Neurophysiology

Question 1

<p>What is the function of the Frontal Lobe?</p>

Answer 1

<ol> <li>Cognitive function</li> <li>Movement control (primary motor cortex)</li> <li>motor programming of speech (Broca's area)</li></ol>

Question 2

<p>what are some of the functions of the Parietal lobe?</p>

Answer 2

<ol> <li>major sensory center</li> <li>somatosensory integration (temperature, taste, touch and movement)</li> <li>Language comprehension (Wenicke's area)</li></ol>

<p></p>

Question 3

<p>what are the main functions of the temporal lobe?</p>

Answer 3

<ol> <li>memory center</li> <li>auditory center</li> <li>taste, sound, sight and touch integration</li></ol>

<p></p>

Question 4

<p>what is the main function of the occipital lobe?</p>

Answer 4

<p>primary visual center</p>

Question 5

<p>from most lateral to most medial, what body structures are somatopically mapped at the precentral gyrus?</p>

Answer 5

<ol> <li>Mouth <ol> <li>swallowing</li> <li>tongue</li> <li>jaw</li> <li>lips</li> </ol> </li> <li>Face</li> <li>HAND</li> <li>arm</li> <li>Trunk</li> <li>Lower extremity</li></ol>

Question 6

<p>what body structure would you expect to see somatopically mapped in the longitudinal fissure of the precentral gyrus?</p>

Answer 6

<p>(betweenL and R sides)</p>

<p>hip, knee, ankle and toes</p>

Question 7

<p>from most lateral to most medial, describe where body structures are represented somatopically at the postcentral gyrus</p>

Answer 7

<p>most laterally to medially</p>

<ol> <li>intra-abdominal</li> <li>phayrnx</li> <li>mouth</li> <li>Face</li> <li>Arm</li> <li>Trunk</li> <li>Leg (at the top)</li></ol>

Question 8

<p>what arteries make up the anterior circulation of the brain?</p>

Answer 8

<ol> <li>Internal carotid arteries</li> <li>Anterior Cerebral arteries</li> <li>Middle Cerebral arteries</li></ol>

<p></p>

Question 9

<p>What arteries make up the posterior circulation of the brain?</p>

Answer 9

<ol> <li>Vertebral arteries</li> <li>Posterior and Anterior Inferior Cerebellar Arteries</li> <li>Basilar artery</li> <li>Pontine arteries</li> <li>superior cerebellar arteries</li> <li>Posterior Cerebral artery</li></ol>

<p></p>

Question 10

<p>What are the 3 major arteries that supply our cerebrum?</p>

Answer 10

<ol> <li>Anterior Cerebral artery</li> <li>Middle Cerebral artery</li> <li>Posterior Cerebral artery</li></ol>

<p></p>

Question 11

<p>What areas of the brain are perfused by the anterior cerebral artery?</p>

Answer 11

<ol> <li>anterior and medial surface of the brain</li> <li>from frontal lobe to anterior parietal lobe</li> <li>subcortical structures <ol> <li>basal ganglia (anterior internal capsule, inferior caudate nucleus),</li> <li>anterior fornix</li> <li>corpus callosum<span></span></li> </ol> </li></ol>

Question 12

<p>What are the functions of the areas perfused by the anterior cerebral artery?</p>

Answer 12

<ol> <li>frontal lobe→ cognitive and motor functions</li> <li>parietal lobe→ sensory center</li> <li>corpus callosum→ two way highway that allows hemispheres to communicate</li></ol>

Question 13

<p>what are some signs and symptoms of a stroke involving the Anterior Cerebral Artery?</p>

Answer 13

<ol> <li>contralateral hemiparesis or hemiplegia</li> <li>contralateral hemisensory loss</li> <li>apraxia</li> <li>problems w/bimanual tasks</li> <li>sig. cognitive deficits</li> <li>lack of spontaneity, motor inaction, slowness and delay</li> <li>difficulty with executive function tasks</li> <li>transcoritical aphasia</li> <li>contralateral grasp reflex</li> <li>Alien Hand syndrome</li> <li>Urinary incontience</li></ol>

<p></p>

Question 14

<p>what is contralaleral hemiparesis or hemipelgia?</p>

<p>what brain structures are involved?</p>

Answer 14

<ol> <li>weakness effecting one side of the body</li> <li>motor cortex (frontal lobe)</li></ol>

Question 15

<p>what is apraxia? what brain structures are involved with it?</p>

Answer 15

<ol> <li>motor agnosia→ knowledge of how to perform a skilled movement is lost</li> <li>supplementary motor area and corpus callosum</li></ol>

<p></p>

Question 16

<p>An ACA stroke involving the pre-frontal cortex will include what symptoms?</p>

Answer 16

<ol> <li>lack of spontaneity</li> <li>motor inaction</li> <li>slowness and delay</li> <li>difficulties with executive function tasks (attention)</li></ol>

<p></p>

Question 17

<p>what is transcortical aphasia and what brain structures does it involve?</p>

Answer 17

<ol> <li>aphasia→ loss of ability to produce or understand speech <ol> <li>this doesn't tend to be as severe as Broac's apahsia (motor) in that they can function a bit better</li> </ol> </li> <li>supplementay motor area (dominant hemisphere)</li></ol>

<p></p>

Question 18

<p>what area's/structures of the brain are involved in the contralateral grasp reflex (sucking reflex)?</p>

Answer 18

<p>No well understood</p>

<p>maybe corpus callosum and frontal lobe?</p>

Question 19

<p>what is alien hand syndrome and what regions of the brain are involved with it?</p>

Answer 19

<ol> <li>involuntary, uncontrollable movement of the upper limb</li> <li>supplemental motor area</li></ol>

<p></p>

Question 20

<p>List some ACA treatment strategies</p>

Answer 20

<ol> <li>structure environment to minimize external distractions</li> <li>closed chain "big muscle" exercises</li> <li>bimanual activities to tackle UE deficits</li> <li>function-based training</li></ol>

<p></p>

Question 21

<p>what areas of the brain does the middle cerebral artery (MCA) perfuse?</p>

Answer 21

<p>two branches</p>

<ol> <li>entire lateral aspect of the cerebral hemisphere (frontal, temporal, and parietal lobes)</li> <li>subcortical structures, <ol> <li>internal capsule (posterior portion)</li> <li>corona radiata</li> <li>globus pallidus (outer part),</li> <li>most of the caudate nucleus,</li> <li>putamen</li> </ol> </li></ol>

<p></p>

Question 22

<p>what are the signs and symptoms of MCA syndrome?</p>

Answer 22

<ol> <li>Contralateral paresis</li> <li>Contralateral sensory loss</li> <li>Motor speech impairment</li> <li>receptive speech impairment</li> <li>global aphasia</li> <li>perceptual deficits</li> <li>apraxia</li> <li>visual deficits</li> <li>loss of conjugate gaze to opposite side</li> <li>pure motor hemiplegia (lacunar stroke)</li></ol>

<p></p>

Question 23

<p>what brain structures are involved with motor speech impairment from MCA syndrome?</p>

Answer 23

<p>Broca's area (dominant hemisphere)</p>

Question 24

<p>what brain structures are involved with recepive speech impairment with MCA syndrome?</p>

Answer 24

<p>Wenicke's area (dominant hemisphere)</p>

Question 25

What is global aphasia and what brain structures are involved with it?

Answer 25

1. also called total apashia
   1. cannot speak fluentyly
   2. cannot communicae verbally
   3. cannot understand language
2. Broca's and Wernicke's areas involved 

Question 26

what are some examples of perceptual deficits observed with MCA syndrome?

Answer 26

1. unilateral neglect → tendency to behave as if one side of the body and/or one side space does not exist. 
2. depth perception issues 
3. spatial relations issues 

Question 27

what brain structures are involved with perceptual deficits observed with MCA syndrome?

Answer 27

parietal sensory association cortex (non-dominant hemisphere)

Question 28

what brain structures are involved with visual deficits observed with MCA syndrome?

Answer 28

optic radiation in internal capsule

Question 29

what is "loss of conjugate gaze to opposite side" and what brain structures are involved with it?

Answer 29

1. conjugate gaze is the ability of the eyes to work together/in unison
2. frontal eye fields or decending tracts

 

Question 30

what brain structure are involved with pure motor hemiplegia (lucunar stroke)?

Answer 30

upper portion of posterior limb of internal capsule

Question 31

what are the small perforating arteries off of the MCA?

Answer 31

lenticulostriate arteries → supply deep structures within the cerebrum 

basal ganglia and internal capsule

Question 32

what is a major symptom of a lacunar infarct?

Answer 32

pure motor hemiparesis

Question 33

List some treatment strategies when treating an stroke involving the MCA

Answer 33

1. Incorperate speech strategies into actions
2. UE functional strengthening
3. sensory reintegration is key

 

Question 34

what regions of the brain are perfused by the posterior cerebral artery (PCA)?

Answer 34

1. occipital lobe
2. posteromedial temporal lobes
3. thalamus

 

Question 35

what are some signs and symptoms that would be observed following a PCA stroke?

Answer 35

1. contralateral homonymous hemianopia 
2. cortical blindness
3. visual agnosia
4. prosopagnosia
5. dyslexia
6. memory deficit
7. topographic disorientation

 

Question 36

what is homonymous hemianopia? what brain structures are involved with this?

Answer 36

1. loss of visual information from the same visual field in both eyes 
2. visual cortex or optic radiation

Question 37

what is cortical blindness? What structures/regions of the brain are impacted?

Answer 37

1. person has no awareness of any visual information due to a lesion in the brain
2. bilateral occiptal lobe

 

Question 38

what is visual agnosia? What regions/structures of the brain are involved?

Answer 38

1. inability to visually recognize objects despite having intact vision
2. occipital lobe (dominant side)

 

Question 39

what is prosopagnosia? what regions/structures of the brain are involved?

