Neurological System Disorders

Front 1

What is Level I of Ranchos Los Amigos Scale?

Back 1

No Response: Total Assistance
- Complete absence of observable change in behavior when presented with sensory stimuli

Front 2

What is Level II of Ranchos Los Amigos Scale?

Back 2

Generalized Response: Total Assistance
- generalized reflex response to painful stimuli
- responds to repeated auditory stimuli
- responds to stimuli with physiological changes, gross body movements, non purposeful vocalizations
- responses may be significantly delayed

Front 3

What is Level III of Ranchos Los Amigos Scale?

Back 3

Localized Response: Total Assistance
- withdrawl or vacalization to painful/uncomfortable stimuli
- turns toward/away from auditory stimuli
- blinks in response to strong light
- follows moving object
- inconsistent response to simple commands
- may respond more to familiar people

Front 4

What is Level VI of Ranchos Los Amigos Scale?

Back 4

Confused/Agitated: Maximal Assitance
- alert and aroused
- may perform motor activities such as sitting, reaching, and walking without apparent purpose
- absent short term memory
- disproportionate reaction to stimulus
- agressive/flight behavior
- mood swings for no reason (euphoric to hostile)
- brief non-purposeful moments of divided attention

Front 5

What is Level V of Ranchos Los Amigos Scale?

Back 5

Confused, Inappropriate Non-Agitated: Maximal Assistance
- not oriented to person, place, time
- Absent: goal directed, problem solving, self-monitoring
- unable to learn new information
- able to respond to simple commands with external structures and cues
- able to converse on a social, automatic level for brief periods of time when provided external structure and cues
- able to perform previously learned tasks when structured and cues provided

Front 6

What is Level VI of Ranchos Los Amigos Scale?

Back 6

Confused, Appropriate: Moderate Assistance
- inconsistant orientation to person, time, and place
- can attend to highly familiar tasks in non-distracting environment for 30 minutes with mod redirection
- vague recognition of some staff
- assistive memory aide with max assist
- supervision for old learning (self care)
- shows carry over for relearned familiar tasks (self care)
- max assist for new learning with little to no carry over
- consistantly follows simple directions
- verbal expressions are appropriate in highly familiar and structured situations

Front 7

What is Level VII of Ranchos Los Amigos Scale?

Back 7

Automatic, Appropriate: Minimal Assistance for Daily Living Skills
- consistant orientation to person and place with highly familiar environments; mod assist for orientation to time
- can attend to highly familiar tasks in non-distracting environment for 30 minutes with min assist for tasks
- minimal supervision for new learning
- demonstrates carry over of new learning
- minimal supervision for safety in routine home and community activities
- unable to think about consequences of a decision or action
- overestimates abilities
- unaware of others' needs and feelings
- oppositional/uncooperative
- unable to recognize inappropriate behavior

Front 8

What is Level VIII of Ranchos Los Amigos Scale?

Back 8

Purposeful, Appropriate: Stand-By Assistance

Front 9

What is Level IX of Ranchos Los Amigos Scale?

Back 9

Purposeful, Appropriate: Stand-By Assistance on Request

Front 10

What is Level X of Ranchos Los Amigos Scale?

Back 10

Purposeful, Appropriate: Modified Independent

Front 11

What is a Transient Ischemic Attack (TIA)?

Back 11

A transitory stroke that lasts only a few minutes. They occur when the blood supply to part of the brain is briefly interrupted.

Front 12

What are the symptoms of a TIA?

Back 12

Symptoms occur suddenly and are similiar to those of a stroke but typically disappear within an hour or as much as 24 hours.

numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; difficulty with walking, dizziness, and/or loss of balance and coordination

Front 13

What are TIAs a warning sign for?

Back 13

TIAs are often warning signs that a person is at risk for a more serious and debilitating stroke. About 1/3 of those who have a TIA will have an acute stroke in the future.

Front 14

What is a Cerebral Infarction?

Back 14

Due to either embolism or thrombosis of the intra or extracranial arteries

Front 15

What is a Cerebral Hemorrhage?

