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167 Cards in this Set
- Front
- Back
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Nervous system divisions |
CNS PNS |
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Central Nervous system |
CNS Brain and spinal cord Brain has 4 regions: cerebral cortex, diencephalon, brain stem, cerebellum |
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Peripheral Nervous system |
Cranial nerves: 12 pairs Spinal nerves: 31 pairs |
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Meningeal Layers |
Skull and PAD |
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PAD |
Pia Arachnoid Dura |
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Skull |
Top layer Above epidural spaces |
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Dura |
Layer under epidural spaces Above subdural spaces |
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Arachnoid |
Layer under subdural spaces Over subarachnoid spaces |
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Epidural Space |
Space under skull Above dura |
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Subdural space |
Space below dura Above arachnoid |
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Subarachnoid space |
Space below arachnoid layer |
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Subarachnoid hemorrhage |
"The worst HA I've ever ad" Develops over seconds to minutes High mortality rate Causes: trauma or spontaneous bleed from cerebral aneurysm Risk factors: HTN |
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Pia mater |
Brain |
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Cerebral Cortex |
Gray matter Highest function: though, memory, reasoning, sensation, voluntary movements Two hemispheres Damage to cortical areas results in loss of function Basal ganglia |
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Gray matter |
Outer layer of cerebrum Composed of nerve cells |
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Hemispheres |
95% of people have a dominant left hemisphere 4 lobes: frontal, parietal, occipital, temporal |
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Frontal lobe |
Personality, behavior, emotions, intellect Damage here can alter personality, sense of humor, emotional lability, poor problem solving Precentral gyrus Broca's area |
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Precentral Gyrus |
Motor cortex/strip Responsible for voluntary skeletal movement and fine repetitive movement |
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Broca's area |
Found in dominant hemishere Damage to Broca's area can lead to expressive aphasia |
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Expressive aphasia |
Can't articulate words Communicates through writing |
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Parietal Lobe |
Post central gyrus Sensory cortex Processes sensory data |
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Occipital lobe |
Vision center Vision loss, blindness if affected |
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Temporal |
Interpretation of sound, balance, integration of taste and smell Wernicke's area: found in dominant hemisphere |
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Wernicke's area |
Found in dominant hemisphere Receptive aphasia if damaged, can't understand sounds but can understand written language |
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Basal Ganglia |
Additional gray matter lying deep in the brain Controls automatic movements of the body: arm swing while walking |
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Damage to basal ganglia |
Increased muscle tone: rigidity Problems with gait Bradykinesia |
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Bradykinesia |
Slow, decreased spontneous/automatic movements |
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Diseases affecting the basal ganglia |
Parkinson's disease |
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Parkinson's disease |
Extension of arm from a flexed position results in rachetlike jerking Cogwheel rigidity |
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Diencephalon |
Thalamus Hypothalamus |
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Thalamus |
Sensory pathways synapse here on their way to the cerebral cortex Stimulation sorts sensory input and sends to appropriate location |
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Hypothalamus |
Temperature control Sleep center Regulates anterior and posterior pituitary gland Coordination of ANS activity Emotional status |
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ANS |
Autonomic nervous system |
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Brain Stem |
Path between brain and spinal cord Controls involuntary function, ie. breathing All cranial nerves originate here except CNI and CNII |
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CN I |
Originates in the brain |
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CN II |
Orginates in diencephalon |
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CN III, CN IV |
Originates in midbrain |
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CN V - VIII |
Originates in pons |
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Pons |
Houses part of the respiratory center |
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CN IX - XIII |
Originates in medulla |
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Medulla |
Contains autonomic center: respiration, heart, GI function Pyramidal decussation: crossing of motor fibers |
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Pyramidal decussation |
Allows for one side of the brain to control the opposite side |
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Consciousness |
Depends on the interaction between intact cerebral hemispheres and the Reticular Activating System |
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Reticular Activating System |
Arousal A structure in the diencephalon and upper brainstem |
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Cerebellum |
Coordinates all movement and helps maintain equilibrium, posture, muscle tone Works with basal ganglia, motor cortex, vestibular system of CN VIII |
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Damage to Cerebellum |
Results in problems with gait, equilibrium, decreased muscle tone |
