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SCI
SCI exam 1
350
Anatomy
Graduate
02/03/2013

Additional Anatomy Flashcards

 


 

Cards

Term
How many spinal nerves are there in each region of the spinal cord?
Definition
8 cervical, 12 thoracic, 5 lumbar, 5 sacral
Term
where and why are there enlargements of the spinal cord
Definition
cervical, lumbar: more motor neurons exit these areas
Term
what is the cauda equina
Definition
bundles of spinal nerves beginning at L2
Term
what is the filum terminale
Definition
fibrous tissue continous with pia mater. Connects spinal cord to dura mater to provide support and stability. Attaches to coccyx
Term
what does the gray matter of spinal cord consist of
Definition
cell bodies and dendrites of spinal neurons
Term
through what spinal horn does afferent information enter
Definition
dorsal horn
Term
what does white matter of spinal cord consist of
Definition
axons of longitudinally running fiber tracts
Term
what are the 3 columns of white matter, separated by gray matter?
Definition
dorsal, lateral, ventral columns
Term
are the dorsal column pathways ascending or descending
Definition
ascending
Term
what do the dorsal column pathways carry
Definition
vibration, light touch, proprioceptoin
Term
what are the 2 dorsal columns
Definition
cuneate, gracilis
Term
what does the fasciculus cuneate carry?
Definition
sensory from upper body
Term
is the fasciculus cuneate medial or lateral?
Definition
lateral
Term
what does the fasciculus gracilis carry?
Definition
sensory from lower body
Term
is the fasciculus gracilis medial or lateral?
Definition
medial
Term
where do the dorsal column pathways cross?
Definition
ascend ipsilaterally and cross in medulla
Term
Does the spinothalamic tract ascend ipsilaterally or contralaterally?
Definition
enters dorsal DRG, goes up and down Lissauer's tract, crosses, ascends contralaterally
Term
what is the function of anterior and posterior spinocerebellar tracts
Definition
carries unconscious proprioception to the cerebellum
Term
is the anterior spinocerebellar crossed in spinal cord?
Definition
yes. Carries information contralaterally
Term
is the posterior spinocerebellar crossed in spinal cord?
Definition
no. conveys ipsilaterally to cerebellum
Term
to what part of the spinal cord does the lateral corticospinal tract synapse and where do these synapses go?
Definition
dorsal lateral horn. Goes to innervate distal flexor muscles
Term
to what part of the spinal cord do the vestibulospinal/reticulospinal tracts synapse and where do these synapses go?
Definition
ventral, medial cell groups. Then go to proximal, extensor muscles
Term
Is lateral corticospinal crossed or uncrossed?
Definition
90% crossed, 10% uncrossed
Term
what info does the ventral corticospinal pathway convey and to where
Definition
Uncrossed UMNs from motor cortex to provide voluntary control of trunk muscles. A small # cross to terminate on contralateral LMNs
Term
Purpose/description of Rubrospinal Pathway
Definition
Descending UMNs to cervical spinal cord to influence UE muscles. Involved in distal control of limbs, fine finger movements. Contralateral/crossed.
Term
Does reticulospinal tract have crossed or uncrossed pathways
Definition
both
Term
purpose of reticulospinal tract
Definition
descending medial tract for extensors, proximal, axial muscles to keep us upright
Term
Does colliculospinal have crossed or uncrossed pathways
Definition
both
Term
purpose of colliculospinal tract
Definition
controls axial muscles in neck, responds to visual stimuli
Term
study the cross section of the spinal cord
Definition
ok
Term
what is the usual cause of central cord syndrome
Definition
hyperextension injuries that cause bleeding into central gray matter of SC
Term
signs and symptoms of central cord syndrome
Definition
more impairment of UE than LE because of damage to the medial part of the lateral corticospinal tract
Term
what is the prognosis for central cord lesion
Definition
good prognosis for ambulation, poor prognosis for hand function
Term
what is the usual cause of anterior cord syndrome
Definition
flexion injuries in which bone or cartilage damages anterior spinal artery
Term
signs and symptoms of anterior cord syndrome
Definition
motor function, pain & temperature lost below level of injury. Proprioception/vibration/light touch maintained
Term
prognosis for anterior cord syndrome
Definition
poor for ambulation, bladder & bowel control
Term
What is a Brown Sequard injury
Definition
hemisection
Term
what is lost with Brown Sequard
Definition
Ipsilateral motor below, ipsilateral light touch/vibration/proprioception below, contralateral pain and temp below, ipsilateral all sensory at level of injury
Term
Prognosis for Brown Sequard
Definition
good prognosis for recovery of function
Term
is posterior cord syndrome common
Definition
no. rare.
