Neuro Review
To test _____________ awareness, the therapist moves the patient's joint in small movements and asks the patient to identify the movement, using pre-agreed terminology, during the movement.
kinesthesia
____________________ gait is characterized by posterior leaning of the trunk at heel strike in order to keep the hip extended during the stance phase. It is caused by weakness of the gluteus maximus. It also is called lurching gait.
Hip extensor gait
When the ____________ is involved, the upper extremity is often more involved than the lower extremity. Personality changes are possible, but more likely with ACA than MCA. Lastly, gait sensory ataxia is more common with MCA, but gait apraxia is more common with ACA involvement.
MCA
The ______________ reflex appears at 28 weeks' gestation and is integrated at 3-5 months of age. The stimulus to elicit the response is dropping the head backward. The response consists of abduction and extension of arms, and splaying of fingers, and may be followed by arm flexion and adduction.
Moro reflex
GCS: Motor Response Scale
Motor Response • Obeys commands for movement 6 points • Localizes pain 5 points • Withdraws in response to pain 4 points • Flexion in response to pain (decorticate posturing) 3 points • Extension in response to pain (decerebrate posturing) 2 points • No response 1 point
The _____________________ is an objective measure of static and dynamic balance abilities. Berg Balance scores have been shown to be useful in predicting falls in the elderly and evaluating changes in patients undergoing physical therapy. The Berg Balance Test would not be particularly useful with an active 36-year-old woman without a history of balance deficits. It may be useful for an older patient with vestibular dysfunction.
Berg Balance Test
The _____________________ pathway is a pyramidal motor tract responsible for contralateral voluntary fine movement of the extremities.
lateral corticospinal *Damage to the corticospinal (pyramidal) tracts (anterior and/or lateral) results in a + Babinski Sign, absent superficial abdominal reflexes and cremasteric reflex, and the loss of fine motor or skilled voluntary movement.
The ______________ nerve supplies the muscles of the thenar eminence, not hypothenar.
median
Activities of the ____________ stage of motor development require free motion that translates a body part in space, which includes movement speed and range of motion.
mobility stage of motor development
An APGAR score after 1 minute that equals _____ indicates that the infant is in life-threatening distress and requires intense medical interventions.
0-2
The _______________ nerve does not have any intrinsic hand muscle innervation and therefore cannot affect the thenar or hypothenar eminence.
radial
In ________________ practice, different tasks are repeatedly practiced, but in random order.
random practice
An APGAR score after 1 minute that equals _____ indicates that the infant is in distress and requires medical interventions.
3-4
An APGAR score after 5 minutes that equals _________ indicates that the infant will require further monitoring and be retested every 5 minutes to see if the infant's respiratory status improves.
5-6
____________________ is an autoimmune disease caused by demyelination of the central nervous system that typically affects females intheir 30s or 40s. Multiple sclerosis is often diagnosed via evidence of lesions to the central nervous system in two or more areas via magnetic resonance imaging. The finding of normal magnetic resonance imaging makes multiple sclerosis an unlikely diagnosis in this scenario.
Multiple sclerosis
_______________ is a central nervous system lesion. Weakness and impaired sensation are common symptoms of this disease. However, deep tendon reflexes should not be absent during examination. In fact, reflexes tend to be hyperactive in these patients.
Multiple sclerosis (MS)
The ___________ reflex appears at 20 weeks of gestation and is integrated at 4-5 months of age. The stimulus to elicit the response is turning of the head. The response consists of facial arm extensions with occipital arm flexion and abduction.
ATNR refrlex
The _____________ reflex appears at birth and is integrated at approximately 6-9 months of age but can last as long as 24 months of age. The stimulus to elicit the response is firmly stroking the sole of the foot from heel toward the toes. The response consists of the big toe extending and the toes fanning out.
Babinski Reflex
The ____________________ is a 55-item questionnaire designed to examine how children and youth participate in everyday activities outside of their school classes.
