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105 Cards in this Set
- Front
- Back
- 3rd side (hint)
a reflex is...?
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an automatic response to particular stimuli, involving a simple reflex arc
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Why do you test
neurological function ? |
to determine if nervous system is intact and functioning &
because we can't see it, so we must perform functional tests |
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neuropathy is...?
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inflammation or degeneration of the peripheral nervous system
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neurological disorders of the lower limb may be due to...?
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-injury to CNS or PNS
-metabolic disease -sensory, motor or autonomic disease |
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A full neurological examination includes examination of...?
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GRAMS CM
Gait Reflexes Autonomic Motor Sensory Coordination Mental state |
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We do a neurological exam in clinic, what four main types of neuropathy are we assessing?
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Motor
Sensory Autonomic Coordination |
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consequences of PNS malfunction..
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1. impaired response to environment
2. pathological damage to tissue 3. lack of awareness of injury |
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a dermatome is...?
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the area of skin that is supplied by a
a single, spinal cutaneous nerve |
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state the nerve supply to the lower limb from the sciatic nerve downwards
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Sciatic nerve
divides above Popliteal Fossa Common Peroneal Nerve, divides into Deep peroneal and superficial peroneal Tibial nerve (posterior leg) through tarsal tunnel to plantar foot (medial & lateral plantar, medial calcaneal) |
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name three causes of peripheral neuropathy...
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1. Diabetes
2. Alcoholism 3. Trauma |
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The nervous system is ____ acting and works alongside the slower acting _________ system.
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fast
endocrine |
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the Central Nervous System is...
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all structures lying within the brain and spinal cord.
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the peripheral nervous system comprises...?
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all the nerves that lie outside the brain and spinal cord.
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The somatic nervous system has three functions which are...
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1. sensory
2. integrative 3. motor |
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a mechanoreceptor senses...?
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touch and pressure
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a thermoreceptor senses...?
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warmth and cold
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a nociceptor senses...?
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painful stimuli
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a proprioceptor senses...?
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position
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The area served by a sensory unit is called...?
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the sensory field
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A "sensory unit" comprises?
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Afferent nerve
its Branches and Receptors |
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An Upper Motor Neuron is...?
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...a motor neuron with its cell body in the cortex and its axon synapsing with the LMN it controls.
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A Lower Motor Neuron is...?
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...a motor neuron with its cell body in the spinal cord grey matter, which sends impulses to skeletal muscle via its axon.
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a neurone which synapses with an UMN in the anterior horn of the spinal cord, and distally with the neuromuscular end plate at the effector muscle
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which three reflexes are of most imprtance to lower limb function?
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1. Pain withdrawal reflex
2. Crossed extensor reflex 3. Stretch reflex |
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the five elements of a reflex arc are...?
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1. receptor organ
2. afferent nerve 3. Integration centre 4. efferent nerve 5. effector organ |
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explain the crossed extensor reflex
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postural reflex enabling an injured lower limb to be withdrawn, while the remaining limb bears weight
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when might the crossed extensor reflex occur?
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during gait (swing--stance)
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how can you demonstrate the stretch reflex?
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by testing the patellar or Achilles tendon reflexes
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what does a stretch reflex tell us?
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the state of contraction in a muscle
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What is the effect of
sensory peripheral neuropathy on gait? |
- wide-walking
- high-stepping - hard-stamping |
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what muscle group is commonly affected in Charco-Marie-Tooth's disease?
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peroneals
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nerve function deficit is called...
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neuropathy
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the five elements of a neurological exam
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sensory (function)
motor (function) autonomic (function) coordination consciousness |
SMACC!
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widespread, symmetrical abnormality of many nerves, in a glove and stocking distribution is called...?
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polyneuropathy
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abnormality of a single nerve is called...?
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mononeuropathy
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name some factors that mean a diabetic foot is "at risk"
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-deformity
-no feeling (neuropathy) -no blood (ischaemia) -hard skin (callus) -swelling |
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signs of a hypoglycemic attack are...?
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-drowsiness
-confusion -aggressive behaviour -loss of consciousness |
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signs of a TIA?
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-speech disorders
-inability to swallow -visual disturbance -movement disturbance |
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why does a syncope occur?
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temporary interruption of blood to the brain
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what causes CVA?
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thrombosis 80%
haemorrhage 20% |
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TIAs last how long?
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1-30 minutes and always less than 24hrs
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cause of epileptic fits?
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unusual electrical activity in the cortex
may arise from trauma or lesion |
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examples of "parasthesia"?
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-pins and needles
-burning -pricking -shooting pains |
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what does ageing do to nerve conduction speed?
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ageing slows the speed of nerve conduction
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signs of UMN disease in lower limb?
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1. Hyperreflexia
2. Hypertonicity 3. Spasticity 4. Muscle atrophy (slow) 5. No fasiculations 6. Extensor response to Babinski 7. No abdominal reflex |
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signs of Lower Motor Neuron disease in lower limb?
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1. muscles flaccid
2. decreased tone 3. lack of stretch reflexes 4. fasculations 5. profound muscle atrophy 6. specific muscle groups affected |
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examples of LMN conditions?
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Polio
Charcot-Marie-Tooth Spina Bifida |
Ian Dury
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examples of UMN conditions?
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Multiple Sclerosis
CVA Cerebral Palsy |
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leg/foot positions in UMN lesions?
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extension of hip & knee
plantarflexion/inversion of foot scissors gait |
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The patellar reflex - tests integrity of which pathway?