Term
cause of posterior cord syndrome
Definition
compromise to posterior spinal artery by compression from tumor or infarction
Term
signs/symptoms of posterior cord syndrome
Definition
lose proprioception, vibration, light touch
Term
what is Cauda Equina damage
Definition
LMN lesion: nerve roots are damaged
Term
signs sympoms of cauda equina injury
Definition
weakness, bowel and bladder loss, loss of spinal reflexes
Term
ASIA: how many dermatomes are tested on each side of the body
Definition
28
Term
what are the 2 types of sensory tested by ASIA
Definition
pin prick, light touch
Term
For the following questions, list the sensory testing location for ASIA
Definition
ok
Term
C2
Definition
occipital protuberance
Term
C3
Definition
supraclavicular fossa
Term
C4
Definition
Top of AC joint
Term
C5
Definition
lateral to antecubital fossa
Term
C6
Definition
thumb: proximal phalanx, dorsal surface
Term
C7
Definition
3rd digit: proxmal phalanx, dorsal surface
Term
T1
Definition
5th digit: proximal phalanx, dorsal surface
Term
T2
Definition
apex of axilla
Term
T3
Definition
3rd intercostal space
Term
T4
Definition
nipple level
Term
T5
Definition
5th intercostal space
Term
T6
Definition
6th intercostal space
Term
T7
Definition
7th intercostal space
Term
T8
Definition
8th intercostal space
Term
T9
Definition
9th intercostal space
Term
T10
Definition
umbilicus
Term
T11
Definition
11th intercostal space
Term
T12
Definition
inguinal ligament midpoint
Term
L1
Definition
half the distance between T12 and L2
Term
L2
Definition
mid-anterior thigh
Term
L3
Definition
medial femoral condyle
Term
L4
Definition
medial malleolus
Term
L5
Definition
dorsum of foot at 3rd MTPJ
Term
S1
Definition
lateral heel
Term
S2
Definition
popliteal fossa in midline
Term
S3
Definition
isch tuberosity
Term
S4-5
Definition
perianal area
Term
what is the 3 point scale system for sensory ASIA
Definition
0 = absent. Cannot detect or cannot distinguish sharp vs. dull. 1 = impaired. Intensity of stimulus is different than on face. 2 = normal. Detects, distinguishes sharp vs dull, feels same as on face
Term
how many times must sensation be correct to receive a score of normal
Definition
8/10 for both pin prick and light touch
Term
what tool to use for pin prick
Definition
safety pin
Term
what tool to use for light touch
Definition
cotton wisp
Term
what is the sensory level
Definition
the most causal segment of the spinal cord with normal (2) pin prick AND light touch sensation on BOTH sides of the body
Term
define the motor level
Definition
most caudal segment of the spinal cord with grade of 3 or better with the next most rostral segment having a normal grade
Term
what is a normal strength score
Definition
5/5 or 4/5 with other circumstances such as pain
Term
what is the neurological level
Definition
the most caudal level with normal sensory and motor bilaterally
Term
Define ASIA A
Definition
complete. No sensory or motor function is preserved in sacral segment S4-5
Term
Define ASIA B
Definition
incomplete. Sensory but no motor function preserved in sacral segment S4-5
Term
Define ASIA C
Definition
incomplete. Motor function preserved below neurological level, mostly <3
Term
Define ASIA D
Definition
incomplete. Motor function preserved below neurological level, mostly >=3
Term
Define ASIA E
Definition
Normal. Sensation and motor function normal
Term
define zone of partial preservation
Definition
dermatomes and myotomes caudal to neurological level that remain partially innervated. Used ONLY with COMPLETE injuries
Term
C5
Definition
elbow flexor
Term
C6
Definition
wrist extension
Term
C7
Definition
elbow extension
Term
C8
Definition
flexion of distal phalanx of middle finger
Term
T1
Definition
little finger abduction
Term
L2
Definition
hip flexors
Term
L3
Definition
knee extensors
Term
L4
Definition
ankle dorsiflexion
Term
L5
Definition
toe extension
Term
S1
Definition
ankle plantarflexors
Term
S4,5
Definition
checked by physician
Term
how to determine neurologic level for T3-12
Definition
sensation only
Term
C3
Definition
SCM, cervical flexors, cervical extensors, cervical rotators, levator, upper traps
Term
C4
Definition
upper trap, diaphragm, cervical paraspinals = scapular elevation
Term
C5
Definition
deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus, early rotator cuff
Term
what is the action of the rhomboids at C5
Definition
retract, rotate scapula
Term
what is the action of serratus
Definition
laterally rotate, protract scapula. (5, 6, 7 raise your arms up to heaven)
Term
Can you supinate with C5?
