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59 Cards in this Set
- Front
- Back
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Segmental Lesion Dysfunction |
Focal lesion disrupts neural function at the level of the lesion only (LMN) -Unilateral -Dermatome/Myotome distribution -Loss of muscle pain info from segment -Reduced/abesent reflexes |
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Vertical Tract Lesion Dysfunction |
Loss of communication to and from levels below the lesion (LMN and UMN) -Bilateral -Loss of ascending sensory info (isp DCML and Contra ST) -Loss of descending motor info below the level (paralysis, spasticity) -Hyperreflexia -Autonomic symptoms - deregulation of BP sweating and bowel/bladder control |
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Define Tetra and Paraplegia |
T: C1-C8 - any loss in upper extremities P: T12-L1 lower extremity and trunk |
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Complete vs Incomplete Lesion |
C: No motor or sensory below the level of the lesion I: Preservation of motor or sensory function below the level of the injury; may be mixed and generally inconsistent |
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Asia Scoring |
A – Complete B – No motor, Some Sensory, Sparing C – Some motor (most muscles below 3/5),Some sensory, sacral sparing D – Some motor (most muscles above 3/5),Some sensory, sacral sparing E – Normal |
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Describe Central Cord Syndrome |
Hyperextension in the cervical region Common postop cervical surgeries due to swelling Motor > Sensory UE > LE |
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Describe Brown Sequard Syndrome
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Hemisection (penetrating wounds) Ipsilateral LMN paralysis at level of lesion and loss of DCML Contralateral Spinothalatmic loss |
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Describe Anterior Cord Syndrome |
Flexion/Compression injuries Reduced blood flow from Anterior Spinal Artery Loss of motor function below level Loss of Spinothalamic below level of injury DCML preserved |
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Describe Posterior Cord Syndrome |
Reducedor interruputedblood flow through Posterior Spinal Artery Spinothalamic and motor is preserved Loss of DCML |
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Describe Cauda Equina |
No UMN signs Saddle anesthesia Variable flaccid paresis or paralysis of lower limb Low back pain Lower limb paresis and sensory deficits Dec lower limb reflexes |
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SxS Autonomic Dysreflexia |
Acute onset of autonomic activity Hypertension Dec HR Headache Sweating above level of lesion Constriction of pupils Blurred Vision Anxiety |
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What kind of wheelchair does C1-C4 injury use? |
Sip and puffed controlled wheelchair |
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What kind of wheelchair does C5-C6 injury use? |
Manual and motorized |
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What kind of wheelchair does C6-C7 use |
Could be manual wheeling |
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Who can start therapeutic ambulation with extensive bracing? |
Low Tspine to L3 Need trunk control |
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Who can start functional walking w/bracning |
L3-L5 w/ Cructches |
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Describe SxS of injury to the Anterior Cerebral Artery |
Contralateral hemiparesis and sensory loss LE > UE Urinary incontenence |
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Describe SxS of injury to the Middle Cerebral Artery |
Contrallateral spastic hemiparesis and sensory loss of face, UE, and LE UE > LE Dom: Aphasia Non Dom: Unilateral neglect, apraxia, spatial disorganization |
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What is Motor neuron disease |
Group of progressive neurological disorders that destroy cells that control essential muscle activity Gradual muscle weakening, atrophy, fatigue, dec endurance and uncontrollable twitching |
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Central vs Peripheral Fatigue |
C: Cannot recruit enough motor units P: Dec force production |
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Pathophysiology of ALS |
Massive loss of anterior horn cells of SC and CN nuclei, demyelination and gliosis of corticospinal tracts and corticobulbar tracts --> Degeneration of BETZ cells UMN and LMN |
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Dx ALS |
Rule everything else out -UMN and LMN degeneration -Progressive spread -Atrophy, fasiculations, positive babinski, spasticity |
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SxS of Guillane Barre |
LMN Affects nerve roots and peripheral nerves Acute rapid onset PMH of virus/vacciens Starts Distally and moves proximally |
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Ptwith c/o LBP and no trauma or stress. Paresthesia in feet and movingsymmetrically up the legs. Dec Vibration. And week ago they got vaccines. |
Suspected GB |
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Early signs of Parkinsons |
•REM sleep disorder •Foot dystonia and cramping •Loss of smell (100%) •Orthostatic hypotension •Constipation |
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Clinical Dx of parkinsonism
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Bradykinesia Rigidity Resting Tremor Postural instability |