Answer 39

1. a highly specific type of visual agnosia → person is unable to visually ID people's faces, despite being able to correctly interpret emotional facial expressions and being able to visually recognize other items in environment
2. visual association cortex

 

Question 40

what region of the brain is involved with dyslexia resulting from PCA syndrome?

Answer 40

dominant calcarine lesion

posterior part of corpus callosum

Question 41

what regions/structures in the brain are responsible for memory deficits observed with PCA syndrome?

Answer 41

lesion of inferomedial potions of temporal lobe (dominant side)

Question 42

what is topographic disorientation? what brain regions/structures are involved?

Answer 42

1. inability to orient in the surrounding and find your way around even in a familiar area
2. nondominant visual area

 

Question 43

a stroke involving the PCA and affecting the thalamus would have what symptoms?

Answer 43

1. central post-stroke (thalamic) pain
2. involuntary movements 
   1. choreoarthetosis, intention tremor, hemiballismus)

 

Question 44

describe/define each of the symptoms for a stroke involving the PCA and affecting the thalamus

Answer 44

1. thalamic pain - neurogenic pain, very hard to control
2. choreoathetosis - involuntary movements
3. hemiballismus - big involuntary movements

 

Question 45

List some treatment strategies for PCA syndrome

Answer 45

1. Gradually increase visual challenges as both symptoms improve and/or pt. is able to habituate to symptoms
2. visual deficts can significantly impact balance
3. remember to give pt visual breaks
   1. eyes closed, shut off lights, etc
4. may require external aids initially to assist in improving visual deficits

 

Question 46

a stroke involving the vertebral arteries and basilar artery is called what?

Answer 46

vertebrobasialr artery syndrome

Question 47

what is a standout symptom to a vertebrobasilar artery stroke?

Answer 47

locked-in syndrome

Question 48

what is locked-in syndrome

Answer 48

pt is cognitively intact but loses ALL motion other than eyes

Question 49

what are NCVs used for?

Answer 49

help diagnose nerve damage or disease

Question 50

what are EMGs used for?

Answer 50

help determine if there is myopathic involvement in the disease

Question 51

List some broad disease categories that electrodiagnostic testing can be helpful in diagnosing

Answer 51

1. Motor neuron disease
2. Radiculopathy
3. Plexopathy
4. Neuromuscular junction disease
5. Muscle diseases
6. Neuropathies
7. Weakness in ICU

 

Question 52

how can you further divide the categeory of neuropathy?

Answer 52

mononeuropathy

polyneuropathy

Question 53

what are the 3 classifications for a mononeuropathy?

Answer 53

1. Neuropraxia
2. Axonotmesis
3. Neurotmesis

 

Question 54

what is neuropraxia?

Answer 54

pressure, compression or stretch injury

distorts myelin sheath w/o Wallerian degeneration

Question 55

what is axonotmesis?

Answer 55

demyelination that causes axonal damage

axonal regeneration will occur over time along w/sprouting

Question 56

What is neurotmesis?

Answer 56

severe injury to the nerve

axon, schwann cell and endoneurium are completly disrupted (like a complete cut)

Question 57

what are the outcome measures we look at when interpreting NCVs?

Answer 57

1. amplitude
2. latency (proximal and distal)
3. conduction velocity

 

Question 58

what is amplitude a measure of?

Answer 58

the strength of the AP

related to the # of axons in the nerve being tested

Question 59

what is latency a measure of?

Answer 59

the time it takes the AP to travel 

Question 60

what is conduction velocity a measure of?

Answer 60

the velocity of the AP

takes the distance traveled by the AP and the latency into account

Question 61

when performing an NCV would type of injury would most likely result in changes to latency?

Answer 61

demyelination in some capacity 

Question 62

what type of damage to a nerve will affect the conduction velocity?

Answer 62

both demyelination and axonal damage

Question 63

T/F: you can only test motor nerves with NCVs?

Answer 63

FALSE

can test both sensory and motor nerves but the set up is a bit different

Question 64

what is the name for an AP generated during motor nerve testing? sensory nerve testing?

Answer 64

1. motor → CMAP (compound motor action potential)
2. sensory → SNAP (sensory nerve action potential)

 

Question 65

SNAPs can be either ____________ or ______________

Answer 65

Orthodromic

Antidromic

Question 66

what does Orthodromic mean?

Answer 66

it is traveling in the natural direction of a sensory AP

Question 67

what does antidromic mean?

Answer 67

testing and recording opposite direction of sensory AP

possible b/c the AP generated during testing will be propogated in both directions

Question 68

If there is suspected proximal damage what tests would we want to do?

Answer 68

1. F-wave
2. H-reflex

Question 69

what is an F-wave?

Answer 69

retrograde "rebound" motor impulse

AP that travels the full length of the motor axon and back

(measures the latency of the antidromic CMAP)

Question 70

T/F: the F-wave can be done on both sensory and motor nerve fibers?

Answer 70

FALSE

just motor

Question 71

what types of damage/diseases is F-wave helpful in diagnosing?

Answer 71

1. proximal damage/demyelination
2. GBS/CDIP
3. Radiculopathies
4. Peripheral neuropathies 

Question 72

What is an H-reflex?

Answer 72

stimualtes an AP that follows the muscle stretch reflex arc

Question 73

what types of disorders would an H-reflex be helpful in diagnosing?

Answer 73

1. evaluation of:
   • nerve root lesions
   • Upper motor neuron lesions
2. commonly done on the S1 root

Question 74

what types of diseases/disorders would an EMG test be most helpful in?

Answer 74

diseases that affect:

1. the muscle (muscular dystrophies)
2. the neuromuscular junction (myasthenia gravis)
3. diffuse disorders that cause peripheal neuropathies
4. disorders that affect the motor neurons in the spinal cord (ALS, ruptured spinal disc)

 

Question 75

what does EMG asses?

Answer 75

the electrical activity (AP) of the muscle in several stages.

refer to the electical activity as a MUAP (motor unit action potential)

Question 76

EMG will asses the electrical activity of a muscle in several stages, what are they?

Answer 76

1. as the needle goes into the muscle (insertional activity)
2. muscle at rest
3. muscle with activation 

Question 77

what type of activity will be observed in a normal/healthy muscle during the at rest phase of an EMG?

Answer 77

1. insertional activity (50-200 ms = very short)
2. should be silent following the crisp static sound of insertional activity
3. normal spontaneous acitivity may be observed

 

Question 78

list some normal spontaneously activity types that can be observed during the EMG at rest

Answer 78

1. MEPPs - mini end plate potential
2. EPPs - end plate potentials
3. EPSs - end plate spikes

 

Question 79

what would be considered abdnormal muscle activity at rest during EMG (3)?

Answer 79

1. decrease in normal insertional activity
2. increase in normal insertional activity
3. prolonged insertional activity

 

Question 80

what can cause a decrease in insertional activity during EMG?

Answer 80

1. loss of muscle fibers (fibrosis, muslce atrophy)
2. some metabolic disordes

Question 81

what can cause an increase in insertional activity during EMG?

Answer 81

1. neuropathic disorders
2. myopathic disorders

Question 82

what can cause prolonged insertional activity during EMG?

Answer 82

1. post acute denervation 
2. inflammatory muscle disorders
3. muscular dystrophy 

 

Question 83

what types of abnormal activity can be observed during rest in EMG testing?

Answer 83

1. Fibrillations
2. Positive Sharp waves
3. Fasciculations 
4. Complex regional discharge (CRD)
5. Myokymic
6. Myotonic

 

Question 84

what is a fibrillation?

Answer 84

spontaneous discharge of one or a few muscle fibers

Question 85

what are fibrillations associted with?

Answer 85

1. muscle degeneration (myopathy)
2. suggests a potential LMN problem (neuropathy)
3. the size of the fibrillations usually directly correspond to the severity of the injury

Question 86

what are fasciculations?

Answer 86

spontaneous, twitch like contraction

not necessarily indivitive of pathology (ex: eye twitch)

Question 87

what types of disorders/diseases are fasciculations more common with?

Answer 87

1. a disease involving alpha motor neurons
2. chronic demyelination conditions

Question 88

what might suggest to you that a fasciculation is normal rather than due to a disease?

Answer 88

it is singular in event, not multiple is short succession

Question 89

what is a complex reptitive discharge (CRD)?

Answer 89

polyphasic waveforms with fairly fixed amplitudes that show up in a high but stable discharge rate

sounds like a machine gun 

spontaneous discharge of multiple different muscle fibers that are asychonous 

Question 90

what types of conditions are CRDs observed in?

Answer 90

1. neurogenic
2. myopathic
3. generally observed with chronic conditions 
4. hereditory neuropathic diseases

Question 91

what are Myokymic discharges?

Answer 91

groups of recurring spontaneous MUAP that fire in a brief repetitive burst pattern 

 

Question 92

what are Myotonic potentials?

Answer 92

rhythmic electrical discharges that are arise from muscle fibers all over the place - super spontaneous

Question 93

what types of disease are myotonic potentials related to?

Answer 93

myotonic diseases

Question 94

an alternative way to group MUAPs observed at rest is by what?

Answer 94

whether they fire alone or in groups

Question 95

what types of MUAPs fire alone at rest?

Answer 95

1. EPSs
2. Fibrillation potentials
3. Myotonic Discharges

 

Question 96

what types of MUAPs fire in groups?

Answer 96

1. adjacent muscle fibers
   1. CRD
   2. insertional activity
2. motor unit potentials 
   1. fasciculation potentials
   2. myokymic discharges
   3. neurotonic discharges

 

Question 97

how would you describe the shape of a normal MUAP during muscle activation EMG?

Answer 97

1. biphasic
2. triphasic

 

Question 98

when a neurogenic injury occurs, what changes will be observed immediately in an EMG?

