Optimising Function - NEURO Flashcards

Question

What nerve does the biceps reflex test?

Answer 1

Temperature Pain Non-discriminative touch Vibration Proprioception

Answer 2

Non-discriminative touch Temperature Pain

Answer 3

Proprioception Vibration

Answer 4

Falls in the past 3 months Mobility problems and use of assistive devices Gait problems, or use of a cane or walker Medications - could cause sedation, confusion, impaired balance, blood pressure changes Mental status - delirium, dementia or psychosis may be agitated or confused Continence - urinary frequency, or frequent toiletting needs IV pole Orthostatic hypotension Oxygen tubing Clutter Vision problems

Answer 5

Refers to the tension or resistance present in a muscle at rest. It is the natural state of muscle readiness for action even when not actively contracting.

Answer 6

A neurological condition characterised by an abnormal increase in muscle tone or stiffness. Typically caused by disruptions in the normal functioning of the nervous system, particularly the part that controls voluntary muscle movement. Hypertonia.

Answer 7

Common muscle tone disorder in which there is resistance to passive movement irrespective of posture and velocity. Cardinal feature of Parkinson’s Disease and usually present in extrapyramidal disorders. Affects agonists and antagonists equally.

Answer 8

Postural Tasks - steady state, proactive, reactive Individual - motor, sensory, cognitive Environment - support surfaces, sensory context, cognitive load

Answer 9

Slippery or uneven surfaces Loss of balance due to dizziness or fainting Weakness or muscle imbalance Medication side effects Environmental hazards Neurological conditions

Answer 10

Physical injuries, fractures, bruising, wounds Shear wounds and pressure injuries Delayed rehab and time increase in hospital Confidence/dignitity lack Manual handling risks - constant repositioning Expenses

Answer 11

Inadequate sitting assessment Inadequate sitting equipment Cognitive impairment Level of consciousness/medication Visual/sensory/proprioceptive problems Muscle weakness Joint restrictions - hip,knee,ankle and back Medical problems/comorbidities Neurological problems (new/old/progressive)

Answer 12

Caused due to loss of neurons, glial cells, neural networks in the brain and spinal cord. Progressive in nature.

Answer 13

Abnormal proteins aggregate and lodge in neural tissues - causing neuronal loss. Altered degradation pathways Mutations Environmental influence Unfolding Transcriptional and translational errors. Risk factors: Genetic predisposition, environment, lifestyle The site of origin of neuronal loss determines the primary clinical feature.

Answer 14

Causes unintended or uncontrollable movements Caused by a loss of nerve cells in the substantial nigra leading to a reduction in dopamine Basal ganglia is unable to send a ‘good’ plan back to the cortex due to loss of neurones, affects the rest of the pathway. Risk factors: Familiar risk factors Genetic Environmental factors eg exposure to toxins

Answer 15

Rigidity, bradykinesia, tremors, fatigue, pain, postural instability.

Answer 16

Stage 1 - only one side of the body is affected Stage 2 - symptoms affect both sides of the body Stage 3 - balance and stability become affected Stage 4 - symptoms increase, however are able to stand and walk Stage 5 - assistance is required for everyday activities.

Answer 17

Abnormal proteins aggregating in the hippocampus, leading to neuronal death.

Answer 18

Preclinical: no symptoms, changes to the brain begin MCI (mild cognitive impairment) stage: mild, memory lapses, changes in cognitive functions may be measurable Mild: memory loss becomes noticeable, difficulty organising and expressing thoughts. Getting lost or misplacing belongings. Moderate: greater memory loss and confusion, significant assistance for daily activities. Changes in sleep patterns, personality and behaviour. Severe: nearly total memory loss, loss of ability to communicate, need for full time assistance.

Answer 19

Withdrawal from social activities Confusion with time and location Difficulty completing familiar tasks Misplacing items Difficulty solving problems Memory loss Difficulty with words Trouble with images and spaces Poor judgement Unfounded emotions

Answer 20

Autoimmune disease of the CNS, characterised by chronic inflammation, demylination, gliosis and neuronal loss. Immune system starts killing the cells. The immune system attacks and destroys myelin, which means communication between neurones breaks down. Hard to predict symptoms due to myelin breakdown can occur anywhere. Sensory, motor and cognitive problems. Often diagnosed in 20s and 30s.