Children's Assessment of Participation and Enjoyment
A physical therapist is treating a patient with a history of seizures due to traumatic brain injury that is being managed by medication. Which of the following adverse effects is common with antiseizure medications? A. Dry mouth B. Hypertension C. Immunosuppression D. Sedation
Correct Answer: D Common classes of antiseizure medications, such as barbiturates, benzodiazepines, and hydantoins, have sedation as one of their most common adverse effects. Bottom Line: Sedation is a common side effect of antiseizure medications, such as barbiturates, benzodiazepines, and hydantoins. TrueLearn Insight : Physical therapists must be familiar with the medications that are commonly used to treat specific neurological diseases so that they can recognize the primary and adverse effects of these medications for their patients.
A patient with a C4 complete spinal cord injury has been treated in an inpatient rehabilitation facility for 2 months and is ready to be discharged. The patient's spouse is supportive and eager for the patient to be discharged home. Which of the following discharge goals is the MOST appropriate for this patient? A. Patient's wife will be independent in assisting with coughing by performing manual pressure to the diaphragm B. Patient will be independent in the use of a power wheelchair adapted with joystick control C. Patient will be independent in feeding while donning strap on hand with utensil attached D. Patient's wife will be independent in monitoring mechanical ventilator settings
Correct Answer: A At the C4 spinal cord injury level, the diaphragm is still innervated, and the patient can breathe independently. However, ability to cough and clear secretions is severely compromised. The patient will be dependent on someone else to support clearance of any fluids or phlegm. Having the spouse be independent in the cough assist will prevent respiratory complications, which are common in patients with spinal cord injury. Working toward independence of the spouse in caring for this complex patient is an important priority and is the best goal from the options presented. Bottom Line: A patient with a complete C4 injury is able to breathe independently (because the diaphragm is innervated) and is able to use a power wheelchair with head and neck controls. The upper extremity and lower extremity muscles do not function except for some trapezius activity, and the patient will be dependent for most ADLs. Patients will need assistance clearing airway secretions.
A physical therapist has been working with a patient who sustained a cerebrovascular accident 2 weeks earlier. The therapy session has focused on transfers from the bed to a chair, and the patient has been able to perform the skill. Which of the following actions would be an appropriate RETENTION TEST for this client? A. Return to the patient later in the day and ask them to demonstrate the skill B. Repeat the transfer one final time without cues to determine if the patient has learned the skill C. Ask the patient to demonstrate the skill in a different location D. Ask the patient to demonstrate their ability to transfer between two chairs
Correct Answer: A In a retention test, the skill is examined after a period of no practice. So returning to the patient later the same day and asking them to demonstrate the bed-to-chair transfer would be an appropriate test of retention. Some retention tests provide a longer interval of no training, however, of the option presented here, this is the only one that includes a time period of no practice and then asks the patient to demonstrate the skill. Bottom Line: Practice may result in the acquisition of a skill and ability to performance a task at that time. However, to determine whether a patient has retained the skill, there needs to be a period without practice, after which the patient can demonstrate the skill. After the patient has demonstrated the basic skill, the concepts of generalizability and transfer can be practiced, in which the skill is taken to a different environment, or the skill is changed. TrueLearn Insight: To demonstrate retention, there must be a period of no practice, a retention interval, after which, if the patient can demonstrate the skill, there is proof of learning.
A 36-year-old, active woman presents with a 1-month history of positional vertigo with rolling to the right side. She is having trouble with bed mobility, bending over to dry her hair, and looking up to get things out of high cabinets. The onset was insidious with no prior issues. She has to sit on the bed for a minute or so until the symptoms subside before getting up in the morning. What outcome measure would be BEST to use for this patient? A. Dizziness Handicap Inventory B. Dynamic Gait Index C. Berg Balance Test D. The SF-36 Health Survey
Correct Answer: A The Dizziness Handicap Inventory is a popular tool used to measure a patient's self-perceived handicap as a result of a vestibular disorder. It has excellent test-retest reliability and good internal consistency reliability. It is useful to establish subjective improvement. It has very specific vestibular questions pertaining to symptoms with looking up and down, and rolling over in bed.