Answer 98

reduced recruitment

increase in firing rates of MUAPs

Question 99

when a neurogenic injury occurs, what changes will be oberved after collateral sprouting has occured?

Answer 99

the shape of the MUAP will change from triphasic to polyphasic 

(MUAPs will be out of sync) 

Question 100

what are polyphasic MUAPs indicative of?

Answer 100

neurogenesis

collateral sprouting has most likely occured following a neurogenic injury and the new branches of the nerves are trying to figure out how to fire in sync again, they are disoriented

Question 101

after a long time has passed following a neurogenic injury (>6 months) what changes will be observed on an EMG?

Answer 101

shape is once again triphasic

amplitude will be greater (1 nerve with 2x as many muscle fibers = must fire at a higher amplitude)

Question 102

myopathic = decrease in _________

Answer 102

number of viable muscle fibers

Question 103

what are the 5 primary categories of tests for cognitive status?

Answer 103

1. consciousness
2. orientation
3. attention/concentration
4. memory
5. executive function

 

Question 104

what are the levels of consciousness?

Answer 104

1. alert/fully conscious
2. lethargy = general slowing of cognitive and motor processes
3. obtundation = dulled/blunted sensitivity, difficult to arouse
4. stupor = semi-conscious state, aroused only w/deep pressure pain
5. coma

 

Question 105

what is the gold-standard test for levels of consciousness?

Answer 105

Glascow Coma Scale (GCS)

Question 106

what are the 3 areas of consciousness measured in the GCS?

Answer 106

1. eye opening
2. motor response
3. verbal response

*graded 3-15 (<8 = severe; 9-12 moderate; 13-15 mild)

Question 107

What are the 3-4 primary areas of examination for orientation?

Answer 107

1. Person
2. Place
3. Time
4. Situation

 

Question 108

what are the 4 different aspects of attention/concentration?

Answer 108

1. sustained attention
2. selective attention
3. divided attention
4. alternating attention

 

Question 109

what is sustained attention? 

How can we test it?

Answer 109

ability to sustain and focus attention over a duration of time

tested via the Cancellation Test

Question 110

what is the Cancellation test?

Answer 110

a method of testing sustained attention

instruct pt to inspect an image and circle all of the ______ in the image. Will take a lot of time and require a lot of attention

Question 111

what is selective attention?

How can we test it?

Answer 111

ability to screen and process relevant sensory info about the task and environment while screening out irrelevant info

Test = Stroop Test

Question 112

what is the Stroop Test?

Answer 112

used to test selective attention

look at a letter outloud and say the color of the word rather than the word itself

Question 113

what is divided attention?

How can we test it?

Answer 113

ability to perform 2 tasks simultaneously

Walkie-Talkie Test

Question 114

what is alternating attention?

How can we test it?

Answer 114

attention flexibility

shifting your attention back and forth between 2 different things

Question 115

What is memory?

Answer 115

the capacity to store knowledge, experiences, and perceptions for recall and recognition

Question 116

what are the 2 types of memory?

Answer 116

Declarative (Explict)

Non-declarative (Procedural/Implict)

Question 117

what is declarative memory?

Answer 117

conscious recollection of facts and events 

Question 118

what is non-declarative memory?

Answer 118

recall movements/movement schema without conscious recollections 

Question 119

what is another 3 part classification of memory?

Answer 119

1. immediate recall
   • "repeat after me" (seconds to minutes)
2. short-term memory
   • recent or working memory (minutes to hours/days)
3. long-term memory
   • remote memory (months to years)

 

Question 120

What is executive function?

Answer 120

capacity to engage successfully in independent, purposeful, self-directed behavior

Question 121

what are the different aspects of executive function?

Answer 121

1. volition/planning
2. problem solving/reasoning
3. insight/awareness
   • poor judgement
4. social pragmatics
   • inappropriate behaviors
5. self-regulation/purposeful action
   • initiate, maintain, switch, and stop tasks

 

Question 122

what is difference between sensation and perception?

Answer 122

sensation = raw data

perception = interpretation of data 

Question 123

what are 2 critera for sensation to occur?

Answer 123

adequate arousal and selective attention

adequate stimulus level to activate sensory receptor

*entire pathway must work!

Question 124

Give a working definition of perception

Answer 124

capacity to transform info from the senses and use it to interact appropriately with the environment 

selective, integrative, dynamic process that includes problem solving and memory

Question 125

what type of sensations are carried in the spinothalamic tract?

Answer 125

1. pain
2. temperature
3. crude touch

 

Question 126

what types of receptors are utilized in the spinothalamic tract?

Answer 126

1. free nerve endings
2. cutaneous receptors in the skin

 

Question 127

what are the afferent fiber characteristics in the spinothalamic tract?

Answer 127

small, thin, slow conducting

no myelination

Question 128

where is the spinothalamic tract heading?

what are it's major connections?

Answer 128

1. lower brainstem
2. thalamus
3. limbic system
4. diffuse cortical areas

 

Question 129

what types of sensations are carried by the dorsal column/medial lemniscus tract?

Answer 129

1. discriminative touch (tactile location)
2. proprioception
3. kinesthesia
4. vibration
5. 2-point discrimination

 

Question 130

what types of receptors are utilized in the dorsal column/medial lemniscus tract?

Answer 130

1. muscle spindle
2. GTOs
3. joint receptors
4. some cutaneous receptors in the skin

 

Question 131

what are the afferent fiber types of the dorsal column/medial lemniscus tract?

Answer 131

large, thick, rapidly conducting

well myelinated

Question 132

where is the dorsal column/medial lemniscus tract headed?

Answer 132

sensory cortex

Question 133

what types of sensations are carried in the spinocerebellar tract?

Answer 133

"unconscious"

proprioception and kinesthesia

Question 134

what types of receptors are utilized in the spinocerebellar tracts?

Answer 134

1. muscle spindles
2. GTOs
3. joint receptors
4. some cutaneous receptors in the skin

 

Question 135

what are the afferent fiber types of the spinocerebellar tract?

Answer 135

fast, direct, heavily myelinated

Question 136

where is the spinocerebellar tract headed?

Answer 136

cerebellum

Question 137

What are the 4 major subcategories/components of the perceptual exam?

Answer 137

1. Body scheme and body image impairments
2. spatial relationships
3. agnosias
4. apraxia

Question 138

what is the difference between body scheme and body image?

Answer 138

body image = visual/mental image of one's body

body scheme = postural model of body (body awareness)

Question 139

Name a major impairment to body scheme/image

Answer 139

Unilateral Neglect

Question 140

what is unilateral neglect?

Answer 140

failure to orient toward, respond to, or report stimuli on the contralateral side to the lesion

*despite normal sensory, visual and motor systems

Question 141

Unilateral neglect occurs mostly with ________ lesions

Answer 141

R tempoparietal junction

posterior parietal 

(**R side most often)

Question 142

what are the 2 classification systems for unilateral neglect?

Answer 142

1. Modality
2. Distribution

 

Question 143

what are the 3 types of modality neglect?

Answer 143

1. sensory
2. motor
3. representational

 

Question 144

What is sensory neglect?

Answer 144

brain loses ability to maintain awareness of a specific sense as it comes in (can be visual, auditory, or tactile)

the sensation is fine but the perception is off

Question 145

what is motor neglect?

Answer 145

"output neglect"

failure to generate a movement response to a specific stimuli even if the pt. is aware of the stimuli

ex: ball is thrown at you, you only raise 1 arm to catch it even though both arms have 5/5 strength

Question 146

what is representational neglect?

Answer 146

loss of internally generated images 

ex: pt asked to recall and draw a clock. They draw a clock with all the numbers on 1 side of a circle

Question 147

What are the two subcategories of distribution neglect?

Answer 147

1. Personal
2. Spatial

 

Question 148

what is personal neglect?

Answer 148

individual lacks awares of entire contralateral side of their body

Question 149

what is spatial neglect?

Answer 149

failure to acknowledge stimuli of the contralateral side of space

can be peripersonal (within reaching space)

extrapersonal (in far space)

Question 150

Other than unilateral neglect. What are 4 other types of body scheme/body image impairments?

Answer 150

1. somatoagnosia
2. R-L discrimination
3. vertical disorientation/midline disorientation
4. Pusher syndrome

 

Question 151

what is somatoagnosia?

Answer 151

an impairment of body scheme

Lack of awareness of relationship of body parts

(how your shoulder relates to your elbow, difficult to differentiate from proprioception)

Question 152

what portion of the brain is primarily/most often affected with somatoagnosia?

Answer 152

usually lesion to dominant parietal lobe

Question 153

what is R-L discrimination?

Answer 153

decreased R/L differentiation with body parts and following directions

Question 154

what portion of the brain is primarily/usually affected with R/L discrimination?

Answer 154

lesion to either parietal lobe

Question 155

what is vertical disorientation/midline disorientation?

Answer 155

cannot ID when their body is in the middle 

Question 156

what is Pusher Syndrome?

Answer 156

a subtype of vertical/midline disorientation

characterized by leaning and active pushing towards hemiplegic side w/o compensation for instability and with resistance to passive correction towards midline

 

Question 157

what portion of the brain is primarily affected with pusher syndrome?

Answer 157

lesion to R hemisphere centered in area of posterolateral thalamus

tends to be more common when L hemiplegia is present alongside L spatial and sensory neglect

Question 158

list the various spatial relationships impairments

Answer 158

1. Figure ground
2. spatial relations disorder
3. position in space disorder
4. topographical disorientation
5. depth and distance perception

 

Question 159

what is Figure ground?

Answer 159

the inability to distinguish a figure from the background in which it is embedded 

ex: pick a screwdriver out of a toolbox full of tools

Question 160

what is spatial relations disorder?

Answer 160

the inability to percieve relationships of one object in space to another object, or to one's self

 

Question 161

what primarily causes spatial relations disorder?

