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97 Cards in this Set
- Front
- Back
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Sx Middle Cerebral artery (MCA) CVA
and Interanal carotid artery (ICA) CVA |
contralateral hemiplegia
hemianethesia homonymous hemianopsia aphaisa apraxia |
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Sx Anterior cerebral artery (ACA) CVA
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contralateral hemiplegia
hemianesthesia grasp reflex incontinence confusion apathy mutism |
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Sx Posterior cerebral artery (PCA) CVA
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homonmous hemianopsia
thalamic pain (chronic pain of affected side) hemisensory loss alexia |
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Left hemisphere specialization
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(R) sided movement and sensory
(R) field visual perception visual verbal processing verbal auditory processing verbal memory speech bilateral motor praxis bilateral auditory reception |
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Right hemisphere specialization
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(L) sided movement and sensation
(L) field visual reception (L) motor praxis visual spatial processing processing nonverbal auditory info nonverbal memory interpreting abstract info attention to incoming stimuli emotion interpreting tonal inflections |
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Possible symptoms following TBI
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hemiplegia, monoplegia
abnormal reflexes decortical/decerebate rigidity fixed pupils coma changes in vital signs |
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what is the Glasgow Coma Scale
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Diagnositc test offering objective method of recording concious state of person
Responses assesed for eyes verbal motor |
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Scoring Glasgow coma scale
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sum and 3 separate scores given (eyes, verbal, motor)
highest score = 15 (fully concious) Lowest scoe = 3 (deep coma/death) Severe = <8 Moderate = 9-12 Minor = >13 |
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Example of how Glasgow coma scale scores are documented
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GCS 11 = E4 V3 M4 at 11:30pm
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Glasgow coma scale: eyes
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4 = opening eyes spontaneously
3= opening eyes to speech 2 = opening eyes in response to pain 1 = no eye opening score best response |
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Glasgow coma scale: verbal response
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5 = A&O to person, time, place, and situation
4 = confused (answeres questions but some confusion persists) 3 = inappropriate words 2 = incomprehensible sounds (moaning, no words) 1 = no verbalizations/sounds score best response |
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Glasgow coma scale motor response
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6 = obeys commands to do simple things
5 = localizes pain (purposeful movements in response) 4 = withdraws from pain (pulls away) 3 = flexion in response to pain (decorticate response) 2 = extenson in response to pain (decerebate response) 1 = no response to pain score best repsonse |
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What does the Rancho scale measure?
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Levels of cognitive functioning
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Rancho level 1
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no response
total assistance complete absence of observable behavior in response to any sensory stimuli |
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Rancho level II
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Generalized response
total assistance -generalized reflex in response to pain -increases or decreases activity w/ auditory stim -responds to external stim with physiological responses, gross movements, non-purposeful vocalizations -responses may be significantly delayed |
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what is a rancho level 3?
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Localized response
total assistance -withdraws/vocalizes to painful stim -turns toward/away from auditory stim -blinks at strong light crossing visual field -responds to discomfort by pulling tubes/restraints -responds inconsistently to simple commands -responses directly realted to type of stimulus -may respond to some people (friends, family) but not to others |
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What is rancho level 4?
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confused/agitated:
Maximal assistance -Alert w/ heightened state of activity -purposeful attempts to remove restraints/tubes and crawl out of bed -may sit, reach, or walk with out purpose or upon reqyest -very brief and non-purposeful moments of sustained alternatives and divided attention -absent short term memory -may cry out/scream in reaction to stimulus, even following removal -may show aggressive or flight behavior -mood swing may go from euphoric to hostile without relationship to events -unable to cooperate with treatment -verbalizations frequently incoherent/inappropriate to environment/activity |
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What is rancho level 5?
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Confused, inappropriate and non-agitated
Maximal assistance -alert, may wander randomly with vague inention of going home - may become agitated in response to lack of external stim/environmental structure -not oriented to person, place, or time -frequent brief periods of non-purposeful sustained attention -severely impaired recent memory, confusion of past and present in reaction to ongoing activity -absent goal-directed, problem solving behaviors -often innapropriately uses objects without direction -May perform previously learned tasks with structured cues -unable to learn new info --responds to commands fiarly consistently given cues -without structure, responses to external commands are non-purposeful -can briefly converse socially given structure verbalizations about present events and confabulation present without structure |
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What is rancho level 6?
