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NBCOT - Chapter 7
Neurological System Disorders
| Question | Answer |
|---|---|
| frontal lobe | primary motor cortex for voluntary muscle activation, controls emotions, judgments, higher order cognitive functions such as ideation and abstraction, planning of movements, includes Broca's area |
| parietal lobe | primary sensory cortex for integration of sensation, receives fibers conveying touch, proprioception, pain, and temperature from opposite sides of body |
| temporal lobe | receives and processes auditory stimuli, wernike's area (language comprehension) |
| occipital lobe | receives and processes visual stimuli |
| insula | deep within lateral sulcus, associated with visceral functions |
| limbic system | oldest part of the brain, associated with instincts and emotions contributing to preservation of the individual; basic functions include feeding, aggression, emotions, endocrine aspects of sexual response, and long term memory formation |
| white matter | myelinated fibers located centrally |
| basal ganglia | masses of gray matter deep within the cerebral hemispheres; has numerous fiber connections associated with the formation of motor plans and sensorimotor components to scale and adjust movements |
| parts of the diencephalon | 1. thalamus 2. subthalamus 3. hypothalamus 4. epithalamus |
| parts of the brainstem | 1. midbrain 2. pons 3. medulla oblongata |
| thalamus | integrate and relay sensory info to cerebral cortex and subcortical regions, relay motor info from cerebellum and globus pallidus to precentral motor cortex, assists in integration of visceral and somatic functions |
| subthalamus | several functional pathways for sensory, motor, and reticular function |
| hypothalamus | integrates and controls the function of the autonomic nervous sytem and the neuroendocrine system, maintains body homeostasis |
| epithalamus | integrates olfactory, visceral, and somatic afferent pathways, pineal gland monitors circadian rhythm |
| midbrain | connects pons to cerebrum, CNs: oculomotor and trochlear, substantia nigra for motor control and tone, superior colliculus for vision and visual reflexes, inferior colliculus for hearing and auditory reflexes |
| pons | connects the medulla oblongata to the mid brain, modulates pain and controlling arousal, CN: abducens, trigeminal, facial, and vestibulocohlear |
| medulla oblongata | connects spinal cord to pons, controls head movements and gaze stabilization, voluntary movement control, CN: hypoglassal, dorsal nucleus of vagus, and vestibulocochlear |
| cerebellum | superior, middle, inferior peduncles, concerned with equilibrium and regulation of muscle tone, proprioceptive pathways, voluntary movement and postural control, accurate force, direction, and degree of movement |
| ipsilateral | motor, discriminative touch, proprioception |
| contralateral | pain and temperature |
| autonomic nervous system | concerned with innervations of involuntary structures, sympathetic vs parasympathetic |
| meninges | the three membranes that envelop the brain; dura, arachnoid, subarachnoid, and pia |
| ventricles | four cavities or ventricles that are filled with CSF and communicate with each other and with the spinal cord canal |
| CSF | provides mechanical support, controls the brain excitability, and exchange of nutrients and waste products |
| 12 CNs | 1. olfactory 2. optic 3. oculomotor 4. trochlear 5. trigeminal 6. abducens 7. facial 8. vestibulocochlear 9. glossopharyngeal 10. vagus 11. accessory 12. hypoglossal |
| CN 1: olfactory | carries impulse for sense of smell |
| CN 2: optic | carries impulses for vision testing: eye chart, visual field |
| CN 3: oculomotor | motor: medial and vertical eye movements sensory: proprioception of eye testing: compare pupil size, visual tracking |
| CN 4: trochlear | proprioceptor and motor fibers for superior oblique muscle of the eye, downward and inward eye movements testing: tracking moving objects |
| CN 5: trigeminal | motor and sensory for face, controls jaw movements testing: test pain, touch, and temp, corneal reflex, ask person to move jaw |
| CN 6: abducens | lateral eye movements testing: tracking objects |
| CN 7: facial | mixed sensory and motor fibers to taste buds and anterior 2/3 tongue, facial expression and salivary glands testing: symmetry of face |
| CN 8: vestibulocochlear | sensory, transmits impulses for equilibrium and hearing testing: tuning fork |
| CN 9: glossopharyngeal | motor fibers for pharynx and salivary glands, sensory for phyarynx and posterior tongue, taste sensation for sweet, bitter, and sour testing: gag and swallow reflexes, posterior one third of tongue for taste |
