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IER Chapter 2

Neuromuscular PT (IER Chapter 2)

Precentral Gyrus Part of the frontal lobe. Primary MOTOR cortex for voluntary muscle activation.
Prefrontal Cortex Controls emotions and judgment.
Broca's Area Controls motor aspects of speech
Postcentral Gyrus Part of the parietal lobe. Primary SENSORY cortex for the integration of sensations.
Primary (and Associative) Auditory Cortex Part of the temporal lobe. Receives & processes auditory stimuli.
Wernicke's Area For language comprehension.
Primary Visual Cortex Part of occipital lobe. Receives & processes visual stimuli
Insula Within the lateral sulcus, for visceral functions.
Limbic System Consists of limbic lobe, hippocampus, hypothalamus, amygdaloid, and anterior nucleus of thalamus. For feeding, aggression, emotions, endocrine aspects of sexual response.
Basal Ganglia Forms associated motor system. Occulomotor, skeletomotor, and limbic circuits.
Occulomotor Circuit (cuadate loop) Functions with saccadic eye movements.
Skeletomotor Circuit (putamen loop) Controls amplitude & velocity of movement, reinforces a selected pattern while suppressing conflicting patterns; preparation/anticipation for movement.
Limbic Circuit Organizes behaviours, executive functions, problem solving, motivation and procedural learning.
Thalamus (Diencephalon) Sensory nuclei to relay information to cerebral cortex. Motor nuclei relays motor information from cerebellum & globus pallidus to precentral motor cortex. Other nuclei also assist in integration of visceral & somatic functions.
Subthalamus Control of several functional pathways for sensory, motor, and reticular formation.
Hypothalamus Controls functions of ANS & body homeostasis (temp, eating, water balance, pituitary).
Dorsal Column/Medial Lemniscal Afferents for proprioception, vibration, tactile discrimination. Fasciculus cuneatus (UE) & Fasciculus gracilis (LE). Tract crosses in the medulla going to thalamus.
Spinothalamic Tracts Afferents for pain & temp, and gross touch. Tracts ascend 1or2 segments in Lissauer's tract then cross.
Spinocerebellar Tracts Convey proprioception info from muscle spindles, GTO's, touch, and pressure receptors to cerebellum for control of voluntary movement. Dorsal tract ascends ipsilaterally to ICP. Ventral tract ascends to contra/ipsilateral SCP's.
Spinoreticular Tracts Convey deep & chronic pain to reticular formation of the brainstem via diffuse polysynaptic pathways.
Plexuses Cervical (C1-C4), Brachial (C5-T1), Lumbar (T12-L4), Sacral (L4-S3)
Levels of Consciousness (arousal) Alertness, Lethargy, Obtundation, Stupor, Coma
Glasgow Coma Scale 3 elements (EMV): eye movement, motor response, verbal response. Mild brain injury (13-15), Moderate (9-12), Severe (3-8).
Mini-Mental Status Exam For cognitive dysfunction. Max score of 30. Mild impairment (21-24), Moderate (16-20), Severe (15 and below).
Rancho Los Amigos Levels of Cognitive Function (LOCF) Assesses cognitive recovery from TBI. 8 levels: no response (I), decreased response (II, III), confused (IV, V, VI), appropriate (VII, VIII).
Weber's Test Strike tuning fork & place handle on middle of forehead. Examine for hearing perceived in middle of head or one ear only.
Rinne Test For air vs. bone conduction. Strike tuning fork & place on mastoid process, then place near external ear canal to check hearing acuity.
Cheyne-Stokes Respiration Period of apnea lasting 10-60 seconds followed by gradually increasing depth & frequency of respiration.
Tests for Meningeal Irritation Neck mobility, Kernig's sign, Brudzinski's sign. Pg. 96
Stereognosis Ability to identify familiar objects by manipulation and touch.
Barognosis Ability to identify different gradations of weight in similar size/shape objects.
