Neuromuscular Flashcards
(266 cards)
1
Q
MCA lesion characteristics
A
Contralateral Hemiplegia, Face, UE>LE
Contralateral Hemisensory loss UE>LE
Homonymous Hemianopsia
2
Q
Superior division of MCA lesion
A
Expressive Aphasia (effects Broca’s area and frontal eye fields)
3
Q
Inferior division of MCA lesion
A
Receptive aphasia (effects wernicke’s area and visual radiation )
Decreased graphesthesia, sterognosis on contralateral side, lack of awareness (hemineglect)
4
Q
Homunculus ACA
A
Trunk, Leg Foot (motor), trunk, leg, foot, genitals, some arm sensory loss
5
Q
MCA homunculus
A
Face, hand arm motor loss
Face, hand, tongue sensory loss (larger tongue sensory loss)
6
Q
PCA stroke characteristics
A
Contralateral sensory loss with involuntary movements like choreoathetosis, tremor, hemibalismus, transient contralateral hemiparesis, homonymous hemianopsia
7
Q
ACA-MCA watershed infarct
A
Trunk and proximal UE are affected !!! Severe drop in BP due to carotid stenosis or occlusion of the ICA
8
Q
MCA-PCA watershed infarct:
A
Higher order visual processing is affected
9
Q
ACA lesion characteristics
A
Contralateral paralysis and sensory loss affecting the LE, may lose control of micturition because bladder control involves frontal gyri and anterior cingulate gyrus
10
Q
Why would an occlusion of the stem of MCA have leg involvement?
A
Gives off lenticulostriate arteries that go to BG and internal capsule (posterior limb of the IC gives off lower limb fibers)
11
Q
Lesion of the posterior limb of internal capsule
A
Lower face weakness, hemi anesthesia, spastic hemiplegia (more severe distally) , Left homonymous hemianopia
12
Q
Paracentral lobule lesion comes from what artery and what happens
A
Anterior cerebral artery, C/L hemiplegia and hemiparesis (lesion of the pre central and post central gyrus)
13
Q
R MCA sup. Division lesion
A
Contralateral hemiparesis (face, arm hand), contralateral sensory loss , NO HOMONYMOUS HEMIANOPIA
Neglect variable
14
Q
expressive aphasia typically found
A
in those with right hemiplegia
15
Q
what is astereognosis
A
inability to recognize objects by touch alone
16
Q
ideomotor apraxia
A
person cannot do a task on command but can do it spontaneously
17
Q
ideation apraxia
A
person lo longer gets the idea of how to do a routine task
18
Q
when does global aphasia occur
A
with occlusion to the main stem of the middle cerebral artery
19
Q
what is conduction/associative aphasia:
A
damage to the arcuate fasciculus, patient struggles with repeating phrases and word finding
20
Q
akinesia
A
hard to initiate movements
21
Q
chorea
A
rapid involuntary jerky movements
22
Q
what is a movement pattern seen in Huntington’s
A
chorea, rapid involuntary jerky movements
23
Q
decorticate=
A
flexion contraction in upper extremities and extension in the lower extremitites , damage to red nucleus in the midbrain
24
Q
decerebrate=
A
extension in UE and LE, injury to the brainstem above the vestibular nucleus an below the red nucleus
25
dysdiadochokinesia most often associated with
cerebellar disorders
26
what movements are common to both flexion and extension synergies
wrist/finger flexion, ankle inversion
27
what two strokes may cause homonymous hemianopsia
posterior cerebral and middle cerebral
28
what part of the brain functions to organize behaviors (executive functions, problem-solving, motivation)
the limbic circuit of the extrapyramidal tracts
29
what part of the brain functions to scale amplitude and velocity of movements and what are the other functions
putamen loops or motor loop of the basal ganglia
also reinforces selected movement patterns, suppresses conflicting patterns and preps for movement
30
_____ relays information from the cerebellum and globus pallidus to precentral motor cortex
motor nuclei of thalamus
31
what does the hypothalamus do
control ANS function and neuroendocrine system , HOMEOSTASIS
32
pineal gland helps with
circadian rhythms
33
injury to what part of the cerebellum may result in issues of muscle tone and synergistic actions, posture and voluntary movement control
spinocerebellum
34
issues of force, direction and extent of movement (coordination) may be a result of ____
May also have issues with cognitive function and mental imagery
posterior love of the cerebellum/neocerebellum,
35
where can you find lateral horns of spinal cord grey matter and what is the function
int he thoracic and upper lumbar segments for preganglionic fibers of the autonomic nervous system
36
what tract is responsible for deep and chronic pain
spinoreticular
37
high fall risk BERG balance score
<45
38
normal adults TUG norm
≤ 10 sec
39
normal TUG for frail elderly or disabled patients
11-20 seconds
40
increased fall risk for TUG
