Reagans amazing work (week 5) Flashcards
(168 cards)
1
Q
When do you use Neuro screening?
A
When a patient is NOT suspected of having neurological involvement.
2
Q
What does a Neuro screen confirm?
A
That the nervous system is intact
3
Q
What is a Neuro exam?
A
A deep dive into the nervous system.
4
Q
When do you use a Neuro exam?
A
When there is a known neurological diagnosis OR when a screen uncovers abnormalities
5
Q
What does deductive reasoning identify?
A
Functional limitation
6
Q
What does deductive reasoning hypothesize?
A
Suspected impairments to examine
7
Q
What is a primary impairment?
A
The direct problem (nerve lesion)
8
Q
What is a consequence of Secondary impairment?
A
Muscle atrophy due to nerve lesion
9
Q
Why do we intervene BOTH primary and secondary impairments?
A
To try and prevent occurrence of secondary impairments
10
Q
What does a neuroscreen help rule in/ rule out
A
To rule in or to rule out the need for a more in depth exam
11
Q
What does a neuroscreen include
A
Alertness - (need this to progress in screening)
Orientation- (person, place, time, situation)
Memory (current levels)
General Cognition- use FOGS, Visual activity (do their eyes follow me?) and communication (quality and content)
12
Q
What is FOGS
A
Family story of memory loss
Orientation of the patient
General information
Spelling
13
Q
What are the steps of a neurological screen
A
- Mental status
- Cranial nerves
- Motor
4.Reflexes - Sensation
- Coordination
- Stance and gait
14
Q
What are the components of a motor exam?
A
A. Visual inspection (is there muscle wasting)
B. Pronator drift test
C. Gross strength screen UE and LE for myotome (cannot be graded since they’re not using standardized ROM and positions)
D. Fasciculations
15
Q
What are the components of Reflexes?
A
A. Looking for absent, diminished, excessive or asymmetry
B. If UMN lesion is suspected, babinski & clonus
16
Q
What are the components of Sensation?
A
A. Touch lightly & bilaterally on face regionally but NOT dermatomal (including face, tip of shoulder, forearm, hand, thigh, lateral side of foot, great toe and medial lower leg)
B. Test stereognosis
17
Q
What are the components of Coordination?
A
A. Finger to nose (Pt’s nose to therapists finger)
B. Use UE’s at 90 abduction, closed eyes, & repetitively touch tip of nose with alternating finger tips
C. Rapid alternating movements (diadochokinesis) UE & LE
18
Q
What are the components of Stance & Gait?
A
A. Observation gait in clinic
B. Sit to stand & heel raises
C. Perturbations
D. Tandem walk
E. Rhomberg (feet together, eyes closed) - balance
19
Q
What are the neurological impairments of Abnormal reflexes?
A
- Hyperreflexia
- Hyporeflexia
- Areflexia
- Pathological reflexes
20
Q
What is the impact of quality of movement for Abnormal reflexes?
A
- Akinesia (usually with areflexia)
- Delayed motor development in children
21
Q
What are the neurological impairments of Sensory/Perceptual impairments?
A
- Impaired tactile awareness or proprioceptive sense
- Astereognosis
- Contralateral Homonymous hemianopia
- Spatial relationship disorders
22
Q
What is the impact of quality of movement for Sensory/Perceptual impairments?
A
- Impaired placing and positioning
- Impaired motor control in any task (usually w/ loss of 3. movement sense)
- Lack of glaze stability and postural imbalance
Dizziness
23
Q
What are the neurological impairments of cognitive impairments?
A
- Apraxia
- Memory deficits
24
Q
What is the impact of quality of movement for cognitive impairments?
A
- Difficult initiating movement
- Attention deficits
- Arousal deficits
25
What are the neurological impairments of Motor impairments?
1. Weakness
2. Impaired coordination
3. Poor postural control
26
What is the impact of quality of movement for Motor impairments?
