Neurological System Flashcards

Question

Cortical sensation - Tactile localization

Answer 1

- Ax the ability to localize touch sensation - Cotton swab or therapist fingertip - PT touches diff surfaces - Pt then point out the exact location - The distance between the stimulus and the location the pt point are recorded - EC

Answer 2

- Ax the ability to perceive two separate points on the skin simultaneously and measure the minimal detectable distance between the points - Special tool - Pt is asked if he feel 1 or 2 points - Testing continues while progressively dec the distance between the 2 points, the minimum detectable distance between two points is recorded - EC

Answer 3

- Ax the ability to perceive simultaneous touch stimulus on: - Identical locations on opposite sides of body - Proximally and distally on a single extremity - Proximally and distally on one side of the body - Pt say if he feels a touch stimulus and the # of stimuli

Answer 4

- Ax the ability to identify either numbers, letters or designs that have been traced on the skin - Agree on orientation prior starting - EC

Answer 5

- Ax the ability to differentiate among various textures - EC

Answer 6

- Ax the recognition of weight - Place object in both hands or single, compare the weight - EC

Answer 7

Non-noxious stimulus produces pain Something not painful become painful

Answer 8

Loss of pain sensitivity

Answer 9

Burning painful sensation, often along nerve distribution

Answer 10

Touch sensation produces pain

Answer 11

Heightened sensitivity to pain

Answer 12

Heightened sensitivity to sensory stimulus

Answer 13

Dec sensitivity to pain - Higher threshold for pain

Answer 14

Abnormal sensation with no apparent cause

Answer 15

- Compensatory approach - Sensory integration approach

Answer 16

- Pt educated on how to accommodate with having sensory impairment - Compensatory methods use to accomplish tasks Goal - Use alternate strategies and environmental adaptations in safe manner

Answer 17

- Stimuli are presented - Used if there's a possibility to recovery - Gradual integration Goal - Enhance sensory integration +ve effect on motor performance

Answer 18

Nerve cells, includes the cell body, dendrites, axon

Answer 19

Brain, brain stem, or spinal cord Originates before the anterior horn cells of the spinal cord

Answer 20

- Carries info down to LMN

Answer 21

Cranial nerve nuclei and motor neurons distal to the anterior horn cells of the spinal cord

Answer 22

- Receives info from UMN and carries it to muscles

Answer 23

- Weakness (spastic paralysis) - Hyperreflexive - Inc tone - Hyperactive stretch reflexes - Involuntary flexor and extensor spasms - Clonus - Babinski's sign - Exaggerated cutaneous reflexes - Loss of precise autonomic control - Dyssynergic mvt patterns

Answer 24

- Weakness (flaccid paralysis) - Atrophy - Fasciculations and fibrillations with denervation - Hyporeflexia/Areflexia - Dec or absent - Dec or absent tone - Paresis

Answer 25

- Amyotrophic lateral sclerosis (ALS) - Brain injury - Cerebral palsy - Multiple sclerosis - Spinal cord injury - Stroke - Tumor in brain or spinal cord

Answer 26

- Amyotrophic lateral sclerosis (ALS) - Bell's palsy - Cauda equina syndrome - Guillain-Barre syndrome - Peripheral nerve injury - Poliomyelitis - Post-polio syndrome

Answer 27

Resistance of muscle to passive elongation, while the individual is attempting to stay relaxed (residual contraction at rest)

Answer 28

- Hypertonia - Hypotonia - Dystonia

Answer 29

- Spasticity - Rigidity ** Inc tonicity (above normal resting levels)

Answer 30

- Flaccidity ** Dec tonicity (below normal resting levels)

Answer 31

Atteinte UMN Inc tonicity Hypertonia

Answer 32

Atteinte LMN Dec tonicity Hypotonia

Answer 33

Disordered tonicity Uncontrolled contraction

Answer 34

- Is velocity-dependent resistance to passive elongation - Inc speed of stretch = Inc resistance

Answer 35

- Clasp-knife response - Chronic spasticity

Answer 36

Spastic catch, followed by sudden inhibition (letting go) in response to a passive elongation of a muscle

Answer 37

Abnormal posturing and deformity contractures, functional limitations and disability

Answer 38

Is velocity independent hypertonic state of muscle Is associated with: Contractures, stiffness, inflexibility, and functional limitations and disability

Answer 39

- Leadpipe rigidity - Cogwheel rigidity

Answer 40

Constant uniform resistance throughout entire ROM Common with Parkinson

Answer 41

Hypertonic state with rachet-like jerkiness during muscle elongation Common with Parkinson

Answer 42

- Corticospinal tract lesion at level of diencephalon - Abnormal flexor response UE: - Shld add - Elbow flex - Wrist flex - Finger flex LE: - Leg ext and IR - Ankle PF

Answer 43

- Corticospinal tract lesion at level of brainstem - Abnormal extensor response UE: - Shld add - Elbow ext - Forearm pronation - Wrist flex - Finger flex LE: - Leg ext - Ankle PF

Answer 44

Pt with IMP cerebral lesions, mostly seen with pt in coma (ICU)

Answer 45

- Dec or absent tone - Dec resistance to passive elongation - Dec or absent stretch reflex - Difficulty in attaining and maintaining antigravity positions - Difficulty moving against gravity - Commonly associated with hyperextensibility of joints - laxe ligament - common with down syndrome - Floppy limbs (easily moved) - Part of LMN syndrome - Heavy limb, feeling like dead weigh when we (PT) try to move Note: Temporary states of flaccidity may be seen in UMN lesions during spinal shock or cerebral shock (depending on location of lesion). Duration of shock is highly variable.

Answer 46

Mvt disorder that is characterized by involuntary twisting and repetitive mvts, abnormal fixed postures and disordered tone

Answer 47

- Generalized (Normal at birth, dev in time, normally affect LE first) - Focal (Only one body part) - Segmental (Affects 2 or more adjacent area)

Answer 48

- Observation - Palpation (Hypertonia/Hypotonia) - PROM/AROM - Observing response to stretch - Symmetrical? - Hypertonia - stiff and resistant - Hypotonia - heavy and unresponsive

Answer 49

0: No inc in muscle tone - Normal 1: Slight inc in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM when the affected part(s) is moved in flexion or extension 1+: Slight inc in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM - Somewhere at 2e half 2: More marked inc in muscle tone through most of the ROM, but affected part(s) easily moved 3: Considerable inc in muscle tone, passive mvt difficult 4: Affected part(s) rigid in flexion or extension

Answer 50

- Stretching - Casting - Splinting - Orthoses - Sensory stimulation techniques

Answer 51

- Dec support - Inc resistance - Joint compression (no pain) - Not indicated for down syndrome - Manual facilitation techniques

Answer 52

- Inc support - Modify tasks - Positioning in lengthened positions - Heat (CI for MS) - Strength

Answer 53

0: No response 1+: Dec response 2+: Normal response 3+: Exaggerated response 4+: Clonus/very brisk

Answer 54

For UE: Pt crosses LE's at ankles and then isometrically abd LE's For LE: Pt interlocks fingertips and then isometrically pulls elbow apart

Answer 55

- Quickly and forcefully dorsiflex the ankle AND HOLD in the fully dorsiflexed position - Abnormal response: sustained clonus of 5 beats or more

Answer 56

- Run a pointed object along the lateral aspect of the foot, from the heel and across the ball of the foot - Abnormal response: slaying of toes and/or extension of big toe

Answer 57

- Middle finger: flick DIP of index or middle finger in flexion - Abnormal response: Reflex flexion of the DIP of the thumb and of the DIP of index or middle finger (which ever finger that was not flicked) Deep tendon reflex

Answer 58

- Clonus - Babinski reflex - Hoffman sign ** +ve finding indicates a possible lesion of the spinal cord, brainstem or brain

Answer 59

The ability to maintain stability and orientation (with the COM over the BOS)

Answer 60

The ability to maintain appropriate control of body segments in relation to each other and gravity

Answer 61

Ability to maintain COM within BOS. All the forces acting on the body must be balanced in order to maintain balance.

Answer 62

An imaginary balancing point representing the average position of all the parts of the system according to their masses. Also known as COG. Doesn't have to be in the body.

Answer 63

The area of the body or an extension of the body in contact with a support surface.

Answer 64

The maximum distance that one can lean to without losing balance or having to change the BOS.

Answer 65

Postural control at rest

Answer 66

Postural control while parts of the body is moving

Answer 67

- Sensory (afferent) input - Visual - Vestibular - Somatosensory - CNS integration (processes afferent input and determines appropriate output) - Motor (efferent) output (Execution of motor response - muscle synergies, timing and force)

Answer 68

It tests the function of 3 primary sense needed for balance and their integration - Visual - Vestibular - Somatosensory Steps: On firm surface 1. EO 2. EC 3. Dome On foam 4. EO 5. EC 6. Dome Dome - vestibular Foam - Somatosensory EO/EC - Visual Hold position for 30 sec with hands on side Test stops if feet or hands change position or if pt open their eye when it's supposed to be closed If fails - 2 more attempts per condition Record times for all 6 conditions and score them

Answer 69

Maintain balance and stability when internal/external perturbations occur

Answer 70

- Reactive - Proactive

Answer 71

- Occurs in response to external perturbations displacing the COM or a moving surface - Feedback mechanism

Answer 72

- Occurs in anticipation of internal perturbation - Prior experiences allow postural control system to be pre-tuned or anticipate the upcoming postural adjustments - Feedforward mechanism

Answer 73

- Ankle strategy - Hip strategy - Stepping strategy Lessor I I Greater

Answer 74

Used to correct balance perturbations and return to stability

Answer 75

- COM is shifted forwards or backwards by moving the body as a relatively fixed pendulum, with the ankle joint acting as the axis. - Fixed support strategy. - Muscle activation occurs from distal to proximal. - Commonly used in response to small displacements of the COM, which are still within the LOS. - Forward sway Vs backward sway Forward: Gastroc -- hamstring -- paraspinals Backward: Tibial ant -- quad -- abdominals

Answer 76

- COM is shifted forwards or backwards by flexing or extending the hip. The head and hips move in opposite direction. - Fixed support strategy. - Muscle activation occurs from proximal to distal. - Commonly used in response to larger and faster displacements of the COM, which exceed the LOS. - More commonly used in the elderly. - Forward Vs backward sway Forward: Abdominals -- quad Backward: Paraspinal -- hamstrings

Answer 77

- Re-establishing a new BOS through mvt of a limb to a new contact support surface. - Change-in-support strategy. - Commonly used in response to large, fast displacements of the COM, which exceed the LOS. - Rapid steps or hops are taken in the direction of the COM in order to establish a new BOS, placing the COM within the newly established BOS.

Answer 78

- Functional balance grades - Romberg test - Functional reach test (FR) - Berg balance scale (BBS) - Performance-orientated mobility assessment (POMA) - Get up and Go test (GUG) - Timed up and Go test (TUG)

Answer 79

4. Normal: Pt able to maintain steady balance without handhold support (static). Pt accepts maximal challenge and can weight shift easily within full range in all directions (dynamic). 3. Good: Pt able to maintain balance without handhold support, limited postural sway (static). Pt accepts moderate challenge, able to maintain balance while bending to pick an object up from the floor (dynamic). 2. Fair: Pt requires handhold support, occasional minimal assistance (static). Pt accepts minimal challenge, able to balance while turning head/trunk (dynamic). 1. Poor: Pt requires handhold support and moderate to maximal assistance to maintain position (static). Pt unable to accept challenge or move without loss of balance. 0. Absent: Pt unable to maintain balance.

Answer 80

- Helps determine proprioceptive contribution to balance. - Pt instructed to remove shoes and socks and stand feet together, arms by their side, with EO for 20-30 sec. If pt is unable to maintain balance test is stopped. - The pt is then instructed to repeat the procedure above with EC. Minimal sway is acceptable (-ve test). - +ve test: Pt is able to stand with EO, but is unstable or falls with EC. - Sharpened Romberg test = Tandem stance

Answer 81

- Provides a quick screen for checking balance problem in older adults. - Measures max distance an individual can reach forward while standing in fixed BOS. - Lower or equal to 6 inches is a predictive of falls. - Dynamic Procedure: - Pt stands sideways next to the wall, feet moral distance apart with equal weight distribution. - Shld nearest to the wall flexed to 90 deg with elbow extended and fist closed. - Start position measurement is made of the position of the 3rd MCP using yard stick. - Pt is asked to reach forward as far as possible without touching the wall and without moving feet (fixed BOS). - End position measurement is made of the position of the 3rd MCP using a yard stick. - The difference between the start and the end position is the pt's functional reach. - 3 trials are performed and the average of the last 2 are recorded.