> 20 sec
41
high fall risk TUG
>30 sec
42
balance efficacy scale low confidence
total score <50
43
tinetti /POMA high risk for falls
<19
44
tinetti/POMA moderate fall risk
19-24
45
DGI predictive of fall risk and for what population
<19/22
elderly
46
FGA strong evidence for what
acute and chronic neurological conditions
47
FGA moderate evidence for
for chronic progressive conditions
48
BERG balance strong evidence for what
sitting and standing balance for acute, chronic and chronic progressive conditions
49
Activities balance confidence scale has high evidence for what
acute, chronic and chronic progressive neurologic conditions
50
Walking tests with strong evidence for patients with chronic and chronic progressive neuro conditions
10 Meter walk and 6MWT
51
Functional reach test score indicating significant fall risk
≤6
52
Functional reach test score indicating moderate fall risk
score of 6-10
53
what is bitemporal hemianopsia and when does it happen
it is loss of vision to the lateral fields on R and L side, occurs with damage to the optic chiasm
54
apraxia correlates to damage where
prelateral frontal cortex and somatosensory association cortex
55
muscle fasciculations are indicative of
LMNL
56
what is opisthotonos
severe spasm of muscles, causing head back and heels to arch backward with arms and hands in rigid flexion
57
what might cause opisthotonos
meningitis, tetanus, epilepsy or strychnine poisoning
58
what is the abdominal reflex
scratching 4 quadrants of abdomen with lateral to medial strokes causes the umbilicus to deviate towards stimulus, absent with corticospinal lesions
59
cremaster reflex tests what levels
L1-L2
60
abdominal reflex tests what levels
T6-L1
61
cremaster reflex absent with what lesions
SCI and corticospinal lesions
62
Asymmetrical Tonic Neck reflex
rotation of head to one side produces flexion of the contralateral limb and extension ipsilateral limb
63
Symmetrical Tonic neck reflex
Flexion of the head produces flexion of the UEs with extension of lower extremities
Extension of the head produces extension of UEs and flexion of the LEs
Head=UEs, head is opposite of LEs
64
behaviors with lesions to Right hemisphere (L hemiplegia)
impulsive, quick, indifferent, poor judgment and safety, overestimating abilities
65
behaviors with lesions to L hemisphere (R sided hemiplegia)
slow, cautious, hesitant and insecure, often aware of impairments resulting in frustration
66
scissoring gait occurs with _____
spastic adductors
67
what does the stroke impact scale measure
biopsychosocial health and participation following stroke
68
what does the trunk impairment scale measure
motor impairment of trunk with static/dynamic sitting and coordination
69
perceptual deficits may be present from what strokes
with parietal lobe damage to non-dominent side (RMCA)
70
what should be avoided with a flaccid UE following stroke
pulleys, overhead activity, risk of sublux or dislocation
71
what should be emphasized for patients with sensory and perceptual losses
compensatory strategies in order to be safe
72
myopathies present with
pelvic girdle and proximal muscle weakness, resulting in hyperlordosis and compensated trandelenburg (hip hike on weight bearing)
73
which imaging has the most radiation
CT scan
74
what is CT scan most useful for
areas of acute bleeding (hemorrhage in developing stroke), cerebral edema (within 3 days post stroke), and cerebral infarction (3-5 days post stroke)
75
limitations of CT
decreased visualization of small/ischemic lesions and radiation
76
what is MRI imaging useful for
superior imaging, tissues and flow of blood within medium/larger arteries and veins, no radiation
77
what is more sensitive to diagnosis acute stroke
MRI, can detect cerebral edema within 30 min and infarction in 2-6 hours instead of 3-5 days)
78
what is primary imaging for tumors, demyelination, vascular abnormalities
MRI (MRA to see the vessels)
79
contraindications for MRI
metal implants, pacemakers
80
disadvantages of MRI
cost, time and movement artifact if the patient moves
81
Advantages of PET scan
allows physiological mapping for biochemical analysis, tool for imaging cerebral blood flow and brain metabolism
82
PET scan can help screen and diagnose what
tumors, dementia, stroke and seizure
83
which imaging might be useful to detect mild TBI, or disruption of projection fibers
diffuse tensor imaging (type of MRI)
84
what imaging can detect hematomas
CT
85
Normal CSF characteristics (following lumbar puncture)
crystal clear and colorless, 90-150ml volume for adult, 60-100 ml of volume for a child, 90-180 mm of pressure for adult or 10-100mm of pressure for child , protein in adult is 15-45 and 15-100 mg.dL for neonates
