Exam 2 Flashcards
(182 cards)
1
Q
Which test measures a patient’s level of consciousness?
A
Glasglow Coma Scale
2
Q
What are the 3 Categories of the Glasglow Coma Scale?
A
-Eyes
-Verbal
-Motor
3
Q
What scores are indicative of Normal functioning each category of the Glasglow Coma Scale?
A
-Eyes: 4
-Verbal: 5
-Motor: 6
4
Q
Definition: Responds immediately to minimal stimuli and is aware of environment
A
Alert
5
Q
Definition: State of severe drowsiness
A
Lethargic
6
Q
Definition: Displays indifference to external stimuli
A
Obtunded
7
Q
Definition: Deep sleep; aroused only with vigorous stimulation
A
Stuppor
8
Q
Definition: No verbal or voluntary response with vigorous stimulation
A
Coma
9
Q
Definition: Awareness of stimulation without distraction from other stimulation
A
Attention
10
Q
Definition: Awareness of time, place, person
A
Orientation
11
Q
Definition: Overall management of emotions
A
Affect
12
Q
What is Amnesia
A
The loss of Memory
13
Q
What is Retrograde Amnesia?
A
Inability to recall events leading up to the brain injury
14
Q
What is Post-traumatic Amnesia?
A
Inability to recall events in between brain injury and regaining consciousness
15
Q
Which test measure Level of Cognitive Functioning?
A
The Ranchos Los Amigos Cognitive Scale
16
Q
How many levels are included in the Ranchos Los Amigos Cognitive Scale?
A
10
17
Q
Which Ranchos Los Amigos Cognitive Scale levels correspond with low, medium, and high cognition?
A
-Low (1-3)
-Medium (4-6)
-High (7 and up)
18
Q
What are the 5 Aspects of Language and in which order do they occur?
A
-Comprehension
-Repetition of speech
-Naming
-Reading
-Writing
19
Q
What are Cranial Nerve Tests used for?
A
To help provide the location of a dysfunction
20
Q
Are pain, touch, and temperature primary or secondary sensations?
A
Primary
21
Q
What is the Absence of Pain?
A
Analgesia
22
Q
What is the Absence of Touch Sensation?
A
Anesthesia
23
Q
What is the term for Abnormal Touch Sensation
A
Parasthesia
24
Q
Are vibration, kinesthesia, and proprioception primary or secondary senses?
A
Primary
25
Are stereognosis, tactile localization, 2-point discrimination, graphesthesia, and barognosis primary or secondary sensations?
Secondary
26
Definition: Knowing what you are touching with your eyes clothes
Steriognosis
27
Definition: The inability to recognize objects by touch
Asteriognosis
28
Definition: Knowing where on your body you are being touched and how much of your body is being touched
Tactile Localization
29
Definition: Being able to distinguish being touched with one point or simultaneously with two points
2-point Discrimination
30
Definition: Knowing what is being drawn on your skin without looking
Graphesthesia
31
Definition: Knowing which object is heavier than the other without looking
Barognosis
32
Definition: A subjective opinion of own body
Body Image
33
Definition: knowledge of own body
Body Concept
34
Definition: perception of sensory input from body
Body Schema
35
Definition: Loss of perception of sensory input from a part of the body
Sensory Neglect
36
Which part of the brain controls Coordination
The Cerebellum
37
What is Intralimb coordination?
Coordinating movement with one limb
38
What is Interlimb coordination?
Integrated performance between 2 or more limbs
39
What is Dysdiadokinesis?
Rapid, alternating movements between agonist and antagonist
40
What is Dysmetria?
Difficulty with endpoint accuracy (finger to nose or finger to finger test)
41
What is Ataxia?
Difficulty coordinating movement/ Difficulty starting and stopping
42
What is the Rebound Phenomenon
This happens when a person is attempting to move a limb against resistance and the resistance is suddenly taken away, the limb will keep going in the direction of movement for a short time then rebound (jerk back in the opposite direction)
43
What is Nystagmus
Rapid, alternating eye movement after spinning
44
Definition: Degree of residual contraction in innervated muscle
Muscle Tone
45
What is Spasticity?
