NM 3

most common canal affected by BPPV

posterior

TUG

10 ft <10 sec - independent 10-20 sec - increased fall risk >30 sec - high fall risk

PET for neurological dysfunction

2 and 3D pictures of brain activity

ankle vs hip strategy

ankle - distal to proximal hip - proximal to distal

myasthenia gravis

autoimmune disease at NM junction antibodies block receptors that are needed for acetylcholine uptake, which prevents muscle contraction

tics

sudden, brief, repetitive coordinated movements at irregular intervals Tourette's

etiology of GBS

thought to be autoimmune after previous infection (Epstein-Barr)

examples of anti-spasticity agents

baclofen, diazepam, dantrolene, tizanidine

akinesia

inability to start movement, PD

cog wheel vs lead pipe

lead pipe - constant resistance throughout range cog wheel - catching throughout resistance, phasic

global aphasia

lesion - frontal, temporal, parietal lobes comprehension severely impaired impaired naming, writing, reptition may involuntarily verbalize may use non-verbal skills for communication

conduction aphasia

lesion to supramarginal gyrus, arcuate fasciculus severe impairment with repetition intact fluency and comprehension issues with word finding reading intact, writing impaired

central vertigo

less ANS sx loss of consciousness diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria

Modified Ashworth 0

no increase in muscle tone

verbal apraxia

non-dysarthria and non-aphasic impairment of speech verbal expression impaired bc of motor planning can't initiate learned movement (speech production) even tho they understand the task L frontal lobe lesion

central vestibular lesion

nystagmus - bidirectional or unidirectional no inhibition with fixation mild vertigo may be chronic etiology - demyelination, vascular lesion, cancer / tumor

peripheral vestibular lesion

nystagmus - unidirectional (fast is opposite to lesion) visual fixation will inhibit nystagmus and vertigo significant vertigo can be recurrent and long lasting etiology - Meniere's, vascular disorders, trauma, toxicity, inner ear infection

testing for BPPV

Dix Hallpike

functional reach test

3 trials, take the average

PD etiology

50-79 uo genetics CO toxicity vascular impairment

Fregly-Graybiel Ataxia Test Battery

8 conditions, measuring time spent in test position and number of steps pt takes without falling 5 trials, items based on pass / fail

CTS tissue pressure

> 30 mmHg, normal is 2-10

anterior horn pathology

ALS sensory intact motor weakness / atrophy fasciculations decreased DTR

types of non-fluent aphasia

Broca's, global

what pathologies can cause irreversible dementia

HD, MS, Alzheimer's tuberculosis, AIDS

tx for ALS

Riluzole

vestibulo-ocular retraining

VOR, VSR oculomotor exercises balance and gait exercises habituation training

types of fluent aphasia

Wernicke's, conduction

Guillain-Barre

acute polyneuropathy temporal inflammation and demyelination of PNS, potentially axonal degeneration autoantibodies

Modified Ashworth 4

affected part is rigid

ALS

amyotrophic lateral sclerosis chronic degeneration of UMN and LMN loss of anterior horn cells in spinal cord demyelination of corticospinal and corticobulbar tracts denervation of muscle fibers, muscle atrophy, weakness

EMG for neurological dysfunction

assesses nerve and muscle dysfunction, spinal cord disease records electrical activity from brain / spinal cord to peripheral nerve root can rule out muscle / nerve pathology, denervated muscle, LMN injury

MG etiology

associated with enlarged thymus, diabetes, RA< lupus

S&S of ALS

asymmetrical muscle weakness, fasciculation, cramping, atrophy of hands (weakness goes distal to proximal) incoordination of movement, spasticity, clonus, (+) Babinski fatigue, oral motor impairment, motor paralysis, eventually respiratory paralysis

HD etiology

autosomal dominent 35-55 yo

spinal / lumbar puncture

below L1-L2 for CSF sample commonly done at L3-L4

examples of cholinergic agents

bethanechol, pilocarpine, donepezil, edrophonium, neostigmine, tacrine

prodromal period / aura

can be a period of mild sx before seizure occurs

epilepsy

chronic condition with temporary dysfunction of brain that results in hypersynchronous electrical discharge of cortical neurons