86
when might ICP pressure occur
intracranial tumors, abscesses, meningitis, inflammatory processes, subarachnoid hemorrhage, cerebral edema and thrombosis of venous sinus
87
when is insertional activity increased
acute denervated muscle and various muscle diseases
88
when is insertional muscle activity decreased
chronic neuropathies/myopathies with significant atrophy and fibrosis in the muscle
89
what correlates with Wallerian degeneration on nerve conduction studies
abnormal spontaneous EMG acticvty that occurs 7-21 days after peripheral nerve injury or compression
90
When might ICP be decreased
leaking CSF, subarachnoid block circulatory collapse, severe dehydration
91
mild TBI characteristics
0-30 min of LOC, brief; >24 hours of altered consciousness, post-trauma amnesia <1 day, GCS 13-15, normal imaging
92
Moderate TBI characteristics
>30 min but <24 hours of LOC, >24 hours of altered consciousness, post-trauma amnesia >1 day <7 days, GCS 9-12, normal or abnormal imaging
93
Severe TBI
>24 hours LOC, >24 hours altered consciousness, >7 days amnesia, <9 GCS, normal or abnormal imaging `
94
Ranchos Los amigos level I
no response, patient does not respond to external stimuli/appears asleep
95
Ranchos Los amigos level II
generalized response, reacts to external stimuli in nonspecific, inconsistent and non -purposeful manner with stereotpic and limited responses
96
Ranchos Los amigos level III
patient responds specifically and inconsistently with delays to stimuli, may follow simple commands for motor action
97
Ranchos Los amigos level IV
confused, agitated response, pt exhibits bizarre , non-purposeful, incoherent or inappropriate behaviors, has no short-term recall, attention is short and non-selective
98
Ranchos Los amigos level V
confused, inappropriate, non-agitated: pt gives random, fragmented and non-purposeful responses to complex or unstructured stimuli, simple commands followed consistently, memory and selective attention are impaired and new information not retained
99
Ranchos Los amigos level VI
confused, appropriate response: pt gives context appropriate, goal-directed responses, dependent upon external input for direction, shows carry over for re-learned but not NEW tasks, recent memory problems persist
100
Ranchos Los amigos level VII
automatic, appropriate: behaves appropriately in familiar settings, daily routines automatically performed, shows carry-over for new learning at lower than normal rates, pt initiates social interactions, judgment still impaired
101
Ranchos Los amigos level VIII
purposeful ,appropriate response: pt oriented and responds to environment but abstract reasoning abilities are decreased relative to pre-morbid levels
102
what is sympathetic storming
result of hypothalamic stimulation of the SNS with an increase in circulating corticoids and catecholamines (stress)
pts will exhibit minimal altertness, minimal awareness and reflexive motor responses to stimulation
103
PT goals for LOCF IV-VI
posted and written daily schedules, memory logs, pictures
clear feedback, written contracts, behavior modification techniques,
provide frequent orientation to time, place, name and task
emphasize safety, behavioral management techniques
calm and focused behavior
104
PT goals for LOCF (I-III)
prevent contractures and ulcers, reposition, keep HOB elevated if possible, structure environment to facilitate alertness and function
105
PT goals for LOCF VII-VIII
allow for increasing independence, wean patient from closed to open environments, allow for decision making, provide honest feedback and prepare for community, improve physical impairments,
106
common epileptic drugs
phenyotin (dilantin), cabamazepine (tegretol), pheobarbital
107
if there is a bump of head, what are the red flags
drowsiness or inability to wake up, pupils are different sizes, repeated vomiting or nausea, convulsions or seizures, LOC >30 sec, HA that is worsening, slurred speech, numbness or decreased coordination, changes in behavior; irritability, restlessness agitation, confusion , disorientation or amnesia
108
mild concussion/grade I
symptoms last less than 15 min, no LOC
109
moderate concussion/grade II
symptoms >15 min, no LOC
110
post concussion syndrome =
persistent symptoms lasting ≥ 3 months, indicates severity, occurs more commonly with multiple concussions
may include seizures, depression and mild cognitive impairment later in life
111
what is found in autopsy from CTE
brain changes of tau-positive neurofibrillary tangles (NFTs), neuropil threads and neocortical diffuse amyloid plaques with or without neoritic plaques
112
typical signs and symptoms of CTE