Answer 161

lesion in the R inferior parietal lobe 

Question 162

what is position in space disorder?

Answer 162

decreased ability to perceive and interpret spatial concepts

can't distinguis between opposite directional/spatial concepts

ex: confused up and down 

Question 163

what is topographical disorientation?

Answer 163

difficulty perceiving relationships from one location to another in the environment

Question 164

what is depth and distance perception?

Answer 164

inaccurate judgement of directions, distance, and depth 

more broad than spatial relationship disorders, and deals with environmental cues (like difficulty negotiating a curb)

Question 165

what is the primary cause of depth and distance perception issues?

Answer 165

lesion of R or bilateral visual assocaition cortex

Question 166

what does the general term agnosias mean?

Answer 166

decreased ability to recognize stimuli despite intact sensory function. 

most commonly associated with damage to temporal lobe

Question 167

what are the different types of agnosias?

Answer 167

1. Sensory
   1. visual
   2. auditory
   3. tactile (asterognosis)
2. Body scheme
   1. anosognosia
   2. somatagonsia 

 

Question 168

what is visual agnosia?

Answer 168

inability to recognize familiar objects despite normal eye function

 

Question 169

what type of lesion normally causes visual agnosia?

Answer 169

occipital and temporal lobe (R or L)

Question 170

what is auditory agnosia?

Answer 170

inability to recognize non-speech sounds and discriminate between them

Question 171

what type of lesion normally causes auditory agnosia?

Answer 171

left temporal lobe

Question 172

what is tactile agnosia (astereognosis)?

Answer 172

inabilty to recongize objects when handling them, despite normal tactile sensation 

Question 173

what types of lesions normally causes tactile agnosia?

Answer 173

parietal/temporal/occipital association areas (R or L)

Question 174

what is anosognosia?

Answer 174

a severe condition in which an individual does not acknowledge, denies, or lacks awareness of presence/severity of one's deficits

Question 175

define apraxia

Answer 175

impairment of voluntary, skilled, well-learned movement 

w/o deficits in motor function, sensory function, or coordination

Question 176

what are the 2 types of apraxia?

Answer 176

ideomotor

ideational

Question 177

what is ideomotor apraxia?

Answer 177

breakdown between concept (idea) and performance (motor execution)

Question 178

what is ideational apraxia?

Answer 178

failure in the conceptualization of the task

Question 179

what type of lesion normally causes apraxia?

Answer 179

left frontal or parietal lobes

Question 180

what is an Upper Motor Neuron (UMN)?

Answer 180

descending axons from cortex to brainstem 

OR

from brainstem to spinal cord

Question 181

what is a Lower Motor Neuron (LMN)?

Answer 181

axons exiting the CNS and innervating peripheral nerves

motor divisions of cranial nerves

Question 182

is weakness a sign of an UMN or LMN Lesion?

Answer 182

Both

Question 183

is atrophy a sign of an UMN or a LMN lesion?

Answer 183

LMN lesion

Question 184

are fasiculations a sign of an UMN or LMN lesion?

Answer 184

LMN

Question 185

are increased reflexes a sign of an UMN or a LMN lesion?

Answer 185

UMN lesion

(LMN have decreased reflexes)

Question 186

is decreased tone a sign of an UMN or a LMN lesion?

Answer 186

LMN lesion

(increased tone = UMN lesion)

Question 187

What are the 6 components of the whole clinical neurological exam?

Answer 187

1. Mental Status
2. Cranial Nerves
3. Motor Exam
4. Sensory Exam
5. Reflexes
6. Coordination/Gait

 

Question 188

Which cranial nerves are pure sensory nerves?

Answer 188

1. Olfactory (CN 1)
2. Optic (CN 2)
3. Auditory (CN 8)

 

Question 189

which cranial nerves are pure motor nerves?

Answer 189

1. Trochlear (CN 4)
2. Abducent (CN 6)
3. Accessory (CN 11)
4. Hypoglossal (CN 12)

 

Question 190

which cranial nerves are mixed nerves (both motor and sensory)?

Answer 190

1. Trigeminal (CN 5)
2. Facial (CN 7)
3. Glossopharyngeal (CN 9)
4. Vagus (CN 10)
5. Occulomotor (CN 3)

Question 191

Th test for olfaction (CN 1) includes what 2 tests?

Answer 191

1. Tests for discrimination (contrast odors)
2. Tests for arousal (noxious stimulant)

 

Question 192

T/F: the CN 1 test is not often included in the cranial nerve screen

Answer 192

TRUE

this nerve tends to be spared from a lot of issues unless there is a specific pathology that impacts this sense

Question 193

If a patient presents with unilateral or bilateral loss of smell but can still distinguish the smell what is the differential diagnosis?

Answer 193

a local nasal disease rather than a neural condition

Question 194

When testing CN 1, what would suggest to you that there might be a neural pathology invovled?

Answer 194

if the pt has a distorted sense of smell for a neutral scent

Question 195

List some possible mechanisms of injury to the olfactory nerve

Answer 195

1. Parkinson's disease
2. chronic meningeal inflammation
3. tumors in sub frontal region
4. head injuries
5. heavy smoking

 

Question 196

What tests are included in the CN 2 exam?

Answer 196

1. Visual acuity
2. Color discrimination
3. Field Cuts
4. Pupillary response to light accommodation 
5. Visual Extinction 

 

 

Question 197

What is visual acuity? How do we test it?

Answer 197

ability to see clearly

Snellin chart 

Question 198

What is a visual field cut?

Answer 198

blindness in one of the 4 quadrants of the eye

this is due to damage to the optic nerve and is NOT the same as visual neglect

Question 199

What is the visual extinction test?

Answer 199

a visual neglect test

helpful to include in testing the optic nerve and ruling out visual neglect over a visual field cut 

Question 200

what cranial nerves are responsible for innervating the extraoccular muscles?

Answer 200

CN III
CN IV

CN VI

Question 201

CN III innervates extraoccular muscles that perform what movements?

Answer 201

elevation

depression

ADDuction

(PSNS: pupil constriction - efferent limb of pupillary reflex)

Question 202

CN IV innervates extraoccular muscles that perform what movements?

Answer 202

Depression/intorsion

Question 203

CN VI innervates extraoccular muscles that perform what movements?

Answer 203

ABDuction

Question 204

what test is performing the examination of CN 3, 4, and 6?

Answer 204

Big H test

Question 205

if a patient presents with a gaze palsy in which both eyes are skewed in the same direction, what type of lesion are you suspecting?

Answer 205

UMN Lesion

(both eyes have dysconjugate gaze)

Question 206

if a pt presents with a gaze palsy in which both eyes are dysconjugate but are skewed in different directions, what lesion do you suspect?

Answer 206

LMN lesion

Question 207

if a pt presents with a gaze palsy in which only one eye has a dysconjugate gaze in a specific direction, what type of lesion are you suspecting?

Answer 207

LMN lesion

Question 208

The trigeminal nerve is a mixed sensory and motor nerve. What afferent/efferent info does it carry?

Answer 208

Afferent:

1. pain
2. temperature
3. joint position
4. vibration
5. anterior 2/3 tongue (somatosensory)
6. nasal sinuses

Efferent

1. muscles of mastication
2. tensor tympani

 

Question 209

How would you test the trigeminal nerve?

Answer 209

1. Light tough to face
   • for all branches (V1, 2, 3)
2. Bite strength 
   • for muscles of mastication
3. Corneal reflex
   • tests both V and VII 

Question 210

when is the corneal reflex test most often performed?

Answer 210

if a pt is obtunded

not commonly performed if a pt is alert 

Question 211

the facial nerve is a mixed sensory and motor nerve. What are it's afferent and efferent branches?

Answer 211

afferent

1. taste afferents for anterior 2/3 of tongue
2. somatosensory for proprioception of facial muscles
3. somatosensory for skin sensation of posterior ear and external auditory meatus
4. motor for facial expression muscles
5. autonomic motor to lacrimal and salivary glands

 

Question 212

What is/are the methods for testnig CN VII?

Answer 212

1. Observation
2. Motor
   1. smile, raise eyebrows, puff out cheeks, purse lips, close eyes tightly
3. Sensory
   1. taste (not typically done)
   2. secretomotor function
4. Reflexes
   1. corneal reflex (CN V and VII)
   2. nasopalpebral reflex

 

Question 213

why is taste not typically tested specifically?

Answer 213

pts wil often complain about it and will let you know if they have lose some taste

Question 214

what is the formal way to test the salivary glands?

Answer 214

give the pt something spicy and then compare the either side of the inside of their mouth.

look for saliva secretion either side

Question 215

When testing CN 7 how can you distinguish between an UMN and a LMN lesion?

Answer 215

look at the forehead

UMN = intact forehead muscle function

LMN = entire side of face will lose motor function

Question 216

how is CN IX assessed/tested?

Answer 216

Palatal activation

inspect for symmetry → with a lesion, one side will deviate to uninvolved side

Gag reflex (sensory limb)

Question 217

The gag reflex tests which cranial nerves?

Answer 217

CN IX (sensory afferent limb)

CN X (motor efferent limb)

Question 218

how would you expect a pt with CN 9 and 10 dysfunction to sound?

Answer 218

hoarse

difficulty with speech production

Question 219

how is CN 11 assessed?

Answer 219

Shoulder Shrug (UTrap)

Side bend and rotate (SCM)

Question 220

how would an UMN lesion impact CN 11?

Answer 220

pt will present with trapezius weakness 

BUT the SCM will be spared

Question 221

how would a LMN lesion impact CN 11?

Answer 221

both the trapezius and SCM would be impacted

Question 222

how is CN 12 assessed?

Answer 222

Stick out tongue (tongue protrusion)

direction may indicate UMN vs LMN

Question 223

how will a pt present with an UMN lesion of CN 12?

