The Nervous System Flashcards
What’s the autonomic nervous system?
“Internal workings”
Sympathetic & parasympathetic
What’s the somatic nervous system?
“External workings”
CNS & PNS
What’s the apgar scale? What’s an adequate score?
Eval integrity of function of the nervous system at birth A - appearance P- pulse G - grimace to pain A - activity R - respiration Perfect = 10, adequate = 7
Function of cerebral cortex (related to mvmt)
Pre-motor, primary motor, & somatosensory processing
Function of the thalamus (related to mvmt)
Center for sensation, mvmt, emotion & memory converge
Function of cerebellum (related to mvmt) (3)
Smooth executive of voluntary mvmt, muscle tone & motor planning (via connect with pre-motor cortex)
How are deficits with the cerebellum expressed (related to mvmt) (3)
Decreased muscle tone, deficits with voluntary mvmt, decreased postural control
Function of basal ganglia (related to mvmt) (1)
Regulate mvmt via thalamus
Probs with basal ganglia result in what deficits? (2)
Deficits in involuntary mvmt
Difficulty with initiation of functional mvmt
What’s the corticospinal tract?
Primary pathway for voluntary mvmt
What’s the limbic system responsible for?
It "MOVEs" us M - memory, motivation O - olfactory V - visceral/autonomic E - emotion
What are the cerebellar tracts? (4)
Spinocerebellar
Ventral spinocerebellar
Cuneocerebellar
Rostral spinocerebellar
What type of tracts of the cerebellar?
Ascending
What’s the fasciculus cuneatus? - where’s it located? What info does it carry?
Located in dorsal column, ascending tract, info from UE
Prop, fine touch, vibration
What’s the fasciculus gracilis? - where’s it located? What info does it carry?
Carries info from LE
Located in dorsal columns
Carries prop, fine touch, vibration
What’s the spinothalamic? - What info does it carry?
Ascending tract
Carries crude touch, pain, pressure & temp
What are descending tracts?
Rubrospinal
Vestibulospinal
Reticulospinal
Corticospinal
What are the cranial nerves? Use the trick!
Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharnyngeal Vagus Accessory Hypoglossal
Cranial nerve: which are sensory, motor, or both?
Olfactory - s Optic - s Oculomotor - m Trochlear - m Trigeminal - b Abducens - m Facial - b Vestibulocochlear - s Glossopharnyngeal - b Vagus - b Accessory - m Hypoglossal - m
How do you remember if a CN is s, m, or b?
Some say marry money but my brother says big boobs matter more
What’s clonus? How’s it tested? What does it indicate?
Involuntary jerking of foot
Tested via quick dorsi flexion at ankle
Indicates prob with descending cortical tracts (UMN)
What’s babinski? How’s it tested? What does it indicate?
Fanning of toes
Stroke along lateral aspect of foot
Sign of UMN paralysis
What’s deep tendon reflex? How’s it tested? What does it indicate (2)?
Use quick stretch to elicit response from muscles spindle
A way to assess integrity of muscle spindle
Hyperactive response - issue w/descending motor pathway (umn - stroke, TBI)
Hyporeactive response - prob e/ reflex
arc - issue within spinal cord
What’s hypertonia?
Increased muscle tone
What’s spasticity? What type of issue does it indicate?
Increased resistance to mvmt in one direction.
Indicates UMN lesion
What’s decorticate posture?
Form of spasticity
Lesion above superior colliculus
UE flexion LE extension
What’s descerebrate posture?
Form of spasticity
UE & LE extension
Lesion below superior colliculus (in brainstem) (stroke, near drowning
What’s rigidity?
Increased resistance to mvmt in all directions
What’s hypotonia? What damage does it indicate?
Decreased tone
Cerebellum damage or LMN
What’s chorea? Indicative of what dx?
Quick jerky/irregular mvmts, small amplitude, distal extremities
Huntington’s disease
What’s hemiballism? Indicative of what dx?
Lg involuntary mvmt “flinging”
Subthalamic nucleus damage
What’s athetosis? Indicative of what dx?
