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5 Neurological Dysfunction > Midterm Practical > Flashcards

Midterm Practical Flashcards

1
Q

Alignment cues

A

emphasizes achieving neutral trunk position in initial conditions

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2
Q

Directional Cues

A

motor responses influenced by stimulation of superficial somatosensory inputs gently guiding the patient in the direction of desired movement

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3
Q

Loading Cues

A

goal is to increase somatosensory input by a force through joint into the ground, recreating the GRF

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4
Q

Approximation Cues

A

Increasing somatosensory input by applying a gentle force through the long axis of the bone into the proximal joint to increase activity in the proximal muscles

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5
Q

Resistance Cues

A

manual application of force away from the axis of motion at the joints as patient is asked to move or to stabilize

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6
Q

Pelvic alignment cueing

A

goal is to facilitate lumbar extension and anterior pelvic tilt

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7
Q

Upright trunk alignment cueing

A

goal is to facilitate thoracic extension

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8
Q

Directional cueing for weight shift and scooting

A

goal is to offload one half of the pelvis to allow for shifting forward of that side

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9
Q

Directional cueing for lateral weight shift in standing

A

goal is to shift weight onto stance limb and offload opposite limb for gait/stepping/etc

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10
Q

Approximation cueing for foot placement in seated

A

goal is to engage the patient is actively offloading the distal extremity in seated for limb respositioning

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11
Q

Loading cueing for the lower extremity

A

goal is to increase muscle activity through the lower extremity in weight bearing tasks

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12
Q

MMT Rating 5

A

pt has full ROM against effects of gravity. examiner provides maximal resistance with no discernible difference between affected and unaffected limbs

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13
Q

MMT Grade 4

A

patient has full ROM against effects of gravity. examiner provides strong resistance with slight difference noted between affected and unaffected limbs

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14
Q

MMT Grade 3

A

Patient has full ROM against effects of gravity, but is unable to sustain any resistance offered by examiner

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15
Q

MMT Grade 2

A

Gravity eliminated: patient is able to produce full AROM

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16
Q

MMT Grade 1

A

gravity eliminated: patient is unable to produce full AROM, but muscle tension is palpable

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17
Q

MMT Grade 0

A

gravity eliminated: patient unable to initiate AAROM and muscle tension is not palpable