Back 15

Bleed secondary to hypertension or aneurysm

Front 16

What is a Cerebral Arteriovenous Malformation (AVM)?

Back 16

Abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures

Front 17

What is the Left Hemisphere responsible for?

Back 17

- movement and processing of sensory information of right side of body
- visual reception from right field
- visual verbal processing
- bilateral motor praxis
- verbal memory
- bilateral auditory reception
- speech
- processing of verbal auditory information

Front 18

What is the Right Hemisphere responsible for?

Back 18

- movement and processing of sensory information of left side of body
- visual reception from left field
- visual spatial processing
- left motor praxis
- nonverbal memory
- attention to incoming stimuli
- emotion
- processing of nonverbal auditory information
- interpretation of abstract information and tonal inflections

Front 19

What are the symptoms of a CVA?

Back 19

An abrupt onset of unilateral neurological signs (weakness, vision loss, sensory changes, etc,)

Symptoms progress over several hours to 2 days

Front 20

What are the specific symptoms of a Middle Cerebral Artery (MCA) stroke?

Back 20

- contralateral hemiplegia
- hemianesthesia
- homonymous hemianopsia
- aphasia
- apraxia

Front 21

What are the specific symptoms of an Internal Carotid Artery (ICA) stroke?

Back 21

Similar to those of a MCA CVA

Front 22

What are the specific symptoms of an Anterior Cerebral Artery (ACA) stroke?

Back 22

- contralateral hemiplegia
- grasp reflex
- incontinence
- confusion
- apathy
- mutism

Front 23

What are the specific symptoms of a Posterior Cerebral Artery (PCA) stroke?

Back 23

- homonymous hemianopsia
- thalamic pain
- hemisensory loss
- alexia

Front 24

What are the specific symptoms of the Vertebrobasilar system?

Back 24

Results in pseudobulbar signs
- dysarthria
- dysphagia
- emotional instability

Front 25

What are the Modifiable Risk Factors of a CVA?

Back 25

- hypertension
- cardiac disease
- atrial fibrillation
- diabetes mellitus
- smoking
- alcohol abuse
- hyperlipidemia

Front 26

What are the Nonmodifiable Risk Factors of a CVA?

Back 26

- age: relative risk increases with age
- gender: males are at higher risk
- race: African-American and Latino are at greater risk
- heredity

Front 27

What medical management can be given for a CVA?

Back 27

Immediate Care:
- airway maintenance
- adequate oxygenation
- nutritional IV fluids, alternative feeding routes
- decubiti prevention
- tx of underlying cardiac dysfunction (dysrhythmias)

Pharmacologic Therapies
- Antithrombotic therapy for rapid recanalization and reperfusion of occluded vessels to reduce infarction area (aspirin, heparin)
- Thrombolytic therapy for acute strokes to open occluded cerebral vessels and restore blood flow to ischemic areas

Front 28

What is the etiology of a Traumatic Brain Injury (TBI)?

Back 28

- damage results from penetration of the skull or from rapid acceleration or deceleration of the brain
- injury occurs in the tissue at the point of impact (coup), at the opposite pole (contrecoup), and diffusely along the frontal and temporal lobes

Front 29

What are the symptoms of a TBI?

Back 29

- concussion characterized by post-traumatic loss of consciousness
- cerebral contusion/laceration/edema accompanied by surface wounds and skull fractures
- hemiplegia or monoplegia and abnormal reflexes
- decorticate or decerebrate rigidity
- fixed pupils
- coma
- changes in vital signs

Front 30

On the Glascow Coma Scale, what scores are considered as severe, moderate, and minor?

Back 30

Severe: <8

Moderate: 9-12

Minor: >13

Front 31

What are the scores for the Best Eye Response (E) on the Glascow Coma Scale?

Back 31

1: no eye opening
2: eyes opening in response to pain
3: eyes opening to speech
4: eyes opening spontateously

Front 32

What are the scores for the Best Verbal Response (V) on the Glascow Coma Scale?

