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2nd Semester Neuro 2nd Exam
STUFF
306
Science
Not Applicable
03/04/2013

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Cards

Term
When doing a PT Assessment in the Acute rehab setting, what percentage of patients come to you with skin integument problems? Thus you should or should not check skin?
Definition
50% of her patient come to Madonna already with a skin related issue. Yes almost the number one thing to think about.
Term
what are the two main focuses for the ASIA standard neurological classification of SCI?
Definition
Strength and Sensation
Term
what are the primary tone and deep tendon reflex levels to assess in the acute seeing?
Definition
C6- Biceps
C7- triceps
L3/4- Quad
S1- Achilles tendon
Term
What is another huge assessment in the acute setting that sometimes has to pushed to the sub-acute phase due to activity precautions?
Definition
FIM- Functional Independence Measure
Term
Motor/ Strength assessment of key muscles with the ASIA. what are the individual classifications for grades 0-5?
Definition
0= total paralysis
1= palpable or visible contraction
2= active movement in gravity eliminated position
3= active movement against gravity
4= active against some resistance
5= active against full resistance
Term
what do the Sensory readings for light touch and pinprick mean for (0-2, NT)?
Definition
0= absent
1= impaired
2= normal
NT= not testable (TLSO, Cast blocking)
Term
How is the motor level classified for the ASIA?
Definition
the motor level is defined by the lowest key muscle that has a grade of at least a 3 bilaterally with all superior levels testing normal with a 5.
Term
Describe the different ASIA classifications (A-E)?
Definition
A= complete SCI, with with no motor or sensory function preserved in the sacral S4/5 region (sphincter region).

B= incomplete, Sensory but no motor function is preserved below the neurological level.

C= incomplete, motor function is preserved below the neuolocial level, and more than half of the key muscles below the neurological level have a muscle grade less than 3.

D= incomplete, with at least half of the key muscles below the neuro level have a muscle grade greater than or equal to 3.

E= normal... motor and Sensory function is normal...
Term
what major muscle groups are innervated with a C6 complete (ASIA-A) SCI?
Definition
biceps, deltoids, wrist extensors, upper traps
Term
prone positioning in the acute rehab setting is?
Definition
as tolerated by the patient
Term
Contraindication for paraplegia patients with ROM and Positioning?
Definition
Trunk movements- upright position, use bracing

Hips - SLR >60 degrees; Flexion (knee/hip) >90 degrees
Term
Contraindications for tetraplegia/ Quadriplegia patients and ROM/ Positioning? in the acute setting?
Definition
Head and neck movements without bracing

shoulder stretching- dislocation risk, fracture location
Term
Selective Stretching: functional tightness

why use tenodesis grasp? what levels does this affect?
Definition
if you do not have wrist flexors or finger intrinsic, must not stretch the flexor side. this affects C6 SCI or higher

Also do not want to stretch the trunk stabolizer/ lower MM (hamstrings)
Term
Selective Stretching: full stretching of hamstrings in an acute setting, and after acute phase
Definition
hamstrings SLR to 90 degrees in acute phase, to 100 degrees after the acute phase.
Term
Selective Stretching: functional tightness

Do not allow Long sitting in the acute rehab phase until the hamstrings can get to what position? for fear or doing what?
Definition
do not long sit until hamstrings are at 90 degrees, to avoid over stretching lower trunk muscles used for postural support.

use the ring sitting position
Term
do not stretch over _______ sites, to avoid placing ______ over them?
Definition
over fracture sites, to avoid placing stress over them
Term
Resistive exercises are CONTRAINDICATED in what area for Tetraplegia and Praplegia patients.
Definition
Tetraplegia- Scapular and shoulder muscles

Paraplegia- hip and trunk muscles
Term
what muscles do you strengthen in a SCI patient? but you must always thing about having ________?
Definition
strenghten all muscles that are available to the patient, but you want to have balance of anterior and posterior muscles.
Term
what UE muscles do you focus on for a paraplegia patient?
Definition
All UE muscles, with a FOCUS ON shoulder depressors, triceps, and latissimus dorsi
Term
what muscles do you focus on for a Tetraplegia pt?
Definition
Lower traps, pectorals, Anterior deltoid, shoulder extensors, biceps, triceps, radial wrist extensors
Term
Gradual orientation to vertical position can be done after _____ is stabilized?

what are some tools used to help with this issue?
Definition
only after fractures are stabilized prior to movement!!!

abdominal binders and TED hoes can be used to keep BP higher.

Elevation of the HOB slowly and in increments over time

the use of a cardiac chair or high back recline wheel chair
Term
what is the most IMPORTANT thing to teach the family in the Acute care?
Definition
pressure relief, the patient and the family... emphasize turning in bed every 2 hours.
Term
Mat activities/ progression with sitting and dynamic sitting balance?
Definition
First it depends on the level of the SCI...

fist in short or long sitting, depending on hamstrings

bilateral and unilateral UE support

work on unlocking and locking out elbows (tetraplegia)

Transition from anterior/ posterior (tetraplegia)

work from supported to unsupported

reaching within/ to outside the BOS

lateral leans on elevated, then non elevated surface and back up. (bed mobility skills)
Term
Some activities for transfer training and Mat mobility (its allot)
Definition
TRUNK and LE management stuff

rolling with bed ladder/ rails and leg loops as needed

sit to supine and vise versa using adaptive equipment as needed

supine to long sit and vise versa with/ without adaptive equipment (leg loops, bed ladder) (also work on dressing and self catherterization

wheel chair to bed/mat and back... using slideboard to start and progressing to without as able.... takes alot of strength so think about clearance first.
Term
power wheel chair skills
Definition
obstacle negotiation, its for increased distances, turning it on and off, increasing and decreasing speed, accessing tilt, performing pressure reliefs, door button and elevator access, door access, home and community access
Term
Manual wheel chair skills
Definition
level, uneven surfaces, obstable negotiation, pressure relieft techniques, home and community access, door access, elevator access, curbs, break down and assembly of w/C for loading into and from a car.
Term
teaching floor transfer techniques. what are 2 techniques?
Definition
a 2 person assist and the beach transfer
Term
Things associated with a wheelchair evaluation?
Definition
pt chooses a vendor and apointment is made.

perform a pressure mapping and trial different W/C options prior to eval.

provide pt education on options needed.