Definition
yes
Term
what shoulder movements can you do with C5
Definition
abduction, flexion, extension
Term
C6
Definition
wrist extension, pec major clavicular portion, lats
Term
what are the actions of latissimus dorsi
Definition
extend, IR, adduct arm. C6, C7, C8 handcuff your date
Term
what is the function of pec major clavicular portion
Definition
horizontal adduction
Term
C7
Definition
pec major sternal portion, triceps, pronator quadratus, extensor digitorum, flexor carpi radialis
Term
what movements can be done at C7 that weren't available earlier
Definition
elbow extension, wrist extension, wrist flexion
Term
C8
Definition
More wrist flexors/extensors, hand muscles
Term
what actions can you do with C8 that you couldn't do earlier
Definition
sronger wrist ext/flex. May still have tenodesis depending on strength. Finger flex/ext stronger. More thumb movements.
Term
what are some important things to consider when working with patient with SCI
Definition
reduced activity, muscle strength and tone, ROM, respiratory status, speech, sensation, skin integrity, functional status
Term
what are some complications of reduced activity for people with SCI to look out for
Definition
pressure ulcers, heterotopic ossification, osteoporosis and fractures, elevated blood calcium, kidney stones, spine deformity = kyphosis
Term
what to look for with muscle strength following SCI
Definition
do detailed testing for specific muscles. Stabliize and watch for substitutions
Term
what to look for with muscle tone following SCI
Definition
when does it occur? Is it constant or fluctuating? Can inc tone be used for functional activities, such as extensor tone in extremities to get from floor to WC?
Term
what ROM is critical following SCI in the shoulder
Definition
flexion, abduction, ER, extension important for transfers, dressing, sitting stability, pressure relief
Term
what ROM is critical following SCI in the elbow
Definition
extension to lock elbows and help with transfers, pressure relief
Term
what ROM is critical following SCI in the wrist/hand
Definition
wrist extension without overstretching finger flexors. Some shortening of finger flexors gives tenodesis, which allows for functional flexion
Term
what ROM is critical following SCI in the hip
Definition
hip flexion/rotation important for dressing and transfers. Hip extension necessary for parastance. Hamstring length critical for bed mobliity, dressing, transfers
Term
what ROM is critical following SCI in the knee
Definition
flexion for dressing, transfers. Extension for ambulation
Term
what to consider when stretching hamstrings
Definition
don't overstretch hamstrings at risk of overstretching low back. Some shortening of low back can increase sitting balance to make up for weak abdominals
Term
what ROM is necessary in Ankle following SCI
Definition
dorsiflexion to at least neutral for ambulation
Term
what is the biggest cause of death following SCI
Definition
respiratory complications like pneumonia
Term
what to observe regarding respiratory status
Definition
overall color, presence of tracheostomy, chest shape and symmetry, bony abnormalities, chest expansion
Term
what is the normal amount of expansion of the ches at the xiphoid
Definition
2.5-3cm
Term
how to determine respiratory muscle strength
Definition
are abdominals present? Are accessory muscles present
Term
what to use of abdominals are not present
Definition
abdominal binder
Term
list the accessory respiratory muscles
Definition
SCM, levator, pectorals, serratus, scalenes, upper trap, intercostals
Term
define phonation
Definition
how many syllables you can say in one breath
Term
what does increased respiration rate indicate and why is this bad
Definition
shallow breathing = increased risk of infection
Term
what are signs of hypoventilation
Definition
drowsiness, irritability, difficulty waking
Term
what are signs of hyperventilation
Definition
numbness, tingling, faintness
Term
what to check out regarding cough
Definition
effective? Needs assistance?
Term
how to test sensatin
Definition
detailed testing using pin prick and light touch. Patient education regarding injury prevention/ulcer prevention with pressure relief, inspection, safety
Term
what to consider with skin integrity
Definition
inspection, pressure relief, bed mattress, WC cushion, dressing, transfers, comfy clothing: watch for seams, tight places, things in pocket
Term
what to consider with functional status
Definition
bed mobility, transfers, sitting/standing balance, WC mobility, ambulation, ADLs, standardized assessments
Term
at what SCI level does autonomic dysreflexia occur
Definition
T6 and above
Term
when does AD occur?