Slower, irregular mvmt, varying amplitude in entire extremity
Basal ganglia or cerebral palsy
What’s dystonia? Indicative of what dx?
Slow twisting mvmt - sustained in trunk or extremity
Globus pallidus lesion
What’s tremor? Indicative of what dx?
Quick regular oscillating mvmt of small amplitude Substantia nigra (dopamine) a Parkinson's
4 specific conditions associated with cerebellum damage
- Dysmetria (over/undershoot reaching for object)
- Dysdiadokinesia
- Ataxia
- Intention tremor
Romberg test
Tests systems used to stay upright - ability to stand with eyes occluded (vision, proprioception, vestibular)
Spinothalamic tract - carries what info?
Crude touch, pain, & temp
Crosses in SC - travels contralaterally
Spinoreticular tract carries what info?
Dull/aching pain
Anterior lesion of spinal cord affects what?
Motor
Posterior lesion of spinal cord affects what?
Sensory
Describe Brown-Sequad Syndrome
Lesion to lateral aspect of spinal cord Spinothalamic tract - contralateral Dorsal columns - ipsilateral So, eg: lesion on R side of SC produces Lost pain sensation on L Lost discrimination sensations on R
The dorsal columns include what tracts? What to they service?
Fasciculus gracilis (lower body)
Fasciculus cuneatus (upper body)
Travel ipsilaterally, cross in the brainstem
Carries light touch (discriminative), vibration, proprioception
Damage indicates positive Romberg test
What conditions are associated with damage to the spinal cord? (4)
Hypertonia
Hyperreflexia
Clonus
Paralysis
What’s clonus?
Spasmodic involuntary contractions of affected muscles - induced via stretching
What conditions are associated with damage to the brain stem? (3)
Locked-in syndrome Decerebrate rigidity (UE/LE ext) Associated reactions (widespread increase in tone - overflow. Eg when one hand grasps an item, the other hand grasps as well)
What conditions are associated with damage to the basal ganglia? (2)
Athetosis
Parkinson’s (resting tremor, festinating gait)
What conditions are associated with damage to the cerebellar level? (5)
Ataxia Dysmetria Dysdiadochokinesia Intention tremors Asthenia (excessive fatigue in voluntary muscles)
What conditions are associated with damage to the cortical level (cerebral cortex)? (4)
Hemiplegia
Pathological reflexes (presence of reflexes that should be integrated)
Babinski sign
Hoffman’s sign (tap fingernail or flex dip joint - elicits pinch action between index finger & thumb)
General characteristics associated with “right hemiplegic” (L sided insult) (4)
Language deficits
Anxiety
Slow/disorganized response to familiar tasks
Difficulty understanding verbal instructions
General deficits associated with “left hemiplegic” (R side insult) (4)
Impulsivity
Denial of disability
Distorted body image
Depth perception issues
Visual deficits: what is strabismus?
Eyes not yoked together (move in different directions)
Visual deficits: what is diplopia?
Double vision
Visual deficits: what are symptoms of nystagmus?
Oscillopsia (sensation of world moving)
Visual deficits: what are symptoms of lagophthalmos?
Incomplete eye closure
What’s homonymous hemianopsia? What’s a tx strategy?
Due to damage to optic pathway - lose half of vision. Compensate via lighthouse strategy
What’s hemi-inattention? What side of insult is it associated with? Why? Tx strategy?
Visual neglect (eg L sided neglect). Associated with R side injury bc R is “gestalt” (whole pic). Always approach on hemiplegic side.
What’s convergent insufficiency?
limited ability to bring eyes together along the midline axis (eg difficulty switching focus from far away to nearby)
Whats the result of visual field deficits?
Poor mobility - danger of running into things, etc.
What is oculomotor dysfunction? Symptoms? Tx?
