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IER Chapter 2
Neuromuscular PT (IER Chapter 2)
| Question | Answer |
|---|---|
| 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
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