Definition
one month to one year post injury
Term
what causes AD
Definition
reflexive dysfunction of the sympathetic and parasympathetic nervous systems triggered by a noxious stimulus in the periphery
Term
what is the sympathetic system
Definition
flight/flight response
Term
where is the sympathetic system
Definition
T1-L2
Term
what is the parasympathetic system
Definition
rest/digest
Term
describe pathophysiology of AD
Definition
noxious stimulus triggers reflex to create vasoconstriction, increasing BP as a sympathetic response. Receptors in brain detect hypertension and send parasympathetic signal to reduce heart rate via vagus nerve. Dilation of blood vessels is blocked at the cord. Slowing of HR alone is not enough to sufficiently lower BP. Can result in stroke
Term
AD symptoms
Definition
pounding headache, elevated BP, sweating above injury level, goose bumps, chills, nasal obstruction
Term
AD triggers
Definition
distended bladder, fecal mass in rectum, infection, bladder stones, ingrown toenail, pressure sores
Term
what to do in the case of AD
Definition
recognize symptoms. Confirm increased BP. Sit up quickly to induce orthostatic hypotension. Look for triggers: kinked tube, tight clothes, full bag. Nursing to investigate other triggers. Medical treatment to lower BP
Term
what causes postural hypotension
Definition
sympathetic/parasympathetic dysufnction PLUS venous pooling
Term
treatments for orthostatic hypotension
Definition
reclining WC, elevating leg rests, abdominal binder, TED hose or ace wraps, slow adjustment to upright
Term
strategies for maximizing respiratory efficiency in patients with tetraplegia
Definition
postural drainage, percussion and vibration, assisted cough
Term
describe modified Heimlic cough
Definition
PT puts hand below xiphoid process and instructs patient to cough out while PT pulls in and up
Term
describe sitting modified Heimlich with rib compression cough
Definition
place hands laterally on ribs and provide inward pressure at same time as attempted cough from patient
Term
describe independent methods of asssisted coughing
Definition
use biceps to do independent Heimlich. Use pillow and lean forward. Prone: cough out while lowering yourself down from prone on elbows.
Term
what are some devices for airway clearance
Definition
incentive spirometry, CPAP and BiPAP, in-exsufflator device
Term
what is a key component of bed mobility and coming to sitting
Definition
rolling
Term
What to think of with transfers
Definition
Get WC set up, get sliding board in place
Term
how to preserve UE function
Definition
use power WC if needed, avoid extreme positions, provide support, educate about risk of stroke,
Term
how to relieve pressure for C4
Definition
WC tilt/recline. Pressure relieving cushion
Term
how to relieve pressure for C5
Definition
WC tilt/recline. Pressure relieving cushion. Use biceps to lean side to side
Term
how to relieve pressure for C6
Definition
wrist extension, shoulder ER to lean forward. Lean forward using wrist
Term
how to relieve pressure with C7, 8
Definition
independent WC pushups
Term
why do you rest the patient's head on your shoulder away from the direction you're going
Definition
so you can see where you're going
Term
what are things to think about when treating SCI
Definition
pain, secondary injuries, education, discharge planning
Term
what are factors that affect outcome following SCI
Definition
complete vs incomplete; body shape/size and fitness level; age; needs and motivation
Term
what things affect C3 and above SCI outcome
Definition
movement capabilities, ventilator dependence, total assist for most activities, require 24 hour attendant and back-up ventilator, extensive equipment needs, WC with recline/tilt, head or sip/puff, need for family asistance
Term
what to consider for sitting of C4 patient
Definition
can she tolerate vertical? Hands on! Totally dependent for balance
Term
describe bed mobility of C4 patient
Definition
independent supine to sit with electric hospital bed and modified controls. Assists with moving head. Otherwise dependent
Term
describe WC mobility for C4 patient
Definition
sip and puff or head control WC. Independent with power WC over level surfaces. Needs back up manual reclining WC
Term
describe C4 transfers
Definition
dependent
Term
describe C5 sitting
Definition
uses head to alter COM. May be able to remain stable for short periods of time
Term
decribe bed mobility for C5
Definition
independent supine to sit with electric hospital bed. Assists with moving head, upper trunk, and shoulders
Term
describe WC mobility for C5 patient
Definition
independent with power WC using hand controls. Manual WC may be independent indoors. Requires assist for outdoors or carpet.
Term
describe transfers for C5
Definition
mostly dependent. Some patient with very strong biceps and deltoids can do even transfers with sliding board
Term
can a person with C5 drive?
Definition
yes, in specialized van with lift
Term
describe sitting in C6
Definition
can stabilize with head/UE movement. Can sit unsupported with elbows locked in extension via ER at shoulders
Term
describe C6 bed mobility
Definition
independence with or without siderails, loops, etc is possible. Probably needs assistance in coming to sitting, leg management
Term
WC mobility for C6
Definition
independent with power WC using joystick hand control. Some to total assist for outdoor manual WC propulsion
Term
describe transfers for C6
Definition
independent to some assist for even transfers. Some to total assist for uphill transfers
Term
can a person with C6 drive?