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18
Q

C5 Nerve Root

A

Elbow flexion
Shoulder Abduction

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19
Q

C6 Nerve Root

A

Wrist Extension

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20
Q

C7 Nerve Root

A

Elbow extension

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21
Q

C8 Nerve Root

A

Finger flexion

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22
Q

T1 Nerve Root

A

Finger abduction

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23
Q

L2 Nerve Root

A

hip flexion

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24
Q

L3 Nerve Root

A

knee extension

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25
L4 Nerve Root
ankle dorsiflexion
26
L5 Nerve Root
great toe extension
27
S1 Nerve Root
ankle plantar flexion
28
What is muscle tone?
the amount of inherent neuromuscular activity present even in a resting muscle and is detected y the response, specifically the amount of resistance, to passive elongation or stretch of the muscle being tested
29
Hypertonia
an increase in muscle tone that results from damage to the corticospinal tract in the cortex, brainstem, or spinal cord. Clinician will feel more ressitance than you would expect normally
30
Hypotonia
a decrease in muscle tone that results from damage to the lower motor neuron Clinician will feel less resistance than you would expect normally
31
Rigidity
an increase in muscle tone caused by damage to extrapyramidal motor structures
32
Spasticity
an increased resistance to passive stretch taht is velocity dependent that is often seen in conjunction with hypertonia and indicates an UMN lesions. The faster movement increases the resistance to the stretch due to an uninhibited monosynaptic stretch reflex
33
Grade 0 Spasticity
no increase in muscle tone
34
Grade 1 Spasticity
slight increase in muscle tone, manifested by a catch and release or by minimal resistance but only at the end of the ROM when the affected part is moved in flexion or extension
35
Grade 1+ Spasticity
slight increase in muscle tone, manifested by a catch, followed by minimal resistance detected throughout the remainder of the ROM
36
Grade 2 Spasticity
more marked increase in muscle tone detected through most of the ROM but affected parts are easily moved
37
Grade 3 Spasticity
Considerable increase muscle tone, passive movement difficult
38
Grade 4 Spasticity
Affected parts rigid in flexion and extension
39
Procedures for Sensory Exam
Patient lies in supine Both right and left sides are tested for each site All sites are tested for light touch and pin prick Score = 0 for absent, 1 for altered, 2 for normal
40
Cervical Sensory Testing Areas
C2 = behind the ear/lateral to occipital protuberence C3 = in supraclavicular folssa C4 = Over the AC joint C5 = on the lateral side of antecubital fossa just proximal to the elbow C6= dorsal surface of proximal phalanx of thumb C7 = dorsal surface of proximal phalanx of middle finger C8 = dorsal surface of proximal phalanx of little finger
41
Thoracic Sensory Testing Areas
T1 = on the medial side of antecumbital fossa T2 = at the apex of axilla T3 = third rib intercostal space T4 = fourth intercostal space (level of nipples) T5 = fifth intercostal space T6 = sixth intercostal space, xiphoid T7 = slightly below seventh intercostal space T8 = halfway between xiphoid and bellybutton T9 = slightly above belly button T10 = belly button line T11 = between belly button and inguinal ligament T12 = inguinal ligament
42
Lumbar Sensory Testing Areas
L1 = midway between T12 and L2 L2 = mid femur L3 = medial femoral condyle above knee L4 = over medial malleolus L5 = on dorsum of foot at third metatarsal phalangeal joint
43
Sacral Sensory Testing Areas
S1 = on lateral aspect of calcaneus S2 = at midpoint of popliteal fossa S3 = over ischial tuberosity S4/5 = perianal area
44
Classification of SCI
1. Determine the sensory level for R and L sides 2. Determine motor levels for R and L sides 3. Determine neurological level of injury 4. Determine if the injury is complete or incomplete 5. Determine the ASIA impairment scale grade
45
C1-C3 Level of Injury
Muscles: SCM, paraspinals, neck Bed Mobility: total assist Transfer: Total assist Standing: none Wheelchair: need power
46
C4 Level of Injury
Muscles: C3 + upper traps, diaphragm Bed Mobility: Total Transfers: Total w/c: power Standing: none
47
C5 Level of Injury
Muscles: C3-C4, deltoid, biceps, brachialis, bracioradialis, rhomboids, some serratus Bed mobility: some assist Transfers: total w/c: power or manual (needs assist) standing: no functional
48
C6 Level of Injury
Muscles: C3-C5, ECRL, ECRB, Serratus, Lats Bed mobility: some assist Transfers: Some assist w/c: power or manual standing: no functional
49
C7-C8 Level of Injury
Muscles: C3-C6, pecs, triceps, pronator, ECU, FCR, finger flexors Bed mobility: independent to some assist Transfers: Independent to some assist w/c: independent w/manual standing: no functional
50
T1-T9 Level of Injury
Muscles: C3-C8, hand intrinsics, intercostals, erector spinae Bed mobility: independent Transfers: independent w/c: independent standing: typically not functional
51
T10-L1 level of injury
muscles: everything above and abs bed mobility: independent transfers: independent w/c: independent standing: walker and orthoses
52
L2-S5 Level of Injury
muscles: everything above plus full abs, and partially to full LE bed mobility, transfers, standing: independent
53
High lesions and cough
muscles of inspiration and force expiration are affected
54
Lower lesions and cough
will have intact muscles of inspiration, muscles of forced expiration will be impaired
55
Functional Cough
# of coughs per exhalation: 2 or more Sounds loud and forceful 2 or more coughs per exhalation functional significance: can clear secretion
56
Weak functional cough
sounds soft and not forceful one cough per exhalation assistance needed to clear large amounts of secretions
57
Nonfunctional cough
sounds like a sigh or throat clearing no true coughs per exhalation assistance needed for airway clearance
58
Abdominal Thrust for coughs
1. place hand in flat fist at least 1-2 inches below the xiphoids process, centered on abdomen 2. Have patient inhale/exhale twice, then apply firm upward pressure on third exhale
59
Modifications for Abdominal Thrust
1. Anterior chest wall compression. One arm goes on chest at nipple line, second at umbilicus 2. seated position for quicker resolution of congestion. Wide w squeeze in and push up
60
Sidelying Rotation Cough assistance
1. Position pt in sidelying with supports as mecessary 2. Explain that you will be providing pressure while pt tries to cough on third exhale 3. stand behind pt, with one hand on AC joint and other on hip 4. provide a side compression and rotation pressure with third exhale
61
Dose of Pressure Relief
Frequency = every 20 min Duration = 30-90 sec
62
C2-C5 Level of Injury Pressure Relief
anterior trunk lean
63
C6 Level of Injury Pressure Relief
lateral trunk lean
64
C7-C8 Level of Injury Pressure Relief
cross and trunk lean
65
T1-T9 Level of Injury Pressure Relief
Lifting with triceps
66
T10-L1 Level of Injury Pressure Relief
stand/squat
67
Complete SCI Bed Mobility Techniques
Rolling Supine to sit w/equipment Supine to sit w/out equipment Long sit
68
Complete SCI Rolling
They need at least triceps to perform to decrease difficulty, cross legs or have them 3/4 sidelying to increase difficulty, uncross legs, increase incline
69
Supine to sit (w/out equipment) for complete SCI
does not require triceps, uses shoulder protraction. Does require ROM of upper and lower body 1. Start prone on elbows. The elbows are walked to the side until trunk is about perpendicular with hips 2. Use hands to crawl farther, and then hook one arm under closest leg. 3. Use other arm to push up into sitting position
70
Long sit for complete SCI
passive tension of the hamstrings to avoid falling elbows go into extension, with wrists extended, fingers curled. Maintains tendonesis grip
71
Wheelchair transfers for those with SCI complete
Short sit Sit pivot using head hips principle Transfer board
72
Stretches for Shoulder maintenance
Behind the chair Cross arm upper triceps
73
Active movements for shoulder maintenance
Full can ER scapular squeeze cross body
74
Resistance for shoulder maintenance
full can with weight ER with band attached to door shoulder squeeze, band attached ahead cross body pull downs

5 Neurological Dysfunction (16 decks)

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