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NMS 1 > Dorsal Column and Cerebellar Tests > Flashcards

Dorsal Column and Cerebellar Tests Flashcards

1
Q

The cerebellum is important for ________ and ___________

A

Motor learning

Timing of motor activity

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2
Q

The cerebellum fine tunes the force of agonist and antagonist muscle activity simultaneously and sequentially across multiple joints to produce _________

A

Smooth flowing, goal directed movements

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3
Q

Cerebellar dysfunction will result in:

A
  • Decomposition of movements

- Under and over shooting of goal directed movements

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4
Q

Under and over shooting of goal directed movements

A

Dysmetria

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5
Q

Romberg Test

A
  • Have patient stand still with heels together.

- Ask patient to remain still and close their eyes

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6
Q

Positive Romberg test

A

Patient falls

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7
Q

To achieve balance, a person requires 2 out of the following 3 inputs to the cortex:
1)
2)
3)

A
  • Visual confirmation of position
  • Non-visual confirmation of position (including proprioception and vestibular input)
  • A normally functioning cerebellum
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8
Q

+ Romberg test with eyes open and closed may indicate:

A
  • Cerebellar deficit

- Vestibular mechanism deficit

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9
Q

+ Romberg test with eyes closed only may indicate:

A

Dorsal column pathology

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10
Q

Positive Hoping on one foot test

A

-Patient takes a step to maintain posture

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11
Q

+ Hopping on one foot test with eyes open and closed may indicate:

A

Cerebellar deficit

Vestibular mechanism deficit

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12
Q

+ Hopping on one foot test with eyes closed only may indicate:

A

Dorsal column pathology

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13
Q

Best test to assess minor weaknesses of the lower extremity

A

Squatting on one foot test

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14
Q

+ Squatting on one foot test with eyes open and closed may indicate:

A

Cerebellar deficit

Vestibular mechanism deficit

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15
Q

+ Squatting on one foot test with eyes closed only may indicate

A

Dorsal column pathology

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16
Q

Finger-to-nose test

A
  • Arms straight out to side and attempts to touch tip of the nose. Perform eyes open and closed
  • Movement should be smooth and accurate
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17
Q

+ Finger-to-nose test where movements are uncoordinated is known as _________

A

Dyssynergia

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18
Q

+ Finger-to-nose test where the person displays inaccuracies in measuring distance

A

Dysmetria

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19
Q

Undershooting

A

Hypometria

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20
Q

Overshooting

A

Hypermetria

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21
Q

Finger-to-finger test

A

Patient begins with arms stretched out to the side and attempts to touch index fingers together in front of them with eyes open and closed
-Movement should be smooth and accurate

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22
Q

+ Finger-to-finger test that shows uncoordinated movement is known as __________. If movement is coordinated, but inaccurate in measuring distance, it is known as __________

A 
Uncoordinated = Dyssynergia
Inaccurate = Dysmetria
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23
Q

Finger-to-nose-to-finger Test

A

Dr. stands with finger about 2 feet from patient alternating touching the nose then the finger.

  • Dr changes position of his finger after each touch
  • Movement should be smooth and accurate
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24
Q

