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317 Cards in this Set
- Front
- Back
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Neurogenic vs. Vascular Claudication |
Neurogenic: ABSENCE of paralysis, pulselessness (has a pulse), pallor Vascular: 5 P's -Paralysis -Paresthesias -Pain -Pulselessness -Pallor |
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Syringomyelia |
-Cyst in spinal cord -from excess CSF in spinal cord -expands over time & destroys areas of SC |
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Lyme Disease |
Bacterial infection from deer ticks |
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Spasticity |
-exagerrated stretch reflex of the mm that can occur after injury to CNS -not a primary condition, but secondary effect from CNS damage |
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Locked in Syndrome |
-complete paralysis of all voluntary mm's except eye mm's -typically aware -cognitively intact -unable to speak |
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Stroking the Skin |
Tests the cutaneous reflex |
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Spinal Muscular Atrophy |
-NM disorder -Caused by anterior horn cell degeneration Symptoms -progressive mm weakness -swallowing & resp. issues common -facial mm's NOT typically involved |
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Peripheral Nerve Conditions |
-GB -Carpal Tunnel -TOS |
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CNS Conditions |
-Parkinsons -MS -Huntingtons |
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Limbic System |
-Comprised of: corpus callosum, olfactory tract, mammillary bodies, fornix, thalamic nuclei, amygdala, hippocampus, parahippo-carpal gyrus, cingulate gyrus, hypothalamic nuclei -lies w/in the brain |
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Pt. w/ head injury. Signs of involvement of the limbic system? |
-aggressive behavior -extreme fearfulness -absence of motivation |
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Limbic System Controls |
-expression of mood & emotion -processing & storage of recent memory -olfaction -control of appetite -emotional responses to food |
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PNS |
-bundles of nerve fibers & axons that is supported by CT that conducts info to/from CNS
- spinal nerves have ant. & post. nn roots -anterior root: EFFERENT - carries motor info. away from CNS -posterior root: AFFERENT - carries info. regarding sensation to CNS |
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Somatic Nervous System |
-peripheral nn fibers that travel directly to skeletal mm w/o intervening synapses -myelinated nerve fibers control voluntary movements & provide the ability to sense, touch, smell, sight, taste, & sound |
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Seizure Presentation |
-flex or ext rigidity -rhythmic jerking of mm's -blank stare -visual changes -sensory disturbances |
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Neuro condition that affects LE more than UE |
peripheral neuropathy |
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Cauda Equina |
-ends at L1, still have some regeneration & recovery |
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T9 Injury |
-don't have use of legs -reciprocal gait would be difficult to accomplish |
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Ectopc Bone |
-bone formation occuring in abnormal position or place |
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Carpal Tunnel Syndrome Pathogenesis |
-high pressure causes ischemia in the nn -ischemia creates nocturnal Sx's that occur w/ wrist flex -unrelieved compression creates initial neuropraxia & segmental demyelination -when axons lose myelin they are more vulnerable -unrelieved compression can -> axonotomesis axon continuity is lost & wallerian degeneration occurs) |
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Neurological deficits greater in UE & are more prox. than distal |
-myasthenia gravis -muscular dystrophy |
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LMN |
Lesion that affects anterior horn cell &/or peripheral nerve |
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LMN. Signs |
-diminished reflexes (hyporeflexia) -hypotonia -fasciculations -flaccid paralysis -decreased movement -decreased tone -muscles are atrophed & flaccid |
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UMN |
Lesion that affect motor pathways in SC &/or brain |
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UMN. Signs |
-clonus (cyclical, spasmodic, alteration of muscular contraction & relaxation in response to sustained stretch of spastic mm) -spastic paralysis manifested by incoordinated hyper reflexs -weakness -increased muscle tone -minimal atrophy |
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Hoffman Sign |
-reflex contraction of thumb w/ index finger -evidence of UMN lesion |
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UMN. Examples |
-CP -Hydrocephalus -ALS -CVA -birth injuries -MS -Huntingtons -TBI -pseudobulbar palsy -brain tumors |
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LMN. Examples |
-ALS -polio -GB -tumors involving SC -trauma -progressive muscular atrophy -infection -bell's palsy -CTS -muscular dystrophy -spinal muscular atrophy |
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UMN vs LMN |
UMN -hyperactive reflexes -disuse atrophy (mild) -no fasciculations -hypertonic LMN -diminished/absent reflexes -atrophy present -fasciculations present -hypotonic to flaccid |
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Instructions to give a caregiver of a pt. w/ alzheimers & cognitive impairments |
-fence the yard w/ a locked gait to prevent wandering |
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Stage II Alzheimers. Signs |
-memory deficits more evident -unable to behave spontaneously -increasing episodes of confusion |
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Stage II Alzheimers -interventions to manage chronic confusion |
-create boundaries to help pt stay in safe area -begin each session w/ an introduction -only ask yes/no questions -keep stimuli to a minimum |
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Alzheimers Stage I |
-mild memory loss |
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Alzheimers Stage II |
-wandering -agitation that leads to sundowning |
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What other signs/symptoms woud you expect to see with impairments in short term memory |
-increasing forgetfullness -some memory deficits |
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ALS |
-neurogenerative disorder -degeneration & scarring of the motor neurons in the lateral aspect of the spinal cord, brainstem, & cerebral cortex |
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ALS. Symptoms |
-asymetric weakness with distal to proximal progression -facial muscles may be involved in the bulbar form of this disorder |
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ALS. What is spared? |
-sensory impairment -cognition -bowel & bladder sphincter control -extraocclar muscle control |
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ALS. Signs |
-abnormal DTR's (hypo/hyper). Could be either bc it's both and UMN & LMN disoder -progressive respiratory muscle weakness (bronchial hygiene is essential) -pt is dependent on caregivers for positioning & voiding |