Meet with vendor to spec out W/C and write letter of medical necessity to be submitted to insurance.
Term
what is a good time frame for a person to have one wheel chair?
Definition
about 5 years, depending on the type and change in status
Term
what are the purposes of a standing frame in rehab?
Definition
prevention of contractures, improve ROM

improve renal function, drain urinary tract

prevent pressure ulcers

improve circulation (orthstatic hypotension)

improve bowel function
Term
what are the purposes of electrical stimulation in rehab?
Definition
decrease spasticity, maintain muscle tone, circulation
Term
what are some standing activities for pts with LE movement?
Definition
sit to stand, stand to sit: controlled to improve muscle activation and for strengthening. mini squats in standing

static standing with muscle facilitation at quads, abdominals, gluts as needed. facilitate equal BLE WB and upright position

dynamic standing: A/P and Lateral stepping with muscle facilitation as needed, reaching outside BOS, throwing/ catching ball, standing on uneven surfaces, step-ups or toe taps on 2-6 inch steps
Term
Gait training in rehab phase... use _____ as needed. which type is the most common?
Definition
orthotics, AFO
Term
gait training in the rehab phase... bioness L300????
Definition
E-stem on DF instead of an AFO...

stimulates the nerve and has wireless communication for easier use

has switch on the bottom of the shoe to sense when the foot is off the ground and stimulates the DF
Term
Use of Body weight Supported treadmill training and lokomat in gait training acute setting?
Definition
requires 3 skilled therapists- 2 on legs, one on hip

promotes a more symmetrical gait pattern at faster speed to activate central pattern generators and improve gait patter off of the treadmill.
Term
if land therapy is to hard for gait training? this type of therapy is used? and how often per week?
Definition
Aquatic therapy 2-3x per week
Term
outpatient: Wheel chair transfers

ways to make a Floor to W/C transfer easier...

what if only one individual to help one pt back into the W/C
Definition
work on transfers. floor to W/C with a step. or floor to mat to W/C....

also teach the beach transfer...

difficulty of transfer increases if TSLO is on
Term
outpatient: wheel chair FALLS
Definition
in the occurrence of a fall (cross arms over legs on W/C to keep from hitting in face and flex head to avoid hitting the floor)
Term
outpatient: functional mobility skills
Definition
slide board transfers, bed mobility to increase independence and decrease use of adaptive equipment as able.
Term
standing frame use in the OUTPATIENT SETTING???
Definition
30-60 min 5-7x per week

a letter of justification for fram for home use if appropriate...

need to show consistent use and good trial of equipment.
Term
OUTPATIENT: Gait Progression

less ore more AD?
increased or decreased speed?
Definition
work toward the lease restrictive assistive device that is possible

increase speed and demonstrate more symmetrical gait pattern
Term
OUTPATIENT SETTING: continue/ initiate these 2 therapies as appropriate
Definition
aquatic therapy and BW support treadmill training/ LOKOMAT
Term
Myelodysplasia
Definition
a group of congenital defects of the vertebrae and spinal cord (also skull and brain), that vary widely in functional outcomes

Neural tube defects

"myelomengiocele Syndrome"
Term
the lower the lesion in the lumbar spine for a myelodysplaia lesion, does what to the likely hood of walking?
Definition
it increases the likely hood the child will walk...
Term
at what day in gestation does the neural tube close completely? and what problem is associated with it and diet?
Definition
the neural tube closes around the 28th day of gestation..

folic acid is needed to healthy neural tube development, but at 28 days alot of mother do not even know they are pregnant yet.
Term
anencephaly
Definition
a neural tube defect that affects the brain more than the spinal cord.

the child tends to have a brainstem, but not a cortex

these children typically don't life past a month, if that.
Term
what is the order of neural tube closure...

superior (brain)
anterior (face)
posterior (brain stem)
thoracic spine
sacrolumbar spine
Definition
fist= thoracic spine
second= superior brain
third= anterior face
fourth= posterior brain stem
fifth= sacro-lumbar spine
Term
the prefix "myelo" means?
Definition
spinal cord involvement
Term
meningocele
Definition
a sac with the neural tissues still intact and not involved
Term
myelomengocele
Definition
a sac that contains neural tissues, the worse kind and normally associated with paralysis... not skin covered (open or viable)
Term
Spina bifida aperta involves what types of neural tube defects?
Definition
a visible or open neural tube defect.

this group involves myelomeningocele, meningocele, and myelodysplasia
Term
Spina bifida Occulta involves what types of neural tube defects?
Definition
this involves hidden neural tube defects

lipomyelomeningocele, lipomeningocele, and lipoma
Term
lipomyelomeningocele
Definition
a sac with nerve tissue involvement. a hidden form of spina bifica occulta
Term
lipomeningocele
Definition
open sac, not nerve tissue involvement, but has fat tissues... a hidden form of spina bifida occulta
Term
Clinical presentation of Sensory and motor impairments with neural tube defects (mylodyplasia)???
Definition
Alot similar to SCI, but also can have other issues like:

hydropcehphalus/ chiari 2 malformation (80% of those have shunts due to CSF pressure issues)

seizures (15-20%)

Tethered Cord - issues shows up at age 6-12 with growth spurts
Term
clinical presentation of specifics myelodisplasia levels....

high lumbar (L1-2)
mid lumbar (l3)
lower lumbar (L4/5)
Definition
high lumbar L1/2- issues with hip flexion and hip adduction

mid lumbar L3- issues with some knee extension

low lumbar L4/5- knee extension, some hamstrings, DF
Term
Chiari II Malformation
Definition
a banana shaped hind brain, with the cerebellum getting pressed into the foramen magnum...
Term
other orthopedic impairments associated with myelodisplasia ???
Definition
muscle weakness utero= CLUBFOOT (50%)

contractures in the hip flexors and adductors

hip subluxation- due to muscle imbalances

scoliosis (20%)- congenital or acquired

osteoporosis- due to not wt. bearing
Term
is bowel and bladder impaired with myelodysplasia???
Definition
yes, think of my patient Landon
Term
what are the cognitive impairments associated with myelodysplasia?
Definition
can have a below average cognitive ability.... every shunt infection results in a 10 point decrease in IQ score. which is another reason MD's do not want to place shunts in if they dont have to
Term
% of people with hydrocephalus and myelodysplasia
Definition
25% of the children with myelodysplasia are born with hydrocehpaus, and 60% develope it after the closure of the lesion.
Term
are integument and obesity issues associated with myelodysplasia?
Definition
yes, due to the decreased activity of the pt... 20% of the pts are obese
Term
what allergy is associated with myelodysplasia?
Definition
up to 73% of the pts with it have an allergy to LATEX...

