166 Neuromuscular Conditions, Examination, And Intervention

Front 1

Agnosia:

Back 1

inability to recognize familiar objects with one form of sensation (for example – visual agnosia)

Front 2

Akinesia:

Back 2

Inability to initiate movement

Front 3

Aphasia:

Back 3

Disturbance to language that results in errors in word choice, comprehension, or syntax

Front 4

What is expressive aphasia and what area of the brain is affected with this?

Back 4

Severe difficulty in verbal expression with impairment in object naming and writing abilities. This is found in Broccas area; mostly found in those with R hemiplegia

Front 5

What is the global aphasia?

Back 5

The most common and severe form of aphasia: characterized by reduced speech and comprehension. Reading and writing are impaired as well

Front 6

What is receptive aphasia and what area of the brain is affected with this?

Back 6

Severe disturbance and auditory comprehension. Reading, writing, and word recognition are also impaired. This is found in Wernecke's area

Front 7

apraxia:

Back 7

Inability to perform movements previously learned even though there is no loss of strength, coordination, sensation, or comprehension

Front 8

Ideational apraxia:

Back 8

Person no longer gets the idea of how to do a routine task; for example washing hands or brushing teeth

Front 9

Ideomotor apraxia:

Back 9

Person cannot do a task on command but can do it spontaneously

Front 10

Astereognosis:

Back 10

Inability to recognize objects by touch alone

Front 11

Asynergia:

Back 11

Inability to move muscles together in a coordinated manner

Front 12

Ataxia:

Back 12

Uncoordinated movement, especially gait

Front 13

Athetoid:

Back 13

Slow, involuntary, worm like, twisting motions. Usually seen in forms of cerebral palsy

Front 14

causalgia:

Back 14

Burning sensations, which are painful.

Front 15

What impairment or disorder is causalgia often associated with?

Back 15

Complex regional pain syndrome Type I (formerly reflex sympathetic dystrophy)

Front 16

Cheyenne-Stokes respiration:

Back 16

A common and bizarre breathing pattern characterized by periods of apnea lasting 10 to 60 seconds followed by gradually increasing, then decreasing depth and frequency of respirations.

Front 17

What does Cheyne-Stokes respirations accompany? What may it be a result of?

Back 17

it is postulated to be a result of an abnormality in the neurologic respiration center; can occur with severe cases of TBI or CHF

Front 18

Chorea:

Back 18

Rapid, involuntary jerking movements; seen especially in Huntington's disease

Front 19

Clonus:

Back 19

rhythmic oscillation of the muscle in response to sustained stretch in patients with upper motor neuron disease

Front 20

Decerebrate rigidity:

Back 20

Contraction of the extensor muscles of the upper and lower extremities because of an injury at the level of the brainstem

Front 21

Decorticate rigidity:

Back 21

Contraction of the flexor muscles of the upper extremities with contraction of the extensor muscles of the lower extremities

Front 22

Delirium:

Back 22

Temporary confusion and loss of mental function

Front 23

What is delirium often a result of?

Back 23

1) Illness

2) drug toxicity

3) lack of oxygen

Often reversible

Front 24

Dementia:

Back 24

Loss of memory or intellectual functioning

Front 25

In what cases may dementia be reversible?

Back 25

When caused by toxins, drugs, metabolic, or psychiatric disorders.

Front 26

In what cases is dementia often not reversible and slowly progressing?

Back 26

When it is a result of alcoholism, Alzheimer's disease, infarction, Parkinson's disease, etc.

Front 27

Dysmetria:

Back 27

Inability to judge distances

Front 28

What part of the brain is generally associated with dysmetria?

Back 28

Cerebellar dysfunction

Front 29

Electromyography (EMG):

Back 29

The study of a graphic record of the contraction of a muscle as a result of electrical stimulation. Used to evaluate the voluntary electrical activity of the muscle

Front 30

Glove and stocking anesthesia:

Back 30

Can occur in generalized peripheral neuropathy's in which the distal portions of the nerves degenerate resulting in anesthesia of the distal extremities in a pattern as if the patient were wearing long gloves and stockings

Front 31

What impairment is glove and stocking anesthesia occasionally scene with?

Back 31

Guillain-Barré

Front 32

Herpes zoster (shingles):

Back 32

A painful inflammation of the posterior root ganglion

Front 33

What causes herpes zoster?

Back 33

A virus

Front 34

What is the result (regarding presentation) of herpes zoster?

Back 34

The formation of vesicles (fluid filled sac) along the course of the nerds (dermatomal pattern)

Front 35

Horner's syndrome:

Back 35

Ptosis of the eyelid, construction of the pupil, and sweating of the ipsilateral face

Front 36

What does Horner's syndrome often accompany?

Back 36

stroke involving the anterior inferior or posterior inferior cerebellar arteries

Front 37

morton's neuroma:

Back 37

Often an excessive pronation during stance produces compression between the third and fourth metatarsals; The nerve can enlarge forming a neuroma on the inter-digital nerve resulting in metatarsalgia

Front 38

Nerve conduction velocity test (NCV)

Back 38

determines the speed of propagation of an action potential along a nerve or muscle fiber

Front 39

If the nerve is compressed or damaged, what happens to the velocity of action potential and latency?

Back 39

The velocity of the action potential will be slowed and the latency, or time the potential takes to travel between two points, will be increased.

Front 40

What is a nerve conduction velocity test utilized to determine?

Back 40

the severity of nerve compression (Ie: from a herniated disc) prior to surgery.

Front 41

Nystagmus:

Back 41

rapid, usually back and forth, movement of the eyeballs

Front 42

Reciprocal inhibition:

Back 42

inhibition of muscles antagonistic to those being facilitated

Front 43

What is reciprocal inhibition essential for?

Back 43

Coordinated movement

Front 44

Romberg's sign:

Back 44

loss of balance in standing when the eyes are closed

Front 45

Somatagnosia:

Back 45

A lack of awareness of the relationship of one's own body part or the body parts of others

Front 46

Vegetative state:

Back 46

a deep coma with abnormal posturing; the patient may not have rehabilitation potential if this state persists

Front 47

Visual acuity:

Back 47

sharpness of vision; generally decreases with age or certain disabilities such as diabetes

Front 48

What might people with visual acuity impairment require?

