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Neuro II lecture exam I
CVA (stages, synergies), ALS, MS, GB, Brunnstrom
158
Medical
Graduate
02/10/2012

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Term
Ischemic stroke
Definition
Lack of blood flow by blockage (most common)
Term
Hemorrhagic stroke. Presentation.
Definition
Rupture that leads to swelling. Presents as worst headache ever.
Term
Why are TIA (transient ischemic attacks)important for PTs?
Definition
Even though symptoms resolve in 24 hours 35% of TIA have CVA within 5 years.
Term
When do you want to see CVA in rehab?
Definition
As soon as they are stable (first 72 hours) and rehab for first 3-6 months (most gains)
Term
Which has greater neuroplasticity and why? CP or CVA
Definition
CP because young children have massive cell division
Term
What is a synergy?
Definition
Muscles that work in conjunction together that produce coordinated movement
Term
UE flexion synergy and the strongest component
Definition
GH ext rot
GH abduction to 90
Forearm supination
wrist and finger flexion

STRONG COMPONENT: ELBOW FLEXION
Term
UE extension synergy and strong components
Definition
Shoulder girdle protraction
Elbow extension
Wrist extension or flexion

STRONG COMPONENTS:
GH internal rotation
GH adduction
Forearm pronation
Term
LE flexion synergy and strong component
Definition
Hip external rotation
Hip abduction
Knee flexion
Ankle DF/inversion

STRONG COMPONENT: Hip flexion
Term
LE extension synergy and strong component
Definition
Hip extension
Hip internal rotation
Hip adduction
Ankle PF/eversion

Strong component: Knee extension
Term
Most common UE and LE synergy patterns
Definition
UE is flexor
LE is extensor
Term
Associated reaction
Definition
Voluntary forceful movements produce involuntary movements in affected extremity
Term
UE associated reaction and stimulus
Definition
Flexion evokes flexion
Extension evokes extension

stimulus: resisted motion (may req reps)
Term
LE associated reaction
Definition
Flexion evokes extension
Extension evokes flexion
Term
Homolateral synkinesis
Definition
Home(same)lateral(limb) synchrony

Hip flexion and shoulder flexion
His favorite: Resist hip flexion to facilitate DF
Term
Raimistes Phenomenon
Definition
Used overflow and helps patient psychologically.

Hip adduction resisted on one side will overflow to other side and cause hip adduction.
Term
Souques phenomenon
Definition
Raise arm over head facilitates hand and finger extension
Term
Stage 1 recovery UE and LE
Definition
Flaccidity, no voluntary movement, no spasticity, limbs feel heavy and may be different.
Term
Stage 2 recovery UE and LE
Definition
Weak associated reactions
Voluntary attempts to move
Spasticity developing (UE flex, LE ext)
Term
Stage 3 recovery UE
Definition
Spasticity at max (pt may not progress)
Term
Stage 4 recovery UE
Definition
1. Place hand behind body
2. elevation of arm to forward horizontal
3. Pronation/supination elbow at 90
Term
Stage 5 recovery UE
Definition
Spasticity is waning
1. Arm raising to side horizontal
2. Arm raising forward and overhead
3. Pron/Sup arm at side or in front elbow straight
Term
Stage 6 recovery UE
Definition
Movements well isolated and appear normal to near normal
Some awkwardness
Spasticity not demonstrated w passive movement
Active movements may show spasticity
Interference may or may not be spasticity
Term
Stage 7 recovery UE and LE
Definition
Normal
Term
Stage 3 recovery LE
Definition
Hip, knee, ankle flexion
Term
Stage 4 recovery LE
Definition
Sitting with knee flexed BEYOND 90
Foot sliding backward on floor
Voluntary DF w/o lifting foot off floor
Term
Stage 5 recovery LE
Definition
Standing: isolated non weight bearing knee flexion, hip extended
Standing in half step position with knee extended
Perform isolated DF (toe tapping)
Term
Stage 6 recovery LE
Definition
Standing: Hip abduction (ROM beyond pelvis elevation)
sitting: reciprocal isolation of inner and outer hamstring mm's (rolling knee in and out)
Inversion and eversion
Term
If you saw a patient in stage 1 recovery what would you do?
Definition
ANYTHING AND EVERYTHING to get patient to move without causing harm.

