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Basecamp Neuro

Neuromuscular PTA Review

Somatosensory Input for Balance Receptors located in joint, mm's ligaments and skin provide proprioceptive input about length, tension, pressure, pain and joint position; proprioceptive and tactile info from ankles, knees, hips and neck send balance info to brain
Somatosensory Input for Balance - Testing Examination of pressure and vibration; observing pt when changing the surface they are standing on
Visual Input for Balance Visual cues provide for perceptual acuity of verticality, motion of objects & self; environmental orientation; postural sway and head/neck movement; Children rely on it heavily
Visual Input for Balance - Testing Examine quiet standing with eyes open; observe balance strategies to maintain COG with and without visual input; assessment of potential visual problems in neccessary
Hemianopsia Loss of vision on in half the field of vision or 1 or both eyes
Pursuits Allows our eyes to smoothly follow moving targets
Saccades Rapid movement of the eyes between fixation points; voluntary directing of gaze
Gaze Control Controlled by 4 systems: Saccade, pursuit, nystagmus (optokinetic system) and vestibulo-ocular reflex system
Acuity Sharpness of vision
Vestibular Input for Balance Provides CNS feedback of position/movement of head in relation to gravity; labyrinth includes 3 semicircle canals (monitors fluid movement) and 2 otolith organs (measure effects of gravity and movement with regards to acceleration and deceleration;
Vestibular Input for Balance - Testing Examine balance with head movement; many types of assessments
Dix-Haulpike Maneuver AKA Nylen Barany test; determines whether vertigo is connected to certain head movements, which ear is affected and whether it is inner ear/nerve (peripheral) or the brain (Central); tests for otoconia
Bithermal Caloric Testing To test for virtigo, dizziness or hearing loss associated with an antibiotic; cold and/or warm water into ear canal should cause nystagmus; abnormal means there is damage to acoustic nerve, balance sensors of the inner ear or brain
Head Thrust Sign AKA Head Impulse Test; tests vestibule ocular reflex; normal detection of head movement allows eyes to rapidly adjust; this will test that; see slides
Vestibulo-ocular Reflex (VOR) Allows for head/eye movement coordination; supports gaze stabilization through counter head movement
Vestibulospinal Reflex (VSR) Stabilizes body and controls movement while head is moving and trunk is coordinated during up right posture
Automatic Postural Strategies Automatic motor responses used to maintain COG over BOS; ankle, hip, suspensory and stepping
Ankle Strategy elicited by small range, slow velocity movement; distal to proximal mm contractions
Hip Strategy elicited by greater force, challenge or perturbation through hips/pelvis; hips move in opposite direction of head; proximal to distal mm contractions
Suspensory Strategy lowering COG for better control; used when both mobility and stability are required to complete a task
Stepping Strategy Elicited in response to unexpected challenges and perturbations and when COG is outside BOS; LE steps and/or UE's reach to regain COG over BOS
Berg Balance Scale 14 tasks score 0-4 each; Max score is 56; 41-56 =low fall risk, 21-40 medium fall risk, 0-20 high fall risk; can be used 1 time or in succession
Fugl-Meyer Sensory-motor Assessment of Balance Performance Battery Stroke specific performance based impairment index; 7 items scored from 0-2; Max score is 14; ,ax score does not indicate normal mobility
Functional Reach Test Test reach 3x; 24-40 yo = 14.5-17 in, 41-69 yo = 13.5-15 in, 70-87 yo = 10.5-13.5 in; following age category measurement indicates increased fall risk
Timed up and Go Test Tests level of mobility/balance; Sit in a supported chair with feet flat, stand, walk 10 ft, turn and sit again; observe all parts of stability and mobility; Normal - 10 sec or less; Limit of functional independence is 20 sec; High fall risk is 30+ sec
Tinetti Performance Oriented Mobility Assessment Tests standing and ambulating balance and mobility; Max - 16 points for standing and 12 for gait using a 0-1 or 0-2 scale for each item assessed; 28 point max; low fall risk - 24-28; moderate risk - 19-23; high risk - <19
Romberg Test Assessment of balance and ataxia (loss of body control); narrow BOS with arms crossed over chest, eyes open then closed for up to 30 sec; positive or abnormal = instability with eyes closed; ataxia indicates sensory ataxia NOT cerebellar ataxia
Sharpened Romberg Test Same examination with tandem stance with eyes closed for 1 minute
Otoconia Crystals in inner ear moving or staying stagnant abnormally
A patient who is stable in standing but not weight shifting has a balance descriptor of Fair