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L CVA |
Aphasia |
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R CVA |
L sided unilateral neglect |
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Typical pattern of spasticity in UE when recovering from CVA |
Spasticity strong in the following: -shoulder adductors -forearm pronators -elbow flexors -wrist flexors -hand flexors |
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Best activity to break up LE synergies |
Hip ext. & knee flex (bridging & pelvic extension) |
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How to help someone release food from hand to mouth |
-slowly stroke the finger extensors in prox. to distal direction (to facilitate hand opening) |
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PICA (post. inf. cerebellar artery) |
-branch of vertebral artery -involves descending tract & nuceus of CN 5, the vestibular nucleus & its connection -involves CN IX, X, cuneate & graccile nuclei, & spinothalamic tract |
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Signs of posterior infereior cerebellar artery thrombosis |
BRAINSTEM INVOLVEMENT -decreased pain & temp sensation of the ipsilateral face -nystagmus -vertigo -nausea -dysphagia -ipsilateral Horner's syndrome -contralateral loss of pain & temp sensation of the body -this is a presentation of lateral medullary (Wallenberg's) syndrome |
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Internal Carotid Artery Stroke Symptoms |
-combines middle cerebral and anterior cerebral artery strokes |
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Vertebral Artery Stroke |
-numbness & weakness in face -dysphagia -facial pain |
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Middle Cerebral Artery Stroke |
-stupor -drowsiness -global aphasia |
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Anterior Cerebral Artery Stroke |
-contralateral weakness -contralateral sensory loss of toes, foot, leg -inability to make decisions -urinary incontinence |
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What is controlled by the medula oblongata |
ABD -sneezing -vomiting -HR -blood vessel diameter -breathing -swallowing |
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Occurs in the first 3-6 mos after stroke (ist stage of CVA recovery 1-6 mos) |
recovery of partially damaged ischemic neurons |
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Occurs in the forst 6 mos of stroke |
-resolution of local edema -augmentation of local circulation -destruction of local toxins |
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Second stage of recovery from a stroke (6 mos +) |
neuroplasticity -includes changes of structural and functional neuron organization |
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L anterior descending artery supplies |
anterior ventricular wall |
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circumflex artery supplies |
lateral surface of L ventricle |
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Internal Carotid Artery Stroke |
-aphasia -apraxia -homonymous hemianopsia |
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Brunnstrum Stages |
1. No volitional movement initiated 2. Development of synergy, no voluntary movement. Appearance of basic limb syneries. Beginning of spasticity 3. Marked spasticity. Synergies are performed voluntarily 4. Decreasing spasticity, relative independence of limb synergies (movement not dictated only by synergies) 5. Motor recovery. Further decrease in spasticity. Independence from limb synergies 6. Isolated jt. movements. Normal motor function is restored. |
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Tone reducing intervention for pt w/ a stroke |
-passive manipulation -icing -contraction of agonists -weight bearing *pressure splints and manual stretch = NO LONG TERM EFFECTS |
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Common pattern of motor recovery after a stroke |
-UE is usually more involved than LE at onset -However, motor recovery is less than LE motor recovery during rehab -the severity of weakness in the UE is a sig. predictor of eventual motor recovery |
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Tasks used to evaluate mobility for CVA assessment |
-ability to ambulate on various surfaces -ability to get on/off floor -def. of required word assistance -ability to sit up and lie down -ability to transfer from one surface to another -negotiation of stairs and curbs -word assistance scale: total assistance-independent |
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CVA: what is assessed during balance exam |
sitting & standing balance |
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Prognosis for return of useful hand function is ----- when UE paralysis is complete |
unfavorable |
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Most CVA recovery occurs in ? |
the first 6 mos -only minor improvement made after 6 mos |
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Signs of L brain damage |
-paralyzed R side -impaired speech -slow performance |
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Signs of R brain damage |
-impaired judgment -paralyzed L side |
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Assessment of what within 72 hrs after CVA are useful when predicting upper limb recovery |
Finger ext Shoulder abduction -if by the 2nd day following CVA a pt. demonstrates voluntary ext of fingers and abd of affected shoulder there is a 0.98 probability dexterity is regained by 6 mos |
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Unilateral neglect |
-can't register and integrate stimuli from one side of the body -not caused by a lack of sensory info -occurs from impairment in perception |
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Treatment for unilateral neglect |
-dress in front of mirror (force to visualize and percieve both sides of body) -self massage to neglected side (forces attn to neglected side) -place TV to neglected side -have people sit on neglected side |
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L hemisphere damage |
-difficulty communicating and processing info sequentially -cautious -anxious -disorganized -realistic in awareness f problems -apraxia -aphasia -R hemiparesis & motor impairments -impaired speech -UE>LE (MCA) -contralateral motor & sensory |
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R hemisphere damage |
-L neglect -impaired spatial awareness |
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CVA shoulder subluxation & pain |
-active WB exercises -passive limb PT -functional e-stim |
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Active WB exercises, what do they do? |
-lengthen or inhibit spastic muscles -facilitate inactive muscles |
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What does passive limb PT do? |
-maintenance of full pain-free ROM w/o causing jt. trauma |
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What is functional e-stim used for? |
-treatment of soulder subluxation -restoration of function in upper & lower limbs -treatment of spasticity |
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CVA & L brain damage (post acute phase). Instructions for good nutrition? |
-place food in back of mouth on unaffected side to avoid rapping food in affected cheek -assesss gag reflex before meals -soft & semi-soft foods are tolerated better than liquids -eat in a sitting position w/ neck slightly flexed to facilitate swallowing |
