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711: Neurological Rehabilitation > The Neurological Exam > Flashcards

The Neurological Exam Flashcards

1
Q

Define validity

A

the quality of being logically or factually sound

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2
Q

Define reliability

A

the quality of producing the same results repeatedly

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3
Q

_______ measures the proportion of actual positives which are correctly identified as such.
_______ the proportion of negatives which are correctly identified as such.

A

Sensitivity

Specificity

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4
Q

Sensitivity is aka as the true _____.

Specificity is aka as the true _____.

A

negative

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5
Q

What things must be assessed during the functional assessment?

(Think MR CLOCK)

A
  • Memory
  • Reasoning
  • Consciousness
  • Language
  • Orientation
  • Calculation
  • Knowledge
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6
Q

Short-term memory is considered normal if the patient is able to recall a set of words after how long?

A

5 minutes

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7
Q

When is long-term memory considered normal?

A

When a patient is able to correctly recall facts about the past

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8
Q

Abstract reasoning is a function of which lobe?

A

The frontal lobe

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9
Q

Deficits in abstract reasoning may indicate what?

A

dementia

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10
Q

What conscious state can be defined as arousable with repeated stimulation?

A

obtunded

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11
Q

A patient who requires a painful stimulus for arousal is considered to be in what conscious state?

A

Stuporous (light coma)

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12
Q

A patient that is unable to be aroused regardless of stimulus is considered to be in what conscious state?

A

Comatose (deep coma)

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13
Q

For the Glasgow Coma Scale, a patient is assigned a score up to 15 points based on responses to 3 areas, what are these 3 areas?

A
  • Eye opening
  • Verbal responses
  • Motor responses
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14
Q

According to the Glasgow coma scale a score less than __ is considered a coma

A

8

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15
Q

What are the 3 types of aphasia?

A
  • Receptive
  • Expressive
  • Global
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16
Q

What is receptive aphasia aka?

A

Wernicke’s aphasia

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17
Q

Describe receptive/Wernicke’s aphasia

A

Patients have difficulty comprehending language

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18
Q

Where is Wernicke’s area located?

A

On the posteriosuperior aspect of the temporal lobe in the dominant hemisphere

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19
Q

What is expressive aphasia aka?

A

Broca’s

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20
Q

Describe expressive/Broca’s aphasia

A

Patients have difficulty producing spoken language

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21
Q

Where is Broca’s area located?

A

In the inferior aspect of the frontal lobe of the dominant hemisphere just anterior to primary motor strip

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22
Q

What is global aphasia?

A

A combination of receptive and expressive aphasia

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23
Q

Dysarthria is associated with what?

A

cerebellar disease

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24
Q

Dysphonia is associated with what?

A

CN X dysfunction

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25
Q

What is the difference between dysarthria and dysphonia?

A
  • Dysarthria patients have problems with speech articulations
  • Dysphonia patients have difficulties with sound production
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26
Q

What refers to a patient’s knowledge of the present circumstances?

A

Orientation

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27
Q

What is the typical presentation of a lesion in the brain (CVA, TBI, or tumor)

A

unilateral somatosensory deficits on opposite side of lesion

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28
Q

What is diabetes mellitus?

A

A metabolic disease in which the body fails to produce or adequately use insulin

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29
Q

What is MS?

A

A progressive autoimmune disease that causes demyelination of the axons in the CNS

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30
Q

What is Guillain-Barré syndrome?

A

A nonprogressive autoimmune disease in which demyelination of axons in PNS occurs

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31
Q

What is Hansen’s disease?

A

A chronic bacterial infection (aka leprosy) that primarily affects skin and peripheral nerves.

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32
Q

What are the 3 main sensory systems that require screening?

A
  • Visual
  • Vestibular
  • Somatosensory
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33
Q

Testing a patient for light touch is testing which tract?

A

Spinothalamic

34
Q

A monofilament of ___ (10 g) of pressure is required for protective function on the dorsal and plantar surfaces of the foot

35
Q

Testing a patient for sharp/dull touch is testing which tract?

A

Spinothalamic

36
Q

Testing a patient for vibration sense is testing which tract?

A

posterior column

37
Q

When testing the posterior column via vibration you should start at ____ joints and then work your way ______.

A

distal

proximally

38
Q

Testing a patient for temperature sense is testing which tract?

A

Spinothalamic

39
Q

Why is temperature testing often omitted?

A

Because it is easier to test pain sensation rather than temperature and both are carried via the spinothalamic tract

40
Q

Position sense (proprioception) is carried via which spinal tract?

A

Posterior colmns

41
Q

How is a joint space test performed?

A

With the patient’s eyes closed the clinician places either the index finger (UE) or great toe (LE) on the uninvolved side to a position and then asks the patient to mirror with the involved extremity

42
Q

When testing a patient’s discriminative sensation you are testing which tract?

A

Posterior column (plus portions of the cerebral cortex)

43
Q

Patients with lesions in the somatosensory cortex have impairments with what?

A
  • Stereognosis
  • Graphesthesia
  • 2-point discrimination
  • Point localization
44
Q

What is stereognosis?

A

The ability to identify objects by touch

45
Q

What is Graphesthesia?