1. Bradykinesia
2. Resting tremor
3. Dyskinesia
4. Impaired fractionation of movement
5. Abnormal synergies
27
When should vitals be taken? *
For every patient at least 2x per session
28
What are choreiform movements?
irregular , involuntary movements that are associated with a variety of conditions.
29
What may choreiform movements include?
Fidgeting
Twisting
Jerking of arms, legs and/or facial muscles
30
What are abnormal synergies?
A motor impairment.
31
What is the result of abnormal synergies?
Patients lose independent control of selected muscle groups, resulting in coupled movements that are often inappropriate for the desired task.
32
What do vital signs include?
HR
BP
RR
Temperature
33
When do you take vital signs?
Resting, immediately post activity and at recovery.
34
Importance of vital signs
Critical to our exam but not often done frequently enough
35
What are we looking for HR to be?
regular, consistent and strong.
36
What is the range for HR vital sign rate with bradycardia:
<60 bpm
37
What is a normal range for HR vital sign rate:
60-100 bpm
38
What is the range for HR vital sign rate with tachycardia:
>100 bpm
39
What is BP?
Pressure in arterial blood vessels
40
How do you measure BP vitals ?
At rest, with position changes, during exercises and in recovery (along 1/ HR)
41
Where do you measure BP vitals?
Take in both arms initially, continue to take in arm with the highest measure
42
What should BP vitals be at for a patient younger than 60?
Goal of less than 140/90
43
What should BP vitals be at for a patient older than 60?
Goal of 150/90
44
What is Orthostatic Hypotension?
Drop in SBP of >20 mmHg that accompanies change to more upright position OR appearance of symptoms (dizzy or lightheaded)
45
When should you measure RR vitals?
Asses at rest and while patient is not aware you are counting
46
What should RR vitals be at?
14-22 is normal in adults (ranges vary by age)
47
What is paradoxical breathing?
Upper chest collapses & abdomen rises excessively during inspiration
48
What should you often combine with RR?
Pulse oximetry
49
Who is the Modified Borg Scale for perceived Dyspnea (0-10) used for?
For those with spinal cord impairment or abnormal cardiac response. Ex: patients taking beta blockers
50
What are types of diagnostic tests?
1. Clinical lab test
2. Diagnostic imaging
3. Electrophysiologic testing
51
What is critical care monitoring?
Vitals monitored via bedside screen, may be more than vitals. Lots of “lines and tubes”
52
Things other than vitals taken in critical care monitoring:
1. Central vascular pressures (pressure in pulmonary artery, central venous pressure)
2. Intracranial pressure monitoring (can be monitored by a catheter inserted through a small hole drilled into the skull (may be increased with a tumor or stroke)
53
What are the 4 areas of clinical lab?
1. Chemistry
2. Hematology
3. Microbiology
4. immunohematology
( we are focusing on a few that are especially critical in neuromuscular practice)
54
What does Hematology describe?
Cellular blood composition
55
What is Hemostasis?
Information on clotting function of blood
56
What is the most commonly ordered lab test?
CBC (complete blood count)
57
What provides information on erythrocyte production and RBC health?
Erythrocyte ( red blood count), hematocrit and hemoglobin
58
What happens when Erythrocyte is impaired?
Decrease may impact O2 capacity
59
What does a low white cell count result in?
increase seen in acute infection, inflammation, tissue damage, necrosis and leukemia.
60
What do thrombocytes (platelets) initiate?
Initiate clotting and alterations can impair hemostasis
61
What is Thrombocytopenia
Low platelet count (ex: bleeding too freely)
( can play a role in stroke)
62
Thrombocytosis:
High platelet count (ex: clotting too much)
( can play a role in stroke)
63
What can play a role in a stroke
Thrombocytopenia and Thrombocytosis
64
What is the result from pathology related to abnormal immune responses?
