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REHAB 4th Year > NEURO > Flashcards

NEURO Flashcards

1
Q

Explain the term freezing in Parkinsons

A

A phenomenon that occurs in those with Parkinson when a gait pattern needs go be altered
It happens because they are unable to control movement due to lack of inhibition from thalamus
Patients experience this when they need to stop walking, initiate walking or when they change direction

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2
Q

How do we manage freezing

A

Think of walking as a higher level cognitive task rather than relying on autonomic movements
1. Counting steps or stepping over an imaginary line or brick block when approaching freezing time
2. Action observation training (explain)

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3
Q

What is muscle tone

A

Resistance of muscle to passive stretch

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4
Q

Expected functional recovery: C1-C3

A

Depend on ventilator
Limited talking
C3=limited neck movement

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5
Q

Expected functional recovery: C3-C4

A

Usually have head and neck control
Initially requires ventilator
Ability to shrug shoulders

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6
Q

Expected functional recovery: C5

A

Biceps brachii present
Has neck, shoulder shrug, head and shoulder control
Can bend elbow and face palms up
Independence with eating, drinking, face washing, tooth brushing and hair care
Push a manual wheelchair over short smooth surfaces
Can do self assisted coughs
Can do pressure relief by leaning forwards and to the side
May drive adapted car

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7
Q

Expected functional recovery: C6

A

Tenodesis grip
Able to extend wrist
Can use manual wheelchair for daily chores but may need transfer board for transfers
May independently do bladder and bowel management
Have greater independence with ADLs

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8
Q

Expected functional recovery: C7

A

Have intact triceps brachii
Have major part of latissimus dorsi
May need assistance with cutting food
Able to use manual wheelchair independently and transfers without transfer board

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9
Q

Expected recovery function: C8-T1

A

Have better use of fingers
Have all latissimus dorsi
Independent with ADLs, transfers and bowel and vladder management

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10
Q

Expected functional recovery: T2-T6

A

Good motor function of the head, neck, shoulders and arms with fingers
Better trunk control

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11
Q

Expected functional recovery: T7-T12

A

Better abdominal control
Can have better cough
Ability to sit unsupported for functional activities

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12
Q

4 aims of physiotherapy in acute stage of management.

A
  1. Supportive
    Maintaining airway through adequate airway
    Relief pain
    Maintain MSK
  2. Preventative
  3. Educative (caregivers and pt themselves)
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13
Q

Clinical features of Parkinsons

A

Loss of postural reflexes
Gait problems
Badykinesia
Rigidity
Tremor
Monotonous speech
Blank facial expression
Lack of blinking

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14
Q

Which 4 nerves are likely to be affected by residual paralysis from GBS

A

Median nerves
Peroneal nerves
Ulnar nerve
Tibial nerve

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15
Q

Define Parkinsons

A

A slowly progressive degenerative disorder of the extrapyramidal system

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16
Q

Physiotherapy Principals for end stage parkinsons treatment

A

Pressure sore care if pt wheelchair bound
Passive movements to present contracture and maintain ROM
encourage active movement if available
Education for caregivers
Circulatory exercises to minimize risk of DVT
prevent chest complications by maintaining adequate airway and encourage breathing exercises
Endurance ??

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17
Q

Presentation for MND and psuedobulbar palsy

A

Swallowing problems
Slurred speech
Aspiration
Dysphagia

Treatment:
Facilitating jaw and lip closure with microfiber cloth for sensory input
Elevation of the posterior third of tongue
Elevation of the boarders of the tongue
Cheek closure
Control of breathing in relation to swallowing

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18
Q

Precautions for GBS

A
  1. Do not overstretch (can cause pain and tissue damage)
  2. Beware of postural hypotension
  3. Do not exercise to the point of fatigue (paradoxical weakening)
  4. Autonomic dysreflexia
  5. DVT
  6. Beware of decreased sensation
19
Q

Physiotherapy management to preventing chest complications

A

Increase respiratory muscle strength through incentive spiratory or PEP bottle
Postural drainage with frequent suctioning
Frequently asses breath sounds for added sounds
Monitor patients ABG and chest X-ray
Encourage coughing through ACBT

20
Q

Define the term positive impairments and give examples

A

Any impairment that is considered new or additional to the CNS injury
Spasticity
Babinski response
Extensor spasms
Flexor withdrawal spasms