A

The ability to identify writing on the skin solely by touch

46
Q

What is normal 2 point discrimination on the pads oft the fingers?

47
Q

What testing should be performed at a minimum?

A

Light touch

48
Q

What is the most common source of uncoordination?

A

cerebellar dysfunction

49
Q

What 4 things are necessary for coordination?

A
  • Balance
  • Vision
  • Muscle function
  • ROM
50
Q

What do cerebellum disturbances stem from?

A

Lack of motor coordination

51
Q

List a few things that can cause cerebellar damage

A
  • CVA
  • Head trauma
  • Alcoholism
  • 1° and metastatic tumors
  • Toxins (Chemotherapy)
  • MS
  • Friedreich’s ataxia
52
Q

What are the 5 global signs of cerebellar dysfunction?

A
  • Ataxia
  • Tremor
  • Hypotonia
  • Dysarthria
  • Deviations in eye control
53
Q

What must you test if you believe a patient has some sort of cerebellar dysfunction?

A

One test of the UE, one test of the LE, and one test of unsupported stance or gait

54
Q

What is Diadochokinesia

A

The ability to perform alternating movements of the extremities

55
Q

Rebounding is indicative of a cerebellar lesion. What does this mean?

A

When pushing down on patient’s arms they do not have the ability to stop the downward motion quickly and then in an effport to correct this they move past horizontal , followed by a downward motion again before stopping.

56
Q

In patients up to 60 years of age they should be able to tandem walk __ steps without losing their balance

57
Q

What can be defined as the ability to orient one’s self to their surrounding environment while simultaneously maintaining their COG within the BOS

58
Q

Dysfunction of the visual, somatosensory, and vestibular systems can lead to what?

59
Q

Where does the processing of somatosensory information occur?

A

In the basal ganglia, cerebellum and supplemental motor area

60
Q

What is responsible for all movements that control posture & maintain balance?

A

The peripheral motor system

61
Q

What are the 3 strategies that occur to maintain balance?

A
  • ankle
  • hip
  • stepping
62
Q

What role does cognition play on balance?

A

Decision making is difficult, balance strategies cannot be relearned or remembered, and dangerous situations may not be remembered

63
Q

A 67% on the Activities-specific Balance Confidence (ABC) Scale can predict a fall __% of the time

64
Q

Balance tests must be performed on patients who exhibit any of the following 6 conditions…

A
  • History of falls or episodes of instability
  • Known or suspected CNS dysfunction that affects postural stability
  • Frequent LE injuries (ankle sprains)
  • Recent surgeries of LEs
  • Deconditioning, weakness, or if using an AD for ambulation
  • Over 65 years of age
65
Q

In order to be considered an UMN lesion where must the lesion occur? This means they are considered conditions of the ______ nervous system.

A

In the brain or spinal cord

central

66
Q

In order to be considered an LMN lesion where must the lesion occur? This means they are considered conditions of the ______ nervous system.

A

Within the spinal nerve roots or peripheral branches

peripheral

67
Q

What are a few symptoms of CNS dysfunction

A
  • increased muscle tone
  • increased spacticty
  • hyperactive DTRs
  • positive pathological reflexes (Babinski, Hoffman, etc.)
68
Q

In what types of pathologies does hypotonia occur?

A
  • Down syndrome
  • some types of CP
  • diseases of the PNS
69
Q

In what types of pathologies does hypertonia occur?

A
  • CVA
  • TBI
  • SCI
70
Q

Describe the role of modulation following a serious insult to the CNS

A

Initially the CNS goes into a state of shock which results in hypotonia. After this period of shock, signals begin firing again but the modulation signals are lost which leads to hypertonia

71
Q

What can be defined as the manifestation of hypertonicity in which the resistance to passive motion is rate or velocity dependent?

A

Spasticity

72
Q

Spasticity is common in ____ motor neuron lesions and typically manisfests in the _____ of the arms and the _____ of the legs

A

upper

flexors

extensors

73
Q

What is a tell tale sign of spasticity?

A

If you feel greater resistance as you increase speed of passive motion

74
Q

If a lesion occurs on the right side of the brain what can be expected?

A

abnormal reflexes on the left side

75
Q

If a lesion occurs in the spinal cord what can be expected?

A

abnormal reflexes bilaterally below the level of the lesion

76
Q

Define clonus

A

Abnormal rapid, reflexive, back and forth motion that continues until the stretch on the tendon is removed

77
Q

Describe reflex testing (5+, 4+, 3+, 2+, 1+, 0)

A 
5+ sustained clonus
4+ hyperreflexive with clonus
3+ more reflexive than normal
2+ normal
1+ diminished
0.5+ reflex is only initiated with reinforcement
0 no response
78
Q

What is the flexor withdrawal reflex?

A

It is a secondary response to the Babinski test in which the hip and knee flex when the plantar surface is stroked

79
Q

A positive Hoffman’s test indicates dysfunction of which tract?

A

corticospinal

80
Q

What are the 5 most important tracts to assess?

A
  • Lateral corticospinal tract
  • Dorsal columns
  • Lateral spinothalamic tract
  • Spinocerebellar tracts
  • Vestibulospinal tracts

711: Neurological Rehabilitation (10 decks)

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