important when thinking about cathing
Term
is upper limb dyscoordination associated with myelodyplasia?
Definition
yes, C2M- pushing the cerebellum into the foramen magnum... and cordination issues occurs...
Term
hydromyelia
Definition
pockets of fluid in the spine causing pressure and even tissue death
Term
Tethered Cord
Definition
spinal cord attaches to the surrounding tissues (bone, fat, skin, or other), then in a growth spur, pain and deformity occurs
Term
a common spinal abnormality with myelodysplasia??? and can occur 2 ways?
Definition
scoliosis

congenital and acquired (weakness and positioning issues)
Term
Etiology of myelodysplasia? 4 main associations
Definition
genetics, medication, nutrition (folic acid), geography (England 2.5 our of every 1000 live births)
Term
Diagnositc methods for myelodysplasia
Definition
Medical screening- looking at mother protein levels.

neuro-imaging: ultrasound for 90% accuracy to diagnose. also if a banana shaped hind brain is seen in the second trimester may be a sign for C2m.

Amniocentesis- huge needle (invasive)
Term
prevention of Myelodysplasia
Definition
diet- foic acid 3 months prior to conception

genetic profiling... expensive
Term
is an osteotomy/ skull decompression surgery still used for chiari 2 malformation on a common basis?
Definition
No because we use shunts instead...
Term
is a Myelodysplasia a progressive or non-progressive dysfunction?
Definition
progressive... due to many factors, shunts, hydrocephalus, tethered cored and growth spurts
Term
surgical management for Myelodysplasia? before birth? for hydrocephalus? and for tethered cord?
Definition
intrauterine repair/ closure of the lesion before birth

V-P shunt for hydrocephalus

spinal cord de-tethering
Term
Research for intrauterine repair vs repair after C-section birth. what were the outcomes?
Definition
the intrauterine group had a decreased risk of neonatal death, hydrocephalus, chiaria 2, and of shunts by 1 year with earlier walking...

although there were no decreased risks of cognitive impairments, and an increased risk for tethered cord
Term
why a C-section birth for Myelodysplasia
pts?
Definition
to decrease the risk of infection as the child is born... also decrease the risk of stressing the lesion though the birth canal
Term
what are the symptoms of tethered Spinal Cord?
Definition
numbness and loss of sensation in LE
restless legs during sleep
spasticity in LE and or clonus
decreased LE strength
gait deviations
progressive scoliosis or curvature of spine
chronic low back pain
progressive loss of control over bowl and bladder (incotinence)
recurrent UTI's
Term
Symptoms/ Warning signs of Arnold Chiarir 2 malformation
Definition
Major headaches (commonly misdiagnosed as a migraine)... pain in the back of the head, and aggrevated by valsava, yawning, sneezing, and coughing

muscle weakness - declining hand grip strength may be a good indicator

stidor

apnea

facial pain

poor feeding - reflux/ failure to thrive
Term
Early warning signs of shunt dysfunction..... OMG LIST FROM HELL!!!
Definition
RECURRING HEADACHE
DECREASED ACTIVITY LEVEL
INCONTINENCE BEGINS OR WORSENS
START OR INCREASED SPASTICITY
PERSONALITY CHANGE
DICREASED VISUAL ACUITY OR DIPLOPIA

changes in speach, fever and malaise, decreased school performance, onset of or increased strabismus, change in appetite and weight, onset or worsening of scholiosis, decreased static grip, difficulty to arouse in morning, decreased visuomotor coordination, seizures
Term
Medical Management for orthopedic issues with Myelodysplasia... Hips, derotational osteotomies congenital club feet, scoliosis
Definition
rarely fix the hips, ODD, let them wt bear on the dislocated hips...

try to fix the club feet with casting

scoliosis treatment depends on the COBB angle
Term
what type of cathing is used for Myelodysplasia pts?
Definition
CIC- clean intermittent catheterization... to prevent UTI and kidney infections.....

Foley catheter for hospital settings
Term
at what age is CIC- clean intermittent catheterization started? and at what age is the child independent? how often should CIC be performed?
Definition
begin around age 5 or even age 3, but try to be independent by age 8?

4-6x/ 24 hour period
Term
PT examination finding with Myelodysplasia?
Definition
generally no UE involvement...

LE- check closely (hip dislocation, club foot, alignment issues)

neck and trunk (scoliosis and muscle imbalances)

look at strength and reflexes

risk for torticollis
Term
what standardized test are commonly used?
Definition
something with overall function (PEDI or SFA in the school)
Term
is the modified ashworth scale used with Myelodysplasia pts?
Definition
if the lesion is at L1 or above, there may be spasticity, thus would be appropirate
Term
PT goals for Myelodysplasia pt?
Definition
to prevent secondary conditions

to maximize functional independence

individualized to the child

to educate the parents, child, caregiver, teacher on medical/ developmental need

Adaptive equipment/ Assistive devices

HEP- with standing program (stop contractures, pressure relief, self esteem), biophosphate medication for O/P
Term
Ambulation factors with Myelodysplasia?
quads
illipsoas
gluteus medius strength
Definition
Quad strength 3 or < 88% exclusively use W/C
grade 4 and > 82% community ambulators

illiopsoas grade 3 or < partial or compete W/C users
Grade 4 or > all community ambulators

Gluteus Medius strength (best indicator of Assistive devices, orthosis)
grade 0-1... 95% require AD, orthosis or both
Grade 2-3... 72% require AD, orthosis or both
Term
average walking speed for 50 feet and a kindergartener vs a 6th grader
Definition
13.5 seconds for KG
10.6 seconds for 6G
Term
OUTcomes with myelodysplasia the following lesion locations?

