Neuroanatomy Flashcards
(93 cards)
1
Q
Lateral spinothalamic :
- function
- receptor type
- nerve fibre type
- path:
- lesion results
A
- tests pain, hot/cold
- receptors are Free Nerve Ending
- sharp pain = A delta fibers
- Dull pain = C fibers
Ascends in lateral white column & crosses within 1-2 segments then finishes in parietal lobe
Half cord lesion:
- ipsilateral loss at that level, contra loss below
2
Q
Anterior spinothalamic
- function
- receptor type
- fibre type
- path
- half cord lesion results
A
- crude touch + pressure
- Ruffini corpuscles, Merckle discs, free nerve endings
- A delta + A beta fibers
Ascends in anterior white column, crosses 1-2 segments , ends in parietal lobe
Half cord lesion :
- ipsilateral loss at level, contralateral loss below lesion level
3
Q
Dorsal column medial lemniscus
- Function
- receptor type
- fibre type + path
- lesion above or below medulla results
A
- 2 point discrimination, fine touch, vibration, sterognosis
- Pacinian corpuscles (vib), Merckel’s discs, Meistersinger (fine touch),
- A beta fibers that cross in the brain stem and finish in parietal lobe
Lesion:
- below medulla: ipsilateral loss
- above medulla; contralateral loss
Lesion:
4
Q
List of the Ascending and descending tracts
A
Ascending:
1) lateral spinothalamic
2) anterior spinothalamic
3) dorsal columns (medial lemniscus)
Descending:
1) lateral corticospinal
2) Anterior Conrticospinal
5
Q
Lateral Corticospinal tract:
A
Primary motor tract
- 90 % cross in pyramids (medulla of brainstem)
- synapses in Anterior Horn in grey matter of SC, leaves as alpha motor neutron to the neuromuscular junction
Lesion:
- above medulla where they cross: loss of voluntary mvmt contralateral to lesion
6
Q
Anterior Corticospinal tract
A
Primary motor
- 10% that cross at level of innervation
Lesion Of one side:
- loss of 10% voluntary movement contralateral to lesion
7
Q
List of Cerebellar arteries:
A
1) Internal Carotid
2) Anterior Cerebral
3) Middle Cerebral
4) Posterior Cerebral
5) Vertebral
6) Superior cerebellar
7) Anterior-Inferior Cerebellar
8) Posterior- Inferior Cerebellar
8
Q
Internal Carotid Artery
- fxn
- deficits
A
Fxn: supplies Ant, Mid, Post Cerebral arteries
Deficits:
- contralateral hemiplagia/ sensory disturbances
- global aphasia
- mentally slow
- gaze palsy
- partial Horner’s syndrome
9
Q
ACA - deficits
A
Deficits:
- weakness + sensory loss of contralateral limbs
- initiation of speech via Broca’s area
- Motivation + emotional problems (frontal lobe)
- potential L side neglect if R was affected
10
Q
MCA deficits
A
Deficits:
- Contralateral hemiplegia, hemisensory loss, hemianopia
- Contralateral Neglect
- Aphasia
- Apraxia (motor planning disturbance)
- speech dysfunction (broca’s area)
- impaired hearing
11
Q
PCA
- fxn
- deficits
A
- supplies occipital lobes
Deficits:
- vision problems, CN III palsy,
- Contralateral hemiplegia
- Chorea (abnormal volt movements [dancing])
- Hemiballism (involuntary flinging of extremities)
- difficulty with naming and colors
- hemisensory impairment
12
Q
Vertebral artery
- fxn
- important branches
A
- two join to form Basilar Artery
Branches: important for strokes
- PICA (largest), AICA, PCA (posterior cerebral)
13
Q
Superior cerebellar artery
- fxn
- deficits
A
Supplies:
- Anterior lobe, Vermis, superior 1/3 of posterior lobe
"Anterior love disease": Deficits: - Proprioception - Ataxia - Horner's syndrome: droopy eyelids, red face - Contralateral sensory loss
14
Q
Anterior-Inferior Cerebellar Artery (AICA)
- fxn
- Deficits
A
Supplies: Cerebral Peduncles, Flocculus, deep cerebellar nuclei
Deficits:
Gait difficulties, trunk imbalance, abnormal head posture, occulomotor dysfunction.
