Neuro Pathology Pt. 2

Question 1

Define vertigo

Answer 1

• Sensation that the visual surrounding is spinning or flowing; can be spontaneous or triggered; if severe accompanied by nausea & vomiting

Question 2

Define unsteadiness

Answer 2

• Occurs when the brain receives inadequate info about the body’s position from the somatosensory, visual, & vestibular systems, may result from peripheral neuropathy, eye disease, or peripheral vestibular disorders

Question 3

Define presyncope

Answer 3

• Caused by cardiovascular disorders reducing cerebral perfusion

Question 4

Define lightheadedness

Answer 4

• Nonspecific & hard to diagnose
• It may result from panic attacks with hyperventilation

Question 5

Difference between internal and external vertigo

Answer 5

• Internal: sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during on otherwise normal head movement
• External: the false sensation that the visual surround is spinning or flowing

Question 6

What are some causes of an unilateral peripheral vestibular hypofunction (PVH)

Answer 6

• Trauma
• Vestibular neuritis/labyrinthitis: acute infection with prolonged attack of sx
• Meniere’s disease
• BPPV
• Tumor: acoustic neuroma (vestibular schwannoma)

Question 7

Define Meniere’s disease

Answer 7

• Episodic vertigo syndrome associated with low/medium frequency sensorineural hearing loss & fluctuating aural sx (tinnitus/ear fullness) in affected ear
• Duration of vertigo sx is between 20 min and 12 hrs

Question 8

What are some causes of bilateral PVH

Answer 8

• Otoxic drugs or certain chemotherapy drugs
• Bilateral Meniere’s disease
• Meningitis
• Tumors
• Autoimmune diseases

Question 9

Characteristics of a central nervous system lesion when looking at nystagmus

Answer 9

• Direction changing
• Pure down-beating
• Pure torsional with inability to walk even short distances

Question 10

Describe how to assess for vestibulospinal reflex function

Answer 10

• Examine posture & balance
• Examine for instability in sitting, standing, during functional activities, and gait

Question 11

Outcome measures for vestibular patients

Answer 11

• Dizziness Handicap Inventory (DHI)
• Activities Specific Balance Confidence Scale (ABC)
• Postural stability/balance tests
• Functional gait tests
• Vestibular disorders activities of daily living scale (VADL)

Question 12

Define habituation training

Answer 12

• Repetition of movements & positions that provoke dizziness & vertigo

Question 13

Difference between VOR x1 and VOR x2

Answer 13

• VOR x1: head moves horizontally while eyes remain stationary
• VOR x2: moving target while head is stationary

Question 14

What are the 3 intervention types for BPPV

Answer 14

• Canalith repositioning maneuver: for debris that is free-floating in the semicircular canal
• Liberatory maneuver: for debris that is adherent to the cupula (cupulolithiasis)
• Brandt-Daroff exercises: for residual or mild vertigo

Question 15

Spinala read of greatest frequency of injury

Answer 15

• C5
• C7
• T12
• L1

Question 16

Define a tetraplegia (quadriplegia)

Answer 16

• Injury occurs between C1 and C8
• Involves all four extremities & trunk

Question 17

Define a paraplegia

Answer 17

• Injury occurs between T1 and T12-L1
• Involves both lower extremities & trunk (varying levels)

Question 18

Complete versus incomplete SCI

Answer 18

• Complete: no sensory or motor function below level of lesion
• Incomplete: preservation of sensory or motor function below level of injury; spotty sensation, some muscle function

Question 19

Describe the ASIA SCI impairment scale

Answer 19

• A = Complete, no motor/sensory function preserved in sacral segments S4-S5
• B = Incomplete, sensory but no motor function preserved below the neurological level & includes the sacral segments S4-S5
• C = Incomplete, motor function preserved below neurological level; most key muscles below lesion level have a muscle grade less than 3
• D = Incomplete, motor function is preserved below neurological level & most key muscles below level have a muscle grade of 3 or more
• E = Normal motor & sensory function

Question 20

Describe central cord syndrome

Answer 20

• Loss of spinothalamic tracts with bilateral loss of pain/temperature
• Loss of ventral horn with bilateral loss of motor function (primarily upper extremities)
• Preservation of proprioception & discriminatory sensation
• Typically caused by hyperextension injuries to the cervical spine

Question 21

Describe Brown-Sequard syndrome

Answer 21

• Ipsilateral loss of DCML with loss of tactile discrimination, pressure, vibration, & proprioception
• Ipsilateral loss of corticospinal tracts with loss of motor function & spastic paralysis below level of lesion
• Contralateral loss of spinothalamic tract with loss of pain/temperature below level of lesion (at level of lesion is bilateral loss)
• Hemisection of spinal cord typically caused by penetration wounds (gunshot/knife) with asymmetrical symptoms

