neuro rehab midterm Flashcards
(144 cards)
1
Q
what is motor control?
A
the ability to regulate mechanisms essential to movement
how nervous system interacts with rest of body and environment
2
Q
what is reflex theory?
A
reaction to stimulus causes mvmt
3
Q
what is hierarchical theory?
A
top down control
4
Q
describe the reflex-hierarchical theory.
A
motor control emerges form reflexes that are organized in a top down manner
cant explain voluntary mvmts, fast complex mvmts, or lower level mvmts that control higher centers
5
Q
what is the neuro-maturational theory?
A
as nervous system matures, motor skills develop
what about MSK changes - growth and strength
clinical relevance: treat the neuromuscular system not just an isolated muscle
6
Q
what is motor programming theory?
A
CNS is reactive and active
mvmt is centrally organized
controls many degrees of freedom in action
clinical relevance: shift towards teaching/training, looking for mvmt pattern
7
Q
what is ecological theory?
A
how actions are geared to environment
8
Q
what is the systems approach?
A
interaction of individual, task, and environment
9
Q
what is task oriented training?
A
mvmt is organized around a behavioral goal
mvmt is constrained by environment
emphasizes functional tasks
assumes pts learn by attempting to solve problems
10
Q
task: stability vs mobility
A
stab: non-moving BOS - sitting, standing
mob: moving BOS - walking, running, transfer
11
Q
task: closed vs open
A
closed: predictable, non moving surface
open: unpredictable, uneven or moving surface
12
Q
task: upper extremity function
A
easy: no object manipulation
hard: precise object manipulation
13
Q
environment: regulatory vs nonregulatory
A
reg: aspects of envrionment shape that shape the mvmt
nonreg: mvmt does not conform to these features
14
Q
define primary and secondary impairments.
A
pri or direct: specific thing
sec or indirect: what the thing causes
15
Q
order of patient management
A
examination
evaluation
diagnosis
prognosis
intervention
outcomes
16
Q
what are the factors of patient prognosis?
A
progressive nature of pathology
extent of path
age related neural plasticity
comorbidities
acuity of disorder
prior level of physical function
sensation
decreased arousal, orientation, attention
motivation
social/family support
recent trends of recovery
17
Q
why perform neuro exam?
A
id impairments
determine impact on functional tasks
test hypoth/diff diag
guide prognosis
id red flags/need for referral
18
Q
what is the UMN?
A
going down
MOTOR
2 and 3 order
corticobrainstem
corticospinal
19
Q
what are the 4 components of a neuro exam?
A
pt observation
pt history
review of systems
tests and measures
20
Q
how to choose appropriate test and measure?
A
what is pt’s:
current functional status
current cognitive status
clinical setting
chief concerns
goals and reasonable expectations for recovery
21
Q
define arousal.
A
physiologic readiness of human system for activity
22
Q
define alert.
A
awake and attentive
23
Q
define lethargic.
A
drowsy and falls asleep easily
loud voice needed
24
Q
define delirium.
A
often when emerging from coma
confusion, may hallucinate
25
define obtunded.
difficult to arouse from sleep
needs loud voice and shake awake
26
define stupor.
only responds to noxious stimuli
aka vegetative state
27
define coma.
cannot be aroused, no response
glasgow score of 8 or less
28
glasgow coma scale scores.
minor brain injury: 13-15
moderate brain injury: 9-12
severe brain injury: 3-8
29
what is decerebrate posture?
upper brain stem injury
elbows extended
wrists pronated
fingers flexed
30
what is decorticate posture?
one or both corticospinal tracts
elbows flexed
wrist and fingers flexed on chest
legs in IR
31
Rancho los amigos level of cognitive functioning scale
1 no repsonse
2 generalized response
3 localized response
4 confused agitated
5 confused inappropriate
6 confused appropriate
7 automatic appropriate
8-10 purposeful appropriate
32
4 parts of orientation
person
place
time
situation
A&O x4
33
where is attention controlled from?
nondominant hemisphere
34
how do you test attention?
spell a word backwards
count back by 7's
sustained: groups of numbers, listen for specific letter
divided: do two things at once
MMSE
MoCA
35
what is explicit memory?
declarative
remembering specific fact
36
what is implicit memory?
procedural
remembering phone number or how to do something without thinking about it
37
what to pay attention to in outpt settings?
ask about changes
look at meds
are they consistent
do they have difficulty describing a problem
do they avoid filling out forms
38
what to pay attention to in inpt settings?
medical conditions
history of loss of consciousness
change in attention during the stay
bradyphrenia
39
what are the two depression measures?
geriatric depression scale
beck depression inventory
40
what is the rationale for cognition screening?