thoracic
high lumbar (L1-3)
low lumbar (L4-5)
Sacral S1
Definition
thoracic: difficulty with independent sitting, use W/C for mobility, cognitive deficits

high lumbar: muscle imbalances, hip flexion contractures, hip dislocation, and W/C mobility

Low lumbar: knee flex, DF, functional ambulators as kids, foot deformities

Sacral: may walk without orthotics, but may use for more active lifestyles and jogging
Term
6 key factors to determine ambulation or W.C for mobility?
Definition
Endurance
Efficiency
Effectiveness- with transfers
Safety
Accessibility
Prevention- obesity and osteoporosis
Term
myelodysplasia and indicators or specific orthocics

what is needed for an SMO and what does an SMO provide the pt?
Definition
lesion at S1 or below

allows DF and PF motion while giving medial/lateral support

need to have DF (foot clearence) and push-off (PF)

improves balance, ankle alignment, ankle instability
Term
myelodysplasia and indicators or specific orthocics

what is needed for an AFO and what does an AFO provide the pt?
Definition
lesion at L4 to S1

can be a standard or ground reaction (for crouched gait) AFO

knee extensors need to be a grade 4, with weak or no ankle strength?

improves crouched gait pattern, toe clearance, knee extension during stance, improved gait efficient
Term
myelodysplasia and indicators or specific orthocics

what is needed to use an KAFO and what does an KAFO provide the pt?
Definition
lesion most likely at L3-L4

need to have hip flexion of 3 or greater...

improves medial/ lateral stability of the knee and is and indicator weak quads (less than 4)
Term
myelodysplasia and indicators or specific orthocics

what is need to use an RGo or HKAFO and what does and RGO or HKAFO provide the pt?
Definition
lesion at L1 to L3...

allows for reciprocal gait (RGO)

facilitaties hip extension and swing

need some weak hip flexion to work
Term
Evidence with orthotics and myelodysplasia

throacic and upper lumbar lesions?
Definition
little benifit to walking with parapodium, RGO, HKAFO...

get medical benificts for bowl and bladder function, self motivation, osteoporosis prevention

NOT GOING TO MAKE THEM A COMMUNITY WALKER
Term
Evidence with orthotics and myelodysplasia

Lower lumbar (L4/L5)
Definition
AFO effectiveness affected the following items:

decrease DF in stance
decrease double support time
increase gait velocity (speed)
Term
Theratogs are what?
Definition
velcro straps for proprioceptive sensation everywhere
Term
equipment used for myelodysplasia pts
Definition
carts before a W/C, W/C, standards, Environmental modification
Term
Evidence with the use of gaming devices for aerobic training in spinal cord dysfunction adolescents?
Definition
shows that the game cycle seems adequate to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction
Term
does strength training help children push there wheelchair farther?
Definition
showed to improve performance in selected disabled children... pilot study of 6
Term
the evidence shows what affect on abulatory children with spina bifida and home based treadmill training?
Definition
showed an increase in 6min walk test immediately after intervention, and 3 months post intervention
Term
most children with spina bifida and a lesion at L4 and below are ambulatory until what age? after this depends on what major factors?
Definition
til age 12-14 normally, but then self motivation and family support will dictate if the person will stay as a community ambulatory....
Term
max bite force at molars?
saliva volume per day?
swallows per hour?
length of digestive system?
Definition
max bite force at molars?---- 110lbs
saliva volume per day? 500-600ml
swallows per hour? 296/ hour
length of digestive system? 30 ft
Term
what is dysphagia? is it a medical diagnosis?
Definition
difficulty with swallowing... alot of speech therapy

not a medial diagnosis
Term
is it possible to talk about dysphagia separate from ethology?
Definition
no because it is caused by many other conditions or surgical procedures.
Term
what are some common conditions associated with dysphagia?
Definition
stroke, brain injury, dementia, motor neuron disease, myasthenia gravis, CP, Gillian Barre, Polio, myopathy

Parkinson's diseases, hunting-tons, progressive supranuclear pasly, age

RA, systematic sclerosis
Term
the results of an uncoordinated swallow?
Definition
aspiration into the lungs...
Term
Tanners definition of dysphasgia...
Definition
impairment of emotional, cognitive, sensory and or motor acts involved in transferring substance from mouth to stomach, resulting in failure to maintain hydration and nutrition and posing a risk of choking and aspiration.
Term
difference between a swallowing and a feeding disorder?
Definition
swallowing= mouth to stomach

feeding involves transport outside of the alimentary system (arm weakness or coordination)

a kids with CP can have feeding and swallowing issues
Term
are anorexia and bulimia considered dysphagia?
Definition
nope!
Term
what is the incidence of dysphagia?

acute general hospital?
acute rehab at admissions
stroke
brain injury
spinal cord
Definition
ASHA: says 6-10 million Americans

acute general hospital? 13-33%
acute rehab at admissions 30%
stroke---- 50%
brain injury ---- 20%
spinal cord---- 7%
Term
what is the rule with the brain stem and dysphagia?
Definition
there is a high likelihood of dysphagia issues is the brain stem is damaged...
Term
aspiration pheumonia can have what medial consequences?
Definition
costly, increased stay in care, greater disability at 3 and 6 months post, or poor nutritional stats during hospitalization
Term
consequences of dehydration? medically?
Definition
increased mental confusion, generalized organ failure, lead to increased de-compensation of swallowing
Term
consequences of under nutrition? medically...
Definition
affects energy levels, can compromise immune system if severe
Term
psychosocial consequences of dysphagia?
Definition
limits social interaction...
change in lifesyte
fear of chocking
social isolation
impact is pushed to the family
Term
differences of these terms

chew
bite
Definition
chew is the up and down motion
bite is to not release
Term
treatment goal for dysphagia?
Definition
to ensure the pt can consume enough food and liquids to remain nourished/ hydrated without treat to airway safety
Term
the four main interventions for dysphagia?
Definition
behavioral: posture, rehab strategy, earting rate, maneuvers, strengthening

dietary: modify textures, taste and volume

Medical: medication change, nasogastric tube

surgical: mobilization of weak vocal fold, PEG
Term
focus of a Otolaryngolosist?
Definition
evaluate of the upper digestive tract

endoscopy for visualization (nasopharynx, oropharynx, phaynx, larynx)
Term
focus of a gastroenterolist?
Definition
esophasgeal speacilist
GERD (reflex)
manometry
endoscopy of esophageal function
non-surgical placement of per-cutaneous endoscopic gastrostomy (PEG)
Term
the four phases of swallowing?
Definition
oral preparatory, oral transit, phayngeal transit, esophageal
Term
oral preparatory phase?
Definition
phase one of swallowing...