- ipsilateral limb ataxia
- ipsilateral Horner’s
- facial weakness
- paralysis of lateral gaze
- Contralateral sensory loss of limbs and trunk
15
Q
Posterior-Inferior Cerebellar Artery
- fxn
- deficits
A
Supplies: Inferior 2/3 of posterior lobe, tonsils, vermis/ nodules
Deficits:
- Dysarthria (poor verbal articulation [motor issue])
- dysmetria
- Ipsilateral limb ataxia
- Vertigo
- Nystagmus
- Ipsilateral Horner’s
- sensory loss of Pain and temp of face
- pharyngeal/ laryngeal paralysis
- Contralateral Pain temp loss of trunk
- paralysis of vertical eye movements and reduced pupil reflex
16
Q
Broca’s Aphasia
- location
- impairment
A
“Expressive Aphasia”
- left frontal lobe
Impairment:
- dysarthria (verbal articulation), but can understand speech fine
17
Q
Wernicke’s Aphasia
- location
- impairment
- types
A
” Receptive Aphasia”
- Left Temporal lobe
Impairment:
- speaks normal but words don’t make sense (word salad)
Types:
- somatosensory: located in both parietal lobes
- visual: located in both occipital lobes
- auditory: temporal lobes
- olfactory: temporal lobes
18
Q
Left CVA impairments
A
Decreased:
- R-side muscles affected.
…..more…
19
Q
Right CVA
A
Decreased:
- spatial pattern awareness
- recognition of faces
- emotional content of language (monotone)
- discrimination of smells
- HEMI-NEGLECT of the LEFT
- musical and artistic awareness
20
Q
List of Cranial Nerves:
A
1) Olfactory
2) Optic
3) Occulomotor
4) Trochlear
5) Trigeminal
6) Abducens
7) Facial
8) Vestibular
9) Glossopharyngeal
10) Vagus
11) Accessory
12) Hypoglossal
Mnemonic:
Oh, oh, oh, to touch and feel very good velvet and Hypoglossal
21
Q
CN I:
- fxn
- deficits
A
Olfactory
Damage:
- via frontal lobe lesion
- anosomia (loss of smell)
22
Q
CN II:
- fxn
- damage
A
Optic - vision
Damage:
- Hemianopsia: visual field loss of the same side of both eyes
- myriad of issues…
23
Q
CN III
A
Occulomotor - pupillary reflex
- MM: medial Rectus, superior & inferior Rectus, and inferior oblique
Damage:
- absence of pupillary constriction reflex
- difficulties with accommodation
- Horner’s syndrome (drooping eye lid [ptosis])
- decreased sweating of the face
- redness/ conjunctiva of eyes
24
Q
CN IV
A
Trochlear
- MM: superior oblique
Fxn: - turns adducted eyes downward
25
CN V
Trigeminal:
V1) Opthalamic: sensory of scalp and forehead
V2) Maxillary: Sensory for cheeks, upper lip
V3) Mandibular: Sensory for lower face + muscles of mastication
26
CN VI
Abducens:
| - Turns eyes out via Lateral Rectus mm
27
CN VII:
- fxn
- damage
Facial nerve:
- parasympathetic control of lacrimal, submandibular, sublingual gland,
- Taste to anterior 2/3 of tongue
- Facial motor mm
- sensation behind ear
Damage:
- inability to close eye, droopy corner of mouth, difficulty speaking
UMN lesion: Contralateral lower Half of face lost
LMN lesion: ipsilateral total paralysis the side of face
28
CN VIII
Vestibular:
fxn: balance, gaze stability, auditory
Damage:
- vertigo, nystagmus, deafness
29
CN IX:
- Fxn
- deficits
```
Glossopharyngeal:
- Swallowing mm ( stylo-pharyngeal mm)
- Taste of posterior 1/3 of tongue
- phonation
- sensory to uvula (gag sensation??)
- receives carotid bodies info (chemo/baroreceptors)
Damage:
- horse or nasal voice
- Swallowing difficulties
```
30
CN X:
| - fxn/ deficits
Vagus:
- muscle to Larynx, Pharynx
- parasympathetic to all but adrenal gland (HR, peristalsis, sweating)
- gag reflex (uvula??)