Associated reactions (raimestes) and attidunial reflexes (putting finger in hand to facilitate flexion)
Term
What would you do with patient in stage 2 recovery?
Definition
anything and everything.Try to create movement and observe synergies that develop.
Term
What do you do with patient in Stage 3 recovery?
Definition
Start working out of synergy
Term
What do you do with patient in stage 4?
Definition
Keep working out of synergy and the next stage's actions
Term
Main goal?
Definition
GET PATIENT TO SITTING AS SOON AS POSSIBLE
Term
Bernsteins 3 stages of recovery?
Definition
Facilitate
Inhibit
Re-educate
Term
Cognitive features R vs L hemisphere
Definition
Right: Holistic
Left: Process linear/sequence
Term
Perception feature of R vs L hemisphere
Definition
Right: Visual spatial perception
Left: Produce language
Term
Academic features of R vs L hemisphere
Definition
Right: synthesizing inferences
Left: mathematical calculations
Term
Motor features of R vs L hemispheres
Definition
Right: Posture
Left: Perform movement
Term
Emotion features of R vs L hemisphere
Definition
Right: Negative emotion
Left: Positive emotion
Term
Left hemisphere injury features
Definition
R weakness/sensory loss
Speech and language loss
Apraxia
Slow cautious behavior
Difficult to express positive emotion
Term
R hemisphere injury features
Definition
L weakness/sensory loss
Visual perception unilateral neglect agnosis
Impulsive behaviors
Poor judgement
Safety risk
Difficulty sustaining movements
Difficulty expressing negative emotion
Term
Lacunar type strokes (1/4 all ischemic strokes)
Definition
small infarcts (2-20mm diameter) in the deep cerebral white matter, basal ganglia, or pons presumed to result from the occlusion of a single small perforating artery supplying the subcortical areas of the brain
Term
Pure motor hemiperesis
Definition
MOST COMMMON STROKE LOCATION: in posterior limb of INTERNAL CAPSULE, which carries descending corticospinal and corticobulbar fibers
Term
What is pure sensory syndrome and what part of the brain does it affect?
Definition
Hemibody sensory systems that involve the face, arm, leg and trunk. THALAMUS infarct (aall sensory info except smell goes through)
Term
Ataxic Hemiparesis syndrome
Definition
Combo of cerebellar and motor symptoms on the SAME SIDE of the body.