provide feedback on performance
influence treatment
determine time needed
determine prognosis and POC
41
what are fluent aphasias?
wernicke - loss of auditory comprehension
anomic - word finding difficulty
pure word deafness - difficulty comprehending
42
what are non-fluent aphasias?
broca - difficulty producing speech
global - loss of production & comprehension
transcortical motor - difficulty naming and repeating words
43
either fluent or non-fluent aphasia
conduction - difficulty naming and repeating words
44
what are some strategies for communication?
slow speech
pauses
avoid dual tasks
short message
speak face to face
direct wording
increase saliency
increase redundancy
narrow down context
45
how do you observe CN 2 and 3?
asymmetric pupils
46
how do you observe CN 3?
ptosis
47
how do you observe CN 3, 4, 6?
abnormal eye position
48
how do you observe CN 7?
drooping or asymmetry of facial muscles
49
how do you observe CN 5, 7, 9, 10, 12?
jaw position, muscle wasting, difficulty articulating words
50
how do you observe CN 11?
muscle wasting
51
which CN have parasympathetic function?
3, 7, 9, 10
52
how do you test CN 1?
close eyes, close on nostril and smell coffee or cloves
normal: ids
abnormal: lack of ability to smell
53
describe optic nerve lesion
whole eye gone
54
describe optic chiasm lesion
(bitemporal hemianopsia)
both temporal fields gone
55
describe optic tract lesion
(homonymous hemianopsia)
if left tract, left nasal and right temporal gone
56
describe geniculocalcarine tract lesion
HH with macular sparing
57
how to test CN 2?
acuity: vision chart
visual field: move finger from peripheral to center of visual field
normal: sees finger
abnormal: cannot see finger
consensual reflex: shine light, observe other pupil
pupilary reflex: shine light, observe pupil
58
what are the disorders of CN 3?
ptosis
diplopia
loss of light and accommodation reflexes
59
how to test CN 3?
observe the pt's eyes with pt looking forward
norm: both eyes look in same direction, no nystagmus
abnorm: ipsi eye looks outward, double vision
smooth pursuit: pt's eyes follow finger moving up, down and in
norm: symm and smooth mvmts
abnorm: deficits in add, depression or elevation of eye
pupillary reflex
consensual reflex
observe pupillary response to near and far objects
norm: near = constriction, far = dilation
abnorm: pupil unchanged
convergence: pt looks at tip of pen as it is moved from 2ft to nose
norm: both eyes directed to pen until within 6-10 mm of nose
abnorm: only one eye moved to midline
60
disorders of CN 4
double vision
difficulty reading
visual problems with descending stairs
61
how do you test CN 4?
observation: eye and head position
abnorm: head tilt to opp side with chin tucked
pt's eye follows finger about 50 deg in add then down
norm: in then down
abnorm: deficit in infero-medially, double vision, difficulty reading, descending stairs
62
what is trigeminal neuralgia?
sharp, intense, stabbing pain in the cheek or jaw that may feel like an electric shock
63
how to test CN 5?
with eyes closed, use light touch and pin to assess forehead, cheek and chin
norm: id sharp/dull and localization
abnorm: anesthesia in affected area
pt sitting with jaw relaxed and open, tap downward on chin and reflex hammer
norm: masseter contracts, elevating chin and closes
abnorm: lost or decr reflex
corneal reflex: touch outer cornea with wisp of cotton
norm: eye blinks
abnorm: eye does not close
MMT of jaw opening and closing
norm: jaw opens strongly and sym, palpate muscles while pt clenches and relaxes
abnorm: unilateral damage, jaw deviates to weak side
64
disorders of abducens
eye looks inward
double vision
abductor paralysis of ipsi eye
65
how to test CN 6?
observe eye with pt looking forward
norm: both in same direction
abnorm: one inward
follow finger to look laterally
norm: eye moves laterally
abnorm: deficit of abd
66
disorders of facial
paralysis or paresis of ipsi facial muscles
loss of lacrimation
decr salivation
67
how to test CN 7?
facial mvmts of smile, puff cheeks, close eyes, wrinkle forehead
norm: able to perform
abnorm: paralysis or paresis with upper and lower face equally involved
68
disorders of vestibulocochlear
unilateral deafness
tinnitus
vertigo
disequilibrium
nystagmus
gaze instability with head rotations
69
what is conductive deafness?
transmission vibrations are prevented in outer or middle ear
could be from wax in outer ear or inflam in inner ear
70
what is sensorineural deafness?
due to damage of receptor cells or cochlear nerve
less common
71
what is tinnitis?
sensation of ringing, hissing, or buzzing sounds
72
how to test CN 8?
