Neurological System Disorders Flashcards Preview

COTA Neurological Disorders and Intervention Approaches > Neurological System Disorders > Flashcards

Flashcards in Neurological System Disorders Deck (75):

Precentral Gyrus Frontal Lobe

primary motor cortex for voluntary muscle control


Prefrontal Cortex Frontal Lobe

controls emotions, judgments, higher-order cognitive functions such as ideation and abstraction


Premotor Cortex Frontal Lobe

related to planning movements includes Broca's area, which controls motor aspects of speech


Postcentral Gyrus Parietal Lobe

Receives fibers conveying touch, proprioceptive, pain, and temp sensations


Temporal Lobe

receives/processes auditory stimuli Wernicke's area- language comprehension


Occipital Lobe

receives/processes visual stimuli


Limbic System

concerned with instincts and emotions contributing to preservation of the individual

basic functions include feeding, aggression, emotions, endocrine aspects of sexual response, and long-term memory


Controllable CVA Risk Factors


Cardiac Disease

Diabetes Mellitus


Diet; High Cholesterol

Use of oral contraceptives with high dose of estrogen

Cigarette smoking; Alcohol abuse


Uncontrollable CVA Risk Factors


Gender (male)

Race (African American and Hispanic)

Genetic predisposition


CVA Warning Signs

Numbness or weakness of the face, arm, or leg, especially on one side of the body


Difficulty speaking or understanding, slurred speech

Blurred vision

Difficulty walking, dizziness, loss of balance or coordination

Severe headache with no known cause


Transient Ischemic Attack (TIA)

Temporary interruptions in blood supply to the brain Mini-Strokes Symptoms generally last 24 hours


Cerebral Infarction

due to either embolism or thrombosis of intra or extracranial arteries


Cerebral Hemorrhage

bleed secondary to hypertension or aneurysm


Cerebral Arteriovenous Malformation AVM

abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures


Right CVA

Left sided weakness and sensory loss

Visual-spatial and perceptual deficits

Left sided neglect

Swallowing deficits, slurred speech

Difficulty with abstract thinking

Short attention span

Behavior: impulsivity, denial of deficits, inappropriate comments, excessive talking


Left CVA

Right sided hemiplegia and sensory loss

Global Aphasia

Difficulty reading and writing

Decreased analytical thinking, impaired time concepts, impaired memory

Difficulties in learning new info

Apraxia, left/right confusion

Behavior: slow, cautious, easily frustrated, decreased motivation


Flexion Synergy Patterns

Scapular adduction and elevation; Humeral abduction and external rotation; Elbow flexion; Forearm supination; Wrist flexion; Digit flexion


Extension Synergy Patterns

Scapular abduction and depression; Humeral adduction and internal rotation; Elbow extension; Forearm pronation and wrist and finger flexion or extension


Open vs Close Head Injury TBI

Open Injury Injury results from an object penetrating the skull

Closed Injury Injury tends to be more diffuse Injury can be due to compression, expansion, acceleration, deceleration, or rotation of the brain inside of the skull


Glasgow Coma Scale Eye Opening

1- Never

2- To Pain

3- To Sound

4- Spnotaneous


Glasgow Coma Scale Motor Response

1- No Movement

2- Extension

3- Flexion Abnormal

4- Flexion Normal

5- Localizes Stimulus

6- Obeys Commands


Glasgow Coma Scale Verbal Response

1- None

2- Incomprehensible

3- Inappropriate

4- Confused

5- Oriented


Rancho Los Amigos Scale

I. No Response

II. Generalized Response

III. Localized Response

IV. Confused-Agitated

V. Confused-Inappropriate, Non-Agitated

VI. Confused-Appropriate

VII. Automatic-Appropriate

VIII. Purposeful-Appropriate


Generalized Response RLAS 2

inconsistent, non-purposeful. delayed response


Localized Response RLAS 3

specific but inconsistent


Confused-Agitated RLAS 4

respond to internal stimulant, maybe combative because of confusion


Confused-Inappropriate, Non-Aggitated RLAS 5

appears alert.responds to very simple commands. reacts to external stimuli but out of proportion