Postural Stability Control The ability to maintain stability and orientation with the COG over the BOS at rest
Aphasia Acquired neuro impairment of processing for receptive and/or expressive language; associated symptoms - perseveration of speech, severe auditory comprehension impairments, unreliable yes/no answers; use of empty speech w/o recognition of impairments
Perseveration of Speech Repetition of speech or "getting stuck"
Fluent Aphasia Usually involves temporal lobe, Wernicke's area and/or parietal lobe; word production and speech output is functional; empty speech/jargon with prosody; speech lack substance; neologisms
Prosody Sounds and rhythms used in speech and poetry
Neologisms Paraphrases within a word is so severe it is unrecognizable
Non Fluent Aphasia Usually affects frontal lobe of dominant hemisphere; Poor word output; dyprosodic speech, poor articulation; increased effort for speech, content is present but impaired syntactical words
Syntactical Words of or according to syntax; supporting words
Wernicke's Aphasia Lesion to posterior superior temporal gyrus; fluent aphasia AKA receptive aphasia; comprehension impaired (reading/auditory), good articulation; impaired writing; poor naming ability; motor impairment not typical; "word salad"
Broca's Aphasia 3rd convolution of frontal lobe; Non fluent AKA expressive aphasia; most common; intact comprehension; impaired repetition and naming skills; frustration; paraphasias; motor impairment typical
Paraphasias Production of unintended syllables, words or phrases
Global Aphasia Non fluent; usually affects frontal, temporal or parietal lobes; comprehension of reading/auditory is severely impaired; impaired naming, writing, repetition skills; may use non verbal communication
Dysarthria Inability to articulate; Motor disorder of speech caused by upper motor neuron lesion that affects the muscles used to articulate words and create sound; speech i s"slurred"; may affect respiration
Treating Aphasia Co tx or consult with speech therapist; use tactile and visual cues; only 1 person talking at a time; use concise language and yes/no q's; allow adequate response time; cut back on feedback as needed
Conduction Aphasia AKA associative aphasia; intact comprehension; fluent speech; poor repetition; interrupted speech due to difficulty finding words; impaired writing, excessive repetition; intact fluency with good comprehension
Agnosia Inability to interpret information
Language Dominant Hemisphere Typically the left hemisphere; 99% of R handed people and 66% of left handed people
Alexia Inability to comprehend written language
Broca's Area In frontal lobe; responsible for expression of speech
Olfactory Nerve (I) Afferent - smell; nose; Test - identify familiar odors
Optic Nerve (II) Afferent - Sight; eyes; Test - test visual fields
Oculomotor (III) Efferent - Voluntary - levator, superior, medial and inferior recti; inferior oblique; Automatic - smooth mm's; Test - up, down and medial gaze, and reaction to light
Trochlear (IV) Efferent - voluntary - superior oblique mm; Test - down and in gaze
Trigeminal (V) Afferent - touch, pain: skin of face, mucous membranes of nose, sinuses, mouth, anterior tongue; Efferent - voluntary - mm's of mastication; Test - corneal reflex, face sensation, clench teeth and push down on mandible
Abducens (VI) Eye; Efferent - lateral rectus mm; Test - lateral gaze
Facial (VII) Afferent - taste; anterior tongue; Efferent - Voluntary - facial mm's; Automatic - lacrimal, submandibular and sublingual glands; Test - Close eyes tight, smile and show teeth, whistle and puff cheeks, identify familiar tastes
Vestibulocochlear (Acoustic Nerve) (VIII) Afferent - hearing and balance; ear; Test - hear watch ticking, hearing tests, Balance and coordinaiton tests
Glossopharangeal (IX) Afferent - touch, pain of posterior tongue and pharynx; Efferent - Voluntary - select mm's of pharynx; Automatic - Parotid gland; Test - gag reflex, ability to swallow
Vagus (X) Afferent - Touch, pain of pharynx, larynx and bronchi, taste of posterior tongue and epiglottis; Efferent - Voluntary - mm;s of palate pharynx and larynx; Auto - thoracic and abdominal viscera; Test - Gag reflex, ability to swallow, say "ahh"
Accessory (XI) Efferent - Voluntary - SCM and trapezius mm's; Test - resisted shoulder shrug
Hypoglossal (XII) Efferent - Voluntary - mm's of tongue; Test - tongue protrusion with deviation toward injured side
Bell's Palsy is the result of damage to which cranial nerve? Facial (VII)
Anosmia Loss of sense of smell; damage to Olfactory nerve (CNI)
Diplopia Double vision; damage to trochlear nerve (CNIV))
Which 2 CN pathways are associated with the corneal reflex? Afferent trigeminal and efferent facial
Which 3 cranial nerves sense taste? Facial (VII), Glossopharengeal (IX) and Vagus (X)
Which 2 cranial nerves require eyes closed during test? Olfactory (I) and Trigeminal (V)