| CN 10: vagus | sensory/motor for parasympathetic testing: in conjunction with CN 9 |
| CN 11: accessory | sensory motor fibers for SCM, traps, soft palate, pharynx, and larynx, movement of neck and shoulder testing: SCM and trap muscle testing |
| CN 12: hypoglossal | motor, sensory to/from tongue testing: ask person to stick out tongue |
| dermatome | a specific segmental skin area innervated by sensory spinal axons |
| myotome | skeletal muscles innervated by motor axons in a given spinal root |
| rancho level: 1 (no response, total assist) | rancho level: complete absence of observable behavior when presented with sensory stimuli |
| rancho level: 2 (generalized response, total assist) | rancho level: generalized reflex response, responds to external auditory stimuli with physiological changes, responses are delayed |
| rancho level: 3 (localized response, total assist) | rancho level: withdrawal or vocalization to painful stimuli, turns toward/away from auditory stimuli, blinks, follows moving objects, responds inconsistently to verbal commands |
| rancho level: 4 (confused/agitated, max assist) | rancho level: alert/in heightened state of activity, purposeful attempts to get out of bed, may perform motor activities such as sitting, reaching without purpose, absent short-term memory, may be aggressive with mood swings, u/a to cooperate, incoherant |
| rancho level: 5 (confused, inappropriate/non-agitated, max assist) | rancho level: not oriented to person, place, or time, non-purposeful sustained attention, absent goal directed, problem solving and self monitoring bx, inappropriate use of objects, u/a to learn new info, responds appropriately to simple commands |
| rancho level: 6 (confused, appropriate, mod assist) | rancho level: inconsistently oriented to person, time, place, able to attend to highly familiar tasks for 30 minutes, vague recognition of staff, shows carry over for familiar tasks, max assist for new learning, little-no carryover, u/a of impairments |
| rancho level: 7 (automatic, appropriate, min assist for daily living skills) | rancho level: consistently oriented, min sup for new learning, demonstrates carry over for new learning, min sup for safety, u/a to think about consequences of actions or realistic ideas for future, u/a to recognize inappropriate social interaction bx |
| rancho level: 8 (purposeful, appropriate, SBA) | rancho level: independently attends to familiar tasks for ~1 hour, uses assistive memory devices to recall schedule, aware of impairments, depressed, irritable, self centered, min assist for social interaction |
| rancho level: 9 (purposeful, appropriate, SBA on request) | rancho level: independently shifts back and forth between tasks, uses assistive memory devices, accurately estimates abilities, may have low frustration tolerance, able to self monitor appropriateness of social interaction |
| rancho level: 10 (purposeful, appropriate, mod/I) | rancho level: able to handle multiple tasks, independently initiates and carries out tasks, able to adjust to demands of task, periodic periods of depression, social interaction is consistently appropriate |
| central cord | SCI resulting from hyperextension injuries and presenting as more UE deficits vs lower extremity |
| brown-sequard (hemi section of the cord) | SCI resulting in ipsilateral paralysis, ipsilateral loss of position sense, ipsilateral loss of discrim touch, contralateral loss of pain and thermal sense |
| anterior cord | SCI: caused by flexion injuries; motor function, pain, pinprick, and temperature sensation are lost bilaterally below the lesion while proprioception and light touch are preserved |
| posterior cord | SCI: least frequent syndrome, results in proprioceptive loss. Pain, temp, and touch are preserved. Motor function is preserved to varying degrees |
| conus medullaris | SCI: results in LE motor and sensory loss and an areflexic bowel and bladder |
| cauda equina syndrome | SCI: injury at L1 and below resulting in lower motor neuron lesion; flaccid paralysis with no spinal reflex activity, an areflexic B&B |
| tremor | rhythmic, alternating, oscillary movement produced by repetitive patterns of muscle contraction and relaxation |
| dyskinesias | involuntary, nonrepetitive, but occasionally stereotyped movements affecting distal, proximal, and axial structures, most often a result of basal ganglia disorders |
| myoclonus | a brief and rapid contraction of a muscle or group of muscles |
| tics | brief, rapid, involuntary movements, often resembling fragments of normal behavior, tend to be stereotyped and repetitive but not rhythmic |
| chorea | brief, purposeless, involuntary movements of the distal extremities and face, usually considered to be a manifestation of dopaminergic overactivity in the basal ganglia |