Confused-Appropriate RLAS 6

Goal directed behavior, needs a lot of guidance


Automatic-Appropriate RLAS 7

increased awareness. follow simple directions consistently. can relearn old task


Purposeful-Appropriate RLAS 8

Appropriate and oriented. complete ADLs. requires supervision for decreased insight


Spinal Cord Etiology

Trauma to the spinal cord as a result of compression, shearing force, contusion secondary to motor vehicle accident, diving accident, gunshot/knife wound, sports injury, or fall

Non-traumatic cord injuries may be a result of tumor, progressive degenerative disease


ASIA Impairment Scale

A= complete, no sensory or motor func in the sacral segments S4-S5

B= incomplete, sensory but no moter func below neurological lvl and extends thru sacral segments

C= incomplete, motor func below neurological lvl and majority of key muscle groups muscle grade 3/5

D= incomplete, motor func below neurological lvl and majority of key muscle groups muscle grade >/= 3/5

E= normal, sensory and motor func are normal


SCI Symptoms

Spinal shock- 4-8wks

Cessation of all reflex activity below the level of injury

Sensory deficits- partial or complete

Loss of bladder/bowel control

Loss of temp control below lesion

Decreased respiratory func

Sexual dysfunction

Changes in muscle tone- spasticity/flacciidty

Loss of motor func- quadraplegia/paraplegia complete/incomplete


SCI Complications


Decubitus ulcer

Orthostatic Hypotension


Autonomic Dysreflexia


Heterotopic Ossification


Heterotopic Ossification

Abnormal bone development in soft tissue in or around a joint Symptoms: Swelling Painful extremity Decreased range of motion with boney end feel


Autonomic Dysreflexia

A syndrome occuring in patients with spinal cord lesions above T6. Sudden and significant increase in blood pressure above their usual levels in response to a noxious stimuli


C1-C3 Spinal Injury

FO: Neck flx/ext, and rot; shrug shoulders (C3 only) ROM is WFL and painfree. Patient is able to direct PROM program

RE: Mechanical ventilator, commun mouth sticks or env. control units, w/c sip/puff tech


C4 Spinal Injury

FO: Neck flexion, ext, rot; scap. elevation (shoulder shrug) and inspiration May breathe w/o ventilator

RE: Power W/C, keyboard, mounted smartphone,commun mouth sticks or env. control units


C5 Spinal Injury

FO: Shoulder flx/ext, abd; elbow flx and sup; scap. add/abd

Bed mobility w/assist. UED/UEB: Min-ModA. Feed s/u and Indp w/ae.

RE: Power W/C, suspension sling, dorsal wrist w/universal cuff, wash mitt, scoop dish, angled utensils


C6 Spinal Injury

FO: Scap. protractor, some horiz. Add, forearm pron, wrist ext., tenodesis

Bed mobility w/assist, indp eating, indp LED (maxA w/shoes and socks),assist grooming (Indp w/tenodesis grasp or splint), Trns w/assist-indp, MinA bathing w/handheld shower, tub bench

RE: Power or manual W/C, move from universal cuff to built-up utensils, adapted cups/mugs, AE for dressing and eating, hydraulic standing frame, transfer board


C7-C8 Spinal Injury

FO: Elbow ext, wrist flex/ext, finger flex/ext, thumb use. 

Ind-assist bladder and bed mob, ind transfers and press relief, ind eating and UED/UEB, ind-assist LED/LEB

RE: Manual W/C, padded tub bench or shower commode chair, handheld shower,button hook, modified vehicle


T1-T9 Spinal Injury

FO: UEs fully intact, ltd. upper trunk stability, endur.