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CVA. What are good communication techniques for a PT to have |
-use a low pitched voice -statements and questions should be short & simple to decrease frustration -stand in front of pt -allow adequate time for pt to respond which helps pt to be motivated to communicate |
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Why is correct positioning important for pts who had a CVA |
-correct posture encourages jt. alignment -prevents contractures -promotes comfort |
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In supine a pt who has L hemiplegia must have ------- for proper positioning |
-affected LE must be on pillow in neutral -small rolled towel under the knee -head & neck in slight flex -small pillow under affected scapula -wrists in neutral |
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Language impairments in CVA's are most commonly seen w/ damage to ? |
L hemisphere -language centers are located in L hemispheres |
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CVA |
-an event that results in a lack of oxygen to the brain d/t ischemia or hemorrhage |
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Types of strokes |
TIA Completed Stroke Stroke Evolution Ischemic Stroke |
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TIA |
-atherosclerotic thrombosis -temporary interruption in blood supply to the brain -sx's usually resolve in 24-48 hrs -usually carotid or vertebrobasilar artery -predicts future CVA |
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Completed Stroke |
totl neuro deficits at onset |
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Stroke Evolution |
CVA from thrombus, total neuro deficits not seen for 1-2 days |
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Ischemic Stroke |
Thrombotic or embolic |
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Thrombotic Stroke |
Blood clot that developed in the blood vessels inside the brain |
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Embolic Stroke |
Clot that develops somewhere in the body and travels to the brain |
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CVA: Anterior Cerebral Artery |
-anterior frontal lobe -medial surface of frontal lobe -medial surface of parietal lobe -contralateral loss of LE motor and sensory -B&B loss -aphasia -apraxia -agraphia -akintic mutism |
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CVA: Middle Cerebral Artery |
Cerebrum Basal Ganglia -UE more affected -contralateral weakness -sensory loss of face -Wernickes aphasia -apraxia -anosognosia -homonymous hemianopsia |
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CVA: Posterior Cerebral Artery |
Occipital lobe Midbrain Thalamus -contralateral hemiplegia -contralteral loss of pain & temp -prosopagnosia |
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CVA: Vertebral Basilar Artery |
Cerebellum Medulla Pons -hemi-tetraplegia -dysphagia -ataxia -LOC -locked in syndrome |
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How to measure Stroke |
Brunnstrom National Institute of Health Stroke Scale Functional Independence MEasure Stroke Impact Scale Fugl-Meyer |
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Fugl Meyer |
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CVA in brainstem. What is affected? |
-CN VI (Abducens) |
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CVA is central or peripheral? |
CENTRAL |
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CVA Timeline |
0-6 mos: most gain gain in this time. 6 mos-1 yr: minor gains 1 yr +: little/min progress |
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Do people with Guillan Barre have difficulty speaking? |
No GB is demyelination of peripheral nerves |
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Why does ROM decrease with MS? How to treat? |
-It usually decreases d/t increased spasticity -Treatment: flexibility exercises necessary to ensure adequate muscle length & ROM |
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Treatment for decreased coordination in pts with MS? |
-decreased coordination is common in people with MS Frenkels exercises are commonly used for Tx of MS -consistes of a series of gradual progressive activities designed to increase coordination -require a high degree of mental concentration & effort -if successful they help regain control of movement through cognitive compensatory strategies |
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Technique to conserve energy d/t extreme fatigue in pts with MS? |
-perform more difficult tasks in the AM bc the normal rhythm of the body facilitates greater energy in the AM -avoid extreme temps (esp heat) bc it aggravates Sx's -pace activities -short periods of rest between activities replenish energy |
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Med to decrease hypertonocity & spasticity in pts with MS? What are its side effects? |
Baclofen Side effects -hypotonicity -general weakness -confusion -sedation -dizzy -liver toxicity |
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Myasthenia Gravis can weaken which muscles of swallowing? |
laryngeal & pharyngeal |
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When a person with myasthenia gravis has weakened muscles of swallowing, how to ensure safety? |
-give cues to encourage focus to enhance swallowing -eat slowly -eat small bites -schedule mealtimes when pt is well rested -caregive should know Heimlich manuever |
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PT's task when treating pts with PD? |
promote mobility & posture skills |
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Myoclonus |
Involuntary twitching of a specific muscle or muscle group -often associated with UMN disorders |
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Brunnstrom focuses on what techniques? |
-tonic reflexes to elicit muscle contractions -uses associated rxns for mm contractions -voice commands -resistance - |
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Glagow Coma Score? Localize Painful Stimulus Verbally respond in confused manner Open eyes in response to stimuli |
5+4+3 = 12 GCS < 8 indicates coma |
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Closed head injury from MVA. Difficulty with bike riding & jogging. Struggles to play saxophone even though he's played for years. What's going on? |
Procedural Memory Loss -Implicit Memory -the most basic & primitive form of memory -"how to" knowledge for basic associations between stimuli & responses |
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Declarative Memory |
Explicit Memory -type of long term memory responsible for retention of facts & event -Divided into: *semantic: knowing facts *episodic: remembering events |
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Retrograde Amnesia |
-acute onset amnesia -loss of memory for events immediately prior to onset of the disorder |
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Anterograde Amnesia |
-acute onset amnesia where there is memory loss for events immediately following the onset of the disorder |
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TBI is associated with? |
-Neuromuscular imapirments (primitive posturing & abnormal tone) -Cognitive impairments -Behavioral impairments |
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TBI UMN or LMN? |
UMN |
