Neurological Dysfunction Flashcards

Question

Hypertonicity: | tx?

Answer 1

spastic, high tone with hyperactive reflexes and decreased thoracic mobility - risk of contractures and deformity - changes in body position can affect one Treatment: - work to inhibit reflex activity via postures, positions or techniques of relaxation training - inhibition techniques - --prolonged static muscle stretch - --inhibiting postures - --limb movements emphasizing rotation - --slow stroking - --neutral warmth - --prolonged icing - --deep pressure to tendons - --Reciprocal inhibition: using facilitation techniques to the non spastic muscles will cause inhibition of the spastic muscles

Answer 2

*depends on the side of the brain that is damaged R CVA - problems with spatial relationships and hand eye coordination - irritability, short attention span - can't retain info, difficulty learning individual steps - poor judgement affecting personal safety - diminished body image with L sided neglect - quick and impulsive L CVA: - apraxia - difficulty starting and sequencing tasks - perseveration - easily frustrated with high levels of anxiety - inability to communicate verbally - cautious and slow

Answer 3

1- receptive, Wenicke's or fluent aphasia: - speech may flow smoothly but auditory comprehension is impaired. - following commands may be difficult - use word repetition and manual cues during rehab 2- Expressive, Broca's or nonfluent aphasia: - syntax is impaired, speech may be slow, vocal is small. - comprehension is good - phrase questions in simple "yes" or "no" responses 3- Global aphasia: - characterized by significant limitations in comprehension - use of symbolic gestures may help

Answer 4

L CVA: - develop an appropriate communication base: words, gestures, pantomime; assess level of understanding - give frequent feedback and support - don't underestimate learning ability R CVA: - use VC; demos or gestures may confuse patients with visuospatial deficits - give frequent feedback; focus on slowing and controlling movement - focus on safety - avoid environmental clutter - don't overestimate ability to learn

Answer 5

Etiology: MOI is contact forces to to skull and rotational acceleration forces, causing varying degrees of injury to the brain various S&S associated with localized lesions of the cortex Primary brain damage Secondary brain damage Concussion

Answer 6

diffuse axonal injury: -disruption and tearing of axons and small blood vessels from shear-strain of angular acceleration; results in neuronal death and petechial hemorrhages focal injury: -contusions, lacerations, mass effect from hemorrhage and edema (hematoma) coup-contracoup injury: -injury at point of impact and opposite point of impact closed or open injury (with fracture of skull)

Answer 7

hypoxic-ischemic injury: -results from systemic problems (respiratory or cardiovascular) that compromise cerebral circulation swelling/edema: -can result in mass effect, with increased intracranial pressures, brain herniation (uncal, central or tonsillar) and death electrolyte imbalance and mass release of damaging neurotransmitters

Answer 8

loss of consciousness, either temporary or permanent, resulting from injury or blow to head, with impaired functioning of the brainstem reticular activating system -may see changes in HR, RR, BP

Answer 9

Mild TBI: - Loss of consciousness: 0-30 minutes - alteration of consciousness: brief; >24 hours - post-traumatic amnesia: 30 minutes, 24 hours - post-traumatic amnesia: >1, 24 hours - alteration of consciousness: >24 hours - post-traumatic amnesia: >7 days - Glascow coma scale:

Answer 10

delineates 8 general cognitive and behavioral levels -descriptive scale of response to stimuli that is useful for communicating or documenting cognitive and/or behavioral status I- no response to any stimuli II- generalized response; reacts inconsistently and nonspecifically to stimuli III- localized response; pt. reacts inconsistently but specifically to stimuli IV- confused/agitated; heightened state of activity; behavior is bizarre and non purposeful relative to immediate environment; recall and attention span are poor V- confused/inappropriate: pt. able to respond to simple commands but not to complex tasks; memory is impaired; verbalization is inappropriate VI- confused-appropriate: pt. is dependent upon external input but can perform consistently; memory improved. VII- automatic-appropriate: can perform automatically and appropriately in structured environments; judgement remains impaired VIII- purposeful-appropriate: patient acts appropriately though not perfectly. may have some-problems in stressful or unusual circumstances

Answer 11

an objective way to describe a patient's level of consciousness Each category is quantified: - eye opening: spontaneous to none - best motor response: follows commands to abnormal responses to no response - verbal response: oriented to inappropriate to no response mild TBI=13-15 moderate TBI=9-12 severe TBI=

Answer 12

=the overall level of alertness or reaction to stimuli low arousal associated with coma high arousal may occur during agitated state following brain injury -may require quiet environment and consistency in management (daily routine)

Answer 13

1: coma: - state of unconsciousness in which there is neither arousal nor awareness; eyes remain closed, no sleep/wake cycle s 2- unresponsive vigilance/vegetative state: - marked by the return of sleep/wake cycles and normalization of vegetative functions (respiration, digestion, BP control); - persistent vegetative state= >1 year 3- mute responsiveness/minimally responsive: -pt. is not vegetative and does show signs, even if intermittent, of fluctuating awareness 4- confusional state: -mainly a disturbance of attention mechanisms; all cognitive operations are affected, patient is able to form new memories; may demo either hypoarousal or hyperarousal 5- emerging independence: - confusion is clearing and some memory is possible - significant cognitive problems and limited insight remain - frequently inhibited social behaviors 6- Intellectual/social competence -increasing independence, although cognitive difficulties (problem solving, reasoning) persist along with behavioral and social problems (mood swings) *patient can plateau at any stage or regress under conditions of stress or repetitive brain injury

Answer 14

general signs of increased intracranial pressure level of consciousness, cognitive function, learning disorders, memory and complex info processing CN function behavior changes speech and communication sensory deficits motor function (cerebellar damage is common) functional mobility level of general de-conditioning following prolonged hospitalization

Answer 15

maintain ROM, prevent contracture, positioning maintain skin integrity maintain respiratory status, prevent complications: postural drainage, percussion, vibration, suctioning to keep airway clear provide sensory stimulation for arousal and to elicit movement: environmental and direct stimulation (auditory, visual, olfactory, gustatory, tactile stimuli) promote early return of FMS: upright positioning for improved arousal, proper body alignment

Answer 16

provide structure, prevent overstimulation for confused, agitated patient: closed, reduced stimulus environment, daily schedules and memory logs, relaxation techniques provide consistency: clear feedback, written contacts engage patient in task-specific training; limit activities to familiar, well-liked ones; offer options; break down complex tasks into parts provide verbal or physical assistance control rate of instruction emphasize safety, behavioral management techniques model calm, focused behavior

