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