Answer 82

- Used to ax both static and dynamic balance and determine risk of falls in adult populations using 14 separate items. - Items are scored from 0 (poor performance)-4 (excellent performance) - Item scores are summed; maximum score of 56 (14x4). - Certain scores can indicate level of fall risk specific neurological populations. - Dec score = Inc fall risk General interpretation: 41-56: low fall risk 21-40: medium fall risk (walking with assistance) 0-20: high fall risk (wheelchair bound)

Answer 83

- Brief and reliable measure of static and dynamic balance. - Balance tests: 9 test, max score 16 - Gait tests: 7 tests, max score 12 Grading: - Some items scored 0-2, some items scored 1-2, and some are timed. - Total max score 28. - Lower than 19 = high risk for falls. - 19-24 = moderate risk for falls/

Answer 84

- Brief measure of dynamic balance and mobility. - Pt is seated in a standard arm chair with back resting against the chair. - The pt is instructed to stand up from the chair and walk 3m at their normal speed, turn around, return, and sit down in the arm chair. - Assistive devices may be used, but must be documented. Graded: 1 - Normal 2 - Very slightly abnormal 3 - Mildly abnormal (higher or equal to 3 = inc risk of falls) 4 - Moderately abnormal 5 - Severely abnormal

Answer 85

- Used to ax mobility, balance, walking ability and fall risk in older adults. - Advise pts to use their regular shoes and any assistive devices the pt uses to ambulate in the community. Setup: Instruct the pt to sit back in a standard arm chair and mark a line 3m away on the floor. Instructions: - When I say GO, I want you to stand up from the chair, walk to the line on the floor at your pace, turn, walk back to the chair at your normal pace and sit down. - Timing begins when you say GO and ends when the pt's buttocks touches the seat. - Pt is allowed 1 practice trial, and is to use the same aid throughout all the trials (maintain consistency). - Observe for pt's postural stability, appropriate use of walking aid, gait, stride length and sway. General interpretation: - Less than 10 sec = normal for most adults - Higher/equal to 12 sec = fall risk - 11-20 sec = WNL for frail elderly or individuals with disability - More than 30 sec = impaired functional mobility

Answer 86

- Clear obstacles in the room - Proper footwear - Guard appropriately: guard closely, hands up, stand on their weaker side - Monitor their face for signs of fear or unsteadiness - Gauge pt's abilities - Start with MOST to LEAST stable position - Challenge appropriately: Progress from the LEAST to MOST difficult mvt - Regress positions or mvt if necessary

Answer 87

- Altered BOS - Internal perturbations - Reactive balance strategies (expected vs unexpected) - Altered vision - Altered speed - Moving COM higher - Include cognitive demanding tasks

Answer 88

Disruption in cerebral circulation causing a sudden loss of neurons and neurological function Problem with blood circulation causing ischemia or tissue death.

Answer 89

- Ischemic (Thrombus blocking an artery or embolus blocking an artery) - Hemorrhage (From an aneurysm, an artery, an arteriovenous malformation)

Answer 90

Cloth forming at the vessel wall in the brain and stay's there. It interrupt cerebral blood flow. And is the most common etiology.

Answer 91

Cloth that dislodge and travel threw the blood stream. Is formed elsewhere in the body. And lodge in the cerebral arteries' vessels interrupting cerebral blood flow. *Sudden onset -- Become suddenly occluded* 2e most common etiology.

Answer 92

Weakening of the artery wall causing an abnormal localized dilation of an artery. Can burst and create bleeding.

Answer 93

Majority of strokes are ischemic (80%)

Answer 94

May be due to cardiac failure or significant blood loss leading to systemic hypotension and thus dec cerebral blood flow. The brain is not getting enough oxygen therefore can eventually lead to ischemia and tissue death.

Answer 95

Less common (20%) Typical sudden onset Inc mortality rate

Answer 96

- Intracerebral - Subarachnoid

Answer 97

Due to a rupture or leak of a weak blood vessel in the brain.

Answer 98

Due to an arteriovenous malformation or a ruptured aneurysm which causes bleeding in the subarachnoid space.

Answer 99

Ischemia without tissue death which causes a transient episode of neurological dysfunction. TIA symptoms typically resolve in 24 hours or less. Is often referred as a mini stroke or warning stroke and is considered a warning sign for CVA. Many people who have a stroke have had one or more TIA's before their stroke.

Answer 100

- Area surrounding ischemic event - Penumbra area may remain viable following an ischemic event for several hours due to supply of collateral arteries to the area - One of the main priorities immediately following an ischemic stroke is attempt to save the ischemic penumbra. Thrombolytic agents (helps break the cloth) are administered within 4-5 hours following onset of symptoms and attempts are made to dec ICP from cerebral edema.

Answer 101

- A congenital defect resulting in a tangle of abnormal arteries and veins, which bypass the capillary system - Progressive dilation with age - Eventual bleeding in 50% of AVM cases

Answer 102

- Hypertension - Heart disease - Disorders of heart rhythm - Diabetes mellitus - Hypercholesterolemia - High levels og LDL - Low levels of HDL - Elevated hematocrit - End-stage renal disease and chronic - Kidney disease - Sleep apnea

Answer 103

- Early menopause - Estrogen supplementation - Pregnancy, birth, first 6 weeks post-partum - Preeclampsia (High blood pressure during pregnancy)

Answer 104

- Smoking - Physical inactivity - Obesity - Diet - Excessive alcohol use

Answer 105

- Family hx - Age - Gender (M more than W) - Race (African American)

Answer 106

FAST F - ace is it drooping? A - rms can you raise both arms S - peech is it slurred or jumble? T - ime to call 911

Answer 107

- Anterior Cerebral Artery (ACA) syndrome - Middle Cerebral Artery (MCA) syndrome - Internal Carotid Artery (ICA) syndrome - Posterior Cerebral Artery (PCA) syndrome - Vertebrobasilar Artery syndrome - Lacunar strokes ** The clinical presentation and impairments of a pt is related to what area of the brain is affected, the size of the lesion, hemisphere involved, blood vessel involved, collateral blood flow availability, neural redundancies available in the brain, as well as individual anatomical differences. **

Answer 108

- ACA supplies medial aspect of cerebral hemisphere (frontal and parietal lobes), and subcortical structures (basal ganglia, anterior fornix, corpus callosum) - The anterior communicating artery allows for perfusion of the proximal ACA from either side - If the occlusion is proximal to the anterior communicating artery there will be minimal - If the occlusion is dilated to the anterior communicating artery there will be greater deficits - Common characteristics - Contralateral hemiparesis and hemi-sensory loss - LE affected more than UE - Urinary incontinence - Abulia - Akinetic mutism (doesn't move and speak much) - Apraxia (difficulty with motor planning - Broca's aphasia (frontal lobe) - Motor speech impairments

Answer 109

- MCA supplies the lateral aspect of cerebral hemisphere (frontal, temporal, and parietal lobes), and subcortical structures (internal capsule, corona radiata, globus pallidus, caudate, and the putamen) - Occlusion of proximal MCA results in extensive neurological damage - Most common site of occlusion in stroke - Common characteristics - Contralateral hemiparesis and hemi-sensory loss of face, UE, and LE - UE affected more than LE - Contralateral homonymous hemianopia - Wernicke's aphasia (temporal lobe) - Problem with receptive speech, problem with understanding, but talking tone is normal - Broca's aphasia (frontal lobe) - Global aphasia (nonfluent speech + poor comprehension) - Perceptual deficits (unilateral neglect, anosognosia, apraxia, spatial disorganization/depth perception) - typically if lesion is in non-dominant hemisphere Anosognosia - typically in R hemisphere, present as someone who lack insight

Answer 110

Hemianopia = Loss of visual field on one side of midline Homonymous = Loss on the same side of both eyes

Answer 111

- ICA supplies both the MCA and ACA - Occlusion of the ICA typically results in large obstruction of area supplied by MCA - ACA has collateral circulation from circle of Willis, but if absent, area supplied by ACA will also be affected - Significant edema is common which may inc ICP possibly leading to uncal herniation, coma and even death

Answer 112

- PCA supplies the occipital lobe, medial and inferior temporal lobe, upper brainstem (midbrain), posterior diencephalon (includes most of thalamus) - The posterior communicating artery allows for perfusion of the proximal PCA from either side - If occlusion is proximal to the posterior communicating artery there will be minimal deficits - If occlusion is distal to the posterior communicating artery there will be greater deficits Common characteristics: - Peripheral Territory: Amnesia, homonymous hemianopia, visual agnosia (no problem with vision, but can't recognize objects), prosopagnosia (Difficulty naming people), dyslexia (learning disorder characterized by difficulty of reading), color naming and discrimination problems - Central Territory: Central post-stroke (thalamic) pain - severe shooting/burning pain, hemianesthesia (can't feel anything on one side), sensory impairments (all modalities - Vision, touch, smell), contralateral hemiplegia (completely paralyzed), oculomotor nerve palsy (controlling mvt of eyes)

Answer 113

- Vertebral artery supplies the cerebellum and medulla - Basilar artery supplies the pons, interna ear, and cerebellum - May produce both ipsilat and controlat signs and sympts because some tracts in the brainstem will have crossed and some have not at the site affected - Typically from high neck force or aggressive neck manipulation Common characteristics: - Ataxia (ipsilat), impaired sensation over face, impaired pain and thermal sensation (controlat), vertigo, diplopia, dysarthria, dysphagia - Many other presentations - dependent on the structures involved

Answer 114

- A condition in which a pt is aware and awake, but has completely paralyses or nearly all voluntary muscles in the body except for the eye and are otherwise cognitively intact. Pts with LIS may be able to communicate through blinking or vertical eye mvt, which are often not affected by the paralysis. - LIS has a sudden onset - There is preserved consciousness and sensation - When the eyes are paralyzed as well, the syndrome is known as Total Locked-in syndrome

Answer 115

- Caused by occlusion of small penetrating arteries suppling the brains deep structures - Account for more than 20% of all stroke - Strongly associated with hypertension and diabetes - Can be symptomatic or silent - Lacunar syndromes are consistent with specific anatomical sites - Pure motor lacunar stroke - Pure sensory lacunar stroke - Other lacunar syndromes: dysarthria/clumsy hand syndrome, ataxic hemiparesis, sensory/motor stroke, dystonia/involuntary mvts - Higher cortical areas are preserved. Consciousness, language, or visual fields are not affected

Answer 116

- Disorders of speech and language - Dysphagia - Cognitive dysfunction - Altered emotional status - Hemispheric behavioral differences - Perceptual dysfunction - Seizures - Bladder and bowel dysfunction - Cardiovascular and pulmonary dysfunction - DVT and pulmonary embolus - Osteoporosis and fracture risk

Answer 117

- Dysarthria - Aphasia

Answer 118

- Motor speech disorder affecting the muscles used to produce speech (lips, tongue, vocal cords) - Speech may be slow, and/or slurred and can be difficult to understand

Answer 119

Impairment of language (speech or written) affecting comprehension and/or production. - Receptive aphasia - Expressive aphasia - Global aphasia

Answer 120

- Difficulty with comprehension of language - Speech flows smoothly and melody of speech is preserved - Also known as fluent aphasia or Wernicke's aphasia ** What pt is saying doesn't make sense in context **

Answer 121

- Difficulty with speech production - Flow of speech is slow and hesitant, limited vocabulary, and impaired syntax - Comprehension is not affected ** Content words, struggling to get the words out **

Answer 122

- Difficulty with language comprehension and production - Indicative of extensive brain damage - Limit's pt ability to learn, therefore affects outcomes of rehab ** As PT we want to break down what we are saying, use hand signals and closed ended questions **

Answer 123

- Difficulty swallowing - Aspiration (breathing in food) occurs in 1/3 of pt with dysphagia - Aspiration can lead to respiratory distress (because of obstruction in airway), aspiration pneumonia, and possibly even death - If dysphagia is severe nothing-per-oral precautions are given, using tube feeding - Dysphagia is associated with dehydration and poor nutritional status

Answer 124

Impairments in alertness, orientation, attention, memory, or executive functions. - Memory - Perseveration

Answer 125

- Short-term memory may be affected, long-term memory unaffected - Memory gaps may be filled with made-up stories or inappropriate words

Answer 126

- Persistent repetition of words, thoughts, or gestures without appropriate context - Pt gets stuck and repeat words or acts Common post-stroke or with people with down syndrome

Answer 127

- Pseudobulbar affect - Apathy - Euphoria - Depression

Answer 128

- Sudden and unpredictable outburst of crying, laughing, or other emotional displays not consistent with mood - Quickly changes from one extreme to another - Also known as emotional lability or emotional dysregulation syndrome

Answer 129

- Blunted emotional response - May be mislabeled as depressed or having poor motivation

Answer 130

- Exaggerated feelings of well-being and happiness

Answer 131

- Persistent feelings of sadness - Psychomotor slowing - motor changes due to depressed state (not directly due to stroke) - Pt with L hemisphere lesions may experience more frequent and severe depression

Answer 132

- Slow, cautious, anxious, and disorganized - Hesitant to try new tasks (requires more feedback, support, and encouragement) - Aware of their deficits - Difficulties with communication and processing info in a sequential linear order

Answer 133

- Quick, impulsive, poor judgement - Overestimate abilities - Unaware of their deficits - Inc safety risk (feedback focused on slowing down, and recognizing risks and consequences of actions) - Difficulties with spatial-perceptual tasks and in grasping the whole idea of an activity or task

Answer 134

Typically, as a result of lesion in the R parietal cortex - Body scheme - Body image - Spatial relations - Agnosia

Answer 135

Internal awareness of the relationship of the body parts to each other and to the environment

Answer 136

The mental image and feeling of one's own body Can lead to depression

Answer 137

Difficulty perceiving relationship between self and objects in space. Inability to recognize vertical, horizontal, depth and distance.