A physical therapist is treating a patient with a history of type I diabetes who is unable to dorsiflex his right foot or extend his toes, and who has numbness between the first and second toes. The patient has no other complaints of motor or sensory loss in the right lower extremity. Nerve conduction velocity testing found decreased conduction velocity in the right lower leg. A shoe evaluation showed no excess wear. Which of the following areas of the nervous system is the MOST likely location of injury for this patient? A. Deep peroneal/fibular nerve B. Superficial peroneal/fibular nerve C. Common peroneal/fibular nerve D. Diabetic neuropathy
Correct Answer: A This scenario described above describes an isolated injury to the deep fibular/peroneal nerve since nerve conduction testing isolated the injury to the lower leg and the dorsiflexion weakness and location of the sensory loss is related to that portion of the nerve. Bottom Line: The common fibular/peroneal nerve divides into: Superficial fibular nerve, which innervates the muscles of the lateral compartment of the leg; fibularis longus and brevis. Deep fibular nerve, which innervates the muscles of the anterior compartment of the leg; tibialis anterior, extensor digitorum longus, and extensor hallucis longus.
A patient with a mild brain injury is seen in the acute care hospital. The patient scores a 14 on the Glasgow Coma Scale (GCS). Based on these findings, the patient is MOST likely to have demonstrated which of the following reactions during testing? A. Localized motor response to pain B. Eye opening to pain only C. Inappropriate words D. Extensor motor response to pain
Correct Answer: A To be categorized as a mild brain injury, the patient has to score 13 or more on the scale (out of a maximum of 15). To achieve this, they have to be in the higher categories of the scale, and localized motor response s the highest scoring category of the answers given. The others all score only 2 or 3 in their category, which would not allow the patient to score a 14 as noted in the question stem. Glasgow Coma Scale Eye Opening Response • Spontaneous: open with blinking at baseline 4 points • To verbal stimuli, command, speech 3 points • To pain only (not applied to face) 2 points • No response 1 point Verbal Response • Oriented 5 points • Confused conversation, but able to answer questions 4 points • Inappropriate words 3 points • Incomprehensible speech 2 points • No response 1 point Motor Response • Obeys commands for movement 6 points • Localizes pain 5 points • Withdraws in response to pain 4 points • Flexion in response to pain (decorticate posturing) 3 points • Extension in response to pain (decerebrate posturing) 2 points • No response 1 point Head Injury Classification: Severe Head Injury: GCS score of 8 or less Moderate Head Injury: GCS score of 9 to 12 Mild Head Injury: GCS score of 13 to 15
A physical therapist performs a neurologic examination on a patient with generalized weakness and reports of tingling in the legs. The weakness started in the legs about a week ago and is now in all four extremities. Strength testing revealed knee extensors 3-/5 bilaterally, dorsiflexors 2+/5 bilaterally, and all other musculature 3/5 at present. Deep tendon reflexes in the Achilles tendon and patellar tendon are absent bilaterally. Which of the following conditions is the patient MOST likely to have? A. Impingement of the S1 nerve root and the L4 nerve root B. Acute inflammatory demyelinating polyneuropathy C. Multiple sclerosis D. An old stroke
Correct Answer: B Acute inflammatory demyelinating diseases, such as Guillain-Barré syndrome, affect the peripheral nervous system. The hallmarks of this disease are weakness, loss of sensation, and hyporeflexia or areflexia. In this case, the lack of deep tendon reflexes is the most telling sign that this patient is presenting with a peripheral nervous system problem. In addition, the involvement of different areas of the body also indicates that the problem is not isolated to a single area or nerve root.
A physical therapist is examining a child who has been referred for gait training due to cerebral palsy. When the child ambulates, the gait is characterized by forefoot strike to initiate the gait cycle, and premature plantarflexion in the loading response interval to midstance. This is an example of WHICH type of gait pattern? A. Diplegic gait B. Equinus gait C. Sensory gait D. Hip extensor gait
Correct Answer: B Equinus gait is characterized by forefoot strike to initiate the gait cycle, and premature plantarflexion in the loading response interval to midstance, also known as "toe walking gait pattern."
