Week 4 Flashcards
1
Q
What is the purpose of a neuromuscular(neurologic) screening exam?
A
It identifies or rules out signs consistent with lower neuron pathology and upper motor neuron pathology
2
Q
A lower motor neuron pathology is classified as a ____
A
Radiculopathy
3
Q
Examples of an upper motor neuron pathology
A
Stroke, spinal cord compression, TBI
4
Q
____ uses sensory, motor, and reflex testing to determine the source and location of a neurological dysfunction. It also assist in differential diagnosis of these conditions
A
A neuromuscular screen
5
Q
What are the components of a basic neurological screening examination?
A
Motor testing, Somatosensory/sensory testing, reflex testing, central nervous system screen.
6
Q
What are the things to look for in a functional motor observation/ myotome testing?
A
- Can the patient do what we want them to and how does it relate to their function?
- Issues with tremors
- Fasciculations in muscles
- Atrophy
- 1 vs multiple testing to test performance
7
Q
Functional myotomal assessment assesses which ability?
A
Step up (quads)
8
Q
Functional myotomal assessment L4-5 assesses which ability?
A
Heel walking
9
Q
Functional myotomal assessment L5-S1 assesses which ability?
A
Toe walking/ toe raise
10
Q
UE myotome C1-2 assesses which ability?
A
Neck flexion
11
Q
UE myotome C3 assesses which ability?
A
Neck sidebending
12
Q
UE myotome C4 assesses which ability?
A
Shoulder elevation
13
Q
UE myotome C5 assesses which ability?
A
Shoulder abduction
14
Q
UE myotome C6 assesses which ability?
A
Elbow flexion
15
Q
UE myotome C7 assesses which ability?
A
Elbow extension
16
Q
UE myotome C8 assesses which ability?
A
Thumb abduction
17
Q
UE myotome T1 assesses which ability?
A
Finger abduction
18
Q
LQ myotome L2-3 assesses which ability?
A
Hip flexion
19
Q
LQ myotome L3-4 assesses which ability?
A
Knee extensors
20
Q
LQ myotome L4 assesses which ability?
A
Ankle dorsiflexors
21
Q
LQ myotome L5 assesses which ability?
A
Hallux extension
22
Q
LQ myotome S1 assesses which ability?
A
Ankle plantar flexors
23
Q
What position are motor screening typically done?
A
In a sitting position
24
Q
What is positive finding?
A
Significant weakness or diminished resistance relative to the opposite side
25
UQ dermatome C5
Mid deltoid
26
UQ dermatome C6
Radial aspect of 2nd metacarpal
27
UQ dermatome C7
Dorsal aspect of middle finger
28
UQ dermatome C8
Ulna aspect of 5th metacarpal
29
UQ dermatome T1
Medial forearm
30
LQ dermatome L1
Inguinal area
31
LQ dermatome L2
Anterior mid thigh
32
LQ dermatome L3
Medial knee
33
LQ dermatome L4
Medial malleolus
34
LQ dermatome L5
Distal medial dorsum of foot
35
LQ dermatome S1
Lateral border of foot
36
LQ dermatome S2
Medial/ posterior calcaneus
37
A monosynaptic reflex automatically regulates ____
Muscle length
38
In a monosynaptic reflex, tapping of tendon places a quick stretch on muscle and activates _____
Muscle spindle
39
What does the activation of a muscle spindle result in?
Results in contraction of stretched muscle
40
What will tapping a muscle 5-6 times reveal?
Any fatigue or fading response
41
What is an hypo-reflexive reflex show?
Lower motor neuron (possible nerve root compression or neuropathy)
42
What is an hyper-reflexive reflex show?
Upper motor neuron (possible CNS pathology)
43
UQ reflex: C5
Biceps brachii
44
UQ reflex: C6
Brachioradialis
45
UQ reflex: C7
Triceps
46
Positive finding reflex found to be diminished or absent can be correlated with the dermatome and myotome assessment to...?
Determine the presence of nerve root pathology
47
What may hyperactive/reflexive findings indicate?
Upper motor neuron pathology
48
LQ reflex: L2-4
Patellar reflex
49
LQ reflex: S1-2
Achilles reflex
50
What is the response of LQ reflex grade 4+?
Very brisk response; associated with clonus
51
What is the response of LQ reflex grade 3+?
Brisk response; possibly hyper reflexive
52
What is the response of LQ reflex grade 2+?
Normal, average response
53
What is the response of LQ reflex grade 1+?
Low-normal response
54
What is the response of LQ reflex grade 0?
No response
55
What is the response of LQ reflex grade 1+(R)?
Absent response which appears with reinforecement
56
What is the response of LQ reflex grade 0(R)?
No response even with reinforcement
57
Example of a reinforcement technique (R)
Jendrassik maneuver
58
How is the jendrassik maneuver done?
Patient is told to clasps hands together and asked to pull then apart without doing so, while looking away.