rubs fingers near pt's ear
norm: hears
abnorm: difference in ability to hear
rinne: tuning fork on mastoid
norm: cannot hear through bone
abnorm: sound heard through bone is equal or longer than air
weber: tuning fork on top of head, where is sound coming from
norm: midline
abnorm: louder in one ear
73
disorders of glossopharyngeal
decr gag or swallowing reflex
decr salivation
dysphagia
dry mouth
loss of taste
74
how to test CN 9?
gag: touch soft palate with cotton swab
norm: gagging
abnorm: lack of gag reflex
pt opens mouth and says ah
norm: elevation of soft palate
abnorm: asym elevation, hoarseness
palpate for normal swallowing response
75
disorders of vagus
difficulty speaking and swallowing
poor digestion
decr peristalsis
asym elevation of palate
hoarseness
cardiac dysrhythmia
respiratory disturbances
76
how to test CN 10?
pt opens mouth and says ah
norm: elevation of soft palate
abnorm: asym elevation, hoarseness
palpate for normal swallowing
77
disorders of accessory
paralysis of ipsi SCM and trap
78
how to test CN 11?
MMT of SCM and upper trap
79
disorders of hypoglossal
atrpohy of ipsi tongue
deviation to ipsi side of protrusion
dysphagia
difficulty with sounds
80
how to test CN 12?
protrude tongue
norm: midline
abnorm: deviated to side of lesion
push tongue into cheek, push against outside of cheek
norm: able to resist
abnorm: tongue easily moves against force
81
UMN vs LMN lesions (signs)
UMN:
hemiplegia/hemiparesis
spastic hypertonia
hyperreflexia
clonus
babinski
LMN:
paralysis/paresis
reduced tone/flaccidity
atrophy, reduced muscle bulk
hyporeflexia
fasciculations
82
how to measure muscle bulk?
visually inspect
measure circumference (BILATERALLY)
83
MMT essential for (UMN OR LMN).
LMN
in an UMN injury, MMT will not be valid if isolated mvmt cannot be performed.
84
myotomes
C1-2 - neck flexion
C3 - neck lat flex
C4 - scap elevation
C5 - GH abd
C6 - elbow flex
C7 - elbow ext
C8 - thumb abd
T1 - 5th abd
L1-2 - hip flex
L3 - knee ext
L4 - ankle DF
L5 - great toe ext
L5-S1 - PF
S1-S2 - PF and eversion
85
how to test neuro myos?
test in supine
small differences to msk myos
C5 - elbow flex
C6 - wrist ext
C8 - finger flexors
86
define the following: flaccid, hypotonia, spastic hypertonia, rigid hypertonia.
flaccid - complete absence of resistance
hypotonia - decr resis
spastic - incr resis, vel dep
rigid - incr resis, no incr with speed, both sides of joint
87
what are cog wheel and lead pipe rigidity?
cog: choppy, rachet strap like
lead: constant resistance throughout ROM
88
what postures indicate hypertonia?
antigravity positions
89
asymmetrical tonic neck reflex posture
ext of arm and leg on face side
flexion of arm and leg on skull side
promoted hand eye coordination
90
symmetrical tonic neck reflex posture
with head flexed: arms flex and legs extend
with head ext: arms extend and legs bend
what top does, bottom does opposite
91
arm dropping test
if they have good tone, arm will not drop as quickly
92
pendulum test
drop the leg and count how many swings
93
pronator drift test
15-30 sec of holding UE in supination with 90 deg of shoulder flexion and elbow ext
if incr in spasticity, involved hand will drop or pronate
94
how to test muscle tone?
one slow PROM
then quick PROM to test for spas
95
modified ashworth scale
supine
before any other passive mvmt
0 - no incr
1 - slight incr, catch and release at end ROM
1+ - slight incr, catch and resistance though less than half of ROM
2 - incr through most ROM
3 - considerable incr, PROM difficult
4 - rigid
96
reflexes
biceps - C5
brachioradialis - C6
Triceps - C7
Patella - L4
Achilles - S1
97
sensory exam considerations
has your feeling changed?
does one side feel different than the other?
visually demonstrate before starting test.
define stimulus.
close eyes.
randomize sequence.
perform bilaterally.