A physical therapist is completing an initial examination of a 40-year-old patient with dementia. The patient exhibits uncontrolled writhing movements of the extremities that has caused repeated falls. The patient demonstrates decreased executive function and attention. The patient's family also reports a history of psychotic episodes in which the patient attempted self-harm. Which of the following is the MOST likely diagnosis for this patient? A. Alzheimer's disease B. Huntington's disease C. Korsakoff's syndrome D. Parkinson's disease
Correct Answer: B Huntington's disease is a neurodegenerative disease that is due to a genetic abnormality on chromosome 4 that causes symptoms to initially present when the patient is in their 30s or 40s. Patients with this disorder typically demonstrate movement dysfunction, which is typically chorea, and cognitive symptoms, including decreased executive function, inattention, depression, and psychosis. There is no treatment currently available to slow the progression of Huntington's disease, which leads to death typically within 10 to 20 years from diagnosis. Bottom Line: Huntington's disease is a fatal neurodegenerative disease that is due to a genetic abnormality that causes movement dysfunction and cognitive symptoms. Physical therapists must be able to identify various diagnoses associated with neurological dysfunction and adapt their strategies for the treatment and examination according to the diagnosis.
A physical therapist in the hospital is performing a chart review of a 38-year-old female with a history of sudden-onset headache, photophobia, and neck stiffness. Magnetic resonance imaging was normal. A lumbar puncture found an elevated white blood cell count, elevated proteins, and increased cerebral spinal fluid pressure. What is the most likely diagnosis in this scenario? A. Guillain-Barré syndrome B. Meningitis C. Multiple sclerosis D. Hydrocephalous
Correct Answer: B Meningitis is an infection that causes inflammation of the meningeal layer of the central nervous system. Meningitis may be caused by bacterial, viral, or fungal infection. The symptoms of meningitis include headache, photophobia (sensitivity to light), and neck stiffness. A lumbar puncture for a patient with meningitis will indicate an elevated white blood cell count, elevated proteins, and increased cerebral spinal fluid pressure. Bottom Line: Meningitis is an infection that causes inflammation of the meningeal layer of the central nervous system. The symptoms of meningitis include headache, photophobia, and neck stiffness. Physical therapists must be able to identify different diagnoses associated with neurological dysfunction and adapt their strategies for the treatment and examination according to the diagnosis.
If a baby continues to demonstrate the asymmetric tonic neck reflex (ATNR) after 6 months of age, which of the following activities would be MOST affected? A. Prone lying B. Rolling C. Sucking D. Cervical rotation
Correct Answer: B Rolling involves rotating the neck. If the ATNR is retained, then as the child turns the head, the upper extremity (UE) on the side of the head rotation will move into extension, and the other arm will flex. These UE positions make it difficult to roll. Bottom Line: The asymmetric tonic neck reflex (ATNR) occurs with rotation of the head and causes extension of the upper extremity on the face side and flexion of the upper extremity on the contralateral side. This reflex is usually integrated by 6 months of age, and if retained can make some ADLs, such as rolling or feeding oneself, difficult.
A physical therapist is treating a 1-year-old child with spastic diplegic cerebral palsy. The physical therapist is practicing weight-shifting activities in quadruped position by rocking back and forth with the arms on the floor to prepare the child to crawl reciprocally. What Rood stage of motor development is this activity? A. mobility B. controlled mobility C. skill D. stability
Correct Answer: B The Rood stages of controlled mobility describe a system of classifying motor development based on the developmental sequence. According to Rood, infants in the controlled mobility stage are stable in a weight-bearing position in which the proximal limb moves on a fixed distal limb, which includes activities such as weight shifting. Bottom Line: The Rood stages of controlled mobility describe a system of classifying motor development based on the developmental sequence. According to Rood, infants in the controlled mobility stage are stable in a weight-bearing position in which the proximal limb moves on a fixed distal limb, which includes activities such as weight shifting.