Back 48

Reading glasses to focus on or read things nearby

Front 49

What strategies may assist people with visual acuity impairments?

Back 49

Due to the decreased ability to adapt to very dark or light environments these people may need more or higher intensity lighting at home or use color contrast on the walls, floors, and stairs to increase safety during ambulation.

Front 50

Name the three common visual field deficit.

Back 50

1) Homonymous hemianopsia, 2) Bitemporal hemianopsia, 3) blindness in one eye a.k.a. monocular blindness

Front 51

Homonymous hemianopsia:

Back 51

a visual deficit of either the right or left halves of both eyes

Front 52

What causes a Homonymous hemianopsia?

Back 52

Damage to the contralateral optic tract

Front 53

Bitemporal hemianopsia:

Back 53

a visual deficit of the outside halves of both eyes

Front 54

What causes bitemporal hemianopsia?

Back 54

Injury at the optic chasm

Front 55

What is another term for bitemporal hemianopsia?

Back 55

Tunnel vision

Front 56

What is monocular blindness or blind in one eye a result of?

Back 56

Damage to the optic nerve

Front 57

Cerebral vascular accident:

Back 57

arterial occlusion or hemorrhage in the brain

Front 58

Stroke produces focal signs specific to what?

Back 58

The artery involved

Front 59

What are the most common sites for lesions to occur ( with regard to stroke)?

Back 59

1) The origin of the common carotid artery me, 2) at the main bifurcation of the middle cerebral artery, 3) at the junction of the vertebral arteries with the basilar artery

Front 60

What artery is most commonly involved in a stroke?

Back 60

MCA a.k.a. middle cerebral artery

Front 61

A stroke that presents with contralateral hemiplegia, mostly upper extremity involvement, and loss of sensation primarily in the arm and face is likely to stem from a lesion where?

Back 61

MCA

Front 62

A stroke that presents with Homonymous hemianopsia is commonly due to a lesion where?

Back 62

MCA a.k.a. middle cerebral artery

Front 63

An infarction in a dominant left hemisphere may produce what type of presentation?

Back 63

Aphasia and apraxia

Front 64

Occlusion of the main stem of the MCA can cause what?

Back 64

Global aphasia

Front 65

This artery is rarely involved, however when it is involved in a stroke the lower extremity is more frequently affected; what artery is this?

Back 65

Anterior cerebral artery

Front 66

A lesion in this area will often result in contralateral hemiplegia and sensory loss

Back 66

Anterior cerebral artery

Front 67

A lesion in what area can result in mental confusion, aphasia, and contralateral neglect if involvement is extensive on the dominant side?

Back 67

Anterior cerebral artery

Front 68

A lesion in what area presents as persistent pain syndrome or contralateral pain and temperature sensory loss?

Back 68

Posterior cerebral artery

Front 69

Homonymous hemianopsia, aphasia, and thalamic pain syndrome can result from the occlusion of this artery

Back 69

posterior cerebral artery

Front 70

A lesion in what area often results in death from the edema associated with the infarct?

Back 70

Vertebral basilar

Front 71

If a patient survived a vertebral basilar lesion affecting the pons what could be the result?

Back 71

Quadriparesis and bulbar palsy or a "locked in state" whereby the patient can only communicate by eye blinking

Front 72

What are other the vertebral artery symptoms?

Back 72

1) vertigo, 2) coma, 3) diplopia, 4) nausea, 5) dysphasia (difficulty swallowing), and 6)ataxia

Front 73

Stages of recovery following a stroke: what is present early, often with no voluntary movement?

Back 73

Flaccidity

Front 74

Stages of recovery following a stroke: what might the flaccid stage be followed by?

Back 74

1) spasticity, 2) hyperreflexia, 3) synergies (mass patterns of movement)

Front 75

Stages of recovery following a stroke: late in recovery, what type of movement patterns become possible?

Back 75

Isolated and advanced movement patterns

Front 76

Stages of recovery following a stroke: describe stage 1

Back 76

flaccid, no limb movement

Front 77

Stages of recovery following a stroke: describe stage 2

Back 77

1) synergies may appear, 2) Spasticity begins to develop, 3) minimal voluntary control

Front 78

Stages of recovery following a stroke: describe stage 3

Back 78

1) spasticity increases and may become severe, 2) voluntary control of movement synergies appear

Front 79

Stages of recovery following a stroke: describe stage 4

Back 79

1) some movement independent of synergies, 2) spasticity begins to decline

Front 80

Stages of recovery following a stroke: describe stage 5

Back 80

if patient progresses, synergies no longer dominate and movement becomes more complex

Front 81

Stages of recovery following a stroke: describe stage 6

Back 81

1) spasticity is gone, 2) coordination and movement approach normal

Front 82

Synergies:

Back 82

primitive and stereotyped movement patterns associated with spasticity

Front 83

How may synergies be elicited?

Back 83

Reflexively, as associated reactions or as voluntary movement patterns

Front 84

What are the two basic synergies of each extremity?

Back 84

Flexion synergy and extensor synergy

Front 85

What does flexion synergy of the upper extremity present as?

Back 85

1) scapular elevation and retraction, 2) shoulder abduction and external rotation, 3) elbow flexion (generally the strongest component), 4) forearm supination and 5) wrist/finger flexion

Front 86

What does flexion synergy of the lower extremity present as?

Back 86

1) hip flexion (generally the strongest component), abduction, external rotation; 2) knee flexion; 3) ankle dorsiflexion and inversion, 4) toe dorsiflexion

Front 87

Extensor synergies are exactly the opposite of flexor synergies except for what?

Back 87

Except for wrist/finger flexion and ankle inversion, which are common to both

Front 88

When do tonal changes occur in patients?

Back 88

In patients following a stroke as well as with other neurological conditions

Front 89

Name one positive and one negative effect of tone?

