Neurology - Part 1 Flashcards
1
Q
Somatosensory Pathway
A
Spinal Cord to Brain (Afferent)
2
Q
Motor Pathway
A
Brain to Spinal Cord (Efferent)
3
Q
Subgroups of Neuromuscular Conditions
A
- Non-progressive disorders of the CNS: Congenital or acquired in infancy/childhood (Autism, Epilepsy, Spina Bifida, Down’s Syndrome, Meningitis, Cerbral Palsy
- Non-progressive disorder of CNS: Acquired in adolescence or adulthood (TBI, meningitis, CVA, concussion, asphyxia
- Progressive disorders of the CNS (Alzheimer’s disease, MS, ALS, Parkinson’s)
- Spinal Cord Injury (Trauma or Tumor)
- Peripheral Cord Injury (Brachial plexus lesion, CTS, Tarsal Tunnel Syndrome)
- Acute or Chronic Polyneuropathies (Diabetes, alcoholism, Guillain-Barre Syndrome)
- Coma or near coma state
4
Q
Who do you observe?
A
Providers, patients, etc.
5
Q
What will you look for?
A
- Having symptoms they haven’t told you or think they should tell you
- How they respond to the conversation
- Attitude
6
Q
How do conversations contribute to clinical decision making?
A
Guide Priority List
7
Q
What is cruical for pediatric observation?
A
How children interact with the environment
8
Q
Who do you prioritize a global observation for?
A
EVERY PATIENT
9
Q
Dysarthria
A
Speech difficulties from impaired motor control
- Injury to tongue, palate, lips or pharaynx
- Lesion of motor nerve PNS or CNS
- Disease process of CNS
9
Q
Dysarthria
A
Speech difficulties from impaired motor control
- Injury to tongue, palate, lips or pharaynx
- Lesion of motor nerve PNS or CNS
- Disease process of CNS
10
Q
Dysphonia
A
Difficulties in voice production volume, pitch, quality
- May be due to inflammation or tumor or larynx
- Vagus nerve damage to larynx
11
Q
Dysphagia
A
Difficulties with swallowing
12
Q
Aphasia
A
Cognitive, nerological disorder that results in diffculty or inability to produce or understand language
13
Q
Receptive aphasia
A
Difficulty understanding
14
Q
Expressive aphasia
A
Difficulty talking/expressing
15
Q
Global aphasia
A
Both receptive and expressive
16
Q
How can you test the ability to participate and react?
A
- Understanding of questions
- Word Comprehsnsion (one step command)
- Repetition
- Naming
- Writing
17
Q
Communication Assessment
A
Priority
- If diagnosis is known to cause communicarion problems
- Patient has diffuculty answering interview
18
Q
What is cognition?
A
Conscious awareness of brain activity
-Includes attention, speed of processing, working memory, learning, adaptibility, problem solving
19
Q
What is alertness?
A
State of active attention
Indluences by illness, medications, fatigue, emotions
20
Q
Decordicate rigidity
A
Arms to core
21
Q
Decerebrate rigidity
A
Arms back
22
Q
Working memory
A
immediate recall and processing
23
Q
Short-term memory
A
Recent
24
Long-term memory
Stored memories
25
Anterograde amnesia
Difficulty recalling events that occur after the trauma
26
Retrograde amnesia
Loss of memories from before the trauma
27
Cognition Assessment
Priority
- Diasnosis is known cause of communication problems
- Patient has difficulty answering interview questions
28
What if your patient has a psychological disorder?
-Normalize
-Address symptoms that may influence care
-Refer to the appropriate provider
-Provide resources available
29
What if your patient has a psychological disorder?
-Normalize
-Address symptoms that may influence care
-Refer to the appropriate provider
-Provide resources available
30
Emotional and Psychological Factors
Priority
-Informal assessment begins at interview/observation
-Variable to the degree it will interfere
-Chronic Pain
-Life altering conditions
-Depression screening questions
31
What does the doral root carry?
Sensory Fibers
32
What does the ventral root carry?
