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NPTE > Neuromuscular > Flashcards

Neuromuscular Flashcards

(118 cards)

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1
Q

What is Brown-Sequard Syndrome

A

Pain and Temperature loss on contralateral side of spinal cord injury

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2
Q

What’s lost with Brown -Sequard syndrome on Right sided Hemisection?

A

T12 motor function and sensation Right side
+
Pain and temperature on left side

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3
Q

What functions are preserved with Brown-Sequard Syndrome and right sided Hemisection of spinal cord at T12?

A

Pain and temperature on right side
+
Sensation and motor function
+
Proprioception and vibration

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4
Q

Position of Conus Medullaris/End of spinal Cord

A

L1

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5
Q

Symptoms of spinal Cord Injury above Conus Medullaris

A

Act like upper motor neuron injury
Spastic/hyperreflexive bladder
-> empties whit adequate filling pressure

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6
Q

Symptoms of spinal Cord Injury below Conus Medullaris

A

Act like lower motor neuron injury
Flaccid/areflectic bladder

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7
Q

Treatment/Management of flaccid/hyporeflective bladder

A

Catheterization
Valsalva maneuver

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8
Q

Treatment/Management of spastic/hyperreflective bladder

A

Initial catheterization
Suprapubic tapping

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9
Q

Symptoms/Bowel function with SCI above Conus Medullaris

A

Spastic/hyperreflexive bowel
Defecation when rectum fills

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10
Q

Symptoms/Bowel function with SCI below Conus Medullaris

A

Flaccid/reflexive bowel

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11
Q

Treatment Bowel function with SCI above Conus Medullaris

A

Digital stimulation to initiate reflex

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12
Q

Treatment Bowel function with SCI below Conus Medullaris

A

Manual evacuation
Gentle valsalva maneuver
Bowel program training/Timetable

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13
Q

Diaphragm Innervation

A

C3/4/5 KEEP THE DIAPHRAGM ALIVE

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14
Q

Pulmonary symptoms with SCI

A

Decreased diaphragm & intercostals

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15
Q

What’s the pulmonary paradox In cervical or high thoracic SCI?

A

-> decr. Activity external intercostals
-> upper ribcage moves inwards in Inspiration
-> decr chest wall compliance
+ Incr abdominal compliance

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16
Q

Integumentary prevention in SCI Patients

A

Pressure relief every 15min
-sideways +forward >45°
- tilt in space >65°

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17
Q

ROM considerations in SCI

A

-Hamstrings straight leg raise to 100°
-Intrinsic plus position
!!! Avoid overstretching Hamstrings and Quadratus lumborum

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18
Q

What’s the “intrinsic plus” position of the wrist?

A

20° Ext + 90° flexion MCP + IP slight flex
-> maintains tenodesis grasp control
(Grasp with wrist extension)

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19
Q

What to do when P exhibits any kind of symptoms when in upright positioning Table?

A

BRING BACK TO SUPINE!
OR TRENDELENBURG POSITION
Let symptoms completely subside before continuing at lesser degree

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20
Q

C1-C4 SCI functions

A

Respiratory considerations
Dependent for ADL’s
Wheelchair motorized with sip/puff controls/head/chin/tongue

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21
Q

C5 SCI functions

A

Joystick wheelchair with electronic recline
Car with modifications
Dependent for transfer
Manual WC with safety set up

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22
Q

C6 SCI functions

A

Mostly independent
Manual wheelchair with modifications
Transfer with slideboard
Car with adaptive equipment