Answer 138

Inability to interpret sensory info (despite intact sensations). This results in an impairment in recognition. There's... - Visual agnosia - can't perceive what they are seeing - Auditory agnosia - no problem with earing just can't recognize what is being said - Tactile agnosia - can't recognize thing with touch

Answer 139

- Unilateral neglect - Anosognosia - Somatagnosia - R-L discrimination - Finger agnosia

Answer 140

- Lack of awareness of part of one's own body or of the external environment - Limited use of the more affected limbs - No reaction to sensory (visual, auditory, or somatosensory) stimuli presented on the more affected side - Can lead to injury of affected limbs - Almost always seen in R hemisphere lesion - Also known as hemi-neglect, hemispatial neglect, or hemisensory neglect ** Not only affecting vison, but also hearing + sensory ** L eye only see on R R eye can see both sides

Answer 141

Lack of insight, unaware they have a disorder

Answer 142

Disorder of body awareness, unable to recognize their body parts and their relationship Exemple si on decompose une doll, les pt vont la reconstruire toute croche, ils ne savent pas quels partie est quoi

Answer 143

Unable to recognize finger

Answer 144

Hemianopia: Loss in visual field, it's the sense, there fully aware of their condition, if someone is talking to them on affected side, they can turn their head. Neglect: There's no problem with their vision, they can't perceive it, as if it doesn't exist, they only see half

Answer 145

- Pt hx - Systems review - Tests and measures

Answer 146

- Cranial nerve integrity - Sensation - Flexibility and joint integrity - Motor function - Stages of motor recovery - Tone - Reflexes - Voluntary mvt - Coordination - Motor programming - Muscle strength - Postural control and balance - Gait and locomotion - Integumentary integrity - Aerobic capacity and endurance - Functional status - Stroke specific instruments - FMA - STREAM - Chedoke-McMaster - SIS

Answer 147

Stage 1: Flaccid paralysis Stage 2: Recovery begins. Spasticity begins. Development of minimal mvt in synergies. Stage 3: Voluntary control of mvt synergies. Spasticity inc. Stage 4: Spasticity begins to dec. Some mvt out of synergies. Stage 5: Further dec in spasticity. Mvt almost independent synergies. Stage 6: Disappearance of spasticity. Patterns of mvt are near normal.

Answer 148

- Initial flaccidity immediately following stroke (that's because of cerebral shock) and last only a few days - After that, spasticity emerges and it will look more like an UMN syndrome - UE spasticity strong in scapular retractors; shld add, depressors, and IR; elbow flexors and forearm pronators; and wrist and finger flexion - LE spasticity strong in pelvic retractors; hip add, extensors, and IR; knee extensors; PF and supinators, and toe flexors - In the neck and trunk strong spasticity may cause inc lat flexion to hemiplegic side (pusher syndrome)

Answer 149

- Initial hyporeflexia (because of cerebral shock) - Hyperreflexia is seen when spasticity and synergies emerge May demonstrate UMN syndrome responses: - DTR: Hyperreflexia - Clonus - Babinski - Clasp knife response - Associated reactions may be seen. May affect functional performance.

Answer 150

- Obligatory synergies with spasticity following stroke - Pt is unable to perform an isolated mvt of a single segment without producing mvt in the other segments of the same limb - Synergies will interfere with functional mobility skills and normal ADL's - Synergies influence and voluntary control may vary from one limb to the other

Answer 151

Think of bicep flexion - Scapula retracted and elevated - Shld abd and ER - Elbow flexion - Forearm supinated - Wrist flexion - Finger flexion

Answer 152

Think of triceps extension - Scapula protraction - Shld add and IR - Elbow extension - Forearm pronated - Wrist Flexion - Finger flexion

Answer 153

- Hip flexion, abd, ER - Knee flexion - Ankle DF - Toe extension

Answer 154

- Hip extension, add, IR - Knee extension - Ankle PF and inversion - Toe flexion

Answer 155

May have poor coordination depending on the area affected - Sensory ataxia (Proprioception loss) - Cerebellar ataxia (Cerebellum affected) - Bradykinesia (slow mvt), choreoathetosis Type of mvt disorder, involuntary mvt, twisting mvt "snake mvt of wrist"), hemiballismus (Half, mvt disorder, sudden uncontrolled fast mvt) (Basal ganglia affected) Examine coordination using both unilat and bilat mvt Performance may vary depending on position due to postural demands and degrees of freedom (Supine --- Sitting --- Standing)

Answer 156

- Apraxia - Ideational apraxia - Ideomotor apraxia

Answer 157

- A motor disorder causing difficulty planning and performing tasks or purposeful mvts - No primary motor impairments - More evident with L hemisphere damage

Answer 158

- Inability to produce purposeful mvt on command or automatically - No idea how to do the mvt

Answer 159

- Inability to produce purposeful mvt on command, BUT is able to perform mvt automatically - Can perform habitual tasks when not asked to do so, but can't perform if asked to do so - Often perseverates

Answer 160

- May exist following a stroke - Pt with hemiplegia typically fall towards the hemiplegic side - It is IMP to ax both static and dynamic balance control in both sitting and standing - Performance-based tests may also be used to ax postural control and balance (BBS, POMA, TUG...) - Stroke-specific tests for postural control and balance may be used to ax balance (PASS, FIST) Potential causes: - Hemiparesis - Poor reactive or anticipatory reaction - Sensory loss - Uneven weight distribution - Spasticity - Abnormal core activation - Delay's in muscle contraction - Postural control

Answer 161

- Also know as contraversive pushing or ipsilat pushing - A disorder of postural control which may lead to a loss of balance - Unusual tendency to push weight from the non-hemiparetic (strong) side to the hemiparetic (weak) side with resistance to passive correction - Tendency to fall towards to the hemiparetic side - Altered sense of verticality - Occurs in 10% of acute stroke pts with posterolat thalamus involvement

Answer 162

1. tilting toward the paretic side often 2. abd and extension of unaffected limb 3. resistance to passive correction Each criteria is done in sitting and in standing and scored 0 to 1. The pt is dx with pusher syndrome if they have all 3 criteria and present with a score of 1 or more in each criteria

Answer 163

- Avoid transfers to paretic side (might push themselves over) - Avoid gait aids (will often use to assist in pushing towards paretic side) - Be aware of where and how you position pt (may give opportunities to push off of objects in surrounding environment or may at risk of falling) 1 way to help with cane, short cane on good side help them lean back Improve postural control and balance by... - Train active mvt shift toward strong side - Encourage pt to problem solve (ask question - what direction are you tilted? What position should you move to to be upright?) - Visual cues or stimuli - Verbal cues or stimuli - Tactile cue or stimuli - Shorten cane on good side

Answer 164

Is based on stage of recovery, degree of disability, and pt goals Preventative: Aimed at minimizing potential complications and secondary impairments. Restorative: Aimed at improving impairments and limitations. Compensatory: Aimed at modifying the task, activity, or environment to improve function and participation

Answer 165

- Improve sensory function - Improve flexibility and joint integrity - Improve strength - Improve mvt control and UE function - Improve functional status - Improve postural control and balance - Improve gait and locomotion - Improve aerobic capacity and endurance

Answer 166

Sensory retraining/stimulation approach - Mirror therapy - Sensory discrimination activities - Compression techniques - Electrical stimulation - Thermal stimulation Safety education (improve awareness of impairments and protection of anesthetic limb) Interventions for hemianopia (aware) and unilat neglect (unaware) - Encourage awareness and use of environment on hemiparetic side - Active visual scanning mvt - Cueing to direct attention - UE exercises involving crossing midline toward hemiparetic side - Functional activities involving bilat interaction - Prism glasses

Answer 167

- PROM and AROM should be performed daily in all motions - Scapula should be mobilized on thoracic wall with emphasis on protraction and upward rotation to prevent shld impingement with overhead activities and to prepare for reaching activities - Overhead pulley self-mvt is CI if haven't achieved proper scapula-humeral mvts - WB with open hand and extended wrist is often prescribed to work on wrist and finger flexor tightness - Position to maintain soft tissue length and encourage proper joint alignment - Use of protective devices

Answer 168

GOOD - Allows pt to become more aware of affected side - WB on weaker side will regulate abnormal muscle tone - Inhibits abnormal postures

Answer 169

- Pt is sideling with the back parallel to bed rail to reduce trunk flexion - Affected shld should be in 90 deg of flexion to prevent flexion spastic patterns - Forearm supinated and elbow is either in flex/ext - Affected leg is slightly flexed at the knee - Unaffected leg is placed on a pillow ahead of the affected

Answer 170

- A pillow should be placed behind the pts back to prevent them from going into supine - Between the knees - Under the head

Answer 171

- Pt should be lying on their affected scapula rather than the humeral head - If you are correcting the position of the scapula, do not pull the affected arm - Slide your hand underneath the scapula wrapping your fingers around medial border of the scapula and bring the shld blade forward

Answer 172

- Inhibits extension synergy in LE - Allows control for abnormal mvt patterns

Answer 173

- Pt is sideling with the back parallel to bed rail to reduce trunk flexion - Position affected scapula in protracted position with arm in 90 deg of flexion with elbow extended - Affected hand open with wrist neutral - Unaffected limb in comfortable position - Affected leg is slightly flexed in both hip and knee - Unaffected leg has the hip positioned in slight extension and knee flexion - Affected foot in neutral position

Answer 174

- A pillow should be placed behind the pt's back to prevent them from going into supine - Between the knees - Under the head - Pillow supporting affected arm, elbow and hand

Answer 175

- Prevents knee flexion contractures - Allows symmetry of trunk and limbs

Answer 176

- Trunk is symmetrical to prevent lateral flexion - Affected shld is supported with elbow extended, wrist supinated with wrist in neutral and finger open - Knees in full extension (DO NOT PLACE A ROLL UNDER KNEES)

Answer 177

- Under head - Under affected arm - Under affected hip if pelvis is causing ER of hip - Towel under affected shld if it is lower than the unaffected shld (DON"T RAISE SHLD WITH A TOWEL IF IT'S AT THE SAME LEVEL OF UNAFFECTED)

Answer 178

- Progressive resistive strength training helps improve strength with no evidence on -ve effects on spasticity or ROM - Combined resistance training with functional activities in order to enhance carry over to assist with daily functional tasks Exercises precautions: - Specially designed gloves or wrist weights may be used for pts demonstrating poor hand function - Impaired sensation = Inc injury risk - Postural deficit = Inc fall risk - High incidence of hypertension and cardiac disease in pts with stroke *** Spasticity does not = strength ***

Answer 179

- Focus on dissociation of segments and selective out-of-synergy mvt patterns - Aim is to practice mvts as close to normal as possible - Therapist may help guide mvt or use facilitation techniques but should shift to active control as soon as possible - Meaningful task-oriented practice should be included using the affected limb - Constrain-induced mvt therapy may be used to promote inc use of affected UE, used 90% of waking hours

Answer 180

- Arm should be supported at all times - Proper positioning and handling - Tray or arm trough for wheelchair - Arm sling - Strapping/taping - Gentle guided exercises - PROM 9with scapula mobilization) and gentle mobilization - Functional electrical stimulation - Don't pull on arm or let it hang unsupported