98
terms for documenting sensation
absent - completely lost in region
impaired - decr in intensity, only sensed 2/5 times
anesthesia - all sensory is lost
99
allodynia
pain from non noxious stim
100
analgesia
complete loss of pain sensitivity
101
causalgia
painful, burning sensations along nerve distribution
102
dysesthesia
touch sensation experienced as pain
103
hypalgesia
decr sensitivity to pain
104
hyperalgesia
incr sen to pain
105
hypoesthesia
decr sen to sensory stim
106
paresthesia
abnormal sensation: numbness, prickling, tingling, without apparent cause
107
sensory tests:
touch awareness
tactile localization
sharp/dull
temp: 40 deg C and 10 deg C for water
tactile threshold: filaments
joint mvmt
joint position
vibration: tuning fork
two point discrimination
bilateral simultaneous touch
graphesthesia
sterognosis
108
tactile threshold spots for DM
big toe
TMTJ of 1st
TMTJ of 3rd
TMTJ of 5th
109
sensory assessment
normal/intact: 5/5
impaired: 3-4/5
absent: 0-2/5
110
define coordination.
ability to execute smooth, accurate, controlled mvmts
111
what is intralimb coordination?
mvmts within a single limb
112
what is interlimb coordination?
2 or more limbs working together
113
what is visual motion coordination?
integrate visual and motor abilities with the environment.
ex. eye-hand-head coordination
114
what are the 3 primary structures that can impact coordination?
basal ganglia
DCML
cerebellum
115
what are the characteristic motor deficits for basal ganglia?
impaired coordination
bradykinesia
involuntary tremors of trunk, head, limbs
rigidity
116
what are the characteristic motor deficits for DCML?
lack of joint position sense
lack of awareness of joint mvmt
impaired localized touch sensation
117
which coordination structure is impaired when sensory ataxia or dymetria is a symptom?
DCML
118
why is the cerebellum called the great comparator?
compares intended mvmt and actual mvmt
119
what are some causes of cerebellar ataxia?
inherited
autoimmune - MS
tumors or strokes
normal pressure hydrocephalus
infections
toxicity
120
what is the purpose of coordination examination?
assess for safety
determine efficiency, control, timing and accuracy of mvmt
assess for appropriate synergy
assists in establishing diag, limitations, restrictions
assists with goal setting/expected outcomes
supports decision making in prognosis
121
what are the 5 steps to a coordination exam?
observation
mental status
balance and gait
limb coordination
outcome measures
122
static vs kinetic tumor
s: resting/postural tumor at rest
k: an intention tremor of extremities with voluntary mvmt
123
what are some balance deficits associated with cerebellar involvement?
incr postural sway during quiet stance
abnormal oscillations of trunk
wide BOS
difficulty scaling size of of postural responses during perturbations and anticipatory mvmts
124
what are some gait deficits associated with cerebellar involvement?
wider BOS
unsteady, clumsy, veering path
impaired multi-joint coordination
irregular, erratic foot placement
step length varies unpredictability
high guard position of UE's
difficulty stopping gait
difficulty changing force, speed or direction
125
what happens in both cerebellar and sensory ataxia?
unsteady gait
poor coordination
dysmetria
126
what are some examples of UE coordination tests?
finger to nose
finger to therapist's finger
alternate nose to finger
finger opposition
pronation/supination
rebound test (antag should check mvmt)
127
what are some examples of LE coordination tests?
tapping the balls of foot
alternate heel to knee, heel to toe
heel to shin - slide heel up shin
toe to examiner's finger
128
what should occur during coordination testing?
5 reps
choose a couple
observe mvmts
can repeat with eyes closed
can time for comparision
129
what are the 3 power grips?
cylindrical
hook
spherical
130
what are the 5 precision grips?
tip to tip pinch
pad to pad pinch
3 jaw chuck - includes middle finger
lateral key pinch
pen/pencil tripod grasp
131
what is the palmar grasp reflex?
emerges at 11 weeks and becomes integrated at 6 months
put finger in baby's hand, they will grasp it
132
name the 3 arches in the hand.
distal palmar
proximal palmar
longitudinal
133
what is the general process of reaching and grasping?
visual regard
reaching
grasping
manipulation
releasing
134
use dance to explain the key players in motor control.
pre and supp motor: choreos
basal gang: dancer perfecting a routine
cerebellum: coach providing feedback
primary motor cortex: dancer's muscles
135
neurosignature vs neurotags
sig: how brains are wired
tags: networks
136
how can we remap after an injury?
just use it.
needs some sort of input
ACTIVE engagement
137
active research arm test
many UE tasks
138
nine hole peg board
for grasp and release, fine motor manip
pick up, place, remove the 9 pegs
139
box and blocks
grasp and release, manip
as many of the 150 as possible in one min
140
functional dexterity test
3 jaw chuck testing
stay in pronation
move the fingers
141
purdue peg board
gross and fine motor mvmts
pins, collars, washers
pins in holes, collars and washers over pins
142
minnesota rate of manipulation test
speed of gross arm and hand mvmts
placing and turning
143
jebson test of hand function
7 subtests
writing
turning over 3x5 inch cards
picking up small common objects
simulated feeding
stacking checkers
picking up large objects
picking up large heavy objects
144
what is bimanual training?
using both UE simultaneously
encourages interlimb coordination