An individual had a hemorrhagic stroke and presents with minimal left-sided weakness of the extremities with the lower extremity more involved than the upper extremity, gait apraxia, and behavioral changes. The physical therapist should suspect a lesion primarily in which of the following locations? A. Left anterior cerebral artery B. Right anterior cerebral artery C. Left middle cerebral artery D. Right middle cerebral artery
Correct Answer: B The anterior cerebral artery (ACA)supplies oxygenated blood to the frontal lobes and superior medial parietal lobes. A stroke in the right ACA would cause weakness contralaterally in the left extremities.The most common results of a stroke in this area include: Contralateral motor and sensory loss with lower extremity more affected than upper extremity Gait apraxia Personality and behavior changes (frontal lobe involvement) Bottom Line: The anterior cerebral artery (ACA) supplies oxygenated blood to the frontal lobes and superior medial parietal lobes. A stroke in the right ACA would cause weakness contralaterally in the left extremities. TrueLearn Insight : When reviewing the effects of a hemorrhagic stroke, it is important to know: The area of the brain supplied by each artery The function of each of these areas of the brain Whether the presentation would be seen ipsilaterally or contralaterally
The physical therapist is assessing a full-term infant for primitive reflex activity. The therapist places the infant in supine and firmly strokes the sole of the foot. The therapist notes flexion in the stimulated leg and extension of the opposite leg with adduction. The reflex demonstrated is: A. Babinski reflex B. Crossed extension reflex C. Moro reflex D. Galant reflex
Correct Answer: B The crossed extension reflex appears at 28 weeks' gestation and is integrated at 1-2 months of age. The stimulus to elicit the response is a noxious stimulus to the foot. The response consists of flexion in the stimulated leg and then extension of the opposite leg with adduction.
A 70-year-old woman was referred to physical therapy with a 6-month history of progressive gait difficulties, left-leg numbness, and urinary problems. Previously the patient was able to walk 2 to 3 miles a day until she noticed gait difficulties and bilateral leg stiffness. She complained that she was not able to fully control her legs. The therapist would like to test the lower extremities for vibration sense. What pathway carries this information? You answered this question correctly. A. Lateral corticospinal B. Posterior column-medial lemniscal C. Anterolateral D. Spinothalamic
Correct Answer: B The posterior column-medial lemniscal pathway conveys proprioception, vibration sense, and fine, discriminative touch. This would be the appropriate pathway to test vibration.
A 58-year-old male with a prior medical history of hypertension, diabetes mellitus (type II), and obesity presents with low back pain and numbness in both feet. Sensation testing reveals numbness to the bottom of both feet and over the dorsal surface of toes 3 and 4 on the right and toes 1 and 2 on the left. Which of the following impairments is MOST consistent with these findings? A. Compression of the L4 nerve root on right and S1 nerve root on left B. Compression of the S1 nerve root on right and L4 nerve root on left C. Diabetic neuropathy D. Compression of anterior spinal cord
Correct Answer: C Diabetic neuropathy is a common complication of diabetes mellitus. About half of individuals with diabetes mellitus have some sort of neuropathy. Common symptoms include numbness, tingling, and pain, usually in the distal extremities such as in the feet and toes. Symptoms do not follow dermatomal patterns, such as in nerve root compressions. Therefore, in this case, symptoms are more consistent with diabetic neuropathy
Which of the following lists of equipment is required to perform the Berg balance scale with a patient accurately? A. Stopwatch, armchair, measured walkway, foam pad B. Foam pad, 6-inch step, stopwatch, armchair C. Chairs with and without arms, stopwatch, ruler, 6-inch step D. Measured walkway, ruler, chair without arms, foam pad
Correct Answer: C The Berg Balance scale is an objective test to measure balance and fall risks in adults.The Berg balance scale requires chairs with and without arms for the transfer test, a stopwatch for timing, a ruler for the functional reach component, and a 6-inch step for the alternative stepping activity. Without this complete list of equipment, the therapist cannot accurately perform the test.
A physical therapist is conducting an evaluation on a patient who is 1 day post cerebrovascular accident. Which of the following sensory tests should the therapist conduct FIRST? A. Kinesthesia awareness B. Stereognosis perception C. Touch awareness D. Tactile localization
Correct Answer: C Touch awareness is determining if the patient can feel tactile touch in specific areas of the body. It is tested through the application of a cotton swab or ball or tissue brushed lightly on the patient, and the patient reporting if they have been touched. A patient that is not able to feel they are being touched will not be able to perform the other tests that ask the location of the touch, or the recognition of an object with eyes closed, if for example that extremity has no sensation. In addition testing position sense on a limb or extremity with absent sensation may have to be done differently. In summary, one must assess if the patient has intact sensation first, then, other tests can build upon that.
