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PT eval of patients with neuro disorders
PT eval of patients with neuro disorders
105
Anatomy
Graduate
09/25/2012

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Term
will you often perform a complete "neurological examination:
Definition
no, rarely. Instead, you'll discern what you need and combine neurological examination with elements of PT examination
Term
what to look at first in neuro patient evaluation
Definition
functional issues/concerns/goals of patient and family.
Term
what to do after learning concerns/issues/goals of patient
Definition
try to determine which impairments may be contributing to functional impairments. Could be environmental, could be physical.
Term
what to do after identifying which impairments are contributing to functional impairments
Definition
identify which impairments and functional limitations you can change with PT
Term
what to determine in history
Definition
Nature of the movement/functional problem; Circumstances, time frame, environmental factors; results of neuroradiological, EMG, NCV tests; surgeries; medications/treatment; social history, occupation, living environment; equipment
Term
what are components of a basic neurological examination
Definition
mental status, communication/language, cranial nerves, reflexes, sensation/perception, motor, cerebellar, gait
Term
what are components of a basic PT evaluation
Definition
vital signs, PROM, movement control (jerkiness, difficulty moving), posture, function
Term
what are the general guidelines for prioritization of PT + neuro examination components
Definition
quick check of mental status; vital signs; motor screen; function; gait; sensation maybe; reflexes maybe; cranial nerves maybe; cerebellar maybe
Term
what to look for in the motor screen part of PT/neuro examination
Definition
What movement abilities does patient have? Try MMT, describe what you're seeing
Term
what does GCS stand for
Definition
glascow coma scale
Term
what does LOC stand for
Definition
level of consciousness
Term
if a patient is alive, what is the lowest GCS score they can get
Definition
3
Term
what 3 things are looked at in the gcs
Definition
eye opening, best motor response, verbal response
Term
describe the scoring of eye opening
Definition
spontaneous 4; to speech 3; to pain 2; no response 1
Term
describe the scoring of best motor response in GCS
Definition
follows motor commands 6; localizes 5; withdraws 4; abnormal flexion 3; extensor response 2; no response 1
Term
describe the scoring of verbal response in the GCS
Definition
oriented 5; confused conversation 4; inappropriate words 3; incomprehensible sounds 2; no response 1
Term
how to cause noxious feelings
Definition
sternal rub, nailbed pressure
Term
what does it mean that a patient localizes motor response
Definition
they don't squeeze your hand as commanded but they do move that arm
Term
what is posturing
Definition
abnormal flexion, extension
Term
what is the term for abnormal flexion with arms crossed up over chest
Definition
decorticate flexion
Term
what does decorticate flexion indicate
Definition
serious damage of major descending spinal cord pathway that originates in midbrain such as vestibulospinal, reticulospinal, rubrospinal
Term
what is the term for abnormal extension posturing
Definition
decerebrate posturing
Term
is the prognosis better for decerebrate or decorticate posturing
Definition
better for decorticate
Term
what to look for in motor function part of exam
Definition
is strength movement bilateral?
Term
what is the ashworth scale
Definition
a scale for evaluating tone
Term
what is a 0 on the ashworth scale
Definition
normal: no increase in tone
Term
what is a 1 on the ashworth scale
Definition
slight increase in tone. Small catch with movement at end of ROM
Term
what is a 1+ on the ashworth scale
Definition
catch followed by minimal resistance throughout less than half of ROM
Term
what is a 2 on the ashworth scale
Definition
more marked increase in tone but affected part can still be flexed
Term
what is a 3 on the asworth scale
Definition
considerable increase in tone; passive movement difficult
Term
what is a 4 on the ashworth scale
Definition
affected parts rigid in flexion or extension
Term
what is hypertonia
Definition
resting tone is higher than normal
Term
is hypertonia always nervous system related?
