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55 Cards in this Set

  • Front
  • Back
What are the 3 domains of human function according to the ICF?
-body fxn and structure
-activity
-participation
What are the 3 components of a task oriented approach to examination?
-function
-strategy
-impairment
What assumptions are the basis of the Reflex Motor Control Theory?
-sensation necessary for mvmt
-sensory input controls motor output
-reflexes = building blocks
-closed loop feedback mechanism
What were the clinical implications of the Reflex Theory?
-reflex testing to predict fxn
-rx aimed at facilitating/inhibiting reflexes during motor tasks
What are the limitations of the Reflex theory?
-reflex not basic unit of mvmt
-doesn't explain fast mvmt
-doesn't explain novel mvmt
-single stimulus can cause variable responses
-coordinated mvmt can occur in absence of sensory input
What are the assumptions of the Hierarchical Motor Control Theory?
-brain controls all mvmt
-top-down organization
-reflexes emerge w/ brain dmg
-CNS links muscle contractions to produce mvmt patterns
-CNS maturation drives motor development
What is the chain of control according to the Hierarchical Theory?
cortex -> basal ganglia/cerebellum/brainstem -> spinal cord -> receptors
What clinical implications resulted from the Hierarchical Theory?
-abnormal mvmt result of lack of CNS inhibition
-reflex testing to predict fxn and level of neural maturation
-facilitate normal mvmt w/ proprioceptive input
-inhibit abnormal tone/mvmt
-pts to be trained through developmental sequence
What were the limitations of the Hierarchical Theory?
-normal presence of primitive reflexes in neurologically healthy adults
-pts passive recipients depend on facilitation
-reflex inhibition doesn't release normal mvmt
-unproven carryover to fxnal tasks
What are the clinical implications of the Systems Theory?
-task oriented approach
-teaches motor problem solving
-variable environment practice
-improve compensatory strategies
-consider all systems contributing to mvmt
What are the Systems Theory's limitations?
-minimal hands on
-requires active problem solving
-difficult to quantify efficient compensations
-difficult to provide lots of time for skill practice
Name 4 motor impairments following neurologic injury.
-muscle weakness
-abnormal tone
-coordination probs
-involuntary mvmts
Name 3 sensory impairments following neurologic injury.
-somatosensory deficits
-visual deficits
-vestibular deficits
Name 3 perceptual deficits following neurologic injury.
-agnosia
-neglect
-apraxia
Name 3 cognitive deficits following neurologic injury.
-orientation
-memory
-arousal/level of consciousness
Name 3 speech and language deficits following neurologic injury.
-aphasia
-dysarthria
-dysphagia
What terms are commonly used to describe weakness w/ UMN lesion?
-paralysis, plegia, paresis, paraplegia, tetraplegia, hemiplegia/paresis
Name 2 types of hypertonia.
-spasticity
-rigidity
Name 4 Coordination Problems associated w/ UMN lesions.
-timing
-intra/interlimb coordination
-accuracy
-scaling force/amplitude
Name 4 Involuntary Mvmts associated w/ UMN lesions.
-dystonia (basal ganglia)
-chorea (basal ganglia)
-athetosis (CP)
-tremor (PD, cerebellum)
What are the 2 main types of stroke?
-ischemic
-hemorrhagic
What are 3 potential causes of ischemic stroke?
-cerebral thrombus
-embolism
-atherosclerosis
What are 2 types of hemorrhage that can cause CVA?
-intracerebral
-subarachnoid
How does hemorrhage result in neural tissue death?
-blood is an irritant that causes neural death
-ischemia distal to the ruptured blood vessel causes further damage
-sudden severe bleed can cause inc ICP, compress/herniate brain tissue causing 2ndary brain damage
What is the cascade of events that occur as a result of ischemia to neural tissue?
-excessive glutamate release -> Ca2+ influx -> activate destructive Ca2+ enzymes -> further cell death and damage to prenumbra
What are some risk factors for stroke?
-hypertension
-atherosclerosis
-diabetes
-obesity
-smoking
-TIA/prior CVA
-age/gender
-high cholesterol
What are common problems resulting from Anterior Cerebral A. occlusion?
-contra hemiparesis/plegia LE
-contra sensory loss LE
-mental confusion
What are common problems resulting from Middle Cerebral A. occlusion?
-UE contra hemiplegia
-UE contra sensory loss
-homonymous hemianopsia
-aphasia
What are common problems resulting from Posterior Cerebral A. occlusion?