S&S of HD

cognitive impairment and decline chorea personality changes ataxia

etiology of cerebellar disorders

congenital malformations hereditary ataxia - Friedrich's (autosomal recessive) spinocerebellar ataxia (autosomal dominant) acquired ataxia (systemic)

Modified Ashworth 3

considerable increase in tone, passive movement is difficult

MG tx

crisis = emergency, may need ventilator drug therapy, immunosuppressive PT wants to optimize breathing, energy conservation long-term corticosteroid use

PT implications for cholinergic agents

decreased HR, dizziness

Huntington's

degeneration and atrophy of BG deficient neurotransmitters unable to modulate movement

MS

demyelination of white matter sx vary depending on location subsequent plaque development - failure of impulse transmission eventually 20-35 yo

cerebral angiography

determines blockages in arteries of brain can diagnose CVA, brain tumor, aneurysm, vascular malformation

examples of muscle relaxant agents

diazepam, cyclobenzaprine, chlorzoxazone

peripheral vertigo

episodic, short duration ANS sx swelling, N/V fullness in ears tinnitus

discography for neurological dysfunction

evaluates integrity and pathology of spinal disc

S&S of MG

extreme fatiguability skeletal muscle weakness the can fluctuate within minutes or over time (ocular muscles first) - proximal then distal hot and cold can exacerbate sx dysphagia, dysarthria, CN weakness ptosis, diplopia risk of osteoporosis

gaze-evoked nystagmus

eyes shift from primary position to alternate position caused by inability to stabilize gaze indicative of central lesion

S&S of Bell's palsy

facial drooping, dryness of eyes, inability to close eyes

Romberg test

feet together EO and EC sharpened Romberg - tandem (non-dominant in front) EO and EC

PPS S&S

focal, asymmetrical motor impairments (slow and progressive) fatigue, muscle atrophy pain, swallowing difficulty

dopamine replacement agents

for PD side effects - arrhythmias, orthostatic hypotension, dyskinesia, mood/behavior changes

anti-spasticity agents

for increased tone / spasticity side effects - drowsiness, generalized muscle weakness, hepatotoxicity, tolerance / dependence

muscle relaxant agents

for muscle spasm side effects - sedation, drowsiness, tolerance / dependence

anti-epileptic agents

for seizure activity side effects - ataxia, behavior changes, blurred vision

non-fluent aphasia - area of leson

frontal lobe, Broca's area

Tinetti

gait and balance components < 19 - high fall risk

etiology of MS

genetics viral infection environment

etiology of ALS

genetics virus metabolic disturbances lead / aluminum toxicity 40-70 yo

myelography for neurological dysfunction

high risk for headache following spinal tap can rule out pathologies to subarachnoid space, SCI, herniated discs, fx, spinal tumors

tx for GBS

hospitalization immunosuppressive meds

chorea

hyperkinesia, brief, irregular, rapid contractions damage to caudate nucleus (HD) ballism - choleric jerks, flailing of limbs (subthalamic nuclei damage)

spontaneous nystagmus

imbalance of vestibular signals to oculomotor neurons that causes a constant drift in one direction that is countered by a quick one in the opposite direction usually after acute vestibular lesion lasts ~ 24 hours

clonus

indicative of UMN involuntary alternating spasmodic contraction precipitated by quick stretch reflex