recurrent HA and dizziness, cognitive impairments eventually progressing to dementia, mood or behavior disturbances, impaired judgement, impulsive, aggressive, irritable
113
what electrolyte disorders may cause seizures
hypoglycemia, hypernatremia, hyponatremia, hypomagnesemia
114
what is a generalized seizure
all areas of the brain are involved, sometimes referred to as grand mal
115
symptoms of grand mal/generalized seizures
dramatic LOC, stiffening then rhytmic movements of arms and legs, eyes are generally open, breathing is altered, loss of urine common
116
timing of grand mal seizures
typically 2-5 minutes
117
what are absence or petit mal seizures
posture is maintained, repetitive blinking or other small movements, brief and last only a couple seconds but may occur multiple times a day
118
what are partial or focal seizures
only one part of the brain involved so the symptoms are focal
119
complex partial seizure=
person appears dazed and confused, not fully alert or unconscious
120
temporal lobe seizure symptoms
episodic changes in behavior, complex hallucinations, automatisms (lip smacking, chewing, pulling on clothing), altered cog and emotional function , voilent
121
what type of seizure is preceded by an aura
temporal lobe seizure
122
secondarily generalized seizures
simple or complex partial seizures evolving to a generalized seizure
123
status epilepticus
prolonged seizure or a series lasting >30 min, very little recovery in between attacks; may be life threatening, medical emergency
124
what is arnold chairi syndrome
cerebellar symptoms due to cerebellum extending into spinal canal due to birth defect
125
which cerebellar lesion is characterized by hypotonia, truncal and gait ataxia and disordered timing of movement
damage to paleocerebellum (spinocerebellum)
126
which cerebellar lesion is characterized by dysmetria, intention tremor, dyssynergia, dysdiadochokinesia
neocerebellum
127
a neocerebellar lesion will show ______ signs (ipsi or contra)?
ipsilateral
128
what type of muscle test should be used for a patient with a cerebellar lesion
use a make test, some patients will have bursts of muscle activation
129
what is common with dysmetric patients
fatigue
130
where are MS lesions common
pyramidal tract, dorsal columns, optic tract, periventricular areas of cerebrum, cerebellar peduncles
131
when should MS be a part of differential diagnosis
when patients have varying symptoms that do not fit a specific anatomical location
132
most common type of MS
relapsing remitting 85%
133
what are the diagnostic tests for MS
CT, MRI, myelogram, EEG, LP with CSF, elevated gamma globulin
134
what is hyperpathia
hypersensitivity to sensory stimuli
135
Lhermittes sign can be positive for
MS, or cervical myelopathy
136
medical management of MS consists of
adrenocorticotropic hormone (ACTH) and steroids (prednisone, betamethasone, methylprednisone, dexamethasone), interferon drugs, spasticity meds, urinary anticholinergics
137
when working with a patient with MS what should we monitor
UTIs and respiratory infection as respiratory infection may lead to death
138
restorative rehab for MS
time limiting intensive designed to improve/stabilize patient status after a relapse
139
functional maintenance rehab for MS
manage effects of progressive dx/ prevent/minimize indirect impairments like contractures, decubitis ulcers, sensation compensations, eye patching with diploplia, tone reduction techniques
140
progression of MS interventions should increase ____ prior to _____
duration before intensity
141
what happens with deficiency of dopamine
loss of inhibitory dopamine results in excessive excitatory output from cholinergic system (acetylcholine) of basal ganglia
142
H &Y stage I
minimal or absent disability, unilateral
143
H &Y stage II
minimal bilateral or midline involvement, no balance involvement
144
H &Y stage III
impaired balance, some restrictions in activity
145
H &Y stage IV
all symptoms present and severe; stands and walks only with assistance
146
H &Y stage V
confined to bed or WC
147
what contractures are common with PD
flexors and adductors,
148
cause of blurred vision
gaze instability secondary to VOR dysfunction
149
dizziness
sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion
150
sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement
internal vertigo
151
false sensation that the visual surround is spinning or flowing
external vertigo
152
unsteadiness definition
feeling of being unsteady, standing or walking without a particular directional preference
153
indicators of central nervous system pathology and need referral for imaging
direction changing gaze-evoked nystagmus and down-beating nystagmus
154
what are the unilateral vestibular hypofunction disorders?