Answer 17

allow for increasing independence; wean patient from structure, involve patient in decision making assist paitent in behavioral, cognitive, emotional reintegration: provide honest feedback, prepare for community reentry promote independence in functional tasks: FMS, ADLs improve postural control, symmetry and balance encourage active lifestyle, improved cardiovascular endurance

Answer 18

``` depression dependent denial aggressive sexually inappropriate agitated poor judgement ```

Answer 19

etiology: partial or complete disruption of SC resulting in paralysis, sensory loss, altered autonomic and reflex activities ``` Paraplegia= only LEs are involved Tetraplegia/Quadriplegia= all 4 extremities are involved ``` Designation of spinal level: - defined as the most caudal level of the SC that exhibits intact sensory and motor functioning - muscles must have a grade of at least 3+/5 strength to demo intact innervation - sensory areas are well demarcated and are innervated by a single SC segment - complete lesions: total and permanent functional (sensory and motor) disruption of the SC >3 segments below the lesion MOI: - flexion- most common lumbar injury - flexion-rotation- most common cervical injury - compression - hyperextension - nontraumatic causes: disc prolapse, vascular insult, infections

Answer 20

1- level of injury: UMN injury - lesion level indicates most distal uninvolved nerve root segment with normal function; muscles must have a grade of at least 3+/5 function - tetraplegia/quadriplegia: injury occurs b/w C1 and C8, involves all 4 extremities and trunk - Paraplegia: injury occurs b/w T1 and L1, involves both LEs and trunk (varying levels) 2- degree of injury - complete: no motor or sensory function below level of lesion - incomplete: preservation of sensory or motor function below level of injury; spotty sensation, some muscle function - ASIA score 3- clinical syndromes - central cord - brown-sequard - anterior cord - posterior cord - cauda equina - sacral sparing

Answer 21

A= complete, no motor or sensory function is preserved in the sacral segments S4-5 B= Incomplete: sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-5 C= Incomplete: motor function is preserved below the neurological level, and most key muscles below the neurological level have a muscle grade of

Answer 22

``` Brown sequard syndrome -UMN anterior cord -UMN central cord -UMN posterior cord -UMN cauda equina -LMN sacral sparing - ```

Answer 23

most commonly occurs with hyperextension injuries with minor trauma to the cervical region results in damage to the central aspect of the SC affecting the UE sensation and motor functioning with normal LE functioning - loss of spinothalamic tracts with bilateral loss of P&T - loss of ventral horn with bilateral loss of motor function: primarily UE - preservation of proprioception and discriminatory sensation

Answer 24

results from trailer to the anterior cord or damage of the anterior spinal artery usually related to flexion injuries of the cervical region characterized by loss of motor function and loss of pain and temperature below the level of lesion - 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 P&T - preservation of dorsal columns: proprioception, kinesthesia and vibration

Answer 25

very rare with deficits of kinesthesia and proprioception an ataxic gait with a wide base of support may result - loss of dorsal columns bilaterally- loss of proprioception, vibration, and pressure sensations - preservation of motor function, pain and light touch

Answer 26

hemisection of the SC, usually from stab or gunshot asymmetrical ipsilateral symptoms: -weakness or motor paralysis, loss of proprioception, vibratory sense, and 2 point discrimination, decreased reflexes, clonus and spasticity - ipsilateral loss of dorsal columns with loss of tactic discrimination, pressure, vibration and proprioception - ipsilateral loss of corticospinal tracts with loss of motor function and spastic paralysis below level of lesion - contralateral loss of spinothalamic tract with loss of P&T below level of lesion; at lesion level bilateral loss of P&T

Answer 27

injury below the L1 segment results in damage to lumbar and sacral roots of peripheral nerves (LMN) sensory loss, paralysis and loss of bladder/bowel control can occur because damage is to the peripheral nerve roots, regeneration may be possible

Answer 28

sparing of tracts to centrally located sacral segments perianal sensation, rectal spincter contraction, cutaneous innervation in the saddle area and active contraction of the scarily innervated toe flexors are intact

Answer 29

spinal shock - transient period of reflex depression and flaccidity - may last several hours or up to 24 weeks spasticity/spasms autonomic dysreflexia (hyperreflexia) heterotypic bone formation DVT

Answer 30

(hyperreflexia) an emergency situation in which a noxious stimulus precipitates a pathological autonomic reflex with symptoms of: - paroxysmal hypertension - bradycardia - headache - diaphoresis (sweating) - flushing - diplopia - convulsions occurs in lesions above T6; more prevalent in first 3 years after SCI examine for irritating stimuli treat as medical emergency- elevate head, check and empty catheter first most common cause: bladder distension other stimuli: rectal dissension, pressure sores, urinary stones, bladder infections, noxious cutaneous stimuli, kidney malfunction and environmental temperature changes bladder drainage system should be checked immediately and opened if necessary if lying flat, bring patient to sitting position to lower BP

Answer 31

monitor changes associated with recovery - spinal shock - spasticity/spasms - autonomic dysreflexia - heterotopic bone formation - DVT improve respiratory capacity maintain ROM, prevent contractures, positioning maintain skin integrity improve strength reorient pt. to vertical position (*orthostatic hypotension) promote early return of FMS and ADLs improve sitting tolerance, postural control, balance appropriate wheelchair prescription and independence gait training cardiovascular endurance

Answer 32

High cervical lesions (C1-4) - require electric w/c with tilt in space seating - microswitch or puff and sip controls - portable respirator may be attached Shoulder function, elbow flexion (C5) - can use manual chair with propulsive aids (projections) for short distances on smooth surfaces - may use electric w/c for distances and to conserve energy Radial wrist extensors (C6) -manual w/c with friction surface hand rims independently Triceps (C7): -same as C6 but with increased propulsion ``` Hand function (C8-T1 and below) -manual w/c, standard heigh rims ```

Answer 33

Midthoracic lesions (T6-9): - supervised ambulation for short distances - requires bilateral KAFO and crutches - swing-to gait pattern - requires A - may prefer standing devices/standing w/c High lumbar lesions (T12-L3) - can be independent in ambulation on all surfaces and stairs - uses a swing through or 4 point gait and bilateral KAFOs and crutches - may also use reciprocating gait orthoses with walker with or without FES system - typically I household ambulators, w/c for community Low lumbar lesions (L4-5) -independent with bilateral AFOs and crutches or canes

Answer 34

Paralysis of voluntary motor control with damage to descending motor tracts, anterior horn cells or spinal nerves Spasticity - after spinal shock resolves, reflexes return and progressively become stronger, resulting in spasticity - more prevalent with higher and incomplete lesions Loss of sensation -leads to discoordination of movements, impaired body awareness Respiration dysfunction Bowel and bladder incontinence Genital function Cardiovascular function Thermoregulation