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TBI -Hypertonia or Hypotonia presents more often? |
Hypertonia bc UMN disorder |
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Flaccidity -UMN or LMN? -Hypertonia or Hypotonia? |
LMN Hypotonia |
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What type of rigidity is commonly seen with TBI? |
Both decorticate and decererate are commonly seen |
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Decorticate Rigidity |
UE: FLEX LE: EXT -indicates lesion at or above brainstem -problms with cervical spinal tract or cerebral hemisphere -commonly seen with TBI *to the cord (arms flexed in to the cord) *deCortiCate (arms like C's moves in toward the cord) |
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Decerebrate Rigidity |
UE: EXT LE:EXT -indicates lesion in the brainstem -problems with midbrain or pons -commonly seen with TBI -Extensor posturing (lots of E's in dEcErEbratE) -Arms like E's |
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Brunnstrom |
encourages the development of flexor and extensor synergies during early recovery |
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NDT uses |
postural control as the foundation |
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PNF uses |
-facilitation is based on spiral-diagonal movement -the technique involves 4 neurophysiological mechanisms 1. reflexes 2. resistance 3. irradiation 4. successive induction |
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RLA IV |
Confused Agitated -often emerging from coma -agitation -aggression -noncompliance -combative |
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Pauses at the end of inspiration & expiration indicate dysfunction in what part of the brain? |
Apneustic Breathing -dysfunction in middle or caudal part of brain (PONS) |
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Cerebral Hemisphere Damage -type of breathing? |
Rhythmical breathing with periods of apnea (Cheyne-Stokes Respiration) |
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Damage to Medulla -type of breathing? |
Neurogenic Hyperventilation -regular rapid & deep sustained breathing |
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Dysfunction of basal ganglia -type of breathing? |
Cheyne - Stokes respiration |
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Brainstem |
-located in fron tof cerebellum -connected to the spinal cord -3 structures (midbrain, pons, medulla oblongata) -many primitive functions essential for survival like regulation of HR and RR are located in the brainstem |
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Non-equilibrium test of coordination for pt with cerebrellar disorder |
non-equilibrium = sitting -finger to nose -alternating pronation/supination -finger opposition -heel to shin slides |
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Which lobe is interpretation of touch, pressure, pain, and temp. in? |
Parietal |
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Which lobe is visual area in? |
Occipital |
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Which lobe is Brocas in? |
Frontal |
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Which lobe is Wernickes in? |
Temporal |
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Visual reflex is controlled by the? |
Midbrain |
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Cerebellum |
Regulates the following for limb movement: -timing -force -extant -direction |
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Dysmetria |
-inability to modulate movement -overestimate/underestimate targets -inability to appropriately reach a target -inability to place feet on floor markers when walking -cerebellum responsible for timing, force, extent, and direction of limb movement |
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Cerebellum Damage |
Difficulty with: -movement -postural control -eye movement disorders -muscle tone -ataxia |
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Alternating Isometrics |
Facilitate isometric holding 1st in agonists on one side of joint, and second holding agonists -instability in WB -poor static posture control -weakness |
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Associated with cerebellar lesions |
-dysmetria -nystagmus -dysdiadokinesia |
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Nystagmus |
Cerebellar lesion = gaze evoked nystagmus -will attempt to look at an object in th eperiphery, but eyes will drift involuntarily back to neutral -can be unilateral or bilateral depending on cerebellar dysfunction |
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Dysdiadokinesia |
-inability to perform rapid alternating movements |
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Athetosis |
NOT from cerebellar lesion -extraneous & involuntary movements, slowness of movement, and alternations in muscle tone -may look worm-like with a rotary component |
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Mechanoreceptors |
-stereognosis -vibration -2 pt discrimination -touch -pressure -itch -tickle -generate info related to discriminitive sensations -info then travels through the dorsal column medial lemniscus -Examples: free nerve endings, Merkel's disks, Ruffini endings, hair follicle endings, meissner's corpuscles, pacinian corpuscles |
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Deep sensory receptors |
-located in muscles, tendons, and joints -muscle and joint receptor are both classified as deep sensory receptors -evaluate position, sense, proprioception, muscle tone, movement -Examples: golgi tendon organs, pacinian corpuscles, muscle spindle, ruffinin endings, free nerve endings, joint receptors |
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Nociceptors |
-specialized peripheral free nerve endings found in tissues in the body that respond to noxious stimuli & result in the perception of pain -pain stimulus travels in lateral spinothalamic tract to several areas of the brain that respond to painful stimuli |
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Thermoreceptors |
-sensory receptors tht respond to changes in temperature stimulation of cold or warm receptors -ascend the lateral spinothalamic tract |
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Golgi Tendon Organ |
-encapsulated sensory receptor -in tendons that attach to muscle fibers -sensitive to tension, esp. when produced from an active muscle contraction -transient info about tension or the rate of change of tension w/in the muscle -10 to 15 muscle fibers are connected in series with each golgi tendon organ -provides neurological system with immediate info on the degree of tension in each small muscle segment |
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Muscle Spindle |
-distributed throughout the belly of the muscle -they send info to the nervous system about muscle length and/or rate of change in its length it is important in the control of posture |
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Bilateral Occlusion od Anterior Cerebral Arteries -Signs |
-paraplegia affecting primarily the legs -incontinence -abulic aphasia -frontal lobe Sx's (personality changes) |
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Bilateral Occulusion of Middle Cerebral Arteries -Signs |
-hemiplegia -sensory impairment -aphasia (wernickes, brocas, global) -MCA supplies a large portion of the cortex, other impairments are lobe dependent |
