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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
What is the difference between dysarthria and dysphonia?
- Dysarthria patients have problems with speech articulations - Dysphonia patients have difficulties with sound production
26
What refers to a patient’s knowledge of the present circumstances?
Orientation
27
What is the typical presentation of a lesion in the brain (CVA, TBI, or tumor)
unilateral somatosensory deficits on opposite side of lesion
28
What is diabetes mellitus?
A metabolic disease in which the body fails to produce or adequately use insulin
29
What is MS?
A progressive autoimmune disease that causes demyelination of the axons in the CNS
30
What is Guillain-Barré syndrome?
A nonprogressive autoimmune disease in which demyelination of axons in PNS occurs
31
What is Hansen's disease?
A chronic bacterial infection (aka leprosy) that primarily affects skin and peripheral nerves.
32
What are the 3 main sensory systems that require screening?
- Visual - Vestibular - Somatosensory
33
Testing a patient for light touch is testing which tract?
Spinothalamic
34
A monofilament of ___ (10 g) of pressure is required for protective function on the dorsal and plantar surfaces of the foot
5.07
35
Testing a patient for sharp/dull touch is testing which tract?
Spinothalamic
36
Testing a patient for vibration sense is testing which tract?
posterior column
37
When testing the posterior column via vibration you should start at ____ joints and then work your way ______.
distal proximally
38
Testing a patient for temperature sense is testing which tract?
Spinothalamic
39
Why is temperature testing often omitted?
Because it is easier to test pain sensation rather than temperature and both are carried via the spinothalamic tract
40
Position sense (proprioception) is carried via which spinal tract?
Posterior colmns
41
How is a joint space test performed?
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
When testing a patient's discriminative sensation you are testing which tract?
Posterior column (plus portions of the cerebral cortex)
43
Patients with lesions in the somatosensory cortex have impairments with what?
- Stereognosis - Graphesthesia - 2-point discrimination - Point localization
44
What is stereognosis?
The ability to identify objects by touch
45
What is Graphesthesia?
The ability to identify writing on the skin solely by touch
46
What is normal 2 point discrimination on the pads oft the fingers?
5 mm
47
What testing should be performed at a minimum?
Light touch
48
What is the most common source of uncoordination?
cerebellar dysfunction
49
What 4 things are necessary for coordination?
- Balance - Vision - Muscle function - ROM
50
What do cerebellum disturbances stem from?
Lack of motor coordination
51
List a few things that can cause cerebellar damage
- CVA - Head trauma - Alcoholism - 1° and metastatic tumors - Toxins (Chemotherapy) - MS - Friedreich’s ataxia
52
What are the 5 global signs of cerebellar dysfunction?
- Ataxia - Tremor - Hypotonia - Dysarthria - Deviations in eye control
53
What must you test if you believe a patient has some sort of cerebellar dysfunction?
One test of the UE, one test of the LE, and one test of unsupported stance or gait
54
What is Diadochokinesia
The ability to perform alternating movements of the extremities
55
Rebounding is indicative of a cerebellar lesion. What does this mean?
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
In patients up to 60 years of age they should be able to tandem walk __ steps without losing their balance
20
57
What can be defined as the ability to orient one’s self to their surrounding environment while simultaneously maintaining their COG within the BOS
balance
58
Dysfunction of the visual, somatosensory, and vestibular systems can lead to what?
vertigo
59
Where does the processing of somatosensory information occur?
In the basal ganglia, cerebellum and supplemental motor area
60
What is responsible for all movements that control posture & maintain balance?
The peripheral motor system
61
What are the 3 strategies that occur to maintain balance?
- ankle - hip - stepping
62
What role does cognition play on balance?
Decision making is difficult, balance strategies cannot be relearned or remembered, and dangerous situations may not be remembered
63
A 67% on the Activities-specific Balance Confidence (ABC) Scale can predict a fall __% of the time
84
64
Balance tests must be performed on patients who exhibit any of the following 6 conditions...
- 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
In order to be considered an UMN lesion where must the lesion occur? This means they are considered conditions of the ______ nervous system.
In the brain or spinal cord central
66
In order to be considered an LMN lesion where must the lesion occur? This means they are considered conditions of the ______ nervous system.
Within the spinal nerve roots or peripheral branches peripheral
67
What are a few symptoms of CNS dysfunction
- increased muscle tone - increased spacticty - hyperactive DTRs - positive pathological reflexes (Babinski, Hoffman, etc.)
68
In what types of pathologies does hypotonia occur?
- Down syndrome - some types of CP - diseases of the PNS
69
In what types of pathologies does hypertonia occur?
- CVA - TBI - SCI
70
Describe the role of modulation following a serious insult to the CNS
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
What can be defined as the manifestation of hypertonicity in which the resistance to passive motion is rate or velocity dependent?
Spasticity
72
Spasticity is common in ____ motor neuron lesions and typically manisfests in the _____ of the arms and the _____ of the legs
upper flexors extensors
73
What is a tell tale sign of spasticity?
If you feel greater resistance as you increase speed of passive motion
74
If a lesion occurs on the right side of the brain what can be expected?
abnormal reflexes on the left side
75
If a lesion occurs in the spinal cord what can be expected?
abnormal reflexes bilaterally below the level of the lesion
76
Define clonus
Abnormal rapid, reflexive, back and forth motion that continues until the stretch on the tendon is removed
77
Describe reflex testing (5+, 4+, 3+, 2+, 1+, 0)
``` 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
What is the flexor withdrawal reflex?
It is a secondary response to the Babinski test in which the hip and knee flex when the plantar surface is stroked
79
A positive Hoffman's test indicates dysfunction of which tract?
corticospinal
80
What are the 5 most important tracts to assess?
- Lateral corticospinal tract - Dorsal columns - Lateral spinothalamic tract - Spinocerebellar tracts - Vestibulospinal tracts

711: Neurological Rehabilitation (10 decks)

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