Lots of neuromuscular diseases
65
Neuromuscular myopathies
Myasthenia gravis (MG) and Lambert Eaton Myasthenic Syndrome
66
Neuromuscular Neuropathies
Amyotrophic Lateral Sclerosis (ALS)
67
Polyneuropathy
Rheumatoid arthritis (RA) and Lupas (SLE)
68
The production of what causes neuromuscular disease?
Immunoglobulins
69
Immunoglobulins target and damage what?
CNS, peripheral nerves Neurons, muscle cells and other organs
70
Myasthenia Gravis:
Chronic autoimmune disorder in which antibodies destroy the communication between nerves & muscles, resulting in weakness of skeletal muscles.
71
What does the Lambert Eaton Myasthenic Syndrome affect?
The neuromuscular junction; it is a miscommunication between the nerve & muscle that leads to gradual onset of muscle weakness. It is a rare autoimmune disorder
72
Where does the Lambert Eaton Myasthenic Syndrome usually start?
In the proximal muscles of the arms or legs.
73
What can Lupas affect?
A range of different body systems including joints, skin, blood cells, brain, heart & lungs. Symptoms usually come and go in waves. Flares may be severe enough to affect ALDs and remissions may have no symptoms.
It is an autoimmune disorder
73
What are the signs of Amyotrophic lateral sclerosis (Lou Gehrig’s)
Often begins with muscle twitching & weakness in an arm or leg and trouble swallowing or slurred speech. Eventually it affects control of muscles needed to move, speak, eat & breathe.
73
What does the Amyotrophic lateral sclerosis (Lou Gehrig’s) affect?
The nerve cells of the brain & spinal cord. It is fatal progressive neurodegenerative disease
74
What are the common symptoms of Lupas:
Joint/muscle pain, chest pain, headaches, rashes, fever, hair loss, SOB. fatigue, swollen glands, swelling in arms/legs/ or face, confusion and blood clots.
75
What is X Ray imaging best for?
Bones, joints, abdomen and sinuses
76
What are the applications in neurology for ultrasound?
Antenatal & neonatal brain hemorrhage, prenatal congenital anomaly imaging
76
What are the applications in neurology for Xray?
Injuries & fractures, pneumonia, sinusitis & abdominal pain
77
What is an ultrasound imaging best for?
Maily liquid imaging (blood, cyst fluid)
78
What is CT imaging best for?
Physical density of matter in the body, much more sensitive than plain X-Ray
79
What are the applications in neurology for CT?
In brain, bony abnormalities in spine and skull
Follow up of MRI diagnosed abnormalities & implanted protheses
Also used when MRI cannot be used (ex: with pacemakers, presence of aneurysm clips)
80
What is MRI imaging best for?
Characteristics of protons in atomic nuclei and the milieu in which they are contained such as water, fat, blood, ect…
80
What is PET imaging best for?
Reflects metabolic rate of tissue (at present)
81
What are the applications in neurology for an MRI?
Brain tumors, small infarctions, unusual brain infections, tiny metastases, small/tiny areas of brain scarring or focal loss of brain tissue.
81
What are the applications in neurology for PET imaging?
Detect metastatic & primary cancer
Detects areas of increased or decreased metabolism seen in dementia.
82
What does electrophysiologic testing measure the activity of?
Directly or indirectly measures physiological activity of the nervous system, peripheral nerves or motor units/muscles (electroneuromyography or ENMG)
83
What does electrophysiologic testing evaluate?
Neuromuscular disorders, especially those of the PNS (Ex: anterior horn cells, DRG, nerve roots, brachial & lumbar plexus, peripheral nerves, neuromuscular junctions and muscles.
84
What are the 2 main components of ENMG?
Nerve conduction study (NCV)
Electromyography (EMG)
85
What does a nerve conduction study (NCV) do?
Assess function of motor & sensory nerves
86
What does an electromyography (EMG) do?
Assess electrical activity in the muscle.
87
What is cognition?