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Posterior Cerebral Artery Occlusion -Signs |
-thalamic pain syndrome (abnormal sensation of pain, temp, touch, & proprioception) -cortical blindness (loss of vision d/t damage to visusal portion of occipital cortex) |
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Damage to vertebral basilar artery -Signs |
-locked in syndrome -unable to speak -cognitively remains intact -wide variety of Sx's based on complex vascularity of vertebral basilar artery |
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Vertebral basilar artery supplies |
-multiple areas of the brain -can produce significant impairment with damage |
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ACA damage |
LE > UE |
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L MCA damage |
-R UE motor function imapirment -impaired speech -impaired R UE sensation L hemisphere damage -contralateral (R) sensory & motor impairments (UE > LE) -speech & language impairments -apraxia -cautious behavior -disorganized problem solving |
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L MCA stroke -types of cues to use |
-visual or tactile -part practice: break down into steps -knowledge of performance -language impairments likely, so NO verbal cues & NO feedback on 00% of practice trails -pts need to use their own intrinsic feedback |
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Test for Concussion |
IMPACT |
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Grading scales for TBI |
-Glasgow Coma Scale -RLA |
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Concussion Scale |
Glasgow Coma Scale -used for concussions bc a concussion is a mild TBI |
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Glasgow Score |
13 |
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During football, a kid is hit hard on helmet. He is slightly shaky coming off the field, but back to normal w/in 2 mins. Has slight HA. What to do? |
Concussion -keep him out |
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Wernickes Aphasia |
RECEPTIVE aphasia -temporal area |
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Brocas Aphasia |
EXPRESSIVE aphasia -frontal area |
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Verbal Apraxia |
Non dysarthritic & non aphasic -acticulation of speech -L frontal lobe adjacent to brocas area |
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Dysarthria |
-motor development of speech caused UMN -affects muscles to articulate speech -so speech is slureed |
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Graphesthesia |
-ability to recognize letters, numbers, or designs traced on skin |
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Stereognosis |
-recognize object through tactile stimulation |
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Kinesthesia |
-PT moves extremity & asks pt to name direction extremity was moved in |
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Apraxia |
-ability to plan & execute coordinated movements -type of perceptual or cognitive impairment -will have adequate sensation & strength -inability to carry out purposeful movement with intact: sensation, movement, coordination |
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Aphasia |
-communication disorder -impairment of language comprehension, formulation, use -deficit in areas of the brain responsible for processing language -the lobe affected and severity of damage determines characteristics (type) of aphasia |
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Non-Fluent Aphasia |
GLOBAL, EXPRESSIVE, BROCAS -difficulty with verbal expression -poor word output -dysprosodic speech -poor articulation -increased effort to speak -able to comprehend language & are often frustrated by an awareness of their deficits |
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Fluent Aphasia |
-difficulty with comprehension of language -word output & speech production are functional, but speech is empty & lacks substance -usually unaware that they aren't understood |
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Global Aphasia |
NONFLUENT Aphasia -severe deficits with both language comprehension & expression -may involuntarily verbalize w/o appropriate context & must rely on non-verbal communication |
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Expressive Aphasia |
BROCAS NON-FLUENT Aphasia -may paraphrase when attempting to communicate as a means of adapting to difficulties with word output |
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Dyskinesia |
-some form of pathological, repetitive, & involuntary movement |
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Dysarthria |
-disturbance in speech -difficulty saying words bc of problems witht he muscles that allow one to talk -could talk if the muscles functioned properly, it's not that you don't know how to speak -pronounced slowly -accents misplaced -pauses in speech inappropriate -neurological injury of motor component of motor-speech system -pyramidal tract sends info to the CNS in charge of speech & swallowing -pyramidal tract originates in cortex of pre-central gyrus (motor strip) |
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Dysphagia |
-swallowing problems -weak: lips, tongue, palate, mastication muscles -damage to glossopharyngeal, vagus, & hypoglossal nerves |
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Form Consistency Dysfunction |
-difficulty attending to subtle variations in form or change in form such as sixe variation of the same object TREATMENT -tactile cues to feel objects in various positions to increase familiarity with objects |
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Body Schema Perception |
-an alteration in perception of body shape, position, or capacity TREATMENT -tactile & proprioceptive stimulation in diverse positions |
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Figure Ground Discrimination |
-can't distinguish foreground from background -difficulty locating objects TREATMENT -mark objects with colored tape so similar objects can be differentiated |
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Proprioception |
-awareness of positioning of a joint -pt ID's the position of a joint or duplicates position with opposite extremity -ist joint is passively moved and then pt isasked to describe position of joint |
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Kinesthesia |
-awareness of movement of an extremity -ID the direction of movement while extremity is in motion -simultaneously duplicate movement with opposite extremity while PT passively moves the other extremity |
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Impaired Body Schema |
-lack of awareness of body parts or position of body in relation to env |
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Ideomotor Apraxia |
-can perform task automatically -CANNOT perform task on demand |
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Ideational Apraxia |
-NOT ABLE to perform purposeful movements automatically OR on demand |
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Stereognosis |
-ID an object by touch w/o looking at it |
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Anomia |
-inability to name common objects -but visually able to demonstrate use of object |
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Visual object agnosia |