Independent all self-care, ind stand w/frame, ind homemaking, driving

RE: Manual W/C, standing frame, hand controls (vehicle), elevated padded toilet seat or padded tub bench, shower/commode chair, handheld shower


T10-L1 Spinal Injury

FO: Good trunk stability. Paralysis of LEs

Independent all self-care, assit-ind walk w crutches, ind homemaking, driving

RE: Manual W/C, standing frame, forearm crutches or walker, KAFO, hand controls (vehicle), padded std or raised padded toilet seat, padded tub transfer bench, hand-held shower


L2-S5 Spinal Injury

FO: Good trunk stability, partial to full control of LEs. Partial paralysis of LEs, hips, knees, ankle, foot

Independent all self-care, assit-ind walk w crutches, ind stand w frame, ind homemaking, driving

RE: Padded toilet seat, padded tub bench, handheld shower, forearm crutches or cane, KAFO or AFO


Cerebral Palsy

Caused by an injury and/or disease prior to, during, or shortly after birth resulting in brain damage and secondary neurological and muscular deficits

Types include Spastic CP, Dyskinetc CP, and Ataxic CP Classifications are Monoplegia, Hemiplegia, Paraplegia, Quadriplegia, Diplegia

Complications include language and intellectual deficits, seizures, visual impairments, and feeding disturbances


Spastic CP

Lesion of the motor cortex resulting in spasticity with flexor and extensor imbalance. Spasticity can express itself as:

1. Hypertonia- increased tone

2. Hyperreflexia- increased intensity of reflexes


Dyskinetic CP

Lesion in the basal ganglia results in fluctuations in muscle tone. The lesion expresses itself as:

1. Dystonia- excessive or inadequate muscle tone

2. Athetosis- writhing involuntary movements

3. Chorea- spasdomic involuntary movements


Ataxia CP

Lesion in the cerebellum results in hypotonia and ataxic movements; characterized by lack of stability resulting in more primitive total patterns of movement.

Classified according to ability by the GMFCS and MACS


Gross Motor Function Classification System (GMFCS) for Children w/CP

1- Walks w/o restrictions

2- Walks w/o ae

3- Walks w/ae

4- Self-mobility w/limitations (manual/power w/c)

5- Self-mobility severely limited, even w/ae


Manual Ability Classification System (MACS) for Children w/CP

1- Handles objects easily and sucessfully

2- Handles most objects but with somewhat reduced quality/speed

3- Handles objects with difficulty, needs help to prepare and/or modify activities

4- Handles a limited selection of easily managed objects in adapted situations

5- Does not handle objects and has severely limited ability to perform even simple actions



involuntary, non-repetitive movements affecting distal, proximal, and axial musculature



brief and rapid, involuntary contractions of a muscle or muscle group



brief, purposeless, involuntary movements of the distal extremities and face



Involuntary muscle contractions that cause repetitive or twisting movements



lack of coordination while performing voluntary movements



involuntary flinging motions of the extremities. continuous and random


CP Treatment Focus for Infants

Positioning Feeding orally Play positions Handling during feeding, holding, dressing, play


CP Treatment Focus for Toddler/Pre-School Age



Fine motor skills/pre-K skills

Self feeding and dressing

Visual motor/visual perceptual skills mobility


CP Treatment Focus for School Aged


Fine motor activities to support performance in the classroom


Visual motor/visual perceptual skills

Classroom adaptations

Adaptive PE


CP Treatment Focus for Young Adult

Monitor positioning equipment, splints

Pre-vocational activities and skills

Readiness for a group home


Hypertonic Abnormal Muscle Development

hyper-ext of neck; retraction of shoulder; pelvis extended; legs add, maybe crossed


On tummy, elbows underneath them; highly motivating toy in front for neck ext

Side-lying Sitting; bolster (car seat if small); have child straddle for abd of legs; support hips; slowly rotate shoulders forward.

