Neuromuscular PT (IER Chapter 2)
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| Precentral Gyrus | Part of the frontal lobe. Primary MOTOR cortex for voluntary muscle activation.
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| Prefrontal Cortex | Controls emotions and judgment.
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| Broca's Area | Controls motor aspects of speech
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| Postcentral Gyrus | Part of the parietal lobe. Primary SENSORY cortex for the integration of sensations.
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| Primary (and Associative) Auditory Cortex | Part of the temporal lobe. Receives & processes auditory stimuli.
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| Wernicke's Area | For language comprehension.
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| Primary Visual Cortex | Part of occipital lobe. Receives & processes visual stimuli
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| Insula | Within the lateral sulcus, for visceral functions.
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| Limbic System | Consists of limbic lobe, hippocampus, hypothalamus, amygdaloid, and anterior nucleus of thalamus. For feeding, aggression, emotions, endocrine aspects of sexual response.
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| Basal Ganglia | Forms associated motor system. Occulomotor, skeletomotor, and limbic circuits.
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| Occulomotor Circuit (cuadate loop) | Functions with saccadic eye movements.
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| Skeletomotor Circuit (putamen loop) | Controls amplitude & velocity of movement, reinforces a selected pattern while suppressing conflicting patterns; preparation/anticipation for movement.
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| Limbic Circuit | Organizes behaviours, executive functions, problem solving, motivation and procedural learning.
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| 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.
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| Subthalamus | Control of several functional pathways for sensory, motor, and reticular formation.
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| Hypothalamus | Controls functions of ANS & body homeostasis (temp, eating, water balance, pituitary).
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| Dorsal Column/Medial Lemniscal | Afferents for proprioception, vibration, tactile discrimination. Fasciculus cuneatus (UE) & Fasciculus gracilis (LE). Tract crosses in the medulla going to thalamus.
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| Spinothalamic Tracts | Afferents for pain & temp, and gross touch. Tracts ascend 1or2 segments in Lissauer's tract then cross.
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| 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.
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| Spinoreticular Tracts | Convey deep & chronic pain to reticular formation of the brainstem via diffuse polysynaptic pathways.
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| Plexuses | Cervical (C1-C4), Brachial (C5-T1), Lumbar (T12-L4), Sacral (L4-S3)
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| Levels of Consciousness (arousal) | Alertness, Lethargy, Obtundation, Stupor, Coma
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| Glasgow Coma Scale | 3 elements (EMV): eye movement, motor response, verbal response. Mild brain injury (13-15), Moderate (9-12), Severe (3-8).
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| Mini-Mental Status Exam | For cognitive dysfunction. Max score of 30. Mild impairment (21-24), Moderate (16-20), Severe (15 and below).
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| 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).
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| Weber's Test | Strike tuning fork & place handle on middle of forehead. Examine for hearing perceived in middle of head or one ear only.
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| Rinne Test | For air vs. bone conduction. Strike tuning fork & place on mastoid process, then place near external ear canal to check hearing acuity.
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| Cheyne-Stokes Respiration | Period of apnea lasting 10-60 seconds followed by gradually increasing depth & frequency of respiration.
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| Tests for Meningeal Irritation | Neck mobility, Kernig's sign, Brudzinski's sign. Pg. 96
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| Stereognosis | Ability to identify familiar objects by manipulation and touch.
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| Barognosis | Ability to identify different gradations of weight in similar size/shape objects.
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| Graphesthesia | Ability to identify numbers, letters, or symbols traced on the skin.
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| Homonymous Hemianopsia | Loss of half the visual field in each eye contralateral to the side of a cerebral hemisphere lesion.
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| Anosognosia | Severe denial, neglect, or lack of severity of the condition.
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| Apraxia | A "disconnect." A problem in the conceptual system, motor system, or both that hinders a person's ability to perform voluntary, learned movements.
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| Ideomotor Apraxia | Inability to perform the task ON COMMAND, but can do the task instinctively.
