off when swallow – Eustachian tubes
46
Q

Primary auditory cortex

A

– awareness of sound – intensity of sound

47
Q

Secondary cortex

A

– memory (determine if language, music, loud noise)

48
Q

Wernicke’s area

A

– language comprehension

49
Q

Superior colliculus

A

– vision

50
Q

Inferior colliculus

A

– auditory

51
Q

Cochlea

A

– organ of hearing

52
Q

Hearing Impairment

A 
SENSORINEURAL
  -Inner ear (cochlea)
  -Vestibulocochlear nerve
  -Central nervous system
CONDUCTIVE
  -Outer ear
  -Middle ear (tympanic membrane, malleus, incus, stapes)
53
Q

Resultant Hearing Impairment

A 
Hearing distortion
  -Tinnitus (ringing)
Hearing loss
  -Loss of certain frequencies
  -Reduction of all frequencies
  -Excessive fluid
  -Presbycusis
Inability to interpret
  -Aphasia
  -Central auditory processing disorder
54
Q

Hearing Distortion - Tinnitus

A

-“ringing” or other head noises
-Can be due to damage anywhere in system (ear canal to CNS)
Etiology
-Allergic reactions
-Diseases/infections/increased blood pressure
-Tumors
-Wax/fluid buildup
-Stress
-Traumatic head injury
-Medication side effect
-Noise exposure
-Temporal mandibular joint syndrome

55
Q

Hearing loss

A
  • Mild- difficulty hearing speech at 26-45 db
  • Moderate – difficulty hearing speech at 46-65 db
  • Severe – a lot of difficulty hearing speech even at 66-85 db
  • Profound – loss over 85 db. Hearing aids may or may not help.
  • Generally higher frequencies lost first
  • Infections with resultant fluid can cause temporary hearing loss
  • Presbycusis – with age cochlear hair cells may become damaged
  • May be 50% of people over 75 years
56
Q

Hearing interpretation – central auditory processing disorder

A

-Difficulty processing auditory information though the hearing mechanism is intact
-figure-ground – can’t pay attention with background noise
-memory – immediate or delayed recall
discrimination – difficulty differentiating between similar words
-attention – cannot sustain attention
-cohesion – higher level listening requiring inferences and comprehension
-May be suspected by OT. Referral to SLP & audiologist for confirmation and treatment.

57
Q

Techniques for working with client with central auditory processing disorder

A
  • Reduce background noise
  • Have person look at you when you’re speaking
  • Use simple, expressive sentences
  • Speak slower rate & mildly increased volume
  • Ask person to repeat directions or paraphrase back to you to ensure understanding
  • Use notes, a watch, and routines
58
Q

Graphesthesia

A

– recognizing writing on your skin

59
Q

Double simultaneous stimulation

A

– i.e. touch arm & leg at same time

60
Q

Barognosis

A

– being able to determine which one is heavier if holding two objects (abarognosis)

61
Q

Topognosia

A

– recognizing a sitmulus on your skin – localizing it

62
Q

Merkel cell

A

– sensitive to fine touch pressure

63
Q

Pacinian corpuscle

A

– deep pressure (lets brain know that the arm actually moved & where)
-can also respond to vibration

64
Q

Meissner’s corpuscle

A

– light touch and vibration

65
Q

Hair cells

A
  • also respond to light touch & vibration
66
Q

Free nerve endings

A
  • pain
67
Q

End-bulb of Krause

A
  • Cold
68
Q

Ruffini end organ

A
  • heat

Neuro (13 decks)

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