Neuro review for NPTE

What are the general stages/progression of motor recovery in the extremities following a stroke? (6)

(1) flaccidity, (2) synergies with some spasticity, (3) (marked) spasticity, (4) less spasticity (out of synergy; pts can recruit isolated movements, but may have spastic synergies in difficult or stressful situations or rapid movement), (5) selective control of movement, (6) isolated/coordinated movement

This is a rare, *acute* autoimmune disorder, in which an abnormal response of the body's immune system is directed against the *peripheral nerves*. Within the periphery, the immune system causes inflammation that damages the myelin sheath that covers axons of nerves. This damage to myelin and nerve fibers leads to messages between neurons being altered or stopped completely. - Early Sx: numbness/tingling in feet or hands, muscle weakness, hyperesthesias (increased sensitivity), pain in buttocks, thighs, and between shoulder blades (preceding onset and/or during recovery) - Paralysis usually starts distally and moves proximally in a *matter of hours or days* to flaccid paralysis of skeletal muscles (rapid progression) - *Paralysis is usually symmetrical (equal bilaterally*) - talking, swallowing, and breathing difficulties often involved

GBS (Guillain-Barré Syndrome) (aka: acute inflammatory demyelinating polyneuropathy, AIPD)

The ___________ is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. It assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviors make up the three elements of the scale: *eye, verbal, and motor* - Score of 13-15 = Mild Brain Injury (concussions) - Score of 9-12 = Moderate Brain Injury - Score of 8 or less = Severe Brain Injury - Not recommended for therapeutic use, but therapists should know how to administer or be exposed to tool due to its ability to inform and communicate across disciplines - appropriate tool for research studies - used during the acute stage of recovery only

GCS (Glasgow Coma Scale)

This outcome measure is used with *children who have cerebral palsy*. Higher levels/scores are associated with lower levels of physical functional mobility. Level 1: walk without limitation Level 2: walk with limitation level 3: walk with assistive device; household ambulator level 4: self-mobility with limitations, may used powered mobility; limited household ambulator level 5: transported in a manual wheel chair

GMFCS (Gross Motor Function Classification System)

This outcome assessment is used to quantify the severity of a person's Parkinson's by classifying the disease into 6 stages ranging from 0 (no clinical signs evident) to 5 (confined to bed or wheelchair). It is typically done by a neurologist.

H&Y staging scale (Hoehn and Yahr Staging Scale) (0: no clinical signs evident 1: unilateral involvement only 2: bilateral involvement only 3: first evidence of impaired postural and righting reflexes by exam or history 4: fully developed severe disease; disability marked 5: confinement to bed or wheelchair)

Signs and symptoms of autonomic dysreflexia (hyperreflexia) include: - Sudden, severe, pounding ______________ - (Hypertension/Hypotension) - Chills (with/without) fever + goosebumps - Sweating and flushed skin (above/below) the level of the lesion - (Increase/Decrease) in HR

HA, Hypertension, without, above (no sweat below lesion), Decrease

_____________ is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking. - autoimmune disease where the body generates antibodies against its own muscarinic and nicotinic receptors and the antibodies can disrupt the function at NMJs - pts have problems with motor functions - Tx: Pyridostigmine, Edrophonium

MG (Myasthenia gravis)

this brain structure is involved in *executive functions* or the higher cognitive functions such as initiation/motivation, attention, planning, problem solving, reasoning, judgement, and short-term memory. - also involved in behavioral regulation (impulse control, high level coping mechanisms for emotions of anger, sadness, frustration, hunger, and other emotions) - supplied by ACA and MCA

PFC (prefrontal cortex)

This *progressive BG disorder* is characterized by *having trouble initiating willed movements* due to increased inhibition of the thalamus by the BG; the condition leads to shaking, stiffness, and difficulty with walking, balance, and coordination. - pts with this *lose Dopaminergic* neurons (from the substantia nigra in the midbrain; which then don't have input on the striatum and also results in an imbalance between dopamine and ACh in the BG) - Sx: hypokinesia, bradykinesia, akinesia, rigidity, tremors of hand and jaw - Avg Onset: ~60 y/o (incidence increases with age) - not hereditary - L-dopa treatment: facilitates production of dopamine to alleviate some symptoms

Parkinson's (Parkinson's Disease, PD)

This type of *cerebral palsy* is characterized by increased muscle tone in antigravity muscles, abnormal postures & movements with mass patterns of flexion/extension, imbalance of tone across joints may cause contractures & deformities - Contractures most commonly seen in the LEs: hip flexor, ADD, IR and knee flexors, ankle PF - Contractures most commonly seen in the UEs: scap retractors, GH extensors & ADD, elbow flexors) - visual, auditory, cognitive, and oral motor deficits may be present - Crouching gait (walks with hip flexion, ADD, IR and knee flexion)

Spastic (CP)

*_____________ cerebellar* lesion: hypotonia with weakness/fatigue, key issue with muscle activation timing, trunk ataxia (dysequilibrium, increased sway, wide BOS, high arm position, worse with eyes closed), gait ataxia (unsteady, increased falls, uneven/decreased step length)

Spinocerebellum

This type of ischemic 'stroke' is not really a stroke, but instead considered "precursors" of stroke. Characterized by a brief, focal loss of function (e.g. hand/leg weakness, speech difficulty, memory difficulty, tongue drifting to one side when stuck out), full recovery within 24 hours, and is usually due to ischemia. - 35% of people who experience this will progress to stroke within 5 years unless medical intervention occurs - Tx: blood thinners, monitor BP and blood flow, diet and exercise, angioplasty with stinting (if caused by plaques), endarterectomy (removes plaque buildup in artery)