Back 89

It can interfere with function or can be used to develop movement patterns (synergies)

Front 90

Hypotonicity:

Back 90

floppy, low tone, flaccid, risk of dislocation of atlantoaxial joint (spinal cord injury potential), hip, knee, elbow, shoulder, etc.

Front 91

What two things are associated with hypotonicity?

Back 91

1) Hypoactive reflexes and 2) shallow breathing patterns

Front 92

What are treatments for hypotonicity?

Back 92

1) avoid hyperextension, 2) work for joint compression and facilitation to help normalize tone, 3) use resistance of functioning muscles and isometric holding to increase activation of inactive muscles, 4) facilitation techniques

Front 93

Name some facilitation techniques for treating hypotonicity:

Back 93

1) quick stretch, 2) tapping of muscle belly or tendon, 3) high frequency vibration, 4) light touch, 5) quick icing, 6) fast spinning or rolling.

Front 94

In a patient with hypotonicity, what does joint approximation facilitate?

Back 94

cocontraction

Front 95

Hypertonicity:

Back 95

spastic, high tone with hyperactive reflexes, and decreased thoracic mobility

Front 96

Individuals with hypertonicity are at risk for what?

Back 96

Contractures and deformity

Front 97

With hypertonicity can changes in body position affect tone?

Back 97

Yes

Front 98

What are treatments for hypertonicity?

Back 98

1) work to inhibit reflex activity, 2) inhibition techniques, 3) reciprocal inhibition

Front 99

How can a PT assist to inhibit reflex activity in a patient with hypertonicity?

Back 99

through the following: 1) postures, 2) positions, 3) techniques of relaxation training

Front 100

What are some inhibition techniques that are used as treatments for hypertonicity?

Back 100

1) prolonged static muscle stretch, 2) inhibitory casting, 3) slow repetitive rocking or rolling, 4) very low frequency vibration, 5) reflex inhibiting postures, 6) limb movements emphasizing rotation, 7) slow stroking, 8) neutral warmth, 9) prolonged icing, 10) deep pressure to tendons

Front 101

Reciprocal inhibition:

Back 101

using facilitation techniques to the non-spastic muscles will cause inhibition of the spastic muscles

Front 102

Why do gait problems occur following a stroke?

Back 102

1) due to sensation impairments, 2) due to perception impairments, 3) due to motor control impairments

Front 103

What are some common gait problems at the TRUNK-PELVIS following a stroke when the patient is in stance phase?

Back 103

1) unawareness of affected side due to poor proprioception, 2) forward trunk from weak hip flexion or extension contracture

Front 104

What are some common gait problems at the HIP following a stroke when the patient is in stance phase?

Back 104

1) poor hip position (typically adduction or flexion) as a result of poor proprioception, 2) Trendelenburg gait due to weak abductors on contralateral side, 3) scissoring as a result of spastic adductors.

Front 105

What are some common gait problems at the KNEE following a stroke when the patient is in stance phase?

Back 105

1) flexion during forward progression from a flexion contracture combined with weak knee extensors and/or poor proprioception, 2) hyper extension during forward progression do the plantarflexion contracture past 90° or severe spasticity in quadriceps or weak knee extensors (compensatory locking of the knee)

Front 106

What are some common gait problems at the ANKLE-FOOT following a stroke when the patient is in stance phase?

Back 106

1) Equinus gait (heel does not touch the ground) from spasticity or contractures of gastroc-soleus, 2) unequal step length due to hammertoes caused by spastic toe flexors

Front 107

What are some common gait problems at the TRUNK-PELVIS following a stroke when the patient is in swing phase?

Back 107

1)insufficient forward pelvic rotation from weak abdominal muscles, 2) inclination to sound side for foot clearance because of weakness of hip flexor muscles

Front 108

What are some common gait problems at the HIP following a stroke when the patient is in swing phase?

Back 108

1)inadequate flexion from weak hip flexors, 2) poor proprioception, 3) spastic quadriceps, 4) hip abductor weakness of opposite side, 5) exaggerated hip flexion due to strong flexor synergy

Front 109

What are some common gait problems at the KNEE following a stroke when the patient is in swing phase?

Back 109

1)inadequate knee flexion from spastic quadriceps or reduced hip flexion, 2) exaggerated but delayed knee flexion because of strong flexor synergy, 3) inadequate knee extension at weight acceptance due to spastic hamstrings or sustained total flexor pattern

Front 110

What are some common gait problems at the ANKLE-FOOT following a stroke when the patient is in swing phase?

Back 110

1)persistent equinovarus from plantarflexor contracture or spasticity, weak dorsiflexors, delayed contraction of dorsiflexors (toe drag during midswing), 2) Varus position of foot from spastic anterior tibialis, weak peroneals, and toe extensors, 3) exaggerated dorsiflexion due to strong flexor synergy pattern

Front 111

Perceptual problems associated with right hemisphere stroke or damage to the brain:

Back 111

left hemiparesis, 1) problems with spatial relationships and hand eye coordination, 2) irritability, short attention span, 3) cannot retain information, difficulty learning individual steps, 4) poor judgment affecting personal safety, 5) diminished body image with left-sided neglect, 6) quick and impulsive

Front 112

Perceptual problems associated with left hemisphere stroke or damage to the brain:

Back 112

right hemiparesis, 1) apraxia, 2) difficulty starting and sequencing tasks, 3) perseveration, 4) easily frustrated with high levels of anxiety, 5) inability to communicate verbally, 6) cautious and slow

Front 113

Functional considerations regarding MOBILITY ACTIVITIES following a stroke:

Back 113

1) initially, focus on using both sides of the body (compensatory training approach), 2) provide guided or active assistive movement (augmented feedback) early in the rehabilitation process, 3) focus on rolling, sitting up, bridging, sitting, standing, and transfers, 4) upright activities should focus on control in both sitting and standing.

Front 114

Upright activities per individual following a stroke should follow what progression?