Graphesthesia Ability to identify numbers, letters, or symbols traced on the skin.
Homonymous Hemianopsia Loss of half the visual field in each eye contralateral to the side of a cerebral hemisphere lesion.
Anosognosia Severe denial, neglect, or lack of severity of the condition.
Apraxia A "disconnect." A problem in the conceptual system, motor system, or both that hinders a person's ability to perform voluntary, learned movements.
Ideomotor Apraxia Inability to perform the task ON COMMAND, but can do the task instinctively.
Ideational Apraxia Inability to perform the task AT ALL, either on command or on own.
Modified Ashworth Scale 6 grades of spasticity. No increase in tone(0). Resistance @ end ROM (1). Resistance through < half ROM (1+). Resistance through most ROM, part still easily moved (2). PROM difficult (3). Rigidity (4).
Common Reflexes Jaw (CN V), biceps (C5-C6), triceps (C7-C8), brachioradialis (C5-C6), hamstrings (L5-S3), quads (L2-L4), achilles (S1-S2), plantar (S1-S2).
Chorea Relatively quick twitches or dancing movements.
Athetosis Slow, irregular. twisting, sinuous movements occurring especially in the UE's.
Tremor Continuous quivering movements; rhythmic, oscillatory movement observed at rest (resting tremor).
Strength Duration Curve Strength (intensity) on Y axis, duration (time) on X axis.
Rheobase Intensity of current to produce a visible twitch.
Chronaxie Duration of a stimulus twice rheobase that will elicit a muscle twitch. Chronaxie of an intact nerve & innervated muscle is much lower than that of a denervated muscle.
Middle Cerebral Artery (MCA) Syndrome MCA supplies lateral cortex, BG, and internal capsule. Occlusions produce contralateral sensory loss and hemiparesis with UE more involved than LE. Maybe also Broca's aphasia.
Anterior Cerebral Artery (ACA) Syndrome The ACA supplies the medial cortex. Occlusions produce contralateral sensory loss and hemiparesis with the LE more involved than UE.
Posterior Cerebral Artery (PCA) Syndrome Occlusions may cause contralateral homonymous hemianopsia, contralateral sensory loss, involuntary movements and more.
Brunnstrom Stages of Motor Recovery - Stage 1 Flaccidity, no voluntary movement
Brunnstrom Stages of Motor Recovery - Stage 2 Spasticity, hyperreflexia, movement synergies, minimal voluntary movement
Brunnstrom Stages of Motor Recovery - Stage 3 Strong spasticity, voluntary movement possible within synergy patterns
Brunnstrom Stages of Motor Recovery - Stage 4 Decreased spasticity, voluntary isolated joint movements possible
Brunnstrom Stages of Motor Recovery - Stage 5 Increase in voluntary movement but with coordination deficits
Brunnstrom Stages of Motor Recovery - Stage 6 Voluntary control and coordination near-normal, spasticity is gone
Fugl-Meyer Assessment of Physical Performance Scoring of movements 0(can't perform),1,2(fully performed). Includes subtests of UE, LE, balance, sensation, ROM, and pain.
Motor Assessment Scale Measures functional capabilities using eight categories and provides criteria for scoring performance.
Guidelines to promote learning in patients with LEFT hemisphere lesions 1) develop appropriate communication base (words, gestures, pantomime; assess level of understanding) 2) give frequent feedback & support 3) do not UNDERESTIMATE ability to learn
Guidelines to promote learning in patients with RIGHT hemisphere lesions 1) use verbal cues (demonstrations or gestures may be confusing) 2) give frequent feedback & focus on slowing down/controlling movement 3) focus on safety 4) avoid cluttered spaces 5) do not OVERESTIMATE ability to learn
Recovery Stages from Diffuse Axonal Brain Injury Coma (1), unresponsive vigilance/vegetative (2), mute responsiveness/minimally (3), confusional (4), emerging independance (5), intellectual/social competence (6)
PT for Ranchos Levels of Cognitive Function (levels I-III): decreased response Maintain skin integrity, respiratory status, PROM & contracture prevention, etc. Provide sensory stimulation. Position upright to promote arousal & proper body alignment.