A 30-year-old male patient who was involved in a motor vehicular accident was diagnosed with traumatic brain injury. The physical therapist noted that the patient is exhibiting signs of lower extremity dysmetria. As part of the treatment plan, what is the BEST intervention for the patient? A. Alternating heel raises and dorsiflexion B. Side-lying hip abduction C. Walking in sync with a metronome D. Placing feet on floor markers alternately
Correct Answer: D Dysmetria is described as inability to judge distance or range of movement. Having an activity that incorporates ability to judge distance or range, such as placing feet on floor markers, is the most appropriate for the patient. Bottom Line: Placing foot markers on the floor is an appropriate intervention for improving lower extremity coordination.
A physical therapist is working with a patient who recently experienced a cerebrovascular accident. The therapist is working on functional transfers but spends a significant portion of the treatment session working on sit-to-stand. After a short rest period, the therapist then works for an extended time with the patient in standing, turning 90 degrees, and then turning back again. Finally, the therapist works on a stand pivot transfer. Which type of practice schedule is the therapist utilizing? A. Serial B. Distributed C. Random D. Parts to whole
Correct Answer: D In parts-to-whole practice, a task is broken down into parts, and each part is practiced individually. The entire task is finally practiced at the end.
A physical therapy student is starting a clinical experience in a neonatal intensive care setting. Which of the following sets of APGAR scores would require no further monitoring or interventions? A. 1 minute: APGAR 2 B. 1 minute: APGAR 4 C. 5 minutes: APGAR 6 D. 5 minutes: APGAR 8
Correct Answer: D The APGAR test is a commonly used screening tool for the health of a newborn that typically is administered 1 and 5 minutes after birth. The APGAR test measures the newborn's appearance (A), pulse (P), grimace (G), activity (A), and respiration (R) on a scale of 0 to 2 so that total scores vary from 0 to 10 on the APGAR test. An APGAR score after 1 or 5 minutes that is greater than 7 is commonly interpreted as normal.
The physical therapist is assessing a full-term infant for primitive reflex activity. The therapist places the infant on all fours, and his head drops forward to the ground in flexion. The therapist notes that the upper extremities flex and the hips extend. The reflex demonstrated is WHICH of the following? A. Asymmetric tonic neck reflex (ATNR) B. Crossed extension reflex C. Galant reflex D. Symmetric tonic neck reflex (STNR)
Correct Answer: D The STNR appears at 4-6 months after full-term delivery and is integrated at 8-12 months of age. The stimulus to elicit the bilateral response is flexion or extension of the head. The response with head flexion is arm flexion and hip extension. The response with head extension is arm extension and hip flexion.
A physical therapist is conducting an initial examination for a patient with an incomplete spinal cord injury. The physical therapist uses a painful stimulus to the right big toe during sensory testing. Which spinal tract is being tested? A. dorsal column medial lemniscus B. gracile fasciculus C. spinocerebellar D. spinothalamic
Correct Answer: D The spinothalamic tract relays pain and temperature information in the spinal cord. Depending on which tracts of the spinal cord are affected, patients will demonstrate different patterns of sensory deficits, which will require the physical therapist to adjust the treatment plan and patient education accordingly.
A patient presents to the clinic with hypothenar atrophy of insidious onset which he noticed is worsening over the past months. His medical history is noncontributory. He works out at the gym 2 days a week and rides his bicycle 5 days a week but does not recall any injuries, just some hand discomfort. He is also having difficulty typing at the computer. What nerve damage does the physical therapist most likely suspect led to the muscle atrophy? A. Median B. Posterior interosseous nerve C. Radial D. Ulnar
Correct Answer: D The ulnar nerve supplies sensation and motor function to the hypothenar eminence. It can be compressed where it enters the hand in Guyon's canal if one leans on the hand for a long periods of time, such as when bicycling. It is also called handlebar palsy. Bottom Line: The ulnar nerve supplies the ulnar side of the hand. The deep branch innervates the hypothenar muscles (abductor digiti minimi, opponens digiti minimi, flexor digiti minimi), all of the interosseous muscles, the 3rd and 4th lumbricals, the adductor pollicis, and the medial head (deep) of the flexor pollicis brevis (FPB). The superficial branch provides sensation to the palmar surface of the medial one and a half fingers.