Hypertonia which specifically affects flexors or extensors
46
What is Rigidity?
Hypertonia of all the muscles
47
Which test measures how much hypertonia a patient has based on their ability to move through a ROM
Ashworth Scale
48
What is Sustained Clonus?
Continuous beating of contraction after a muscle is quickly stretched
49
What is Un-sustained Clonus?
After a muscle is quickly stretched, it will then perform a few beating contractions, then stop
50
Which tests measures the amount of tone a person has with reflexes?
Deep Tendon Reflex Test
51
What are the grades used in the Deep Tendon Reflex Test and what does each grade mean?
0 Absent, no response
1+ Low normal, diminished
2+ Normal
3+ Brisker or mor reflexive than normal
4+ Very brisk, hyperreflexive, with clonus
5+ Sustained Clonus
52
What is Flaccidity?
Absence of tone response (when a patient's arm is limp when being passively moved)
53
What are Fasciculations?
Muscle twitches
54
What is Dystonia?
A disorder causing muscles to contract involuntarily.
55
Definition: The cooperative action of muscles working together
Synergies
56
What are the Brunnstrom Stages of Recovery?
7 recognized stages of Stroke recovery
57
What is Plegia?
Complete paralysis
58
What is Paresis?
Weakness from an incomplete lesion
59
What is Apraxia?
Difficulty with motor planning?
60
What is Ideational Apraxia?
Patient is unable to conceptualize what movement they'd like to perform
61
What is Ideomotor Apraxia?
Patient is unable to comprehend a command to perform a movement
62
What is the Romberg test?
Testing balance with eyes open and closed
63
Which outcome measure assesses Sitting and Standing Balance and also assesses fall risk/ambulation potential
Berg Balance Scale
64
Which outcome measure assesses walking balance?
Functional Gait Analysis
65
Which outcome measure assesses walking speed?
10 Meter Walk Test
66
Which outcome measure assesses Walking Distance?
6 Minute Walk Test
67
Which outcome measure assesses Transfer Ability?
5 Times Sit to Stand (5TSTS)
68
Which outcome measure assesses Balance Confidence?
Activity-Specific Balance Confidence Scale
69
Definition: Neuro deficits lasting less than 24 hrs/ AKA mini strokes with no lasting effects
Transient Ischemic Attack (TIA)
70
Definition: Neuro deficits lasting >24 hrs with minimal deficits
Reversable Ischemic Neuro Deficit (RIND)
71
Definition: Syndrome with onset of neuro deficits involving a specific area of the brain ranging from mild to fatal
Stroke
72
What are the 2 types of Strokes and what makes them different?
-Ischemic: Cut off of blood supply to a specific area of the brain (most commonly from atherosclerosis)
-Hemorrhagic: Pressure on neural tissue due to brain bleed (typically occurs in the younger population)
73
What are the 2 causes of an Ischemic Stroke?
-Thrombus (80%)
-Embolism (20%)
74
Name the 4 locations for Brain Hemorrhage?
-Epidural Space: Between the Cranium and Dura Mater
-Subdural Space: Below the Dura Mater
-Subarachnoid Space
-Intracerebral/Parenchymal Space
75
What are the Risk Factors for a Stroke?
-HTN
-Heart Disease
-Diabetes
-Risk Increases with Age
76
What are the Prevention Factors for a Stroke?
-Diet
-Exercise
-Obesity
-Smoking Cessation
-Alcohol Consumption
77
What are the Warning Signs of a Stroke?
-Trouble Walking
-Trouble Talking
-Trouble Seeing (commonly intermittent)
-Numbness on one side of the body
-Sudden, Severe Head Ache (typically a sign of a hemorrhagic stroke)
78
Signs of which side CVA:
-Language involvement (Aphasia)
-Apraxia
-Difficulty with sequencing
Left CVA
79
Signs of which side CVA:
-Body awareness (neglect)
-Impaired spatial awareness
-Impaired simultaneous processing
-Impaired Judgement
-Impaired time perception
Right CVA
80
What is the term used to describe Leaning toward the Hemiplegic side causing postural imbalance?