Definition
no. muscle tissue can also change
Term
define spasticity
Definition
velocity dependent increase in resistance to passive stretch. Hyperactive stretch reflex
Term
how to check for spasticity
Definition
move extremity at different speeds. If you feel a catch when moving quickly, that is spasticity
Term
describe hypotonia
Definition
floppy, limp muscles
Term
are kids with cp hyper or hypotonic
Definition
often hypertonic in limbs and hypotonic in trunk
Term
what is a technique for reducing hypertonia
Definition
abduct thumb away from palm. Work on extending fingers. Pronate/supinate forearm
Term
what is huntington's chorea
Definition
involuntary movement throughout body
Term
what is chorea of hand
Definition
involuntary movement of hand
Term
what is athetosis
Definition
involuntary moement of hand that is writhig and less sporadic than chorea
Term
what is dystonia
Definition
involuntary muscle contraction that can be either generalized or focal. Tedn to get stuck/postured in a particular position
Term
how to be more specific with light touch sensation testing
Definition
use cotton swab. Touch patient in aplace you know they can feel it. Then, Ask patient to close eyes and nod when they feel touch
Term
what pathway carries light touch
Definition
dorsal column medial lemniscus, some spinothalamic
Term
what pathway carries pin pirck
Definition
spinothalamic
Term
how to test proprioception
Definition
hold DIPJ on lateral sides. Have patient tell you whether it's up or down compared to rest of hand. If finger doesn't do well, go to wrist, then elbow
Term
another way to test proprioception
Definition
move affected arm into a certain position. Ask patient to match with other arm. Then, do with eyes closed
Term
what's another test for proprioception
Definition
thumb find test
Term
which cranial nerves allow eye movements
Definition
3, 4, 6
Term
which cranial nerve allows facial expression
Definition
7 facial
Term
what does PERRLA stand for
Definition
pupils equal, round, reactive to light, accommodate
Term
what is pupil accommodation
Definition
ability to adjust vision from close to far away
Term
what shape to use to test eye movement
Definition
H
Term
what to look for/ask for in eye movement testing
Definition
eyes moving conjugately; ask if there is blurred/doublevision
Term
what does a positive babinski indicat
Definition
upper motor neuron problem - brain or spinal cord
Term
what is sustained clonus
Definition
continues to beat as long as you hold it
Term
how to test c4 myotome
Definition
shoulder elevation
Term
C5 myotome
Definition
shoulder abduction or ER
Term
C6 myotome
Definition
elbow flexion or wrist extension
Term
C7 myotome
Definition
elbow extension or wrist flexion
Term
C8 myotome
Definition
thumb extension or ulnar deviation
Term
T1 myotome
Definition
finger abduction or adduction
Term
what is another term for the VOR
Definition
oculocephalic reflex
Term
what is the VOR
Definition
when you turn your head, your eyes turn toward opposite direction by the same amount
Term
how to distinguish different levels of hyperactive reflexes on a diagram
Definition
+
Term
how to show positive or negative babinski on a diagram
Definition
up arrow = positive, down arrow = negative
Term
also be sure to review neuro handout 2010 in handouts folder in 8-22 Neurological Evaluation folder
Definition
ok
Term
how to test movement control
Definition
see if patient can isolate movements
Term
what is another term for non-fluent aphasia
Definition
Broca's
Term
what are the brodman's areas for Broca's aphasia
Definition
44, 45
Term
what is another term for fluent aphasia
Definition
Wernicke's
Term
what are the brodman's areas for Wernike's aphasia
Definition
22
Term
in which type of aphasia is the patient aware of their deficit
Definition
non-fluent, broc'as
Term
describe Broca's aphasia
Definition
patient knows what she wants to say but can't get it out
Term
describe wernicke's aphasia
Definition
receptive aphasia; difficulty understanding what is being said to them
Term
what is global aphasia
Definition
combination of fluent and non-fluent aphasia
Term
what is oral apraxia
Definition
difficulty related to speech and language. Usually does fine with non-speech kinds of mouth and tongue movements. Motor planning associated with speech is impaired.
Term
define dysarthria
Definition
articulation disorder. Difficulty with control of muscles of tongue and mouth in speech and in other types of oral motor activities like chewing. Able to read and follow instructions. Hard to understand their speech.
Term
in what lobe is Broca's area
Definition
frontal
Term
in what lobe is Wernicke's area
Definition
temporal
Term
what might happen to cause damage at the optic chiasm
Definition
pituitary gland tumor
Term
what is homonymous hemianopsia
Definition
loss of half of the visual field in both eyes, usually due to stroke. For example, if stroke is in the left side of the brain, you might see loss of R visual field in both eyes
Term
how to test for unilateral neglect
Definition
have patient draw a clock, house, person
Term
what is extinction phenomenon
Definition
when you give bilateral, simultaneous stimulation, the person attends only to the less involved side; When sensation is not affected but in touching both arms, they only feel touch on one side.
Term
are cerebellar problems ipsilateral or contralateral
Definition
ipsilateral
Term
what does movement look like in a person with a cerebellar disorder
Definition
uncoordinated, jerky
Term
define dysmetria
Definition
consistently being unable to reach target in finger nose finger test.
Term
what is diadochokinesis
Definition
rapid, alternating movements
Term
what is Dysdiadochokinesis
Definition
trouble with rapid, alternating movements
Term
how to test diadochokinesis
Definition
have them do 5 on each hand. Time and compare if there is a difference between L and R sides
Term
what is the heel to shin test
Definition
person slides heel up and down shin
Term
what is fugelmeyer
Definition
person is supine and touches heel to patella and back down
Term
what is the rebound phenomenon test
Definition
resist elbow flexion then let go, see if patient can stop elbow flexion quickly when it is no longer resisted
Term
what are 4 cerebellar special test
Definition
finger nose finger, heel to shin, RAM, rebound
Term
what are Semmes Weinstein monofilaments
Definition
way to document quantitatively and specifically how severe sensory loss is.
Term
what is rigidity?
Definition
increase in tone. Hypertonia.
Term
what is lead pipe rigidity
Definition
when there's resistance with no threshold angle of the joint.
Term
what is cogwheel rigidity
Definition
resistance with a catch as you go
Term
what must be documented along with clonus
Definition
either sustained or number of beats
Term
what does positive babinski indicate
Definition
upper motor neuron lesion
Term
define apraxia
Definition
motor planning problem. Difficulty determining how to do a certain thing: how to tie your shoe, how to sit criss corss, how to transfer, how to dres
Term
what is supratentorial
Definition
in cortex, cortical
Term
what is the posterior fossa
Definition
cerebellum and brainstem
Term
what indicates a posterior fossa lesion
Definition
weakness on one side of the body but cranail nerve symptoms on the other side of the body.
Term
what are the anatomical levels of lesions
Definition
supratentorial, posterior fossa, spinal, peripheral
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