trauma, meiniere's disease, vestibulo neuronitis/labyrinthitis, BPP, acoustic neuroma, brainstem or gliomas, cerebellar medulloblastoma
155
meniere's disease episode durations
20 min to 12 hours
156
is recovery better in unilateral PVH or bilateral PVH
unilateral
157
gaze stability exercises include
VORx1, VOR cancellation, do them on stable then unstable surfaces, with clear background to cluttered background
158
roll test will test which canal?
horizontal canal
159
what maneuver do you do for an anterior or posterior cupulolithiasis
semont manuever
160
what maneuver do you use for horizontal canal cupulolithiasis
Gufoni maneuver, followed by the canalithiasis
161
what is the most common mechanism of injury for lumbar SCIs
flexion
162
what is the most common mechanis of injury for cervical is SCI
flexion-rotation
163
most frequent spinal cord areas
C5, C7, T12, L1
164
tetraplegia injury occurs between ____ and ____
C1 and C8
165
paraplegia injury occurs between __ and __
T1 and T12-L1
166
central cord syndrome
cavitation of central cord in cervical section
loss of spinothalamic tracts: bilateral loss of pain and temp
loss of ventral horn with bilateral loss of motor function: UE> LE
preservation of DCML
166
Brown-sequard syndrome
hemi-section of spinal cord
ipsilateral loss of DCML so loss of tactile discrimination, pressure, vibration, proprioception
ipsilateral loss of cortico-spinal tracts (loss of motor function and spastic paralysis below lesion)
contralateral loss of pain and temp (spinothalamic), at the level of the lesion will have loss of pain and temp bilaterally
167
anterior cord syndrome
bilateral loss of motor function and spastic paralysis below level of lesion (corticospinal tract)
loss of spinothalamic tracts= bilateral loss of pain and temp
preserved DCML function
167
posterior cord syndrom
loss of DCML bilaterally
preservation of motor, pain and light touch
167
cauda equina symptoms
flaccid paralysis with no spinal reflex activity
flaccid paralysis of bladder and bowel
potential for nerve regeneration, regeneration often incomplete, slows and stops after about a year
168
how long can spinal shock last
several hours to 24 weeks
169
signs of autonomic dysreflexia
HTN, bradycardia, severe headache, feeling anxious, constricted pupils, blurred vision, flushing and piloerection, increased spasticity/tone
170
what do you do if autonomic dysreflexia is suspected
bring pt to upright if they are supine, loosen any tight or restrictive devices/clothes, reduce blockage of urinary drain, monitor blood pressure and HR, notify medical and/or nursing staff
171
common complications of SCI recovery
heterotopic bone formation, DVT, spasticity/spasms, spinal shock
172
appropriate wheelchair for C1-C4 SCI
tilt in space or reclining seat back, microswitch or puff and sip controls, portable respiratory may be attached
173
appropriate wheelchair for C5 SCI
(have shoulder function) manual chair with propulsion aid, independent use for short/flat distances , electric for longer distances and energy conservation
174
appropriate WC for C6 SCI
manual wheelchair with friction surface handrims
175
appropriate WC for C7 SCI
increased propulsion with friction surface handrims
176
appropriate WC for C8 SCI
manual/standard wheelchair and handrims
177
locomotor equipment for T6-T9 injuries
supervised ambulation for short distances/limited household, physiological standing purposes: require bilateral KAFOs with crutches, swing-to pattern or a standing device
178
locomotor equipment for T12-L3 injuries
independent in ambulation on all surfaces and stairs, using a swing through or four point gait pattern, bilateral KAFOs and crutches, may use RGO with or without FES system
independent household ambulation with wheelchair for community
179
locomotor equipment for L4-L5 injuries
bilateral AFOs
180
pts with high lesion paraplegia and tetraplegia, what should we monitor closely during exercise
bloop pressure and heart rate, looking for blunted tachycardia, lack of pressor response, low VO2 peak, higher variability
181
what cells and tracts are involved in ALS
anterior horn cells, descending corticobulbar tracts and corticospinal tracts
182
bulbar onset occurs in what ratio of ALS patients
1/3
183
respiratory impairments in ALS
weakness> paralysis, nocturnal difficulty, exertional dyspnea, accessory muscle use, paradoxical breathing, ventilatory dependent, poor cough/clearance of secretions