Back 32

1: none
2: Incomprehensible sounds / moaning
3: Inappropriate words (random)
4: Confused (coherent but disoriented/confused)
5: Oriented and appropriate

Front 33

What are the scores for the Best Motor Response (M) on the Glascow Coma Scale?

Back 33

1: no motor response
2: extension to pain (decerebrate)
3: flexion to pain (decorticate)
4: withdraws from pain
5: localizes to pain (purposeful movement to change painful stimuli)
6: obeys commands as asked

Front 34

What is the etiology of a Spinal Cord Injury (SCI)?

Back 34

- trauma: compression, shearing force, contusion from MVA, diving accident, penetration wound (gunshot or knife), sports injury, or fall
- non-traumatic: tumor or progressive degenerative disease

Front 35

How are SCIs classified?

Back 35

Using the ASIA Impairment scale rating A-E

Front 36

What is A on the ASIA Impairment Scale for SCIs?

Back 36

A= complete, no sensory or motor function is preserved in the sacral segments S4-S5

Front 37

What is B on the ASIA Impairment Scale for SCIs?

Back 37

B= incomplete, sensory but no motor function is preserved below the neurological level and extends through the sacral segments

Front 38

What is C on the ASIA Impairment Scale for SCIs?

Back 38

C= incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade less than 3/5

Front 39

What is D on the ASIA Impairment Scale for SCIs?

Back 39

D= incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the level have a muscle grade greater or equal to 3/5

Front 40

What is E on the ASIA Impairment Scale for SCIs?

Back 40

E= normal, sensory and motor function are normal

Front 41

What is Spinal Shock?

Back 41

- occurs 4-8 weeks following a SCI
- all reflex activity is obliterated below the level of the injury presenting as flaccid paralysis

Front 42

What are common symptoms associated with SCIs?

Back 42

- spinal shock
- sensory deficits
- loss of bowel/bladder control
- loss of temperature control below the lesion
- decreased respiratory function
- sexual dysfunction
- changes in muscle tone (spasticity in upper motor neuron lesion and flaccidity in lesions below L1)
- loss of motor function resulting in tetraplegia (quadriplegia) or paraplegia: may be complete or incomplete

Front 43

What is Central Cord syndrome?

Back 43

Resulting from hyperextension injuries and presenting as more upper extremity deficits vs. lower extremity

Front 44

What is Brown-Sequard syndrome?

Back 44

Hemi-section of the cord resulting in:
- ipsilateral spastic paralysis
- ipsilateral loss of position sense
- ipsilateral loss of discrimitive touch
- contralateral loss of pain
- contralateral loss of thermal sense

Front 45

What is Anterior Cord syndrome?

Back 45

- caused by flexion injuries
- motor function, pain, and temperature sensation are lost bilaterally below the lesion

Front 46

What is Conus Medullaris syndrome?

Back 46

Injury of the sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and a relfexic bowel and bladder

Front 47

What is Cauda Equina syndrome?

Back 47

Injury at the L1 level and below resulting in a lower motor neuron lesion; flaccid paralysis with no spinal reflex activity

Front 48

What are common complications of SCIs?

Back 48

- respiratory complications, decreased vital capacity, pneumonia
- decubitus ulcer formation
- orthostatic hypotension
- deep vein thrombosis
- autonomic dysreflexia
- UTI
- heterotropic ossification

Front 49

What is Orthostatic Hypotension?

Back 49

An excessive fall in blood pressure upon assuming the upright position

Front 50

What is Autonomic Dysreflexia?

Back 50

An abnormal response to a noxious stimulus that results in an extreme rise in blood pressure, pounding headache, and profuse sweating. This is a medical emergency if not reversed by removing the irritating stimulus quickly.

Front 51

What are some examples of irritants that can cause Autonomic Dysreflexia?

Back 51

- bowel irritation or over-distention
- bladder infection or over distention
- skin irritation
- sexual activity irritants
- heterotopic ossification/myositis ossificans
- skeletal fractures
- appendicitis

Front 52

How can Autonomic Dysreflexia be prevented?

