Flashcards in Neuro Review - Zach Deck (83):
Where is Brocas area located and what is it responsible for?
Frontal lobe, expressive speech and concentration
Where is Wernickes area located and what is it responsible for?
Temporal lobe, understanding and producing meaning speech, verbal and general memory, and understanding language
What is the main function of the hippocampus?
Forming and storing new memories of one's person history and declarative memory. Possesses great importance in learning language.
What is the main function of the Basal Ganglia? What does the basal ganglia consist of?
Function: Voluntary movement, regulation of autonomic movement, posture, muscle tone, and control of motor responses.
Components: caudate, putamen, globus pallidus, substantia nigra, subthalamic nuclei
What is the main function of the amygdala?
Emotional and social processing - fear and pleasure responses, arousal, processing of memory, and formation of emotional memories
What is the main function of the Thalamus?
Relay or processing station for the majority of info that goes to the cerebral cortex
What is the main function of the Hypothalamus?
Receives and integrates information from the autonomic nervous system and assists in regulating hormones. Regulates body temperature, hunger, thirst and sexual behavior.
Main function of the subthalamus?
Regulating movements produced by skeletal muscles - associated with the basal ganglia and the substantia nigra
Main function of the epithalamus?
Represented by the pineal gland - secretes melatonin and is involved in circadian rhythms, internal clock, selected regulation of motor pathways, and emotions
Main function of the midbrain?
Serves largely as a relay area for information passing from the cerebrum, cerebellum, and spinal cord. Also reflex center for visual, auditory, and tactile responses
Main function of the cerebellum?
Fine tuning of movement and assists with maintaining posture and balance by controlling muscle tone and positioning of the extremities in space. Controls the ability to perform rapid alternating movements.
Main function of the Pons?
Assists with regulation of respiration rate and is associated with orientation of head in relation to visual and auditory stimuli.
Main function of the medulla oblongata?
Influences autonomic activity and the regulation of respiration and heart rate. Contains reflex centers for vomiting, coughing, and sneezing. Relays somatic sensory info from the internal organs and for the control of arousal and sleep.
What are the ascending tracts of the spinal cord?
Spinocerebellar tract (dorsal/ventral)
Spinothalamic tract (Anterior/lateral)
What are the descending tracts of the spinal cord?
Corciospinal tract (anterior/lateral)
What are the superficial sensations?
temperature, light tough, pain
What are the deep sensations?
proprioception, kinesthesia, vibration
What are the cortical sensations?
bilateral simultaneous stimulation, stereognosis, two point discrimination, barognosis, localization of touch
What is the mildest for of acute nerve injury?
What is the most severe grade of acute nerve injury?
Neurotmesis - irreversible injury, transection of the nerve trunk
What type of acute nerve injury is reversible and can regenerate at 1mm/day distal to the sight of the lesion?
What are some examples of UMN disease?
CP, hydrocephalus, ALS, CVA, Birth injuries, MS, huntington's, TBI, pseudobulbar palsy, brain tremors
What are some general symptoms of UMN disease?
Weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, abnormal reflexes
What are some general symptoms of LMN disease?
Flaccidity or weakness of the involved muscles, decreased tone, fasciculations, muscle atrophy, decreased or absent reflexes
What are some examples of LMN disease?
Poliomyelitis, ALS, GBS, tumors involving the spinal cord, trauma, progressive muscular atrophy, infection, bells palsy, CTS, muscular dystrophy, spinal muscular atrophy
What disease are resting tremors typically seen in?
What diseases are postural tremors typically seen in?
hyperthyroidism, fatigue or anxiety, benign essential tremor
What diseases are intention (kinetic tremors) typically seen?
MS - typically indicate a lesion in the cerebellum or its efferent pathways
Describe the movements associated with Tics
sudden, brief, repetitive coordinated movements that usually occur at regular intervals
Describe movements associated with Chorea
brief, irregular contractions, that are rapid but not to the degree of myoclonic jerks - typically secondary to damage to the caudate nucleus
Describe the movements associated with dystonia
Sustained muscle contractions that frequently cause twisting, abnormal postures, and repetitive movements. i.e. PD, CP, Encephalitis
Describe the movements associated with Athetosis
slow, twisting, writhing movements that are large in amplitude - commonly found in CP and secondary to basal ganglia pathology
What is myasthenia gravis?