Back 114

1) holding a posture (stability), 2) moving in a posture (controllability), and 3) dynamic challenges to balance (example in sitting, initially maintain proper pelvic alignment)

Front 115

How should transfers be taught to patients following a stroke?

Back 115

To both sides to promote reeducation and reintegration of the two sides of the body

Front 116

What are some respiratory activities for a patient following a stroke?

Back 116

1) improve chest expansion, 2) stress diaphragmatic breathing and combine respiratory activities with movement patterns, 3) avoid Valsalva maneuver

Front 117

How can one improve chest expansion following a stroke?

Back 117

With the use of manual contacts, resistance, and stretch to chest wall segments

Front 118

How can one combine respiratory activities with movement patterns in a patient (following a stroke)?

Back 118

Inspiration with PNF reverse chop and expiration with chop

Front 119

Visualize Decerebrate vs Decorticate Posturing/Synergies and then look at the picture in the answer to see if you were right

Back 119

Front 120

On the other side of this card is a visual to help you remember how a patient with a R sided stroke may present

Back 120

Front 121

On the other side of this card is a visual to help you remember how a patient with a L sided stroke may present

Back 121

Front 122

Oromotor activities following a stroke: describe appropriate posture for a patient following CVA.

Back 122

Establish a right sitting posture with hips well back, symmetrical weight-bearing, and feet flat on the floor

Front 123

Oromotor activities following a stroke:describe appropriate head position for a patient following CVA.

Back 123

Head in normal position, not extended or tipped back, to avoid aspiration or choking, and promote normal swallowing.

Front 124

Oromotor activities following a stroke: initially following a CVA how should food be prepared for a patient?

Back 124

initially semi moist then progressing to foods rich in taste, smell, and texture to aid in swallowing

Front 125

Oromotor activities following a stroke: how can patients be assisted using facilitation techniques?

Back 125

With jaw closure, lip closure, or tongue control using facilitation techniques (examples: quick ice, quick stretch, or resistance)

Front 126

Oromotor activities following a stroke: what can stimulate the posterior elevation of the tongue for swallowing?

Back 126

Firm pressure applied to the anterior third of the tongue

Front 127

Oromotor activities following a stroke: what can stimulate sucking?

Back 127

Deep pressure to the neck above the thyroid notch

Front 128

What is the best way to communicate with a patient with receptive aphasia?

Back 128

Use word repetition and manual cues

Front 129

What is the best way to communicate with a patient with expressive aphasia?

Back 129

Phrase questions for simple yes or no responses to avoid confusion and frustration

Front 130

What is the best way to communicate to a patient with global aphasia?

Back 130

Uses symbolic gestures to reduce the chance of overestimating the patient's ability to understand speech

Front 131

Rancho Los Amigos levels of cognitive functioning:

Back 131

A descriptive scale of response to stimuli that is useful for communicating or documenting general cognitive and/or behavioral status of a patient with a TBI

Front 132

Typical presentation of a patient at Ranchos Los Amigos Level 1:

Back 132

no response; completely unresponsive to any stimuli

Front 133

Typical presentation of a patient at Ranchos Los Amigos Level 2:

Back 133

Generalized response: patient reacts inconsistently and non-specifically to stimuli

Front 134

Typical presentation of a patient at Ranchos Los Amigos Level 3:

Back 134

Localized response; patient reacts inconsistently but specifically to stimuli

Front 135

Typical presentation of a patient at Ranchos Los Amigos Level 4:

Back 135

confused-agitated; patient is in a heightened state of activity; behavior is bazaar and non-purposeful relative to the immediate environment; recall an attention span are poor

Front 136

Typical presentation of a patient at Ranchos Los Amigos Level 5:

Back 136

confused -inappropriate; patient is able to respond to simple commands but not do complex tasks; memory is impaired; verbalization is inappropriate

Front 137

Typical presentation of a patient at Ranchos Los Amigos Level 6:

Back 137

confused-appropriate; patient is dependent upon external input but can perform consistently; memory improved

Front 138

Typical presentation of a patient at Ranchos Los Amigos Level 7:

Back 138

automatic – appropriate; can perform automatically and appropriately in structured environments; judgment remains impaired

Front 139

Typical presentation of a patient at Ranchos Los Amigos Level 8:

Back 139

purposeful – appropriate; patient ask appropriately though not perfect; may have some problems in stressful or unusual circumstances

Front 140

Glasgow Coma scale:

Back 140

Objective way to describe the patient's level of consciousness

Front 141

What are the subcategories within each category of the Glasgow coma scale quantified with?

Back 141

1) eye-opening – spontaneous to none, 2) best motor response – follows commands to abnormal responses to no response, 3) verbal response – oriented to inappropriate to no response

Front 142

What score on the Glasgow Coma scale is indicative of severe brain injury?

Back 142

8 or less

Front 143

Arousal:

Back 143

the overall level of alertness or reaction to stimulus

Front 144

What is low arousal associated with?

Back 144

coma

Front 145

High arousal may occur during which state following a TBI?

Back 145

The agitated state

Front 146

What may help patients in a high state of arousal (with regard to daily routine)?

Back 146

A quiet environment and consistency in management

Front 147

What behavioral difficulties may interfere with therapy and persist over time in a patient with a TBI? What are the characteristics of these behaviors?

Back 147

1) depression: crying, apathetic, poor self-care, 2) dependent: childlike, follows therapist around, 3) denial: blames others for problems or lack of progress; may not go to treatment, 4) aggressive; physically abusive or verbal obscenities, 5) sexually appropriate: verbally or physically, 6) agitated: the frustration tolerance, combative, impatient, 7) poor judgment: regarding actions and behaviors

Front 148

Treatment strategies for behavioral problems when working with the patient status post TBI:

Back 148

1) use a calm voice, perhaps a reassuring touch, 2) if patient becomes disruptive, redirect patient away from frustrating experiences, 3) set limits on behavior and give positive feedback, 4) offer treatment choices to patient and to give greater patient responsibilities to increase self-esteem, 5) remove patient from treatment environment ("timeout") only in the patient becomes overstimulated and strikes out at the therapist, 6) avoid surprises; keep therapist and schedule consistent,7) keep verbal instructions and descriptions to a minimum, 8) practice should follow right after demonstration of the activity, 9) use a memory log with key information (address, phone number, apartment floor, etc.) if the patient demonstrates memory loss; patient can carry it or attach it to clothing when leaving the home, 10) it may take up to a year or more before a patient with a TBI achieves maximal functional return

Front 149

Name a strategy to use of the patient becomes disruptive

Back 149

redirect patient away from frustrating experiences

Front 150

What does offering treatment choices to patients and giving them greater responsibilities produce?