Answer 35

depending on the level of lesion, the diaphragm (innervated from C3-5) may not be active, affects patient's ability to breathe (primarily inhalation) -an artificial ventilator or phrenic nerve stimulator may be required to sustain life disruption to the intercostals and abdominal muscles can impair respiration- primarily forced expiration and inhalation following a SCI, tidal volume and vital capacity are reduced and secondary respiration muscles are utilized (scalene) respiratory dysfunction - most common cause of death in SCI - inability to cough effectively allows secretions to build in the lungs and decreases forced expiration - inadequate inhalation and exhalation can reduce ventilation of the lungs-- lead to atelectasis, pneumonia and respiratory insufficiency

Answer 36

voluntary control of urination and defecation is lost after in injury to the sacral cord S2-4 following spinal shock, 2 types of bladder conditions will develop: 1- Reflex bladders (UMN): -empty in response to a certain level of filling pressure 2-autonomous or nonreflex bladders (LMN): -flaccid and can be emptied by increasing intraabdominal pressure or by manually compressing the lower abdomen

Answer 37

injury to the thoracolumbar and sacral regions of the SC alter the functioning of the genitals, disrupting sexual responses female fertility is unchanged but men are likely infertile

Answer 38

when an injury to the SC blocks communication between the brainstem and the thoracolumbar cord, sympathetic input to the heart is lost and parasympathetic input remains -results in bradycardia, peripheral vasodilation and hypotension orthostatic hypotension occurs due to a drop in BP when the patient moves from horizontal to upright problems are significant in people with lesions above T6 and often resolve within a few weeks

Answer 39

cord injury that interrupts communication with the hypothalamus can cause hypothermia due to peripheral vasodilation reflexive tone returns in the peripheral vasculature, resolving this problem later, hyperthermia occurs due to a loss in sympathetic control of the sweat glands below the level of the lesion sweating doesn't occur -to compensate, diaphoresis occurs above the lesion

Answer 40

decubitus ulcers respiratory dysfunction - most common cause of death in SCI - inability to cough effectively allows secretions to build in the lungs and decreases forced expiration - inadequate inhalation and exhalation can reduce ventilation of the lungs-- lead to atelectasis, pneumonia and respiratory insufficiency contractures osteoporosis -loss of calcium from bones below lesion-- ^risk of fractures DVT GI dysfunction - stress ulcers - bowel obstruction - fecal impaction - gastric dilation autonomic dysreflexia -occurs in lesions above T6 postural or orthostatic hypotension heterotopic bone formation

Answer 41

a decrease in BP that occurs when a patient is moved from horizontal to vertical position the lack of muscle tone and loss of sympathetic vasoconstriction causes venous pooling in the periphery due to immobilization for 6-8 weeks symptoms: dizziness and fitness or impending blackout treatment: slow progression to vertical position while VS are monitored and use of compressive stockings and an abdominal binder to minimize hypotension effects

Answer 42

formation of new bone within muscles or other CT below the lesion unknown etiology different from myositis ossificans, which results from trauma to the muscle tissue and presents with bony deposits within muscle tissue occurs in 16-53% of all patients with SCIs, usually appearing from 1-4 months after injury and can restrict joint ROM Tx: combo of drug therapy and regular exercise during early stages of ectopic bone formation can be effective

Answer 43

"tetraplegia" capable of talking, mastication, sipping, blowing key muscles: face and neck dependent self-care requires a portable ventilator or phrenic nerve stimulator, requires a power tilt-in-space w/c with mouth control and a seatbelt for trunk control SCI at C3 can attain w/c independence with power w/c on smooth level surfaces

Answer 44

capable of respiration, scapular elevation key muscles: diaphragm, trapezius ventilator usually not needed -glossopharyngeal breathing is used to cough chin control to adjust w/c limited feeding and ADLs amy be possible with use of mobile arm supports, environmental controls, adapted eating equipment head or mouth stick

Answer 45

capable of: - elbow flexion and supination - shoulder ER &abd to 90, and limited shoulder flexion key muscles: - biceps - brachialis - brachioradialis - deltoid - infraspinatus - rhomboids - supinator mobile arm support assist UE ADL performance mod to min A required for LE dressing and rolling dependent for transfers with aid of a sliding board power chair with hand controls (joystick) for community integration and manual w/c with rim projectors 200-300 ft indoors driving is possible with van lift may achieve ischial pressure relief with forward lean but usually dependent needs assistance for manual cough technique

Answer 46

capable of: - shoulder flexion, extension, IR, adduction - scapular abduction and upward rotation - forearm pronation - wrist extension key muscles: - ECR - infraspinatus - lats - pec major - serratus anterior - teres minor can become independent in half care with equipment- transfer with sliding board independent in rolling and supported sitting can be LTG use of a manual w/c with projections or friction hand rims for household mobility - may require a power w/c for community - locks on casters positioned sideways provide increased stability in transfers uses manual cough technique independently can live w/o A if well motivated can drive automobile with hand controls

Answer 47

capable of: - elbow extension - wrist flexion - finger extension key muscles: - EPL, EPB - extrinsic finger extensors - FCR - triceps Independent in LE self ROM exercises can use manual w/c with friction hand rims for community integration with some difficulty on rough terrain button hook may be required for independent dressing able to get w/c in and out of car

Answer 48

capable of full use of all UE muscles except hand intrinsics key muscles: - extrinsic finger flexors - FCU - FPL and FPB independent in living at home except for heavy work may be able to independently go up/down curbs with manual w/c may need tub seat, grab bars, et for full independence at home able to work in a building free of architectural barriers

Answer 49

capable of: - full use of UEs - improved trunk control - increased respiratory reserve Key muscles: - top half of intercostals - long muscles of the back - intrinsic finger flexors independent in all areas including car transfers standing table for physiologic standing able to negotiate curbs using "wheelie" technique participates in w/c sports

Answer 50

capable of: - improved trunk control - increased respiratory reserve Key muscles: -long muscles of the back including sarcrospinalis and semispinalis independent in swing-to gait in parallel bars with bilateral KAFO for short distances supervision with walker and KAFOs in home will use w/c for community locomotion

Answer 51

capable of: - increased endurance - improved trunk control Key muscles: - lower abdominals - all intercostals independent swing-to or swing-through gait on level surfaces with bilateral KAFOs and a walker or forearm crutches Independent floor to wheelchair and tub transfers may be independent household ambulators will usually use a w/c for outdoor locomotion and energy conservation