lips are closes, jaw going through a rotary grinding motion, tongue is rolling food up into a bolus
Term
oral transit phase?
Definition
second phase of swallowing?

moving the food from the front of the mouth to the back of the throat, anterior posterior motion of the tongue to move the bolus back
Term
Pharyngeal transit phase?
Definition
3rd phase...

the soft palate closure

back of the wall hits the back of the throat and larynx rises

the muscle abvoce the esophagus relaxes allowing food to pass
Term
esophageal phase?
Definition
4th and last phase of swallowing...

once in the esophagus the food is squeezed into the stomach
Term
duration of the oral transit phase of swallowing?
Definition
1 second
Term
Examination techniques to look at swallowing..
Definition
a clinical evaluation

modified barium swallowing study

fiber-optic endoscopic evaluation of swallowing (FEES)
Term
What are the associated UE muscle groups to spinal levels for the ASIA?
Definition
C4: Shoulder elevation
C5: Biceps
C6: Wrist extensors
C7: Triceps
C8: Finger and wrist flexors
T1: Finger abduction
Term
is Micheal J Foxes hyperkinetic movements normal for Parkinson's disease?
Definition
No, typically Parkinson's patients are hypokinetic
Term
what is the primary cause of Parkinson's disease?
Definition
a decreased or absent production of dopamine from the subtantia nigra
Term
where in the brain is the substantia nigra?
Definition
Basal ganglia
Term
what percentage of Parkinson's patients are idiopathic, in they don't know what caused the substantia to be affected?
Definition
78% are idopathic,

the rest are secondary parkinsonism from a viral, toxic, or metabolic problem
Term
what is Parkinson's - plus syndrome?
Definition
have the parkinson's presentation with other medical complications such as Alzheimer's, Huntington's disease, NPH, or multi-infarct vascular disease
Term
with parkinson's disease, what type of tremor is present? or is there a tremor present?
Definition
yes, there are resting tremors
Term
what does dopamine help control?
Definition
voluntary movement
Term
the Basal ganglia is make up of what structures?
Definition
substantia nigra, subthalamic nucleus, glubus pallidus, striatium (caudate+ putamen_
Term
the Basal ganglia gets inputs from where in the brain?
Definition
cerebral cortex, thalamus, Substantia nigra, and midbrain
Term
the basal ganglia helps production of ___________movement?
Definition
voluntary
Term
the Basal ganglia helps control of _________ adjustments?
Definition
postural
Term
if damage occurs to the Basal ganglia one of the two will occur, what are the two things?
Definition
hypokinetic movements, or hyperkinetic movements
Term
what are some terms considered with hypokinetic movements
Definition
akinesia or bradykinesia
Term
what are some terms considered with hyperkinetic movements?
Definition
chorea- rapid jerky movements

dyskinesia

dystonia
Term
what does the release phenomena have to do with Parkinson's disease?
Definition
as the production of dopamine stops, so does its inhibitory influences with in the basal ganglia, which in turn causes Tremors and eventually rigidity
Term
what are the 4 CARDINAL SIGNS for Parkinson's disease?
Definition
akinesia and bradykinesia

rigidity

resting tremor

postural instability
Term
how is speech affected with Parkinson's patients?
Definition
they can not get a solid closure of the vocal cords, so they are slurred and quite

this also affects dysphagia (swallowing)
Term
for a Diagnosis of Parkinsons what is used __________ ___________? and how many of the cardinal sings must be present?
Definition
a clinical exam is performed...

and 2 of the 4 cardinal signs must be present (tremor, rigidity, akinesia/ bradykinesia, postural instability)
Term
lab tests and CT/MRI scans for Parkinson pts are typically _________?
Definition
typically are normal, until END STAGE
Term
the Hoehn-Yahr Classification of disability scale is specific for what pt population?
Definition
Parkinson's patients to see the stage and severity of the disease
Term
the Hoehn-Yahr classification of disability scale has how many stages? and what are they?
Definition
5 stages

stage 1: minimal or no functional disability; unilateral if present

Stage 2; minimal bilateral or midline involvement; BALANCE IS NOT IMPAIRED

Stage 3: unsteadiness when turning or rising from chair; some activities are restricted; but pt can live independently and continue some form of employement

stage 4: All symptoms present and severe; standing and walking possible only with assistance

Stage 5: confined to bed or wheelchair
Term
Is parkinson's disease a progressive disorder?
Definition
yes, generally over the course of 20-30 years
Term
Monoamine Oxydase inhibitors (MAO's) are used in the treatment of parkinson's disease during what stage? what is this drug trying to do?
Definition
Monoamine oxydase inhibitors (MAO's) are used early on in diagnosis to slow the metabolism of dopamine
Term
Levodopa is used for Parkinson's disease once what develops? how does this drug work?
Definition
Levodopa is for when symptoms develope

it is a precursor to dopamine and counteracts the symptoms
Term
what is Catechol-Omethyl Transferase (COMT) inhibitors used for in the treatment of Parkinson's disease?
Definition
used with Levodopa to decrease the rate that levodopa is metabolized
Term
do dopamine agonist drugs have more or less side effects than levodopa?
Definition
less
Term
anticholinergic agents are good for treating what in parkinson's pts?
Definition
resting tremors
Term
why is carbidopa given with L-dopa?
Definition
help L-dopa get across the blood brain barrier
Term
in the early stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation)
Definition
prevention in the early stage
Term
in the early-middle stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation)
Definition
restoration
Term
in the middle-late stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation)
Definition
compensation- restoration
Term
in the late stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation)
Definition
compensation
Term
what type of diets decreases the effectiveness of L-Dopa?
Definition
high protein diets

try to eat proteins before going to bed when you don't need your L-Dopa
Term
most surgical management for parkinsons is done during what state of the disease? and why?
Definition
late stage, because better at stopping the rigidity
Term
what is a pallidotomy?
Definition
a surgical procedure for parkinsons, where they go in and burn parts of the brain to reduce bradykinesia, improve function
Term
is a thalamotomy done any more for Parkinson's disease?
Definition
nope, to many side effects
Term
what is new procedure for parkinsons disease that is showing some results?
Definition
Deep Brain stimulator, reduces tremor and rigidity....

