FINAL EXAM

Question 1

progressive CNS conditions

Answer 1

Parkinson’s
MS

Question 2

non-progressive CNS conditions

Answer 2

Hemiplegia
Spinal cord injuries (SCI)
Cerebral palsy

Question 3

gait often present with hemiplegia or MS

Answer 3

circumduction gait

Question 4

gait often present with Parkinson’s

Answer 4

festinating gait

Question 5

spasticity can exist with…

Answer 5

hemiplegia
MS
SCI
cerebral palsy

Question 6

what is spasticity?

Answer 6

-occurs when there is loss of inhibition of alpha motor neuron firing
-resistance of a limb to passive movement

Question 7

flexor pattern of the upper body

Answer 7

-flexion of client’s head & trunk towards affected side
-depression of SH
-retraction of scapula
-int.R & ADD of GH joint
-flexion of elbow
-pronation of forearm
-flexion of wrist
-fingers with thumb ADD

Question 8

extensor pattern of upper body

Answer 8

-slight ext of client’s NK & head with trunk bent away from affected side
-scapula retracted
-int.R of GH joint
-elbow rigidly extended
-pronation of forearm
-hand either in flexion forming tight fist, or in flexion at PIP & DIP joint
-palm faces backwards

Question 9

flexor pattern of lower body

Answer 9

-ABD, ext.R & flexion of hip
-flexion of knee
-dorsiflexion & inversion of ankle
-flexion of toes

Question 10

extensor pattern of lower body

Answer 10

-ADD, int.R & extension of hip
-extension of knee
-plantarflexion & inversion of ankle

Question 11

causes person to vigorously extend limbs while arching back, triggered by stimulation or pressure to back of head or trunk

Answer 11

extensor thrust pattern

Question 12

can accompany extensor thrust pattern, teeth clenched together with extreme force, most common with head injuries

Answer 12

bite reflex

Question 13

stiffening of legs in extension or tight flexion, can occur in response to pressure on ball of foot or stretching of plantar surface by dorsiflexing toes

Answer 13

positive supporting reaction

Question 14

stimulus to palmar surface of hand, results in withdrawal of entire arm into a tightly flexed position

Answer 14

grasp reflex

Question 15

techniques to reduce spasticity

Answer 15

gentle, repetitive stroking, GTO release, rhythmical rocking

Question 16

resistance to movement in flexion, extension & rotation, commonly present in clients with Parkinson’s, can result in painful cramps as well as P, numbness & achiness

Answer 16

rigidity

Question 17

palpated as a uniform resistance throughout the ROM of an affected joint

Answer 17

lead pipe rigidity

Question 18

ratchet-like movement of an affected limb, limb can be moved a short distance through ROM but movement is interrupted by a tremor, movement stops for a moment & then resumed again – cycle repeated throughout ROM

Answer 18

cogwheel rigidity

Question 19

techniques to reduce rigidity

Answer 19

-decreasing SNS firing
-swedish techniques, followed by heat
-slow, passive stretches

Question 20

non-progressive condition of paralysis on one side of the body as a result of a brain lesion

Answer 20

hemiplegia

Question 21

causes of hemiplegia

Answer 21

-cerebrovascular pathology (cerebral thrombus, cerebral hemorrhage due to aneurysm & cerebral embolism)
-head trauma (fall/ MVA)
-brain tumor

Question 22

hemiplegia - immediately after a stroke or head trauma, mm on affected side will be weak or flaccid – this is considered the ____ phase

Answer 22

acute

no spasticity or reflex patterns evident (gradually develop)

Question 23

hemiplegia - most common pattern is ____ pattern in upper limbs combined with an ____ pattern in lower limbs

Answer 23

flexor

extensor

Question 24

painful condition with shoulder in ADD & int.R combined with retracted scapula due to reflex patterns & spasticity – flaccidity in SH girdle mm & poor positioning of person’s body results in an inferior subluxation of humerus

Answer 24

hemiplegic shoulder

Question 25

decreased ROM of SH & hand, followed by throbbing P & edema – elbow remains symptom free – syndrome usually occurs with a lesion of the premotor cortex

Answer 25

shoulder-hand syndrome

Question 26

condition in which demyelination of the nerve occurs

Answer 26

MS

Question 27

mild form, few exacerbations followed by complete recovery & client remains asymptomatic

Answer 27

benign MS

Question 28

repeated cycles of exacerbation & remission, symptoms such as double vision, slurred speech, numbness & tingling anywhere in body can occur during these attacks

Answer 28

attack-remitting MS

Question 29

MS - causes only mild disability when attack subsides

Answer 29

benign or mild attack-remitting MS

Question 30

results in increased symptoms following attacks, in some cases, remission periods become less & less frequent, disability increases continuously

Answer 30

chronic progressive attack-remitting MS

Question 31

rapid progression of symptoms & disability, can be fatal within a few years, more severe form of MS, least common

Answer 31

acute progressive MS

Question 32

4 factors involved in the cause of MS

Answer 32

1. genetic 2. environmental 3. viral 4. immunological

Question 33

progressive disorder involving diminishing basal ganglia function, results in slow, increasingly difficult movement, accompanied by resting tremors & muscular rigidity

Answer 33

Parkinson's

Question 34

cause of Parkinson's

Answer 34

unknown, genetics do not appear to play a role

Question 35

Parkinsons as a symptom of some other brain condition

Answer 35

Parkinson’s plus syndrome causes: repeated head trauma (boxing), toxins, medications that block dopamine receptors, brain tumor, Huntington’s disease, Alzheimer’s, hydrocephalus

Question 36

what is the progression of Parkinson’s?