Answer 21

Changes to vision Muscle weakness and spasm Numbness or pain Loss of balance Difficulty with cognitive function Mood changes

Answer 22

Relapsing remitting Secondary progressive Primary progressive Progressive relapsing

Answer 23

Cognitive impairment Neuropsychiatric impairments Motor impairments Age effects Progressive phases Caregiver/family stress

Answer 24

Understand medication side effects Do strength and balance exercises Get your vision and hearing checked regularly Use night lights, grab bars and secured carpet Stand up slowly to avoid dizziness Use a cane or walker if you need more stability

Answer 25

Toe scrunches - grabbing a towel with your toes to work on fully extending your toes (toes help with balance) Toe extensor stretch - so that toes can fully extend to make contact with the ground and improve balance

Answer 26

Contralateral (opposite side to the brain) for motor control and voluntary movement via the corticospinal tract Ipsilateral (same side) for stability

Answer 27

Reticulospinal Vestibuolospinal

Answer 28

Where the pons and the medulla meet: the pontomedullary reticular formation. It inhibits flexion via descending spinal pathways. Sitting in flexed posture on laptops is a deficit of the PMRF. Also the house of the cranial nerves. Stimulation with sensory input at the PMRF (eg through the vestibule nerve) - which will inhibit the PMRF and have better upright stability. The cranial nerves responsible for the vestibular system (the vestibular nuclei) are located in the PMRF, so when these are stimulated it stimulates postural stability.

Answer 29

Tremors as they are unable to hit their target. Affects motor function. It usually refines motor output. Also communicates with the vestibular system, so is fundamental with postural neurology.

Answer 30

The vestibular nuclei live in the pontomedullary (PMRF), and so when these are stimulated it stimulates the PMRF, which inhibits flexion. Equally, the vestibular system also stimulates upright postural extension. Leads to upright postural design.

Answer 31

Floppy - cerebellum Cogwheel rigidity - basal ganglia

Answer 32

Extended legs and flexed arms - physiological extensors Decebrate posture - extended arms and supinated wrists

Answer 33

Reactive postural control test Examiner stands behind the subject, and the examiner gives a sudden brief backward pull to the shoulders. 0 = recovers independantly but may take 1 or 2 steps or an ankle reaction 4 = unable to stand without assistance

Answer 34

Patient leans back onto practioner and then practioner lets go 0 = recovers independently, 1 step of normal length and width 4 = falls without attempting a step or unable to stand without assistance

Answer 35

Assesses functional ability through a range of domains: Forearm movement Hand movement Reaching Lifting Stacking Flipping Gripping Turning Folding Lifting

Answer 36

Power grip: Closing a hand with the thumb in opposition to all other fingers Lumbrical grip Spherical grip - eg holding a tennis ball Hammer grip Hook grip - eg handing from overhead bars Pinch grip: the holding of an object between the thumb and fingers of a single hand Tip pinch Tripod pinch - eg holding a pencil Lateral pinch - eg pinch to twist a key

Answer 37

PROM: maintain mobility, focussing on flexion and extension of the shoulder, elbow, wrist and fingers. Active-Assissted Range: encourage partial voluntary movement Functional electrical stimulation Repetitive task specific training Mirror therapy Bilateral arm training: increases coordination Strength training Motor imagery and mental practice of movement Key points: repetition, consistency, motivation and mental engagement.

Answer 38

Confrontation visual field test: observing the examiner moving their fingers in the patients periphery vision. Detects large visual field deficits. Amster grid: assessing central visual field defects . Patient looks at a grid to detect if any lines appear blurred or are missing.

Answer 39

Action Research Arm Test: 19 items assessed including: grasp, grip, pinch and gross movement Wolf Motor Function Test

Answer 40

Nine Hole Peg Test: fine motor dexterity and finger coordination. Time taken to place 9 pegs into holes on a peg board.