Which 2 nerves originate from mid brain? Oculomotor (III) and trochlear (IV)
How many cranial nerves possess only sensory tracts? 3 - Olfactory (1), Optic (II) and Vestibulocochlear (VIII)
Ptosis When upper eyelid droops over eye; CN damaged is Oculomotor (III)
Homonymus Hemianopsia Visual field loss on left or right side of visual field in 1 or both eyes; CN damaged is - Optic (II)
Rinne Test Hearing Test to evaluate unilateral hearing loss; compares conduction of sounds transmitted by air and then by bone with a tuning fork; normal ratio is 2:1 (air:bone)
Trigeminal Nerve (V) Branches Opthalmic, Maxillary and Mandibular
Snellen Chart Eye chart; tests Optic nerve (II)
Nerve commonly affected when pt has nystagmus Vestibulocochlear (VIII)
Plexus Sequencing from Proximal to Distal Roots, trunks, divisions, cords, nerves
Which artery is used for anatomy of brachial plexus? Axillary; lateral, medial and posterior cords are named according to their position in relation to the axillary artery
Pronator Syndrome The median nerve passes through 2 heads of pronator teres and gets pinched; affects sensory and motor function of medial nerve
Which nerve weakness gives rise to scapular winging? Long thoracic nerve; serratus anterior weakness
Efferent vs Afferent Motor vs Sensory; Ventral vs Dorsal
Motor Control Study of the nature of movement OR the ability to regulate and direct essential movement
Motor Learning The study of the acquisition or modification of movement; learning vs performance; provides guidelines for appropriate use of feedback, prioritizes the use of practice; transfer of learning across tasks and environments
3 Stage Model of Motor Learning Cognitive, Associative and Autonomous
Cognitive Stage of Motor Learning Initial stage of learning; High concentration of conscious processing; begin problem solving; a controlled environment is ideal; Characterized by: lots of errors, inconsistent, high rep, high level of cognition
Associative Phase of Motor Learning Intermediate stage of learning; starting to link info and action; closed environment progress to less structured and open environments; less external feedback and more internal/proprioceptive feedback; Characterized by: refinement and lots of practice
Autonomous Phase of Motor Learning Final Stage of Learning; improves efficiency through cognitive control; success in variable environment; Characterized by: automaticity, mostly error free, automatic, not distracted, little to no extrinsic feedback, internal feedback is dominant
Feedback for Motor Learning Imperative for improvement of motor learning; allows for correction and adaptation; reduction of feedback over progression is best
Intrinsic (Inherent) Feedback All feedback comes form self; mostly sensory
Extrinsic (augmented) feedback Typically verbal or tactile from someone else; during or after performance
Knowledge of Results extrinsic; Terminal; outcome of most current performance vs goal
Knowledge of Performance Extrinsic; refers to expected movement patter and outcome; QUALITY of movement
Practice for Motor Learning Repeated performance of an activity to learn or perfect a skill; physical practice allows for experience and kinesthetic support; mental practice can help
Massed Practice Large amounts of practice with minimal rest
Distributed practice Rest time is equal to or greater than practice time
Constant Practice Practice of a given task under uniform conditions
Variable Practice Practice of a given task under variable conditions
Random Practice Varying practice among different tasks
Blocked Practice Consistent practice of single task
Whole Training Practice of an entire task
Part Training Practice of an individual component or selected components of a task
Closed System Model Nervous system is an active participant, not just a reaction
Habituation Decrease in response that will occur as a result of consistent exposure to non painful stimuli
Non Associative Learning a single repeated stimuli (habituation, sensitization)
Associative Learning gaining understanding of relationship between 2 stimuli; causal relationships (classical or operant conditioning)
Procedural Learning learning tasks that can be done without cognition of it; forming movement habits; developing a habit through repetitive practice
Declarative Learning Requires attention, awareness, and reflection in order to attain knowledge that cna be consciously recalled; mental practice
Open System Model single transfer of info without any feedback loop; nervous system awaiting stimulus
Plasticity Ability to modify or change at the synapse level; temporary or permanent in order to perform a specific function
Concurrent Feedback Providing feedback while task is performed
feedforward control Dependent on experience; signals sent before movement for anticipatory response
Created by: ashleighobrien



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