- motor to uvula deviation to one side = LMN lesion of opposite side
- elevates soft palate
31
CN XI
- fxn
- tract
- lesions
Accessory:
- innervated Traps and SCM
Tract: Corticobulbar, exit through jugular foramen
Damage:
- UMN Lesion: weak trap contralateral + weak SCM ipsilaterally
- LMN Lesion: weak trap and SCM ipsilaterally
- inability to shrug ipsilaterally or turn head to opposite side
32
CN XII:
- fxn
- fibre tract
- deficits:
Hypoglossal: tongue movements
- Corticobulbar tract
Damage:
- UMN Lesion: tongue away (crossed)
- LMN lesion: tongue towards lesion
- dysarthria
33
Neuro- impairment level outcome measures
1) Motor control/ strength: MMT or Fugl-Meyer
2) Cognition and perception: mini-mental state exam or MOCA
3) Tone and Spasticity: Modified ashworth (tardieu for peads)
4) Sensation: body diagram, Nottingham sensory assessment
34
Neuro Rehab goals
1) maintain: participation, activity, body structure and function
2) Prevent: complications
3) Reversal of impairments: as appropriate, neuro plasticity
4) adaptation to impairments: aids, compensatory movements
35
Neuro Activity level outcome measures
1) Gait: 6MWT, 10 m walk, DGI, observational analysis
2) Balance: BERG, Fullerton, community balance and mobility scale, BESTest measure, functional reach
3) Upper extremity: DASH,
4) other: Barthel index, Chedoke stroke ax, COVS, Functional independence measure (fim), motor assessment scale, patient specific functional scale, ABC, stroke impact scale,
36
Discuss neuroplasticity
Use it or lose it, use it and improve it, specificity, repetition, intensity, time matters, salience, age matters, transference, interference, no drug alone will improve neuroplasticity, interventio needs to be paired with behaviour: task specific, goal oriented practice, dose? 6 hrs/day
37
List of basic sensation tests
1) Visual field testing
2) Papillary light reflex
3) Accomodation
4) Ptosis
5) eye movements
6) Smooth pursuits
7) Saccades
8) Nystagmus
38
Visual field testing
- test quadrants with other eye closed, patient looking at you: superior (60deg), inferior (75deg), lateral (100deg), medial (60deg)
39
Papillary light Reflex
In on 2 and out on 3, should see constriction of both pupils, direct and indirect reflex, test both eyes
40
Accomodation reflex
Bring finger slowly towards PT's nose and look for Convergence and papillary constriction.
- tests: optic, oculomotor, trochlear, and abducens nerve
41
Ptosis test
Look for drooping eye lids --> oculomotor, ask patient to gaze upwards without moving their head
42
Eye movement test
tests oculomotor, trochlear, and abducens
- ax superior and inferior oblique close to medial aspect of the eye, and superior and inferior Rectus at midline
43
Smooth pursuit test
Range of 30 degrees side to side and up and down --> look for nystagmus
44
Saccades tests
Have finger 15 degrees to one side of nose, have put look rapidly from nose to finger. Do up and down, and side to side. Looking for overshooting
45
Nystagmus test
Record direction, ax through eye movments, smooth pursuit is normally elicited in extreme ranges of eye movement
46
Vision impairment Rx?
- envriomental modifications, scan the environment, balance exercises to improve other systems, refer to CNIB
47
List of somatosensation tests
1) Light touch (DCML)
2) sharp dull (lateral thalamic)
3) thermal (lateral thalamic)
4) vibratory sense (DCML)
5) joint position (DCML)
6) two point discrimination (DCML)
7) Stereogenesis
8) Graphethesia
9) Double stimulation (perception)
48
Somatosensation Rx:
- limb protection & skin care
- maximize available Somatosensation
- adaptive equipment
49
Vestibular Rx:
- Walking program
- exercises (habituation, accommodation, adaptation)
- balance
- falls prevention
- adaptive aids
50
What are the contraindications for stretching?*
- bony block, recent #, acute inflammation of the joint, sharp or acute joint pain, hematoma or tissue trauma,
- contracture is providing stability or function (tenodesis grip)
51
ROM details to remember
- Do not use pulleys for ROM above 90 degrees
- cautious of plantar response
- bent knee to check for soleus
- do 3 reps then give Rx: 10-20 reps, 1-2 X /day
- caution for shoulder ax above 90
52
When would PNF exercises be used?