Back 150

increased self-esteem

Front 151

When should you remove the patient from the treatment environment (timeout)?

Back 151

Only the patient becomes overstimulated and strikes out of the therapist

Front 152

How can you avoid surprises when working with the patient status post TBI?

Back 152

Keep therapist and schedule consistent

Front 153

What is the best way to communicate with the patient experiencing behavioral problems status post TBI?

Back 153

Keep verbal instructions and descriptions to minimum

Front 154

What should follow right after the demonstration of an activity?

Back 154

Practice

Front 155

What can help with the patient demonstrates memory loss?

Back 155

Using a memory log with key information

Front 156

Amyotrophic lateral sclerosis a.k.a. Lou Gehrig's disease:

Back 156

a degenerative disease that involves both upper and lower motor neuron; cranial nerves may be affected as well

Front 157

What are signs and symptoms of ALS?

Back 157

1) muscle weakness is progressive and can affect muscles of respiration, 2) weakness may appear in hands first 3) dysarthria and dysphasia (difficulty swallowing), 4) muscle atrophy, cramping, and fasciculations (LMN signs), 5) spasticity and hyperreflexia (UMN signs), 6) often no sensory changes

Front 158

What type of motor neuron sign includes muscle atrophy, cramping, and fasciculations?

Back 158

Lower motor neuron (LMN)

Front 159

What type of motor neurons fine includes spasticity and hyperreflexia?

Back 159

Upper motor neuron (UMN)

Front 160

What are some treatments that are used with patients who have ALS?

Back 160

1) maintain respiratory function and activity level, 2) PROM exercises, 3) positioning and skincare, 4) prevent further deconditioning and disuse atrophy and, 5) avoid overworking muscles and teach energy conservation, 6) symptomatic treatment of pain, spasm, and spasticity, 7) provide psychological support and reassurance

Front 161

Bells palsy:

Back 161

An inflammatory response resulting in paralysis of the muscles of facial expression

Front 162

What nerve is affected in Bells palsy?

Back 162

Facial nerve (CN 7); the branch of CN 7 affected will dictate symptoms

Front 163

How will a patient with bells palsy present?

Back 163

The patient may have difficulty in wrinkling forehead, closing the eye tightly, and smiling; Signs and symptoms may vary depending on the branch of the nerve involved but may include loss of control of salvation, one sided facial muscle weakness or paralysis, or normal sensation; the mouth may droop and the patient may have decreased taste sensation with the anterior two thirds of the tongue

Front 164

What are possible treatments for bells palsy?

Back 164

1) artificial tears or temporary patch and protects the cornea, 2) Electrical stimulation to maintain tone and support function of facial muscles, 3) teach facial muscle exercises, 4) provide functional retraining (chewing on the opposite side)

Front 165

Guillain-Barré syndrome – GBS:

Back 165

polyneuropathy of probable immune-mediated viral origin, resulting in the metric motor paralysis and progressive muscular weakness that develops quickly

Front 166

What are signs and symptoms of Guillain-Barré syndrome?

Back 166

1) LMN disease affecting the cranial and peripheral nerves, 2) some sensory loss in stocking glove pattern and parenthesis including tingling and burning, 3) muscle weakness and atrophy progressing from lower extremities to upper and from distal to proximal, 4) may produce full tetraplegia with respiratory failure, 5) tachycardia, and abnormalities in cardiac rhythm, and blood pressure changes, 6) recovery is slow (up to one year) with some mild weakness persisting and a 3% mortality

Front 167

What type of motor neuron disease is Guillain-Barré syndrome?

Back 167

Lower motor neuron disease affecting the cranial and peripheral nerves

Front 168

In Guillain-Barré syndrome, what pattern does sensory loss occur?

Back 168

In a glove and stocking pattern

Front 169

When a patient experiences Guillain-Barré syndrome which muscles we can and atrophy first?

Back 169

Lower extremities first then upper; distal to proximal

Front 170

What vital sign changes may occur in a patient with Guillain-Barré syndrome?

Back 170

1) tachycardia, 2) abnormalities in cardiac rhythm, 3) blood pressure changes

Front 171

How is treatment administered to the patient with Guillain-Barré syndrome?

Back 171

It is based on the phase of the syndrome

Front 172

During the ascending phase (disease progressing) of Guillain-Barré syndrome, what treatment is provided?

Back 172

1) Respiratory function (pulmonary PT), 2) PROM within tolerance, 3) positioning to reduce contractures, 4) skin care to prevent breakdown

Front 173

During the stabilization phase of Guillain-Barré syndrome, what treatment is provided to the patient?

Back 173

1) Prevention of injury to denervated muscles, 2) avoiding overused and fatigue, 3) beginning gentle stretching and initiating movement in a controlled environment

Front 174

During the descending phase (paralysis slowly recedes) of Guillain-Barré syndrome what treatment is provided?

Back 174

1) muscle re-education with a moderate exercise program, 2) improve cardiovascular fitness, 3) teach energy conservation

Front 175

What type of disease is multiple sclerosis – MS?

Back 175

a demyelinating disease

Front 176

In what climate is multiple sclerosis more prevalent?

Back 176

colder climates

Front 177

How does multiple sclerosis progress?

Back 177

The disease may be relatively mild, have bouts of remission and exacerbation, or get progressively worse

Front 178

What are signs and symptoms of multiple sclerosis?