Sensory tract for the trunk, neck and UE proprioception, vibration, 2 point discrimination, and graphesthesia.
Cuneatus Fasciculus
The _______________ reflex appears at 28 weeks of gestation and is integrated at approximately 3 months of age. The stimulus to elicit the response in prone is stroking of paravertebral skin. The response consists of lateral curvature of the trunk on the stimulated side.
Galant reflex
The _____________________ is used to predict cerebral palsy in infants under the age of 20 weeks.
General Movements Assessment
The ____________________ is the part of the dorsal column medial lemniscus and is a sensory tract that relays proprioception, two-point discrimination, vibration, and graphesthesia of the lower leg and trunk in the spinal cord.
Gracile Fasciculus
___________________ is an autoimmune disease that causes demyelination of the peripheral nervous system. A lumbar puncture for a patient with Guillain-Barré syndrome will indicate increased protein levels but no increase in white blood cell count or cerebral spinal fluid pressure
Guillain-Barré syndrome
Patients with ___________ gait have involvement on both sides with spasticity in lower extremities worse than upper extremities. The patient walks with an abnormally narrow base, dragging both legs and scraping the toes.
Diplegic Gait
__________________ practice focuses on the rest periods in relation to the practice time. It requires the patient to have rest time equal to or more than time spent practicing the task.
Distributed practice
The ______________________ is a very useful tool for evaluating high-level gait. It examines the patient's ability to perform variations in walking on command. It can be used for individuals with vestibular dysfunction (examining gait with head turns is particularly useful with vestibular patients).
Dynamic Gait Index
________________________ is a condition caused by an increase in cerebral spinal fluid in the brain. Symptoms of hydrocephalous include headache, decreased balance, double vision, and decreased cognitive status. Hydrocephalous will cause an enlargement in the ventricles of the brain due to the increased intracranial pressure. Hydrocephalous may be caused by scarring associated with meningitis, and a lumbar puncture would indicate an elevated cerebrospinal pressure. However, a finding of normal magnetic resonance imaging along with elevated proteins and white blood cell counts would make hydrocephalous an unlikely diagnosis in this scenario.
Hydrocephalous
________________ is the awareness of movement and is a critical test for individuals post CVA to identify the sensory areas that are damaged. It would not be the first sensory test completed.
Kinesthesia
______________ syndrome is usually caused by chronic alcoholism. Patients with this disorder present with confabulation, decreased short-term memory, and decreased long-term memory as their primary symptoms. There is no associated chorea.
Korsakoff's syndrome
Patients with ___________________ display resting tremors in the hands, a shuffling gait pattern, and difficulty initiating movement; cognitive symptoms appear later in the disease course. While a minority of patients with this disease are diagnosed before the age of 50, a patient is more likely to be diagnosed when they are over the age of 60.
Parkinson's disease
The _______________ is a more generalized questionnaire with 36 health-related questions pertaining to health status and general functioning. It can be used with a variety of impairments but is not specific to dizziness or vestibular patients.
SF-36 Health Survey
The _____________ reflex appears at 4-6 months after full-term delivery and is integrated at 8-12 months of age. The stimulus to elicit the bilateral response is flexion or extension of the head. The response with head flexion is arm flexion and hip extension. The response with head extension is arm extension and hip flexion.
STNR Reflex
_________________ gait occurs when there is loss of this proprioceptive input. In an effort to know when the feet land and their location, the patient will slam the foot hard onto the ground in order to sense it. A key to this gait involves its exacerbation when patients cannot see their feet (i.e., in the dark). This gait also is sometimes called a stomping gait since patients may lift their legs very high to hit the ground hard.