The act of knowing. Multifactorial: awareness, reasoning, judgment, intuition & memory.
88
What is alertness in cognitive skills?
Degree to which person is awake, aroused & attentive
89
What do the executive functions of cognitive skills involve?
Planning, manipulating information, self-monitoring & abstract thinking
90
What is awareness in cognitive skills?
Having knowledge of something, the ability to perceive or be aware of a fact, occurrence or event.
91
What is arousal in cognitive skills?
-Physiological readiness for activity
-Range from fully awake to comatose
- Levels of consciousness 4-1
92
What is attention in cognitive skills?
- Ability to focus on ones consciousness on specific info
- Critical first step to create memories
93
Where is attention usually controlled?
In the non-dominant hemisphere (right side for 99% of people
94
What is attention affected by?
Consciousness, arousal, awareness & motivation
94
What is the screening order?*
- Arousal/ alertness
- Attention
- Cognition & executive function
- Depression
95
What is explicit (declarative) memory?
Acquisition, retention and retrieval of information that can be consciously & intentionally recollected.
96
What does cognitive screening begin with?
Observation and conversation
96
What is Implicit (procedural, nondeclarative) memory?
Can’t be accessed by conscious recall & occurs through unconscious systems such as movement and perception.
97
How do you conduct a cognitive screen?
Use tact with screening, as this line of questioning can create anxiety, defensiveness, and/or uncomfortableness. Allow for adequate time for responses.
(ex: let patients know this is standard just to see how you’re remembering, thinking, ect.
97
What are the levels of consciousness in persons with coma?
Coma
vegetative state
minimally conscious state
98
What is the level of consciousness in a coma?
Complete loss of arousal, with no sleep/wake cycles & no purposeful responses (awareness)
99
What is the level of consciousness in the vegetative state of a coma?
Low awareness, sleep/wake cycles present, responds to noxious stim only
100
What is the level of consciousness in the minimally conscious state of a coma?
‘Partial preservation of conscious awareness’ inconsistent localized responses, purposeful behavior.
101
How many levels of consciousness are there?
5
102
What is the level of consciousness in an obtunded state?
Difficult to arouse from ‘sleep”, requires repeated stimulation; often needs a loud voice, plus a gentle shake to open eyes
102
What are the levels of consciousness?
Coma
Stupor
Obtunded
Lethargy
Delirium
103
What is the level of consciousness in a stupor state?
Responds only to noxious stimuli and quickly returns to unconsciousness if stimulation stops; unable to interact when aroused
104
What is the level of consciousness in a lethargy state?
Drowsy & falls asleep easily; will have difficulty maintaining attention. Loud voices are needed to keep patients engaged and awake.
105
What is the level of consciousness in a delirium state?
Often seen as a person emerges from a coma; characterized by confusion of the circumstances. May hallucinate or act as if in a dream state; conversation may not make sense.
106
How do you test attention?
Ask patient to spell a word backwards, or count backwards from 7. Or say the months in reverse order
107
What is the digit repetition test?
Attend to & repeat progressively longer series of digits beginning with a 3 digit number
(ex: say 516, then say 5167, ect…)
108
How do you test sustained attention
1. Digit repetition test
2. Test of vigilance
3. Watch for motor impersistence
109
What is the test of vigilance
Ask patient to listen & respond to each time they hear the letter ‘A’ when reading long series of random letters; have them tap table
110
What is motor impersistence
The inability to maintain a motor task
Ex: cant stick their tongue out for 30 seconds, its indicative of attention issues
111
How do you test divided attention
Have patient perform a dual task
Ex: walking while talking test, dual task timed up & go (count backwards while doing timed up & go)
112
How do you test cognition or mental status?
A. Mini-mental status exam (MMSE)
B. Addenbrooke cognitive assessment (ACE-R)
C. Montreal cognitive assessment (MoCA)
113
What exam is not publicly available and now cost associated?