Answer 181

- Bed mobility - STS and STS transfers - Sitting - Standing - Transfers

Answer 182

Body weight support and motorized treadmill training (USING HARNESS) - Controls upright posture when postural stability is poor - Dec fear of falling - Can gradually reduce % of body weight supported until pt can fully weight bear - Research does not show significant statistical difference between BWS & TT vs other PT interventions in regards to parameters of walking. A small subset of stroke pts may benefit. Functional electrical stimulation - DF (drop foot) - Quad (prevent knee buckling) Orthosis and assistive devices - Temporary Vs Permanent - AFO Wheelchairs - Hemi-height wheelchair (foot propulsion) - One-arm drive wheelchair - Power wheelchair

Answer 183

- Circumduction (because the foot is in PF) - Spasticity - Weak DF - Dec muscle tone - Drop foot - Hyperextension of knee - Weak quad - Poor motor control

Answer 184

A brain injury caused by an external force

Answer 185

- Primary injury - Secondary injury

Answer 186

Immediate trauma to brain parenchyma at moment of insult or injury

Answer 187

Result of secondary effects of initial injury, hypoxia/ischemia, edema, and inc ICP, which may evolve over time after initial insult or injury

Answer 188

- Contact (open vs closed injury) - Acceleration-deceleration (compression, tension, shearing) - Rotation (Angular acceleration)

Answer 189

- Focal injury (more local and specific to an area) (Non-penetrating vs penetrating) - Diffuse axonal injury - Hypoxic-ischemic injury - Inc ICP

Answer 190

Normal = 5-20 cm H2O Elevated = higher than 20 cm H2O Critical = higher than 25 cm H2O ** Needs medical emergency tx **

Answer 191

- Dec consciousness (stupor and coma) - Altered vital signs - Widened pulse pressure - Irregular breathing (Cheyne-stokes) - Vomiting - Headache - Non-reacting pupils - Papilledema - Progressive impairment of motor function - Seizure activity

Answer 192

We want to elevate HOB at 30 deg, it promotes venous drainage and dec ICP. Time to onset of effect = Immediate Supine + lowering HOB = CI.

Answer 193

- Neuromuscular - Cognitive - Neurobehavioral - Communication - Swallowing - Dysautonomia - Visio-perceptual - Post-traumatic seizure - Secondary impairments and complication

Answer 194

- Paresis - Abnormal tone - Coordination - Motor function - Postural control - Abnormal gait - Somatosensory function

Answer 195

- Arousal level - Attention - Concentration - Memory - Learning - Executive functions

Answer 196

- Coma - Vegetative state - Minimal conscious state - Stupor - Obtunded ** Pt with low arousal states may also present with abnormal tone or posturing (decorticate or decerebrate rigidity) **

Answer 197

- Arousal system not functioning - EC - Sleep/wake cycles absent - Ventilator dependent - No auditory, visual, cognitive, or communicative function - Abnormal motor and postural reflexes may be present

Answer 198

- Eyes may be open, but awareness is absent - Brainstem able to manage basic cardiac, respiratory, and other functions (pt can be weaned off ventilation) - Sleep/wake cycles present - May startle to visual or auditory stimuli - Meaningful motor, cognitive, or communicative function absent

Answer 199

- Minimal evidence of awareness - Cognitively mediated behavior occur inconsistently - Sleep/wake cycles present - Will localize to noxious stimuli and may inconsistently reach for objects - May localize to sound location and demonstrate visual fixation and pursuit

Answer 200

Almost unresponsive state. Can be aroused briefly with vigorous, repeated stimulation.

Answer 201

Dec alertness. Sleeps often.

Answer 202

- Anomia - Anterograde amnesia - Retrograde amnesia - Post-traumatic amnesia

Answer 203

Difficulty remembering name, proper nouns, or other abstract nouns

Answer 204

- Not remembering anything from the injury forward - Likely to remember information prior to insult/injury 50 first date

Answer 205

- Not remembering events prior to injury - May initially be very long, but may partially resolve - May never remember events leading up to injury

Answer 206

The time between the injury and when the pt is able to recall recent events

Answer 207

- Agitation - Apathy - Emotional lability - Mental inflexibility - Disinhibition - Anxiety - Aggression - Impulsiveness - Irritable - Lack of initiation - Psychotic ideation - Egocentricity - Poor self-image - Sexual apathy - Disinhibition

Answer 208

- Aphasia - Auditory processing deficits - Subtle language processing deficit - Disorganized communication - Imprecise language - Difficulty with word retrieval - Socially inappropriate - Difficulty communicating in distracting environments - Difficulty reading social cues or adjusting to the situation

Answer 209

- Dysphagia Tx with speech language therapist

Answer 210

- Inc SNS activity following TBI Resulting in ... - Inc HR - Inc RR - Inc BP - Diaphoresis - Hyperthermia

Answer 211

- Damage to occipital lobe --- resulting in visual impairments - Perceptual impairments: Apraxia, spatial neglect, somatagnosia

Answer 212

Less than half of people with TBI develop post-traumatic seizures

Answer 213

- Cardiovascular problems - Chronic pain - Contractures - DVT - Dec endurance - Fx - Genitourinary problems - GI difficulties - Heterotopic ossification - Muscle atrophy - Peripheral nerve damage - Pneumonia - Pressure ulcers - Respiratory problems

Answer 214

- Arousal, attention, and cognition - Integumentary integrity - Sensory integrity - Motor function - ROM - Reflexes - Ventilation and respiration

Answer 215

- Measure level of consciousness - Helps classify severity of injury (mild, moderate, severe) - Help track progress - 3 Response scores (eyes opening, motor, verbal) - Scores from separate responses are summed to provide total score

Answer 216

- Descriptive scale used to track cognitive and behavioral recovery as pt emerges from a coma - Useful for communication of status and tx planning - Pt may plateau at any level

Answer 217

- Questions include name, city, recall of how pt is, where he or she is, day, date, month, year, and event of injury - Helps in determining outcome or prognosis

Answer 218

Predicators of poor outcome: - Low initial score to GCS - Lower education level - Very young (younger than 7 y.o) and older (holder than 40 y.o) - Longer periods of post-traumatic amnesia (less than 34 days = good recovery)

Answer 219

- Primary goal of PT is to prevent secondary complications and begin mobilization when medically cleared - Cognitive and behavioral impairments can make examination and tx difficult. The therapist must understand how to work with the pt's impairments - PT also plays in IMP role in pt and family education

Answer 220

- Consistency - Expect No Carryover - Model Calm Behavior - Expect Egocentricity - Flexibility/Options - Safety

Answer 221

- Interact and address inappropriate behaviors in a consistent manner - Pt should be seen by the same person at the same place and time every day - Establish a routine. Can be calming and reassuring due to sense of familiarity - Help re-orient the pt in a nonthreatening manner

Answer 222

- Teaching new skills in this stage may be unrealistic. Work near the pt's physical level and use familiar tasks, rather than trying to progress to more challenging skills that require learning - Pt may be able to perform automatic skills like ambulation or brushing teeth. Does not mean that any learning took place. - Pictures, charts, or graphs may be used to help pt recall prior days therapy.

Answer 223

- Therapist must assume calm and focused affect and behavior - The pt lack control of his or her behavior and may feel unsafe. Therapist must be perceived as in control of his or her affect and behavior in order to help model appropriate behavior to the pt

Answer 224

Pt may not be able to see another person's point of view. He or she will typically only think of him or herself and appear selfish. At this stage, do not stress the pt to try and see other people's point of view.

Answer 225

- Pt will likely have short attention span. If pt cannot be redirected back to the selected activity, be prepared with numerous activities that they may be directed to. - Treat the pt at an appropriate age level - When it's safe and appropriate, give control to the pt. This can be done by allowing the pt to choose between therapeutic activities.

Answer 226

Keep the pt and those around them safe. TBI pts can often be unpredictable and display inappropriate behaviors

Answer 227

- A form of traumatic brain injury caused by biomechanical forces that disrupt the physiological functions of the brain - The term mTBI and concussion are often used interchangeably - It is characterized by a functional injury to the central nervous system, primarily affecting metabolic functions, neurotransmitters disturbances, and microstructural changes

Answer 228

Typically results from a direct blow to the head, neck, or forces transmitted to the brain from another part of the body.

Answer 229

- Combination of understanding the mechanism of injury, symptom presentation, and clinical signs - A GCS score of 13-15 indicates mTBI - Neuroimaging is typically not indicated as mTBI do not reveal physical brain abnormalities

Answer 230

- Headache - Nausea - Dizziness - Poor balance - Fatigue - Difficulty sleeping - Eyestrain - Visual difficulties - Feeling confused or foggy - Frustration - Light sensitivity - Noise sensitivity - Ringing in the ears (tinnitus) - Difficulty hearing - Irritable - More emotional - Difficult concentrating and remembering

Answer 231

- Most individual recover within 7-10 days, but 10-20% may experience prolonged symptoms. known as post-concussion syndrome. - Full recovery may take several months or even years in some cases. - Early recognition and management are essential to preventing prolonged disability

Answer 232

- Examination should be conducted in a closed, quiet, dimly lit environment void of distraction. - Examination should begin with least provocative tests Testing may include... - Self-report symptom scales - Cognition testing - Vestibular and Balance testing - Oculomotor testing - Standard musculoskeletal testing for other potentially affected areas - Outcome measures (SCAT, BCTT)

Answer 233

- Worsening or severe headache - Very drowsy or cannot be easily awakened - Cannot recognize people or places - Develops significant nausea or vomiting - Behaves unusually, more confused or irritable - Develops seizures - Weakness or numbness in the arm or legs - Slurred speech - Unsteadiness of gait or balance - Nuchal rigidity - Dec level of consciousness - Battle signs (mastoid ecchymosis) - Developing blurred, double, or loss of vision - Becomes drowsy, lethargic or obtunded - Develops or exhibits worsening mental/cognitive abilities - Unequal or fixed and dilated pupils - Urinary or bowel incontinence - Numbness or burning in legs and/or arms - Red flags for individuals being ax with head injury

Answer 234

- Tx focuses on a gradual return to activity, starting with rest and progressing through inc levels of cognitive and physical activity - Vestibular rehab is often necessary to address dizziness and balance issues - PT provides education, guiding graded exercises programs, and tx secondary issues (headache and neck pain) Areas for PT to examine and intervene in pts with mTBI: - Pt education - Activity intolerance - Vestibular dysfunction - Balance dysfunction - Post-traumatic headache - Temporomandibular disorder - Cervical dysfunction - Attention and dual-task performance - Participant in exercise

Answer 235

Should follow a structured, stepwise process, with each phase taking 24 hours. It is recommended to begin with rest, followed by light activity, and gradually inc intensity, allowing at least 1 week for a return to full activities. If symptoms recur, pts should step back to the previous stage and rest for 24 hours before attempting to progress again.

Answer 236

- Is Latin for little brain - Has 85% of the brain neurons, despite being only 10% of it's total volume - Receive input from almost all sensory systems (except smell and taste) - Sensory input into cerebellum is thought to be a critical component in the cerebellum's function in motor control. Cerebellum compares internal feedback with external feedback and generates corrective signals for subsequent mvts in order to reduce errors (feedforward mechanism) - Cerebellar output remain mostly uncrossed. Therefore, most damage to the cerebellum will lead to unilat and ipsilat motor impairment. Some effects may be bilat. = R side = R side impairments For stroke it's the opposite

Answer 237

- Stroke (hemorrhagic more than ischemic) - Traumatic brain injury - Hypoxic brain injury - Nutritional disorder (vitamin B1 and/or B12) - Exogenous substances (alcohol, medication, industrial agents) - Idiopathic disorders - Congenital disorders - Hereditary disorders - Hypothyroidism - MS

Answer 238

- Truncal ataxia (coordination problem of trunk) - Titubation (oscillation of trunk) - Orthostatic tremor (LE shacking, stops when sitting or walking) - Gait imbalance

Answer 239

- Limb ataxia - Dysarthria (motor speech disorder) - Hypotonia

Answer 240

- Eye mvt disorders (nystagmus, VOR disruption) - Posture and gait imbalance

Answer 241

- Asthenia - Ataxia gait - Delayed reaction time - Dysarthria - Dysdiadochokinesia - Dysmetria - Dysrhythmia - Dyssynergia - Hypotonia - Motor learning problems - Nystagmus - Rebound phenomenon - Tremor - Intention tremor - Postural tremor

Answer 242

Generalized muscle weakness commonly found in cerebellar lesions. More of a problem with coordination than with the muscles.