Pusher's Syndrome
81
Clinical signs of a lesion in which artery?
-Contralateral motor and sensory deficits (greater in UE an face)
-Aphasia
-Homonomous Hemianopsia
MCA Lesion
82
Clinical signs of a lesion in which artery?
-Contralateral motor and sensory deficits (mostly LE
-Expressive aphasia
-Memory and behavioral changes
ACA Lesion
83
Clinical signs of a lesion in which artery?
-Homonomous Hemianopsia
-Visual Neglect
-Reading and writing deficits
PCA Lesion
84
Clinical signs of a lesion in which artery?
-Diplopia
-Vertigo
-Ataxia
-Nystagmus
-Cranial nerve involvement
-Cerebellum involvement
Vertebral/Basilar Artery
85
Which syndrome is responsible for:
-Ipsilateral decreased pain and temp to face
-Ipsilateral Ataxia
-Contralateral decreased pain and temp to body
Wallenberg Syndrome
86
Clinical signs of lesion to which artery?
-Typically no combined cortical affect (pure sensory, pure motor deficits)
Lacunar Arteries
87
What is the body's response to a CNS injury?
Neuroplasticity
88
What is the body's response to a PNS injury?
Wallerian Degeneration
89
What are the Deficits caused by a Stroke?
-Hemi-motor
-Hemi-sensory
-Presence of pathological reflexes
-Cognitive changes
-Cardiovascular deficits
90
Which Stage of Stroke Recovery are these symptoms present:
-Decrease or absence of tone
-GH subluxation
-Pain and edema distally
-SC/Brainstem reflex level
Acute (Flaccid, Hypotonic) Stage
91
Which Stage of Stroke Recovery are these symptoms present:
-Presence of synergistic movement
-Volitional effort on uninvolved side
-Abnormal Posture
-Instability at joints
Subacute and Chronic Phase
92
What are the Goals of treatment for those in the Acute Stage of a Stroke?
-Positioning and handling
-Skin protection
-ROM
-Weight bearing to the affected side
-Early mobility
93
In regards to a stroke patient, what is a Symmetrical Reaction?
Flex of the uninvolved UE will result in flex of the involved UE
94
In regards to a stroke patient, what is a Crossed Reciprocal Reaction?
Flexion of the uninvolved LE will result in extension of the involved LE
95
In regards to a stroke patient, what is a Ramiste Reaction
Hip abduction of the involved side will result in hip abduction of the contralateral side
96
In regards to a stroke patient, what is a Homolateral Synkineses Reaction?
Flexion of UE will result in Flexion of LE on same side
97
What is the Clinical Picture of a Stroke patient?
-Head posturing: SCM short on involved side
-Limb posturing: Brunnstrom's limb posturing
-Trunk posturing: Lateral flexion to affected side
-Gait pattern: circumduction
98
What is the Etiology of Cerebellar Dysfunction?
-Can be caused by CVA, tumors, trauma, degeneration
-Can also be caused by nutritional and metabolic influences
99
What is the Clinical Picture of a patient with Cerebellar Dysfunction?
-Decreased muscle tone
-Decreased postural control
-Postural tremor
-Intention Tremor
-Dysmetria
-Dysdiadochokinesis
-Ataxia
-Decrease in balance (with or without vision)
100
What are the Safety issues associated with a Cerebellar Dysfunction?
-Fall prone
-Impaired Rebound Phenomenon
101
What are the 2 types of Tumors and what are their characteristics?
-Benign Tumor: Will adhere to a specific part of the body
-Malignant: A spreading tumor
-Primary: Where the tumor originates
-Secondary: Area of the body the tumor spreads to
102
What other neurological deficits follows the same rehab course as a CVA?
Brain Tumors
103
What is the Clinical Picture of a patient with a Brain Tumor?
Depends on the location?
104
What are the Safety Considerations for a Brain Tumor?