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23
Q

C7 SCI functions

A

Independent ADL’s
Manual WC
Manual pressure relief

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24
Q

C8 SCI functions

A

Full wrist/elbow control and most fingers
More independent

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25
T1-T12 SCI functions
Independent or modified independent
26
L1-L3 SCI functions
Hip flex and knee ext possible Ambulation with Orthoses (HKAFO/ KAFO) possibly AFO
27
l4-S1 SCI functions
Full ambulation Possibly AFO or assistive device
28
SCI interventions for ADL's
Rolling through flexion of head/neck -> rocking/momentum use Sit (squat) -pivot Transfer (C6 and below) Head-hip opposition head le + hip ri
29
How to adjust axle to facilitate a wheelie in WC?
Anteriorly To decr base of support
30
C3,C4, C5 keep the ...... alive
Diaphragm
31
L2, L3, L4 keep
The poop of the floor
32
ULTT 1 & 2
Median Nerve Gestreckter arm/ABD/supine/elbow EXT/DExt 1.) 90°ABD 2.) 45°ABD
33
ULTT Radial
Gestreckter arm/ internal rotation/PFlex
34
ULTT ulnar
Finger tip to ear 90°ABD +ER/ Elbow flex/wrist finger EXT
35
Radial Nerve innervation
C6-T1 A BEAST Abd poll lingua Brachioradialis Ext of forearm Anconeus Supinator Triceps
36
Musculocutaneous Nerve innervation - spinal level + muscles
C5-6 Flexors Biceps Brachialis Coracobrachialis
37
Long Thoracic Nerve Innervation
C5-C7 Serratus anterior Medial winging of scapula --> weak upwards rotation
38
Supra scapular Nerve Innervation
C5-C6 Supraspinatus Infraspinatus GH joint capsule
39
Axillary Nerve Innervation
C5-C6 Teres minor Deltoid Proximal lateral arm sensory
40
Dermatomes hand
C6 thumb C7 middle finger C8 pinky
41
Median Nerve Innervation
1/2 LOAF P/P 1/2 Lumbricals Opp poll APB Flexors Pronators
42
How to assess Anterior Interosseous Nerve?
Okay Sign/ pinch grip
43
Innervation of Ulnar Nerve
MAFIA Medial 2 Lumbricals Add poll Flexors ulnar side Interossei Abd digiti quinti
44
How to assess ulnar Nerve?
Froments sign --> compensation with median Nerve -> over thumb tip pinch instead of flat
45
Erb's Palsy
C5-6 Upper brachial plexus injury Waiters tip deformity
46
Klumpke's Palsy
C7-T1 Upper brachial plexus injury Klumpke's claw (functional grip like SCI)
47
Possible complication in mid shaft humerus FX:
Radial Nerve palsy
48
Possible complication when using axillary crutches:
Radial Nerve palsy Park-Bank Phenomenon
49
A patient has a paracentral intervertebral disc herniation at L4-5. Which nerve root is affected and what are symptoms occurring?
L5 nerve root (L4 nerve root escapes above disc) Weakness of great toe ext + paresthesia medial thigh
50
Myotome L2
Hip Flexors
51
Myotome L3
Knee Extensors
52
Myotome L4
Ankle Dorsiflexors
53
Myotome L5
Long toe ext
54
Myotome S1
Ankle plantar flexors
55
Dermatome L1
Pelvic line & lap
56
Dermatome L2
Upper quad
57
Dermatome L3
Lower quad & knee
58
Dermatome L4
Medial lower leg & knöchel
59
Dermatome L5
Lateral lower leg + big toe+2 1/2
60
Dermatome S1
Achilles tendon + lat toes 1 1/2
61
Dermatome S2
Hamstring area
62
Dermatome S 3
Outer butt ring /donut
63
Dermatome S4-5
Inner butt ring / donut hole
64
Innervation Femoral Nerve
L2-L4 F-Quips Quadriceps Iliopsoas Pectineus Sartorius
65
Gait with Femoral Nerve injury
Forward leaned
66
Obturator Nerve innervation
L2-L4 Add longue/brevis Gracilis Add Magnus Obturator externus
67
Superior gluteal nerve Innervation
L4-S1 Glute med Glute mind TFL
68
Inferior gluteal nerve Innervation
L5-S2 Glute max backwards trunk lean gait
69
Sciatic Nerve components
Tibial Nerve Common Peroneal Nerve - Superficial Peroneal - Deep Peroneal
70
Tibial Nerve innervation muscles + sensory
L4-S3 as part of Sciatica Nerve Gastroc/Soleus/Popliteus/Tib post/Toe flexors - plantar foot + heel - posterior leg/calf as N suralis
71
Common peroneal nerve Innervation
DFLEX L4-S2 as part of sciatica nerve Divides into: 1.) superficial Peroneal Nerve 2.) deep peroneal nerve
72
Superficial peroneal nerve Innervation - motor and sensory
EVERSION - Lateral Compartment Fibularis/Peroneus longus Fib/Peroneus brevis - lateral leg + dorsum of foot except 1st/2nd Interphalangeal space
73