and electrical stimulator is put in the subthalmic nuclei and the control is under the clavicle
Term
Parkinson's disease in Nebraska?
Definition
there is a higher rate of Parkinson's disease then normal... not sure why

maybe fertillizers
Term
the idea behind a pt with Parkinson's Disease is to do what?
Definition
slow the preogression of the disease

initially prevent
then restore
lastly compensate
Term
the Best test has been proven to be reliable and valid in parkinson's pts for balance.

would you use a mini-BESTest or a BESTest to determine risk of falling in a Parkinson's pt?
Definition
MINI-BESTest has been shown to be more accurate at showing risk for falls in Parkinson's pts

also the MINI only take about 15minutes to perform
Term
is balance, flexibility and functional exercises appropriate for Parkinson's patients?
Definition
yes it was proven to have the best results in a RCT study over home based programs, and supervised aerobic exercises
Term
what are 2 huge goals relating to the care of a Parkinson's patient?
Definition
education of the family

and stop the progression of the disease and secondary conditions
Term
a realistic goal for impairments with Parkinson's pts?
Definition
to reduce the impact of the impairment

decrease pain, increase motor function, aerobic capacity increased
Term
a realistic goal for ability to perform ADLs with Parkinson's pts?
Definition
to increase independence, may have to adapt stuff in later stages of the disease...

MJ FOx- tooth brush on the counter still while putting tooth paste on it...
Term
what muscle groups do you stretch in Parkinson's patients?
Definition
hamps, hip flexors, anything in a flexed position...
Term
more appropriate for a parkinson's pt for balance. AFO or AD like a walker?
Definition
walker...
Term
think big?
Definition
have the pt exaggerate the movement you want... tend to get better rehab results
Term
Driving Neuroplasticity? what is this?
Definition
have to challenge the pt to get resuts...
Term
M.A.T.C.H.
Definition
meaning- for the learning, not the PT
Active- learner is driven and evaluated
task specific to the real world
challenge- hard, but not to hard
hope- within reach
Term
lipoma
Definition
a type of SB occluta... that has no sac or neuro tissue involvement... adipose tissue presence
Term
Muscular dystrophy is an (inherited/ or not inherited disease) and is characterized by what two things...
Definition
MD is inherited and is associated with progressive muscle weakness and degeneration of skeletal muscle

can also be caused by a genetic mutation
Term
Muscular dystrophy has a problem with the cell _______ and the production of_________
Definition
membrane and the production of dystrophin...

it is ether no produced or produced in a lessor amount
Term
disorders of the anterior horn cells?
Definition
spinal muscular dystrophy
Term
how do you prevent muscular dystrophy?
Definition
you really can't

can use genetic counseling to see the percentage of possibility you child will have it...
Term
what comes into the cell and causes cell death in muscular dystrophy?
Definition
calcium, myofibrils are also destroied
Term
what disease is associated with phsudohypertrophy? and what is it?
Definition
fat invades the muscle in muscular dystrophy patients...

calf normally, and it will look normal
Term
ways of diagnosing Muscular dystrophy?
Definition
genetic mapping

muscular biopsy- increase Connective tissues and increased adipose cells

blood tests- with increase cretine kinase

EMG/ nerve velocity is normal...
Term
what are the 5 major kinds of muscular dystrophy?
Definition
duchenne muscular dystrophy
becker
facioscapulohumeral dystrophy
limb girdle dystrophy
spinal muscular dystrophy
Term
of the muscular dystrophies... which is worse ducheene or becker?
Definition
Duchenne... both have a problem with dystrophin production... but the becker makes some and ducheene makes none...
Term
is duchenne's muscular dystrophy the most or least common? and what gender does it affect?
Definition
Males only... and its the most common

X-linked recessive with defect on Xp21... inherited from asymptomatic mother
Term
age that DMD is normally diagnosed?
Definition
age 3 to 5
Term
life expectancy of DMD
Definition
20's
Term
age range to stop walking?
Definition
8-12
Term
the 3 factors relateded to DMD kids from walking?
Definition
falls, can they get up from a fall without assistance or device, LE strength loss of 50%
Term
DMD gross motor signs noticed first?
Definition
increased falling
reluctance to run or walk...
tip-toe walking
issues getting off the floor
Term
they tip toe walking with DMD
Definition
initially a weakness and balance issue..

then PT contracture issue
Term
is there congnitive issues related to DMD?
Definition
intellectual impairment due to lack of dystrophin in the brain
Term
does DMD have any change in the CNS, vascular system, motor neurons, sensory neurons?
Definition
No,NO,NO,NO...
Term
the lordosis of a DMD child will present clinically?
Definition
as excessive
Term
GAIT of a DMD child?
Definition
increase trunk sway and waddle with
decrease arms wing
Term
due to weak hip flexors kids use what muscle to compensate? and at what age does this occur?
Definition
TFL- tensor fascia lata... age 8
Term
what is a Gowers sign? and what is it associated with?
Definition
walking up your own legs to get up off of the floor... DMD
Term
what is the leading cause of death in muscular dystrophy pts?
Definition
pulmonary infection, respiratory failures, cardiomyopthies
Term
long volume of muscular dystrophy pts is ______ in adult hood?
Definition
decreased due weakness and decreased chest wall expansion
Term
initial weakness for muscular dystrophy pts is found where?
Definition
gastroc-soleus
Term
the scapula of muscular dystrophy pts tends to be?
Definition
WING A DING DINGED OUT LIKE A MOTHER FUCKN AIR PLANE!!!!! :) I HAVE LOST IT
Term
any tightness normally doesn't show with muscular dystrophy until age??? and found in what areas?
Definition
age 5, TFL and Gastroc-soleus
Term
secondary condition that need to be prevented with muscular dystrophy pts?
Definition
scoliosis
pneumonia
obesity
Term
is there a cure for DMD and muscular dystrophy?
Definition
NO CURE
Term
creatine and muscular dystrophy
Definition
showed to slightly increase strength, and decreased the fat in muscle cells
Term
myoblast transplant is done in muscular dystrophy pts?
Definition
HELL NO... still experimental... my poor family members in cages everywhere being forced to run on wheels for miles and miles!