Sensory gait
GCS: Head Injury Classification Scale
Severe Head Injury: GCS score of 8 or less Moderate Head Injury: GCS score 9 to 12 Mild Head Injury: GCS 13 to 15
Sensory tract that ascends to the cerebellum for ipsilateral subconscious proprioception, tension in muscles, joint sense, and posture of the trunk and lower extremities
Spinocerebellar Tract (Dorsal and Ventral)
Sensory tract for crude touch and pressure
Spinothalamic Tract (Anterior)
Sensory tract for pain and temperature sensation
Spinothalamic Tract (Lateral)
______________ perception is the ability to recognize familiar objects through touch. This would involve the patient picking up an item such as a paperclip, and without looking at it, be able to identify the item. It would not be the first sensory test completed.
Stereognosis perception
____________ tests whether a patient can localize touch on the skin, that is, identifying where on their body they are being touched by the therapist. It does not involve movement. It would not be the first sensory test completed. First, one must determine if the patient has sensation at all in that area.
Tactile localization
Which of the following tools would be MOST appropriate to use as an outcome measure to track the improvement of functional mobility during age-appropriate activities when treating a 10-year-old child with spastic diplegic cerebral palsy? A. Children's Assessment of Participation and Enjoyment (CAPE) B. General Movements Assessment C. Gross Motor Function Measure ( GMFM) D. Functional Independence Measure for children (WeeFIM®)
The Gross Motor Function Measure (GMFM) is a clinical tool designed to evaluate change in gross motor function in children with cerebral palsy from birth to 21 years of age. Items on the GMFM-88 span the spectrum of activities from lying and rolling up, to walking, running, and jumping skills. Bottom Line: The Gross Motor Function Measure is a clinical tool designed to evaluate change in gross motor function in children with cerebral palsy from birth to 21 years of age. Physical therapists must be able to choose the appropriate outcome measure based on the clinical situation in order to accurately and efficiently examine their patients.
The ____________________ consists of a minimal data set of 18 items that measure functional performance in three domains: self-care, mobility, and cognition. It designed to for children under the age of 7.
WeeFIM® instrument
The __________________ reflex appears at 28 weeks of gestation and is integrated at 1-2 months of age. The stimulus to elicit the response is a noxious stimulus to the foot. The response consists of flexion in the stimulated leg and then extension of the opposite leg with adduction.
crossed extension reflex
The ___________ portion of the peroneal/fibular nerve innervates the muscles of the anterior compartment of the leg; tibialis anterior, extensor digitorum longus, and extensor hallucis longus.
deep
In ____________ practice, several tasks are practiced in a predictable sequence. For example, three tasks are practiced 1, 2, 3 and then repeated 1, 2, 3.
serial practice
Activities of the __________ stage of motor development require the distal extremity to be free from the support surface while moving in a coordinated manner.
skill stage of motor development
Activities of the _____________ stage of motor development require weight-bearing use of the extremities to fix the body using co-contraction of agonist and antagonist muscles.
stability stage of motor development
A ___________ is a central nervous problem. Weakness resulting from a stroke can persist, especially in hemiparesis or hemiplegia. However, deep tendon reflexes should be present or even hyperactive and symptoms would not be bilateral.
stroke
The ___________ portion of the peroneal/fibular nerve innervates the muscles of the lateral compartment of the leg; fibularis longus and brevis.
superficial
The_______________ nerve supplies the ulnar side of the hand. The deep branch innervates the hypothenar muscles (abductor digiti minimi, opponens digiti minimi, flexor digiti minimi), all of the interosseous muscles, the 3rd and 4th lumbricals, the adductor pollicis, and the medial head (deep) of the flexor pollicis brevis (FPB). The superficial branch provides sensation to the palmar surface of the medial one and a half fingers.
ulnar nerve
GCS: Verbal Response Scale
• Oriented 5 points • Confused conversation, but able to answer questions 4 points • Inappropriate words 3 points • Incomprehensible speech 2 points • No response 1 point
GCS: Eye Opening Response Scale
• Spontaneous: open with blinking at baseline 4 points • To verbal stimuli, command, speech 3 points • To pain only (not applied to face) 2 points • No response 1 point