Answer 52

capable of: - hip flexion and adduction - knee extension Key muscles: - gracilis - iliopsoas - quadratus lumborum - rectus femoris - sartorius independent swing-to, swing-through or 4 point gain with bilateral KAFOs and forearm crutches on level surfaces and small elevations. -Independent home ambulators may use w/c for energy conservation in community

Answer 53

capable of: - strong hip flexion and knee extension - weak knee flexion - improved trunk control key muscles: - low back muscles - medial hamstring (weak) - posterior tibialis - quads - anterior tibialis independent home ambulators (can be community) may use w/c for energy conservation

Answer 54

head or mouth stick: - wooden/metal rod 12-18 inches long - lesions C3-5 - holds utensils or types/turns pages Mobile arm support: - typically attached to w/c - patients with weak proximal UE to improve function - pts would have shoulder flexion, ER and elbow flexors between 1-3+ - helps with self-care and hand control in power chair static wrist-hand orthosis: - positional hand splint for pts w/o wrist extension (C1-5) - maintains functional hand position- thumb abduction and palm support - not functional Wrist-driven orthosis (tenodesis splint) - dynamic functional orthosis designed to assist with grasp - transfers muscle force from wrist extension to provide finger flexion with C6-7 lesion Wheelchair cushions -regardless of cushion pressure relief should be performed 3-4x/hour

Answer 55

Vital capacity -depends on level of lesion and muscles innervated Coughing - T10 and below have functional cough - manual cough- technique of abdominal compression to assist with clearing secretions in patients with weak or nonfunctional cough - --pt. can perform themselves if lesion is C6 or below glossopharyngeal breathing (frog breathing) - technique used by high level quadriplegics - -aggressive use of tongue, pharyngeal and laryngeal structures as a respiratory pump to help air and increase VC

Answer 56

the diaphragm is the primary muscle of inspiration -innervated from C3-5 Intercostals (T1-12) assist in inspiration Abdominals (T5-12) are utilized in forced expiration Secondary muscles: assist in inspiration - Trapezius (C1-4) - SCM (C1-3) - Scalenes (C3-5) - Levator scapula (C3-5)

Answer 57

chronic, progressive, demyelinating disease of the CNS mostly young adults more prevalent in colder climates demyelinating lesions (plaques) impair neural transmission, cause nerves to fatigue rapidly variable symptoms: - lesions scattered in time and place - lesions common in pyramidal tract, dorsal columns and periventricular areas of cerebrum, cerebellar peduncles Variable course with fluctuating periods - exacerbations- worsening of symptoms - remissions --> progressing to permanent dysfunction precipitating or exacerbating factors: infections, trauma, pregnancy, stress transient worsening of symptoms: adverse reactions to heat, hyperventilation, dehydration, fatigue

Answer 58

sensory disturbances including tingling, numbness and pain coordination problems and spasticity fatigue (especially in the afternoon) ** #1 complaint diplopia bowel and bladder problems -UTI communication disorders psychosocial problems including euphoria and/or depression adverse reactions to heat respiratory infection- common cause of death

Answer 59

Relapse-remitting MS (RRMS): - relapses with either full recovery or some remaining neurological S&S and residual deficit - periods b/w relapse characterized by lack of disease progression Primary-progressive MS (PPMS): -disease progression from onset, w/out plateaus or remissions or with occasional plateaus and temporary minor improvements Secondary-progressive MS (SPMS): -initial relapsing-remitting course, followed by progression at a variable rate that may also include occasional relapses and minor remissions Progressive-relapsing MS (PRMS): - progressive disease from onset but w/out clear, acute relapses that may or may not have some recovery or remission - commonly seen when onset >40 y/o

Answer 60

Medical Management: - immunosuppressant drugs: treat acute flare ups and shorten duration - interferon drugs: slow disease progression - symptomatic management of spasticity - symptomatic management of urinary problems: anticholinergic drugs PT Tx: - restorative following exacerbation - functional maintenance: ROM, strength - improve function - prevent secondary problems - breathing exercises - PNF to tolerance - skin integrity - improve sensory awareness - improve motor control/coordination - postural control, symmetry - gait or w/c training - energy conservation *preferably morning treatments

Answer 61

chronic, progressive disease of the CNS (basal ganglia) with degeneration of dopaminergic substantia nigra neurons and nigrostriatal pathways -decrease in dopamine production and/or receptors in the brain Etiology: infectious/postencephalic, atherosclerosis, idiopathic, toxic, drug induced - deficiency of dopamine within the BG corpus striatum with degeneration of substantia nigra - loss of inhibitory dopamine results in excessive excitatory output from cholinergic system (acetylcholine) of basal ganglia

Answer 62

resting tremor, rigidity and fatigue -leadpipe or cogwheel rigidity difficulty initiating or slowness of movement (bradykinesia) abnormal gait (festinating or slow shuffling) flexed posture mask-like face decreased postural reflexes behavioral changes: - memory loss - apathy that leads to secondary problems: decubitus ulcers, muscle atrophy, contractures, decreased VC and falls intellectual impairments/dementia in advanced stages

Answer 63

I: minimal or absent disability -unilateral symptoms II: minimal bilateral or midline involvement -no balance involvement III: impaired balance, some restrictions in activity IV: all symptoms present and severe -stands and walks only with assistance V: confinement to bed or wheelchair

Answer 64

Medical management: - Sinemet (levodopa/carbidopa): provides dopamine and decreases effects of disease - --adverse effects: nausea, orthostatic hypotension, arrhythmias, dyskinesias, psychoses, abnormal behaviors - dopamine agonist drugs - anticholinergic drugs: control tremors - amantadine: enhances dopamine release selegiline: increases dopamine; used during early disease to slow progression - deep brain stimulation in thalamus PT: - monitor changes in disease progression and pharm interventions - prevent secondary impairments - compensator strategies for movement; repetitive stimulation - improve strength - PNF diagonals with rhythmic initiation to overcome bradykinesia - gait training to increase stride width and length - endurance *best to treat in AM following dopamine agonist administration

Answer 65

a neuromuscular junction disorder characterized by progressive muscular weakness and fatiguability on exertion -muscular strength worse with continuing contraction, improved with rest Etiology: autoimmunie antibody- mediated attack on acetylcholine receptors at neuromuscular junction Generalized myasthenia: usually involves bulbar (extraocular, facial, and muscles of mastication) and proximal limb-girdle muscles course varies: may progress from mild-severe, typically w/in 18 months myasthenic crisis: respiratory failure, medical emergency