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Confused, appropriate, moderate assist
-inconsistently A&O -attneds to hihgly familiar tasks for up to 30 mins with moderate redirection -remote memory has more detail than recent memory -vague recognition of some staff -use asistive memory aide with max assist -emerging awareness of appropriate responses to self, family, and basic needs -moderate assist to problem solve barriers to task completion -supervised for old learning 0shows carry over of relearned familiar tasks -Max assist for new learning with little carry over -unaware of impairments and safety risks -consistently follows simple directions -verbal expressions appropriate for highly structured situations |
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what is rancho level 7?
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automatic, appropriate
minimal assistance for daily living skills consistently oriented to person in place in highly familiar scenario -attends to highly familiar tasks with min assist for 30 mins -min sup for new learning -demos carry over of new learning -initiates/completes steps of ADL/houshold tasks but may forget what he has been doing -can monitor accuracy and completeness of household routine with min assist -superficial awareness of condition but unaware of implications for safety/accuracy during routines -min sup for safety in home and community -unrealistic planning for future -unable to consider consequences -overestimates abilities -unaware of other's needs/ feelings -oppositional/uncooperative -unable to recognize inapropriate social behavior |
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what is rancho level 8?
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purposeful, appropriate
stand by assistance |
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what is rancho level 9?
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purposeful appropriate
stand by assistance on request |
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what is rancho level 10?
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purposeful, appropate
MODI |
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ASIA A SCI
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complete. no sensorry or motor function preserved in sacral segments S4-s5
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ASIA B SCI
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incomplete
sensory but no motor function is preserved below neurological level |
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ASIA C SCI
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incomplete
motor function preserved below neurological level majority of muscle groups below neurological level have strength grade less than 3/5 |
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ASIA D SCI
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incomplete
motor function is preserved below the neurological level majority of key muscle groups below level of lesion have muscle grade greater that or equal to 3/5 |
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ASIA E SCI
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normal sensory and motor function
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Spinal shock
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following SCI, all reflex activity below level of lesion obliterated for 4-8 wks
presents as flaccid paralysis |
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flaccidity occurs ___
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in SCI lesions occurring below L1
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central cord syndrome
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hyperextension injuries
presents with more upper extremity deficits v. lower extremities |
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brown sequard
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hemisection of the cord
ipsilateral: spastic paralysis, loss of position sense, and loss of discriminitive touch contralateral: loss of pain and temperature |
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anterior cord
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caused by flexion injuries
motor function, pain, and temp are lost bilaterally below level of lesion |
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Conus medullaris
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injury of the sacral cord and lumbar nerve roots
lower extremity sensory and motor loss reflexic bowel and bladder |
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Cauda equina syndrome
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injury at the L1 level and below
lower motor neuron lesion, flaccid paralysis with no spinal reflex activity |
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complications of SCI
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1. respiratory complications with decreased vital capacity
2. decubiti 3. orthostatic hypotension when positioned upright 4. DVTs 5. Autonomic dysreflexia 6. UTI 7. heterotopic ossification (HO) - formation of bone in abnormal locations |
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Sx of autonomic dysreflexia
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abnormal response to noxious stim
extreme rise in BP pounding headache profuse sweating can be related to bowel, bladder, skin, sex, HO |
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Preventing autonomic dysreflexia
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-teach pressure relief
-ensure compliance with intermittent catheterization -well balanced diet -medication compliance -educate to recognize signs and symptoms |
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Infants with CP may initially present with _____ which can later develop to _____ with neuromotor growth
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initial hypotonicity
possibly leads to spasticity |
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Neuromuscular presentations of CP
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may have:
-primitive reflexes and automatic reactions -hyperresponsive reflexes -clonus -variable tone -asymmetry -voluntary movements -feeding difficulties/oral motor impairments |
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Type of cerebral palsy is determined by
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location of lesion
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CP - lesion of motor cortex
presentation |
spasticity
flexor/extensor imbalance |
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CP- lesion of the basal ganglia
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fluctuating tone
diskinesia dystonia athetosis choreoathetosis (jerky movements more proximal than distal) writing involuntary movements (more distal than proximal) |
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CP - cerebellar lesion