-homonymous hemianopsia
-other visual deficits
-sensory loss
-thalamic syndrome
-transient contra hemiplegia and sensory loss
What are common problems resulting from Vertbrobasilar A. occlusion?
-ipsilesional ataxia
-coma
-diplopia
-tetraplegia
-coordination impairments
-"locked in syndrome"
What is locked in syndrome?
-tetraplegia w/ preserved consciousness, sensation, and vertical gaze
What are 2 pharmacological treatments for CVA?
-thrombolytics (optimal w/ in 3 hrs)
-neuroprotectives (glutamate/Ca2+ antagonists)
What are the characteristics of right sided brain damage post-CVA?
-uni left sided neglect
-agnosia
-implusive behavior
-poor judgement
-unaware of deficits
-emotional lability
What are the characteristics of left sided brain damage post-CVA?
-aphasia
-apraxia
-hesitant behavior
-aware of deficits
-depression/negative attitude
What is the etiology of MS?
-chronic demyelinating disease affecting brain and spinal cord
-autoimmune disease thought to be triggered by viral infection
-genetic predisposition
How does MS cause CNS damage?
-autoimmune response against oligodendrocytes causing demyelination, slowing conduction and fatiguing nerves more easily
-inflammation occurs and further impedes nerve conduction
What sites are commonly affected by MS?
-optic pathway
-corticospinal tracts
-dorsal columns of spinal cord
-cerebellar peduncles
What impairments are common to MS pts?
-diplopia
-weakness/spasticity
-parasthesia/loss of proprio
-ataxia, hypotonia
-B&B, easily fatigued
-Uthoff's Syndrome
What is Uthoff's Syndrome?
-impairments of MS and fatiguability increase with exposure to heat
What are 2 main clinical subgroups of MS? How are the diagnoses differentiated?
-relapsing-remitting MS = 2+ attacks lasting 24+ hrs separated by more than 1 month
-progressive MS = impairment lasting greater than 6 mos
What are the potential pharmacological interventions used to treat MS?
-short term use of corticosteroids and methotrexate to suppress immune system
-long term use of interferon to reduce frequency of attacks
What is the etiology of PD?
-idiopathic
-environmental toxins
-genetic factors
-normal aging acceleration
-80% cases
What causes secondary PD?
-infection
-head trauma
-drugs (MPTP, cocaine)
-20% cases
What nuclei make up the basal ganglia?
-striatum (caudate/putamen)
-globus pallidus
-subthalamic nucleus
-substantia nigra
How does PD affect the nervous system?
-slow degeneration of dopamine producers in s. nigra -> dec dopamine-> overactivity mvmt inhibition -> a/bradykinesia, postural instability
-excess facilitory causes tremor and rigidity
What are the 4 cardinal direct impairments of PD?
-tremor
-rigidity
-bradykinesia
-postural instability
What are some other direct impairments associated w/ PD?
-B&B probs, impotence
-dementia in 20-40%
-orthostatic hypotension, non-linear HR inc in response to exercise
-muscle weakness from insufficient neural activation
What are the indirect impairments associated w/ PD?
-kyphosis
-flexion contractures
-festinating gait (fast shuffle)
-dysphagia/dysarthria
-cardiovascular impairment
What are the 2 clinical subgroups of PD?
-postural instability gait disturbed (55%)
-tremor predominant (45%)
What are the characteristics of postural instability gait disturbed PD pts?
-posture/gait
-bradykinesia
-more debilitating
-rapid progression
-impaired cognition
What are the characteristics of tremor predominant PD pts?
-less common bradykinesia/postural instability
-less debilitated
-slower progression
-earlier onset
What are the 5 stages of the Hoehn and Yahr Disability Classification?
I - uni symptoms
II - bilateral or axial involvement w/out posture instability
III - postural instability + physical independence
IV - all sx present and severe assistance to walk/stand
V - wheelchair or bed bound
What is the pharmacological management of PD?
-dopamine replacement therapy w/ levadopa and carbidopa (sinemet)
-reduces bradykinesia and rigidity w/ little effect on tremor/posture
-end-dose deterioration occurs usually 5-7 yrs
what is the significance of dural tears associated w/ compound skull fx?
-increased risk of infection
What is the distinction between primary and secondary brain damage?
-primary = occurs at moment of impact
-secondary = occurs w/in minutes to hours