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Stroke |
Cerebral vascular accident Occurs from deprivation of blood
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Ischemic CVA |
Cerebral artery blockage, thrombus Treat with thrombolytics within 4-5 hrs |
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Hemorrhagic CVA |
Vascular bleeding |
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Misc. CVA |
Vasospasm |
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FAST symptoms |
Face Arm Speech Time |
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Spinal Cord |
Begins at foramen magnum of the skull and ends at L1-L2 of vertebral column Main track for ascending and descending nerve fibers Mediates reflex activities of DTRs |
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Ascending nerve fibers |
Sensory |
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Descending nerve fibers |
Motor |
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Sensory pathways for CNS |
Sensory Receptors Afferent fibers Sensory cortex Broken into 2 pathways: spinothalamic, posterior columns |
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Sensory receptors |
Located in skin, mucous membranes, muscles, tendons, and viscera Important for the facilitation of sensation and reflexes |
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Sensation travel |
Afferent fibers in peripheral nerves and enters spinal cord through the posterior/dorsal root Travels up spinal cord to brain stem Crosses over and travels to thalamus Proceeds to the sensory cortex where sensation is localized |
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Sensory cortex |
Post central gyrus of parietal lobe Arranged in specific pattern Generally opposite of cephalocaudal Sensation localized head to feet |
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Spinothalamic Tracks |
Conduct sensation of: Pain Crude/light touch Temp Deep pressure |
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Crude/light touch |
Not usually lost since sensation goes up both sides of the spinal cord |
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Posterior column |
Conduct sensation of: Position Vibration Deep pressure Fine touch |
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Deep pressure |
Travels up spinothalamic tracks and posterior columns |
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Fine touch |
Stereognosis Graphesthesia 2 - point discrimination |
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Motor pathways of CNS |
Upper motor neurons (UMN) Corticospinal Tract Extrapyramidal Tract Cerebellar System |
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UMN |
Upper motor neurons Consist of descending fibers in the cerebralcortex that relay impulses to LMN which cause muscle action |
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LMN |
Lower motor neurons PNS |
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UMN Disease |
CVA Multiple sclerosis |
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Corticospinal Tract |
Pyramidal tract Relays voluntary movement - skilled, discrete, and purposeful (writing) Starts in motor cortex, travels to brain stem, crosses to other side of brain stem (pyramidal decussation), travels down spinal cord At each level of spinal cord motor fibers synapse with a LMN contained in the spinal cord |
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Extrapyramidal Tract |
More primitive motor system Regulated by basal ganglia Allows for gross movement without conscious thought Fibers relay signals to maintain muscle tone, control body movements (walking) Starts in motor cortex and travels to basal ganglia, brain stem, spinal cord Problems here are Parkinsons, restless legs, tremor, shuffling gait |
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Cerebellar System |
Part of motor system and functions at the unconscious level Responsible for coordination of movement, maintaining equilibrium, posture |
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PNS |
Peripheral nervous system Consists of 12 pairs of CN, 31 pairs of spinal nerves Somatic fibers, autonomic fibers |
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Somatic Fibers |
Innervate skeletal/voluntary muscles |
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Autonomic Fibers |
Innervate smooth/involuntary muscles Cardiac muscles, glands |
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Cranial Nerves |
Supplies mostly the head and neck Vagus nerve supplies heart, respiratory muscles, stomach and gall bladder |
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Spinal Nerves: names |
Cervical - 8 Thoracic - 12 Lumbar - 5 Sacral - 5 Coccygeal - 1 |
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Spinal nerves |
Contain sensory and motor fibers Sensory fibers enter through the ventral root and carry impulses to the muscles and glands Dermatome |
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Dermatome |
Circumscribed area supplied by mainly one spinal cord segment Localize the spinal nerve affected by identifying the area of decreased sensation or motor function |
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Lower motor neurons |
LMN Cell bodies of LMN originate in the spinal cord with nerve fibers extending to muscles and glands |
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LMN disease |
Spinal cord lesions Myesthenia gravis Guillain-Barre |
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Subjective data |
HA hx of head injury Loss of consciousness Dizziness/vertigo Loss of balance R vs L handed Seizures/convulsions Weakness TIA Tremors Coordination problems Numbness/tingling Dysphagia Dysphasia Occupational hazard Family hx |
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History of head injury |
Repeated injury in short period of time prevents neuron recovery and increased risk of permanent brain damage |
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Right or left handed |
Loss of ability to write may tell you whether the injury is in the right or left cerebral hemisphere |
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Seizures/convulsions |
Epilepsy |
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Epilepsy |
Altered level of consciousness, involuntary muscle movement with sensory disturbances - Aura: auditory, visual, olfactory sensation - Motor activity: tonic/clonic muscle action, tense/relax - Other signs: color change, automatisms, incontinence - Post ictal phase: confused |