- increase ROM & strength in multi-joint/muscle involvement
- Assess abnormal movement patterns
53
What are PNF D1 & D2 patterns?
D1:
- shoulder ER --> IR (feeding/ upper cut)
- Hip IR --> ER (cross leg/ kick ball)
D2:
- Shoulder ER--> IR (pick an apple/put in bag)
- hip IR --> ER (fire hydrant )
54
PNF pattern precautions?
- avoid quick stretch on hypertonic muscles, gentle stretch and care on hypotonic muscles, care to not promote invariant movement patterns.
- not used for resistance exercises
55
What is the flexor and extensor synergy position?
UE: flexion of elbow, ER & abd of shoulder, flexion of wrist
LE: hip flex, knee flex, and inversion of foot
Extn:
- UE: shoulder add/IR, elbow extn & probate, wrist extends
- LE: hip extn/IR, knee extends, ankle PF and inversion
56
Define muscle tone/ what factors influence it?
- resistance force in response to lengthening (stiffness)
- flaccidity --> ridigity
- neural or non neural
57
Describe the two types of influences effecting muscle tone
Non-neural:
- muscle length, thixotrophy (extra CT between mm), CT and mm fiber changes, immobilization, weakness, abnormal postures, abnormal movement patterns.
Neural:
- increased input to alpha motor neuron, emotion, fear, pain, infection, full bladder, altered excitability of alpha motor neuron said, loss of functioning of motor units, altered motor unit firing rate, loss of orderly recruitment, impaired motor unit synchronization (innapropriate co-contraction)
58
Define spasticity?
| Define rigitidy?
- velocity dependant increase in passive stretch
| - Velocity Independent resistance to passive stretch
usually seen with a head injury [decorticate rigidity]
59
Features of LMN and UMN lesions
LMN:
- hypotonia or hyporeflexia
UMN:
- hypotonia & hyperreflexia OR hypertonia & hyperreflexia
60
How do you assess spasticity & tone?
1) Modified ashworth scale: 0-5 scale
- ask them to AROM, feel muscle, then PROM, then PROM with quick stretch
2) Exaggerated proprioceptive reflexes (spasticity)
- clonus, tendon jerk, pendulum test
3) exaggerated cutaneous reflexes
- touch of palmar and plantar surfaces
- babinski response
61
General Tx for Spasticity and tone treatments
- postural control
- treat biomechanical limitations (positioning, ROM, mobility)
- promote strength, endurance, coordination
- maintain extensibility/ PROM
- address potential factors contributing to tone ( agitation, bladder, pain, etc)
- provide sustained pressure on tendons
- Referral to health care team (meds/ Botox)
62
Treatment for Clonus? & cutaneous hyperreflexia?
- teach them to contract the muscle with the clonus then relax
- Desensitize, promote active movements within limits of individual capacity, strap legs when in w/c for safety
63
What is ataxia?
Failure of muscle coordination: irregularity of mm action
64
How do you assess ataxia?
1) coordination:
- UE: finger to nose, dysdiadochokinesia, finger opposition
- LE: toe tapping, heel on shin
* ** together, separate, slow then fast, record how many reps and quality
2) balance:
- Rhomberg (differentiate from somatosensory deficit)
3) Functional:
- tug, 10m walk
65
Cerebellar ataxia treatment:
- postural control
- prevent and treat biomechanical limitations
- promote mm strength, endurance, and coordination
- strategies: small ROM near midline, work out, progress: decrease guidance, cueing, number of fixed points, inc active ROM, speed, change of direction.
66
Orofacial assessment
1) facial expression: wrinkle forehead, tightly close eyes, smile widely, purse lips together, smile wide and protrude chin
2) look for asymmetry and differentiate in upper or lower face
67
Orofacial lesion treatment
- exercises promoting symmetry, mouth care, face tapping, stretching active area
68
How to assess the 3 sensory systems?
Balance:
| - eyes open, closed, open on cushion, closed on cushion
69
What strategies do we promote when improving posture?