Answer 223

tongue will deviate away from the side of the lesion 

(picture on the right)

Question 224

how will a pt present with a LMN lesion of CN 12?

Answer 224

tongue will deviate toward the side of the lesion

atrophy and fasciculations will also be observed 

(left picture)

Question 225

T/F: you can performm the motor exam part of the clincial neurological exam without even toughing the pt?

Answer 225

TRUE

Question 226

what are the components of the Motor Exam?

Answer 226

1. Inspection at rest
2. Task Based observation
3. Tone assessment
4. MMT

 

Question 227

what are you looking for during the inspection at rest portion of the Motor Exam?

Answer 227

1. Muscle atrophy
2. Fasiculation
3. Hypertrophy
4. Tremors
5. Involuntary movements
6. posturing

 

Question 228

What is posturing?

Answer 228

occurs when a pt picks up a very specific position of their UE and LE base don where their inujury was

Question 229

What are the 2 main kinds of posturing?

Answer 229

1. Decorticate posture
2. Decerebrate posture

 

Question 230

Describe decorticate posture

Answer 230

pt has full flexion of the UE and they hold it there 

full extension of LE

 

Question 231

What type of damage would result in decorticate posturing?

Answer 231

damage to brainstemm above the red nucleus

Question 232

Describe decerebrate posture

Answer 232

pt has full extension of UE and LE 

might still have some finger flexion

Question 233

What type of damage would result in decerebrate posture?

Answer 233

damage underneath/lower than the red nucleus in the brainstem

ex: pontine lesion

Question 234

T/F: posturing has no prognostic value

Answer 234

FALSE

it is an indicator that the pt might not progress/get that much better

Question 235

What is the distinction between the tone assessment and MMT?

Answer 235

tone assessment = resitance against passive movement

MMT = greater resistance, helps ID patterns of weakness

Question 236

What is assessed during the Sensory Exam?

Answer 236

1. Pain
2. Temperature
3. Vibration
4. Proprioception
5. Light touch/2 pt discrimination

Question 237

How are reflexes graded?

Answer 237

0-5

0 = absent

1 = trace

2 = normal

3= brisk

4 = non-sustained clonus

5 = sustained clonus

Question 238

If reflexes are abnormally increased this is indicative of what?

Answer 238

UMN lesion

Question 239

if reflexes are abnormally decreased, this is indicative of what?

Answer 239

LMN lesion

but could be muscle, nerve fiber and NMJ

Question 240

What are some primary neuromusclar impairments that can result from a neurological pathology?

Answer 240

1. Muscle weakness
2. Abnormal tone
3. Coordination deficits
4. involuntary movements

 

Question 241

What are some secondary neuromusclar impairments that can result from a neurological pathology like an UMN lesion?

Answer 241

1. ROM and alignment issues
2. Endurance issues
3. Pain

 

Question 242

how would you define muscle weakness as a neuromusclar impairment?

Answer 242

inability to generate force or recruit/modulate motor units

Question 243

list some neural contributions that can result in the primary neuromusclar impairment of muscle weakness

Answer 243

Change in:

1. # of motor units recruited
2. D/C frequency
3. type of motor unit recruited

 

Question 244

What are some potential neurological pathologies that can result in neuromusclar weakness as an impairment?

Answer 244

1. Cortical lesions
2. lesions in descending pathways
3. disruption of impulses to alpha motor neurons
4. peripheral nerve injury
5. synaptic dysfunction at NMJ

 

Question 245

Muscle weakness as a neurological impairment can result in what secondary impairments/observations?

Answer 245

1. postural abnormalities
2. asymmetrical weight bearing
3. abnormal synergies

 

Question 246

list 2 types of abnormal synergies

Answer 246

1. Flexor synergy (UE)
2. Extensor synergy (LE)

 

Question 247

describe a flexory synergy?

Answer 247

scapular retraction and elevation

shoulder abduction and ER

elbow flexion

supination

wrist and finger flexion

Question 248

describe an extensor synergy

Answer 248

hip extension, adduction and IR

knee extension

ankle PF and inversion

toe PF

Question 249

what is tone?

Answer 249

muscles' resistance to passive stretch

Question 250

Describe the continuum/varying levels of tone

Answer 250

From too little to too much

1. Flaccid
2. Hypotonicity
3. normal
4. hypertonic/spasticity
5. Rigid 

Question 251

what are the neural contributions to normal tone?

Answer 251

net balance of descending input on motor neurons from:

corticospinal tracts

rubrospinal tracts

reticulospinal tracts

vestibulospinal tracts

as well as the sensitivity of synaptic connections

Question 252

what are the non neural contributions to normal tone?

Answer 252

1. CT plasticity
2. viscoelastic properties of the muscles, tendons, and joints

 

Question 253

How is spasticity different from hypertonia?

Answer 253

spasticity is velocity dependent and hypertonia is not

Question 254

Spasticity can sometime be described as a ___________

Answer 254

clasp-knife phenomenon

Question 255

what is a typical cause of spasticity and a common result/association?

Answer 255

damage to pyramidal tract or other nearby descending paths

can be associated with clonus (commonly in distal > proximal extremities)

Question 256

Describe the mechanism by which spasticity occurs

Answer 256

1. changes in neural contributions
2. results in decreased descending activity
3. reduction of inhibitory synaptic input
4. increases tonic excitatory input
5. results in alterations to threshold of stretch reflex 

Question 257

List 2 scales typically used to measure tone

Answer 257

1. Modified Ashworth Scale
2. Tardieu scale

 

Question 258

which scale used to measure tone, also gives us info on spasticity?

Answer 258

Tardieau 

since we vary the velocities (V1, 2, 3)

Question 259

which applied velocities equate to spasticity on the Tardieau scale?

Answer 259

V2 = speed of limb falling under gravity

V3 = fast as possible

Question 260

In what muscle group is hypertonia typically observed?

Answer 260

Flexors

Question 261

When testing hypertonia with movements, it can be described as _________ or _________

Answer 261

leadpipe or cogwheel

Question 262

what is the difference between leadpipe and cogwheel hypertonia?

Answer 262

leadpipe = constant resistance to movements throughotu entire ROM

Cogwheel = alternating episodes of resistance and relaxation

Question 263

what is hypertonia at rest called?

Answer 263

Posturing

Question 264

What are the 2 types of posturing?

Answer 264

decorticate = UE flexion, LE extension/IR/PF

decerebrate = UE and LE extension

Question 265

what type of posturing is due to a lesion at or above the level of the red nucleus?

Answer 265

decorticate posturing

Question 266

characteristic of the tone abnormality depends on what factors?

Answer 266

1. type and location of pathology
2. Chronicity 
   • increases in nonneural changes = increased "stiffness"

 

Question 267

List the type of abnormal tone that would result if a lesion occured at the cortical, brainstem, and basal ganglia level?

Answer 267

1. cortical: pyramidal → change in descending inputs of alpha motor neurons → spasticity
2. Basal ganglia: extra pyramidal → rigidity
3. brainstem: above/below red nucleus → decorticate/decerebrate posturing 

 

Question 268

List some pathologies in which hypertonicity is commonly observed

Answer 268

1. CVA
2. TBI
3. MS
4. Parkinsons Disease (rigidity)

Question 269

define hypotonicity

Answer 269

reduction in resistance to lengthening

reduction in "stiffness"

Question 270

hypotonicity can be described as _______ or _______

Answer 270

floppy = collapse into gravity, harder to excite

flaccidity = complete loss of muscle tone

Question 271

what causes hypotonicity?

Answer 271

disruption of afferent input from stretch reflex →

lack of cerebellar efference influence →

result in decreased input to gamma motor neurons

Question 272

List some pathologies where hypotonicity is commonly observed

Answer 272

1. Cerebellar lesions
2. down syndrome
3. musclar dystrophies
4. late stage ALS 
5. post-polio
6. Acute CNS injuries → typically end up resulting in hypertonicity/spasticity once subactue phase is over

 

Question 273

what are the functional implications for increased tone?

Answer 273

1. abnormal posturing
2. misalignment
3. high risk for injury during prolonged rest (skin breakdown)
4. bias with recruitment
   1. increased likelihood of synergistic movement
5. destabilization with changes in position (clonus, increased risk for contractures)

 

Question 274

what are the functional implications for decreased tone?

Answer 274

1. fall into gravity
2. high risk for injury during dynamic tasks

 

Question 275

define coordination

Answer 275

ability to use parts of the body together smoothly and efficiently

Question 276

what are the critical components of coordination?

Answer 276

1. sequencing
2. timing
3. grading

 

Question 277

define incoordination

Answer 277

movements that are awkward, uneven, inaccurate

disrupting of sequencing, timing and grading

loss of coupling between synergistic joints and muscles

Question 278

incoordination is typically observed with what types of lesions?

Answer 278

motor cortex

basal ganglia

cerebellar 

(proprioceptive lesions too)

Question 279

the functional implications of incoordination can be divided into what categories?

Answer 279

1. grading/scaling dysfunction
2. timing difficulties
3. activation and sequencing problems

 

Question 280

what are the types of grading/scaling dysfunctions found with incoordination?

Answer 280

1. dysmetria = under/overshooting intended position (a type of ataxia)
2. hypermetria = moving beyond intended goal
3. hypometria = moving short of intended goal

 

Question 281

list some timing difficulties that are a result of incoordination

Answer 281

1. increased reaction times
2. slowed movement times
3. difficulty terminating movements
4. rebound phenomenon
5. dysdiadochokinesia

 

Question 282

list some activation and sequencing problems that occur with incoordination

Answer 282

1. abnormal synergies
2. coactivation
3. impaired inter-joint coordination

 

Question 283

what are the components of the coordination examination?

Answer 283

1. finger to nose
2. alternating pronation/supination
3. hand or foot tapping
4. heel to shin

 

 

Question 284

List several categories/types of involuntary movements that are primary neuromusclar impairments

Answer 284

1. dystonia
2. tremors
3. choreiform
4. athetosis

 

Question 285

what is dystonia?