it is thought to replace the missing dystrophin protein
Term
corticosteroids and muscular astrophysics pts?
Definition
shown to increase strength for 6m to 2years... but has long term side effects of wt gain, hair growth... osteoperosis
Term
is there a tone problem with muscular dystrophy?
Definition
no, muscular atrophy, but not a tone problem
Term
are dynamometers used with muscular dystrophy pts?
Definition
yes, great for objective measurements
Term
a standardized special test for muscular dystrophy?
Definition
VIGNOSS- looks at function
Term
what type of muscular dystrophy tends to have complaints about muscle cramping?
Definition
Becker's muscular dystrophy
Term
what is the onset age for Becker's muscular dystrophy?
Definition
age 8-11
Term
what is the life expectency of someone with Becker's muscular dystrophy?
Definition
40 years
Term
at what age does a Becker's muscular dystrophy pt typically ambulate til?
Definition
20's
Term
is dystrophin produced with Becker's muscular dystrophy?
Definition
yes, just at a decreased rate/amount than normal
Term
FSHD- fascioscapulohumeral dystrophy affects what gender? and is on what chromosome?
Definition
males and females evenly

on the 4th chromosome
Term
what percentage of FSHD- fascioscapulohumeral dystrophy pts ambulate their whole life?
Definition
half
Term
limb-Girdle MD affects what gender? and what muscles does it affect first?
Definition
male and female, hips and shoulder
Term
how many forms of SMA- spinal muscular atrophy are there?
Definition
3 types... type one is the worst
Term
what chromosome is affected by SMA - spinal muscular atrophy?
Definition
5th
Term
SMA - spinal muscular atrophy has what characteristics with the anterior horn of the spinal cord...
Definition
cells tend to larger, fewer of them, and degenerate over time...
Term
what are the types of SMA - spinal muscular atrophy?
Definition
1: Werdnig Hoffman
2: Werdnig Hoffman
3: kugelberg-welander
Term
what are the typical lifespans for the different types of SMA - spinal muscular atrophy?
Definition
1: Werdnig Hoffman----- 6 months
2: Werdnig Hoffman------ 7-10 years
3: kugelberg-welander------ can live normal lifespan
Term
do you want to do resistive exercises with dystrophin deficient muscles?
Definition
NOPE>.. can do more damage then good during the exercise
Term
what is the focus of DMD, MD, SMA.... interventions???
Definition
maintain function level for as long as possible... these are progressive disorders..
Term
when do you have to worry about skin integrity with MD pts?
Definition
when they lose the ability to ambulate by them self... increased time in the chair...
Term
is moderate intensity exercise safe for limb girdle MD pts?
Definition
yes, showed to increase pts ability in work capacity....
Term
is aerobic exercise good for facioscapulohumeral MD pts?
Definition
yes, safe for FSHD pts...
Term
is there a lot of research for muscular dystrophy? what do we do about this?
Definition
nope... understand the basic principles...

functional exercises... transfers and waling... not resistive stuff... more aggressive with the less involved forms of MD
Term
what is a HEP activity for MD pts?
Definition
stretching...
Term
a disorder that is characterized by periods of progression and then recovery phases?
Definition
Guillain-Barre
Term
does a Guillain-Barre patient normally recover to a prior level of function?
Definition
typically will get back to walking, but not really back to 100%
Term
how fast can Guillain-Barre set it? and how bad is it?
Definition
can set in within a day. and goes from tingling in the feet and distal extremities to weakness to respiratory distress...

MEDICAL EMERGENCY!
Term
ethilogy of GB?
Definition
viral infection setting off an autoimmune reaction against the myelin of nerves
Term
is GB a LMN or UMN problem?
Definition
a LMN problem
Term
how long until the initial attach of GB do you get your recovery?
Definition
about a month or so....

schwann cell proliferation
inflammation resolves
remyelination begins
Term
how is GB diagnosed? diagnostic tests and clinical presentation?
Definition
CP; flue like systems, then weakness and sensory loss starting distal, hypo reflexic, and ANS dysfuction with HR increasing and BP decreasing

nerve velocity is decreased and the CSF has increased protein levels..
Term
is the weakness with BF symmetrical or asymmetrical?
Definition
symmetrical ans starts distally
Term
will you have a clonus sign with GB?
Definition
NO, not a UMN lesion issue
Term
a paresthesia (tingling and burning) is a sign of what LMN lesion issue? and what UMN lesion issue?
Definition
BG lower
MS upper
Term
what is the most common deficit with GB when recovering?
Definition
tib anterior weakness... gait issues with drop foot
Term
what percentage of GB pts die? and what percentage of GB pts walk again?
Definition
5% die from secondary complication

80% are ambulatory within 6 months
Term
can GB pts have swalloing (dysphagia) issues?
Definition
yes
Term
what setting do you normally see a GB pt in?
Definition
Acute, normally not on the ventilator for long... and simple tasks like rolling from supine to sideline can be extremely tiring for the pt at first
Term
monitory BP and HR with GB pts, but can u use it as an indicator of exercise intensity?
Definition
not with this patient, because those are commonly affected by the vagus nerve involvement...
Term
Is temp control, bowl and bladder affected with GB pts?
Definition
yes they are both affected...
Term
in what order does stuff return for a BG pt?
Definition
the opposite order that they lost it... they will gain function back starting proximal and going distally...

will come off the ventilator first
Term
with BG pts what do you limit with exercise?
Definition
limit fatiguing exercises for up to 1 year with gradual return to regular activities....
Term
what type of exercise do you start with GB pts? then what are some other intervention options?
Definition
start with ADLS and basic transfers..

passive ROM while on vent

active assisted exercises as coming of the vent

aquatic therapy

PNF
Term
Similar to GB, MS does what? but does this where?
Definition
Ms attacks the myelination of nerve axons, but does this in the brain and the spinal cord, rather than the peripheral nerves.
Term
what are the 2 phases of MS?
Definition
inflammation phase
demyelination phase
Term
what is the exact cause of MS?
Definition
not really sure again!