-ICP
-Seizures
-Pathological Fractures
105
Definition: A sudden, explosive disorderly discharge of cerebral neurons resulting in motor or sensory changes
Seizure
106
Definition: More than one unprovoked seizure with no full recovery between seizures or seizure lasting more than 5 minutes
Status Epilipticus
107
Etiology of what Neurological Deficit:
-Familial/genetic pre-disposition
-Fever
-Toxic substances
-TBI
-Brain Tumors
-Endocrine/Metabollic disturbances
-Vascular brain disorders
CNS infection
Idiopathic
Seizures
108
What is the term for residual paralysis after a seizure?
Todd's Paralysis
109
What is a Tonic-Clonic (Grand Mal) Seizure?
A period of loss of consciousness/stopping of activity, followed by convulsions
110
What is an Absence (Petit Mal) Seizure?
Zoning out/no convulsions
111
What is a Partial Seizure?
Just part of the body convulses
112
What is a Complex Partial Seizure?
A simple partial seizure which can spread to become more generalized.
-no loss of consciousness
113
Etiology of which Neurological Deficit:
-An insult to the brain not of degenerative or congenital nature, but caused by an external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical function.
Traumatic Brain Injury (TBI)
114
What is the definition of an Open Head Injury?
Some type of Fx to cranium
115
What is the definition of a Closed Head Injury?
Trauma to head with no Fx to cranium (Brain moves too much) (e.g. IED explosion, being hit in head with helmet on)
116
What is the definition of an Acquired TBI?
No direct injury to the head (drowning, electrocution)
-causes loss of oxygen to the brain
117
Clinical Picture of a patient with which neurological dysfunction:
-Increased ICP
-Altered states of consciousness
-Altered states of cognitive functioning
-Ventilation
-Amnesia
-Seizures
-Variable motor and sensory deficits
-De-corticate/De-cerebrate rigidity
TBI
118
What are the Safety Considerations for a patient with a TBI
-ICfP
-Seizures
-Change in safety awareness and judgement
-Long-term effects of immobility
119
Definition: Trauma that induces an alteration in mental status
Minimal TBI (Concussion)
120
What are the Clinical Manifestations of a Minimal TBI?
-Dizziness
-Disorientation
-Blurred Vision
-Difficulty Concentrating
-Altered Sleep Patterns
-Nausea
-Headache
-Loss of Balance
121
Etiology of which Disorder?
ATYPICAL:
-Progressive Supranuclear Palsy
-Striato-Nigral Degradation
-Lewy Body Dementia
-NPH (Normal Pressure Hydrocephalus
-Multiple System Atrophy
SECONDARY
-Trauma
-Ischemic
-Metabolic
-Drug Induced
-Brain Tumor
Parkinson's Disease
122
What percent of Parkinson's Disease is Idiopathic?
85%
123
What is the Clinical Picture for Parkinson's Disease?
-Rigidity
-Flexed Posture
-Bradykinesia
-Akinesia
-Resting Tremor
-Flat Affect
-Abnormal Postural Reactions
-Festinating Gait Pattern
124
What are the things doctors look for when diagnosing someone with Parkinson's Disease?
-Early motor symptoms like Bradykinesia, Tremors, Rigidity
-Asymmetrical Distribution
-Positive response to Dopamine replacement therapy
-Differential diagnosis
125
What is the Clinical Picture for someone with a Young Onset of Parkison's Disease?
-Slower progression
-Increased dystonia
-Lower rated of dementia
-Increased dyskinesias due to L-Dopa (medication)
126
Which Scale recognizes the progressive stages of Parkinson's Disease?
The Modified Hoehn and Yahr Scale
127
What are the Safety Considerations for patients with Parkinson's Disease?
-Orthostatic Hypotension
-On-Off Phases
-Fall prone
-Sometimes can see decrease in judgement
128
Pathophysiology of which disorder?
-Plaques disseminated throughout CNS
-Plaques have a prediction for white matter resulting in the de-myelinization of axons
Multiple Sclerosis
129
What is the Clinical Picture for someone with Multiple Sclerosis?
-Motor weakness
-Spasticity
-Parasthesias
-Unsteady gait
-Diplopia
-Incontinence
-Tremor
-Nystagmus
-Fatigue***
130
What are the Safety Considerations for a patient with MS?