Answer 243

Ambulation patterns typically includes: - Wide BOS - High guard position - Stepping pattern irregular in direction and distance - Generally unsteady, irregular and staggering with deviations from line of progression ** High fall risk **

Answer 244

Inc time to initiate voluntary mvt in response to a stimuli

Answer 245

- Motor speech disorder affecting the muscles used to produce speech (lips, tongue, vocal cords) - Cerebellar or ataxia dysarthria is characterized by scanning speech (1 word at a time - robotic) - Speech may be slow, and/or slurred

Answer 246

Impaired ability performing rapid alternative mvts (mvt reversal) Supination/pronation test

Answer 247

Inability to judge length or distance of mvts Hypermetria: Overestimating distance of a mvt (overshooting target) Hypometria: Underestimating distance of a mvt (undershooting target) Therapist finger test

Answer 248

Abnormal rhythm and timing mvt

Answer 249

- Inability to perform mvt as a single, smooth activity. - Mvt is performed in a sequence of parts. - "Mvt decomposition" - Robotic

Answer 250

- Dec muscle tone (dec resistance to passive mvt) - Typically disappears within a few weeks following an acute cerebellar lesion.

Answer 251

- Cerebellum compares internal feedback with external feedback - Subsequent mvt will have corrective signals generated by the cerebellum in order to reduce errors. This is known as feedforward control. In cerebellar dysfunction, this feedforward control may be impaired.

Answer 252

- Rhythmic, oscillatory mvts of the eyes back and forth - Affects accurate fixation of vision - Believed to be due to the cerebellum's influence on the extraocular muscle's synergy and tone

Answer 253

- The ability to stop forceful active mvt when resistance is removed - "Check reflex"

Answer 254

Involuntary oscillatory mvt 2 types - Intention tremor - Postural tremor

Answer 255

- Also known as kinetic tremor - Oscillatory mvt during voluntary mvt - Inc as speed is inc or when approaching target

Answer 256

- Also known as static tremor - Oscillatory mvt during static position - Back and forth oscillatory mvts of the body can be seen while in upright static position - Titubation = oscillatory mvt of head and trunk

Answer 257

- Finger-to-nose - Finger-to-therapist's-finger - Finger-to-finger - Alternate nose-to-finger - Finger opposition - Mass grasp - Pronation/supination - Rebound test - Tapping - Alternate heel-to-knee; heel-to-toe - Toe to examiner's finger - Heel on shin - Drawing a circle - Position holding (fixation)

Answer 258

- Shld abd to 90 deg with elbow extension - Pt instructed to bring tip of index to nose Can see: Dysdiadochokinesia, dyssynergia, dysmetria

Answer 259

- Therapist stands facing the pt (face to face) with the therapist holding his index finger up in front of the pt - Pt is instructed to touch therapist's index finger with their index finger Can see: Dysdiadochokinesia, intention tremor, dysmetria

Answer 260

- Both shlds are abd to 90 deg with elbow extension - Pt is instructed to touch index fingers of opposing hands in midline Can see: Intention tremor

Answer 261

- Pt is instructed to alternatively touch his nose and therapist's finger Can see: Dysdiadochokinesia, dysmetria, dyssynergia

Answer 262

- Pt is instructed to touch the tip of the thumb to each finger in sequence - Speed may be progressively inc Can see: Dysdiadochokinesia

Answer 263

- Pt is instructed to alternate between opening and closing fist - Speed may be progressively inc Can see: Dysdiadochokinesia

Answer 264

- Pt is instructed to flex elbow to 90 deg with arms by his side and alternatively pronate and supinate the forearm - Speed may be progressively inc - Best not to perform with slapping on thigh due to rhythmic auditory and tactile cues potentially confounding with test result Can see: Dysdiadochokinesia

Answer 265

- Pt is instructed to maintain position of a joint (iso contraction) while therapist applies manual resistance. - The therapist suddenly releases the manual resistance without warning - The pt's ability to respond to the removal of manual resistance and halt mvt (check reflex) is examinate Can see: Rebound phenomena

Answer 266

Pt is instructed to tap hands alternatively on lap or alternatively tap feet (without raising leg off floor) on floor. Can see: Dysrhythmia

Answer 267

While in supine position, pt is instructed to alternatively touch his knee and big toe using the opposite heel. Can see: Dyssynergia

Answer 268

While in supine position the pt is instructed to touch his big toe to the examiners finger. Can see: Dyssynergia, intention tremor, dysmetria, dysdiadochokinesia

Answer 269

While in supine position, pt is instructed to slide heel up and down on the shin of the opposite leg. Can see: Dysmetria, dysdiadochokinesia

Answer 270

Pt is instructed to draw an imaginary circle in the air with their UE and LE. Can see: Dysmetria

Answer 271

Pt is instructed to hold arms out in front or hold the knee out straight (extension) while in sitting. Can see: Resting tremor

Answer 272

Lack of muscle control or coordination of voluntary mvts.

Answer 273

- Cerebellar ataxia - Sensory ataxia - Vestibular ataxia

Answer 274

A form of ataxia caused by loss of sensory input.

Answer 275

Disruption of proprioceptive input at: - Peripheral - Peripheral nerve (peripheral neuropathy, diabetes, HIV) - Dorsal nerve roots - Central - Dorsal column of spinal cord - Parietal cortex - Thalamus

Answer 276

Cerebellar ataxia: - Cerebellar dysfunction - Motor impairments (Dysdiadochokinesia, dysmetria...) - Wouldn't see with sensory ataxia - Wouldn't be able to hold balance even with EO - Will see ataxic gait Sensory ataxia: - Able to hold balance with EO, but not with EC = Loss of sensation - Hx of balance loss with EC or in a dark room - High stepping "Stomping" gait (it's giving auditory feedback and inc proprioception)

Answer 277

Preventative: Aimed at minimizing potential complications and secondary impairments. Restorative: Aimed at improving impairments and limitations. Compensatory: Aimed at modifying the task, activity, or environment to improve function and participation.

Answer 278

- Postural stability - Balance - Control and accuracy of mvt - VOR training - Add wrist or ankle weights to slow mvt to work on accuracy - Viscous loading (swimming pool) - Normalize gait Progressions: - Constrain the timing - Inc or alter accuracy demands, speed, direction, or force - Use novel tasks - Change components of task - Change the setting (sensory input) - Reduce or change somatosensory or visual feedback - Inc balance requirements/reduce support (narrow BOS) - Inc attentional demands - Add unexpected demands Other tx suggestion: - Use external constraints - Practice a variety of speeds and amplitudes while maintaining quality of mvt - Practice tasks that require predictive timing (basket ball - bouncing)

Answer 279

Is used when we don't think the pt will restore his function - Decomposition of mvt - Reduce degrees of freedom - Use assistive devices and technology - Use verbal and visual cues to assist with walking speed and stride length

Answer 280

= UMN Damage to the spinal cord resulting in loss of function, mvt, and sensation dependent on the location and extent of damage.

Answer 281

- Traumatic (most common - MVA, falls, violence, sports injuries) - Non-traumatic (Caused by a disease or pathology) - Vascular malfunctions (AVM, thrombosis, embolus, hemorrhage) - Vertebral subluxations secondary to other pathology (RA, Down syndrome, degenerative joint disease) - Global laxity - Infections (syphilis, transverse myelitis) - Spinal neoplasm (cancer to spinal cord) - Abscess in SC - Syringomyelia (cyst SC) - Neurological diseases (ALS, MS)

Answer 282

- Flexion (most common in lumbar injury) - Flexion-rotation (most common in cervical injury) - Axial compression (something heavy falls on head) - Hyperextension - Penetrating injuries

Answer 283

A transient period of areflexia immediately following SCI.

Answer 284

- Absence of all reflex activity (approx. 24h) - Impaired autonomic regulation - Hypotension - Loss of control of sweating - Piloerection (goosebumps)

Answer 285

- Total areflexia - approx 24h - Gradual return of reflexes - 1 to 3 days - Inc hyperreflexia - 1 to 4 weeks - Final hyperreflexia - 1 to 6 months

Answer 286

- Tetraplegia - Paraplegia

Answer 287

- Also known as quadriplegia - Loss of motor and/or sensory function of the trunk, and all four extremities - Results from lesions of the cervical SC (T1 and above) ** More common than paraplegia **

Answer 288

- Loss of motor and/or sensory function of all part of the trunk, and LE - Results from lesions of the thoracic SC, lumbar SC, or cauda equina (T2 and below)

Answer 289

- The American Spinal Injury Associated (ASIA) developed the ISNCSCI - international standards for neurological classification of SCI - The ISNCSCI standardizes the way in which severity of injury is determined, documented, and communicated among health care professionals and researchers - Indicates the extent of motor and sensory loss - Helps guide prognosis - Helps us know where they can get to

Answer 290

The most caudal (lowest) level of the spinal cord with INTACT motor and sensory function bilat. May not correspond to the level at which bones and lig are injured. May changes over time.

Answer 291

The most caudal level of the SC with INTACT motor function bilat.

Answer 292

The most caudal level of the SC with INTACT sensory function bilat.

Answer 293

Complete paralysis (no motor or sensory function) below level of injury (including lowest sacral seg S4/S5)

Answer 294

Having motor and/or sensory function preserved below the neurological level. If motor and/or sensory function below the neurological level is present, but the individual does not have function at S4/S5 then the areas below the neurological level with intact motor and/or sensory function are called zones of partial preservation.

Answer 295

Complete No motor or sensory function is preserved in the sacral seg S4 to S5

Answer 296

Incomplete Sensory but no motor function is preserved below the NLI and includes the sacral seg S4 to S5.

Answer 297

Incomplete Motor function is preserved below NLI, and more than half of key muscle below the NLI have a muscle grade less than 3. Weak + sensory + motor

Answer 298

Incomplete Motor function is preserved below NLI, and more than half of key muscle below the NLI have a muscle grade of 3 or more. Stronger + sensory + motor

Answer 299

Normal Motor and sensory is normal.

Answer 300

- Brown-Sequard Syndrome - Anterior Cord Syndrome - Central Cord Syndrome - Posterior Cord Syndrome

Answer 301

- Conus Medullaris Syndrome - Cauda Equina Injuries

Answer 302

- Damage to one half of SC (Hemi-section) - Typically, due to penetrating injury - Ipsilat. loss - Motor function (descending: lat corticospinal tract) - Proprioception, discriminative touch, and vibration (ascending: dorsal column) - Contralat. loss - Pain and temperature (ascending: spinothalamic tract)

Answer 303

= Longer hospitalization - Damage to the anterior portion of SC - Commonly due to cervical flexion injuries resulting in damage to the ant portion of the SC and/or it's vascular supply (ant spinal artery) - Loss of motor function (corticospinal tract), pain and temperature (spinothalamic tract) below level of lesion

Answer 304

- Damage to central portion of the SC with peripheral portions spared - Most common SCI syndrome - Commonly due to hyperextension injury in cervical region - Compressive forces cause hemorrhage and edema damaging the central portion of SC - Loss of motor more than sensory - Motor loss: UE more than LE - Sacral sensation spared, sacral motor function often spared

Answer 305

- Damage to the post portion of SC - Very rare - Loss of proprioception, pressure sense, and vibratory sense (ascending: dorsal column) - No motor loss - More likely tumor compressing structures

Answer 306

- Damage to cauda equina (long nerve roots below L1) - Variable nerve root damage - Flaccid paralysis - LMN injury, areflexive bowel and bladder, and sacral anesthesia (can't feel anything in sacral area) ** Ne pas tromper avec SC ** More likely to have stress incontinence

Answer 307

- Autonomic dysreflexia - Postural hypotension - Impaired temperature control - Respiratory impairment - Spasticity - Bladder and bowel dysfunction - Sexual dysfunction

Answer 308

- Respiratory complications - Pressures sores - DVT - Contractures - Heterotopic ossification - Pain - Fx/osteoporosis

Answer 309

- A pathological autonomic reflex causing sympathetic over-activity in lower body - Typically occurs in lesions above T6, but has been reported in lower injuries as well - More common in complete injuries or near complete - Emergency situation - Life threatening ** Left untreated may lead to seizures, cardiac arrest, stroke, subarachnoid hemorrhage, retinal damage, renal death, or death **

Answer 310

Noxious stimulus below level of lesion --- Inc sympathetic outflow (mass reflex response) --- Wide spread vasoconstriction, inc BP, inc HR ----- Baroreceptors stimulated leading to inc vagal output causing dec HR, but insufficient to counteract inc BP