Answer 285

syndrome dominated by sustained muscle contractions 

causing twisting, repetitive movements, and abnormal postures

Question 286

what region of the brain is dystonia correlated with?

Answer 286

basal ganglia

Question 287

what are tremors?

Answer 287

rhythmic, involuntary oscillatory movement of a body part

can be intermittent or constant, sporadic or as a sequale to a disease or injury

Question 288

what is the difference between a resting and active tremor?

Answer 288

resting = occurs in a body part that is not voluntarily activated (it's relaxed)

active = any tremor produced by voluntary contraction of muscle (can be postural or intention)

Question 289

what is a postural tremor? Intention tremor?

Answer 289

postural = person maintains a part of body against gravity

intention = produced with purposeful movement 

Question 290

what is a choreiform?

Answer 290

involuntary, rapid, irregular and jerky movements

seen with Huntingtons disease and is a SE of PD meds

Question 291

what is athetosis?

Answer 291

slow, writhing and twisting movements 

UE > LE

common in CP

Question 292

What causes endurance issues to be a secondary neuromuscular impairment?

Answer 292

1. decrease in central drive to spinal cord motor neurons
2. decrease in activity level/immobility

Question 293

T/F: There is a greater proportion of our brain devoted to vision than any other sense?

Answer 293

TRUE

multiple concurrent visual processes are ongoing continuously like:

1. conscious perception of visual image info
2. conventional visual reflexes
3. saccadic movements 
4. regulation of sleep/wake 

 

Question 294

A lesion to the optic nerve prior to the optic chiasm would result in what type of visual deficit?

Answer 294

blindness in the ipsilateral eye

Question 295

what are the functional implications to ipsilateral blindness?

Answer 295

1. poor depth perception
2. small visual field 
3. far peripheral vision is impacted = difficulty with driving and other higher level tasks
4. potential musculoskeletal issues like pain from positioning to compensate

 

Question 296

 compression of the optic chiasm would result in what visual defict?

Answer 296

binasal hemianopsia = loss of nasal fields bilaterally, temporal fields spared

Question 297

what are the functional implications of binasal hemianopsia?

Answer 297

trouble with near vision and any tasks that utilize that like reading

difficulty concentrating

difficulty with ADLS

**these pts can usually learn to compensate pretty well  though

Question 298

a lesion to the optic chiasm would result in what visual deficit?

Answer 298

bitemporal hemianopsia = results in loss of temporal fields, nasal fields spared

 

Question 299

bitemporal hemianopsia is commonly seen with what type of injury?

Answer 299

pituitary tumors

Question 300

what are the functional implications of bitemporal hemianopsia?

Answer 300

it's like having horse blinders on!

miss peripheral objects and trip on things 

miss doors

common fall risk

Question 301

what do patients with bitemporal hemianopsia require?

Answer 301

prism glasses or other external aids to be safe on their feet

 

Question 302

a lesion to the optic tract after the optic chiasm results in what type of visual deficit?

Answer 302

homonymous hemianopsia = complete loss in affected region of binocular visual field

 

Temporal half of R/L visual field + nasal half of L/R visual field

Question 303

homonymous hemianopsia is common with what type of injury?

Answer 303

CVA

Question 304

what are the functional implications of homonymous hemianopsia?

Answer 304

difficulty seeing everything on one side

must teach pt to turn towards the side they are missing

Question 305

a lesion to the lower division of the optic radiations (in temporal lobe) results in what visual deficit?

Answer 305

upper quadrantopia 

Question 306

what are the functional implications for someone with upper quadratanopia?

Answer 306

none really!

just mostly annoying to pts but they can function just fine

Question 307

a lesion to the upper division of the optic radiation (temporal lobe) would result in what visual deficit?

Answer 307

lower quadrantanopia

Question 308

what are the functional implications of lower quadrantanopia?

Answer 308

might just be an annoyance and pt can function/adapt just fine

BUT, pts often forget to compensate with this making tripping and falling more common

Question 309

what causes homonymous hemianopia with macular sparring?

Answer 309

a lesion to both division of the optic radiations 

or a lesion to the visual cortex 

Question 310

what are the functional implications to homonymous hemianopsia with maccular sparring?

Answer 310

the exact same as homonymous hemianopsia

Question 311

what is the typical cause of monoaural hearing loss?

Answer 311

peripheral lesion/damage 

cochlear lesion or damage to CN VIII

Question 312

what does having 2 ears help us with?

Answer 312

localization of source of sound

Question 313

what are some common causes of acquired hearing loss?

Answer 313

1. acoustic neuroma
2. meniere's disease
3. traumatic brain injury
4. ototoxicity
5. presbycusis

 

Question 314

what are the functional implications of hearing loss?

Answer 314

can impact the ability to participate in social settings

but other than that none really/just annoying

Question 315

T/F: if there is acquired hearing loss, vestibular loss/dysfunction is usually not far behind

Answer 315

TRUE

Question 316

List the 3 vestibular reflexes

Answer 316

1. Vestibulo-occular reflex (VOR)
2. Vestibulospinal reflex (VSR)
3. Vestibulocollic reflex (VCR)

 

Question 317

what is the VOR?

Answer 317

allows us to stabilize gaze during head movements 

results in eye movements that equally coutner head movements 

Question 318

describe how the VOR would work with L head turning

Answer 318

+L semicircular canals → +R abducens and +L occulomotor to move eyes 

 

-R semicircular canals → -L abducens and -R occulomotor 

Question 319

Vestibular damage involving the VOR would most likely impact what structures?

Answer 319

1. Central: damage to midbrain and pons
2. Peripheral: CN VIII, labryinth structures 

 

Question 320

damage to the VOR would result in what impairments?

Answer 320

1. difficulty stabilizing image on retina while head is moving
2. bilateral vestibular dysfunction 
   1. oscillopsia = bouncing vision
3. unilateral vestibular dysfunction
   1. nystagmus
   2. saccedes

 

Question 321

what do the VSR and VCR help with?

Answer 321

postural adjustments 

 

Question 322

what structures are involved with the VSR?

Answer 322

1. otoliths (utricle and saccule) project to LVN
2. axons descend to antigravity muscles at all levels of the spinal cord

 

Question 323

what structures are involved with the VCR?

Answer 323

1. MVN axons descend in MLF to upper cervical levels of spinal cord
   • these help dictate head position in response to head rotation 

 

Question 324

how does the VSR work?

Answer 324

Head is tilted to one side

1. Canals and otoliths are stimulated ipsilaterally (and inhibited contralateral)
2. Increased input through the vestibular nerve to the vestibular nuclei ipsilaterally
3. Impulses transmitted through the lateral & medial vestibulospinal tracts to the spinal cord

** result in increased lateral extension of trunk on side of head tilt, increased flexion contralaterally

Question 325

Damage to the VSR/VCR would result in what?

Answer 325

Postural instability, difficulty sensing falling/tipping

Truncal ataxia

Question 326

what is truncal ataxia?

Answer 326

incoordination, unstable trunk movement during movement

Question 327

what is the difference between unimodal and heteromodal corticies?

Answer 327

both are association corties

unimodal are modality specific

heteromodal are higher-order functioning

Question 328

what is one reason for hemispheric specialization?

Answer 328

a reduction in the amount of time it would take to have both hemisphere's "talk to each other" to accomplish the task

Question 329

T/F: there is bilateral representation of language centers in many right handers?

Answer 329

FALSE
it is observed in 60-70% of LEFT handers

Question 330

what is our non-dominant hemisphere primarily responsible for?

Answer 330

1. complex visual-spatial skills
2. imparting emotional significance to events and language
3. music perception

 

Question 331

List some clinical features of a non-dominant hemisphere lesion

Answer 331

1. visual-spatial analysis/constructional difficulties
2. Gestalt difficulties
3. tendency toward relatively severe personality and emotional changes
4. increased likelihood to have delusions and hallucinations (when compared to the dominant hemisphere)

 

Question 332

what is meant by constructional difficulties?

Answer 332

difficulty judging or matching orientation of lines displayed at different angles 

(this person would have a hard time drawing more complex shapes but could draw simple ones)

Question 333

what are gestalt difficuties?

Answer 333

overall spatial arrangement difficulties

(a pt would have difficulty understanding how everything is organized in their visual field, ie. big picture)

Question 334

List some odd nondominant syndromes 

Answer 334

1. capgas syndrome
2. fregoli syndrome
3. reduplicative paramnesia

Question 335

what is capgas syndrome?

Answer 335

patient insists that their friends and family members have been replaced by identical-looking imposters

Question 336

what is fregoli syndrome?

Answer 336

patients belive that different people are actually the same person in disguise 

Question 337

what is reduplicative paramnesia?

Answer 337

patient believes that a person, place, or object exists as two identical copies

Question 338

List some dominant (usually left) hemisphere functions

Answer 338

1. Language
2. skilled motor function (praxis)
3. Arithmetic: sequential and analytical calculating skills
4. Musical ability: sequential and analytical skills in trained muscians 
5. Sense of directions: following a set of written directions in sequence

 

Question 339

List some non-dominant (usually right) hemisphere functions

Answer 339

1. Prosody (emotion conveyed by tone of voice)
2. visual-spatial analysis and spatial attention
3. arithmetic: ability to estimate quantity and to correctly line up columns of numbers on the page
4. musical ability: in untrained musicians, and for complex musical pieces in trained musicians
5. sense of direction: finding one's way by overall sense of spatial orientation

 

Question 340

how do Broca's and Wernicke's area communicate?