184
what cranial nerves are commonly involved in ALS
VII, IX, X, XI, XII
185
bulbar palsy effects what nerves
IX, X
186
bulbar palsy effects what muscles
face, tongue, larynx, pharynx
187
triggering stimulus for trigeminal neuralgia
extremes of cold or heat, chewing, talking, brushing teeth, movement of air across the face
188
trigger points for trigeminal neuralgia
light touch to face, lips or gums
189
what divisions of the CN V are typically involved with trigeminal neuralgia
mandibular and maxillary
190
treatments for trigeminal neuralgia
TENS for desensitization, medications like b12, anticonvulsants, alcohol injections, surgery or permanent anesthesia to the nerve
191
what nerve is effected in bell's palsy and what occurs
CN VII, facial dropp of one side of the face
192
etiology of bell's palsy
acute inflammatory process, immune or viral, compression of nerve within the temporal bone
193
max severity of bell's palsy occurs
in a few hours to days, preceded by a day or two of pain behind the ear
194
full recovery of bell's palsy occurs
several weeks or months
195
facial nerve sensation distribution
taste to anterior 2/3 of tongue
196
neuropraxia definition
197
what is "screening for autonomic dysfunction"
vasodilation and loss of vasomotor tone (dryness, warm skin edema, orthostatic hypotension)
198
nerve conduction studies can rule out ______
radiculopathy, spinal stenosis
199
what can be used for the diagnosis of small fiber cutaneous (pain/temp) neuropathies
skin punch biopsy
200
what is a focus of physical therapy with small fiber neuropathies
decrease pain
201
rapid, nonsymmetric loss of myeline in nerve roots and peripheral nerves, with rapid muscle weakness progression
guillain-Barre
202
etiology of guillian barre
unknown, autoimmune attack, usually occurs after recovery from an infectious illness (respiratory/GI)
203
severe symptoms of guillian barre
dysarthria, dysphagia, diplopia, facial weakness, tetraplegia with respiratory failure
204
recovery of guillain barre
6 months to 2 years, slow recovery, 10-20% of pts have severe disabilities and 5% mortality
205
progression/evolvement of GB
over a few weeks or days
206
medical management of GB
plasmapheresis, IVIG, analgesics for pain management, good nursing care
207
important thing to note for GB therapy
teach energy conservation techniques and activity pacing, avoid overuse and fatigue cause it may prolong recovery
208
_______ is unaffected by post polio syndrome
sensation
209
primary symptom of post polio syndrome
fatigue, new muscle weakness
210
patients with severe paresis, in post polio syndrome should avoid ____
muscle trainging
211
most common neuromuscular junction disorder
myasthenia gravis (MG)`
212
what is myashtenia gravis characterized by
progressive muscle weakness and fatigueability on exertion
213
typical involvement in generalized myasthenia
bulbar (extraocular, facial, muscles of mastication) and proximal limb-girdle muscles
214
myasthenic crisis
MG with respiratory failure, a medical emergency
215
what is the ice pack test and what is it used for
aids in MG diagnosis, positive when ptosis of affected eye decreases following 2 min application of cold pack
216
common difficulties in mobility with Myasthenia Gravis
climbing stairs rising from chair, lifting
217
medical interventions for MG
acetylcholinesterase inhibitors; pyridostigmine, corticosteroids, IVIG, plasmapheresis, thymectomy
218
goals of PT intervention for MG
teach energy conservation, promote independence in FMS and ADLS, monitor changes in condition (respiration, swallowing, vitals), psychological and emotional support
219
Botulinum Toxin=
decreased release of ACh: botox will presynaptic binding to high-affinity recognition sites on cholinergic nerve terminals
220
adverse events of botox
unintended muscle weakness, flaccidity, dysphagia, local hemotoma, general fatigue, dry mouth, pain and flu-like symptoms
221
acquired myopathy s/sx
muscle cramps, exertional fatigue, weakness that progresses in proximal to distal direction, difficulty with overhead activity, stairs and getting in and out of chairs
222
skin changes associated with dermatomyositis
butterfly rash= purple to reddish discoloration of the eyelids, cheeks and bridge of nose; scaling rash on the extensor surface of the fingers)
223