Question 22

Describe Anterior cord syndrome

Answer 22

• Loss of lateral corticospinal tracts with bilateral loss of motor function, spastic paralysis below level of lesion
• Loss of spinothalamic tracts with bilateral loss of pain/temperature
• Preservation of DCML: proprioception, kinesthesia, & vibratory sense (light touch)
• Typically caused by flexion injuries of the cervical spine

Question 23

Describe posterior cord syndrome

Answer 23

• Loss of DCML bilaterally
• Bilateral loss of proprioception, vibration, pressure, & epicritic sensations (stereognosis, 2-point discrimination)
• Preservation of motor function, pain, & light touch
• Extremely rare

Question 24

Describe Cauda Equina syndrome

Answer 24

• Injury below L1 resulting in LMN lesions
• Flaccid paralysis with no spinal reflex activity
• Flaccid paralysis of bladder & bowel
• Potential for nerve regeneration; regeneration often incomplete, slows & stops after about 1 yr

Question 25

Define sacral sparing in SCI

Answer 25

- Sparing of tracts to sacral segments with preservation of perianal sensation, rectal sphincter tone, or active toe flexion

Question 26

Action of diaphragm, respiratory muscles, intercostals; chest expansion, breathing pattern, cough, vital capacity; respiratory insufficiency or failure occurs in lesions above what spinal level

Answer 26

- Above C4 - Phrenic nerve, C3-C5 innervates diaphragm

Question 27

How to determine the spinal cord level of injury

Answer 27

- Lowest segmental level of innovation includes muscle strength present at a grade 3+/5

Question 28

Define spinal shock

Answer 28

- Transient period of reflex depression & flaccidity - May last several hours or up to 24 wks

Question 29

Signs and symptoms of autonomic dysreflexia

Answer 29

- HTN - Bradycardia - Severe HA - Feeling of anxiety - Constricted pupils - Blurred vision - Flushing and piloerection (goosebumps) - Increased spasticity

Question 30

What should you do if patient is experiencing autonomic dysreflexia

Answer 30

- Bring to an upright position - Loosen any tight clothing or restrictive devices - Examine/reduce blockage of urinary drainage - Monitor BP and HR - Notify medical and/or nursing staff ASAP

Question 31

Signs and symptoms of orthostatic hypotension

Answer 31

- Drop in 20 SBP or drop in 10 DBP or both and an increase in HR of 10 bpm - Lightheadedness - Syncope - Mental or visual blurring - Sense of weakness

Question 32

Describe locomotor training for T6-T9 complete SCI

Answer 32

- Supervised ambulation for short distances - Requires bilateral KAFOs and crutches - Swing to gait pattern; requires assistance - May prefer standing devices/standing wheelchairs for physiological standing

Question 33

Describe locomotor training for T12-L3 complete SCI

Answer 33

- Can be independent with ambulation on all surfaces & stairs - Using a swing through or 4 point gait pattern & bilateral KAFOs and crutches - May also use reciprocating gait orthoses with walker with or without FES system - Typically independent household ambulators; wheelchair use for community ambulation

Question 34

Describe locomotor training for L4-L5 complete SCI

Answer 34

- Can be independent with bilateral AFOs & crutches or canes - Typically independent community ambulators - May still use wheelchair for activities with high-endurance requirements - High rejection of orthoses/ambulation in favor of wheelchair mobility & energy conservation

Question 35

Define neuromodulation

Answer 35

- Use of electrical stimulation to replace or improve function of a paralyzed or paretic limb - Includes FES and robotic assisted walking

Question 36

Parameters and progression of body weight support treadmill training for SCI

Answer 36

- High intensity, high frequency training: 4-5 days/wk, 20-30mins, typically for 8-12 weeks - Progression: decrease BWS, increase treadmill speed, eliminate manual assistance - Can progress further to overground gait training for community ambulation

Question 37

What are some exercise precautions for tetraplegia/high lesion paraplegia SCI patients

Answer 37

- Pts may experience blunted tachycardia, lack of pressor response, very low VO2 peak, & substantially higher variability of most responses - Monitor HR and BP closely during exercise & activity training

Question 38

Absolute contraindications to exercise testing & training of individuals with SCI

Answer 38

- Autonomic dysreflexia - Severe or infected skin on weight bearing surfaces - Symptomatic hypotension - urinary tract infection (UTI) - Unstable fracture - Uncontrolled hot & humid environments - Insufficient ROM to perform exercise task