21
Q

Define negative impairments and give examples

A

Impairments that represent a loss of previous function
Muscle weakness

22
Q

Define Neural plasticity

A

The ability of cells to undergo alterations in their form and function depending on environmental influences

23
Q

Mechanisms of Neural plasticity

A

Latent synapse
Potentiation
Recovery
Collateral sprouting
Terminal regeneration
Denervation supersensitivity

24
Q

Describe 2 supra-spinal level inhibitory influences contributing to spasms

A

Basal Ganglia- Refinement and inhibition movement. Akinesia, Rigidity, dyskinesia. Contraleteral to lesion

Vestibulocerebellum- primarily involved in maintenance of balance. Leads to bilateral ataxia and intention Tremor

25
Q

Define ASIA A

A

No motor or sensory function is preserved in the sacral segments S4-S5

26
Q

Define ASIA B

A

Sensory but no motor function preserved believe the neurological level of injury including sacral segments

27
Q

Define ASIA C

A

Motor function is preserved below neurological level of injury and the majority of key muscles have muscle strength less than 3

28
Q

Define ASIA D

A

Motor function is preserved below neurological level and at least half of key muscles have muscle strength greater than or equal to 3

29
Q

Define Parkinsons syndrome

A

Has a known cause (TBI or stroke or drug use)
Sudden onset and progression can be altered if the cause if identified
Can affect any age

30
Q

Define MS

A

An immune-mediated demyelinating disease that affects CNS

31
Q

Explain how increase in body temp causes decrease in conduction of nerve impulses in MS

A

Uhtoff’s syndrome
Heat increases the hydrolysis of Ach leading to decrease in motor unit recruitment. Decrease in motor recruitment leads to decrease in active motor neurons. Decrease in the no of active motor neurons leads to muscle weakness and fatigue

32
Q

Possible causes of fatigue for MS and how to manage it

A
  1. Working against spastic muscles
  2. Heat hydrolysis
  3. Respiratory muscle weakness
  4. Poor endurance from immobility/deconditioning
  5. Loss of proprioception (makes it difficult to conduct coordinated movements)
33
Q

Define GBS

A

Acute inflammatory demyelinating poly neuropathy
Ascending paralysis
Demyelination only happens on peripheral nerves and cranial nerves

34
Q

What is Miller Fisher syndrome

A

Presents like GBS but paralysis starts in the eyes and have ataxic gait

35
Q

Clinical presentation of GBS

A

Abrupt parenthesia
Symmetrical muscle wasting and weakness
Decreased tone and reflexes
Symptoms present in glove and stalking pattern
Autonomic dysfunction I.e unstable BP

36
Q

Medical management for GBS patients

A

Mechanical ventilation
Anticoagulants
Injection with immunoglobulins
Plasma filtration
Flaccid bladder could lead to UTI

37
Q

Causes of MS

A

Low ultraviolet exposure
Autoimmune etiology
Recurrent infections
Trauma
Genetic

THE CAUSE FOR MOST CASES IS MOSTLY UNKNOWN

38
Q

Pathology of MS

A

Mainly affects myelin sheath (Decreased conduction of nerve impulses)
Nerve axons are secondarily affected
Patchy areas of demyelination are spread throughout the CNS

39
Q

Why would remyelination fail in MS

A

Deficiency in precursor cell
Failure of precursor cell recruitment
Failure of precursor cell differentiation
Failure of precursor cell maturation

40
Q

Clinical features of MS

A

Limb weakness (usually asymmetrical)
Respiratory muscle weakness
Spasticity (can progress to be painful)
Fatigue
Ataxia
Intention Tremor
Slurred speech
Loss of proprioception
Diplopia
Urinary retention

41
Q

What are the main reasons for fatigue in MS

A

Working against spastic muscles
Decreased nerve conduction due to decreased internodal distance
Heat- hydrolysis of Ach
Weakness due to deconditioning or immobility

42
Q

Define motor neuron disease

A

Progressive paralysis due to loss of motor neurons with no sensory involvement

43
Q

Name MND area of degeneration

A

Anterior horn cells = LMN
Corticospinal tracts = UMN
Motor nuclei of brainstem = Bulbar palsy
Corticobulbar tracts = Pseudobulbar palsy

44
Q

List the types of MND

A

Progressive muscle atrophy - LMN
Amyotrophic lateral sclerosis - UMN and LMN
Pseudobulbar palsy- UMN
Progressive Bulbar Palsy - LMN
Mixed bulbar palsy

REHAB 4th Year (3 decks)

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