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SxS of Supra nuclear palsy |
Vertical gaze palsy Early onset of falls Cognitive deficits |
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SxS of Multiple Systems Atrophy |
Cerebellar Dysfunction Autonomic Dysfunction |
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SxS of Lewey Body Disease |
Dementia Cognitive changes early on Hallucinations (not drug induced) LBD and PD brains look the same |
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Describe Drug induced parkinsonism |
Symmetrical onset Younger onset Common with prolonged lithium use |
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SxS of Vascular "parkinsonism" |
Stuttering onset Little to no tremor LE > UE |
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Normal Changes in the brain with aging |
White matter atrophy Demylelination Mild Cognitive change - maybe Short term memory loss Balance - due to mild changes in vision/vestibular/somatosensation |
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How do you assess attention |
A-test Mini-mental Digit span - 7 is normal Abstract thought -"How is A similar to B" -Proverbs |
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How to assess orientation |
Person Place Time Purpose |
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How to test constructional ability
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Draw a clock |
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Describe the function of the horizontal canals
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Sense Rotation -Causes Ipsilateral excitation and Contralateral inhibition |
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Describe the VOR |
When you turn your head, your eyes move to the opposite side -The default is for your eyes to stay fixed -Takes Cortical activity to suppress the reflex |
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What should happen in a normal person with the Headshake test |
Eyes should stay forward because the VOR is symmetrically intact |
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What happens if one VOR is damaged?
(Ex. Right side) |
If right side VOR is damaged, when you turn to the right, the right canal will not be as excited. Eyes will shift to the right because the Left VOR is now unopposed |
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What is the primary goal of the positioning of the Dicks Hall Pike? |
To create optimal motion in the posterior canal. Turn the head 45 degrees so that the anterior contralateral anterior canal, and ipsilateral posterior canal is lined in front. |
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What structure in the vestibular system senses motion? |
Cupula |
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What is the best test to assess the cochlear nerve
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Rinnie Test •Hold vibrating tuning fork on mastoidbehind ear •Ask when the ptstops hearing it •When they report stop, move the fork tothe pt’s ear •Normal: air conduction better than boneconduction |
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What are the 4 phases of motor control |
Mobility
Stability Controlled Mobility Skill |
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Describe Mobility |
•Rangeof motion and Strength •Stretching •Ex.If pt onlyhas 10deg of hip flexion, start strengthening at 10deg of flexion |
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Describe Stability |
•Maintainjoint alignment •Controlthrough a range of motion •Ex.ACL tear has mobility, but dec stability •TreatingStability --Nonmoving BoS --PNF -Rhythmic Stabilization |
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Describe Controlled Mobility |
•Changingbase BoS --Transferweight from supine --> sitting --> standing --WeightShifting |
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Describe Skill |
•Movementon moving BoS --GaitTraining |
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Contract relax is for...
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Inc muscle length |
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Rhythmic Initiation is for.... |
Mobility |
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Rhythmic Stabilization is for.. |
Stability |
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Agonist reversal are for... |
Increasing Strength |
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D2 Arm flexion would help with... |
Upper Body Extension |
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Which Reflex: Pt. is supine and cannot flex their neck |
Tonic Labrynthine |
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Which Reflex: Pt. is jumpy with loud noises |
Moro/Startle Reflex |
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Which Reflex: Pt. is in quadruped and they turn their head and flex their elbow |
ATNR |
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Which Reflex: Pt. extends their head, their arms flexand legs extend |
STNR |
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Which Reflex: PT lightly runs their finger down ptsback and ptextends and side bends |
Spinal Galant Reflex |
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Which Reflex: Object contacts palm and ptgrasps |
Palmar Grasp |
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Which Reflex: Pt can stand but not step |
Positive Support (Pressure on feet cause extension) |