Answer 311

- Bladder distention/irritation - Bowel distention/irritation - Stimuli that normally would be painful below level of lesion - Gastrointestinal irritation - Sexual activity - Labor - Skeletal fx below level of injury - Electrical stimulation below level of injury - Pressure sores

Answer 312

- Hypertension (sudden rise in systolic of 20-30 mmHg) - Bradycardia (initially tachycardia) - Severe headache - Profuse sweating - Inc spasticity/hypertonia - Vasodilatation above level of lesion (flushed skin - red skin often in face) - Constricted pupils - Nasal congestion - Goose bumps (piloerection) - Blurred vision

Answer 313

Autonomic Dysreflexia - Usually 3-6 month post SCI - Sit the pt up to dec BP (lying pt down is CI) - Notify nearby nurse or doctor for assistance - Check catheter for kink, block, fulness (notify nurse to empty if needed) - Loosen tight clothing - Look for other potential noxious stimulus below NLI - Document ** If cause remain unknown the pt should receive immediate medical interventions **

Answer 314

- Occiput - Scapula - Vertebra - Elbows - Sacrum - Coccyx - Heels

Answer 315

- Ears (head rotated) - Shlds (ant aspect) - Iliac crest - Male genital region - Patella - Dorsum of feet

Answer 316

- Ears - Shlds (lat aspect) - Greater trochanter - Head of fibula - Knees (medial aspect from contact between knees) - Lateral malleolus and medial malleolus (contact between malleoli)

Answer 317

C4 = Most supply the diaphragm - Most severe of SCI levels - Paralysis of arms, hands, trunk, and legs (tetraplegia) - Pt requires assistance with breathing (C1-C3), secretion clearance, insufficient cough, high risk of infection - Dependent in all ADL's (eating, dressing, bowel and bladder clearance) - Dependent transfers (mechanical lift) - Power wheelchair - Tilt in space or reclining seat - Head, chin, or sip-and-puff control

Answer 318

- NLI past this level can breathe independently, but may be laboured; abdominal blinder may improve breathing - Dependent in transfers - Manual wheelchair with propulsion aids for short distance (flat surface) - Can drive a van using adaptive hand controls - Power wheelchair with adapted joystick for community

Answer 319

- No triceps strength - Able to perform limited self-care activities with use of tenodesis grasp (wrist ext, finger flexion) - Independent to min assist with sliding board (using post delt to brig arm back and delt ant to elbow extend) - Independent with manual cough - Wheelchair propulsion with the use of hand rim projections for short distances - Power wheelchair for community - Independent with pressure relief maneuvers in wheelchair - Can drive a car or van using adaptive hand controls - Capable of living independently

Answer 320

- Can extend elbow allowing for easier use of sliding board transfers - Can do most ADL's by themselves, bed mobility much easier - Manual wheelchair with friction surface hand rims - May require assistance with ramps, curbs, and uneven surfaces

Answer 321

- Full use of hand intrinsic muscles, allowing for grasping of objects with ease and less need for adaptive equipment - Independent in all ADL's, may require adaptive equipment - Manual wheelchair with standard hand rims

Answer 322

- The lower the level of injury in the thoracic spine, the better the trunk control as more abdominals and paraspinals will be functional - May use orthoses (HKAFO, KAFO) with assistive device for short distances - Wheelchair for community

Answer 323

- May use orthoses (HKAFO, KAFO, AFO) with assistive device for short distances - Wheelchair for community

Answer 324

- AFO with assistive device - NLI L4 may choose to use wheelchair for long distance

Answer 325

Respiratory management - NLI C5 and above often require ventilatory support using IPPV - Deep breathing exercises - Glossopharyngeal breathing (High cervical lesions) - Respiratory muscle strengthening - Assisted cough - Abdominal binder

Answer 326

Positioning - Reposition at least every 2 hours in bed Pressure relief - Pressure relief maneuvers should be performed every 15 minutes when in wheelchair (assisted or independent) - Tilt-in-space or reclining wheelchair - Pressure relief maneuvers should be held for at least 2 minutes Skin inspection Education Wound care

Answer 327

- Performed daily (except in areas that are CI) - Pelvis should be kept in neutral when performing LE ROM exercises - Lsp injury - SLR > 60 deg and hip flex > 90 deg should be avoid - Tetraplegia - mvt of the head/neck and shld flex/abd > 90 deg is CI until given orthopedic clearance (spine stable and fully healed) - Selective stretching - Tightness in certain muscles can enhance function - Tight lower trunk muscles may inc trunk stability and sitting posture - Tight long finger flexors will improve tenodesis grasp - Adequate length in certain muscles can enhance function - SLR of approx 100 deg needed for long- sitting and LE dressing - Splinting (intrinsic-plus splint) - HAMBERGUR - Wrist: 20 deg ext - MCP: full flex - IP: full ext or slight flex - Thumb: natural opposition

Answer 328

- Once fx stability established pt is cleared for upright activities - Early on may experience postural hypotension - Gradual exposure to upright posture (acclimatizing period) - Abdominal binders and elastic stocking may help (dec venous pooling) - Monitor vitals closely and document during this period - If pt experiences signs and symptoms of postural hypotension, therapist can assist to recline pt's trunk and elevate their legs - When pt is cleared and acclimatized to upright activities, therapy may begin to focus on bed mobility skills, transfers skills, and other functional mobility skills

Answer 329

- Continue with respiratory care, skin care, and ROM - Strengthening - Cardiovascular/endurance training - Wheelchair skills - Bed mobility skills - Balance - Transfers - Gait training

Answer 330

Chronic inflammatory disease, causing demyelination in the CNS

Answer 331

- Episodes of inflammation damage the myelin sheath and myelin producing cells (oligodendrocytes) - Damaged myelin is replaced by plaque (scar tissue) - Sclerotic plaque prevents normal transmission of nerve impulses causing neurological signs and symptoms - Believed to be an autoimmune disease

Answer 332

- Unknown - Believed to be induced by viral or other infectious agents - Possible genetic susceptibility

Answer 333

- Age of onset typically between 15-50 with peak at age 30 - Females twice as likely to get MS - Canada has the highest prevalence of MS in the world - Environment

Answer 334

- Relapsing-remitting MS - Primary-progressive MS - Secondary-progressive MS - Progressive-relapsing MS

Answer 335

Relapses followed by recovery and disease stabilization Most common

Answer 336

Steady disease progression (no interruptions or distinct episodes) No remission

Answer 337

Begins with relapsing-remitting course followed by steady disease progression with no distinct periods or remission

Answer 338

Progressive disease from onset with super imposed acute attacks or relapses that may or may not have recovery

Answer 339

- Relapse (exacerbation) - New and recurrent symptoms that last for at least 24 hours - Aggravating factors - Viral infection - Bacterial infection - Disease of major systems - Emotional and bodily stress - Pseudoexacerbation - Transient worsening of MS symptoms. Episodes last < 24 hours - Uhthoff's phenomenon - adverse reaction to heat (internal or external)

Answer 340

Sensory changes - Paresthesia, numbness Pain - Most common types: trigeminal neuralgia, paro(sudden)xysmal(worse at night) limb pain, and headache - Other common types Hyperpathia, Chronic neuropathic pain, Lhermitte's sign, musculoskeletal pain Visual changes - Blurred vision, diplopia, loss of acuity/vision, optic neuritis, scotoma, nystagmus Motor dysfunction - Weakness, central fatigue, spasticity, impaired balance and coordination, impaired ambulation and mobility Speech and swallowing dysfunction - Dysarthria, dysphonia (voice problem), dysphagia (difficulty swallowing), inc risk of aspiration pneumonia, inc risk of poor nutrition and dehydration Cognitive and affective changes - Cognitive impairments, depression, pseudobulbar affect (sudden change in emotion not at the right context), euphoria, anxiety, bipolar disorder Autonomic challenge - Cardiovascular dysautonomia, bowel/bladder dysfunction, sexual dysfunction

Answer 341

- MRI - Blood work to rule out other conditions

Answer 342

Medical management - Disease modifying agents (long-term) - Corticosteroid therapy (during relapses) - Medication for symptoms (depends on the presenting symptoms) Physical therapy management - Dependent on presenting symptoms - Exercise has overall good benefits for MS (take fatigue and overheating into consideration)

Answer 343

Pts with MS suffer from heat intolerance. The following may help prevent from adverse affects... - Perform exercises in the morning (early hours of the day is best) due to higher levels of energy, lower body core temperature, and cooler temperatures - Exercises in cool environment - Keep hydrated with cool liquids - Wear light, loose clothing with good ventilation - Use blowing fans during exercises to help keep cool - Avoid hot baths or shower - Use submaximal exercises intensities - Take more rest intervals (3x10 mins) - Do not overwork the pt

Answer 344

- Fatigue is considered one of the most debilitating symptoms for pts with MS - Characterized by sudden and severe sleepiness, tiredness, and sense of weakness - Diurnal: least in morning, worse in afternoon - Balancing act between exercises training, and avoiding overwork and fatigue - Pt asked to maintain an activity diary to help discover "Fatigue triggers" - Rate each activity 1-10 in regards to Fatigue (F), Value of Activity (V), Satisfaction of performance (S) - Based on information from activity diary, the therapist can teach energy effective strategies

Answer 345

- Chronic progressive neurodegenerative disorder - Due to loss of dopamine producing neurons in pars compacta of substantia nigra - Insidious onset, typically in 6th decade (60 y.o) - Etiology unknown

Answer 346

A state of mimicking or appear to look like idiopathic PD without actually having PD

Answer 347

Neurodegenerative diseases that produce parkinsonism as well as other neurological signs

Answer 348

TRAP Tremor (at rest) Rigidity Akinesia/bradykinesia Postural instability Must present with at least 2 cardinal signs and exclusion of alternate diagnosis or explanation for presenting signs.

Answer 349

- Involuntary oscillations of a body part - Occurs at rest and disappears with voluntary mvt - Commonly manifests in "pill-rolling" tremor of the hand - Resting tremor may also be seen in the forearm pronation-supination, jaw, or tongue - Lower extremity tremor is most apparent when in supine - Postural tremor of head and trunk is seen when attempting to maintain an upright posture - Inc with emotional stress and fatigue - Dec when pt is relaxed and disappears when pt is asleep

Answer 350

- Inc resistance to passive mvt (independent from speed or posture) - Pt may complain of heaviness or stiffness - Rigidity often asymmetrical, affects proximal to distal, may progress to entire body 2 types: - Cogwheel rigidity - Leadpipe rigidity (constant) - Disease progression --- inc rigidity --- inc loss of function, inc contractures, inc resting energy expenditure

Answer 351

- Problems with voluntary mvts - Akinesia: absence of mvt - Freezing gait: moments where there is a sudden stop in mvt with a temporary instability to move - Bradykinesia: slowness in mvt - Mvts are often reduced in speed, range, and amplitude - Hypokinesia: dec amplitude of mvt

Answer 352

- Abnormalities in posture and balance - Develops later in the disease - Pts have inability to use normal postural synergies to recover balance, due to abnormal coactivation patterns leading to rigidity - Pts will often adopt a flexed stopped posture due to inc weakness of trunk extensor muscles - Kyphosis is most common postural deformity found in PD - Some pts may develop scoliosis due to having more rigidity on one side of the trunk - Inc falls and falls injury (due to many factors associated with PD)

Answer 353

Start hesitation - Difficulty initiating mvt Freezing episodes - Temporary inability to move - Can be triggered by competing stimulus - Can be exacerbated by stress Hypomimia (masked face) - Reduction in facial expression and animation Poverty of mvt - Dec in number and amplitude of mvt Micrographia - Abnormally small handwriting

Answer 354

- Festinating gait - Shortened strides with progressively inc speed - Stooped posture is a contributing factor - Anteropulsive (forward festinating gait) vs retropulsive (backward festinating gait) - May run into a wall or object due to difficulty stopping - Freezing of gait - Freezing gait: moments where there is a sudden stop in mvt with a temporary inability to move - Shuffling steps - Dec hip, knee, and ankle flexion - Dec trunk rotation - Dec arm swing - Difficulty with dual task demands - Difficulty with inc attentional demands

Answer 355

- Loss of sense of smell (very first) - Masked face - Dysphagia (difficulty swallowing) - Dysphonia (problem with voice) - Micrographia (writing very small) - Festinating gait - Stooped posture

Answer 356

- Unified Parkinson's Disease Rating Scale (UPDRS) - The Parkinson's Disease Questionnaire (PDQ-39)

Answer 357

Medical management - No cure - Medication used to help slow disease process and for symptom management - Standard drug therapy includes Levodopa (dopamine precursor) and Carbidopa (Sinemet) - Sinemet allows for higher uptake of Levodopa in the brain which means you can use lower doses of Levodopa and dec potential side effects - Initially Levodopa causes drastic improvements in symptoms then begins to become less effective at same dosage and inc dosage is required - Sudden discontinuation or unsupervised reduction of Levodopa may cause life threatening adverse effects

Answer 358

- Difficulty arising from a chair - Difficulty turning over in bed - Cognitive changes/dementia - Sialorrhea (drooling) - GI dysfunction: constipation, dec appetite - Foot dystonia

Answer 359

- Motor learning - Exercise training - Relaxation - Flexibility - Strength - Functional - Balance training - Gait training - Cardiopulmonary training

Answer 360

- Gastrointestinal - Anorexia, nausea, vomiting, constipation - Cognitive - Confusion, hallucination - Cardiovascular - Arrhythmias, hypotension - Genitourinary - Dysuria - Neuromuscular - Dyskinesia, dystonia, motor fluctuations - Sleep disturbances

Answer 361

To allow their independent function as well as being able to maintain as long as possible. Using preventive, restorative and compensatory approach

Answer 362

- Repetition - Blocked practice > Random practice - Dec competing cognitive demands - Set up the environment - Use structured instructional sets - Use external cues (not appropriate for all pt)

Answer 363

Rhythmic music/clapping, counting, metronome, instructions

Answer 364

Stepping over lines on the floor or objects, focusing on object or colors

Answer 365

Tapping on hip, thigh, knee, leg, etc.