-uunable to name, describe, or demonstrate use of an object -is the most common form of agnosia |
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Cortical Blindness |
-total or partial loss of vision from damage to visual area of occipital cortex |
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CN V VS CN VII |
Trigeminal CN V -M & S -sensation of face -muscles of mastication -jaw reflex -corneal reflex -trigeminal neuralgia -facial pain, numbness -unilateral or bilateral -pain from mouth to nostril, eye, ear -muscles: masseter, temporalis -exacerbated by stress, cold FACIAL CN VIII -M & S -taste to ant. 2/3 tongue -muscles of facial expression: smile with teeth, puff cheeks, close eyes tight -bells palsy -facial paralysis (upper & lower) -pain from paralysis (ear, eye, mouth) -difficulty w/ eye closing, eating, facial expression, drooping of mouth, drooling, tearing |
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The pain distribution of trigeminal neuralgia follows the? |
sensory distribution of CN 5 |
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Maxillary branch of the 5th CN supplies the? |
-side of the nose -runs through: cheek, upper jaw, top of lips, teeth, gums |
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Which branch of CN 5 supplies the lower jaw & bottom lip? |
mandibular branch |
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Which branch of the 5th CN supplies the front part of the head? |
opthalmic |
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Which CN is involved in trigeminal neuralgia? |
CN 5 (trigeminal nerve) |
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How to test CN 5 |
-cotton wisp test: lightly touch each side of the face -clench the jaw |
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Test for CN 8 |
-weber test -bithermal caloric test |
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Test for CN 4 |
-extraoccular muscle test |
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Vagus nerve |
-sensory AND motor -motor: muscles of swallowing & phonation |
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CN 12 test |
Hypoglossal -push tongue against a tongue depressor |
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CN 9 test |
Glossopharyngeal -ID a taste at the back of the tongue |
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CN 10 test |
Vagus -assesses sensation to the thoracic viscera |
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CN 11 test |
Spinal Accessory Nerve -resistance to traps as pt shrugs |
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Trigeminal Neuralgia -Signs |
PAIN -brief & paroxysmal facial pain (severe intensity, stabbing quality) -pain starts on one side of cheek and radiates to jaw, top lip, teeth, gums, & the side of the nose -pain triggered by vibration, light touch, face washing |
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When to examine cranial nerves |
suspected lesion of: brain, brainstem, c-spine |
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Testing olfactory nerve |
-assess one nostril at a time w/ eyes closed -close off nostril not being tested |
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Which CN causes head tilt when walking & climbing stairs |
CN 4 |
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Damage involving the descending motor pathways causes a set of Sx's called? |
UMN syndrome |
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Ascending Spinal tracts -Type of info? |
Sensory |
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Descending spinal tracts -Type of info? |
Motor |
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Posterior Column Medial Lemniscal Pathway |
-proprioception -vibration sense -fine touch (tactile discrimination)(2 pt discrimination) -graphesthesia -form recognitio |
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Posterior Column Medial Lemniscal Pathway -# of neurons? |
1st, 2nd, 3rd order neurons |
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Posterior Column Medial Lemniscal Pathways -Ipsilateral or Contralateral? |
Ipsilateral Sensory deficits -pathway doesn't decussate until it's at the level of the medulla |
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Spinocerebellar Tract |
Unconscoius -proprioception (upper & lower limbs to ipsilateral cerebellum) -proprioception from muscle spindles & golgi tendon organs -touch -pressure -touch & pressure receptors to cerebellum for control of voluntary movements -tension in muscles -jt. sense -posture of trunk, LE's, & UE's |
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Spinocerebellar Tracts -4 pathways |
1.Posterior Spinocerebellar 2. Cuneocerebellar 3. Anterior Cerebellar 4. Rostral Spinocerebellar |
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Posterior Spinocerebellar |
Leg proprioception |
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Cuneocerebellar |
arm proprioception |
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Anterior Spinocerebellar |
Leg interneurons |
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Rostral Spinocerebellar |
Arm interneurons |
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Injury to spinocerebellar tracts |
Ipsilateral loss of muscle coordination |
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Spinothalamic -2 divisions |
1. Lateral Spinothalamic tract 2.Anterior Spinothalamic tract |
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Lateral Spinothalamic tract |
-pain -temp -sensation |
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Anterior Spinothalamic tract |
-crude touch -light touch -pressure |
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Spinothalamic tract -decussates |
spinal cord |
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Spinothalamic tract -lesions in brainstem or higher |
Contralateral -pain perception -touch sensation -proprioception |
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Spinothalamic Tract -spinal cord lesion |
CONTRALTERAL -pain perception IPSILATERAL -touch -proprioception |
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Spinoreticular Tract- |
-deep pain -chronic pain -influences levels of consciousness |
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Spinotectal Tract |
-spinovisual reflexes -movement of eyes & head toward a stimulus |
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Spinolivary tract |
-relays info from cutaneous & proprioceptive organisms |
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Ascending Sensory (4) |
1.Dorsal Column/Medial Lemniscal Pathway 2. Spinothalamic Pathway 3. Spinocerebellar 4. Spinoreticular |
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Dorsal Column/Medial Lemniscal -2 tracts |
1. Fasciculus Cuneatus 2. Fasciculus Gracilis |
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Fasciculus Cuneatus |
LATERAL -UE tracts -sensory tract for the trunk, neck, & UE -proprioception -vibration -2 pt discrimination -graphesthesia |
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Fasciculus Gracilis |
MEDIAL -LE tracts -same as fasciculus cuneatus except for LE & trunk |
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Dorsal Column/Medial Lemniscus -General |
-proprioception -vibration -tactile discrimination |
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Descending Motor Tracts (5) |
1.Corticospinal 2.Vestibulospinal 3. Rubrospinal 4. Reticulospinal 5.Tectospinal |