Answer 66

disorder characterized by recurrent seizures (repetitive abnormal electrical discharges w/in the brain) Symptoms: - altered consciousness - altered motor activity (convulsions): characterized by involuntary muscle contractions; tonic activity (stiffening/rigidity of muscles); clonic activity (rhythmic jerking) - Sensory phenomena: somatosensory, visual, auditory, olfactory, gustatory and vertiginous sensations - Autonomic phenomena: associated with sudden attack of anxiety, tachycardia, sweating, piloerection, abnormal sensation risking up in upper abdomen and chest - Cognitive phenomena: sudden failure of comprehension, inability to communicate, illusions, hallucinations Common causes of seizures: - acquired brain disease or trauma: tumor, stroke - degenerative brain diseases: Alzheimer's dementia, amyloidosis - developmental brain defects - drug overdose - drug withdrawal - electrolyte disorders: hypo/hypernatremia, hypoglycemia, hypomagnesemia - hyperthermia - infections; brain abscess, meningitis, neurocysticercosis - pregnancy complications: eclampsia

Answer 67

GENERALIZED SEIZURES: 1-Tonic-clonic (grand mal): - dramatic loss of consciousness, with a cry, fall and tonic-clonic convulsions of all extremities; often with tongue biting and arrested breathing, urinary and fecal incontinence - after 2-5 min, contractions subside, and consciousness is gradually regained - patient is confused, drowsy and amnesiac about the event - full recovery may take several hours; some attacks are preceded by brief aura 2-Absence seizures (petit mal): - brief, almost imperceptible lapse of consciousness followed by immediate and full return to consciousness; - posture is maintained, with no convulsive muscle contractions - may occur as often as a hundred times a day PARTIAL SEIZURES ``` 1-Simple partial seizures: 2-Focal motor: 3- Focal motor with march (Jacksonian): 4- Temporal lobe seizure 5- Complex partial seizure ``` Secondarily generalized seizures: simple or complex partial seizures evolving to a generalized seizure Status epilepticus: prolonged seizure or a series of seizures (lasting >30 min) with very little recovery between attacks - may be life threatening - medical emergency

Answer 68

Exam/determine: - time of onset, duration, type of seizure, sequence of events, frequency, duration - patient activity at onset, presence of aura - sensory elements, motor activity: type, degree and location of involvement - presence of tongue biting, incontinence, respiratory distress - behavioral elements, changes in mood - patient responses after seizure Medical management: - antiepileptic meds: dilantin - surgical intervention: lobe resection, hemmispherectomy PT: - protect patient form injury during seizure: remain with patient, remove potentially harmful nearby objects, loosen restrictive clothing and don't restrain limbs - establish airway, prevent aspiration: turn head to side or SL position; wait for tonic-clonic activity to subside before initiating artificial ventilation if needed - promote regular routines for physical activity and emotional health

Answer 69

hereditaty ataxia, Friedreich's ataxia neoplastic or metastatic tumors infection vascular: stroke developmental: ataxic CP, Arnold-Chiari syndrome Trauma: TBI drugs, heavy metals chronic alcoholism

Answer 70

tend to produce ipsilateral S&S Lesions of the archicerebellum -vestibular symptoms lesions of the paleo cerebellum -hypotonia lesions of the neocerebelum -ataxic limb movements asthenia: generalized weakness hypotonia: - especially in acute cerebellar lesions, difficulty with postural control of proximal muscles motor learning impairments: -decreased anticipatory control, feedback and learning delays Cognition: -deficits in information procession, attention deficits emotional dysregulation: changes in emotional behaviors

Answer 71

Central vestibular symptoms: - ocular dysmetria - poor eye pursuit - dysfunctional vestibular ocular reflex (VOR) - impaired hand-eye coordination Gait and trunk ataxia: - poor postural control and orientation - wide based gait Little change in tone or dyssynergia of extremity movements

Answer 72

hypotonia truncal ataxia: -dysequilibrium, static postural tremor -increased sway wide BOS and high guard arm position posture worse with eyes closed, narrow BOS (romberg) -ataxic gait -unsteady, increased falls, uneven/decreased step length, increased step width

Answer 73

produces ataxic limb movements intention tremor: irregular, oscillatory voluntary movements dysdiadochokinesia: impaired rapid alternating movments dysmetria: - hypermetria: overshooting - errors or force, direction, amplitude - rebound phenomenon Dyssynergia: - abnormal timing (errors of velocity, onset and stop) - movement decomposition of agonist/antagonist interactions - impairments of multijoint coordination, movement sequences and complex motor tasks errors in timing related to perceptual tasks

Answer 74

Goals: - improve accuracy of limb movements - improve postural stability and dynamic postural control - improve functional movement and safety - stabilize VOR/vision Eye-head coordination exercise: slow head movements with visual fixation; active eye and head movements Stability exercises: use of WB postures, carefully graded resistance and approximation to promote steady holding. Use of theraband, weights, weighted waist belts and walkers to decrease ataxic movements dynamic stability exercises: promote small range control, smooth reversals of movements, movement transitions, using carefully graded resistance balance training locomotor training therapeutic pool: water provides graded resistance, decreases ataxic movement and postural instability coordination exercises: proprioceptive neuromuscular facilitation (PNF) patterns, ball gymnastics to promote balance stationary bike: assists timing of reciprocal movements motor learning strategies: closed environment ideal; focus on practice and repetition; distributed practice biofeedback energy conservation

Answer 75

Dizziness: sensation of lightheadedness, giddiness, faintness Vertigo: sensation of moving around in space or having objects move around; tends to come in attacks -if severe: accompanied by nausea Visual changes - Nystagmus: involuntary, cyclical movement of the eyeball - Blurred vision: gaze instability secondary to VOR dysfunction Disequilibrium or postural instability: vestibular spinal reflex dysfunction; ataxia, gait disturbances; increased risk of falls Anxiety, fear, depression Indirect impairments: physical deconditioning, decreased cervical ROM

Answer 76

Trauma: -vestibular symptoms seen in 30-65% of patients with TBI Vestibular neuronitis, labyrinthitis - acute infection with prolonged attack of symptoms, persisting for several days or weeks - caused by viral or bacterial infection Meniere's disease Benign paroxysmal positional vertigo tumor - acoustic neuroma - gliomas/brainstem or cerebellar medulloblastoma

Answer 77

recurrent and usually progressive vestibular disease episodic attacks may last minutes to hours with severe symptoms: - tinnitus - deafness - sensation of pressure/fullness within ear etiology unknown -edema of membranous labyrinth is a consistent finding

Answer 78

BPPV brief attacks of vertigo and nystagmus that occur with certain head positions -lying down, turning over in bed, tilting head back may be related to degenerative processes, mechanical impairment of peripheral vestibular system Tx techniques: - canalith repositioning treatment: for horizontal SCC BPPV, posterior SCC BPPV - liberatory maneuver: for posterior - brandt-daroff exercises: for residual or mild vertigo