Definition
yes, in specialized van with lift
Term
describe C7-8 sitting
Definition
independent. Uses UEs to provide support.
Term
describe bed mobility of C7-8 patient
Definition
independent without special equipment
Term
describe WC mobility of C7-8 patient
Definition
independent manual with some assist for ramps, long distances, uneven terrain
Term
describe transfers for patient with C78
Definition
independent even transfers. Some assist uneven transfers
Term
how can a person with C78 drive
Definition
transfer to captain's chair from WC or use lift in van, then transfer to captain's chair
Term
why his hamstring length important for a patient with paraplegic injury
Definition
getting up from the floor, wearing long leg braces, donning shoes/pants in sitting
Term
why is hip extension important for patient with paraplegic injury
Definition
parastance
Term
when to teach self ROM to patient with paraplegic injury
Definition
as soon as they're able
Term
describe bed mobility for patient with paraplegic injury
Definition
independent. Rolling with UEs,head, shoulders
Term
how to transfer supine to sit and reverse for patient with paraplegic injury
Definition
use UEs to push up straight or roll first.
Term
how to scoot in bed for person with paraplegic injury
Definition
small push ups using head hips relationship
Term
potential problem for sitting for patient with paraplegic injury
Definition
orthostatic hypotension
Term
how to prevent orthostatic hypotension for patient with paraplegic injury
Definition
TED hose, abdominal binder
Term
name an activity to improve standing balance
Definition
crutch ball
Term
what are the suggested times for pressure relief
Definition
2 minutes every 20. also be sure patient has a good cushion
Term
how to go down a ramp in a WC
Definition
backwards, lean forward
Term
how to go up a ramp in a WC
Definition
forward, lean forward
Term
which way to face when going down a ramp in a wheelie
Definition
forward
Term
which way to face when going up a ramp in a wheelie
Definition
backward
Term
how to transfer for patient with paraplegia
Definition
twist head and shoulders away from the surface you're transferring to
Term
why to limit transfers and use adaptive devices
Definition
limit stress on shoulders from repetitive use
Term
ways to strengthen patient with paraplegia
Definition
lat pull downs. Shoulder depression. Strengthen all innervated UE muscles. Wall pulleys, free weights, swimming
Term
what things to take into account for ambulation for person with paraplegia
Definition
Upper body strength, cognition, motivation, trunk strength, ROM, body proportions, BMI, muscle tone, spasticity, other health issues
Term
what is the cutoff point as to whether someone can walk community distances
Definition
innervation of hip flexors
Term
what to do for spasticity and ambulation
Definition
medications. Use HKAFOs
Term
ideas for endurance training for patient with paraplegic injury
Definition
WC propulsion, arm ergometer, swimming, ambulation, Nustep
Term
bathroom transfers for patient with paraplegia
Definition
independent transfers with modifications and assistive devices. Use cushioned seat
Term
WC-car transfers for patient with paraplegia
Definition
should be independent. Use quick-release wheels
Term
WC considerations for patient with paraplegia
Definition
seat inclination 10-15 degrees. Solid seat back with custom sized lumbar support. Seat to back angle 85-90 deg
Term
is someone with ASIA A or ASIA D more likely to be ambulatory
Definition
ASIA D
Term
are FIM scores higher for someone with ASIA D or ASIA A
Definition
ASIA D
Term
what are the major factors affecting outcome for patients with incomplete SCI
Definition
level of injury, muscle tone, age, concurrent brain injury, pressure ulcers, pain, limited ROM, obesity, body proportions, motivation, sensory sparing and return
Term
why does a C4 lesion have varying prognosis even for incomplete injury
Definition
depends on how much the diaphragm is affected
Term
what is the possible problem of TUG, Berg, FIM for patients with SCI
Definition
all have floor effects
Term
If a patient has L2 intact, what does that mean for bracing
Definition
hip flexors available. Probably need a KAFO
Term
if a patient has L3 intact, what does that mean for bracing
Definition
quads now available, might be ok with just an AFO. AFO should be solid with DF and PF block since they have no control of either
Term
if a patient has L4 intact, what does that mean for bracing
Definition
She can now dorsiflex. AFO is probably all she needs. Might need a DF block because of limited PF to balance ability to DF can lead to crouch gait. Still needs PF block. 2 canes/crutches
Term
what new muscles does a patient with L4 have that can help with gait
Definition
sartorius can help with knee flexion in swing phase of gait. Starting to get some glutes for hip stability. can DF
Term
what new muscle is innervated with L5
Definition
full innervation of TA
Term
what bracing/ADs needed for someone with L5
Definition
canes, AFOs. May need DF block if they have weak plantarfleors
Term
what new muscles are innervated with S1
Definition
hamstrings, glute max, partial PFs
Term
what braces are needed for S1
Definition
SMO to increase stability at ankle
Term
can someone with S1 lesion walk without an AD
Definition
possibly
Term
is an AD needed for someone with S2 lesion
Definition
possibly
Term
what are the tenants of universal design
Definition
equitable, flexible, simple/intuitive, perceptible, tolerant of error, low physical effort, size and space for approach and use
Term
what is the idea ramp slope?