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ataxic movements
lack of stability |
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diplegia
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less UE involvement and more LE involvement
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monoplegia
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only 1 involved extremity
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dyskinesias
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involuntary, non-repetitive movements (non repetitive)
involve any muscle group most represent basal ganglia disorders |
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chorea
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brief, purposeless, involuntary movements of distal extremities and face
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dystonia
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sustained abnormal postures and disruptions of ongiong movement resutling form alterations in muscle tone
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cogwheel or leadpipe rigidity
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resistance to passive motion that is not velocity dependent
associated with PD |
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Parkinsons, stage 1
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unilateral tremor
rigidity akinesia minimal to no functional impairment |
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Parkinsons, stage 2
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bilateral tremor
rigidity or akinesia with/without axial signs independent with ADL No balance impairment |
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Parkinsons, stage 3
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-worsening of symptoms
-first signs of impaired righting reflexes -onset of disability in ADLs -can lead independent life |
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Parkinsons, stage 4
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-requires help with some/all ADLS
-unable to live alone without some assistance -able to walk/stand unaided |
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Parkinsons, stage 5
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confined to w/c or bed
maximally assisted |
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side effects of pharmacological management of PD
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early: side effects from carbidopa-levidopa are usually not a problem
later: may experience more involuntary movements when meds having peak effects -may need more frequent doeses ALSO: hallucinations, orthostatic hypotension, nausea |
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with spina bifida, prognosis depends on ___
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level of lesion
(usually at thoracic or lumbar spine) extent of neural tube defect of vertebral arches and spinal column |
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spina bifida occulta
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bony malformation - separation of vertebral arches of 1 or more vertebrae
No external manifestations |
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occult spinal dysraphism
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external manifestations of spina bifida occulta
red birthmark hair dermal sinus (opening) fatty tumor |
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spina bifida cystica
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spina bifida occulta with exposed pouch
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spinal bifida with meningeocele
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protrusion of sac containing CSF and meninges through spine
does not include spinal cord |
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spina bifida with myelomeningeocele
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protrusion of a sac through the spine
contains CSF, meninges, and spinal cord or nerve roots |
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Spina bifida occulta- symptoms
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-usually no symptoms
-occasional instability or neuromuscular impairments (slight, gait or bowel/bladder) |
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occult spinal dysraphism - symptoms
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may result in SC being split (diplomyelia) or tethered (diatamatomeylia)
can lead to neurological damage and abnormaility as child grows |
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spinal bifida meningeocele - symptoms
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usually none as spinal cord is not trapped
occassional slight instability or neuromuscular impairment |
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spina bifida with meylomeningeocele - symptoms
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sesnory and motor deficits below level of lesion
can result in LE paralysis/deformities and bowle/bladder incontinence (neurogenic bladder or bowel, risk of infections) |
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why might a child with spinal bifida require a shunt?
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if there is a complication of hydrocephalus
CSF is not absorbed, causing increase in ventricle size in the brain -can result in brain damage and MR -increased intracranial pressure can also lead to arnold-chiari syndrome |
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arnold chiarai syndrome
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following increased intracranial pressure (as in spina bifida with hydrocephalus)
portion of cerebellum and medualla oblongata slip down foramen mangnum |
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Symptoms of shunt blockage or infection
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LIFE THREATENING
1st yr of life: extreme head growth or soft spot on forehead 2nd yr of life: headache, vommiting, irritability can possibly lead to paralysis of CN VI, or seizure disorders |
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Muscular dystrophies/atrophies
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degeneratvie and hereditary
can begin in infancy, childhood, or adulthood (earlier onset tend to have more rapid progression) Sx: hypotonia, muscle weakness, atrophy |
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Duchenne's muscular dystrophy
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most common
-found at 2-6 yrs -enlarged calf muscles can make the child appear healthy (actually adipose tissue) Weakness of proximal joints weakness in all voluntary muscles including heart and diaphragm |
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Gowers sign
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sign of Duchenne's MD.