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Corticospinal -Damage |
(+) Babinski -absent superficial abdominal reflexes -absent cremasteric reflexes -loss of fine motor & skilled oluntary movement |
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Corticospinal (2) |
-Anterior -Lateral |
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Corticospinal Anterior |
-ipsilateral voluntary motor control, discrete, skilled movement |
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Corticospinal Lateral |
-contralateral voluntary fine movement |
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Vestibulospinal -Damage |
-significant paralysis -hypertonicity -exagerrated deep tendon reflexes |
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Vestibulospinal |
-control of muscle tone -postural reflexes -ipsilateral gross postural adjustments subsequent to head movement -facilitate activity of EXTENSOR muscles and inhibit flexor muscles |
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Tectospinal |
-assists in head turning responses to visual stimuli -contralateral postural muscle tone associated with auditory/visual stimuli |
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Rubrospinal |
-motor function -motor input of gross postural tone -facilitate activity of FLEXOR muscles & inhibit extensor muscles |
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Reticulospinal |
-facilitation or inhibition of voluntary or reflex activity through influence of alpha & gamma motor neurons |
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Reticulospinal -Dorsal |
-modifies transmission of sensation (mostly pain) |
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Reticulospinal -Ventral |
-influences gamma motor neurons & spinal reflexes |
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Central Grey Matter |
2 anterior ventral horns 2 posterior dorsal horns |
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Anterior Grey Horns |
EFFERENT (Motor) Neurons -alpha motor neurons affect muscles -gamma motor neurons affects muscle spindles |
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Posterior Horns |
AFFERENT (Sensory) Neurons -cell bodies are in dorsal root ganglia |
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White Matter -Location |
The following columns -Anterior (ventral) -Lateral Posterior (dorsal) |
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White Matter Pathways |
-Ascending (sensory) afferent -Descending (motor) efferent |
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Baclofen -other name |
Lioresal |
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Baclofen (Lioresal) |
-antispasticity agent used to relax spastic muscles |
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Baclofen used for |
MS CP |
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Selective Serotonin Reuptake Inhibitor -belongs to which pahmaceutical class? |
ANTIDEPRESSANT -usually associated with psychiatric management -effective in managing Sx's associated with fibromyalgia even in pts without psychiatric mobidity |
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Selective Serotonin Reuptake Inhibitor -used for |
-sleep disturbance -chronic pain -fibromyalgia -psychiatric management |
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SSRI -example? |
Amitriptyline |
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Anticonvulsant agents -example |
Pregabalin |
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Anticonvulsant Agents -used for |
-reduces sx's of pain, fatigue, & sleep disturbances associated with fibromyalgia -typically associated with seizure disorder |
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Alpha 2 Adrenergic Agonist Agents -examples |
Clonidine Tizanidine |
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Alpha 2 Adrenergic Agents -used for |
-usually associated with spasticity management -may be used as adjunct intervention to help manage chronic pain conditions like fibromyalgia |
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Muscle Relaxant Agents -examples |
Cyclo benzaprine |
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Muscle Relaxant Agents -used for |
-typically associated with muscle spasms -low dosage have been shown effective in reducing sleep disturbances & chronic pain sx's associated with fibromyalgia |
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Analgesic commonly prescribed for neuropathic pain? |
Meloxicam |
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Med for neuropathic pain to decrease endoneurial edema |
Steroids |
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Med to treat trigeminal neuralgia |
Carbamazepine -used for INITIAL drug treatment -it inhibits Na channel activity, which decreases the excitability of neurons -Later on the following meds are used *Gabapentin *Phenytoin *Baclofen |
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Gabapentin -Use -Side Effects |
Antiepileptic Agent -used for decreasing seizure activity Side Effects -ataxia -behavior changes -GI distress -HA -blurred vision -weight gain |
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Levadopa |
Dopamine Parkinsons Disease |
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Baclofen |
-for spasticity -CP Side Effects -drowsiness -dizziness -weakness -tiredness -HA -trouble sleeping -nausea -constipation |
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Equilibrium Coordination Tests |
-consider both static & dynamic components of possible balance -IN UPRIGHT POSITION Examples -Romberg -Walking -Marching in place |
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Coordination tests can be divided into? |
Equilibrium Non-Equilibrium |
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Home changes that decrease fall risk? |
-increase daytime lighting in dark areas -keep traffic areas free from clutter |
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Perturbations in standing |
-intervention for challenging balance -not an established test to determine postural control & risk for falls |
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Approximation |
-for contraction & stability through jt. compression -compression force is applied to jts through gravity action on body weight, manual contacts, weight belts |
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Rhythmic Initiation |
-voluntary relaxation -then passive movemens through movement in range -followed by active assistive movements -resisted movements USED FOR -relax -hypertonicicty -inability to initiate movement -motor learning deficits -communication deficits |
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Timing for Emphasis |
-uses max resistance to elicit a sequence of continuous contractions from major muscle components of a pattern of motion -allows overflow from strong to weak muscles -commonly used with repeated contractions USED FOR -weakness -incoordination |
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Continuous feedback -------- performance, Continuous feedback -------- motor learning |
improves delays |
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What is the associative stage of motor learning? |
Errors are decreasing and movements are becoming more organzed -some trial & error learning is the goal |
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Muscle Re-education |
-mainly develops coordinated movements, beginning with learning to control individual muscles on a cognitive level |