Back 178

1) sensory disturbances including tingling, numbness, and pain, 2) coordination problems and spasticity, 3) fatigue (especially in the afternoon), 4) diplopia, 5) bowel and bladder problems, 6) communication disorders, 7) psychosocial problems including euphoria and or depression, 8) adverse reactions to heat (caution with heating modalities and hot environment)

Front 179

What type of sensory disturbances might an individual with multiple sclerosis experience?

Back 179

1) tingling, 2) numbness, 3) pain

Front 180

In a patient with multiple sclerosis what might over vigorous exercise or activity cause?

Back 180

Fatigue that may worsen symptoms

Front 181

What time of day our sessions preferred for a patient with multiple sclerosis?

Back 181

Morning treatment sessions

Front 182

What type of disease is Parkinson's disease and what is affected?

Back 182

It's a progressive disease affecting the basal ganglia

Front 183

What neurotransmitter or receptor is decreased in a patient with Parkinson's these?

Back 183

Dopamine production and or dopamine receptors in the brain or decreased

Front 184

What are signs and symptoms of Parkinson's disease?

Back 184

1) tremor, rigidity, and fatigue, 2) difficulty initiating or slowness of movement (bradykinesia), 3) abnormal gait (festinating or slow shuffling), 4) flexed posture, 5) mask-like face, 6) decreased postural reflexes, 7) behavioral changes including memory loss or apathy that can lead to secondary problem including decubitus ulcer's, muscle atrophy, contractures, decreased vital capacity, and falls

Front 185

What type of movements and gait do patients with Parkinson's typically present with?

Back 185

difficulty initiating movement, bradykinesia, and a festinating or slow shuffling gait

Front 186

What type of posture do patients with Parkinson's disease tend to present with?

Back 186

Flexed posture

Front 187

What are PT treatments for patients with Parkinson's disease?

Back 187

Gait training to increased stride width and length, 2) breathing exercises, 3) relaxation techniques (examples: gentle rhythmic rocking, vestibular stimulation, and prone on a large ball), 4) mobility exercises, 5) PNF diagonals with rhythmic initiation to overcome bradykinesia, 6) range of motion activities including PNF contract – relax, inhibitory casting, or orthoses, 7) avoid excessive exercise or stretching; pain or lack of endurance could lead to fatigue

Front 188

What type of relaxation techniques might be used for a patient with Parkinson's disease?

Back 188

1) gentle rhythmic rocking, 2) vestibular stimulation, 3) prone on a large ball

Front 189

What activity may overcome bradykinesia in a patient with Parkinson's disease?

Back 189

PNF diagonals with rhythmic initiation

Front 190

What type of range of motion activities might be implemented for a patient that has Parkinson's disease?

Back 190

1) PNF contract – relax, 2) inhibitory casting, 3) orthoses

Front 191

Why would you want to avoid excessive exercise or stretching with the patient that has Parkinson's disease?

Back 191

Pain or lack of endurance could lead to fatigue

Front 192

What artery would a lesion affect if the patient presented with unilateral deafness, loss of pain and temperature on the contralateral side, paresis of lateral gaze, unilateral Horner's syndrome (ptosis, constricted pupils, and loss of sweating), plus ataxia, vertigo, and nystagmus?

Back 192

anterior inferior cerebral artery AICA

Front 193

What artery would a lesion affect if the patient presented with severe ataxia, dysarthria (loss of muscle articulation control), dysmetria (finger to nose test), and contralateral loss of pain and temperature?

Back 193

Superior cerebellar artery

Front 194

What does the patient with Wallenberg's syndrome present with?

Back 194

Vertigo, nausea, hoarseness, dysphasia, ptosis, and decreased impairment of sensation and ipsilateral face and contralateral torso and limbs.

Front 195

What artery would a lesion affect if the patient presented with Wallenberg's syndrome and possibly Horner's syndrome?

Back 195

Posterior inferior cerebellar artery PICA

Front 196

Dopamine agonist medications may be used for what?

Back 196

Tremor and Brady can Ezio in patients with Parkinson's disease.

Front 197

Dopamine agonist medications I do what overtime?

Back 197

Lose their effectiveness

Front 198

What time of day is it best to treat patients following dopamine agonist administration?

Back 198

In the a.m. after they have had their medication

Front 199

Post polio syndrome:

Back 199

a new form of muscular dystrophy that may occur decades after the initial episode of polio

Front 200

With post polio syndrome how does new denervation occur?

Back 200

With asymmetrical muscular weakness

Front 201

What are signs and symptoms of post polio syndrome?

Back 201

1) myalgia, 2) joint pain, 3) variable asymmetrical muscle atrophy with decreased strength, 4) excessive fatigue and decreased endurance which contribute to loss of function

Front 202

What are possible treatments for post polio syndrome?

Back 202

1) low intensity exercise never to the point of fatigue (stop exercise with pain or weakness), 2) use orthotic device as needed to improve function, 3) work on endurance and energy conservation techniques

Front 203

What are some presentations of Charcot Marie tooth disease?

Back 203

1) stored like deformity, 2) footdrop, 3)distal lower extremity muscle weakness

Front 204

Pain syndromes: neuropathic –

Back 204

pain as a result of lesions in some part of the nervous system

Front 205

What is neuropathic pain usually accompanied by?

Back 205

Some degree of sensory deficit

Front 206

What type of pain is Thalamic pain?

Back 206

Neuropathic

Front 207

How does someone with Thalamic pain present?

Back 207

With continuous, intense pain occurring on the contralateral hemiplegic side

Front 208

What is Thalamic pain the result of?

Back 208

Stroke involving the posterior cerebral artery – PCA

Front 209

What type of pain is complex regional pain syndrome?

Back 209

Neuropathic

Front 210

What is complex regional pain syndrome formally referred to as?

Back 210

Reflex sympathetic dystrophy

Front 211

What is nervous system is complex regional pain syndrome maintained by?

Back 211

the sympathetic nervous system

Front 212

How would a patient with complex regional pain syndrome present?

Back 212

1) burning pain (causalgia), 2) hypersensitivity to light touch, 3) coldness, 4) sweating

Front 213

What is complex regional pain syndrome usually associated with?