some immune system dysfunction with a viral trigger?

possible genetic factor
Term
pathophysiology to MS
Definition
infection leads to an increase in WBC (lymphocytes and macrophages)... which have toxic effects destroying the oligodentrocyes and myelin sheaths in the spinal cord and brain. causing localized edema, and inflammation
Term
an MRI with show plaques in the brain and Spinal cord with what progressive disorder?
Definition
multiple sclerosis
Term
MS plaques appear in what locations?
Definition
cortiocospinal tract
optic nerve
subortical white matter
cerebellar peduncles
posterior white column of the spinal cord
Term
how to diagnose MS?
Definition
2 or more attacks of neurological symptoms reflecting white matter lesions (more than one month apart)

or chronically progressive deficits for at least 6 months
Term
evoked potentials with MS will be?
Definition
slowed
Term
CSF of MS patient will be?
Definition
increase IgG- showing immune response
Term
direct impairments from MS?
Sensory
Definition
parenthesis, pain (burning and aching), lhermitte's sign- electric shock down the leg
Term
direct motor impairment from MS?
Definition
UMN, fatigue, ataxic, balance problems

vertigo
Term
what UMN issues has a problem with Diplopia? or other optic issues
Definition
MS...
Double vision

24 year old mother... left eye vision lost
Term
can cognition be affected with MS pts?
Definition
yes!
Term
bowel and bladder is not effected from MS.
Definition
False, it is
Term
what are the 4 types of MS?
Definition
relapsing-remitting
primary-progressing
secondary-progressing
progressive-relapsing
Term
what is the worst kind of MS
Definition
primary progressive, due to not alot of recover time
Term
what age does MS normally set it?
Definition
40
Term
factors that EXACERBATE MS?
Definition
infections
stress
heat, cold
hyperventilation
dehydration
Term
uthoff's symptom
Definition
reaction to heat
Term
drugs used to treat MS?
Definition
ACTH for immunesuppressant
Steroids- side effects
Interferon- EXPENSIVE
immunomodulators- decoy clogging T cell
Term
baclofen for?
Definition
spastic muscles
Term
what setting will you see MS pts most?
Definition
outpatient
Term
weakness from MS is characterized as?
Definition
asymmetrical
Term
the "Expanded Disability Status Scale (EDSS)" is for what progressive disorder?
Definition
MS- measures disability
Term
12 item MS Walking Scale
Definition
specific for MS

can use 2 min walk, 6min walk... depends on the pt...
Term
rating on a Berg balance scale that indicates fall risk?
Definition
below a 45
Term
DGI cut off for risk of falling?
Definition
greater than 12
Term
things to teach your MS pts about with HEP?
Definition
use breaks often and when needed

avoid heat!
Term
how does MS kill you?
Definition
leads 2 secondary conditions like pneumonia that kill you!
Term
how long does ALS take to kill you?
Definition
5 years typically
Term
ALS is what type of motor neuron lesion?
Definition
a combination of upper and lower
Term
the etiology for ALS?
the CURE FOR ALS?
Definition
UNKNOWN and NO CURE
Term
ALS Spares what nuclei? and what other function?
Definition
it spares the oculomotor nuclei

while also not affecting bowl and bladder
Term
what tracks does ALS affect?
Definition
cortiocpinal and corticobulbar

bulbar- swallowing
Term
what are the two forms of ALS?
Definition
Family form (FALS) has a genetic component... rare form and may have prolonged survival with childhood onset

sporadic ALS- typical form
most common
Term
age onset for ALS? male or female?
Definition
late 50s
M:F = 1.7:1
Term
how to diagnose ALS?
Definition
UMN and LMN issues with 3 spinal regions, or 2 spinal regions and bulbar signs (language and swallowing)

also the progression! as ALS is progressive!
Term
is sensory and ANS dysfunction associated with ALS?
Definition
NO, GB is though
Term
are there sphincter control problems with ALS?
Definition
NO, bowel and bladder control are spared
Term
is the oculomotor nerve affected by ALS?
Definition
no it is also spared!
Term
CPK- serum creatine phosphokinase is high in what 2 progressive disorders?
Definition
DMD and ALS
Term
what is the pts primary complaint with ALS initially?
Definition
muscle weakness
Term
ALS issues normally start ____ then ____ then_____?
Definition
LE then UE, then swallowing problems
Term
the weakness of ALS is more similar to MS or GB?
Definition
more like MS because it is asymmetric.

GB is symmetrical
Term
achticholinergic drugs for ALS pts helps them with?
Definition
drooling
Term
ALS pts deal with spacticty with what drugs?
Definition
baclofen or diazepam
Term
ALS leads to the total paralysis of all spinal muscles and muscles innervated by cranial nerves.... Except?
Definition
the oculomotor
Term
reflexes with ALS are?
Definition
mixeds, since it is a LMN and a UMN issus
Term
focus of PT for ALS in these phases
EARLY
MIDDLE
LATE
Definition
early- prevention, increase capacity

middle- compensate for what is lost and continue to prevent more loss

late- compensate main focus...
Term
avoid heavy eccentric exercises with this population?
Definition
ALS, MS and GB, and DMD... try not to over tax them... high risk of injury
does occur
Term
what is demyelinated with GB, MS and ALS?
Definition
GB- peripheral nerves
MS- brain and spinal cord
ALS- specifically the corticosteroid and bulbar tracts
Term
Masked face?
Definition
This is a sign of parkinson's disease, in which the face is emotionless due to inability to voluntarily control the facial muscles and react emotionally.
Term
How is myelomeningocele diagnosed?
Definition
There are three methods:

1: Quad screen, which is a blood screen and they are looking for maternal alpha-fetoprotein levels and comparing to aged matched peers. Doesn't diagnosis but requires further testing.



2: Neuroimaging, peform an MRI and high resolution US and those are 97 percent accurate in diagnosis of myelomeningocele. (bannana and lemon sign)



3: Amniocentesis but is more risky
Term
What is dysautonomia? What disease is it associated with?
Definition
his is a broad term for disruption of the ANS. This consists of:

Excessive fatigue

lightheadedness, vertigo, dizziness

Feeling of anxiety or panic

Rapid or slow heart rate

Syncope (fainting)



Associated with Parkinson's Disease
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