Definition
0.06
Term
what is the preferred ramp slope
Definition
0.05
Term
what is the acceptable/code ramp slope
Definition
0.05
Term
how often is a landing/switchback required on a ramp
Definition
every 30 ft
Term
doorway width
Definition
32 inches
Term
ramp width
Definition
36 inches
Term
what should the surface of a ramp be like
Definition
nonslip
Term
what else should be on a ramp
Definition
rails or a lip so that you don't fall off the side
Term
how much room should there be for a turnaround on a ramp
Definition
5x5 feet
Term
closet width
Definition
52 inches
Term
how high should accessible toilet be
Definition
17-19 inches
Term
things to consider for bedroom and universal design
Definition
bed height and firmness. Special bed, rail. Can they access their clothes
Term
will medicare pay for home repairs
Definition
no
Term
will workers comp pay for home repairs
Definition
yes
Term
who else to get help for home repairs
Definition
churches
Term
what are the 4 major types of CNS tumors?
Definition
gliomas, meningiomas, neurilemomas, pituitary adenomas
Term
what is a glioma
Definition
tumor involving glial cells, which are supporting cells of the nervous system
Term
are gliomas malignant or benign
Definition
can be either
Term
what is the most common type of glioma
Definition
astrocytoma
Term
what is the problem with malignant astrocytomas
Definition
they recur
Term
what is the most highly malignant type of astrocytoma
Definition
glioblastoma multiforme
Term
what part of the brain is usually affected by astrocytomas
Definition
cerebral hemispheres
Term
what grade malignancy is a glioblastoma multiforme
Definition
IV
Term
what age is most likely to get a glioblastoma multiforme
Definition
45-55 years
Term
is glioblastoma multiforme more common in men or women
Definition
more common in men
Term
what is the prognosis for glioblastoma multiforme
Definition
poor
Term
what age is most likley to get an oligodendroma
Definition
50's 60's
Term
what is the prognosis for oligodendroma
Definition
good. Well defined and slow growing
Term
what age is most likely to get a medulloblastoma
Definition
children
Term
where do medulloblastomas form and what does this affect
Definition
develops near vermis of cerebellum, tends to obstruct 4th ventricle causing hydrocephalus
Term
what is the prognosis for medulloblastoma
Definition
highly malignant but better prognosis for older children
Term
at what age does ependymoma usually occur
Definition
children, adolescents
Term
where can ependymomas form
Definition
ventricals or spinal cord
Term
what is the prognosis for ependymoma
Definition
fairly good. 80% survival rate of 5 years
Term
what is a meningioma
Definition
tumor of the meninges
Term
are meningiomas malignant or benign
Definition
well-defined and slow-growing. Usually benign.