Answer 340

arcuate fasciculus

Question 341

List all the regions of the brain associated with language

Answer 341

1. inferior lateral primary motor cortex
2. Frontal lobes
3. supramarginal gyrus and angular gyrus
4. visual cortex, visual association cortex
5. Non-dominant hemisphere is also involved
6. subcotical regions

 

Question 342

what is the role of the Frontal Lobe with respect to language processing?

Answer 342

1. higher-order motor aspects of speech formation and planning
2. syntax

 

Question 343

what is the role of the supramarginal and angular gyrus (parietal and tempral lobes) in language?

Answer 343

1. lexicon
2. writing

 

Question 344

what is the role of the visual and visual association cortices in language?

Answer 344

reading

Question 345

List some syndromes related to aphasia

Answer 345

1. Alexia
2. Agraphia
3. Alexia with agraphia

 

Question 346

what is alexia?

Answer 346

an impairment in reading ability

 

Question 347

what is agraphia?

Answer 347

impairment in writing ability

Question 348

alexia without aphasia will have a lesion where?

Answer 348

dominant occipital cortex extending to the posterior corpus callosum (often PCA infarct)

Question 349

Agraphia without aphasia will often involve a lesion where?

Answer 349

lesion of inferior parietal lobule of language-dominant hemisphere 

Question 350

what is alexia with agraphia? 

what regions of the brain does it impact?

Answer 350

aphasia absent or only mild dysnomia and paraphasias

lesions of dominant inferior parietal lobe, region of angular gyrus

Question 351

what are the symptoms of gerstmann's syndrome?

Answer 351

1. agraphia
2. acalculia
3. R/L disorientation
4. Finger agnosia

 

Question 352

a lesion to what region of the brain often results in gerstmann's syndrome?

Answer 352

dominant inferior parietal lobe

(right where the angular gyrus is)

Question 353

List some disorders involving the primary visual cortex

Answer 353

1. Cortical blindness
2. Blindsight
3. Anton's Syndrome

 

Question 354

What is cortical blindness?

Answer 354

complete visual loss on confrontation testing

bilateral occiptial lobe lesion

Question 355

what is blindsight and what causes it?

Answer 355

individual can perform a task without conscious visual perception

visual cortex lesion

Question 356

What is Anton's Syndrome? What causes it?

Answer 356

Complete visual loss on confrontation testing + anosognosia

Bilateral occipital lobe lesion

Question 357

List some disorders involving the Inferior Occipitotemporal Cortex

Answer 357

1. Prosopagnosia
2. Achromatopsia
3. Micropsia, Macropsia
4. Metamorphopsia
5. Cerebral dipopia/polyopia

 

Question 358

what is archromatopsia?

Answer 358

Difficulty with color perception

whole visual field involved = lesions in bilateral inferior occititotemporal cortex

one eye = contralateral cortical involvement

Question 359

what is micropsia and macropsia?

Answer 359

objects appear unusually small or big

Question 360

what is metamorphopsia?

Answer 360

objects have distorted shape or size

Question 361

what causes cerebral diplopsia/polyopia?

Answer 361

occipital lobe lesion

Question 362

List some syndromes of the Dorsolateral Parieto-Occipital Cortex

Answer 362

1. Simultanagnosia
2. Optic ataxia
3. ocular apraxia
4. Baliant's syndrome

 

Question 363

what is simultanagnosia?

Answer 363

impaired ability to percieve parts of a visual scene as a whole

Question 364

what is optic ataxia?

Answer 364

impaired ability to reach for or point to objects in space under visual guidance

Question 365

what is occular apraxia?

Answer 365

difficulty voluntarily directing one's gaze towards objects in peripheral vision

Question 366

what is Baliant's syndrome?

Answer 366

bilateral lesions of DL parieto-occipital cortex

presents with a clincial triad of the following symptoms:

• simultanagnosia
• optic apraxia
• occular apraxia 

 

Question 367

Functions of the frontal lobe can fit into 3 categories, what are they?

Answer 367

1. restraint
2. initiative
3. order

 

Question 368

list some restraint functions of the frontal lobe

Answer 368

1. judgement
2. foresight
3. perseverance
4. delaying gratification
5. inhibiting socially inappropriate responses
6. self-governance
7. concentration

 

Question 369

List some initiative functions of the frontal lobe

Answer 369

1. curiosity
2. spontaneity
3. motivation
4. drive
5. creativity
6. shifting cognitive set
7. mental flexibility
8. personality

 

Question 370

list some Order functions of the frontal lobe

Answer 370

1. abstract reasoning
2. working memory
3. perspective taking
4. planning
5. insight
6. organization
7. sequencing
8. temporal order

 

Question 371

what is the difference in symptoms between a dorsolateral and ventromedial orbitofrontal lesion?

Answer 371

DL = apthetic, abulic

VM = impulsive, disinhibited, poor judgement

 

Question 372

what is the difference between a L and R hemisphere frontal lobe lesion?

Answer 372

left = associated with depression-like symptoms

right = more associated with behavioral disturbances like mania

Question 373

frontal lobe syndromes are also known as ________________

Answer 373

dysexecutive syndrome

Question 374

What types of symptoms are typically observed with an orbitofrontal lobe syndrome?

Answer 374

(disinhibited)

1. impulsive behavior (psuedopsychopathic)
2. inappropriate jocular affect, euphoria
3. emotional lability
4. poor judgement and insight
5. distractibility

 

Question 375

what types of symptoms are typically observed with frontal convexity syndrome?

Answer 375

(apathetic)

1. apathy (pseudodepressive)
2. indifference
3. psychomotor retardation
4. motor perseveration and impersistence
5. stimulus-bound behavior 
6. motor programming deficits
7. poor word list generation

 

Question 376

What are some additional frontal lobe lesion symptoms?

Answer 376

1. disinhibition 
2. inappropriate jocularity (witzelsucht)
3. limited insight
4. utilization behavior/environmental dependence
5. frontal release signs
6. paratonia
7. frontal gait

 

Question 377

what is the symptom of disinhibition?

Answer 377

silly behavior, crass jokes, aggressive outbursts

Question 378

define inappropriate joculatiry (witzelsucht)

Answer 378

seemingly unconcerned about potentially serious matters

Question 379

what is utilization behavior/environmental dependence?

Answer 379

respond to whatever stimuli at hand, even when not appropriate 

(also called new bed over syndrome)

Question 380

List some frontal release signs

Answer 380

1. palmar reflex
2. grasp reflex
3. sucking reflex

 

Question 381

what is paratonia?

Answer 381

increase in tone, but in a manner in which patient appears to resist the movements of the examiner in almost a willful fashion

Question 382

define Frontal gait

Answer 382

shuffling, unsteady, magnetic gait

Question 383

what is being tested during the 

light touch: localization test?

Answer 383

dorsal column 

ability to detect and localize a light touch stimulus

Question 384

what is being tested during the pin prick test?

Answer 384

spinothalamic tract

ability to detect difference between sharp and dull sensation

Question 385

what is being tested during the hot:cold test?

Answer 385

spinothalamic tract

ability to detect between a hot and cold stimulus

Question 386

what is being tested during a vibration test?

Answer 386

dorsal column/medial lemniscus

ability to detect a vibration (when it starts and when it stops)

Question 387

what is being tested during the extinction test?

Answer 387

test for unilateral neglect

specifically tactile neglect

Question 388

what is being tested during the 2-point discrimination test?

Answer 388

dorsal column/medial lemnsicus tract

ability to accurately distinguish between 1 or 2 points of contact

 

Question 389

what is the normative data/distances for the 2-point discrimination test?

Answer 389

fingertips = 2-5 mm

palms = 8-12 mm

hand, extremities, trunk = 20-30 mm

Question 390

what is being tested in the proprioception test?

Answer 390

dorsal column/medial lemniscus tract

ability to detect position of limb when it is changed slightly (up/down)

Question 391

what is being tested during the stereognosis test?

Answer 391

dorsal column → integrative ability of the parietal cortex

ability to accurately ID common objects based off of touch alone (eyes closed)

Question 392

what is being tested during the graphesthesia test?

Answer 392

dorsal column → integration at parietal cortex

ability to accurately ID a letter/number that is drawn on your hand w/eyes closed

Question 393

what is being tested during the kinesthesia test?

Answer 393

dorsal column → integration at parietal cortex → motor cortex

ability to detect movement in space and then match it with the contralateral limb (eyes closed)

Question 394

how are all sensations tests graded?

Answer 394

5/5 = normal

1 - 4/5 = impaired

0/5 = absent

Question 395

what are the deep tendon reflexes for the UE/LE testing for?

Answer 395

presence or absense of an UMN/LMN lesion

Question 396

what nerve roots are responsible for the patellar tendon reflex?

Answer 396

femoral nerve (L2, 3, 4)

Question 397

what nerve roots are responsible for the achilles reflex?

Answer 397

tibial neve (S1, 2)

Question 398

what nerve roots are responsible for the biceps brachii tendon reflex?

Answer 398

musculocutaneous nerve ((C5, 6)

Question 399

what nerve roots are responsible for the brachioradialis tendon reflex?

Answer 399

radial nerve (C5, 6)

Question 400

what nerve roots are responsible for the triceps tendon reflex?

Answer 400

radial nerve (C6, 7)

Question 401

what are the grades/scores for reflex testing?

Answer 401

0-1+ = LMN

2+ = norma

3+ = Brisk

4+ and 5+ = UMN lesion

Question 402

what is the purpose of the Hoffman's sign?

Answer 402

it is a pathological reflex that indicates the presence or absence of an UMN/LMN

flexion of 1,2 phalanx = a positive sign

 

Question 403

what is the purpose and grading of the Babinski's sign?

Answer 403

tests for the presence/absence of an UMN/LMN

splaying of toes and ext of hallux is a positive sign

Question 404

what is the UE and LE synergy test for?

Answer 404

it tests the corticospinal tract and isolation of movement at a joint

 

Question 405

what is considered an abnormal result for an UE and LE synergy test?