typical finding in polymyositis
joint pain
224
what lab tests confirm myopathy
elevated creatine phosphokinase (CPK), elevated aldolase, elevated lactate dehydrogenase (LDH), elevated liver enzymes
225
____ might be normal in mild myopathies
MEG
226
What should be done to identify etiology of the myopathy
metabolic panel, thyroid/parathyroid hormone, sedimentation rate and c-reactive protein
227
a myopathic muscle defined by
random areas of CT and or lipid deposits
228
muscle weakness in MG is worse with _____ contractions
repeated or prolonged
229
Epstein barr virus is known best for causing
mononucleosis
230
Sjogren's syndrome common sx/sx
dry eyes and dry mouth
231
prognosis for transverse myelties
partial recovery for most patients, occurs in first 3 months to 2 years, 1/3 of patients left with permanent disability, MS can be the cause and pt may experience relapse
232
CRPS type I
no damage to peripheral nerve, example may be ankle sprain
233
CRPS type II
specific damage to peripheral nerve
234
what is acute flaccid myelitis
rare-polio like condition affecting motor neurons in gray matter of the SC< causing muscles and reflexes to become weak ; occurs in children; increasing frequency
235
symptoms of acute flaccid myelitis
sudden onset of arm or leg weakness, loss of muscle tone and reflexes, may have difficulty with eye or eyelid movement, dysarthria and dysphagia some bladder and bowel issues potentially
236
important education point with chronic fatigue syndrome/myalgic encephalomyelitis
avoid push and crash cycle, teach energy consercation techniques
237
exercise recommendations for persons with chronic diseases/disabilites)
low to moderte intensity (RPE 9-12) with gradual progression, 3-5 days/wk, 5 min session initially and progress to 40-60 min; distrubuted, longer rest preaks, avoid overexertion
238
allodynia=
pain response to stimulus that doesn't usually provoke pain (light touch or brush)
239
primary hyperalgesia
increased pain sensitivity to normally painful stimulus in the direct area of damage or inflammation
240
secondary hyperalgesia
pain sensitivity that occurs in surrounding undamaged tissues
241
symptoms of AIDS
one-third of patients exhibit CNS or PNS deficits, confusion and memory loss to disorientation, may have peripheral neuropathy, hypersensitivity, pain and sensory loss
242
chronic pain persists for
> 6 months
243
in distributed practice, rest time is ____ practice time
greater
244
in massed practice, rest time is _____ than practice time
less
245
variable feedback improves
learning and retention
246
early in learning, feedback should be on
correct aspects of performance
247
later in learning, feedback should focus on
errors as they become consistent
248
feedback after every trial is useful during
early learning
249
when should you use distributed practice
when superior performance is desired, when motivation is low, or when learner has short attention, poor concentration or fatigues easy
250
retention=
ability to demonstrate the skill after a period of no practice
251
what is required for task specific training
repetition and extensive practice
252
pure motor lacunar stroke involves what structures
involvement of the posterior limb of the internal capsule, pons and pyramids
253
pure sensory lacunar stroke involves what structures
involvement of the ventrolateral thalamus or thalamocortical projections
254
dysarthria/clumsy hand syndrome is damage to what
pons, genu of anterior limn or the internal capsule
255
ataxic hemiparesis involves what structures
involves pons, genu of internal capsule, corona radiata, cerebellum
256
damage to what may cause lacunar sensory and motor stroke
junction of internal capsule and thalamus
257
hemibalismus can be seen with damage to what structure
subthalamic nucleus
258
dystonia/involuntary movements can be seen with damage to what structure
subthalamic nucleus, lacunar infarction of putamen or globus pallidus
259
what deficits are not seen in lacunar strokes
consciousness, language or visual fields
260
What is cheyne-stokes respiration
period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations
261
what do cheyne stokes respirations accompany
frontal lobe depression and diencephalic dysfunction
262
damage to upper pons may show what type of breathing pattern
apneustic breathing: abnormal respiration marked by prolonged inspiration
263