Back 213

Traumatic injury

Front 214

What are selected neuropathic techniques?

Back 214

Treatment strategies for patients with neurological dysfunction which include neuromuscular facilitation, sensory stimulation, and exercises designed to reduce impairments and improve function of involved body segments

Front 215

Proprioceptive neuromuscular facilitation – PNF:

Back 215

uses total patterns of movement and posture to promote motor learning in synergistic muscle patterns and prepare the body for advanced and I'll skills (for example – date)

Front 216

PNF diagonal D1 Flexion upper extremity:

Back 216

Starts with glenohumeral medial rotation, abduction and extension then goes to lateral rotation, adduction and flexion

Front 217

PNF diagonal D1 Flexion lower extremity:

Back 217

Starts with his medial rotation, abduction and extension then goes to lateral rotation, adduction and flexion

Front 218

PNF diagonal D2 Flexion upper extremity:

Back 218

starts with glenohumeral medial rotation, adduction and extension then goes to lateral rotation, abduction and flexion

Front 219

PNF diagonal D2 Flexion lower extremity:

Back 219

starts with hip lateral rotation adduction and extension then goes to medial rotation, abduction and flexion

Front 220

What might diagonal patterns of the head and trunk be used for?

Back 220

To enhance breathing and movement patterns

Front 221

What PNF activity the silicate rolling to prone position?

Back 221

supine or sitting chopping

Front 222

How is supine or sitting chopping performed?

Back 222

Upper trunk flexion with rotation and upper extremity D1 extension (facilitates rolling to prone position)

Front 223

What is another supine PNF pattern that can be used to enhance breathing and moving?

Back 223

Supine lower trunk flexion with rotation to right or left; needs flexing

Front 224

What does lower extremity D1 flexion help with?

Back 224

Rolling in any direction

Front 225

Approximation:

Back 225

joint compression

Front 226

What is approximation used for (think PNF)?

Back 226

to stimulate afferent nerve endings and facilitate postural extensors promoting stability

Front 227

Agonist reversals (AR):

Back 227

Slow isotonic shortening contractions through the range followed by eccentric lengthening contractions with the same muscle group

Front 228

What are agonist reversals used for?

Back 228

Weak postural muscles, inability to eccentrically control body weight during movement transitions (example – sitting down)

Front 229

Contract – relax (CR):

Back 229

isotonic movement in rotation followed by an isometric hold of the range limiting muscles in the antagonistic pattern against slowly increasing resistance, then passive motion and active contraction of the agonistic pattern

Front 230

When is contract– relax indicated?

Back 230

with limited range of motion caused by muscle tightness or spasticity

Front 231

Hold – relax (HR):

Back 231

isometric contraction of the antagonistic happen against slowly increasing resistance, followed by voluntary relaxation and passive movement into the newly gained range of the agonist pattern.

Front 232

Hold – relax active contraction (HRAC):

Back 232

Active contraction of the agonist performed which relaxes the antagonist through receptacle inhibition

Front 233

When is hold – relax and hold – relax active contraction indicated?

Back 233

With limitations in range of motion due to muscle tightness, spasm, or pain

Front 234

Repeated contractions (RC):

Back 234

repeated isotonic contractions induced by quick stretches and enhanced by resistance performed through the range or part of range at a point of weakness

Front 235

When should it repeated contractions be used?

Back 235

With 1) weakness, 2) incoordination, 3) muscle imbalances, and 4) lack of endurance

Front 236

Rhythmic initiation (RI):

Back 236

voluntary relaxation followed by passive movement through increasing our ROM, followed by active – assisted contractions progressing to resisted isotonic contractions

Front 237

When is rhythmic initiation indicated?

Back 237

With 1) spasticity, 2) rigidity, 3) hypertonicity and the inability to initiate motion (apraxia), 4) Motor learning deficits, 5) communication deficits (aphasia)

Front 238

Rhythmic stabilization (RS):

Back 238

simultaneous isometric contractions of both agonistic and and agonistic patterns performed without relaxation using careful grading of resistance

Front 239

Co-contraction of opposing muscle groups is part of what type of PNF?

Back 239

rhythmic stabilization

Front 240

When is rhythmic stabilization indicated?

Back 240

1) Instability in weight-bearing and holding, 2) poor antigravity control, 3) weakness, 4) ataxia, 5) limited range of motion caused by muscle tightness, 6) painful muscle splinting

Front 241

Slow reversal (SR) and slow reversal hold (SRH):

Back 241

Alternating isotonic contractions of agonist and antagonist patterns using careful grading of resistance and optimal facilitation.

Front 242

What is the difference between slow reversal hold and slow reversal?

Back 242

In SRH, an isometric hold is added at the end of the range at a point of weakness

Front 243

When is slow reversal and slow reversal hold indicated?

Back 243

1) Inability to reverse directions, 2) muscle weakness or imbalance, 3) incoordination, 4) lack of endurance

Front 244

Traction:

Back 244

separation of joint surfaces

Front 245

When is traction indicated?

Back 245

1) facilitates flexor muscles and 2) mobilizing patterns

Front 246

Exteroceptive stimulation:

Back 246

facilitation techniques applied to the antagonist to inhibit the agonist via reciprocal inhibition

Front 247

Name some Exteroceptive stimulation FACILITATION techniques and what they are used for

Back 247

1) repetitive brushing– Facilitates tactile receptors and movement responses, 2) Quick icing – for muscles, 3) quick stretch or tapping – agonist tendon or muscle belly is stimulated, 4) high-frequency vibration – 50 to 300 Hz to agonist

Front 248

Name some Exteroceptive stimulation INHIBITION techniques and what they are used for

Back 248

1) prolonged icing – inhibits muscle, 2) neutral want – relaxation by wrapping patient in towels or blankets to decreased postural tone, 3) prolonged stretch – muscle tone decrease, 4) low frequency vibration – 5 to 50 Hz inhibition of agonist, 5) pressure on tendons – firm, constant pressure may decrease tone

Front 249

What are some examples of the vestibular stimulation and what are the effects?