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Automatisms |
Lip smacking Eyelid fluttering |
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Proximal Weakness |
Myopathy Can't get out of a chair without using hands/arms Closest to body
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Distal Weakness |
Neuropathy |
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Transient ischemic attack |
TIA Manifested by stroke-like symptoms lasting <1 hr Often a precursor to stroke 1% have a stroke within 3 months after a TIA Transient monocular vision loss, aphasia, dysarthria, change in facial movement/sensation, weakness, paralysis, paresthesia |
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Dysarthria |
Difficulty forming words |
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Tremors |
Involuntary shaking, vibrating or trembling |
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Coordination problems |
Paresis Paralysis Motor symptom |
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Paresis |
Slight paralysis, weakness |
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Paralysis |
Complete loss of motor function |
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Paresthesia |
Sensory symptom Numbness or tingling |
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Dysphagia |
Difficulty swallowing |
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Dysphasia |
Difficulty speaking |
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Past medical history |
Neuromuscular diseases CVA, SCI, meningitis, congenital defect, ETOH |
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ETOH |
May affect the central/peripheral nervous system |
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Subjective: Children |
Prenatal exposure: toxins, ETOH Birth Trauma: APGAR scores, distress at birth Seizures: febrile Motor ability and developmental milestones |
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Subjective: Aging adult |
Dizziness: Decreased cerebral flow, usually vascular Micturition syncope Memory Muscle strength Sudden sensory changes Ability to preform ADLs |
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Micturition syncope |
Males may faint while urinating r/t decreased cerebral blood flow Often nocturnal |
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Neuro exam sequence |
Mental status Cranial nerves Motor/cerebellar function Sensory system Reflexes |
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Cranial nerves |
Usually only test 2-12 unless some c/o smelling problems |
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CN I |
Olfactory: sensory Test sense of smell Aromatic substances Anosmia: loss of smell |
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CN II |
Optic Nerve: sensory Test visual acuity by Snellen Test visual fields by confrontation Fundoscopic exam |
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CN III, IV, VI |
Oculomotor, Trochlear, Abducens: motor PERRLA - CN II (afferent), CN III (efferant) EOM's: assess nystagmus - CN III: most eye movements - CN IV: Down and inward eye movement - CN VI: Lateral eye movement Assess lid lag, ptosis |
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Dysfunction at CN VI |
Dysfunction may indicate early sign of increased ICP |
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Lid lag |
Visible sclera above iris |
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Ptosis |
unequal palpebral fissures |
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CN V |
Trigeminal: motor and sensory Motor: innervates muscles of chewing (temporal and masseter muscle strength), lateral jaw strength Sensory: 3 zones of sensation, opthalmic, maxillary, mandibular |
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CN VII |
Facial nerve: motor and sensory Motor: assess facial movement and expression, look for symmetry Sensation: sweet and salty on anterior 2/3 of tongue |
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Corneal reflex |
Requires an intact: Sensory - CN V Motor - CN VII |
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CN VIII |
Acoustic: sensory Hearing acuity: whisper, Weber, Rinne Romberg: vestibular, test equilibrium |
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CN IX, X |
Glossopharyngeal and Vagus: motor and sensory Responsible for talking and swallowing Uvular and soft palate rise Gag reflex |
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CN IX |
Glossopharyngeal Sour and bitter on posterior 1/3 tongue |
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CN X |
Vagus Supplies throat, heart, respiratory muscles, stomach, gallbladder |
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CN X Dysfunction |
Dysphagia or hoarseness may be associated Lung cancer or chest tumor may press on Vagus nerve causing dysphagia or hoarseness |
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CN XI |
Spinal Accessory: motor SCM and Trapezius muscle test: shrug against resistance |
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CN XII |
Hypoglossal: motor Movement and strength of tongue, position |
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Note muscle size |
Atrophy Hypertrophy |
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Atrophy |
Abnormally small muscle wasted appearance |
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Hypertrophy |
Increased muscle size Exercise |
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Muscle strength |
5/5 Full strength against resistance |
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Muscle tone |
Test by checking resistance to passive stretch of muscle |
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Flaccid |
Decreased tension |
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Balance |
Cerebellar function Gait: smooth, rhythmic, effortless movement Tandem walk Romberg's test Shallow knee bed: balance and strength Hop on one foot x 5 seconds |
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Ataxia |
Uncoordinated movement |
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Romberg |
Cerebellar ataxia or vestibular dysfunction Positive: person falls out of stance |
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Upper Extremity coordination |
Rapid alternating movements: RAM Touch thumb to each finger Finger-to-finger Finger-to-nose |