Answer 79

patient sits on table; clinician turns patient's head horizontally 45 deg and quickly moves patient down to supine position with neck extended 30 deg below horizontal check for symptoms - vertigo and nystagmus return patient to sitting and test other side + for BPPV on side that produces symptoms

Answer 80

repetition of movements and positions that provoke dizziness and vertigo

Answer 81

eye movements: - side to side eyes on stationary target (X1 paradigm) - side to side eyes on moving target (X2 paradigm) head movements up and down, side to side while maintaining eyes focused on a visual target - progressing slow to fast movements - standing to walking

Answer 82

Pathological processes: 1-wallerian degeneration 2-segemental demyelination 3-axonal degeneration Traumatic nerve injury classes: Class I-neurapraxia Class II-axonotmesis Class III-neurotmesis

Answer 83

transection (neurotmmesis) results in degeneration of the axon and myelin sheath distal to the site of axonal interruption - chromatolysis and repair processes occurs in nerve cell body - endoneuriusm (sheath) does not degenerate but forms a tube directing regeneration

Answer 84

axons are preserved (no wallerian degeneration) -remyelination restores function ex: Guillain-barre syndrome

Answer 85

degeneration of axon cylinder and myelin, progressing from distal to proximal "dying back" of nerves ex: peripheral neuropathy

Answer 86

Class 1 traumatic nerve injury injury to nerve that causes a brief loss of function (conduction block ischemia) nerve dysfunction may be rapidly reversed or persist a few weeks (ex: compression)

Answer 87

Class 2 traumatic nerve injury injury to nerve interrupting the axon and causing loss of function and wallerian degeneration distal to the lesion with no disruption of the endoneurim regeneration is possible ex: crush injury

Answer 88

Class 3 traumatic nerve injury cutting of the nerve with severance of all structures and complete loss of function re-innervation typically fails without surgical intervention because of aberrant regeneration (failure of regenerating axon to find its terminal end)

Answer 89

weakness/paresis of denervated muscle, hyporeflexia and hypotonia, (rapid atrophy, fatigue sensory loss: corresponds to motor weakness; proprioceptive losses may yield sensory ataxia autonomic dysfunction: vasodilation and loss of vasomotor tone (dryness, warm skin, edema, orthostatic hypotension) hyper excitability of remaining nerve fibers - sensory dysesthesias: hyperalgesia, pins and needles, numbness, tingling, burning - motor: fasciculations, spasms ``` muscle pain (myalgia) with inflammatory myopathies -ex: post polio syndrome ```

Answer 90

any disease of nerves characterized by deteriorating neural function polyneuropathy: bilateral symmetrical involvement of peripheral nerves, usually legs>arms, distal segments earlier and more involved than proximal mononeuropathy: involvement of a single nerve radiculopathy: involvement of nerve roots

Answer 91

neuralgia of the trigeminal nerve (CN V) Etiology: results from degeneration or compression - mean age ~50 - abrupt onset Characteristics: - brief paroxysms of neurogenic pain (stabbing and/or shooting pain) recurring frequently - occurs along unilateral distribution of the trigeminal nerve, mandibular and maxillary divisions (ophthalmic division is rare) - autonomic instability: exacerbated by stress cold; relieved by relaxation TENS can be effective for pain relief

Answer 92

LMN lesion involving facial nerve (CN VII) resulting in unilateral facial paralysis Etiology: acute inflammatory process of unknown etiology-- results in compression of the nerve w/in the temporal bone Characteristics: - weakened or paralyzed muscles of facial expression (wrinkling the forehead, closing the eye tightly, smiling) - decrease taste sensation anterior 2/3 of tongue - loss of control of salivation or lacrimation - acute onset with max severity in a few hours or days - commonly preceded by a day or 2 of pain behind the ear - most fully recover in several weeks or months - normal sensation TX: - protect corneas- artificial tears/patch - E-stim to maintain tone, support facial muscles - active facial muscle exercises - functional retraining- foots, chewing

Answer 93

refers to weakness or paralysis of the muscles innervated by the motor nuclei of the lower brainstem, affecting the muscles of the face, tongue, larynx and pharynx Etiology: result of tumors, vascular or degenerative diseases of lower CN motor nuclei (ex: ALS) Examine: - glossopharyngeal and vagal paralysis: phonation, articulation, palatal action, gag reflex, swallowing - changes in voice quality: dysphonia (hoarseness or nasal quality) - bilateral involvement: severe airway restriction with dyspnea, difficulty with coughing - possible complications: aspiration pneumonia TX: - suctioning, oral care - maintenance of respiratory function, open airway - elevated HOB - dietary changes: soft foods, liquids

Answer 94

a polyneuropathy resulting in symmetric motor paralysis and progressive muscular weakness that develops quickly - probable immune-mediated viral origin - usually occurs after recovery from an infectious illness (respiratory or GI) Characteristics: - involves acute demyelination of both cranial and peripheral nerves (LMN disease) - sensory loss, paresthesias, pain (sensory loss typically less than motor loss) "stocking/glove" pattern - motor paresis or paralysis: relative symmetrical distribution of weakness; progresses from LE to UE (ascending pattern) and from distal to proximal; may produce full tetraplegia with respiratory failure - dysarthria, dysphagia, diplopia, and facial weakness may develop in severe cases - progression evolves over a few days or weeks - recovers slow (6 months -2 years) and usually complete (85%); some mild weakness persists; 3% mortality Complications: - respiratory impairment and failure - autonomic instability: tachycardia, arrhythmias, BP fluctuations - pain: myalgia - risk of pneumonia - prolonged hospitalizations and immobility - relapse: if treatment inadequate PT: - ascending (disease progressing) phase: respiratory function, PROM, positioning, skin care - when stabilized: prevent injury to denervated muscles, avoid overuse and fatigue, begin gentle stretching, and initiate moment in a controlled environment - descending (recovery) phase: muscle re-ed with a mod exercise program, improve cardiovascular fitness and energy conservation

Answer 95

degenerative disease affecting both UMN and LMN (degeneration of anterior horn cells and descending corticobulbar and corticospinal tracts) -CN can be affected as well Etiology: unknown; 5-10% genetic (autosomal dominant) Characteristics: - muscle weakness is progressive and can affect muscles of respiration - weakness may appear in hands first progressing to whole body - dysarthria, dysphagia, dysphonia - muscle atrophy, cramping and fasciculations (LMN signs) - spasticity and hyperreflexia (UMN signs) - often no sensory changes - typical sparing of bowel and bladder function - normal cognition - death typically in 2-5 years