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spinal reflex pathway L3, L4
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What manouevre can you ask the patient to do if they are not relaxed for the patellar reflex test?
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The Jendrassik manouevre
(clasp both hands and pull) |
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Achilles tendon reflex - tests what spinal pathway?
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spinal reflex pathway S1, S2
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Babinksi response
- describe how to do it; and - describe abnormal/normal response? |
stroke surface of foot from heel across to ist MTPJ
normal=PF hallux abnormal=DF hallux |
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positive Babinksi test means...?
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- possible UMN lesion
- release of inhibitory spinal reflex |
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symptoms of Parkinsonism?
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- festinating gait
- slow or no movement - mask-like features - tremors at rest |
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tests for proprioception?
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- Hallux movement with hand
- Romberg's test - heel-shin test |
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signs of autonomic neuropathy?
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- dry or hyperhidrotic skin
- hypotension/hypertension - slowing of heart rate |
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main descending motor pathway?
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corticospinal pathway
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Babinski reflex - what type of reflex is it?
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a superficial reflex
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Patellar and Achilles reflexes are what type?
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Deep tendon reflexes
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What is the Jendrassik's Manoeuvre?
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a reinforcement technique used to check whether a reflex is absent
(clench hands in front of chest) |
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the four categories used to describe reflexes?
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Brisk
Absent Reduced Normal brisk |
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age at which positive Babinski response disappears?
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7mths
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segmental supply for Achilles reflex (foot PF)?
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S1/S2
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segmental supply for Patellar reflex?
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L3/L4
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differerence between a deep tendon reflex and a superficial reflex?
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deep tendon reflex = monosynaptic
superficial reflexes = polysynaptic |
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what is being tested when we test a reflex?
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1. afferent and efferent pathways
2. upper and lower motor neurons |
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what would stop transmission of an impulse across a synapse?
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failure to reach the action potential threshold
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drop foot - caused by UMN or LMN lesion?
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foot drop can result from
UMN and LMN lesions |
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stroke is upper or lower MN lesion?
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Upper motor neuron lesion
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how does RA cause peripheral neuropathy?
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-
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how does Hypothyroidism cause peripheral neuropathy?
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-
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Name the 6 signs of autonomic peripheral neuropathy
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1. dry skin
2. increased callus formation 3. bounding pulses 4. Warm feet 5. Dilated dorsal veins 6. postural hypotension |
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Why does dry skin occur in autonomic neuropathy?
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Denervation of sweat glands
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Why do bounding pulses occur in autonomic neuropathy?
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vasomotor control of arteries is lost,
causing permanent arterial dilation |
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Why is the skin warm in autonomic neuropathy?
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permanent arterial dilation increased blood flow to the skin
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Why would you observe
dilated dorsal veins in a patient with autonomic neuropathy? |
permanently dilated arteriovenous shunts
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Why does postural hypotension occur in autonomic neuropathy?
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arteries lose the ability to constrict, gravity pulls blood towards lower limbs, causing drop in BP
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Name the 5 signs of motor neuropathy
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1. high arched feet
2. Clawed toes 3. Altered gait 4. Wasting of intrinsic muscles 5. increased pressure at met heads and apices |
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Why do feet become highly arched in motor neuropathy?
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-
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Why do toes become clawed in motor neuropathy?
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intrinsic muscle wasting
extensor substitution occurs |
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Why does gait alter in motor neuropathy?
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-
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How does Jendrassik's manouevre work?
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It removes spinal influence.
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What does a reflex arc test?
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-
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What four areas of function
should you examine in a motor function assessment? |
Position
Posture Muscle Tone/Power Reflexes |
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Name four signs relating to muscle behaviour that might indicate a neurological problem.
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Spasticity
Rigidity Clonus Fasiculations |
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What is "clonus"?
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-
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What does testing of deep tendon reflexes indicate?
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-
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What does a reflex arc test?
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it tests both the afferent and efferent parts of the spinal nerve in a given reflex
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What four areas should you examine in a motor function assessment?
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Position
Posture Muscle Tone/Power Reflexes |
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Name four signs relating to muscle behaviour that might indicate a neurological problem.
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Spasticity
Rigidity Clonus Fasiculations |
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What is "clonus"?
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-
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What does testing of deep tendon reflexes indicate?
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What does a reflex arc test?
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-
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What four areas should you examine in a motor function assessment?
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Position
Posture Muscle Tone/Power Reflexes |
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Name four signs relating to muscle behaviour that might indicate a neurological problem.
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Spasticity
Rigidity Clonus Fasiculations |
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What is "clonus"?
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-
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What does testing of deep tendon reflexes indicate?
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tests the integrity of the CNS and PNS
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What is an arteriovenous shunt?
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A sphincteric mechanism controlling capillary bed blood flow.
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What nerve roots does the Patellar reflex test?
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L3,L4
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What tract does the Babinski test test?
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Corticospinal tract
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Why does high muscle tone occur?
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disinhibition of spinal influence on LMNs
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What (broadly) causes UMNs?
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Damage anywhere between the cortex and L1 in the spinal cord
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UMNs connect the ____ to the appropriate spinal cord level, from which point the LMNs transmit nerve impulses to the ______.
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UMNs connect brain --> spinal cord level
LMNs transmit from spinal cord --> muscles |
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What descending tract is responsible for skilled movements?
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CorticoSpinal = Skilled Movements
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extension of hip & knee
circumducted gait plantarflexed, inverted foot ....upper or lower MN? |
Upper Motor Neuron
Hemiplegia |
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