Answer 41

Cherokee Arm and Hand Ability Inventory (CAHAI): Evaluates 13 functional tasks: pouring water, opening a jar, use of a knife and fork, dressing tasks. Nine-hole peg tests (performed bilaterally)

Answer 42

Cherokee Arm and Hand Ability Inventory (CAHAI): Evaluates 13 functional tasks: pouring water, opening a jar, use of a knife and fork, dressing tasks. Nine-hole peg tests (performed bilaterally)

Answer 43

Restorative therapy: re-building lost cognitive skills eg attention and memory Compensatory strategies: use of tools like planners and reminders to compensate for cognitive deficits Computer based cognitive training: eg Lumosity, Cognifit or BrainHQ Cognitive Behavioural Therapy: managing frustration and anxiety Cognitive Stimulation Therapy: discussions, puzzles, word games and reminiscence therapy.

Answer 44

Interncranial injury - injury to the brain caused by external force. Can be classified based on mechanism (closed or penetrating head injury) or other features (occuring in specific locations or widespread areas)/

Answer 45

Mild traumatic brain injury Symptoms: loss of conscioussness, headaches, thinking difficulty, lack of concentration, nausea, blurred vision, dizziness, sleep disturbances, mood changes. Direct brain injury Acceleration-decceleration injury (eg rotational forces) Blast brain injury The brain experiences forces, causing it to move backwards or forwards within the cranial vault. Symptoms can be delayed by 1-2 days Not unusual for symptoms to last 2 weeks in adults and 4 weeks in children

Answer 46

Cerebral blood flow - impaired autoregulation, brain odema, increased ICP Oxygen - hypoxia, ischemia, impaired )2 regulation, impaired microcirculation Energy flow - glucose utilisation, glucose availability, mitochondrial failure

Answer 47

Kinetic impact 1. Neurones stretch/shear 2. Electrolytes (K, Na, Ca) move across gradients 3. Neurones 'fire' indiscrimintively via Ca --- Glutamate release 4. Energy deficit results from restoring electrolyte gradient. Simpler: Potassium leaks out Calcium rushes in Glutamate (excitory) released (significant energy demands nerves become overexcited, swell and die). Mitochondria gets impaired which prevents production of ATP Brain must switch to anaerobic production of ATP, less efficient Can last up to 30 days post concussion

Answer 48

Cerebral autoregulation - autonomic system reacts to changes in systemic blood pressure Cerebrovascular reactivity - changes in cerebral flow in response to changes in pp of CO2. Neurovascular coupling - blood shunted to areas of the brain due to increased activity in this region Neuroautonomic cardiovascular regulation - reflected in heart rate variability

Answer 49

When a concussed individual sustain a second impact upon their head before recovering form the first impact. Symptoms: loss of conscioussness headache vomitting dilated pupils or vision loss seizure Common misdiagnosis: CV emergency, stroke, seizure

Answer 50

Brain fog Lack of focus Headache Memory difficulties Fatigure Iritability or nervoussness Mood disruption Light or sound sensitivity Sleep problems Change in quality of life

Answer 51

Fall Collision Struck by object Struck by person Assault Unknown

Answer 52

Vestibular symptoms: balance, dizziness, nausea) Ocular-motor symptoms: vision, movement, blurred vision, double vision, difficulty reading) Headache Cognitive symptoms: (decision making, processing information, brain fog, memory problems, concentration, word retrieval) Mood related Symptoms (how you feel, anxiety, depression, irritation, feelings of overwhelm).

Answer 53

No symptoms at rest Light activity eg jogging Light practice of sport 'Yellow shirted' - can participate but no contact Full contact practice Return to play Any problems then must drop down to the level below

Answer 54

A standardised tool for evaluating suspected concussions. Includes the following section: - red flags - memory assessment - maddocks questions - glasgow coma scale examination - cervical spine assessment - symptom evaluation - cognitive screening - neurological screening - balance examination - delayed recall

Answer 55

Alert Confusion Voice Pain Unresponsive

Answer 56

Smooth pursuit - clinician moves finger horizontally in front of patient 5 repetitions: looking for jerky eye movements or multiple beats of nystagmus Horizontal and vertical saccades - look back and forth between two points for 20 repetitions: ask if symptomatic Horizontal and vertical gaze stability - shake head looking at one spot for 20 repetitions: ask if symptomatic Near point of convergence - bring pen towards eyes and stop when splits into two. 6cm or lower is normal Left and right monocular accommodation: cover one eye and bring pen towards face until it blurs. Measure distance. 12cm or lower is normal. Complex tandem gait - 5 steps forward and back (tightrope) eyes open and closed. Looking for errors and sway

