Systems Final T3

Question 1

Response to CNS damage that may persist for weeks or months after brain injury. Astrocytes migrate to the site of neuronal death, clustering together to create a soft scar structure which is called…

Answer 1

Gliosis

A.k.a astrocytosis, astrocitic gliosis

Question 2

These myelinate axons in the CNS and are what get attacked in MS

Answer 2

Oligodendrocytes

Question 3

Diminished sensation; the experience matched the nature of the stimulus but is less strong than expected. Lay term is numbness.

Answer 3

Hypaesthesia

Question 4

Heightened or exaggerated sensation; the experience accurately matches the stimulus, but produces an exaggerated or unexpectedly strong response.

Answer 4

Hyperaesthesia

Question 5

Define paraesthesia

Answer 5

Abnormal sensation e.g pins & needles, bugs crawling on skin

The sensation experience does not correlate with the stimulus

Question 6

Define Dysaesthesia

Answer 6

When a paraesthesic sensation is painful e.g hot pokers, electric burning

Question 7

Instead of the expected sensation, an innocuous stimulus results in pain. A usual pain experience is being created in response to a normally non-nociceptive stimulus. E.g feather like touch

Answer 7

Allodynia

Question 8

Define hypalgesia

Answer 8

The response to a nociceptive stimulus is weak

Question 9

Heightened sensitivity to painful stimuli. The person experiences an unexpectedly strong pain intensity as compared to the predicted response to stimulus. Often there is a continuation of the pain after the stimulation has ceased.

Answer 9

Hyperalgesia a.k.a hyperalgia

Question 10

Rigidity is a manifestation of…

Answer 10

Basal ganglia dysfunction

Question 11

What are some important treatment goals when working with rigidity in limbs.

Answer 11

• general relaxation; lowering sympathetic activation
• optimizing perfusion and draining; improve circulation
• reduce/minimize contracture
• MET/muscle fatigue in the target muscles to reduce tone
• using reflex techniques

Question 12

What may be a reason for adapting positions while treating rigidity?

Answer 12

Rigidity can affect breathing muscles. A patient may have dysphasia or breathing difficulties, so adaptations may need to be made so the patient can feel comfortable and at ease. With dysphasia lying completely flat may promote choking.

Question 13

What is the most effective reflex technique to for rigidity? What is the least effective?

Answer 13

• GTO release, light vibrations and stroking
• reciprocal inhibition, antagonist contraction techniques etc also mm approx

Question 14

Sensory overload can help renormalize reflex sensitivity. This can be a combination of touch/pressure, movement and temperature.

Question 15

True or false: Minimizing contracture and maximizing jt health are both key treatment aims when treating rigidity.

Answer 15

True

Question 16

True or false: passive forced movements can be effective if done properly.

Answer 16

True

Question 17

True or false: It is best to treat before the px’s rigidity- influencing meds are in full force.

Answer 17

False; It’s best to treat WHEN the px’s meds are in full force.

Question 18

A lesion on pyramidal pathway will cause loss of distal motor function on the ___ side of the body

Answer 18

• opposite

Question 19

Muscle hypertonia as a result of exaggerated, disregulation of reflex responses is…

Answer 19

Spasticity

Question 20

Spasticity can be a result of…

Answer 20

UMN injury or disease-caused damage

Question 21

Spasticity typically results from…

Answer 21

White matter lesions in the
Brain, brainstem & spinal cord

Question 22

Spasticity vs Rigidity: which is typically seen in Extrapyramidal lesions ex. Parkinson’s?

Answer 22

Rigidity

Question 23

Spasticity vs rigidity: which generally only occurs during muscle stretch and usually accompanied by increased tendon reflexes and a babinski response?

Answer 23

Spasticity

Question 24

True or false: Rigidity is velocity dependent and more rapid movements triggers a stronger involuntary contraction or “catch” of affected mm.

Answer 24

False; this is spasticity

Question 25

Alternating activation of agonist and antagonist stretch reflex responses acting on a joint causing a reverberating back & forth action. This is…

Answer 25

Clonus a characteristic of spasticity

Question 26

Define spastic co-contractions…

Answer 26

Abnormal antagonist contractions that occur during voluntary agonist effort

Question 27

What is spastic dystonia?

Answer 27

Muscle contraction present at rest, leading to a holding position very sensitive to stretch.

Question 28

What characteristics of spasticity develop 6 months after the spastic-causing event?

Answer 28

• 1a neuronal sprouting
• reduced spinal cord availability of gaba

Question 29

What is happening 6 months after spasticity causing event when there is reduced spinal cord availability of GABA?

Answer 29

• the strength/duration of the GTO reflex response is reduced. It’s still present but is weaker & shorter in duration
• Spasticity is intensified by reducing the GTO’s capacity to counteract the stretch reflex response

Question 30

What do you want to avoid when treating a patient with spasticity?

Answer 30

• stress/agitation and a lot of physical movement/activity (keeps reactivity at a higher level)
• anything unexpected
• ‘pokey’ or stop-start quality techniques
• targeted reflex techniques like vibrations and tapotment
• techniques that stimulate nociception
• cold and hot extremes
• massaging and stretching at the same time

Question 31

Give a summary of spasticity massage guidelines

Answer 31

• tx should be relaxation focused
• consistent, smooth, firm touch and techniques that aren’t painful
• tx in sidelying for most of tx, use lots of pillows to keep jts in flexed position
• use neutral flexion of jts
• hold mm in a tolerable shortened position for 30 seconds to calm its mm spindles
• Use GTO technique
• use warm hydro only no extremes of cold or hot
• use jt mobs, stretching but maybe interspersed through tx
• tx when anti spastic med are strongest in px’s system

Question 32

What are some clinical problems that increase spasticity?

Answer 32

• ischemia
• altered biomechanics & degenerative jt change
• compensatory postures and movements
• contracture
• poor tissue healing

Question 33

True or false: resistance exercise can help reduce tone levels in spastic muscles.

Answer 33

True

Question 34

True or false: You should only check on cardiovascular status in px w/spasticity who also have a history of cardiovascular problems?

Answer 34

False: You should always check for px’s w/spasticity regardless of cause. Spasticity esp full body can generate stress on the heart.

Question 35

True or false: Medically induced functional contractures should also be removed in a px with spasticity.

Answer 35

False; They should not be removed!

Question 36

What is dysarthria?

Answer 36

Speech is slurred because articulation is not precise

Question 37

Group of dysfunctions related to limited language output. Person may have normal or close to normal cognition but has limited or no capacity to produce language. May result in the production of sounds but not words. This is…

Answer 37

Broca’s aphasias

Question 38

Group of dysfunctions where verbal output is not limited or constrained, however there are major problems with conveying meaning. This can range from word-finding and word- association m errors to producing jibberish. This is called…

Answer 38

Wernicke’s aphasias