Answer 96

I: early disease - mild focal weakness - asymmetric distribution - symptoms of hand cramping and fasciculations II: - moderate weakness in groups of muscles - some atrophy of muscles - modI with AD III: - severe weakness of specific muscles - increasing fatigue - mild-mod functional limitations - ambulatory IV: - severe weakness and wasting of LEs - mild weakness of UEs - mod A and AD required - w/c user V: - progressive weakness with deterioration of mobility and endurance - increased fatigue - mod-severe weakness of whole limbs and trunk - spasticity, hyperreflexia - loss of head control - maxA VI: bedridden - dependent ADLs, FMS - progressive respiratory distress

Answer 97

new, slowly progressive muscle weakness occurring in people with confirmed history of acute poliomyelitis - follows a stable period of functioning - new form of muscular dystrophy - new denervation occurs with asymmetrical muscle weakness S&S: - myalgia - joint pain - variable asymmetrical muscle atrophy with decreased strength - excessive fatigue and decreased endurance contribute to loss of function - difficulty in concentration, memory, attention - sleep disturbances Tx: - low intensity exercise never to the point of fatigue - stop exercise with pain or weakness - use orthotic devices as needed to improve function - endurance and energy conservation

Answer 98

response to an immediate noxious stimulus signaling impending tissue damage inflammatory pain occurs after tissue damage and increases sensitivity to pain

Answer 99

pain as a result of lesions in some part of the NS (central or peripheral) usually accompanied by some degree of sensory deficit 1-central neurogenic pain: arises from injury or disease affecting CNS - pain is often burning, acing or prickling - hyperanalgeisa and allodynia (pain from normal stimulus) 2- peripheral neurogenic pain: arises from mechanical or chemical damage to peripheral nerves; may include symptoms of paresthesia, dysesthesia and pain

Answer 100

arises from injury or disease affecting CNS - pain is often burning, acing or prickling - hyperanalgeisa and allodynia (pain from normal stimulus) 1- central post-stroke (thalamic) pain: - continuous, intense, central pain occurring on the contralateral hemiplegic side - result of a store involving the ventral posterolateral thalamus - autonomic and vasomotor dysfunction is common 2- TBI 3- fibromyalgia

Answer 101

arises from mechanical or chemical damage to peripheral nerves; may include symptoms of paresthesia, dysesthesia and pain 1- Complex regional pain syndrome I -AKA reflex sympathetic dystrophy/causalgia -a complex disorder or group of disorders that develop as a result of trauma affecting body parts and disuse -CRPS I= tissue injury without nerve damage; CRPS II involves nerve injury -"regional"= t/o limb, not in a peripheral nerve or distribution reflex neurogenic inflammation affecting the SNS and pain disproportionate to injury -pain maintained by the SNS, characterized by burning pain (causalgia) -usually associated with traumatic injury 2- disorders of peripheral roots and nerves - neuralgia: pain occurring along the branches of a nerve - radiculalgia: neuralgia of nerve roots - paresthesias - allodynia 3- Herpes zoster (shingles) - acute, painful mononeuropathy caused by varicella zoster virus - characterized by vesicular eruption and marked inflammation of the posterior root ganglion of the affected spinal nerve or sensory ganglion of the CN - ventral root involvement (motor weakness) in 5-10% of cases - infection can last from 10 days to 5 weeks - posthepetic neuralgia pain may persist for months or years 4- phantom limb pain -folowing amputation

Answer 102

-AKA reflex sympathetic dystrophy/causalgia -a complex disorder or group of disorders that develop as a result of trauma affecting body parts and disuse -CRPS I= tissue injury without nerve damage; CRPS II involves nerve injury -"regional"= t/o limb, not in a peripheral nerve or distribution reflex neurogenic inflammation affecting the SNS and pain disproportionate to injury -pain maintained by the SNS, characterized by burning pain (causalgia) -usually associated with traumatic injury

Answer 103

painful inflammation of the posterior root ganglion, caused by a virus resulting in the formation of vesicles (fluid filled sacs) along the course of a nerve (dermatome) - acute, painful mononeuropathy caused by varicella zoster virus - characterized by vesicular eruption and marked inflammation of the posterior root ganglion of the affected spinal nerve or sensory ganglion of the CN - ventral root involvement (motor weakness) in 5-10% of cases - infection can last from 10 days to 5 weeks - posthepetic neuralgia pain may persist for months or years

Answer 104

1- fibromyalgia: 2- myofascial pain syndrome 3- postural stress syndrome -postural malalignment produces chronic muscle lengthening and/or shortening and stress to soft tissues 4-movement adaptation syndrome -habituated movement dysfunction leading to muscle strain and pain

Answer 105

widespread pain accompanied by tenderness of muscles and adjacent soft tissues a nonarticular rheumatic disease of unknown origin

Answer 106

persistent, deep aching pains in muscle nonarticular in origin characterized by well defined, highly sensitive tender spots (trigger points)

Answer 107

origin of pain experience is due to mental or emotional disorders

Answer 108

pain arising from deep visceral tissues that is felt in a body region remote from site of pathology, resulting in tenderness and cutaneous hyperalgesia ex: - medial L arm and jaw pain with MI - R subscapular pain from gallbladder attack - thoracic or flank pain from kidney problems - L upper quadrant and shoulder pain with spleen damage - R upper quadrant pain with liver problems

Answer 109

Non-traumatic: - ~10%; most likely in ppl with narrowing spinal canals - possible causes: disc prolapse, vascular insult, neoplasm, RA, radiation, spinal stenosis, surgery, cardiac arrest, AAA, infection Traumatic: - most result from from forces that create violent motions of the head/neck - Cervical: *C5-7; flexion, vertical loading, and extension accompanied by rotation or lateral flexion are most likely - Thoracic: less likely d/t rib cage and higher stability; *T12-L1 most common; flexion or vertical compression can cause wedge compression or burst fractures of vertebral bodies damaging the cord - Lumbar: neuro damage from trauma is usually incomplete due to large vertebral canal and good vascular supply; most common L1-2; cauda equina less likely to sustain a complete injury actual transection of the cord is rare Mechanisms of secondary tissue destruction: - ischemia - edema - demyelination and destruction

Answer 110

intrinsic= sensory info self acquired during performance of task augmented: externally presented feedback (VC)

Answer 111

KR: augmented feedback about the outcome of a movement KP: augmented feedback about the nature of the movement produced (characteristics)

Answer 112

Blocked: repetitive single skill Variable: varied motor skills, rapid modifications Random: skills in random order Serial: group of skills in a predictable order Massed: relatively continuous practice Distributed: rest time is larger than practice Mental: cognitive rehersal