Answer 57

Offactory - smell Optic - vision Vestibulocochlear - hearing, balance/equillibirum

Answer 58

Occulomotor - eye movement, elevation of eyelid, pupil size, and reactivity to light Trochlear - eye movement (vertical and aDduction) Abducens - eye movement (abduction) Accessory - head/neck/shoulder movement Hypoglossal - tounge movement, speech

Answer 59

Trigerminal - chewing/face/mouth sensation Facial - facial expression, eyelid and lip closure, taste, corneal reflex Glossopharyngeal - gagging, swallowing, taste Vagus - gagging, swallowing, speech

Answer 60

SMELL Sensory Loss of smell - anosmia Well-established sequels of head injury, can follow blunt traumas Temporary anosmia due to inflammatory response

Answer 61

VISION Sensory Optic neuritis - inflammation to the myelin sheath, may affect one or both eyes, common in MS Glaucoma - high intra-ocular pressure causes cells to die. Atrophy of the optic nerve Nutritional optic neuropathy - bilateral, symmetrical, and progressive impairment with loss of central vision acuity. Common due to widespread bariatric surgery and strict vegetarian diets. Ischemic optic neuropathy - reduced blood flow to the optic nerve. May be linked to atherosclerosis or arteritis eg giant cell arteritis (headache presentation).

Answer 62

EYE MOVEMENT Motor Disorders can impair ocular mobility, pupillary function, or both Diplopia and ptosis (drooping of the upper eyelid). Ask about double vision as may link to Horner’s syndrome. Affected eye may deviate slightly out and down in a straight ahead gaze. Abduction is slow.

Answer 63

EYE MOVEMENT Motor Palsy impairs superior oblique muscle, causing paresis of vertical gaze, mainly in aDduction Patients report seeing double images, one above and slightly to the side of the other eyes do not abduct normally Possible causes: Closed head injury Infarction due to small vessel disease eg diabetes Can result from aneurisms or tumors

Answer 64

SOMATOSENSORY INFORMATION - touch, pain from the face and head MOTOR - chewing Motor and sensory Mechanisms: Manifests as severe facial pain and allodynia Caused by compression of the nerve at its root by an adherent loop of an intracranial artery Rarely, a venous loop may compress the 5th cranial nerve at its root entry into the brain stem Less common causes include compression by tumour or MS

Answer 65

EYE MOVEMENT Motor Mechanisms: affects lateral rectus muscle, impairing eye abduction and may cause severe headache Eyes may be slightly aDducted when patient looks straight ahead Causes impaired aDduction and horizontal diplopia May be secondary to nerve infarction …..

Answer 66

TASTE SOMATOSENSORY information from the ear, controls muscles of facial expression Mixed Mechanisms: Sudden onset, unilateral peripheral facial nerve palsy Symptoms are hemispheres-facial peresis of the upper and lower face Mechanism is thought to be swelling of the facial nerve due to an immune or viral disorder. Swollen nerve is maximally compressed as it passes through the labyrinthine portion of the facial cancel, resulting in ischemia and paresis. Common viral causes: herpes simplex, herpes zoster. Cytomegalovirus, Epstein-Barr, mumps, rubella, influenza B.

Answer 67

HEARING AND BALANCE Sensory Nerve along which the sensory cells of the inner ear transmit information to the brain. This facilitates hearing and equllibrium. Dysfunction of the nerve may cause hearing loss, vertigo, false sense of motion, loss of equilibrium, nystagmus, motion sickness or gaze-evoked tinnitus.

Answer 68

TASTE Mixed Somatosensory info from the tongue, tonsil, pharynx, control of some muscles used in swallowing Episodic brief, excricusting pain occurring spnaaneously when chewing or swallowing, coughing, yawning or sneezing. Usually. Begins in tonsil region and may radiate to the ear. May be difficulty in swallowing.