Term
in what age group are mengiomas most common
Definition
older adults
Term
in what age group are pituitary adenomas most common
Definition
30's 40's
Term
what is a functional pituitary adenoma
Definition
symptoms of endocrine dysfunction only
Term
what is a nonfunctional pituitary adenom
Definition
neurological deficits from tumo
Term
what is the survival of pituitary adenoma
Definition
usually longterm survival
Term
what are other names for neurilemomas
Definition
neurinomas, neurolemmomas, schwannomas
Term
what are neurilemomas
Definition
slow-growing, benign tumors that originate from Schwann cells
Term
what is an acoustic neuroma
Definition
neurilemoma that involves the vestibular nerve and results in facial paralysis and hearing loss on the affected side
Term
what are signs and symptoms of brain tumors
Definition
increased ICP symptoms, seizures, focal disturbances
Term
what are the symptoms of increased ICP
Definition
headache most severe in the morning, vomiting in the morning esp in children, lethargy, drowsiness, irritability, gait disturbances
Term
what are focal disturbances
Definition
direct destruction of neural tissue or compression of the brain that results in headache, visual deficits, cranial nerve deficits, hemiparesis
Term
what are the 2 types of spinal tumors
Definition
intradural, extradural
Term
what is the first symptom of an extradural spinal tumor
Definition
pain
Term
what do extradural spinal tumors usually come from
Definition
metastases to the vertebrae that invade epidural space
Term
what are the symptoms of intradural spinal tumors
Definition
either sensory and motor deficits or pain
Term
how are CNS tumors managed
Definition
surgery, radiation, chemotherapy, biologic therap
Term
describe surgical management of CNS tumors
Definition
surgical removal, stereotactic resection, stereotactic radiosurgery using a gamma knife to destroy tumor cells
Term
what is the purpose of radiation
Definition
suppress tumor growth
Term
what is the purpose of chemotherapy
Definition
destroy cancer cells by interfering with DNA during cell division
Term
what do biologic therapies of CNS tumors do
Definition
angiogenesis inhibitors, gene therapy
Term
what are side effects of cancer treatments
Definition
nausea, fatigue, hair loss, vomiting, lethargy, skin damage from radiation, immune system depression
Term
what are side effects of steroids given to reduce cerebral edema
Definition
increased BP, water retention, weight gain, muscle weakness, steroid myopathy, osteoporosis
Term
what is diffuse cerebral radiation injury
Definition
occurs 6-18 months after radiation: patient shows cognitive changes like dementia, also gait disturbances
Term
what are medical complications following CNS tumors
Definition
seizures, diffuse cerebral radiation injury, focal cerebral radiation necrosis, thromboembolism
Term
what are the 4 Dietz classifications
Definition
preventative, restorative, supportive, palliative
Term
describe preventative classification
Definition
patient has no impairments that significantly impact function.
Term
how to treat someone with preventative classification
Definition
intervene early to minimize functional loss. Educate patient and family
Term
describe restorative dietz classification
Definition
patient will return to premorbid status with some residual impairments
Term
how to treat someone with restorative classification
Definition
maximize function
Term
describe supportive dietz classification
Definition
slowly progressive disability from residual tumor
Term
how to treat someone with supportive classification
Definition
functional training, equipment needs, discharge early
Term
describe palliative dietz classification
Definition
terminal
Term
how to treat someone with palliative classification
Definition
increase comfort. Provide emotional support
Term
list the manifestations of myelodysplasia
Definition
myelomeningocele, meningocele, lipoma,
Term
what is myelomeningocele
Definition
spina bifida aperta: open spinal cord defects that protrudes dorsally and causes spinal nerve paralysis
Term
what is meningocele
Definition
spina bifida aperta with skin covering and without paralysis
Term
what is a lipoma
Definition
fatty mass in spinal cord that can put pressure on part of the spinal cord
Term
do lipomyelomeningoceles cause paralysis
Definition
yes
Term
do lipomeningoceles cause paralysis
Definition
no
Term
what is the impact on body structure and function from myelodysplasia
Definition
musculoskeletal deformities of spine and lower limbs, postural problems
Term
what causes deformities associated with myelodysplasia
Definition
coexisting congenital malformations like club foot; secondary effects of neurologic deformities like contractures, intrauterine positioning/decreased fetal movement, habitually assumed positions due to weakness, fractures
Term
what are some postural problems you might see in a child with myelodysplasia
Definition
forward head, rounded shoulders, kyphosis, scoliosis, lordosis, anteior pelvic tilt, rotational deformities of hip or tibia, hip and knee flexion, foot pronation
Term
why is the hip prone to deformity in kids with myelodysplasia
Definition
unopposed muscle action. Torsional deformities result from hip anteversion or retroversion
Term
what deformities can be present/caused in the knee in kids with myelodysplasia
Definition
knee flexion from prolonged WC sitting. Knee extension from immobility. Varus and valgus from positional input
Term
what are negative effects of musculoskeletal deformities
Definition
positioning, body image, weightbearing, ADLs, energy expenditure, mobility
Term
give 3 tips for examination of a child with myelodysplasia
Definition
age-specific, test all dermatomes to get a baseline, beware of shunting and cognitive deficits
Term
what are some intervention strategies for kids with myelodysplasia
Definition
Maintain ROM; use orthotics to improve asymmetries; casting/taping/splinting for club foot; orthotics to maintain good foot integrity and position; assitive devices; promote good posture; promote proper weightbearing; promote proper alignment
Term
what are causes of brain abscesses
Definition
wounds, extensions of local infections
Term
what visual deficit is associated with pituitary adenoma
Definition
bitemporal hemianopsia
Term
what is the term for tumors that originate from structures outside the CNS
Definition
metastases
Term
speech disturbances and right hemiparesia are an example of ICP, cerebral hemorrhage, direct destruction of neural tissue, or overproduction of CSF?