Characterized by weakness and rapid fatigue of any muscles under voluntary control. Typically seen in women younger than 40 and men older than 60. Autoimmune disease that blocks the uptake of Acetylcholine and prevents muscle contraction.
What is hemibalism?
involuntary and violent movement of a large body part
What are the grades of the modified ashworth scale?
0 - no increase in tone
1 - slight increase in tone, catch and release at the end of ROM
1+ - slight increase in tone, catch w/ min resistance throughout remainder of motion
2 - Marked increase in tone
3 - considerable increase in tone
4 - Rigid
Describe the VOR
Allows for head/eye movement coordination Supports gaze stabilization through eye movement that counters movement of the head. Maintains stable image on retina during movement
Describe the VSR
Attempts to stabilize the body and control movement by assisting with stability while the head is moving and coordinates trunk during upright postures
What is conduction aphasia?
lesion to the supramarginal gyrus/arcuatefasciulus that results in impairment with repetition, good reading ability but impaired writing ability
What is global aphasia?
Lesion to the frontal, temporal, parietal lobes that presents with severe comprehension impairments, impaired naming, writing, and repetition skills, may verbalize inappropriately and involuntarily. Non-verbal skills for communication
What is verbal apraxia?
Cannot articulate speech due to deficits in motor planning although the patient may understand how to complete the task. Lesions usually found in the left frontal lobe adjacent to brocas area.
What is dysarthria?
UMN that affects the muscles used to articulate words, speech often noted as slurred.
What are some examples what causes acquired ataxias?
Alcoholism, hypothyroidism, vitamin E deficiency. Various toxins may create acquired ataxias including carbon monoxide, heavy metals, and lithium.
What conditions are associated with epilepsy?
genetic influence, head trauma, dementia, CVA, CP, down syndrome, and autism.
What is the progression of Guillain Barre Syndrome?
Distal to proximal weakness
Is Guillain barre syndrome life threatening?
Yes - w/ respiratory involvement can paralyze respiratory muscles
How is Huntington's Disease/chorea characterized?
Disorder of the CNS - with degeneration of the basal ganglia and the cerebral cortex. Movement is unable to modulated due to deficiency of neurotransmitters. It is an autosomal dominant trait.
What are the goals of Physical Therapy in the treatment of Huntington's disease?
maximize endurance, strength, balance, postural control and functional mobility
What are the cardinal signs of Myasthenia Gravis?
extreme fatigueability and skeletal muscle weakness, Ocular muscles usually affected first and half of patient experience ptosis and diplopia
Are proximal or distal muscle affected more in Myasthenia gravis?
What is a stroke in evolution?
A CVA, usually caused by a thrombus, that gradually progresses. Total neurologic deficits are not seen until 1-2 days after onset.
What is the emphasis w/ alternating isometrics?
endurance or strengthening
What is the main goal of contract/relax?
What is the goal of hold-relax and what patient's is it often used with?
ROM, patients with pain
What type of patients is hold relax w/ active movement used for?
Use to improve initiation of movement to muscle groups tested at 1/5 or less
What are repeated contractions used for?
To initiate movement and sustain a contraction through the ROM.
What is resisted progression used for?
To emphasize coordination of proximal components during gait. Resistance is used to enhance coordination strength or endurance.
What is rhythmic initiation used for?
Used to assist in initiating movement when hypertonia exists. Helps reduce hypertonia and allow for full ROM w/ slow movement.
What is rhythmical rotation?
A passive technique used to decrease hypertonia by slowly rotating an extremity around the longitudinal axis.
What is rhythmic stabilization?
Used to increase ROM and coordinate isometric contractions.
What is slow reversal used for?
used to improve control of movement and posture through slow resisted concentric contractions of agonists and antagonists.