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| Ideational Apraxia | Inability to perform the task AT ALL, either on command or on own.
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| 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).
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| 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).
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| Chorea | Relatively quick twitches or dancing movements.
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| Athetosis | Slow, irregular. twisting, sinuous movements occurring especially in the UE's.
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| Tremor | Continuous quivering movements; rhythmic, oscillatory movement observed at rest (resting tremor).
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| Strength Duration Curve | Strength (intensity) on Y axis, duration (time) on X axis.
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| Rheobase | Intensity of current to produce a visible twitch.
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| 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.
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| 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.
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| 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.
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| Posterior Cerebral Artery (PCA) Syndrome | Occlusions may cause contralateral homonymous hemianopsia, contralateral sensory loss, involuntary movements and more.
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| Brunnstrom Stages of Motor Recovery - Stage 1 | Flaccidity, no voluntary movement
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| Brunnstrom Stages of Motor Recovery - Stage 2 | Spasticity, hyperreflexia, movement synergies, minimal voluntary movement
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| Brunnstrom Stages of Motor Recovery - Stage 3 | Strong spasticity, voluntary movement possible within synergy patterns
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| Brunnstrom Stages of Motor Recovery - Stage 4 | Decreased spasticity, voluntary isolated joint movements possible
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| Brunnstrom Stages of Motor Recovery - Stage 5 | Increase in voluntary movement but with coordination deficits
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| Brunnstrom Stages of Motor Recovery - Stage 6 | Voluntary control and coordination near-normal, spasticity is gone
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| 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.
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| Motor Assessment Scale | Measures functional capabilities using eight categories and provides criteria for scoring performance.
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| 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
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| 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
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| 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)
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| 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.
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| 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.
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| 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.
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| ASIA Impairment Scale: A | Complete, no motor or sensory function below the level.
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| ASIA Impairment Scale: B | Incomplete: sensory but not motor function preserved below the level.
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| ASIA Impairment Scale: C | Incomplete: motor function is preserved below the level & most key muscles have muscle grade <3.
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| ASIA Impairment Scale: D | Incomplete: motor function is preserved below the level & most key muscles have muscle grade >3 (or equal to).
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| ASIA Impairment Scale: E | Normal: motor & sensory function is normal
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| 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).
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| 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.
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| Wheelchair prescription for patients WITH cervical lesions, radial wrist extensors (C6) | Independent with manual w/c with friction surface hand rims.
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| Wheelchair prescription for patients WITH cervical lesions, triceps (C7) | Same as C6 but with greater propulsion.
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| Wheelchair prescription for patients WITH hand function (C8-T1 and below) | Manual w/c with standard hand rims.
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| Categories of Multiple Sclerosis | Relapsing-remitting, primary progressive, secondary progressive, progressive-relapsing.
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| Hoehn & Yahr Stages of Parkinson's: Stage I | Minimal or absent disability with unilateral symptoms
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| Hoehn & Yahr Stages of Parkinson's: Stage II | Minimal bilateral or midline involvement, no balance involvement
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| Hoehn & Yahr Stages of Parkinson's: Stage III | Impaired balance, some restrictions in activity
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| Hoehn & Yahr Stages of Parkinson's: Stage IV | All symptoms present and severe; stands and walks only with assistance
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| Hoehn & Yahr Stages of Parkinson's: Stage V | Confinement to bed or wheelchair
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| Wallerian degeneration | Degeneration of the axon and myelin sheath distal to the site of injury
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| 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.
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| 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).
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| 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).
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| 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.
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| Guillain-Barre syndrome | Acute ascending polyneuropathy: polyneuritis with progressive muscular weakness that develops rapidly, but is recoverable in 6-24 months
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| Amyotrophic Lateral Sclerosis (ALS) | Degeneration of anterior horn cells and corticobulbar & corticospinal tracts. Typically death in 2-5 years.
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