59
What does the jendrassik manuever do to the nervous system?
Ramps up the nervous system
60
What is clonus?
A series of involuntary muscular contractions due to sudden stretching of the muscle (reflex response)
61
___ is normally one little jolt, while _____ continually contracts
*Clonus* is normally one little jolt, while *colonus* continually contracts
62
Clonus is a ______ system disorder
CNS disorder.
63
_____ are specifically diseases or disorders that damage the upper motor neuronsor associated tracts
Clonus
64
Clonus most commonly testing in the ___
Ankle and wrist
65
What clonus is considered abnormal?
Sustained clonus (5 beats or more)
66
How is the Babinski CNS screen done?
- Drag something on the bottom of the foot.
- Normal response- toes flex
- Babinski response
67
What is the babinski response?
The hallux extends and toes fan out
68
What is the hoffman's reflex?
- When you flick distal IP joint of middle finger
| - Looking for the index finger and thumb flexion
69
What is the inverted supinator sign?
There will be either a pronation of the forearm of a clasp/flexion of the fingers in a pathologic case
70
What lesion is weakness a sign of?
Upper and lower motor neuron lesion
71
What lesion is atrophy a sign of?
Lower motor neuron lesion and mild atrophy in the upper motor neuron may develop due to disuse over time, but ultimately no
72
What lesion is fasciculations a sign of?
Lower motor neuron lesion
73
What lesion is reflex a sign of?
- Increased in an upper motor neuron lesion
| - Decreased in a lower motor neuron lesion
74
What lesion is MM tone a sign of?
- Increased in an upper motor neuron lesion
| - Decreased in a lower motor neuron lesion
75
Why do we take a patient's vitals?
- Essential component of every new patient as documented in the Guide to PT practice
- Responsible for screening patients for conditions that may negatively impact their response to our interventions
76
A patient may have abnormal vitals, yet be ___
A patient may have abnormal vitals, yet be *asymptomatic*
77
Types of vital signs
- Traditional and modern/updated
78
Types of traditional vital signs?
- Heart rate
- Blood pressure
- Respiration rate
- Body temperature
79
Characteristics of heart rate vital sign
* Generally normal range is between 60-100 beats per minute (BPM)
* Can take brachial, radial, carotid, femoral or dorsalis pedis pulses
* May do manually or with a pulse oximeter (pulse ox)
80
Characteristics of BP vital sign
o Set up done right: cuff shouldn’t go around clothing
o No reading
o Leg not crossed
o Leaning upright
o Used the bathroom
o No talking
81
What is a normal BP?
Systolic: less than 120
and
Diastolic: less than 80
82
What is an elevated BP?
Systolic: 120-129
and
Diastolic: less than 80
83
What is an hypertension stage 1 BP?
Systolic: 130-139
or
Diastolic: 80-89
84
What is an hypertension stage 2 BP?
Systolic: greater than or equal to 140
or
Diastolic: greater than or equal to 90
85
What is an hypertensive crisis BP?
Systolic: greater than or equal to 180
and/or
Systolic: greater than or equal to 120
86
Types of a modern/updated vitals
- Gait speed
| - Waist circumference/ BMI
87
According to white paper, ____ is the 6th vital sign
Walking/gait speed
88
Characteristics of gait speed vital sign
o 20-meter distance
o First 5-meter accelerating
o Time over 10 meters
o Last 5-meter deceleration
89
What is the range of a hazard gait speed?
0-0.6 m/s
90
What is the range of a normal gait speed?
0.6-1m/s
91
What is the range of an above risk gait speed?
1- 1.4 m/s
92
Where is the position for waist circumference measurement?
Waist/abdominal. (above iliac crest). Around the umbilicus
93
What is the measurement is an high risk of a metabolic disorder/cardiovascular disease for men?
Over 40in
94
What is the measurement is an high risk of a metabolic disorder/cardiovascular disease for women?
Over 35in
95
What does BMI stand for and what is it?
Body mass index. A number calculated from a person's weight and height
96
What group of people is BMI not overly accurate for?
Those who are frail or overly muscular
97
Why is BMI not overly accurate for a muscular person?
Because muscle is more dense and it brings more weight
98
BMI of an underweight person
less than 18.5
99
BMI of normal weight
18.5-24.9
100
- BMI of overweight
- Disease risk with optimal waist
- Disease risk w/o optimal waist
- 25 -29.9
- Increased
- High
101
- BMI of obesity class 1
- Disease risk with optimal waist
- Disease risk w/o optimal waist
- 30- 34.9
- High
- Very high
102
- BMI of obesity class 2
- Disease risk with optimal waist
- Disease risk w/o optimal waist
- 35- 39.9
- Very high
- Very high
103
- BMI of obesity class 3
- Disease risk with optimal waist
- Disease risk w/o optimal waist
- Greater than or = to 40
- Extremely high
- Extremely high
104
____ is still possible even though a person has a low BMI, but are no active
Cardiovascular mortality