What is Roods theory based on?
All motor output was the result of both past and present sensory input - treatment is based on sensorimotor learning. Sensory system is stimulated through facilitation or inhibition.
What is decerebrate rigidity?
Extension of the trunk and all extremities due to a corticospinal lesion at the level of the brainsem
What is decorticate rigidity?
Corticospinal lesion a the level of the diencephalon in which the trunk and lower extremities are positioned in extension and the upper extremities are positioned in flexion
Key characteristics of anterior cord syndrome?
incomplete lesion resulting from compression to the anterior portion of the spinal cord or anterior spinal artery. Loss of motor function and pain and temp below the lesion due to damage to the corticospinal and spinothalamic tracts
Key characteristics of brown-sequard syndrome?
Usually caused by a stab wound which produces a hemi-section of the spinal cord. Paralysis and loss of vibratory and position sense on the same side as the lesion due to damage to the corticospinal and dorsal colums. Loss of pain and temp on the opposite side of the lesion from damage to the lateral spinothalamic tract.
Key characteristics of cauda equina injuries
Below lvl of L1, flaccidity, areflexia, and impairment of bowel and bladder. Full recovery not typical. Saddle parasthesia.
Key characterstics central cord syndrome
compression and damage to the central portion of the spinal cord. UE>LE affected w/ greater motor deficits as compared to sensory deficits
Key characteristics posterior cord syndrome
compression of the posterior spinal artery w/ loss of proprioception, two point discrimination, stereognosis. Motor function preserved.
What are the levels of the ASIA impairment scale for spinal injury?
A - complete: no sensory or motor function at S4-S5
B - Sensory incomplete: sensory but not motor function is preserved below the neurologic level and extends through S4-S5
C - Motor Incomplete: motor function is preserved below the neurologic level, and most key muscles below the lvl have muscle grade = 3
E - Normal
How is motor level determined in SCI?
most caudal key muscles that have muscle strength >=3 w/ superior segment tested at 5
How is sensory level determined in SCI?
most caudal dermatome with a normal score of 2/2 for pinprick and light touch
When can Autonomic dysreflexia occur?
In patients w/ lesions at above the level of T6
What is contraindicated w/ autonomic dysreflexia?
lying a patient supine - will further elevate blood pressure
What is ectopic bone?
spontaneous formation of bone in the soft tissue
What blood pressure change is indicative of orthostatic hypotension?
decrease in sytolic BP of 20mmHg or greater
How often should a patient w/ SCI weight shift and change position?
Weight shift - at least every 15-20 mins
Change position in bed - every 2 hours
Can a patient w/ SCI at the levels of C1-C5 (high tetraplegia) use a wheel chair?
C5 - mod I on smooth surface going forward, MaxA in all other situations
C1-C5 - Power wheelchair possible
What are the 8 Levels of Ranchos Los Amigos Levels of Cognitive Functioning for TBI?
I - No Response; unresponsive to stimuli
II - Generalized Response - non purposeful reaction
III - Localized Response - Specific but inconsistent response
IV - Confused-agitated - heightened state of activity
V - Confused inappropriate - responds to simple commands, highly distractible, severe impairments in memory
VI - Confused appropriate - goal directed behavior, dependent on external input or direction
VII - Automatic appropriate - goes through daily routine automatically but frequently robot like, impaired judgment
VIII - purposeful appropriate - able to recall and integrate past and recent events and is responsive to environment. Carryover for new learning
What are the general ratings on the glasgow coma scale?
What is the galant reflex and when is it integrated?
- A touch to the skin along the spine from shoulder to hip creates lateral flexion of the trunk to the side of the stimulus
- Integrated at 30 weeks gestation to 2 month
What is the moro reflex?
head dropping into extension suddenly for a few inches causes arms to abduct with fingers open then cross trunk to adduction and cry
Integrate - 28 weeks of gestation to 5 months
What is the positive support reflex?
Weight placed on balls of the feet when upright causes stiffening of legs and trunk into extension