Answer 405

movement in two or more joints in compensatory/synergistic pattern 

this indicates an UMN lesion

Question 406

what does dysmetria (for UE and LE) test for?

Answer 406

cerebellar coordination/functioning

Question 407

what are abnormal results for dysmetria UE/LE?

Answer 407

hypometria = undershooting 

hypermetria = overshooting, varying course of movement, disintegration of pattern

Question 408

what does dysdiadochokinesia test for?

Answer 408

cerebellar coordination/functioning 

Question 409

what is included in a spasticity test?

Answer 409

1. shoulder FLX/EXT
2. elbow FLX/EXT
3. wrist FLX/EXT
4. thumb flexors
5. finger flexors
6. hip FLX/EXT
7. hip ABD/ADD
8. knee FLX/EXT
9. ankle DF/PF
10. clonus

 

Question 410

what does spasticity test for?

Answer 410

velocity dependent tone

presense of an UMN lesion

Question 411

how are spasticity tests measured?

Answer 411

Modified Ashworth Scale

Question 412

what results indicate the presence of clonus?

Answer 412

repeated bouncing of foot (plantarflexors)

Question 413

what results are you looking for when testing the papillary reflexes?

Answer 413

direct and consensual constriction

accommodation

Question 414

what is considered an abnormal result when testing the papillary reflex?

Answer 414

absense of constriction (direct/consensual)

absense of accommodation

Question 415

what is tested when performing the big H test?

Answer 415

EOMs

pursuit eye movements

Question 416

what are considered abnormal results from the big H test?

Answer 416

any asymmetry in movement

gaze palsies

2 or more of the following: nystagmus, strabysmus, saccades, and double vision

Question 417

what gaze palsies can be observed as an abnormal result from a big H test?

Answer 417

UMN = same direction limitation

LMN = opposite direction limitation or in one eye

 

Question 418

what are the grades that can be assigned during a Weber and Rinne test?

Answer 418

normal

conductive loss

sensoryneuro loss

Question 419

what suggests conductive hearing loss during a Weber test?

Answer 419

positive is louder in affected ear

Question 420

what suggests neurosensory hearing loss during a Weber test?

Answer 420

positive weber = louder in unaffected ear

Question 421

what suggests conductive hearing loss during a Rinne test?

Answer 421

hear sound only in mastoid process

no sound heard when tuning fork is placed in front of auricle

Question 422

what suggests neurosensory hearing loss during a Rinne test

Answer 422

no sound hear at either the mastoid or in front of the ear

Question 423

when testing CN XI what indicates and UMN or LMN?

Answer 423

asymmetry in strength

UMN = trap is weak but SCM is spared

LMN = both are weak/absent

Question 424

define dysesthesia

Answer 424

unpleasant and abnormal sensation

can be evoked or spontaneous

Question 425

what are the 2 types of dyesthesia?

Answer 425

1. allodynia
2. hyperalgesia

 

Question 426

what is allodynia?

Answer 426

pain evoked by stimulus that is not usually noxious

(a cotton ball evoking pain)

Question 427

what is hyperalgesia?

Answer 427

excessive sensitivity to stimuli that are normally mildly painful

Question 428

T/F: when a part of the body is injured, special pain receptors convey the pain message to your brain

Answer 428

FALSE

incomplete concept

pain is a perception/experience

nociceptive fibers carry sensations that can be later interrpreted as pain

Question 429

what evidence is there that type C and A-delta fibers do not carry pain signals?

Answer 429

if they carried pain fibers then every time they were stimulated, the result should be the same pain.

Not the case, the same injury in the same person can cause different levels of pain depending on the context

Question 430

T/F: pain only occurs when you are injured

Answer 430

FALSE

injury or degeneration may be present in the absence of pain

significant pain may be present with no identifiable disease process or even after tissue healing

Question 431

pain is an emotional experience and can develop due to emotional overload. However it is important to not classify it as _____________

Answer 431

a psychosomatic issue

Question 432

T/F: the timing and intensity of pain matches the timing and number of signals in nociceptors 

Answer 432

FALSE

repeated signals from nociceptors to the dorsal horn of spinal cord can result in action potential windup leading to heightened sensitization

Question 433

what is action potential windup?

Answer 433

repeated stimulation of nociceptors to the dorsal horn of the spinal cord resulting in a progressive increase in action potentials 

Question 434

what can action potential windup cause?

Answer 434

heightened sensitization

death of interneuron in dorsal horn ⇒ decreased ability to modulate response

2nd order neuron receptors get replaced with receptors that increase danger messages to the brain

Question 435

T/F: Nerves have to connect a body part to your brain in pain

Answer 435

FALSE

phantom limb pain

 

Question 436

T/F: in chronic pain , the CNS becomes more sensitive to nociception

Answer 436

TRUE

due to:

1. action potential windup
2. changes at the interneuron ⇒ increased sensitization
3. changes in descending modulation of pain

 

Question 437

how does changes at the dorsal horn interneurons come about? How does this result in increased sensitization?

Answer 437

persistent input from C-fibers → changes interneuron

→ changes in 2nd order neuron receptors → sprouting and expansion of receptor fields → increased sensitization

Question 438

T/F: the body tells the brain when it is in pain?

Answer 438

FALSE

the brain tells the body

 

Question 439

T/F: the brain sends messages down your spinal cord that can increase the nociception going up your spinal cord?

Answer 439

TRUE

changes in the CNS as a result of AP windup allow for increased info to be processed in the brain

Question 440

T/F: nerves adapt by increasing their resting level of excitment

Answer 440

TRUE

ion channels possess neuroplastic characteristics 

Question 441

how often does ion expression change on a nerve?

Answer 441

continuously

half-life reported to be 48 hours

Question 442

T/F: Chronic pain mean that an injury hasn't healed properly

Answer 442

FALSE

injury and pain are not synonymous

not uncommon for a chronic pain pt to have no injury history

Question 443

T/F: receptors on nerves work by opening ion channels in the walls of the nerve

Answer 443

TRUE

ion channel expression constantly changes

ion channels are found on axons

Question 444

what is ion channel expression dependent on? 

Answer 444

genetic coding 

and

the brain's expression of the survival needs of the individual

Question 445

how is increased expression of certain ion channels impactful to chronic pain?

Answer 445

increased expression of certain ion channels may result in the development of sensitivity to the stimulus that opens that specific channel

Question 446

T/F: the brain decides when you will experience pain

Answer 446

TRUE

pain is a brain construct based on perception of threat

Question 447

T/F: worse injuries always result in worse pain

Answer 447

FALSE
stepping on a lego vs soldier not noticing getting shot

Question 448

T/F: when you are injured, the environment that you are in will not have an effect on the amount of pain you experience

Answer 448

FALSE

injuries in high stress environments are 7-8x more likely to result in persistent pain

Question 449

T/F: it is possible to have pain and not know about it

Answer 449

FALSE

the decision to produce pain is a conscious decision by the brain

this is why you aren't in pain while under anesthesia

Question 450

T/F: Nerves can adapt by making more ion channels

Answer 450

TRUE

Question 451

T/F: 2nd order nociceptor post-synaptic membrane potential is dependent on descending modulation

Answer 451

TRUE

Question 452

how should the placebo effect be viewed?

Answer 452

an endogenous mechanism to modulate the pain experience

Question 453

T/F: Nerves adapt by making ion channels stay open longer

Answer 453

TRUE

G-protein channels can remain open for minutes

in persistent pain, a greater concentration of G-protein channels may be seen in 2nd order neurons

can contribute to the windup effect

Question 454

T/F: when you are injured, chemicals in your tissues can make nerves more sensitive

Answer 454

TRUE

various chemicals can influence opening/closing of specific ion channels

Adrenaline and cortisol

Question 455

T/F: in chronic pain, chemicals associated with stress can directly activate nociception pathways

Answer 455

TRUE

the stress response 

Question 456

using a the lion metaphor, describe the stress response if "the lion enters the room and follows you around for months/years"

Answer 456

if the stressors remain present for months, the stress response of increased adrenaline is then followed by cortisol changes in your body

Question 457

what is the IASP definition of pain?

Answer 457

pain is an unpleasant sensory and emotional experience which follows actual or potential tissue damage or is described in terms of such damage

Question 458

List 2 key things to keep in mind when defining what chronic pain is

Answer 458

1. it can be thought of as maladaptive neuroplasticity (increased sensitivity)
2. associated with abnormal intracortical inhibitory mechanisms 
   1. smudging

 

Question 459

List the PNE Principles (summary)

Answer 459

1. pain is an output of the brain
2. pain is not always an indicator of tissue damage
3. the amount of pain you percieve does not = the amount of damage
4. in chronic pain, the brain believes you are in danger and need protecting
5. context of pain experience is vital

 

Question 460

what is fibromyalgia?

Answer 460

chronic disorder

widespread pain, abnormal pain processing (pain amplification and impaired descending inhibition), sleep disturbances and fatigue

Question 461

what is chronic regional pain syndrome (CRPS)?

Answer 461

syndrome resulting in pain, vascular changes and atrophy

occurs in a regional distribution as opposed to a peripheral nerve or nerve root distribution

S/S worse in distal extremities

Question 462

when does CRPS usually occur?

Answer 462

secondary to trauma (surgery, fracture, crush injury, sprain)

 

Question 463

what is the primary complaint for CRPS?

Answer 463

severe, spontaneous pain, out of proportion to the injury

Question 464

what are the S/S of CRPS?

Answer 464

1. sensitivity to cold, pressure and touch
2. early symptoms:
   1. red/pale skin
   2. excessive sweating
   3. edema 
   4. skin atrophy
3. later signs
   1. skin becomes dry and cold and joints become stiff and swollen
4. motor signs (paresis, spasms, and tremor)

 

Question 465

what is the primary precipitating factor for CRPS?

Answer 465

disuse