Slow rocking motions to help break up tone


Hypotonic Abnormal Muscle Development

Needs lots of flx


Facilitate tone prone in a platform swing

Side-lying to bring head, legs, and arms into midline

Sitting with lots of support in hips and trunk "W" sit for core strength

Prone with pillow underneath (so face not on flr)


Multiple Sclerosis MS

chronic, inflammatory disease of the CNS in which most patients incur disability over time


Sensorimotor Changes- spasticity, ataxia, weakness, gait instability, hemi/quadriplegia

Balance Disturbance- dizziness/vertigo

Visual Changes

Bowel and Bladder Disturbance

Cognitive Changes- apathy, memory loss, lack of judgement, inattention

Dysarthria and Dysphagia


Sexual Dysfunction


Treatment- assist w/managing symptoms, maintain func, optimize QOL declining- adaptive approach; recovery- remedial approach


Types of MS

Relapsing Remitting- acute attack, recovery. another attack may or may not happen

Secondary Progressive- relapse/remit, then progressive decline

Primary Progressive- progressive w/o remitting

Progressive Relapsing- progressive w/acute decline


Parkinson's Disease

Slow progressive disease of the nervous system


Bradykinesia; Muscle Rigidity; Resting Tremor; Cog-wheel Rigidity; Micrographia; Dementia; Memory Deficits; Voice softens-becomes monotone; Reduced facial expression; Shuffling Gait; Freezing


Parkinson's Disease Stages

I- Unilateral symptoms, no or minimal functional implications, usually a resting tremor

II- Bilateral symptom involvement, no balance difficulty, mild problems with trunk mobility and postural reflexes

III- Postural instability, mild to moderate functional disability

IV- Postural instability increasing, though able to walk; functional disability increases, interfering with ADL; decreased manipulation and dexterity

V- Confined to wheelchair or bed


Shunt Precautions

Blockage- headache, vomiting, irritability

Infection- vomiting, lethargy, fever; seizures and deterioration of physical/cognitive functioning


Muscular Dystrophies/Atrophies

a group of degenerative disorders due to a hereditary disease process; can begin in infancy, childhood, or adulthood

Includes Duchenne's MD, arthrogryposis multiplex congenita, limb-girdle MD, spinal muscular atrophy, congenital myasthenia gravis, and myopathies

Symptoms: Low muscle tone and weakness Difficulty w/oral feeding Breathing difficulties


Amyotrophic Lateral Sclerosis ALS

Degenerative motor neuron disease of unknown etiology; more prevalent in men; avg onset 57yrs; life expectancy 2-5yrs Symptoms

Affects Voluntary Muscles

Spasticity and Stiffness Weakness, low tone and atrophy

Speech deficits, swallowing and respiratory involvement

Eye Muscles; external sphincters controlling bowel and bladder management; five senses; heart, liver, and kidneys are spared.


Stages of ALS 

I: Independent in walking and ADLs, some weakness

II: Can walk; mod weakness

III: Can walk; severe weakness

IV: Req w/c for mobility; some assist w/ADLs; severe weakness in legs

V: Req w/c for mob; dependent for ADLs; severe weakness in arms and legs

VI: Confinded to bed; req assist for ADLs and most self-care


Peripheral Neuropathies

Result of trauma, pressure paralysis, forcible over-ext of a joint, hemorrhage into a nerve, exposure to cold or radiation, or ischemic paralysis.

Symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve


Guillain-Barre Syndrome

 a disorder in which the body's immune system attacks part of the peripheral nervous system. Inflammatory disease that causes demyelination of axons in peripheral nerves

Etiology unknown; may occur after an infectious disorder, surgery, or immunization

Three Phases

Onset and Acute: acute weakness occurs in at least two extremeties and advances (20-30% req mechanical ventilation)

Plateau: sypmtoms most disabling with little/no change for days-weeks

Recovery: starts head/neck moves distally; sig-complete return of func, may have residual fatigue



Guillain-Barre Syndrome Symptoms

Rapid progression

Pain, fatigue, edema

Prickling, "pins and needles" sensations in your fingers, toes, ankles or wrists

LE weakness that spreads to UE, can evolve into paralysis

Unsteady walking 

Difficulty with eye or facial movements, including speaking, chewing or swallowing

Severe pain that may feel achy or cramp-like and may be worse at night

Difficulty with bladder/bowel function

Rapid heart rate

Low or high blood pressure

Difficulty breathing



OT TBI Acute Treatment Focus

Sensory stimulation





OT TBI Rehab Treatment Focus

Regaining func in ADLs, IADLs, executive func skills, and community reintegration