Deep peroneal nerve Innervation - Motor + Sensory
DFLEX Tib ant Toe Extensors - area between 1st/2nd toe
74
Tarsal Tunnel Syndrome affects
Tibial nerve - medial ankle Weak foot intrinsics PAIN: med heel/ Arch --> worse with standing/walking
75
Posterior Cord Syndrome
Dorsal column/medial lemniscate tract LOSS: bilat. Proprio/ vibr/ pressure/2point discrimination KEEP: motor fct/ light touch/pain ->Compression of posterior spinal artery
76
Central Cord Syndrome
Spinothalamic tracts/ ventral horn LOSS: bilat pain+temp/ Motor (UE) KEEP: proprio/2point discrim/vibr Usually hyperextension injury!!!!
77
Anterior Cord Syndrome
Lateral corticospinal / spinothalamic tracts LOSS: bil motor/ spastic below lesion/pain+ temp KEEP: proprio/ kinesthesia/vibr Flexion injury mechanism
78
Glasgow Coma Scale
Eye opening/ motor respo/ verbal resp 1-8=severe brain injury 9-12= moderate brain injury 13-15=minor brain injury
79
Gait with Sciatic Nerve Palsy
Steppage Gait (foot drop)
80
Signs of UMNL
Spasticity Clonus Hypertonia Hyper reflexive
81
Signs of LMNL
Muscle wasting Flaccidity Hypotonia Hypo reflexive
82
Dermatomes of the foot
L4 medial malleolus L5 top of foot S1 lateral mall+ pinky
83
Deep Tendon Reflex of which muscle at C5?
Biceps tendon
84
Deep Tendon Reflex of which muscle at C6?
Brachioradialis
85
Deep Tendon Reflex of which muscle at C7
Triceps tendon
86
Deep Tendon Reflex of which muscle at L3
Patellar tendon
87
Deep Tendon Reflex of which muscle at L4
Tibialis posterior
88
Deep Tendon Reflex of which muscle at S1
Achilles Tendon
89
Deep Tendon Reflex - Absent, no reflex
Grade 0
90
Deep Tendon Reflex - diminished
Grade 1
91
Deep Tendon Reflex active, normal
Grade 2
92
Deep Tendon Reflex - exaggerated, brisk
Grade 3
93
Deep Tendon Reflex clonus, very brisk
Grade 4
94
Hoffmans
95
Neuropathic/Neurogenic Pain
Sharp/ shooting/burning/tingling/ electric/ Evoked with non-noxious stimulus: light touch, cold, etc
96
Allodynia
Normally non-noxious stimulus cause severe pain
97
Liver flap
Clonus when hyper extending wrist --> sign of liver dysfunction
98
Blocked Practice
Same task repeatedly Then moving to different task -> learn skill quickly & initially
99
Part Practice
Break down of tasks Then practice whole task -> NOT recommended for continuous and highly integrated tasks like walking
100
Autonomic dysreflexia
Sympathetic symptoms to noxious stimulus = med. Emergency Increased BP (>25mmHg above base) Decreased HR --> SIT UP!!! Sweating Flush face
101
102
Dynamic postural control exercises
E.g. standing + move upper body
103
Functional mobility exercises
Involves related task E.g. STS/ bed mobility/ fctl task
104
What promotes motor learning best when difficulty progressing locomotion after stroke?
Variable Practice
105
Anterior Vertebral Artery - stroke symptoms
LE>UE Urinary incontinence likely
106
Middle Cerebral Artery - stroke symptoms
UE>LE Visual impairments Aphasia
107
Posterior Cerebral artery - stroke symptoms
Visual impairments Difficulty reading Memory impairments Agnosia
108
Symptoms of Basal Ganglia and central Canal stenosis are observed..?
Bilaterally
109
Automatic-appropriate level VII RLA LOCF
Robot like daily routines
110
Confused-appropriate level VI RLA LOCF
Dependent on external input or instructions to complete task
111
Generalized response Level II RLA LOCF
Inconsistent and non purposeful reactions to stimuli ML
112
Complete basilary artery Syndrome
Tetraplegia
113
Medullary artery syndrome
Paralysis ipsilateral tongue Contralateral UE+LE paralysis with Decreased proprio/ tactile sensation
114
Middle Cerebral artery syndrome
Contralateral hemi + sensory loss UE>LE + face Aphasia
115
Posterior cerebral artery
Contralateral Homonymous hemianopsia Dyslexia Memory defect Choreaathethosis Cerebellum /tremor/ hemiballismus
116
Obtunded state
Diminished arousal Once aroused -> confused No interest or awareness of envrnmt
117
Minimally conscious state
Return of irregular sleep-wake cycle Normalization of vegetative fct - respiration/digestion/ BP control/
118
Stupor state
Only arousal with vigorous, unpleasant stimuli

NPTE (8 decks)

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