Child crawls up thighs to stand from a kneeling position |
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Arthrogryposis multiplex congenita
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detected at birth, loss of anterior horn cells
weakness, deformities, joint contractures resting UE position: shoulder IR, elbow ext, flexed wrists |
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Limb girdle muscular dystrophy
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onset between 1st and 3rd decade of life
proximal pelvis and shoulders affected initially >>progresses |
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fascioscapulohumeral muscular dystrophy
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onset in early adolescence
inovlves face, upper arms scapula facial masking, can't lift arms above shoulders |
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spinal muscular atrophy
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rapidly progesses,
short life expectancy |
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Vertebrobasilar system CVA
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dysarthria
dysphagia emotional stability tetrapeliga |
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congenital myasthenia gravis
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onset at birth
involves transmission of impulses at neuromuscular junction |
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Charcot Marie-tooth disease
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effects peripheral nerves causing progressive weakness
particularly in distal leg muscles onset in teenage years |
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myopathies
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similar to dystrophies but progress more slowly
better prognosis often weakness of face, neck, limbs |
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Characteristic Sx of muscular dystrophies
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Low muscle tone/weakness (abnormal tone, delayed movement patterns). May be delayed w/ steroids
problems w/ oral motor/feeding (may need NG or g-tube) weakness >> deformities breathing problems. may need trach or vent (med decrease pulmonary complications) |
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progressive supranuclear palsy
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loss of voluntary eye movements
reflexic movements preserved |
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Huntington's Chorea
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hereditary
begins in middle age choriform movements and progressive neurological deterioration may be preceeded by psychological disturbance |
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Friedrich's ataxia
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a spinocerebellar degeneration
onset at childhood or early adolesence a spinal ataxia |
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Cerebellar cortical degeneration
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onset between ages 30 - 50
cerebellar symptoms are the only detectable signs |
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Multiple systems degeneration
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a type of spinocerebellar degeneration
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how are spinalcerebellar degenerations treated pharmaceuticly
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clonzapam, clonadine, anticholengergics
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amyotrophic lateral sclerosis
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progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons
SX: -muscle weakness/atrophy beginning distally -cramps/fasticulations precede weakness -lower motor neuron signs are soon accompanied by spasticity, hyperactive deep tendon reflexes -dysarthria, dysphagia -sensory, eye movements, urinary sphincters often spared |
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Brachial plexus disorders
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often due to traction at birth, metastatic Ca., radiation, traction injury
Mixed motor/sensory disorders of the corresponding limb Rostral injuries: Sh. dysfunction Caudal: hand dysfunction Erbs palsy Klumpkes palsy |
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Erbs palsy
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children
waiter's tip position (arm straight, wrist flexed paralysis of upper brachial plexus including C5 and C6 nerves paralysis may include supraspinitus, infraspinitus, deltoid, biceps, brachialis, subscapularis can't raise arm. wek elbow flexion Positioning and ROM indicated to retain ER, AB, Sh. flexion |
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Klumpke's palsy
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Paralysis of lower brachial plexus (c7/c8 nerves, T1)
paralysis of hand and wrist, often with ipsilateral Horner's syndrome (miosis, ptosis, facial anhidrosis) hand limp, fingers don't move |
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Peripheral neuropathies
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single nerve involvement or multiple nerve involvement
pain, weakness, parasethias in affected nerve distribution |
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Guillan Barre Syndrome
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unknown etiology (infectious dz., surgery, immunization)
80% ambulatory after 6 mos 50% exhibit only mild long term deficits Acute, rapidly progressing symmetric muscle weakness, mild distal sensory loss/parasethias weakness first predominant distally sensory disturbance may occur in stocking-glove distribution deep tendon reflexes lost possibly dysphagia or resp. difficulty |
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Myasthenia Gravis
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autoimmune attack of acetylcholine receptor of neuromuscular junction
episodic muscle weakness, particularly w/cranial nerves -ptoisis, diplopia, muscle fatigue after exercise, dyarthria, dysphagia, proximal limb weakness senstation/deep tendon reflexes in tact Sx fluctuate t/o day |
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Post polio syndome
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following years of stability post-polio, motor units break down, causing new muscle weakness
Sx: onset of weakness, easily fatigued, muscle pain, joint pain, cold intolerance, atrophy, loss of functional skills Tx: braces, pacing, stretching, HEP, |
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Multiple sclerosis
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A deymeylinating dz.
Progressive, patches of demeylination in brain and SC paresthesias in one of more extermities, trunk, face weakness/clumsiness visual disturbances emotional disturbance vertigo bladder dysfunction cognitive changes sensorimotor changes such as ataxia, weakness, gait instability, easy fatigue, hemiplegia ,quadriplegia 4 patters: -relapsing remitting -secondary progressive -primary progressive -progressive relapsing may need cath for bladder dysfunction |