Mini-mental status exam (MMSE)
114
What test is more focused on dementia?
Addenbrooke cognitive assessment (ACE-R)
115
What is Post traumatic amnesia? (PTA)
Loss of memory regarding events pre and post brain injury. Loss of ability to process information after brain injury.
116
What test is the shortest of the 3 given tests and assesses a broad range of cognitive function?
Montreal cognitive assessment (MoCA)
117
What type of amnesia is memory loss POST injury?
Anterograde amnesia
118
What type of patients may have agitation?
Patients with TBI
118
What type of amnesia is memory loss PRE injury?
Retrograde amnesia
118
What is the ability to recognize, perceive, and reflect on aspects of one’s self?
Self awareness (parts of executive function)
119
What scale is used to assess agitation?
Agitated behaviors scale (ABS)
120
What is it called when a patient does not have any sense of self awareness deficits?
Anosognosia
121
What does Montreal cognitive assessment (MoCA) asses?
Visuospatial/executive function, naming, memory, attention, language, abstraction, delayed recall & orientation utilizing a worksheet.
122
What does the agitation behavior scale measure?
If the agitation was Slight (2), Moderate (3) or extreme (4)
122
What scale is used to determine if agitation was present?
Agitated behavior scale
123
What are some examples of agitation?
1. Violent and or threatening violence toward people / property
2. Explosive & or unpredictable anger
3. Uncooperative, resistant to care, or demanding
4. Self abusiveness (physical and or verbal)
124
What is the recognition of symbols traced on the palm?
Graphesthesia
125
What is the ability to recognize objects by tactile manipulation only?
Stereognosis
125
What are two of the deep sensations?
1. Joint position sense (proprioception)
2. Joint movement sense (kinesthesia)
126
What are the two parameters of sensory impairment?
Quantity
Quality
127
What is the extend, size, regional dimensions of deficits?
Quantity. (dermatomal distribution, peripheral nerve distribution, regional distribution)
128
What causes excessive or increased sensitivity in sensory stimuli?
Hyperesthesia
128
What is the abnormal sensation of burning, pricking, tickling, tingling or numbness?
Paresthesia
129
What is the degree of sensory dysfunction?
Quality (can be intact (normal), impaired or absent)
130
What ordinary stimulus results in a disagreeable sensation?
Dysesthesia
131
What causes all sensory modalities to be lost?
Anesthesia
131
What causes a decrease in sensibility or awareness?
Hypoesthesia
132
What is the surface structure of C2?
Posterior half of skull
133
What is the surface structure of C3?
Medial end of clavicle
134
What is the surface structure of C4?
Medical acromion & below clavicle
135
What is the surface structure of C5?
Lateral elbow (and lateral acromion)
136
What is the surface structure of C6?
1st digit (and 2nd)
137
What is the surface structure of C8?
5th digit ( and 4th)
137
What is the surface structure of C7?
3rd digit
138
What is the surface structure of T1?
Medial elbow
138
What is the surface structure of T2?
Anterior axilla
139
What is the surface structure of T4?
Nipple line
140
What is the surface structure of T6 or T7?
Xiphoid process
141
What is the surface structure of T10?
Umbilicus
142
What is the surface structure of T12?
Anterior iliac crest/pubic symphysis
143
What is the surface structure of L1?
Inguinal region ( upper medial thigh)
144
What is the surface structure of L2?
Medial thigh mid-distance
145
What is the surface structure of L3?
Medial knee
146
What is the surface structure of L4?
Medial malleolus
147
What is the surface structure of L5?
Base of great toe (and lateral aspect of leg/plantar aspect to heel)
148
What is the surface structure of S1?
Lateral heel (Base of 5th digit, fibular head, lateral malleolus, little toe)
149
What is the surface structure of S2?
Posterior knee
149
GOOD LUCK !!!
I LOVE YOU !!! <3
150
What is the surface structure of S3?
Ischial tuberosity