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Lower Extremity coordination |
Tap feet on floor repetitively Heel-to-shin |
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Sensory testing |
Identifies intact peripheral nerves Assess distal locations and compare sides |
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Peripheral neuropathy |
Test for protective sensation with monofilament |
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Spinothalamic Tract testing |
Pain: sharp/dull Light touch Temperature: test when pain is absent Deep pressure: test if pain is absent |
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Analgesia |
No pain perception |
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Posterior column |
Position/kinesthesia Vibration: often first sensation lost, worse in feet, DM and ETOH Deep pressure Fine touch: sensory cortex and posterior column |
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Stereognosis |
Recognize objects by feel |
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Astereognosis |
Failure to recognize objects by feel |
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Graphesthesia |
Read numbers by tracing on skin |
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Two-point discrimination |
Fingers most sensitive Often tested with hand lacerations to etermine nerve involvement |
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Extinction |
Simultaneously touch both sides of the body in the same location Normal should be able to sense both |
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Point Location |
Touch pt with your finger, withdraw stimuli, and have pt touch same location |
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DTRs |
Deep Tendon Reflexes Reveal intactness at specific levels of the cord Limb must be relaxed and muscle partially stretched |
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DTR Pathway |
Starts at afferent sensory nerve Synapses at spinal cord Relays impulse to motor/efferent nerve Travels to neuromuscular junction: nerve dendrites and muscle spindles Ends with a functioning muscle response |
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Reflex grade |
4+ hyperactive 3+ above average 2+ normal 1+ low normal 0 absent |
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Absent reflexes |
Seen with paraplegia or quadriplegia depending on level of cord injury |
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Hyperreflexia |
UMN lesion CVA: loss of higher cortical inhibition of reflex by neurotransmitters Modulated by high cortical inhibition in the brain If there is brain damage, lose the inhibition and the reflex is hyperactive Test ankle for clnus |
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Ankle clonus |
Hyperreflexia Brisk dorsiflexion of the foot causes rhythmic cycle of dorsiflexion and plantar flexion UMN disease |
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Hyporeflexia |
LMN lesion SCI, problem with sensory afferents or motor efferents |
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Compete quadriplegia |
Injury about C6 |
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Incomplete quadriplegia |
Injury below C6 Gross motor function of shoulder and arms |
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DTR locations |
Brachioradialis: C5-C6 Biceps: C5-C6 Triceps: C6-C7/8 Quadriceps/Patellar: L2-L3/4 Achilles/Ankle jerk: S1-S2 |
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Superficial Reflexes |
Upper Abd: T7-T8/9 Lower Abd: T10-T11 Cremasteric: T12-L1/2 Plantar Reflex/Babinski: L4/5 - S1/2 |
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Babinski |
Abnormal in adults Occurs with UMN/pyramidal tract disease Big toe up, other toes flare Normal in children < 2 yrs |
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Neurocheck: Level of consciousness |
Glascow Coma Scale: eye opening, verbal response, motor response Total score reflect brain functional level |
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Neurocheck: motor function |
Check voluntary movement Evaluates ability to follow commands and muscle strength |
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Neurocheck: pupillary response |
Measures reaction Unilateral, dilated, non-reactive pupils Pressure on CN III occurs with herniation of brainstem - Uncal herniation |
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Neurocheck: Vital signs |
Changes are late signs of ICP Increased SBP/Widening pulse pressure Decreased HR |
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Meningeal Irritation |
Nuchal Rigidity Opisthotonos Brudzinski sign Kernig sign |
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Opisthotonos |
Prolonged arching of the back with head and knees bent backwards |
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Brudzinski sign |
Flexion of the neck causes involuntary flexion of the hip and knees |
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Kernig sign |
Low back pain and resistance to leg straightening occurs when attempting to straighten a flex knee and hip |
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Brain and Brain stem injury |
Response to painful stimulus or motor stimulus Felxor posturing Extensor posturing |
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Decorticate posturing |
Flexor Damage to cerebral cortex |
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Decerebrate posturing |
Extensor Damage to brain stem |
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Infants |
Neuro system is not developed at birth Neurons aren't mylinated Movement is characterized by primitive reflexes |
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Infant reflexes |
Disappear as the cerebral cortex develops, mostly during the first year Rooting, sucking, palmar grasp, moro, tonic neck, stepping, babinski |
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Developmental concerns: Aging adults |
Decreased muscle bulk/strength Muscle tone decrease in face, neck, spine Loss of vibratory sense at ankle (common) Loss of position sense of big toe DTRs less brisk Loss of ankle jerk Senile tremors: intention tremor Dyskinesia: repetitive movements in jaw, lip, tongue Nerve velocity decreases 5-10%, reaction time Sensation diminishes: decrease taste, smell, hearing, vision Decrease cerebral flood flow, may cause dizziness and loss of balance |
