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YR3S2- PM4 > wk3- neuro diseases > Flashcards

wk3- neuro diseases Flashcards

1
Q

what is cerebral palsy and what causes it

A

motor function disorder

caused by a permanent, non progressive brain defect or UML present from birth or slightly after birth

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2
Q

when is CP diagnosed by

A

first 2 years of life

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3
Q

CP pathology

A

lesions on the cerebral motor cortex which is responsible for voluntary movements
injury causes
-paralysis and weakness
-voluntary control lost
-spastic cerebral palsy

lesions on the basal ganglia which influence muscle movement
injury results in
-posture disturbance
-change in muscle tone
-tremors/ involuntary movements (due to loss of inhiibtory signals)
-atheototic cerebral palsy (long, slow, uncontrolled writhing movement)

lesions on the cerebellum which is responsible for precise timing and patterns of muscle contraction
injury causes
-loss of smooth muscle contraction
-clumsy
-ataxis cerebral palsy

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4
Q

types of cerebral palsy

how common

what causes it

A
  1. spastic- most common (75% of cases)
    -diplegia - most common
    quadplegia,
    hemiplegia

cerebral motor cortex lesion

  1. ataxia (18%)
    cerebellar lesion
  2. dyskinetic (7%)
    basal ganglia lesion
  3. mixed
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5
Q

Spastic CP results in

A

CMC is responsible for voluntary movements

resulting in
- paralysis and weakness
-voluntary control lost
-spastic cerebral palsy- cerebral motor cortex lesion

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6
Q

lesions on basal ganglia result in what

A

muscle movement directed by motor cortex

results in
-disturbance in posture and muscle tone
-tremors/involuntary movements
-dyskinetic cerebral palsy (long, slow, uncontrolled writhing)

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7
Q

lesions of the cerebellum

A

C is in charge of timing and patterns of muscle contraction

results in
-loss of smooth muscle contraction
-clumsy
-ataxic cerebral palsy

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8
Q

diagnosing CP

A
  1. motor tests (reflexes, clonus, catch, resisted strength, tone, gait)
  2. medical history (early traumatic event)
  3. functional tests (gait, impaired coordination, loss of proprioception
  4. retained primitive reflexes
  5. CT scan, MRI, US
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9
Q

clinical features of cerebral palsy
tone, strength, gait, coordination

A

-abnormal muscle tone
-abnormal gait patterns
-impaired coordination
-muscle weakness

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10
Q

hemiplegia is

A

affecting both limbs on one side of body (arm and leg)

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11
Q

what happens in gait for spastic hemiplegia

A

-foot drop due to weak tib ant, ankle equinas and tight posterior calf muscles

-ankle equinus and RF varus

-excessive knee and hip flexion for foot drop

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12
Q

most common deformity in diplagia is

A

bilateral equinovalgus

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13
Q

what happens in gait for diplagia

A

-increased knee flexion from
tight hamstrings

-increased hip flexion and anterior pelvic tilt giving a crouching gait look

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14
Q

what happens in quadriplegia gait

A

-foot drop
-increased knee flexion during stance
-reduced knee flexion during swing
-increased hip flexion with a forward lean and anterior pelvic tilt

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15
Q

clinical features of the gait of CP

A

-instabily in stance
-poor foot clearance in swing
-inadequate heel strike (Foot drop)
-inadequate step length
-excessive energy expenditure

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16
Q

typical manifesttions in hip, knee, ankle and foot of cerebral palsy

A

hip- flexed
knee- flexed
ankle- equinas
foot- valgus or varus and toe deformities (met adductus, HAV, lesser toe retraction/rotation)

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17
Q

treatment options for cerebral palsy. outside of pods and with pods

A

outside of pods:
- physical therapy
-oral/injectable drug therapy
-surgery- only in severe soft tissue contracture

pods- help move better:
1. foot orthoses- to stabilise STJ motion
2. ankle foot orthoses (AFO)- to stabilise STJ, ankle and knee motion
3. footwear therapy
4. footwear devices- heel raises
5. floor reaction ankle foot orthoses (AFO)

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18
Q

AFO is used when

A

-control of STJ and MTJ and
-control of ankle joint is required

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19
Q

what is spina bifida and when does it occur

A

failure of closure of spinal column causing a defect in the neural tube

occurs early in foetal development

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20
Q

types of spina bifida

A

occulta- absence of small portion of vertebrae which rarely affects nervous system

cystica- lump/cyst formation
-meningocele
-myelomeningocele

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21
Q

meningocele

A

lump in lumbar region caused by herniation of spinal meninges

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22
Q

myelomeningocele

A

severe form

open cyst and exposure of CSF, spinal canal and cord/nerves

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23
Q

clinical presentation of myelomeningocele

A

sacral dimples or hair tufting
leg weakness (flaccid paraparesis or paraplegia)
posterior chain atrophy
apropulsive steppage gait

24
Q

types of CMT

A

type 1- demyelination (onset in teens/twenties)

type 2- axonal degeneration (onset in adult life)

25
Q

what is CMT

A

hereditary motor and sensory neuropathy

autosomal dominant condition

26
Q

when is onset of CMT

A

within the first decade- type 1
adulthood- type 2

27
Q

clinical presentation of type 1 CMT

A

demyelination
-slow progressive foot drop due to wasting of peroneals
-nerve conduction are slowed
-peripheral nerves palpably enlarged

28
Q

clinical presentation of type 2

A

axonal degeneration
- onset is not until adulthood
-nerves arent palpable
-reduced nerve conduction