Answer 113

feedback given after every trial improves performance variable feedback improves learning and retention early training should emphasize visual feedback (cognitive phase) later training should focus on proprioceptive feedback (associative phase of learning) early- closed environment --> open supportive feedback (reinforcement) to shape behavior, motivate

Answer 114

1- cognitive -- "what to do" - develops understanding of task - assess abilities - develop overall understanding of the skill through trial and error 2- associated -- "how to do" - practices movements - decreases errors - refinement of the motor skill through continued practice 3-autonomous -- "how to succeed" - practices - minimal level of cognitive monitoring - largely error free - after considerable practice the motor performance becomes largely automatic

Answer 115

uses total patterns of movement and posture to promote motor learning in synergistic muscle patterns and prepare the body for advanced functional skills (gait) utilizes proprioceptive elements: stretch resistance, overflow, manual contacts, approximation, traction utilizes motor learning principles: VC, visual guidance of movement, repetition and practice

Answer 116

D1 flexion for UE: "disco" - starts with GH IR, abd and extension - ends with ER, adduction and flexion - D1 extension is the opposite D2 flexion for UE: "seatbelt" - starts with GH IR, adduction and extension - ends with ER, abduction and flexion - D2 extension is the opposite D1 flexion of the LE - starts with hip IR, abduction, and extension - ends with ER, adduction, and flexion - D1 extension is the opposite D2 flexion of the LE - starts with hip ER, adduction and extension - ends with IR, abduction and flexion - D2 extension is the opposite

Answer 117

may be used to enhance breathing and movement patterns supine or sitting chopping, upper trunk flexion with rotation and UE D1 extension facilitates rolling to prone position supine lower trunk flexion with rotation to right or left; knees flexing LE D1 flexion helps rolling in any direction

Answer 118

agonist reversals approximation contract-relax hold-relax repeated contractions rhythmic initiation rhythmic stabilization slow reversal traction

Answer 119

a chronic, progressive, widespread deterioration of the cerebrum intellectual decline, loss of memory, confusion, anxiety, depression, loss of reasoning, possible motor impairment, and gait problems or contractures as the disease progresses

Answer 120

manic-depressive disorder characterized by mood swings from depression to mania

Answer 121

conversion reaction or hysterical paralysis a response to severe emotional stress resulting in involuntary disturbance of physical functions disturbances are often connected with the NS, resulting in problems with vision, sensation, hearing or motor disturbances (hemiplegia, paraplegia, quadriplegia, tics or tremors) patient is frequently indifferent to the symptoms

Answer 122

Valium, Prozac, Elavil require 3-4 weeks for mood-elevating effect side effects: - dry mouth - blurred vision - disturbed sleep - increased anxiety - disturbed balance - postural hypotension - increased HR - weight gain - blood glucose fluctuations - orthostatic hypotension in elderly patients

Answer 123

psychotic disorder characterizted by loosening of association (fragmented thoughts, errors of logic, bizzarre ideas), autistic withdrawal, ambivalence to themselves and others, and inappropriateness of affect Meds: Haldol, serouquel, risperdal -probably block postsynaptic dopamine receptors Side effects: - sedation, drowsiness - insomnia - seizures - headaches - back pain - tachycardia - orthostatic hypotension - dry mouth - constipation - weight gain

Answer 124

inability to recognize familiar objects with one form of sensation (visual agnosia)

Answer 125

inability to initiate movements

Answer 126

disturbance to language that results in errors in word choice, comprehension or syntax (word order) Expressive/Broca's - severe difficulty in verbal expression with impairment in object naming and writing abilities. - mostly found in those with L CVA Global - most common and severe form of aphasia - reduced speech AND comprehension - reading and writing impaired also Receptive/Wernicke's - severe disturbance in auditory comprehension - reading, writing and word recognition also impaired

Answer 127

inability to perform movements previously learned even though there is no loss of strength, coordination, sensation or comprehension ideational apraxia: person no longer gets the "idea" of how to do a routine task ideomotor apraxia: person can't do a task on command but can spontaneously

Answer 128

inability to recognize objects by touch alone

Answer 129

inability to move muscles together in a coordinated movement

Answer 130

uncoordinated movement, especially gait

Answer 131

slow involuntary, worm-like, twisting motions usually seen in forms of CP

Answer 132

painful burning sensations often associated with CRPS I

Answer 133

a common and bizarre breathing pattern -period of apnea lasting 10-60 seconds followed by gradually increasing, then decreasing depth and frequency of respirations accompanies depression of the frontal lobe and diencephalic dysfunction postulated to be a result of an abnormality in the neurological respiration center can occur with severe cases of TBI or CHF

Answer 134

rapid, involuntary, jerky movements seen especially in Huntington's disease

Answer 135

rhythmic oscillation of a muscle in response to sustained stretch in patients with UMN disease

Answer 136

contraction of the extensor muscles of both the UE and LE because of an injury at the brainstem

Answer 137

contraction of the UE flexors and LE extensors

Answer 138

temporary confusion and loss of mental function often as a result of illness, drug toxicity, or lack of oxygen often reversible

Answer 139

loss of memory or intellectual functioning may be reversible if caused by toxins, drugs, metabolic or psychiatric disorders often slowly progressive and nonreversible if a result of alcoholism, Alzheimer's, infarction, or Parkinson's disease

Answer 140

inability to judge distances seen in cerebellar dysfunctions

Answer 141

study of a graphic record of muscle contraction as a result of electrical stimulation used to eval the voluntary electrical activity of muscle

Answer 142

can occur in generalized peripheral neuropathies in which the distal portions of the nerves degrease resulting in anesthesia of the distal extremities seen in Guilin-barre

Answer 143

an excessive pronation during stance produces compression between the 3rd and 4th metatarsals nerve can enlarge, forming a neuroma on the interdigital nerve resulting in metatarsalgia

Answer 144

determines speed of propagation of an action potential along a nerve or muscle fiber if nerve is compressed or damaged, the velocity of AP will be slowed and the latency or time the potential takes to travel between two points will be increased test utilized to determine the severity of nerve compression prior to surgery

Answer 145

rapid, usually back and forth movement of the eyeballs

Answer 146

inhibition of muscles antagonist to those being facilitated essential for coordinated movement

Answer 147

lack of awareness of the relationship of one's own body parts or the body parts of others

Answer 148

homonymous hemianopsia - deficit of either the R or L halves of the visual field - caused by damage to the contralateral optic tract bitemporal hemianopsia - deficit of the temporal or peripheral visual fields - caused by injury at the optic chasm - AKA tunnel vision monocular blindness - blindness in one eye - result of damage to optic nerve