Cerebellar ataxia always on SAME SIDE.
Term
Ipsilateral pushing or Pushers syndrome
Definition
Lean to affected side
Thalamus R hemisphere
18 degrees of vertical misperception
Vestibular inputs intact
Term
[image]
Definition
A - Premotor area
B - Primary motor cortex
C - Prefrontal area
D - Broca's area (motor speech area)
E - Auditory association area
F - Primary auditory cortex
G - Central sulcus
H - Primary somatic sensory cortex
I - Somatic sensory association area
J - Visual association area
K - Wernicke's area (sensory speech area)
L - Visual cortex
M - Taste area
Term
When do stroke survivors show the most functional improvement? Further improvement? (time span) - outcomes
Definition
First 3 months
Further improvement during next 3 months
Term
Loss of leg movement in the 1st week and no arm movement after 4 weeks has poor or good outcomes? (stage 1)
Definition
POOR
Term
What are the statistics of stroke survivors?
What % are hemiparetic after 6 mos?
What % can't walk?
What % partially dependent in ADLs?
What is rate of recurrent strokes per year?
Definition
48% are hemiparetic
22% can't walk
50% are dependent
3-7% have recurrent strokes
Term
When should t-PA (IV tissue plasminogen activator) be given to someone with symptoms of stroke?
Definition
Within 3 hours of symptom onset
Term
What % of patients were more likely to experience an excellent recovery at 3 mo when given t-PA?
Definition
30%
Term
What is the associated risk with t-PA?
Definition
6.4% incidence of intracranial hemorrhage (10-fold increase in risk)
Term
Is t-PA used for hemorrhagic or ischemic stroke?
Definition
Ischemic
Term
What serious complications should you watch for when you begin PT on post-stroke pt? (5)
Definition
Cardiac arrhythmias
Dysphagia (avoid aspiration)
DVT (most common cause of death)
Uncontrolled BP
Additional strokes
Term
What is the most common cause of death among stroke patients and when do they happen?
Definition
DVT pulmonary embolism in the 2-4 weeks post stroke
Term
What are some drugs used for spasticity? (6)
Definition
Diazepam
Procaine
Phenol
Botox
Dantolene
Baclofen
Term
How does the drug Diazepam work?
Definition
decreases spasticity but also depresses entire CNS system (drowsy)
Term
How does the drug Procaine work?
Definition
inhibits intrafusal muscle fibers the effect is transient
Term
How does the drug phenol work? ** not a good answer sorry
Definition
intramuscular. It is effective 2-12mo post stroke, but can damage tissue
Term
How does the drug Botox work?
Definition
Temporarilty interferes with acetylcholine at motor plate
COMMON
Term
How does the drug dantolene work and some side effects?
Definition
Sodium decreases excitation of skeletal muscles
Side effects: drowsiness and weakness
Term
How does the drug Baclofen work and what forms can be used?
Definition
Skeletal muscle relaxer
Pill form and IV
Term
What are the treatment strategy categories? (4)
Definition
Compensation training
Substitution training
Habituation training
Neural adaptation
Term
How would you use compensation training?
Definition
Giving pt walker or cane
Term
How would you use substitution training?
Definition
Use a good working muscle as a substitute for a very weak or paralyzed muscle.
Ex) Use anterior deltoid for elbow extension
Term
How would you use habituation training?
Definition
Getting used to weird sensations
Term
How would you use the neural adaptation treatment strategy?
Definition
create motor programs (nueroplasticity) with consistent practice
Term
What is the functional retraining strategy of treatment?
Definition
Practicing functional activities (walking, transfers, etc)
Term
What is impairment training strategy?
Definition
Identify the impairment and work on it
Ex) identify weak quads and strengthen to perform sit to stand.
Term
What is the somatosensory reintegration interventions strategy?
Definition
treating impaired sensory function
Ex) lean on intact side and feel the table (temp and pressure) then lean on affected side and try to imitate the feeling. Look at it for visual. Bend and straighten while looking at it.
Term
What is the first symptom of Parkinson?
Definition
Sensory symptoms first
Loss of smell
Term
What tone would you find in a Parkinson's patient?
Definition
Lead pipe and cogwheel rigidity WITHOUT spasticity (velocity dependant)
Term
What is "phantom pillow" in Parkinson's disease?
Definition
When pt is supine they are kyphotic as if they have a pillow underneath them
Term
What is wrong with the motor unit in Parkinsons? (3)
Definition
Delay in recruitment. (They cant recruit when they want/need to)
Pauses once unit fires (inability to increase firing and inability to sustain contraction)
They need to complete a movement before starting another
Term
What are the statistics of Parkinsons falls?
Definition
Common - 1/3 fall
10% more than once a week
Term
Why do Parkinson's pt fall? (gait pattern)
Definition
Flat foot or toe heel sequence that cause them to trip on carpet
Term
What are some strategies to use to improve gait function in Parkinson's? (9)
Definition
Integrate the 5 senses!
Random practice
Mental practice
Speed variation
Large steps and arm swings (BIG)
Start/stop activities
Chant L/R progress to singing
Scoot on mat
Evaluate devices
Term
What are the 15 "Bernstein tips" to use for Parkinson's pt?
Definition
tapping of leg for freezing
Rocking on heels (trunk forward)
Visualize chair further
Distract mind
Rolled magazine in hand or canes (increase arm swing)
Wide turns
Ladder steps
Beach ball, balloons
Reach in pocket to decrease tremor
Facial expressions
Clapping to music
Metronome
Marching
Sit and stand
Dance waltz
Term
How long will Parkinson's treatment carryover?
Definition
<6 mo they need to continue at home!
Medication: 5 years
Term
What is Guillain-Barre syndrome?
Definition
Disorder in which the bodies immune system attacks part of the peripheral nervous system with axon degeneration and demyelination.
Term
What usually causes Guillian barre syndrome?
Definition
they don't really know but usually occcurs within days or weeks after a repiratory or GI infection
Term
How does Guillian barre syndrome usually progress?
Definition
Gets progressively worse for 2-3 weeks with complete recovery in 75% of cases. Only 3% mortality (when it hits repiratory function)