Answer 366

Mental image of appropriate step length

Answer 367

- Auditory cues: Verbally cue pt to take "big exaggerated steps" or "Big steps! BIGGER! BIGGER!" - Visual cues: Have pt step over small Styrofoam cups lined up in a row - Cognitive cues: Instruct pt to imagine themselves taking big step

Answer 368

- Auditory cues: Verbally cue by counting, "On the count of 3, I want you to take a step" - Visual cues: Have them step over or to something such as a piece of tape - Tactile cues: Tap the pt's leg to cue them to initiate a step - Cognitive cues: Instruct pt to imagine themselves taking a step

Answer 369

- Auditory cues: Clap rhythmically or have a metronome and cue for the pt to step on beat.

Answer 370

- Chronic degenerative disease of the motor neurons in the brain, brain stem, and spinal cord - Results in UMN and LMN impairments - Also know as Lou Gehrig's disease

Answer 371

Progressive degeneration and loss of motor neurons - UMN in motor cortex and corticospinal tracts - Brainstem nuclei of CN V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), XII (hypoglossal) - LMN in anterior horn cells of spinal cord Areas that are generally spared - Sensory system, spinocerebellar tracts - Brainstem nuclei of CN III (oculomotor), IV (trochlear), VI (abducens) - Anterior horn cells for S2 (innervate striated muscles of pelvic floor) Early disease sprouting of nearby axons can help preserve strength and function. As disease progresses, the rate of reinnervation cannot compensate for the rate of degeneration. At this point the pt's function begins to more rapidly decline.

Answer 372

- Unknown - 5-10% ALS is inherited as an autosomal dominant trait. This is known as Familial ALS or FALS.

Answer 373

- Most common and fatal motor neuron disease in adults (average onset to death 27-43 months) - Usually respiratory distress leading to death - Can occur at any age (average - mid-to-late 50's)

Answer 374

- Clinical manifestations depend on extent as well as location ALS affects - UMN & LMN syndrome effects - Asymmetrical distribution - Distal --- proximal progression - Caudal --- rostral spread within spinal cord

Answer 375

- Weakness - Cardinal signs of ALS - Focal and asymmetrical - May begin in UE (clumsy, difficulty with boutons), LE (drop foot, toe dragging) or bulbar muscles (speech, swallowing, changes in voice, difficulty moving lips) - Distal to proximal progression - Can lead to secondary impairments - Dec ROM (predisposition to joint subluxation, tendon shortening, and contractures) - Postural control issues - Dec functional ability - Deconditioning - Fatigue - Pain - Fasciculations - Atrophy - Muscle cramps - Hyporeflexia - Hypotonicity

Answer 376

- Mixed palsy common - UMN (spastic) & LMN (flaccid) components - Bulbar muscle weakness - Dysphagia (difficulty swallowing) - Inc risk of aspiration - Inc weight loss and potential cachexia - Dysarthria - Weakness in tongue, muscles of lips, jaw, larynx, pharynx - Initial symptoms: instability to project voice and problem with enunciation - Late stages pt can become anarthric (so severe they become speechless) - Sialorrhea "drooling" - Absence of spontaneous swallowing to clear excess saliva - Weakness of oral muscles making it difficult to close lips and prevent saliva from leaking out - Pseudobulbar affect - Poor emotional control, not appropriate for context

Answer 377

- Respiratory impairments - Respiratory muscle weakness - Dyspnea - Fatigue - Disordered sleep - Morning headaches - Secretion retention - Inc risk of pneumonia - Cognitive impairments - Frontotemporal dementia (FTD) - Cognitive decline, executive functioning impairment, difficulty with planning and organization, and personality and behavioral changes (irritability, social disinhibition) - Pts with bulbar-onset ALS more likely to have cognitive impairments

Answer 378

Presence of: - LMN signs by clinical, electrophysiological or neuropathological exam - UMN signs by clinical exam - Progression of disease within a region or to other regions Absence of: - Evidence of other disease that may explain UMN and LMN signs - Neuroimaging evidence of other disease processes that may explain observed signs ** For pts with clinical presentation suggestive of ALS, laboratory studies are conductive to help support or refute the dx. These include EMG, nerve conduction studies, muscle and nerve biopsies, and neuroimaging. **

Answer 379

- Management of ALS is dependent on impairments, stage of disease and personal factors - Rapid and progressive decline in function requires constantly changing plan of care - Tx may be preventative, restorative, or compensatory

Answer 380

Restorative/preventative: - Strengthening exercises - Endurance exercises - AROM, AAROM, PROM Compensatory: - Energy conservation techniques - Education regarding condition and support groups - Potential need for adaptive or assistive devices - Potential need for ergonomic modifications

Answer 381

Preventative: - Strengthening exercises (early middle stage) - Endurance exercises (early middle stage) - Prescribe pressure-relieving devices - AROM, AAROM, PROM Compensatory: - Support weak muscles using adaptive equipment, slings, neck collars, orthoses, etc. - Modifications to home or workplace (ramps, stair lifts) - Prescribe wheelchair - Educating family and caregivers regarding functional training

Answer 382

Preventive/palliative: - PROM - Pulmonary rehab - Prescribe pressure relieving devices - Prevent skin breakdown (positioning, skin care, hygiene) Compensatory: - Educating caregivers regarding transfers, positioning, and skin care - Mechanical lifts

Answer 383

- An auto-immune disorder causing acute inflammation and demyelination of the cranial nerves' and peripheral nerves' myelin sheaths - Also known as AIDP - acute inflammatory demyelination of polyneuropathy - Symmetrical disease, affecting both side at the same time - Affecting more LMN COMPARED TO MS affecting more UMN

Answer 384

- Acute inflammatory polyneuropathy due to auto-immune response - Primarily involves Schwann cells causing demyelination of peripheral nerves - Demyelination causes impulse conduction to be slowed down, become dispersed, or blocked - Potential axonal damage (if inflammation severe)

Answer 385

- Unknown - Often occurs after recovering from recent infection or illness - Most often occurs after a recent upper respiratory tract infection

Answer 386

- Rare condition - Age of onset: Any age, highest between 16-35 and 50-74

Answer 387

1. Progressive deterioration 2. Plateau 3. Recovery

Answer 388

- Demyelination and potential axonal damage - Lasts approx 1-4 weeks ** No strengthening **

Answer 389

- Disease peaks and there is no further deterioration ** No strengthening **

Answer 390

- Axonal regeneration and myelination - Progressive recovery usually lasts 6 months - 2 years - Complete recovery common. Most have no permanent disabilities. Some mild weakness may persist. - Low mortality rate

Answer 391

- LMN syndrome - Motor signs always present, sensory signs may be present - Symptoms begin distally and moves proximally - Symptoms resolve from proximal to distal - Typically symmetrical presentation

Answer 392

- Distal lower extremity paresis (weakness) - Distal sensory disturbances (glove and/or stocking distribution) - Muscle aches and tenderness

Answer 393

- ANS dysfunction - High risk of CRPS due to immobility - Atrophy - Fatigue - Hyporeflexia - Hypotonia - Pain - Throbbing pain, deep ache - Low back and leg muscle pain most common - Exacerbated with SLR - Paresis - Distal -- proximal - LE more than UE - May include CN's (most common VII) - Paresthesia - Glove and/or stocking distribution - Paresthesia or hypoesthesia - Respiratory problems - Possible phrenic nerve involvement (innervate diaphragm) - May require mechanical ventilation

Answer 394

- Autonomic instability (arrhythmias, BP fluctuation, tachycardia) - Deep vein thrombosis - Pressure sores - Respiratory tract infection - Respiratory failure

Answer 395

Medical management: - Corticosteroids - May require intubation and mechanical ventilation - Pain meds - Immunosuppressive meds Physical therapy management: - Pulmonary rehab - Prevent respiratory complications - Education on energy conservation techniques - Improve respiratory function and cardiovascular fitness (recovery phase) - Respiratory muscle strengthening (recovery phase) - Strengthening - Not performed until recovery phase - Gentle stretching and positioning - Maintain ROM and joint integrity - Mobility training - Wheelchair prescription - Assistive device training - Education - Aerobic training

Answer 396

An acute infectious viral disease caused by the poliovirus

Answer 397

- Enteric virus (related to intestine) - Main route of transmission: fecal-oral route (get passed threw mouth, generally due to poor hygiene) - In a small # of pts (less than 5%), the virus attacks the motor cells in the brain stem and spinal cord leading to paralysis

Answer 398

- Until mid 1950, poliomyelitis had a worldwide distribution - Introduction of effective vaccine in mid 1950 drastically dec incidence of poliomyelitis - North American and Europe polio-free - Poliomyelitis outbreaks still occur in some Asian and African countries

Answer 399

- LMN syndrome - Weakness/paralysis may be "patchy" - Asymmetrical distribution - More commonly affects LE than UE - Brainstem much less commonly affected as anterior horn cells

Answer 400

- Partial or full recovery may occur. Recovery process may last up to 2 years. - Muscle hypertrophy and neuroplastic changes

Answer 401

Poliomyelitis symptoms reappearing after at least 15 years of disease stability in people who had been affected by poliomyelitis

Answer 402

- Unknown - Believed to be due to neural fatigue - Denervation more than reinnervation - Find balance between musculoskeletal disuse and overuse to optimize function

Answer 403

- Previously affected by poliomyelitis virus - Average onset occurs approx 35 years after original poliomyelitis

Answer 404

Typical age of onset 35-60

Answer 405

- Slow progression. Periods of stability followed by new declines. - LMN syndrome - Weakness/paralysis may be "patchy" - Asymmetrical distribution - More commonly affects LE than UE - Brainstem much less commonly affected as anterior horn cells

Answer 406

- Fatigue - Muscle atrophy - Weakness - Pain - Cold intolerance - Breathing or swallowing disorders if brainstem is involved

Answer 407

PT management: - Education on energy conservation techniques - Weight loss if pt is obese - Work and home environment adaptations - Exercises therapy - Avoid overuse and fatigue - Balance periods of rest and activity - Exercise when pt is least fatigued/more relaxed - Hydrotherapy (warm water) - If brainstem affected - Positive pressure ventilation while sleeping - Prevent respiratory complications - Education on swallowing techniques and training - Breathing - Assisted coughing

Answer 408

Peripheral pathology: - Benign Paroxysmal Positional Vertigo (BPPV) - Unilateral Vestibular Hypofunction (UVH) - Bilateral Vestibular Hypofunction (BVH)

Answer 409

- Gaze stabilization - Postural stabilization - Spatial orientation

Answer 410

A vague term to describe a range of sensation such as lightheadedness, faintness, whirling or unsteadiness

Answer 411

- An illusion of mvt - Feels like the room is spinning - May be due to BPPV, UVH or lesion affecting the vestibular nuclei

Answer 412

- A feeling that fainting may occur or is about to occur - May be due to hypotension, hypoglycemia, or anxiety

Answer 413

- Sensation of being off balance - May be due to vestibular problems, cerebellar or motor pathway lesion, dec somatosensation, or weakness in LE

Answer 414

- Subjective experience of objects moving in the visual environment that are known to be stationary - May occur with head mvt in pts with vestibular hypofunction (poor gaze stabilization)

Answer 415

Rhythmic eye mvt ( most often involuntary)

Answer 416

- A biomechanical disorder of the inner ear in which the otoconia (calcium carbonate crystals) is displaced from the utricle into the semicircular canals - The most common cause of vertigo - Sensation of mvt when there isn't

Answer 417

- Can occur at any age, but most common in older adults

Answer 418

- Most often idiopathic in older adults - Most common cause in people < 50 in head injury

Answer 419

Occur only with changes in head position - Nystagmus - Vertigo - Nausea - Disequilibrium Duration of symptoms typically < 60 sec

Answer 420

- Dix-Hallpike test - Roll test

Answer 421

The pt is positioned in long sitting with the head rotated at 45 deg to one side. The pt is lowered to a supine position with the head extended at 30 deg with the head still rotated at 45 deg and the PT observes for nystagmus (pt's eyes must remain open during test). The test is then repeated with the pt's head rotated to the other side.