Back 52

- teach patient/caregiver frequent pressure relief principles
- ensure compliance with intermittent catheterization
- practice well-balanced diet habits
- ensure medication compliance
- teach patient and caregiver to recognize the cause, signs, and symptoms

Front 53

What is Heterotopic Ossification?

Back 53

The formation of bone in abnormal anatomical locations.

Front 54

What is the etiology of Cererbral Palsy (CP)?

Back 54

- caused by an injury or disease prior to, during, or shortly after birth resulting in brain damange and secondary neurological and muscular deficits
- common causes during perinatal period: lack of oxygen, intracranial hemorrhage, meningitis, chronic alcohol abuse, toxicosis, infections, genetic factors, endocrine and metabolic disorders

Front 55

What symptoms may accompany CP?

Back 55

- deformities and contractures
- seizures
- intellectual and behavioral disorders
- significant motor deficits
- persistent primitive reflexes
- initial hypotonia which may evolve into spasticity

Front 56

What characteristics of CP occur with a lesion of the motor cortex?

Back 56

Spasticity with flexor and extensor imbalance.

Front 57

What characteristics of CP occur with a lesion in the basal ganglia?

Back 57

- fluctuations in muscle tone causing dyskinesia, dystonia, or athetosis
- choreoathetosis with jerky involuntary movements more proximal than distal and lack of cocontractions
- writhing involuntary movements more distal than proximal

Front 58

What characteristics of CP occur with a lesion in the cerebellum?

Back 58

- Ataxic movements
- lack of stability so coactivation is difficult resulting in more primitive total patterns of movement

Front 59

What complications are common with CP?

Back 59

- language and intellectual deficits: 50-75% of cases
- seizures: 50% of cases
- visual impairments: 40-50% of cases
- feeding disturbances

Front 60

What is a Tremor?

Back 60

- rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation
- classified by rate, rhythm, and distribution
- resting tremor: occurs at rest
- action or intention tremor: occurs during activity

Front 61

What is Dyskinesias?

Back 61

involuntary, nonrepetitive, but occasionally stereotyped movements affecting distal, proximal, and axial musculature in varying combinations

most dyskinesias are representative of basal ganglia disorders

Front 62

What is Myoclonus?

Back 62

A brief and rapid contraction of a muscle or group of muscles.

Front 63

What are Tics?

Back 63

- brief, rapid, involuntary movements, often resembling fragments of normal motor behavior
- tend to be stereotyped and repetitive, but not rhythmic

Front 64

What is Chorea?

Back 64

- brief, puposeless, involuntary movements of the distal extremitites and face
- usually considered to be a manifestation of dopaminergic overactivity in the basal ganglia

Front 65

What is Dystonia?

Back 65

- results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone
- may be generalized or focal

Front 66

What is Ataxia?

Back 66

- describes a lack of coordination while performing voluntary movements
- may appear as clumsiness, inaccuracy, or instability
- movements are no smooth and may appear disjointed or jerky

Front 67

What is the first sign of Parkinson's disease?

Back 67

Insidious "pill-rolling" tremor of one hand

Front 68

What are the cardinal signs of Parkinson's disease?

Back 68

- tremor
- rigidity
- resistance to passive motion that is not velocity dependent (cogwheel or lead pipe)
- akinesia
- postural instability
- festinating gait
- falling backwards (retropulsion
- falling forwards (propulsion)
- mask face
- micrographia

Front 69

What is Stage I of Parkinson's disease using hoehn and Yahr's 5 stage scale?

Back 69

- unilateral tremor
- rigidity
- akinesia
- minimal or no functional impairment

Front 70

What is Stage II of Parkinson's disease using hoehn and Yahr's 5 stage scale?

Back 70

- bilateral tremor
- rigidity or akinesia
- independent with ADL
- no balance impairment

Front 71

What is Stage III of Parkinson's disease using hoehn and Yahr's 5 stage scale?

Back 71

- worsening of symptoms
- first signs of impaired righting reflexes
- onset of disability in ADL performance
- can lead independent life

Front 72

What is Stage IV of Parkinson's disease using hoehn and Yahr's 5 stage scale?