| dystonia | results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone, may be generalized or focal |
| ataxia | describes a lack of coordination while performing voluntary movements, may appear as clumsiness, inaccuracy, or instability |
| hemiballismus | involuntary flinging motions of the extremities, often violent and have wide amplitudes of motion, continuous and random |
| parkinson's disease | dx that includes tremors, rigidity, resistance to passive motion, akinesia, postural instability, festinating gait, falling backwards or forwards, mask face, micrographia |
| Hoehn and Yahr stage 1 | Hoehn and Yahr stage, unilateral tremor, rigidity, akinesia, minimal or no functional impairment |
| Hoehn and Yahr stage 2 | Hoehn and Yahr stage, bilateral tremor, rigidity or akinesia, with or without axial signs, independent with ADL, no balance impairment |
| Hoehn and Yahr stage 3 | Hoehn and Yahr stage, worsening of symptoms, first signs of impaired righting reflexes, onset of disability in ADL performance, can lead independent life |
| Hoehn and Yahr stage 4 | Hoehn and Yahr stage, requires help with some or all ADL, u/a to live alone without some assistance, able to walk and stand unaided |
| Hoehn and Yahr stage 5 | Hoehn and Yahr stage, confined to a w/c or bed, max assist |
| spina bifida occulta | a bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations |
| occult spinal dysraphism (OSD) | when external manifestations such as a red birthmark, patch of hair, a dermal sinus, fatty benign tumor, or dimple covering the site are present |
| spina bifida cystica | an exposed pouch comprised of the spinal cord and meninges |
| meningocele | protrusion of a sac through the spine, containing cerebral fluid and meninges; however, does not include spinal cord |
| myelomeningocele | protrusion of a sac through the spine, containing CSF, meninges, and the spinal cord/nerve roots |
| tethered cord syndrome | occurs in the tail end of the spinal cord when the cord is stretched as a result of compression, being trapped with a fatty mass or scar tissue, developmental abnormality, or an injury |
| duchenne's MD | most common, pseudohypertrophy of calf, forearm, and thigh muscles, weakness of proximal joints, frequent falls, gower's sign |
| becker MD | MD that is slower to progress, less severe, and less predictable; loss of motor function of the hips, thighs, pelvic area, and shoulders, enlarged calves, cardiac system involvement |
| arthrogryposis | presence of weakness, deformities, and associated joint contractures, position of rest for UE: internal rotation of shoulders, extension of elbows, wrist flexion; LE: hip flexion and internal rotation, clubfeet |
| limb-girdle MD | proximal muscles of the pelvis and shoulder are initially affected, progresses slowly, onset between first and third decades of life |
| fasciscapulohumeral MD | occurs in early adolescence, involves face, upper arms, and scapular region causing masking, weakness, and decreased mobility of the face and inability to lift arms above shoulder level, progresses slowly |
| spinal muscular atrophy | weakness of the voluntary muscles of the shoulders, hips, thighs, and upper back, muscles for breathing/swallowing can be affected, four types dependent on onset (type 1: wednig-hoffman, ~2yrs to type 4 later onset) |
| congenital myasthenia gravis | disorders involving transmission of impulses in the neuromuscular junction, occurs mostly in males |
| charcot marie tooth disease | a disease involving the peripheral nerves marked by progressive weakness, primarily inperoneal and distal leg muscles |
| myopathies | progress more slowly than disrophies, weakness of face, neck, and limbs is characteristic |
| progressive supranuclear palsy | manifested by loss of voluntary, but preservation of reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudobulbar palsy, and dementia; occurs in later life |
| huntington's chorea | an autosomal dominant disorder, begins middle age, characterized by choreiform movements and progressive intellectual deterioration, psychiatric disturbance may preceded the onset of the movement disorder |
| cerebellar/spinocerebellar disorders | characterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movement decomposition tremor, dysarthria, and nystagmus |
| spinocerebellar degenerations | a group of degenerative disorders, characterized by progressive ataxia d/t the generation of the cerebellum, brain stem, spinal cord, peripheral nerves, and the basal ganglia (spinal ataxias, cerebellar ataxias, and multiple system degeneration) |
