Neuro Flashcards
What is chronic spasticity associated with?
Abnormal posturing and deformity, contractures, functional limitations and disability
What are the 2 types of rigidity?
Leadpipe: constant uniform rigidity throughout entire ROM
Cogwheel: hypertonic state with rachet like jerkiness during muscle elongation
What is rigidity associated with?
Contractures, stiffness, inflexibility, functional limitations and disability
Describe the Modified Ashworth Scale?
0 - no increase in tone
1 - slight increase in tone - minimal resistance at end of ROM
1+ - slight increase - minimal resistance through less than half ROM
2 - noticeable increase - mod resistance through most of ROM
3 - considerable increase throughout - PROM difficult
4 - max rigidity through entire ROM (passive and active)
What is the order of testing sensation?
Superficial - light touch, pain, temp, pressure
Deep - proprio, kinaesthesia, vibration
Combined - stereognosis, graphasthesia, etc.
What are the cortical sensation tests and what do they assess?
Stereognosis - tactile object recognition
Tactile localization - ability to localize touch sensation
2 point discrimination - ability to perceive 2 separate points on the skin simultaneously
Double simultaneous stimulation - ability to perceive simultaneous touch stimulation (identical spots on both sides, proximal and distal on one extremity, prox and distal on one side of the body)
Graphesthesia - ability to identify numbers, letters, etc that have been traced on the skin
Texture recognition - differentiate between textures
Barognosis - recognition of weight
What are coordination tests? What are you looking for with each one?
Nose to finger - intention tremor, dysmetria, postural control, speed
Pro/Sup RAM - dysdiadochokinesia
Finger Opposition RAM - dysdiadochokinesia
Rebound test - inability to adapt to removal of resistance causing jerky response
Heel to Shin - speed of movement, dysmetria, postural control with movement
Tapping RAM - dysdiadochokinesia
Toe to finger - intention tremor, speed of movement, dysmetria, postural control
What is the progression of positions to assess balance in?
Most supported –> least supported
4 point kneeling –> kneeling –> sitting –> standing –> walking
How do you progress the balance assessment in each position? What are other ways to increase difficulty?
Internal perturbations - pt generated movements
External perturbations - expected and unexpected
Ways to increase difficulty: BOS, speed of movement/perturbation, expected vs. unexpected, amount of sensory input
What are the 3 strategies used to maintain balance?
Ankle - small perturbations
Hip - large or fast perturbations where ankle isn’t enough
Equilibrium restoring - pivoting, movement of extremities, changing BOS
Romberg Test/Sharpened Romberg Test
Measures balance
In standing (barefoot), feet together, eyes closed, arms at sides. Count seconds pt can maintain balance
Opening eyes, using arms or stepping ends the test
Sharpened = same but in tandem
Sensory Organization Test
Tests function of 3 senses needed for balance (vision, vestibular and somatosensory)
6 test conditions Firm - eyes open, closed, dome; Foam - eyes open, closed, dome
Pt must keep hands at sides and are timed for 30s
Test ends if pt’s arms or feet change position or eyes open when should be closed
3 attempts per condition if fail
Berg Balance Scale (General Interpretation)
Static and dynamic balance
0-20 - high fall risk
21-40 - medium fall risk
41-56 - low fall risk
Functional Reach Test
How far pt is able to reach without moving feet
Standing beside wall but not touching, can’t use wall to lean or for support
3 trials, avg of last 2
< 7 in (18cm) = limited functional balance, restricted in ADLs
>10 in (26cm) = mostly independent, low risk of falls
TUG
Assess mobility, balance, walking ability and fall risk in older adults
Use regular shoes and gait aid if needed
Sitting, line 3m away
>12s = fall risk
Describe ALS and its impairments
Loss of brainstem nuclei and anterior horn cells in spinal cord. Affects UMN and LMN.
Impairments: muscle atrophy, cramps, problems breathing, difficulty with walking/tripping, fatigue, fasciculations, hyperreflexia, spasticity, pain (from spasticity, cramps, joint hypomobility), resp dysfunction, no pattern of muscle loss, dysphagia, dysarthria, sensation unaffected
Describe myasthena gravis and its impairments
Autoimmune neuromuscular junction dysfunction due to blocking of ACH receptors
Impairments: problems chewing, difficulty with speech, swallowing and breathing, symmetrical muscle weakness in proximal limbs, neck muscle weakness, loss of control in eye and eyelid muscles
Describe GBS and its impairments
Autoimmune, demyelination of peripheral nerves and nerve roots, progressive muscle weakness and respiratory paralysis (LMN).
Impairments: progressive symmetrical weakness in arms and legs (distal to proximal), sensory loss/parasthesia, absent reflex or hypo, resp dysfunction in 2-3 weeks (vent), dysarthria, dysphagia, diploplia, facial weakness, autonomic dysfunction (arrythmia, tachycardia, etc.)
Describe Parkinson’s and its impairments. What are some outcome measures for PD?
Loss of dopaminergic neurons in the substantia nigra.
Impairments: tremor, rigidity, akinesia, postural dysfunction, shuffling gait, masked face, stooped posture, dysphonia, dysphagia, weakness, decreased ROM
Outcome Measures: Unified Parkinson’s Disease Rating Scale (UPDRS), Short Parkinson’s Evaluation Scale (SPES), Scales for Outcomes in Parkinson’s Disease (SCOPA)
Describe TBI and its impairments
Leads to axonal damage due to excessive force, diffuse axonal injury
Impairments: spasticity, weakness, ataxia, poor balance, hypokinesia, cognitive deficits, pain
Describe Post polio syndrome and its impairments
Development of new muscle weakness and fatigue in skeletal and bulbar muscles that begins 25-30 years after poliomyelitis.
Impairments: 2 new symptoms among - excessive fatigue, muscle or joint pain, muscle atrophy, cold intolerance, no other medical explanation + fasciculations, cramping, sensation intact
Describe MS and its impairments. What are the subtypes?
Chronic and progressive autoimmune demyelination of CNS neurons.
Impairments: symptoms vary depending on location and extent, sensory and motor impairment, fatigue, heat sensitivity, ataxia/balance, poor bladder control, slurred speech, visual deficits, sexual, cognitive, pain, Lhermitte’s sign - intense burst of pain that runs down back into arms and legs when flex neck
Sub types: relapsing remitting, primary progressive, secondary progressive, progressive relapsing
What are the signs and symptoms of a hemiplegic shoulder?
Pain, subluxation (from supraspinatus flaccidity), loss of ROM
MCA Stroke
C/L sensory and/or motor in UE/face mostly
Left - may have language deficits (Wernicke’s)
Right - may have spatial perception deficitis (neglect)