S&S of Alzheimer's

initial - difficulty with new learning subtle changes in memory / concentration progression - loss of orientation difficulty word finding depression poor judgment rigidity, bradykinesia shuffling gait can't do self-care skills end-stage - severe intellectual and physical destruction incontinence functional dependence inability to speak

hemiballism

involuntary, violent movement of large body part

Dix Hallpike test

long sitting and head rotated 45 degrees rapidly move to supine with head still rotated, then extended 30 degrees off table hold head and observe for nystagmus

etiology of Alzheimer's

lower levels of neurotransmitters higher levels of aluminum in brain issue genetics autoimmune disease abnormal processing of amyloid virus

suspensatory strategy

lowers COG crouch / squat when you need mobility and stability

EEG for neurological dysfunction

measures electrical activity of the brain baseline, then with stimuli can rule out seizure disorders, brain death, brain tumors, alcoholism, etc

tx for Alzheimer's

meds - alleviate cognitive sx, control behavior change - however, they can have significant side effects PT - maximize function, caregiver education

cholinergic agents

mimic ACH and bind to receptors to activate and create response at cellular level for glaucoma, dementia, post-op decrease in GI mobility, myasthenia gravis side effects - impaired visual accommodation, bronchoconstriction, bradycardia, flushing

Modified Ashworth 2

more marked increase in tone thru most of ROM, still easily moved

S&S of GBS

moto weakness, distal to proximal (distal, symmetrical) sensory impairment (mild, distal) respiratory paralysis disability peaks 2-4 weeks absence of DTR inability to speak / swallow

dysarthris

motor speech disorder MN lesion slurred speech

asthenia

muscle weakness associated with cerebellar disease

muscle PNS pathology

muscular dystrophy motor weakness sensation intact decreased DTR

fasciculation

muscular twitch caused by random discharge of LMN

NM junction pathology

myasthenia gravis motor fatigue > weakness sensation intact normal DTR

when to take Levadopa for max benefit with PT

one hour before

peripheral vs central nystagmus

peripheral - peripheral lesion, inhibited with fixation on an object central - central lesion, not inhibited with fixation

characteristics associated with aphasia that have poor prognosis

perseveration of speech severe auditory comprehension impairments unreliable yes / no use of empty speech without recognition of impairments

Alzheimer's

progressive neurodegenerative disorder deterioration and irreversible damage in cerebral cortex and subcortical areas of brain development of amyloid plaques and neurofibrillary tangles

evoked potentials for neurological dysfunction

records time for an impulse to reach the brain external stimuli used to evoke electrical potentials within the brain can rule out MS, brain tumor, acoustic neuroma, SCI

BPPV

repeated episodes of vertigo that occur when head position changes lasts a few seconds first noted when recumbent nystagmus present

clasp-knife response

resistance during ROM of a hypertonic joint resistance greatest at initiation of range then lessens throughout

tremors

resting - may or may not go away with movement, can increase with stress (PD) postural - with voluntary contraction to maintain posture intention - absent at rest, start with movement (cerebellum, MS)

examples of anti-epileptic drugs

secobarbital, clonazepam, valproic acid, phenytoin, carbamazepine, methsuximide, gabapentin

vertigo

sense of movement and rotation of self or environment sensation of spinning usually can be peripheral or central in origin

Modified Ashworth 1

slight increase in tone catch and release or min resistance at end-range

Modified Ashworth 1+

slight increase in tone catch then min resistance thru reminder of range

athetosis

slow, twisting, writhing movements large amplitude face, tongue, trunk, extremities common with CP

dystonia

sustained muscle contractions that causes twisting, abnormal postures, repetitive movements in PD, CP, encephalitis

PPS tx

sx management

fluent aphasia - area of lesion

temporal lobe, Wernicke's area, parietal lobe

Bell's palsy

temporary unilateral facial paralysis bc of trauma with demyelination / axonal degeneration of facial nerve 15-45 yo

what is a seizure

transient event that is a sx of interrupted brain functioning hallmark sign of epilepsy

VOR

vestibulo-ocular reflex, allows for head / eye movement coordination supports gaze stabilization thru eye movement that centers movements of the head maintains stable image on retina during movement

VSR

vestibulo-spinal reflex stabilizes body and controls movement while head is moving coordinates trunk

etiology of Bell's palsy

viral infection (herpes)

post-polio syndrome

viral infection resulting in neuropathy, anterior horn cells

S&S of MS

visual disturbances ataxia balance dysfunction fatigue sensory changes weakness