May start in arms and move down\
or MORE COMMONLY
may start in feet and move up
Term
How do you diagnose Guillian barre syndrome? (4)
Definition
Loss of reflexes (knee and ankle) Nerve conduction velocity slows Spinal tap (CSF show elevated protein) Blood and urine sample may show excess proten
Term
What is plasma exhange (PE)? Plasmapheresis
Definition
Involves taking blood out then removing antibodies from it and replacing blood
Term
How long is PE (plasma exchange) suggested for ambulatory and non ambulatory patients?
Definition
4 weeks for nonambulatory 2 weeks for ambulatory
Term
What is Immunoglobin therapy? (IVIg)
Definition
Immunoglobins are added to blood which blocks the antibodies
Term
How long do you use IVIg for ambulatory patients? and when do you not use them?
Definition
2-4 weeks for ambulatory patients
Dont administer after PE (plasma exchange)
Term
what is multiple sclerosis (MS)?
Definition
Disease of myelin in the CNS. Ages 16-60, but between 20-40 most common. More in women 2-3:1.
Term
What are the 4 conditions in the MS disease course?
Definition
Progressive
Relapsing/Remitting
Secondary progressive
Progressive relapsing
Term
What are symptoms of MS? (9)
Definition
Fatigue (most common)
weakness
Paresthesias
Spasticity
Unsteady gait
Double vision
Tremor
Neurogenic bladder/spastic bladder
Absence of bowel constipation
Term
What is ALS (amyotrophic lateral sclerosis)?
Definition
Loss of motor nerve cells in the anterior horns of the spinal cord and in the other motor nuclei of the brain stem
Term
What does lateral sclerosis refer to?
Definition
corticospinal tract degeneration
Term
Does ALS affect sensation?
Definition
No which makes it a characteristic important to making diagnosis
Term
Does ALS affect sensation?
Definition
No which makes it a characteristic important to making diagnosis
Term
What are the phases and stages of ALS?
Definition
Phase 1 (stage I-III) Independant
Phase 2 (stage IV, V) Partially independant
Phase 3 (stage VI) Dependant
Term
Rehab for Phase I ALS? (5)
Definition
Strengthen but dont overexert
Breathing exercises
ADs
Measure for motor chair
Energy conservation
Term
What do you in Phase II ALS rehab?
Definition
Isometric exercises of all major muscles
Control edema in hand
Teach transfers
Term
What do you do in rehab of Phase 3 of ALS?
Definition
Positioning, draw sheets
Term
What are some pt characteristics in Phase I ALS? (2)
Definition
Weakness but ambulatory except for long distances
Slight increase in respiratory effect
Term
What are some pt characteristics in Phase 2 ALS? (2)
Definition
Wheelchair dependent
Hanging arm syndrome - pain, edema, atrophy
Term
What are some characteristics of Phase 3 ALS pt? (5)
Definition
Bedridden
Completely dependent in ADL
Need soft foods
Suction
Speech amplification
Term
How do you position patients with abnormal synergies?
Definition
Position out of synergy.
Most common UE - flexion so position in extension
LE extension most common so position in abduction and hip flexion and knee flexion
Term
Does ALS affect sensory and motor?
Definition
NO it ONLY attacks motor neurons
Term
What is the hallmark initial sign of ALS?
Definition
Weakness (occurs in 60%)
Term
How does ALS progress (body)?
Definition
Starts in hands and feet
Progresses to trunk muscles
Eventually affects speech, swallowing, chewing and breathing.
Ultimately a ventilator is needed
Term
How long does a person live after being diagnosed with ALS?
Definition
3-5 years (few live 15-20 years)
Term
When does ALS usually appear? (age, gender)
Definition
50-70 yo
1.5-2x more men
Term
What are some symptoms of heat illness? (7)
Definition
dizziness or fainting heavy sweating muscle cramps cold or clammy skin headaches rapid HR nausea
Term
When do you call 911 with heat illness? symptoms? (8)
Definition
Rapid HR
Confusion or delirium
Warm dry skin
Fever >104
Severe headaches
Seizure or muscle twitching
Unconsciousness
Death
Term
What is PNF?
Definition
Combination of functionally based diagonal patterns of movement with techniques of facilitation to evoke motor responses,
Term
What is the goal of PNF?
Definition
Improve neuromuscular control and function
Term
What can PNF techniques be used for?
Definition
Develop muscular strength and enduracne, facilitate stability, mobility, coordinated movements, and lay a foundation for functional restoration
Term
What is NDT?
Definition
Guiding (pt won't do anything they can't)
Term
What are the components of NDT?
Definition
Postural stability (trunk - pelvis and scapula)
Key points of control are the point of the body we cue
Proximal key points (hip)
Distal key points (knee, hand)
Term
What are the stages of motor control? (7)
Definition
Rolling side to side
Moving from supine to sit and sit to supine
Maintain sitting posture
Transfers
Moving from sitting to standing and standing to sitting
Maintaining standing posture
Walking
Term
The 4 basic task requirements?
Definition
Mobility
Stability
Controlled mobility
Skill
Term
Heavy Joint Compression: Facilitation or Inhibition?
Definition
Facilitation
Term