Ankle --> hip--> stepping
70
What functional measures are used to assess posture/balance?
- berg, Fullerton, ABC, functional reach test, Chedoke
71
Balance/ posture treatments principles
Static --> dynamic-->unstable surface-->perturbations
72
What velocities for ambulation ability
0. 8 m/s community ambulation
1. 3 m/s Avergage walking speed for community ambulatory
Tips: salient, task specific, aids? Orthoses? FES?
73
What 3 systems work in parallel during reach and grasp?
- Postural control, transport, manipulation
| * **need to integrate all systems during Rx
74
Differentiate between ballistic movements and manipulation
- Ballistic are preprogrammed and don't require sensory feedback
- manipulation needs feedback to figure out grip force
75
How to teach someone to use their hand properly
- move hand to object
- look and pay attention to hand and environment
- make postural adjustments prior to and during arm movement
- utilize sensory feedback required for manipulation
76
Key factors required for reach and grasping
Reach:
- trunk control, elbow extension, pronation, stable scapula and shoulder, wrist extension, finger opening
Grasp:
- radial deviation, wrist extension, thumb opposition
77
Key factors required for holding and manipulation
- sensation
| - finger cupping/opposition
78
Tips for better positioning
- Symmetry
- prevent secondary side effects of immobility: short mm, sores, etc
- HOB should never be zero (aspiration risk)
- w/c: clear tray, socks on
79
Key Q's during seating Ax for SCI
- perform sitting and lying
- ask what they need it for
- measure:
- -PSIS, inf angle of scap, spine of scap, elbow, top of head
- - trunk depth, thigh length, shank length, outer knee width, wheat width, hop width
- cushions: foam, gel, air (benefits/ cons of each)
80
Pupillary light reflex:
| - nerve that carries the signal
CN III:
| - damage to right CN III GVE fibers = only left eye will constrict
81
Pupil dilator reflex:
| - stimuli and nerve conduction
Parasympathetic stimulation by hypothalamus. Travels along CN V1
82
Blink reflex:
| Pathway
CN V1 projects to CN VII to innervate Obicularis oculi
83
Disjunctive gaze
Divergence = CN VI abducens :
Convergence = CN III oculomotor : medial rectus
84
Accommodation reflex:
| - 3 responses
- thickening of lens (ciliary mm)
- construction of pupil
- convergence
85
Ascending medial longitudinal fasciculus:
- fxn
- descending mlf fxn
A: gaze coordination:
D: mm tone for balance and posture + head and neck position
86
Horizontal gaze path
1) H gaze to abducens nucleus
2) ipsilateral CN VI to Lateral rectus
2a) MLF to CN 3 nucleus to contralateral medial rectus
87
Saccade:
| - neuro definition simple form
It's a horizontal gaze that was initiated by the Frontal eye fields and superior colliculus
-
88
Smooth pursuit:
| - 3 systems involved
- cortical: primary visual cortex + frontal eye fields = object + "move eyes"
2) cerebellum: how am I moving?/ feedback
3) vestibular: where am I in the movement?
They trigger abducens nucleus and H gaze system
89
Lesions and eye control:
- right CN III
- right ascending MLF
- left horizontal gaze center
- right MLF and abducens nucleus
- L gaze = R eye doesn't move, R gaze = all good
- same as above: R eye won't move on L gaze ( no connection to CN III)
- L gaze = both eyes straight, R gaze = all good
- L gaze = right eye doesn't move , L good, R gaze = nothing, both eyes straight
90
Rotational acceleration is detected by? + depolarization results
3 semicircular canals
| - depolarization = a deflection towards kinocilum
91
Linear acceleration is detected by?
```
Otolithic organs (utricle and saccule) within the vestibule
- gravity = linear
```
92
Differentiate between vestibulo-cervical or spinal reflex.
Cervical: posture of head and neck from semi circular canal input via medial vestibular nucleus
Spinal: rapid balance correction. Signal to legs and trunk via lateral vestibular nucleus
93
Differentiate medial and lateral vestibular nuclei
Medial:
- rotational acceleration
- bilateral head and neck posture
Lateral:
- linear acceleration
- extensor mm and trunk for stability