29
Q

patho of CMT

A

nerve conduction dysfunction results in weakness and atropy of the leg muscles and the posterior medial muscles gain advantage leading to lateral ankle instability/cavus foot type

this usually plateaus in adulthood

30
Q

clinical features of CMT

A

-weakness of leg muscles
-lateral ankle instability
-cavus foot type
-muscle wasting focal to anterolateral comp
-glove and stocking sensation loss
-lesser toe contracture
-tendon hyporeflexia

31
Q

diagnostic tests for CMT

A

neurological tests
-tendon reflexes (hyporeflexia)
- babinski (glove and stocking impaired sensation)
-muscle strength testing (weakness on lateral muscles)
-FPI

32
Q

treatment for CMT

A

to preserve ROM
-splinting
-surgical - PT tendon transfer
- orthoses and footwear aid

33
Q

what is duchenne muscular dystrophy

A

hereditary myopathy (progressive muscle atrophy)

34
Q

patho of DMD

A

Mutation at position 21 chromosome (short arm of X) so more common in men

35
Q

clinical features of DMD

A

most appear before age 5

-delayed independent walking
-muscle weakness
-abnormal gait
-falls
-difficulty with stairs
-muscle cramping/spasms

36
Q

gait patterns in DMD

A

waddling gait
lumbar lordosis
gowers sign positive
psudeohypertrophy of calf muscles (adipose)
toe walking due to proximal weakness

37
Q

prognosis of DMD

A

weelchair by 12 years
death early twenties

important to avoid immobilisation to offset contracture but also not overuse as it can speed up muscle breakdown

38
Q

diagnostic tests for DMD

A

-motor nerve tests
-ROM (equinovarus)
-muscle strength (weak)
-gowers sign (positive)
-milestones (delay in walking)
-gait (abnormal, falls, toe walking, waddling)
-run/hop (abnormal, absent)

39
Q

treatment of DMD

A

-splints
-braces
-orthoses/footwear in youth
-surgery- tendon transfers for ROM
-physiotherapy to avoid contracture

40
Q

What is autism

A

Restricted or hyper focused behaviours along with impaired social interaction

41
Q

Diagnosis checklist for autism

A
  • impaired social interaction/communication
    -preservative motor movements
    -need for routine
    -restricted range of interests/focuses
  • intense or diminished sensitivity to sensory/tatile stimuli
    -developmental regression
42
Q

Clinical features of autism

A

-regression of milestones
-hypotonia
-awkward motor skills
-neurocutaneous abnormalities
-seizures

43
Q

How to run a session with someone with autism

A

-run on time
-remove stimulus like bright lights or loud noises
-textures and colours of shoes/devices are important to them
-they may be focused on something in the room
-they may need to stim

44
Q

if toe walking is unilateral what are diagnosis

A
  • LLD
    -spastic hemiparesis
    -achilles tendonitis
    -rearfoot or forefoot equinas
    -coalition/ inclination angle (boney deformity)
45
Q

if toe walking is bilateral what Dx

A

-idiopathic/habitual
-spastic diplegia
-peripheral neuropathies
-muscular dystrophies
-learning disorder (ASD, schiz, OCD)
-spinal cord anomoly
-tight posterior chain (soft tissue contracture)

46
Q

questions for toe walking

A
  1. age of onset
  2. abnormal neuro exam?
  3. family history?
  4. posterior chain contracture?
47
Q

early onset of toe walking dx

A
  1. idiopathic
  2. spastic diplegic CP
  3. psychological (ASD, schiz)
48
Q

late onset of toe walking

A
  1. CP
  2. CMT
  3. DMD
  4. spinal cord anomalies
  5. juvenile MS

usually linked to a neuromuscular conditon

49
Q

idiopathic toe walking clinical features

A

-early onset
-positive family history (40%)
-neuro WNL
-milestones WNL
-balance/behaviour WNL
-achilles may not be tight in OKC

50
Q

CP toe walking clinical signs

A

premature birth
developmental delay
tight posterior chain
abnormal arm swing
gowers sign present

51
Q

what assessment can you use for toe walking

A

toe walking tool for ages 4-8 years

52
Q

Treatment of idiopathic toe walking

A

Equinas
- splinting
-serial casting series
-BTX-A
-surgery (tendo-Achilles lengthening)

Non Equinas
- FF plate
- heel raise
- orthoses
- AFO
-footwear shank stiffness dependent

53
Q

red flags with medical history on GALLOP form

A
  1. type of birth:
    vaginal (spontaneous or induced- can be linked to CP)
    c section (planned or emergency- increased risk of CP including delayed c section due to reduced oxygen levels)
  2. duration of term (full is 37 terms)- preterm linked to cp
  3. birth weight (less than 2.5kg is associated with cognitive delay, CP)

4.interventions (forceps- linked to cp)

  1. nursey and what for
  2. neonatal intensive care
54
Q

milestone beginning walking, crawling, sitting, walking time periods

A

concern if not hitting 2 or more milestones

beginning walking later than 20 months shows delay

crawling: 4-10 months
sitting 8-12 months
walking: 11-14 months

55
Q

milestones running, squatting, jumping time periods

A

running: 14-18 months
squatting: 12-18 months
jumping: 1.5 years - 2years

56
Q

milestones SLS, hopping, skipping time periods

A

single leg stance (1 sec): 2-3 years
hopping: 3-4 years
skipping: 4-5 years

YR3S2- PM4 (12 decks)

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