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Distributed Practice |
-amt. of rest is equat to or greater than amt. of practice time FOR pts with -short attn san -drop in oerformance d/t fatigue |
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Random Practice |
-order in which different tasks are performed is variable -has no effect on attn span or fatigue |
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Blocked Practice |
-one task performed several times before movng to the next task |
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Massed Practice |
-amt of practice time is greater than the rest time -can lead to fatigue |
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Neuro Developmental Treatment (NDT) (BOBATH) |
-activation of normal righting and equilibrium reactions |
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Motor Relearning Program |
Elimination of unecessary muscle activity |
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Proprioceptive Neuromuscular Facilitation (PNF) |
-diagonal patterns of movement -combines functional diagonal movement patterns with neuromuscular techniques to facilitate motor control & function |
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PNF -how is it named |
-based on the position of the most proximal joint at the completion of the diagonal pattern |
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PNF Technique commonly used for shoulder injury? |
-contract releax -repeated contraction -hold relax |
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D1 UE Flex |
-close hand & pull up & across body shoulder: flex, add, ER scapula: elevation, abd, up rot elbow: flex or ext forearm: supination wrist: flex, radial dev. thumb: add |
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D1 UE Ext |
-open hand and push down & away from body shoulder: ext, abd, IR scapula: depression, ADD, down rot. elbow: flex or ext forearm: pronation wrist: ext, ulnar dev thumb: abd |
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D2 UE Flex |
-open hand & pull up & away from body -start: hand at opposite hip -end: shoulder in flexed & abducted position shoulder:flex, abd, ER scapula: elevation, abd, up rot elbow: flex or ext forearm: supination wrist: ext, rad dev thumb: ext |
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D2 UE Ext |
-close hand & pull down & across body shoulder: ext, add, IR scapula: depression, add, IR elbow: flex or ext forearm: pronation wrist: flex ulnar dev thumb: opposition |
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D1 PNF for hip or shoulder |
flexion - adduction - ER |
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D2 PNF for hip or shoulder |
flexion-aBduction-ER |
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Reciprocal shoulder patterns |
Ext-Add-IR Ext-Abd-IR |
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Constructional ability assessment |
-copy drawn figures of varying shapes & sizes Impairment = damage to parietal lobe (CVA) |
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what is a primary intervention to resolve burners |
-chest out posture -this posture opens foramina maximally, reducing the effect of the weight of the head on the nerve roots -it decreases pressure on the brachial plexus by the scalene muscles -flexibility -strenthening -protective gear -anti inflammatories -ice a few days after the injury to reduce swelling |
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burner -signs |
-frequent burning pain above clavicle pain radiates into arm pain resolves in about 2 mins w/o intervention |
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burner -MOI |
-traction is most common MOI -traction where the head & neck are forcefully moved away from the ipsilateral depressed shoulder -direct blow to supraclavicular fossa -compression from hyperext & ipsilateral lateral flex |
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meralgia paresthetica |
-abnormal distribution of lateral cutaneous nerve or sensory assessment |
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each nerve root has 2 components: somatic & visceral -what is a somatic function |
-it provides sensory input from skin, fascia, & muscles -it also innervates skeletal muscles VISCERAL -innervates: blood vessels, dura mater, intervertebral discs, ligs, periosteum |
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cause of femoral nerve dysfunction |
lithorny position -lying on back w/ thighs & legs flexed during surgery |
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torniquet paralysis is what type of injury |
mechanical |
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compression syndrome injury cause |
crush & precussion injury |
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SC compression is associated with |
-ant cord syn -post cord syn -cauda equina |
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stretch injury example |
severe blow to a nerve traction |
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mechanical injury example |
tourniquet paralysis |
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best test to verify diagnosis of cervical radiculopathy |
spurling test (AKA: foraminal compression test) POSITION -neck ext -head rot -compressive force applied POSITIVE -pain extends to extremity on same side to which head is rotated |
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median nerve damage at elbow |
-d/t supracondylar fx of humerus MOTOR -forearm flexors & pronators paralyzed -supinated bc pronation weak -flex is weak -add bc pull of flex carpi ulnaris -can't flex thumb -can't flec MCP bc 2 lateral lumbricals paralyzed SENSORY -no sensation SIGNS -thenar atrophy -when make fist only little & ring finger flex = hand of benediction |
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muscular wasting -diagnostic test |
electromyography |
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in the L & T spine the spinal nerves exit --- the vertebra |
below |
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in the Cspine the spinal nerves exit --- the vertebra
|
above -but C8 exits below the C7 vertebra |
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there are how many pairs of spinal nerves that branch from the SC |
31 pairs |
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following a TBI a pt has a contracture/tightness& problems w/ supination & pronation -first thing to do |
-primarily focus on mobilization & stretching -once you have the range start strengthening -stretching & strengthening must be in directly proportional ratio (stretch to gain ROM to 10 degrees, then strengthen the muscles in those 10 degrees before stretching further) -ROM gain is only possible through stretching -mobilization isn't really required here, focus on stretch, then strengthen |
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myelodysplasia -type of? |
spina bifida |
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orthotic device for T10 level myelodysplasia -parapodium or lightweight WC |
-either -depends -parapodium can't be used int he community or everywhere the pt wants to go (primarily home use) -light weight WC is handy, can take it in their car, can use it for community & social purposes |
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perseveration -which area of the brain is affected? |
frontal lobe |