Answer 36

progresses slowly or rapidly, with mild or severe symptoms Stage 1: one side of body involved – rigidity or tremors – if symptoms mild, no Tx given, if moderate, PT & massage helpful Stage 2: both sides of body involved – moderate tremors, rigidity & bradykinesia – balance not affected – levodopa drug therapy may begin Stage 3: significant tremors, rigidity & bradykinesia – balance & walking impaired - unsteadiness, dystonia, freezing Stage 4: severe disability results because of bradykinesia – walking still possible, marked impairment – some assistance required with ADL’s Stage 5: loss of ability to function independently – person is immobile

Question 37

slow initiation & performance of movements

Answer 37

bradykinesia

Question 38

most often in hand, at a rate of 4/5-8 cycles per second – often start in one hand, then appear in foot on same side

Answer 38

resting tremors may be accompanied by a “pill rolling” tremor benign essential tremor: familial tendency & can begin at any age, trembling in both hands spreading to head & voice – does not occur at rest and will cease when limb is supported

Question 39

retropulsion & propulsion (Parkinson's)

Answer 39

retropulsion: person unable to stop from falling backwards propulsion: results in inability to stop from falling forward, leads to falls which can result in injury

Question 40

sudden inability of person to move – occurs if person becomes distracted or interrupted while doing an action (Parkinson's)

Answer 40

freezing phenomenon

Question 41

an injury to the vertebral column, spinal cord or both due to a direct or indirect trauma

Answer 41

spinal cord injury (SCI)

Question 42

spinal cord begins from medulla oblongata, just superior to foramen magnum & ends at __, where it becomes the ____and then the cauda equina

Answer 42

L2 conus medullaris

Question 43

how many pairs of spinal nerves

Answer 43

31

Question 44

what are the most vulnerable segments of the spinal cord?

Answer 44

C4 to C6 T12 to L1

Question 45

affects 4 limbs, trunk & pelvic organs – results when spinal cord damage occurs in cervical segments – T1 & above

Answer 45

quadriplegia

Question 46

affects lower limbs – spinal cord lesion occurs in thoracic, lumbar or sacral segments – T2 & below – depending on specific area damaged, trunk or pelvic organs may be involved

Answer 46

paraplegia

Question 47

difference between complete & incomplete spinal cord injury

Answer 47

COMPLETE: lesion results in total loss of function below level of lesion INCOMPLETE: lesion results in some function below level of lesion

Question 48

damage in the centre of the cord with the periphery of the cord unaffected

Answer 48

central cord syndrome cause: hyperextension injury, usually C-spine, affects elderly with arthritic changes to spine

Question 49

central cord syndrome impairment

Answer 49

motor & sensory abilities of upper limbs affected, mm weak or flaccid, LL spared or less affected

Question 50

damage to one side of the cord

Answer 50

Brown Sequard Syndrome cause: stabbing & gunshot wounds

Question 51

Brown Sequard Syndrome impairment

Answer 51

on same side of lesion, decreased or absent motor function, proprioception, vibration & two-point discrimination but normal P & temp perception

Question 52

damage to the anterior spinal artery or anterior aspect of the cord, resulting in corticospinal & spinothalamic tract injury

Answer 52

anterior cord syndrome cause: direct trauma, often hyperflexion injury

Question 53

anterior cord syndrome impairment

Answer 53

variable bilateral loss of motor function & P, temp & crude touch perception, proprioception

Question 54

term used for motor function disorders that result from damage to the immature brain

Answer 54

cerebral palsy

Question 55

3 main causes of cerebral palsy

Answer 55

1. hypoxia & ischemia 2. trauma to, or rupture of, cerebral blood vessels 3. toxicity & infection

Question 56

4 main types of movement disorders with cerebral palsy

Answer 56

1. spastic (increased tone), most common 2. athetoid (uncontrolled movement) 3. ataxic (poor coordination), least common 4. mixed (usually spastic & athetoid)

Question 57

many years after a recovery of polio, a client may begin experiencing a return of Sx & increasing disability, what is this called?

Answer 57

post-polio syndrome

Question 58

acute viral infection specifically affecting motor neurons in the spinal cord & brain stem

Answer 58

poliomyelitis

Question 59

most common type of polio

Answer 59

spinal poliomyelitis: inflammation & destruction of anterior horn cells may occur at any level of spinal cord

Question 60

most serious type of polio

Answer 60

bulbar poliomyelitis: involves cranial nerves & sometimes cardiorespiratory centre, has poor prognosis with very high mortality rate if paralysis of respiratory mm & failure of medulla occur

Question 61

seizure presents → blank stare, change on postural tone, short in time

Answer 61

Petite Mal (absence seizure)

Question 62

tonic contractions of mm, loss of consciousness, bladder & bowel incontinence, followed by bilateral, rhythmic contraction & relaxation of limbs

Answer 62

Grand mal (tonic-clonic seizure)

Question 63

causes of decubitus ulcers

Answer 63

pressure, friction damage, shear forces

Question 64

no impairment of consciousness, an aura or prodromal symptoms are only manifestation, could lead to a generalized seizure

Answer 64

partial seizures