Answer 69

SENSORY, MOTOR and AUTONOMIC function Mixed Loss of reflex contraction of the palate or altered gag reflex, hoarseness of the voice

Answer 70

MOTOR FUNCTION - head/neck/shoulder Dysfunction results in weakness of the sternocleidomastoid and upper portion of the trapezius Diminished muscle mass, partial paralysis of trapezius muscle

Answer 71

MOTOR FUNCTION - tongue Dysfunction is characterised by flaccid paralysis/weakness of ipsiliateral tongue musculature Clinical feature may be muscle atrophy and tongue weakness

Answer 72

Loss of smell Alteration/loss of vision. Double vision/nystagmus Drooping eyelid Facial pain/allodynia He I-facial paresis Hearing loss Vertigo/motion sickness Gaze evoked tinnitus Difficulty swallowing Altered gag reflex Hoarseness of the voice Autonomic dysfunctions eg heart rate Atrophy/partial paralysis of the sternocleidomastoid/trapezius muscles Tongue function/weakness Pain and headaches too …

Answer 73

Head injury Road traffic collisions Inflammation Glaucoma Atherosclerosis/Carotid aneurysm Vasculitis/Giant cell arteritis Nutritional neuropathy Smalll vessel disease eg in diabetes Herpes simplex Demylinating disorders eg MS Peritonsillar abscesses Anatomical anomalies/space occupying lesions Tomours/arterivenous malformation/aneurysm

Answer 74

A measure of motor neurone excitability

Answer 75

Resistance Irradiation and reinforcement Manual contact Body position and body mechanics Verbal commands Vision Traction or approximation Stretch Timing Patterns of movement

Answer 76

Traumatic: - road traffic accidents, falls, violence, sport-related, surgical complications, diving accidents Non-traumatic: - spinal tumours, degenerative diseases, vascular

Answer 77

Impact with transient compression of the cord Impact with persistent compression of the cord Distraction injury Direct laceration or transection

Answer 78

Ascending tracts - from peripheries to the brain. Carry sensory information. 2 major types of tracts: - Facilullus cuneatus and facilius gracilis: fine touch, vibration and proprioception. Provide info from same side of the body. - Spinothalamic tracts: pain and temperature sensations. Get information from the spinal nerves. Carry information from the opposite side of the body. Descending tracts - from the brain (higher nerve fibres) to the peripheries. Carry motor information to your muscles. - Corticospinal tract: voluntary movement and motor commands. Control contralaterally.

Answer 79

Complete spinal cord injury - everything below that level if affected Incomplete injury - C4 injury - complete paralysis below the neck C6- partial paralysis of hands and arms as well as lower body T6 - paralysis below the chest L1 - paralysis below the waist

Answer 80

Classification for complete and incomplete spinal cord injuries ABCDE

Answer 81

Central cord syndrome - caused by neck hyperextension: upper greater than lower extremity weakness. loss of pain and temp sensation, Anterior cord syndrome - caused by injury of ishchemia associated with anterior spinal artery: weakness/paralysis below injury, loss of pain and temp sensation below injury Brown sequard syndrome - caused by complete hemisection of the spinal cord: ipsilateral paralysis and loss of touch, proprioception and vibration sense below injury. Contralateral loss of pain and temp below injury. Conus medullaris - injuey to terminal end of spinal cord, affectting sacral roots. Bladder, bowel and sexual dysfunction and loss of achilles tendon reflex. Cauda equina - injury or compression of lumbar and sacral nerves that trave below the level of conus medullaris.Lower extremity motor and sensory impairment alongside symptoms of clonus medullaris.

Answer 82

Pressure injuries Respiratory complications Decreased ROM Heterotopic ossification - bone formation in different parts of the body. Osteoporosis and fractures Pain GI complications UT complications DVT and PE Autonomic dysreflexia CVD

Answer 83

ASIA scale Spinal cord independent measure SCI standing and walking assessment tool

Answer 84

Spinal orthosis Splints Progressive sitting, tilt table FES, gait orthosis, BWS - gait training, robotic devices Sensory interventions - MT, electrical stimulation, hand therapy Hydrotherapy Pain management CR rehab Repositioning Referrals

Answer 85

Motor neurone disease happens when the motor neurones stop working. Symptoms include: muscle weakness, twitches, slurred speech, difficulty swallowing. The symptoms worsen over time.

Answer 86

Sialorrhea Pseudobulbar affect Spasticity Cognitive impairment Respiratory insufficiency Bronchial secretions Muscle cramps Insomnia and fatigue Communication difficulty Impaired swallowing and malnutrition

Optimising Function - NEURO Flashcards

(121 cards)