+ Finger-to-nose-to-finger test would indicate only __________

A

Dyssynergia

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25
Heel-to-shin test
Patient attemps to run heel from one side down the anterior shin from the knee to the ankle of the opposite leg. - Perform bilaterally with eyes open and closed - Movement should be smooth and accurate
26
+ Heel-to-shin test that shows uncoordinated movement is known as ___________, while inaccuracies in assessing distances is known as ________
``` Movement = Dyssynergia Accuracy = Dysmetria ```
27
Ability to perform rapid alternating actions properly and improperly
``` Properly = Diadochokinesia Improperly = Dysdiadochokinesia ```
28
Dysdiadochokinesia indicates a possible ___________
Cerebellar dysfunction
29
Holmes Rebound phenomenon
Patient contracts flexors of forearm against Dr's resistance. - Dr. releases quickly - Performed bilaterally with eyes open and closed - Should see normal check reflex
30
+ Holmes Rebound that is an uncoordinated movement is known as ___________, while coordinated but inaccurate movement is known as______
``` Uncoordinated = Dyssynergia Inaccurate = Dysmetria ```
31
Tandem Gait
Walking in a straight line placing heel directly in front of opposite toes - Performed with eyes open and closed - Movement should be smooth and accurate
32
+ Tandem gait findings
``` Dyssynergia = uncoordinated movement Dysmetria = inaccurate movements with respect to distance ```
33
Joint position test
Dr. examines one digit of the patients hand or foot grabbing a single digit from the sides performs moving the joint - Patient should identify if the joint went up or down - Done with eyes closed only
34
+ Joint position test indicates what pathology?
Posterior column disease
35
Deep pain and pressure sensation is mediated by what area of the spinal cord?
Dorsal columns
36
Abadies sign
Loss of pain when pinching the achilles
37
Pitre's sign
Loss of pain when pinching the testicles
38
Biernacki's sign
Loss of pain when pinching or striking the Ulnar nerve (proximal medial aspect of the Ulna)
39
Last test for deep pain and pressure
Pressure on the eyeball
40
Classic example of a posterior column disease
Tabes dorsalis
41
Combined superficial and deep sensations which are subject to higher function of memory
Multimodal sensation
42
Stereognosis test
Place a common object in the hand (pin, key, button, paperclip) with the eyes closed - Patient should be able to identify it in that hand - Perform bilaterally
43
Barognosis test
Assess relative weight of similarly sized and shaped objects that have differing weights
44
Topognosis test
Touch patient somewhere on skin and have them point to the area
45
Graphognosis test
Test by writing a letter or number on palm, chest, or back
46
Normal values for the 2-point discrimination test on the fingertips, dorsum of fingers, palm, and dorsum of the hand
Tips = 2-4 mm Dorsum fingers = 4-6 mm Palm = 8-12 mm Dorsum of hand = 20-30 mm
47
Other name for a lower motor neuron lesion
Radiculopathy
48
Primary sensory modality worker order deficit is known as:
Anesthesia | Analgesia
49
Where in the brain stem do the dorsal columns synapse (mechanosensory)?
``` Cuneate nucleus (UE) Gracile nucleus (LE) ```
50
Where do the cuneate and gracile nuclei synapse as they travel from the brains tem to the cerebral cortex?
Both synapse in the Ventral Posterior Lateral Nucleus (VPL) of the Thalamus and are further relayed to the Primary Somatosensory Cortex (Brodmann 3,1,2)
51
What tracts in the spinal cord relay pain and temperature to the cortex?
Anterior and Lateral Spinothalamic tracts
52
Pathway of pain and temperature from the ascending spinothalamic tracts to the cerebral cortex
-Both tracts synapse in the Ventral Posterior Medial Nucleus (VPM) of the thalamus. Nerves are further relayed to the primary somatosensory cortex (Brodmann 3,1,2)
53
C4 dermatome
Posterior aspect of the shoulders
54
C5 dermatome
Lateral aspect of the upper arms
55
C6 dermatome
Tip of the thumb
56
C7 dermatome
Tip of the middle finger
57
C8 dermatome
Tip of the pinky finger
58
T1 dermatome
Medial aspect of the lower arms
59
Superficial sensory examination includes tools to test for the following sensations:
- Pain = sharp, pin prick - Temperature = test tubes with hot or cold water - Light touch = cotton swab, small brush
60
Mechanoreceptor for light touch
Tactile disc of Merkle
61
Neuropathway for light touch would be the _________________ of the cord to the thalamus
Anterior spinothalamic tract
62
Deficits to light touch in dermatomal pattern or pain exmination may indicate _________ or __________ lesions
- Nerve root compression | - Peripheral nerve lesions
63
Pain examination
- Use sharp and dull sides of safety pin or pinwheel - Patient is instructed to say if it is sharp or dull and to point to the spot - When comparing side to side only use sharp
64
Differences in pain examination from side to side is used to find problems in what neuropathway that relays information to the thalamus?
Lateral spinothalamic tract
65
Areas insensitive to pain
Alganesthesia/Analgesia
66
Decreased pain sensation
Hypalgesia
67
Increased pain sensitivity
Hyperalgesia
68
Vibration examination
- Begin at ankles using a tuning fork - If no sensation move to knee, then hip. - Patient should report vibration sensation
69
Loss of vibration sensation. What tracts are affected if no vibration sensation is felt
Pallanesthesia - UE = Cutaneus - LE= Gracilis
70
What sensation is carried along the same pathways as pain?
Temperature
71
T/F Routine temperature exam is not required, but it would be more localized findings compared to pain sensation
True
72
MC symptoms of dorsal nerve root compression
Numbness | Tingling
73
Other symptoms of dorsal nerve root compression
- Pallanesthesia - Loss of position sense - Hyporeflexia with no muscle atrophy
74
Compression of anterior nerve root symptoms
- Muscle weakness - Loss of deep tendon reflex - Vasomotor changes (ANS affected)
75
T/F Compression of the anterior nerve root will never cause muscle atrophy
FALSE. | It may cause muscle atrophy
76
Causes of nerve root compression
- Disc herniation - DJD - Recent trauma - Inflammatory changes - Tumors

NMS 1 (10 decks)

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