-Temperature (they have trouble cooling off)
-Response time
-Fall precautions
131
What is the Etiology for a Spinal Cord Injury?
Trauma, Disease, or Congenital
132
What are the different Spinal Cord Syndromes?
-Anterior Cord
-Posterior Cord
-Central Cord
-Brown Sequard
-Cauda Equina
133
What classifies Anterior Cord Syndrome?
Bilateral paraplegia (UMN), bilateral loss of pain and temperature, and sphincter dysfunction (urinary retention)
134
What classifies Posterior Cord Syndrome?
Bilateral loss of vibration and proprioception sense. Preserved motor function, but can have bladder dysfunction.
135
What classifies Central Cord Syndrome?
Bilateral motor weakness (UE > LE). Intact sensation above and below level of injury.
136
What classifies Brown-Sequard Syndrome?
Ipsilateral: Loss of voluntary motor (UMN), vibration and proprioception sense
Contralateral: Loss of pain and temperature 2-3 levels below the lesion
137
Which disorder is characterized by a progressive degeneration and loss of motor neurons in the spinal cord, brainstem, and motor cortex?
Amyotrophic Lateral Sclerosis (AKA Lou Gehrig's Disease)
138
What is the Clinical Picture of a patient with ALS?
-Progressive weakness of skeletal muscle
-Cranial nerves also involved
-Hypoventilation (weakness in breathing muscles)
139
What are the Safety Factors for a patient with ALS?
-Profound weakness
-Risk for aspiration
140
Which disorder causes atrophy of muscles in the lower leg?
Charcot-Marie-Tooth (AKA Progressive Peroneal Atrophy)
141
Which disorder is classified by inflammation of the nerve roots and peripheral nerves?
Guillain Barre Syndrome
142
What is the clinical picture for someone with Guillain Barre Syndrome?
-Progressive loss of motor function
-Parasthesia
-Hyperasthesia
-Hypoventilation
-Myalgia
143
What are the Safety Considerations for a patient with Guillain Barre Syndrome?
-Hypersensitivity
-Impaired sensation
144
Which disorder is characterized by a viral infection that affects the anterior horn cells resulting in muscle paralysis?
Polio
145
What are the late effects of Polio called?
Post-Polio
146
What is the Clinical Picture of a patient with Polio?
-Weakness
-Pain
147
Does a Stroke affect the vestibular system centrally or peripherally?
Centrally
148
Does Meniere's Disease affect the vestibular system centrally or peripherally?
Peripherally
149
Does an infection affect the Vestibular system centrally or peripherally?
Centrally
150
What are the Vestibular Contraindications for PT?
-Unstable Meniere's Disease
-Uncontrolled migraines
-Unrepaired superior semicircular canal dehiscence
-Sudden loss of hearing
-Increased feeling of pressure/fullness in one or both ears
-Ringing in one or both ears
-s/p: any discharge from ears or nose
151
What is the Etiology of Peripheral Neuropathies?
-Trauma
-Entrapment: pressure on nerves
-Systemic: Diabetes, HIV
152
What is the Clinical Picture of a patient with Peripheral Neuropathies?
-Weakness of denervated muscle
-Hyper or Hypo sensation
-Trophic changes
153
What are the Safety Considerations for a patient with Peripheral Neuropathies?
Sensory Loss
154
Which disorder is characterized by pre or per-natal trauma resulting in a decrease in O2 to the brain before, during or shortly after birth?
Cerebral Palsy
155
What does Athetoid CP look like?
It is characterized by fluctuating muscle tone between hyper and hypotonia. It looks like writhing movements.
156
What forms can Spastic CP take?
-Diplegia/Paraplegia
-Quadriplegia
-Hemiplegia
157
What is the Clinical Picture for a patient with CP?
-Postural deviations
-Scissoring gait pattern
-Common foot deformities
158
What are the Safety Considerations for a patient with CP?