Definition
direct destruction of neural tissue
Term
why are patients with brain tumors often on steroids
Definition
to decrease ICP
Term
can PTs check for papilledema?
Definition
no, that's for physicians.
Term
in what region of the brain do most tumors occur in children
Definition
brainstem and cerebellum
Term
in what region of the brain do must tumors occur in adults
Definition
supratentorial
Term
what are the 3 major types of brain infections
Definition
brain abscesses, meningitis, encephalitis
Term
symptoms of brain abscesses
Definition
increased ICP, altered consciousness, focal neurological deficits
Term
what are symptoms of increased ICP
Definition
headache, vomiting, papilledema
Term
what are symptoms of focal neurological deficits
Definition
hemiparesis, dysphagia, visual field deficits, ataxia
Term
what medical management options exist for brain abscess
Definition
surgery, antibiotics
Term
what is meningitis
Definition
infection spread through CSF
Term
what parts of the CNS can be affected by meningitis
Definition
pia mater, arachnoid mater, subarachnoid space, adjacent brain and spinal cord
Term
what causes meningitis
Definition
trauma, spread of middle ear infection
Term
is meningitis bacterial or viral
Definition
can be either
Term
is viral or bacterial meningitis more common
Definition
viral
Term
is viral or bacterial meningitis more severe
Definition
bacterial
Term
symptoms of meningitis
Definition
increased ICP, increased BP, fever, nuchal rigidity, Kernig's sign, Brudzinski's sign
Term
what are symptoms of increased ICP
Definition
severe headache, nausea, vomiting
Term
what is nuchal rigidity
Definition
resistance to passive neck flexion
Term
what is kernig's sign
Definition
pain and resistance to knee extension with hips flexed to 90 deg
Term
what is brudzinski's sign
Definition
involuntary flexion of hips and knees with passive neck flexion
Term
what is medical management of meningitis
Definition
manage symptoms. Antibiotics for bacterial type
Term
what are longterm sequelae of meningitis
Definition
sensorineural hearing loss from involvement of CN VIII, involvement of other CN, sensorimotor dysfunction, cognitive/perceptual deficits
Term
what is encephalitis
Definition
inflammation of brain tissue and surrounding meninges
Term
is encephalitis more often bacterial or viral?
Definition
viral
Term
what are symptoms of encephalitis
Definition
fever, headache, nuchal rigidity, vomiting, general malaise, CN palsy, hemiplegia, coma
Term
how to manage encephalitis
Definition
manage ICP. Manage symptoms
Term
major components of PT intervention for acute CNS infection
Definition
manage symptoms. ROM, positioning, skin care, coma stim if appropriate. Quiet environment and monitor physiological function. Progress to work on motor and functional abilities.
Term
major components of PT intervention for subacute/rehab CNS infection
Definition
similar to intervention for someone post TBI or CVA: improve motor and function.
Term
is hypertonia or hypotonia likely after CNS infection?
Definition
yes, either
Term
have functional improvements been shown in research involving neuroplasticity?
Definition
yes
Term
what types of intervention strategies have been used in research?
Definition
treadmill locomotion, uptraining/downtraining of spinal stretch reflexes, changing frequency/intensity/duration of training
Term
what is downtraining of a spinal stretch reflex
Definition
decreasing the spinal stretch reflex
Term
what are some intervention strategies for facilitating neuroplasticity and behavioral recovery
Definition
LiteGait BWST, treadmill locomotion, adding sensory feedback, using estim, aquatic treadmill, EMG + biofeedback for uptraining/downtraining
Term
what changes can be seen in someone with SCI following BWSTT
Definition
improvements with stepping. Least improvements with locomotor robot (more with estim, manual assistance)
Term
what are some options for improving functional abilities and fitness in individuals after spinal cord injury
Definition
Step Training!! Pool/aquatic treadmill. BWSTT. EMG + biofeedback to uptrain/downtrain Spinal stretch reflexes. Estim. Proprioception/sensory feedback. Neural prosthesis = brain/computer interface that takes signal from brain and implants it into muscle or other device
Term
what are critical components of equipment evaluation
Definition
alignment, patient ability, adjustments for growth, portable, appearance, modifiable for increase or decrease in function, replacement costs, safe, what will it be used for, who will help use it
Term
what are reasons for adaptive/assistive equipment
Definition
facilitate normal posture/tone/alignment. Mobility. Improve function. Improve learning experiences.
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