NPTE
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3 elements of Glasgow Coma Scale | eye opening, motor response, verbal response
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Scoring of GCS | 3-8 severe, 9-12 moderate, 13-15 minor
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State defined by no eye opening even to pain, failure to obey commands, inability to speak | Coma
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Return of sleep/wake cycles, normalization of basic functions, lack of cognitive responsiveness | Vegetative state
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Central language DO with speech is awkward, restricted, interrupted, produced with effort | Expressive aphasia (Broca’s, nonfluent, motor)
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Expressive aphasia result of | L hemisphere – Broca’s area
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Impairment of speech production | Dysarthria
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Central language DO where spontaneous speech preserved/smooth while auditory comprehension impaired | Receptive or Wernicke’s aphasa
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Receptive aphasia is result of damage to | Posterior frist temporal gyrus of L hemisphere (Wernicke’s area)
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Severe aphasia with impairments in comprehension & production of language | Global aphasia
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Periods of apnea followed by gradually increasing depth/frequency of respirations | Cheyne Stokes respiration
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Cheyne Stokes caused by | depression of frontal lobe and diencephalic dysfunction
increased ICP
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Increased rate and depth of respirations | Hyperventilation
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Abnormal respiration with prolonged inspiration | Apneustic breathing
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Signs of meningeal irritation | Kernig’s sign, Brudinski’s sign, guarding in neck flexion, photophobia, disorientation, restlessness, persistent HA that increases with head down, altered vitals, weakness
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Kernig’s sign | meningeal irritation. Supine with flexed hip/knee to chest then extend knee.
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Brudzinski’s sign | meningeal irritation. Supine, flex neck. Causes flexion of hips/knees
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Increased ICP leads to | restless, confused, decr LOC, incr BP, widening pulse P & slowed pulse, Cheyne-Stokes, elevated temp, HA, vomiting, unequal pupils, slowed PLRs, dilated pupils*, papilledema, weakness, hemiplegia, Babinski, decorticate or decerebrate rigidity, seizures
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Kinesthesia | movement sense
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Pallesthesia | vibration sense with tuning fork
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Combined cortical sensation testing | Discriminative sensory tests including Sterognosis, Tactile Localization, Two Point Discrimination, Bilateral Simultaneous Discrimination, Barognosis, Graphesthesia
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Stereognosis | ID familiar objects by touch
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Two point discrimination | ability to recognize one or two blunt points applied to skin simultaneously
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Barognosis | ability to differentiate weights
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Graphesthesia | ability to ID numbers, letters or symbols traced on skin
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Homonymous hemianopsia | loss of half of visual field in each eye contralateral to side of cerebral hemisphere lesion
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Somatognosia | body scheme disorder – unable to ID body parts or relations to each other
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Unilateral neglect | patient ignores one side of body and stimuli from that side
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Anosognosia | severe neglect or denial of severity of condition
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Form constancy | pick out object from array of similar shapes but different sizes
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Spatial relations | pt duplicates a pattern of 2-3 blocks
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Topographical disorientation | navigation of a familiar route
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Vertical disorientation | inability to accurately determine what is upright
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Agnosia | inability to recognize familiar objects with one sensory modality
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Apraxia | inability to perform voluntary learned movements in the absence of loss of sensation , strength, coordination, attention, or comprehension. Breakdown in conceptual or motor production system or both
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Ideomotor apraxia | cannot perform task on command, but can do independently
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Ideational apraxia | cannot perform the task at all, either on command or independently
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Clasp-knife response | marked resistance to PROM suddenly gives way
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Clonus | maintained stretch stimulus produces cyclical spasmodic contraction, usu plantar flexors or wrist flexors
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Babinski | DF of great toe with fanning of other toes with stroke to lateral bottom of foot
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Babinski indicates | corticospinal (pyramidal) tract disruption
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Hyperreflexia | increased DTRs
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Lead pipe Rigidity | uniform throughout range
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Cogwheel rigidity | interrupted by series of jerks
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Decerebrate posturing | increased tone in extension, seen in brainstem lesions between superior colliculus and vestibular nucleus
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Decorticate posturing | UEs in flexion, LEs in extension, seen in brainstem lesions above superior colliculus
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Opisthotonos | arching back of head back and heels with UEs rigidly flexed. Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning
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Plantar reflex | Normal is PF of toes in response to stroking lateral sole of foot from calcaneus to 5th met, S1-2, tibial nerve
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Abdominal reflex | T6-L1, lateral to medial scratching of skin to umbilicus in each of 4 quadrants should cause deviation of umbilicus to stimulus
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Cremasteric reflex | L1-L2, stroking of skin on inner thigh elevates testicle, lost in SCI and Corticospinal lesions
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Extrapyramidal disorders (basal ganglia dysfunction) | Tics, Chorea, athetosis, tremors, myoclonus
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Tics | spasmodic contractions of specific muscles
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Chorea | relatively quick twitches or dancing movments
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Athetosis | slow, irregular, twisting movements, esp in UEs
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Tremor | continuous quivering mvmt, rhythmic, oscillatory observed at rest
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Myoclonus | single, quick jerk
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Cerebellar disorders cause | intention tremors
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Cortical disorders cause | seizures, tonic/clonic convulsive mvmts
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Dyssynergia | impaired ability to associate muscles together for complex mvmt
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Dysmetria | impaired ability to judge distance or range of movement
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Dysdiadochokinesia | impaired ability to perform rapid alternating movements
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Where is Broca's area located? | inferior portion of frontal lobe
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Where is Wernicke's area located? | posterior superior temporal gyrus
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What impairments are seen with frontal lobe lesions? | CL weakness (primary motor cortex), preservation, inattention, personality changes and emotional liability
Brocas Area - expressive aphasia
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What impairments are seen with parietal lobe lesions? | CL sensory loss, decreased touch, vibration, temperature (primary sensory cortex)
agraphia, alexia, apraxia and agnosias
impaired taste
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What impairments are seen with temporal lobe lesions? | Wernicke's aphasia, aggression, decreased memory, learning and facial recognition
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What impairments are seen with occipital lobe lesions? | homongmous homonopsia, visual deficits, cortical blindness if both lobes
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What is the function of the frontal lobe | primary motor cortex, Brocas, orientation, personality and self-awareness
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what is the function of the parietal lobe | Primary sensory cortex, meaning of objects, touch, vibration, kinesthesia, temp. Spatial and visual perseption
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Spatial and visual perseption function is located in what lobe | parietal
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Which part of the brain is responsible for determining the meaning of objects | parietal
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what is the function of the temporal lobe | primary auditory cortex, wernickes area - receptive language.
Memory and learning
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What are neoglisms? | word substitutions that are unrecognizable.
ex: with Wernicke's
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Asterognosis | cannot recognize an object by touch
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constructional apraxia | cannot visualize how to perform a task
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2 examples of Anterior horn cell pathologies | ALS and polio
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Myasthenia gravis is what type of degeneration | degeneration of the neuromuscular junction
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anterior cord syndrome | hyper V, loss of motor (corticospinal) and pain & temp (spinothalamic)
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posterior cord syndrome | hyper /
motor preserved, loss of pain, proprio, 2point discrimination and steroginosis
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central cord sndrome | hyper /
Motor worse than sensory, UE worse than LE
DCML, spinothalamic and corticospinal
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