Motor Fibers
33
What is distal to spinal nerve roots?
Branches -> Cords -> Divisions -> Trunks -> Roots
34
Somatosensory Assessment
Priority
- Symptoms of nervous system involvement
- Those at risk for a condition that impairs distal extremity sensation
- Suspected nerve root level
35
Upper Motor Neurons (UMN)
- Affects spinal cord or brain
- Traumatic or disease process
- Common conditions: TBI, Stroke, SCI, MS
36
Lower Motor Neurons (LMN)
- Involves peripheral nerves
- Traumatic nerve or disease process
- Common conditons: Disc Bulge, Sciatica
37
Spinal Nerve Root Testing
Priority
-Use when symptoms suggest nerve root pathology
-Differential between nerve root and peripheral nerve
38
What is a reflex?
- An action that is performed as a response to a stimulus and without conscious thought
- Protects from harm
39
Deep Tendon Reflexes (DTR)
Afferent nerve has direct connection with muscles spindle in target muscle
Quick stretch tendon (stretch reflex) stimulates muscle spindle
No specific DTR for each spinal level
40
How are DTRs assessed?
Grading
0 = No reflex
1+ = minimal or depressed response
2+ normal response
3+ overly brisk response
4+ brisk response with clonus
(IF 1+ and 3+ are bilateral may not indicate pathology)
41
Hypotonic DTRs
- Injury or compression along the nerve pathway, including the nerve root
- Prohibits transfer of the reflex message, either incoming or outgoing
- If interruption of pathway, DTR will be diminished
- If only one nerve root is involved, DTR might be present but diminished
42
Hypertopic DTRs
- CNS pathology
- DTRs are influences by the descending motor pathways
- Corticospinal tract messages tend to inhibit the synaptix response
- Any point superior to the tract may inhibit modulation
43
When should you perform a Deep Tendon Reflex Assessment?
Symptoms of CNS or PNS dysfunction
Suspected disease of CNS
44
What is required for coordinated, volitional movement?
Adequate joint ROM
Strength
Intact neural pathway
Adequate cognitive processing to carry out the motion
45
Role of Cerebellum
Movement synergies – does not cause movement but influences quality
Maintenance of upright posture
Maintenance of muscle tone
Receives sensory input from spinal cord and brain
46
Types of Cerebellar Dysfunction
- Ataxia
- Dysdiadocokinesia
- Intention Tremor
- Postural Tremor
- Hypotonia
- Dysarthria
- Deviations in eye control
47
Ataxia
Without coordination; lack smooth trajectory and fine motor
Ex: Not normal heel to toe; odd rocking of foot
48
Dysdiadochokinesia
Inability to produce rapid alternating movement
49
Intention Tremor
Tremor increases as the limb reaches the target
50
Postural Tremor
Induced by intentionally maintained head or trunk posture or holding a limb in front of body
51
Hypotonia
Overall decrease in resting muscle tone
52
Dysarthria
Poor word formation because inability to coordinate muscles and structures of speech
53
Deviations in eye control
Lack of smooth pursuit, saccades, delayed initiation of eye movement
54
Coordination Testing - Priority
Known or suspected lesions in CNS that may affect cerebellar function
Observed uncoordinated movement or gait abnormalities
Difficulty manipulating small objects
55
Upper Motor Neuron Conditions: POTENTIAL FINDINGS
* Cognitive Deficits
* Weakness
* Balance Deficits
* Coordination Deficits
* "Global" Somatosensory deficits (spinothalamic and/or posterior columns)
* CN Involvement
* Hypo or Hypotonia (spasticity)
* Hyperreflexia
* +UMN testing
- Clonus
- Babinski and/or Hoffman
56
Lower Motor Neuron Conditions: POTENTIAL FINDINGS
* Pain and/or numbness and tingling along nerve distribution
* Weakness
* Hypotonia
* Pattern "Somatosensory deficits" (along peripheral N or dermatome)
* Hyporeflexia
* Negative UMN testing