Difficulty with smooth pursuits & rapid shifting saccades. Vision may be jerky, non-continuous, over or under-shooting objects. Results in difficulty w/ eye-hand action, finding objects, reduced visual memory. Tx - incorporate vestibular input with eye-hand activity
Principles of Proprioceptive Neuromuscular Facilitation (PNF) (11)
- Human potential
- Development is cervico-caudal & proximal-distal
- Reflex activity is basis for motor development
- Shifts between extensor & flexor patterns
- Reversing mvmts make up functional mvmts
- Balanced interactions/syngerism of antagonists
- Development of motor behavior expressed as total pattens of mvmt & posture
- Normal motor development is orderly, but not step-wise
- Improved motor ability is dependent on motor learning
- Repetition = retention
- Goal-directed activities facilitate learning
PNF procedures (6)
- Positioning
- Manual contacts
- Quick stretch
- Tactile/Approximation
- Resistance
- Verbal commands
Contraindications for PNF (6)
- Inflammatory arthritis
- Malignancy
- Bone disease
- Bone fx
- Congenital bone deformities
- Joint subluxation
General/overall goal of PNF
Speed up the response of the neuromuscular mechanism through stimulation of the proprioceptors, which could result in either facilitation or inhibition
PNF - tactile system: gentle touch is used to…
guide the ct’s mvmt
PNF - tactile system: quick stretch is used to…
initiate mvmt
PNF - tactile system: maximal resistance is used to…
strengthen mvmt
PNF - tactile system: joint traction is used to…
increase ROM
PNF - tactile system: joint approximation is used to…
promote joint stability & control
4 specific goals of PNF
- Restore/enhance postural responses/normal mvmt
- Enhance stability or mobility
- Strengthen or stretch a group of muscles
- Improve motor control for functional activities
5 common dx used with PNF
- Parkinson’s
- SCI
- CVA
- TBI
- Hand injuries
What’s ideational apraxia? Symptoms?
Loss of ability to conceptualize/plan/execute tool use/use of everyday objects
Difficulty with planning, sequencing, & initiating action
Tx for ideational apraxia
Reteach the behavior via: 1. hand over hand, 2. modeling, 3. repetition, 4. simple instruction
What’s dressing apraxia?
Inability to plan & carry out dressing tasks
Results in difficulty orienting clothing, putting clothes on incorrectly,
Tx for dressing apraxia (4)
- physical cues
- chaining
- using pics
- highly structured & systematic
What’s constructional apraxia? What are some practical implications?
Impaired ability to reconstruct 2D/3D designs
Difficulty orientating clothing, loading dishwasher, assembling furniture, house cleaning, etc.
Tx for constructional apraxia
Teach to problem solve, anticipatory planning
What’s agraphesthesia?
Inability to recognize numbers, letters, or forms traced onto the skin
What’s ideomotor apraxia?
Inability to perform motor action on command, but is able to perform the mvmt automatically
What’s topographical disorientation?
Inability to fine one’s way around
What’s anosagnosia?
Ct fails to recognize the presence or severity of their disability, especially paralysis
What’s somatognosia?
Lack of awareness of body structure & the failure to recognize one’s parts & their relationship to each other
What’s unilateral neglect?
Inability to integrate & use perceptions from one side of the body - typically the left side
What’s finger agnosia?
Difficulty naming fingers that have been touched
What’s ideational apraxia?
Inability to form concepts of mvmt & the inability to execute an act in response to a command/automatically or unable to properly sequence
Strategies for working with memory impairment (3 internal strategies, 4 external strategies)
Internal: 1. Rehearsals (mental repetition) 2. Grouping (chunking) info 3. Verbalization External: 1. Alert & cue 2. Backward chaining 3. Enviro cues 4. Written info
Tx approaches for cognitive dysfunction (5)
- Adaptive (compensate)
- Remedial (for specific cog deficits)
- Process approach (changes to changing ct)
- Multicontext approach
- Self-monitoring strategies
What’s Wernicke’s aphasia?
AKA receptive aphasia - difficulty understanding language
What’s Broca’s aphasia?
AKA expressive aphasia - ct knows what they want to say, but cannot produce language
What’s aprosodia? Which hemisphere injury is it associated with?
Inability to interpret emotional info - R hemisphere damage
What’s dysarthria?
Neurological damage to motor components of speech leads to inability of muscles to articulate