Answer 422

- The pt presents with nystagmus - The direction and duration of the nystagmus can help determine whether the pt has posterior semi-circular canal BPPV or central lesion

Answer 423

The pt is positioned in supine with the head flexed at 20 deg. The pt's head is rapidly rotated to one side and the PT observes for nystagmus (pt's eyes must remain open during test). The test is then repeated to the opposite side. Alternatively, the pt may also rotate their own head actively.

Answer 424

- The pt presents with nystagmus or vertigo - Indicates horizontal semi-circular canal BPPV

Answer 425

- Canalith repositioning maneuver (Epley maneuver) - The liberatory (Semont) maneuver - Brandt-Daroff exercises

Answer 426

- Pt's head is moved into different positions in a specific sequence to move the debris out of the involved semi-circular canal and into the vestibule (utricle and saccule) - May be used for posterior or horizontal SCC BPPV

Answer 427

- Pt rapidly moves through positions designed to dislodge the debris from the cupula - May be used for cupulolithiasis

Answer 428

- Pt rapidly moves through positions designed to dislodge debris from the cupula or move debris out of the canal - Exercises should be performed 5-10 reps, 3x/day until symptoms have resolved for 2 consecutive days

Answer 429

A condition in which one of the peripheral vestibular receptors or the vestibulocochlear nerve (CN VIII) is functioning improperly

Answer 430

- Infection - Trauma - Vascular events - Meniere's disease

Answer 431

- Vertigo - Spontaneous nystagmus - Oscillopsia during head movements - Postural instability - Disequilibrium

Answer 432

- Improve gaze stability during head mvt - VOR training - Improve static and dynamic postural stability - Postural stability exercises - Dec sensitivity to motion - Habituation exercises (motion sensitivity)

Answer 433

- An inner ear disorder that can lead to low-frequency hearing loss and episodic vertigo - Chronic Meniere's disease may lead to UVH

Answer 434

- Unknown - Pathophysiology in part is due to an abnormal amount of endolymph fluid collecting in the inner ear

Answer 435

- Low frequency hearing loss - Episodic vertigo - Aural fullness - Tinnitus

Answer 436

A condition in which there is bilat loss of peripheral vestibular function

Answer 437

- Ototoxicity Less common: - Meningitis - Autoimmune disorders - Head trauma - Tumors on each CN VIII - Vascular episodes - Sequential unilat vestibular neuritis

Answer 438

- Dysequilibrium - Oscillopsia - Gait ataxia

Answer 439

- Improve gaze stability during head mvt - VOR training - Improve static and dynamic postural stability - Postural stability exercises - Pool exercises - Tai chi - Enhanced decision-making skills regarding performance of basic and instrumental ADL's - Education

Answer 440

- An external device used to restrict or assist motion, or to transfer load to a different part of the body - Also known as a brace - Splint = Orthosis for temporary use

Answer 441

Choose based on pt's impairments and activity limitations (dx less imp)

Answer 442

- Foot orthosis (FO) - Ankle-Foot orthosis (AFO) - Knee-Ankle-Foot orthosis (KAFO) - Hip-Knee-Ankle-Foot (HKAFO) - Trunk-Hip-Knee-Ankle-Foor (THKAFO)

Answer 443

Internal modifications: - Shoe insert - Heel-spur insert orthosis - Longitudinal arch supports - Scaphoid pad - Metatarsal pad External modifications: - Heel wedge - Metatarsal bar - Rocker bar

Answer 444

Motion assistance: CI if spastic - Posterior leaf spring (for Drop foot, bring the foot in DF) - Steel DF spring assist Motion resistance: - Plastic hinged (only allows DF, contracture in PF) - Posterior stop (only allows DF, contracture in PF) - Anterior stop (only allows PF, limited DF) - Solid AFO (blocks all mvts, for instability) - Hinged AFO (limited subtalar mvts and PF, allows controlled DF, subtalar OA)

Answer 445

- Wear time will vary depending on age, condition, activity level, and goals - Always wear socks with AFO's - Wrinkle free - Smooth texture - Long enough to roll over top edge of AFO - Always wear shoes with AFO - Prevents slipping and falling - Fit AFO all the way in the shoe - Build up time wearing AFO (unless instructed otherwise) - Day 1 = 30 mins, Day 2 = 1 hour, Day 3 = 1.5 hours - Applies to first time AFO wearers only - Inspect skin frequently - Feet, ankles, and legs should be inspected regularly - Pay close attention to bony areas - Inspect skin each time AFO is taken off

Answer 446

- Prescriptive wheelchair act as both a mobility device and a seating support device for people with disabilities - Properly seated wheelchairs can provide a seated environment which may allow a person with disabilities to achieve max function and help them reintegrate into community

Answer 447

- Pt-related factors - Environmental-related factors - Dx-related factors - Function - Safety

Answer 448

- Traditional manual wheelchair - One-arm drive system - Appropriate for a person who is only able to functionally use one UE - There are two rims on the side being used for propulsion, the outer rim will enable turning to one direction, the inner rim will enable turning to the other direction, and both rims enable moving forward - Self-propulsion using feet - Wheelchair seat is lower than traditional fit to allow user to propel wheelchair using one or both feet

Answer 449

- If a person is unable to manually propel a wheelchair, yet is cognitively aware of surroundings, then a power mobility system may be considered - A power mobility system may also be considered for an individual who is able to manually propel a wheelchair, but is unable to do so in the community environment without excessive stress to muscles and joints, postural problems, or excessive cardiovascular strain

Answer 450

- Hand controls (Joystick) - Head Array Systems (3 main controls - the behind head moves the chair forward, and left and right + combo of them) - Slip 'n' Puff systems/Breath control system (Hard puff = forward, hard sip = back, soft puff = R, soft sip = L) - Other systems (if a person can't use any of the above, but has minimal mvt somewhere else like chin, foot, elbow it can be set up to control wheelchair)

Answer 451

- A seating system that can be adjusted to tilt rearward or upright (depending on the needs of person) - In a manual wheelchair a caregiver will need to change the tilt position, but in a power wheelchair, the user can use a switch on the chair to change the tilt position independently - Tilt feature is beneficial for individuals who have fair to poor trunk control and are unable to sit upright for long durations Benefits of tilt feature: - Improve balance and head positioning while in wheelchair - Improve skin integrity and provides pressure relief - Improves comfort

Answer 452

- The postural support system is composed of the surfaces that directly contact the wheelchair user's body and the additional components needed to maintain postural alignment - Poor positioning of the pelvis and trunk can INC the risk of respiratory and urinary tract infections - Sacral sitting (posterior tilt = hammy tight) makes it more difficult to complete bladder emptying - Kyphotic or scoliotic spine posture in sitting affects the breathing and ability to clear secretions effectively - Poor alignment of head, neck, and trunk while eating may INC the risk of aspiration

Answer 453

A firm seat support is IMP for good LE alignment, and pressure distribution

Answer 454

- A firm back support is IMP to help maintain good sitting posture - Back support height is determined based on the user's trunk control, functional abilities, and comfort - A shorter back support is more appropriate for users with good trunk control, ability to maintain good alignment, and who will be propelling the wheelchair - A taller back support is needed for users who require tilt-in-space feature

Answer 455

- Lateral trunk supports help maintain midline posture - A chest belt/harness helps INc trunck stability, maintain upright body posture, and prevents the user from falling out of the wheelchair

Answer 456

A pelvic belt or rigid pelvic positioner helps maintain good pelvic positioning and prevents the user from sliding forward or falling out of the chair

Answer 457

- Armrests provide a support surface for the arms and a surface for pushing up to standing or for ischial pressure relief - Some users may require an upper extremity support surface such as an arm tray or trough - UE support surfaces can help maintain correct alignment of the shld joint, support the weight of the arm, and DEC pulling on the shld and trunk

Answer 458

LE supports (leg rest, medial/lateral thigh supports) can affect the position of the lower body and influence the tone and posture of the trunk, head, and arms

Answer 459

An improperly fitting wheelchair can lead to potential complications. Each component of the wheelchair must be evaluated for fit to ensure the pt is comfortable, secure, stable and safe.

Answer 460

Foot plates too high (leg rest too short): - Improper weight distribution ( Inc ischial tuberosity pressure) and leg positioning - Legs may be positioned too high to fit under tables or desks - Dec trunk stability due to dec weight distribution across surface area of posterior thighs Foot plates too low (leg rest too long): - Inc pressure on distal posterior aspect of thighs - Potential insufficient clearance of footplate from ground (safety issue) - Dec trunk stability due to dec weight distribution across surface area of posterior thighs

Answer 461

Leg rests elevated too high: - Post tilt --- Inc pressure -- Inc fall risk - May place excessive stretch on tight hammy causing the pelvis to go into a post tilt

Answer 462

Seat too high: - Poor trunk support due to back upholstery being too low - Legs may be positioned too high to fit under tables or desks - Problems propelling the wheelchair due to difficulty in reaching hand rims on wheels below - Poor posture when forearms rest on the armrest Seat too low: - Difficulty standing for transfers due to lowered COG - Improper weight distribution (Inc tuberosity pressure) and leg positioning when feet rested on foot plates.

Answer 463

Seat depth too long: - Inc pressure in the popliteal area leading to compromised circulation and/or skin discomfort Seat depth too low: - Dec trunk stability due to dec weight distribution across surface area of post thighs - Dec balance due to reduced BOS - Improper weight distribution (inc tuberosity pressure)

Answer 464

Seat width too wide: - Difficulty propelling wheelchair with UE due to inc distance to hand rims - Difficulty moving through narrow hallways or doorways Seat width too narrow: - Excessive pressure on the greater trochanters - Inadequate spacing for bulky clothing, orthoses, or braces

Answer 465

Back height too high: - Irritation on skin over inferior angles of the scapula - Potential difficulty with balance due to trunk possibly being inclined forward by high upholstery Back height too low: - Dec trunk support leading to dec trunk stability

Answer 466

Armrest too high: - Difficulty propelling wheelchair with UE as a result of having to reach over high armrest - Difficulty standing for transfers due to poor functional position of UE for pushing - Poor posture when forearms rest on the armrest Armrest too low: - Poor posture when forearms rest on the armrest - Difficulty standing for transfers due to poor functional position of UE for pushing

Answer 467

- Pressure relief maneuvers - Push-up maneuver - Lateral lean maneuver (leaning side to side) - Leaning forward (must lean > 45 deg) - Elevation of the caster wheels (wheelie) - Skill required to clear objects on the ground, ascend or descend curbs, and navigate irregular surfaces - Ascending and descending ramps - Entering and exciting doors and doorways - Falling in the wheelchair - Moving from wheelchair to floor and floor to wheelchair

Answer 468

- Arms somewhat spastic - UE flexion hypertonia, LE extension hypertonia - LE stiff - Significant circumduction in affected leg - Proximal strong, distal weak (foot drop) L side lesion = R side affected

Answer 469

- All joints are flexed - Typically small steps - Can have tremor

Answer 470

- Broad stance - Tend to fall on affected side L side lesion - L side affected

Answer 471

- Slam foot down to get vibration to trunk to let you known that your foot as landed - More promeminate in dark

Answer 472

- Almost walking on tip-toes - Circumduction, but ADD spasm keeping legs close - Can see scissors gait

Answer 473

- Hip drop - Trunk flexion - Trendelenburg

Answer 474

- High hip flexion to prevent fall from weak DF

Answer 475

- Mvt of all kind - Involuntary