PT for Ranchos Levels of Cognitive Function (levels IV-VI): mid-level recovery Prevent overstimulation, provide structure/consistency (schedule, logs, etc.). Task specific training. Simplify complexities, offer options. Provide assitance. Emphasize safety & behavioral managemnet. Model calm, focused behavior.
PT for Ranchos Levels of Cognitive Function (levels VII-VIII): high-level recovery Promote independence, assist in re-integration, improve postural control & balance, encourage active lifestyle & improved cardiovascular endurance.
ASIA Impairment Scale: A Complete, no motor or sensory function below the level.
ASIA Impairment Scale: B Incomplete: sensory but not motor function preserved below the level.
ASIA Impairment Scale: C Incomplete: motor function is preserved below the level & most key muscles have muscle grade <3.
ASIA Impairment Scale: D Incomplete: motor function is preserved below the level & most key muscles have muscle grade >3 (or equal to).
ASIA Impairment Scale: E Normal: motor & sensory function is normal
Wheelchair prescription for patients with high cervical lesions (C1-C4) Pts require electric w/c with tilt in space or recline seating, microswitch or puff-and-sip controls. (portable respirator may also be attached).
Wheelchair prescription for patients WITH cervical lesions, shoulder function & elbow flexion (C5) can use a manual w/c with propulsion aids (projections, etc.) independently for short distances on smooth, flat surfaces. May choose electric w/c for distances & energy conservation.
Wheelchair prescription for patients WITH cervical lesions, radial wrist extensors (C6) Independent with manual w/c with friction surface hand rims.
Wheelchair prescription for patients WITH cervical lesions, triceps (C7) Same as C6 but with greater propulsion.
Wheelchair prescription for patients WITH hand function (C8-T1 and below) Manual w/c with standard hand rims.
Categories of Multiple Sclerosis Relapsing-remitting, primary progressive, secondary progressive, progressive-relapsing.
Hoehn & Yahr Stages of Parkinson's: Stage I Minimal or absent disability with unilateral symptoms
Hoehn & Yahr Stages of Parkinson's: Stage II Minimal bilateral or midline involvement, no balance involvement
Hoehn & Yahr Stages of Parkinson's: Stage III Impaired balance, some restrictions in activity
Hoehn & Yahr Stages of Parkinson's: Stage IV All symptoms present and severe; stands and walks only with assistance
Hoehn & Yahr Stages of Parkinson's: Stage V Confinement to bed or wheelchair
Wallerian degeneration Degeneration of the axon and myelin sheath distal to the site of injury
Neurapraxia (Class 1) Injury to a nerve that causes transient loss of function (conduction block ischemia, compression injury, etc.). Nerve dysfunction may be rapidly reversed or last a few weeks.
Axonotmesis (Class 2) Injury to the nerve interrupting the axon, causing loss of function and Wallerian degeneration. No disruption to the endoneurium, so regeneration is possibe. (crush injury).
Neurotomesis (Class 3) Cutting of the nerve with complete severance of all structures & complete loss of function. Regeneration unlikely without surgery (terminal ends can't meet).
Bulbar Palsy Weakness or paralysis of the muscles innervated by motor nuclei of lower brainstem, affecting the muscles of the face, tongue, larynx and pharynx.
Guillain-Barre syndrome Acute ascending polyneuropathy: polyneuritis with progressive muscular weakness that develops rapidly, but is recoverable in 6-24 months
Amyotrophic Lateral Sclerosis (ALS) Degeneration of anterior horn cells and corticobulbar & corticospinal tracts. Typically death in 2-5 years.
Created by: carsonwolf on 2010-03-20

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