Back 72

- requires help with some or all ADLs
- unable to live alone without some assistance
- able to walk and stand unaided

Front 73

What is Stage V of Parkinson's disease using hoehn and Yahr's 5 stage scale?

Back 73

- confined to a wheelchair or bed
- maximally assisted

Front 74

What are common side effects of medications used for Parkinson's disease?

Back 74

- as disease progresses, the drug works less evenly and predictably
- may experience involuntary movements (dyskinesia), primarily when the medication is having its peak effects
- the length of time that each dose is effective may begin to shorten (wearing-off effect), leading to more frequent doses
- movement proglems may appear and disappear suddenly and unpredictably
- hallucinations
- drop in blood pressure when standing (orthostatic hypotension)
- nausea

Front 75

What is the etiology of Spina Bifida?

Back 75

- genetic, intrauterine, and/or environmental factors contribute to the neural tube defect involving the vertebral arches and the spinal column
- some studies suggest medications and a lack of folic acid may induce neural tube defects

Front 76

What is Spina Bifida Occulta?

Back 76

A bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations

Front 77

What is Spina Bifida Occult Spinal Dysraphism (OSD)?

Back 77

When external manifestations such as a red birthmark (hemangioma or flame nevus), patch of hair, a dermal sinus (opening in skin), a fatty benign tumor (lipoma), or dimple covering the site are present.

Front 78

What is Spina Bifida Cystica?

Back 78

An exposed pouch

Front 79

What is Spina Bifida with Meningocele?

Back 79

Protrusion of a sac through the spine, containing cerebral spinal fluid and meninges; however, does not include the spinal cord.

Front 80

WHat is Spina Bifida with Myelomeningocele?

Back 80

Protrusion of a sac through the spine, containing cerebral spinal fluid and meninges as well as the spinal cord or nerve roots.

Front 81

What are the symptoms associated with Spina Bifida Occulta?

Back 81

Usually does not result in any symptoms

Occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur

Front 82

What are the symptoms of Spina Bifida - Occult Spinal Dysraphism?

Back 82

May result in the spinal cord being split (diplomyelia) or being tied down and tethered (diastematomyelia) which may lead to neurological damage and developmental abnormality as the child grows.

Front 83

What are the symptoms of Spina Bifida Meningocele?

Back 83

Usually does not present with symptoms impacting on function as the spinal cord itself is not entrapped.

Occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur.

Front 84

What are the symptoms of Spina Bifida with a Myelomeningocele?

Back 84

- Results in sensory and motor deficits occuring below the level of the lesion, and may result in lower extremity paralysis and/or deformities, and bowel and bladder incontinence.
- The level of lesion impact leg movements.
- Lesions of S2-S4 results in bladder and bowel problems

Front 85

What complications can occur with Spina Bifida?

Back 85

- hydrocephalus (resulting in needing a shunt) can cause brain damage and MR
- Arnold Chiari Syndrome
- shunts can become blocked or infected

Front 86

What is Arnold Chiari Syndrome?

Back 86

A portion of the cerebellum and medulla oblongata slip down through the foraman magnum of the cervical spinal cord

Front 87

What are signs that a shunt is blocked resulting in increased intra-cranial pressure?

Back 87

- first year of life: extreme head growth and often a ten soft spot on forehead
- second year of life: severe headache, vomiting, and/or irritability
- paralysis of the sixth crainal nerve: visual impairments occur
- seizure disorders and deterioration of physcial and/or cognitive functioning

Front 88

What are signs that a shunt is infected?

Back 88

- vomiting, lethary, and/or fever
- seizures and deterioration of physical and/or cognitive functioning

Front 89

What is Tethered Cord Syndrome?

Back 89

Occurs in the tail end of the spinal cord when it is stretched as a result of compression, being trapped with a fatty mass, or a developmental abnormality

Front 90

What are symptoms of Tethered Cord Syndrome?

Back 90

- hairy patch of skin
- hemangioma
- dimple of the lower spine
- difficulties with bowel and bladder
- gaid disturbances
- deformities of the feet