Back 249

1) Slow rocking, rolling on ball– Inhibits postural tone and has a calming effect, 2) fast spinning – the silicates postural tone and promote head writing, 3) head down position, prone over large ball– can activate postural extensors of neck, trunk, and proximal joint – has a soothing effect especially for sympathetic responses

Front 250

Neurodevelopmental treatment – NDT, Bobath:

Back 250

The idea that motor learning (or relearning) can be facilitated by repetition and experience in the environment

Front 251

What does NDT inhibit?

Back 251

Unwanted activity precedes practice of normal motor patterns (for example abnormal tone or reflex patterns)

Front 252

Guided movement falls under what type or category of treatment?

Back 252

NDT

Front 253

Guided movement:

Back 253

active movements that are guided or assisted only when needed

Front 254

When (at what point) is guided movement used in the rehabilitation process?

Back 254

Early in the rehabilitation process

Front 255

Normalization of postural tone includes what?

Back 255

1) efforts are made to increased tone if hypotonic or decrease tone if hypertonic, 2) abnormal patterns of movement and reflexes are inhibited or prevented

Front 256

Normalization of sensory or perceptual experiences falls under what type or category of treatment?

Back 256

NDT

Front 257

What is normalization of sensory or perceptual experiences?

Back 257

Resumption of normal functioning activities that are meaningful, goal oriented (for example rolling, sitting up, standing, walking)

Front 258

Asymmetrical tonic neck reflex- describe the following for this reflex: 1) stimulus, 2) response, 3) strongest influence, 4) prolonged influence result, 5) results if the reflexes severe, 6) onset, 7) typical time of integration

Back 258

1) rotation of the head to one side, 2) flexion of the skull limbs, extension of the jaw limbs, "fencing posture", 3) strongest influence in the supine are sitting position, 4) along to influence can result in scoliosis or even hit subluxation or dislocation if there is marked hypotonia, 5) if the reflex is severe, grasping of objects with the extended arm is only possible if the patient looks away from the object to lessen the reflex influence, 6) onset birth, 7) integrated at 4–6 months

Front 259

Crossed extension reflex –describe the following for this reflex: 1) stimulus, 2) test position 3) response, 4) effect when coupled with another reaction, 5) onset, 6) typical time of integration

Back 259

1) noxious stimulus to the ball of foot of extremity fixed and extension, 2) tested in supine position, 3) opposite lower extremity flexes, then adducts and extends; inpatient with hemiplegia, lifting the uninvolved leg off the ground during ambulation results in increased extensor tone in the involved leg, 4) this reflex, when coupled with the "positive supporting reaction", can result in hyper extension of the knee, 5) onset 28 weeks gestation, 6) integrated 1 to 2 months

Front 260

Equilibrium reactions – describe the following for this reaction: numeral one) stimulus, 2) response, 3 onset, 4) typical time of integration

Back 260

1) displace the center of gravity by tilting or moving the support surface (for example with an equilibrium board or ball), 2) curvature of the trunk tour the afford side along with extension and abduction of the extremities on that side, protective extension on the opposite (downward) side, and the equilibrium reaction will be absent if there is marked spasticity, 3) onset approximately 6 months of age and develop sequentially in prone (six months), then into pine (7 to 8 months) and then and sitting (7 to 8 months), kneeling in front of the 9 to 12 months) and a standing (12 to 21 months), 4) it is not integrated, but rather persists.

Front 261

Grasp reflex – describe the following for this reflex: 1) stimulus, 2) response, 3) onset, 4) typical time of integration

Back 261

1) maintain pressure to palm of hand (Palmer) or ball of foot under toes (plantar), 2) maintain flexion of fingers or toes, 3) onset – Palmer at birth; plantar at 28 weeks gestation, 4) integrated – Palmer 4 to 6 months; plantar 9 months

Front 262

Name two disorders of peripheral roots and nerves?

Back 262

1) neuralgia – pain along a nerve, 2) radiculalgia - neuralgia of nerve roots

Front 263

What type of pain syndrome is herpes zoster?

Back 263

Neuropathic

Front 264

What type of pain syndrome is phantom limb?

Back 264

Neuropathic

Front 265

Phantom limb pain:

Back 265

Pain in the residual limb following amputation

Front 266

What type of pain syndrome is fibromyalgia?

Back 266

Musculoskeletal

Front 267

How would a patient with fibromyalgia present?

Back 267

With widespread pain accompanied by tenderness of muscles and adjacent soft tissue

Front 268

What is the origin of fibromyalgia?

Back 268

Non-articular rheumatic disease of unknown origin

Front 269

What type of pain syndrome is myofascial pain syndrome – MPS?

Back 269

Musculoskeletal

Front 270

How would a patient with myofascial pain syndrome present?

Back 270

persistent, deep aching pains in muscle

Front 271

What is myofascial pain syndrome characterized by?

Back 271

Well-defined, highly sensitive tender spots (triggerpoints)

Front 272

Referred pain:

Back 272

starts in the deep visceral tissues and is felt in a body region remote from the site of pathology, resulting in tenderness and pain in superficial locations

Front 273

Referred pain presenting in the medial left arm and jaw pain may be associated with what?

Back 273

Heart attack

Front 274

Referred pain presenting in the right subscapular area may be associated with what?

Back 274

A Gallbladder attack

Front 275

Referred pain presenting in the thoracic area or flank pain maybe associate with what?

Back 275

Kidney problems

Front 276

Referred pain presenting in the left upper quadrant and shoulder pain may be associated with what?

Back 276

Spleen damage

Front 277

Referred pain presenting in the right upper quadrant may be associated with what?

Back 277

Liver problems

Front 278

What are some goals and interventions when working with a patient with neuropathic, musculoskeletal, or referred pain?

Back 278

1) Assist the patient and identifying pain behaviors, 2) teach coping skills, 3) provide relaxation training, 4) provide direct pain – symptom control (time-limited), 5) establish a realistic daily exercise program