Resistance: Facilitation or Inhibition?
Definition
Facilitation
Term
Quick stretch: Facilitation or Inhibition?
Definition
Facilitation
Term
Fast vestibular stimulation (fast spinning): Facilitation or Inhibition?
Definition
Facilitation
Term
Slow vestibular stimulation: Facilitation or Inhibition?
Definition
Inhibition
Term
Tapping: Facilitation or Inhibition?
Definition
Facilitation. Quick stretch of muscle spindle.
Term
Therapeutic fast vibration: Facilitation or Inhibition?
Definition
Facilitation. On muscle belly (IA fibers sensitive to stretch and vibration - like tapping DTR)
Term
Traction: Facilitation or Inhibition?
Definition
Facilitation. Facilitates agonists to enhance contraction.
Term
Light moving touch: Facilitation or Inhibition?
Definition
Facilitation
Term
Quick Icing: Facilitation or Inhibition?
Definition
Facilitation
Term
Prolonged icing: Facilitation or Inhibition?
Definition
Inhibitory
Term
Neutral warmth: Facilitation or Inhibition?
Definition
Inhibitory
Term
Slow stroke:Facilitation or Inhibition?
Definition
Inhibition
Term
Rocking:Facilitation or Inhibition?
Definition
Inhibition
Term
Tendinous pressure: Facilitation or Inhibition?
Definition
Inhibitory
Term
Which side is lengthened when shifted and slouched?
Definition
The side you are shifted to
Term
Which side is shortened when you lift leg up?
Definition
the side the leg is lifting on
Term
What does the quick stretch do?
Definition
lengthen muscles that are to contract during diagonal movement pattern
Term
What does rhythmic initiation do?
Definition
initiate a movement pattern
Term
contract-relax/hold-relax/autogenic inhibition
Definition
contract biceps then elongate into elbow extension
Term
Reciprocal inhibition/agonist contraction
Definition
contract triceps to make biceps relax. Fire triceps to increase extension.
Term
hold relax with agonist contraction
Definition
combination of contract relax and agonist contraction. both ways. contract biceps then triceps then elongate.
Term
What are repeated contractions?
Definition
repeated dynamic contraction initiated with repeated quick stretches followed by resistance are applied at any point in ROM to strengthen a weak agonist component of a diagonal pattern
Term
What is a slow reversal?
Definition
dynamic contraction of strong agonist pattern immediately followed by dynamic concentric contraction of weaker antagonist pattern
Term
what is slow reversal hold?
Definition
isometric contraction at end of range of a pattern to enhance end-range holding of weakened muscle
Term
what are alternating isometrics?
Definition
manual resistance applied in a single plane on one side of the body segment then on the other
Term
What is rhythmic stabilization?
Definition
multi-directional resistance by placing manual contacts on opposite sides of the body (rotators)
Term
What are the progression concepts? (4)
Definition
1. Mobility
2. Stability
3. Controlled-mobility
4. Skill
Term
Define mobility in terms of motor control
Definition
Initial movement in a functional pattern (adequate ROM and muscle activity for movement to occur?)
Term
Define stability in terms of motor control
Definition
The ability to maintain a steady position in weight bearing, anti-gravity posture. (can pt maintain posture w/ min sway or instability?)
Term
Define controlled mobility in terms of motor control
Definition
The ability to alter a position or move into a new position while maintaining stability. (independent assumption of posture and weight shifting)
Term
Define skill in terms of motor control
Definition
Highly coordinated movement that allows for investigation and interaction with the physical and social environment.
Term
Define static-dynamic control in terms of motor control (part of controlled mobility)
Definition
ability to shift weight onto one side and free up a limb for non-weight bearing, dynamic activities.
Term
D1 UE flexion components
Definition
palm to face
Shoulder: flex, add, ext rot
Scapula: anterior elevation
Elbow: flex or ext
Forearm: supination
Wrist: flex, radial deviation
Term
D1 LE flexion components
Definition
knee up and in
Hip: flex, add, ext rot
Ankle: DF and inversion
Knee: flex or ext
Term
D1 UE extension components
Definition
face to ext
Shoulder: ext, abd, int rot
Scapula: posterior depression
Elbow: flex or ext
Forearm: Pronation
Wrist: ext, ulnar deviation
Term
D1 LE extension components
Definition
Hip: Ext, abd, int rot
Ankle: PF, eversion
Knee: flex or ext
Term
D2 UE flexion components
Definition
Sword out
Shoulder: fl, abd, ext rot (thumb back)
Scapula: posterior elevation
Elbow: fl or ext
Forearm: supination
Wrist: ext, radial deviation
Term
D2 LE flexion components
Definition
Fire hydrant
Hip: Flex, abd, int rot
Ankle: DF, eversion
Knee: fl or ext
Term
D2 UE extension components
Definition
Sword in
Shoulder: Ext, add, int rot
Scapula: anterior depression
Elbow: flex or ext
Forearm: pronation
Wrist: flex, ulnar deviation
Term
D2 LE extension components
Definition
Cross legs
Hip: Ext, add, ext rot
Ankle: PF, inversion
Knee: flex or ext
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