| friedrich's ataxia | gait unsteadiness, UE ataxia, dysarthria; may have tremors; the prototype of spinal ataxia |
| multiple systems degeneration | characterized by spasticity, extrapyramidal, sensory, lower motor neuron, and autonomic dysfunction |
| amyotrophic lateral sclerosis (ALS) | dx that is progressive, sx include muscle weakness, atrophy, cramps and fasciculations before weakness, signs usually begin in hands, spasticity, hyperactive deep tendon reflexes, dysarthria, dysphagia |
| erb's palsy | dx that affects the the fifth and sixth cervical vertebras, sometimes C7, muscles affected include supraspinatus, infraspinatus, deltoid, biceps, brachialis, and subscapularis |
| klumpke's palsy | dx that affects 7th and 8th cervical vertebra and first thoracic nerves, paralysis of the hand and wrist |
| peripheral neuropathies | a syndrome of sensory, motor, reflex, and vasomotor symptoms, includes pain, weakness, and paresthesias in the distribution of the affected nerve |
| guillain-barre syndrome | onset of recovery is about 2-4 weeks after first symptoms, acute, rapidly progressive form of polyneuropathy characterized by symmetric muscular weakness and mild distal sensory loss/parasthesias |
| myasthenia gravis | dx characterized by autoimmune attack, progressive, muscle weakness, chiefly in muscles innervated by CNs |
| post-polio syndrome | new onset of weakness, easily fatigued, muscle pain, joint pain, cold intolerance, atrophy, loss of functional skills |
| multiple sclerosis | slowly progressive, demyelination in the brain and spinal cord, usually have remissions and exacerbations, paresthesia, weakness, visual, emotional, and cognitive disturbances, balance loss, bladder dysfunction, sensorimotor findings |
| neuropathic pain | pain as a result of lesions in some part of the nervous system; usually accompanied by some degree of sensory deficit |
| thalamic pain | continuous, intense pain occurring on the contralateral hemiplegic side |
| complex regional pain syndrome type 1 | abnormal burning pain, hypersensitivity to light touch, and sympathetic hyperfunction (coldness, sweating, etc) |
| complex regional pain syndrome type 2 | pain occurring along the branches of a nerve, frequently paroxysmal |
| referred pain | pain arising from deep visceral tissues that is felt in a body region remote from the site of pathology, resulting in tenderness and cutaneous hyperalgesia |
| poor registration | high neurological thresholds and passive behavioral responses |
| sensory seeking | high neurological thresholds and active behavioral responses |
| sensory sensitivity | low neurological thresholds and passive behavioral responses |
| sensory avoiding | low neurological thresholds and active behavioral responses |
| ecological model of sensory modulation disorder | SI theory that describes individuals' unique response to interactions between external and internal dimensions of sensory processing in the context of their lives, difficulty with modulation result in poor social/environmental interactions, self reg |
| sensory modulation disorders | 1. sensory overresponsivity 2. sensory underresponsivity 3. sensory seeking/craving |
| sensory based motor disorder | 1. dyspraxia 2. sensory-based postural disorders |
| primary generalized seizures | seizures begin with widespread involvement of both sides of the brain |
| partial seizures | seizures that begin with involvement of a smaller, localized area |
| tonic clonic/grand mal | seizure that results in loss of consciousness, stiffening of body, heavy and irregular breathing, drooling, skin pallor, incontinence, alternating rigidity |
| myoclonic akinetic seizure | seizures that are brief, involuntary jerking of extremities, loss of tone |
| petit mal seizures | seizure that usually occurs between ages 4 and 12, rapid blinking or staring into space |
| simple partial seizure | seizure that is involuntary, involves repetitive jerking of the hand and arm |
| complex partial or psychomotor seizures | seizure that person may appear confused or dazed, u/a to respond, automatic motions like lip smacking, chewing/swallowing, etc |
| infantile spasms, west syndrome, or jackknife epilepsy | seizures that begin 3-9 months, dropping of the head and flexion of the arm occurs |
| lennox gastaut syndrome | severe seizures, associated with various brain disorders |
| landau-kleffer syndrome or acquired epileptic aphasia | seizure resulting in loss of language, auditory agnosia, and behavioral disturbances |
| simple febrile seizures | seizure that includes loss of consciousness and involuntary generalized jerking of a grand mal seizure |
| status epilepticus | prolonged seizures or seizures in rapid succession |
Created by:
jbrueckner