-Age
-Hip subluxation
-Seizure history
-Positions to avoid: W-sitting, chair sitting without foot support
159
Which disorder is characterized by malformation of the neural tube during the germinal phase of pre-natal development?
Spina Bifida
160
Which form of Spina Bifida is characterized by failure of 1 or more vertebrae to fuse?
Spina Bifida Oculta
161
Which form of Spina Bifida is characterized by the protrusion of meninges and can include spinal cord and cerebrospinal fluid?
Spina Bifida Cystica
162
Which form of Spina Bifida can present as a spinal cord injury?
Spina Bifida Cystica
163
Where does Spina Bifida usually occur?
In the Lumbar region
164
What is the Clinical Picture for a patient with Spina Bifida?
-Flaccid paralysis below level of lesion
-Impaired sensation below level of lesion
-Absence of or diminished reflexes
-Skeletal deformities
-Scoliosis (Congenital: Fixed/ Acquired: Flexible)
-Flattened acetabulum
-May have neurogenic bladder
-Foot deformities
165
What are the Safety Considerations for a patient with Spina Bifida?
-Shunts
-Hip integrity
-Sensory deficits
-Latex allergies
-Positions to avoid ("frog leg", W sitting, ring sitting, heel sitting, cross-legged sitting)
166
What are the Precautions for a patient with a Shunt?
-Headaches
-Sudden high spiking fever
-lethargy
-vomiting
-disorientation
-vision change
-changes in coordination or balance
**Need to send for medical assistance!
167
Which disorder is characterized by having an extra chromosome?
Down's Syndrome (AKA Trisomy 21)
168
What is the Clinical Picture for a patient with Down's Syndrome?
-Moderate to severe intellectual functioning
-Low muscle tone
-Ligament laxity
-Developmental delays
-Congenital heart defects
-Atlanto-Axial subluxation
-Visual and hearing impairments
169
What are the Safety Considerations for a patient with Down's Syndrome?
-Congenital heart defects
-Atlanto-axial subluxation
170
Which disorder is characterized by a sex-linked recessive gene in males causing progressive weakening of muscles proximal to distal. Also by muscle being replaced by fatty tissue?
Duchenne's Muscular Dystrophy
171
What is the life expectancy for a patient with Duchenne's Muscular Dystrophy?
Adolescence
172
What is the Clinical Picture of a patient with Duchenne's Muscular Dystrophy?
-Impaired strength
-Gower sign
-Impaired:
-Respiration
-Gait
-Functional Activities
173
Which disorder is characterized by atrophy of the facial, scapular, and humeral muscles; and usually with adolescent onset?
Facio-scapulo-humeral Muscular Dystrophy
174
Which disorder is characterized by shoulder and hip girdle muscle atrophy with very late onset?
Limb-Girdle Muscular Dystrophy
175
Which disorder is characterized by chronic, progressive deterioration of anterior horn cell and cranial nerve nuclei resulting in marked muscle atrophy?
Spinal Muscular Atrophy (AKA Werdnig-Hoffman Disease)
-Pediatric form of ALS
176
Which disorder is characterized by congenital contractures of limbs with wasting of skeletal muscles and stiff/deformed joints?
Arthrogryposis
177
Which disorder is characterized by a slow and progressive presence of tumors in CNS and PNS; also, cafe au lait spots on skin indicates presence of tumors?
Neurofibromatosis
178
Which disorder is characterized by a disease of collagen synthesis that affects bone production; brittle bones and skeletal deformities; susception to fractures.
Osteogenesis Imperfecta
179
Which disorder is characterized by a breakdown in perceptual motor skills due to SI dysfunction, and may be accompanied by ADD/ADHD?
Developmental Coordination Disorder (DCD) (AKA Minimal Brain Dysfunction or Clumsy Child)
180
When do children usually start showing signs of DCD?
Pre-school age
181
What is the Clinical Picture for a patient with DCD?
-"Soft neurological signs"
-Low muscle tone
-Tactile defensiveness
-Gravitational insecurity
-Poor eye-hand coordination
-Apraxia
-Learning disability
182
What are the Safety Considerations for a patient with DCD?
Do not overstimulate!