TIA (transient ischemic attack)

A pt recovering from GBS started attending a supervised OP exercise program. The pt failed to show up fro follow-up sessions. The pt reported increased muscle pain and being too weak to get out of bed for the past 2 days. The pt is afraid to continue with the exercise class. What is the PT's BEST course of action regarding the patient's exercise program? a. Discharge the pt from the program because exercise is counterproductive in GBS b. Reschedule exercise workouts for early morning when there is less fatigue c. Decrease the intensity and duration, but maintain the frequency of 3x/week d. Decrease the frequency to once a week for an hour session, keep the intensity moderate

C (Decrease the intensity and duration, but maintain the frequency of 3x/week)

The diaphragm is innervated at ___________, but ______ is the first level that an individual does not require a ventilator at all. At this level it can be scary for the patients due to them having the feeling that they cannot breathe.

C3-5, C4 (people with C4 innervation have their diaphragms and no longer need vents, suctions, etc. - but will still need max assistance for respiratory hygiene like coughing and deep breathing!)

Smooth pursuits (H-shape + some diagonals), saccades (eyes moving between targets), convergence (patient keeping their eyes on your finger as you slowly move it towards their nose), and the pupillary light reflex (efferent) are lumped together to test which cranial nerves? - these are all early tests done during concussion screenings (VOMs test)

CN III (oculomotor), CN IV (trochlear), CN VI (abducens)

having the patient say "AHHHH" as well as testing gag reflex tests what two cranial nerves? - gag reflex is usually only tested on an unconscious person

CN IX (glossopharyngeal), CN X (vagus) (hoarse voice may indicate issues with the vagus nerve as well)

Assessing sharp/dull on 3 regions of face, clench jaw (look for masseter m. contraction), corneal reflex (generally only done on unconscious pt in hospital) is done to test which cranial nerve?

CN V (trigeminal)

Test: sensory test 5 regions (temporal, zygomatic, buccal, mandibular, cervical), raise eyebrows, puff cheeks, smile, close eyes - taste and salivation usually not tested - performed more in hospitals - This is assessing the integrity of which cranial nerve?

CN VII (facial)

Test: check hearing loss by rubbing fingers together, Rinne and Weber tests, HINTs test - These tests assess the integrity of which cranial nerve?

CN VIII (vestibulocochlear)

having a patient shrug their shoulders (in general and against resistance) as well as turn/rotate their head is an assessment of what cranial nerve?

CN XI (accessory - innervates the SCM and upper trap)

having a patient stick out their tongue and move it up/down and side to side is an assessment of what cranial nerve?

CN XII (hypoglossal - motor innervation to tongue)

A pt with MS presents with dysmetria in both UEs. Which of the following interventions is the BEST choice to deal with this problem? a. 3 lb weight cuffs to wrists during ADL training b. Isokinetic training using low resistance and fast movement speeds c. Pool exercises using water temperatures greater than 85 deg (F) d. PNF patterns using dynamic reversals with carefully graded resistance

D (PNF patterns using dynamic reversals with carefully graded resistance) ( Adding manual resistance to PNF can assist the pt in slowing down the movement and achieving better control; Adding 3 lb weight cuffs to the wrist could help with slowing down movements as well but would unnecessarily fatigue the pt which is not ideal in MS population)

The PNF pattern of the UE that *ends with* the shoulder in extension, *abduction*, and internal rotation is:

D1 extension (arm extending across the body to fasten the seatbelt) (kind of ends up looking like the ULTT for the radial nerve / waiter's tip position) (D1 extension: GH extension, ABD, IR, wrist + finger extension)

The PNF pattern of the UE that ends with the shoulder in flexion, *adduction*, and external rotation is:

D1 flexion (leading with the *pinky side of the hand*) (arm reaching up and across your body to grab the seatbelt) (D1 flexion: GH flexion, ADD, ER, wrist & finger flexion)

The PNF pattern of the UE that *end with* the shoulder in adduction, and internal rotation reaching towards the contralateral ASIS is:

D2 extension (lead with the thumb side of the hand) (D2 is like grabbing money from your opposite front pocket and then chucking it over your shoulder.)

The PNF pattern of the UE that *ends with* the shoulder in flexion, *abduction*, and external rotation is:

D2 flexion (lead with the *thumb side* of the hand) (D2 is like grabbing money from your opposite front pocket and then chucking it over your shoulder.)

An infant who was 39 weeks gestation age at birth and is now 3 weeks chronological age demonstrates colic. In this case, what is the BEST intervention the PT should teach the mother? a. stroking and tapping b. swaddling or wrapping c. visual stimulation with a colored object d. bouncing and fast rocking

b (swaddling or wrapping) (Colic = frequent, prolonged and intense crying or fussiness in a healthy infant. Colic can be particularly frustrating for parents because the baby's distress occurs for no apparent reason and no amount of consoling seems to bring any relief. These episodes often occur in the evening, when parents themselves are often tired. Episodes of colic usually peak when an infant is about 6 weeks old and decline significantly after 3 to 4 months of age. While the excessive crying will resolve with time, managing colic adds significant stress to caring for your newborn child.)

toe movement elicited by manipulation in a neurologic test performed on the sole of the foot to indicate injury to the brain or spinal nerves - The toes flex upward when sole of foot is stimulated, indicating motor nerve damage

babinski

*_________* = lesion of Facial nerve (VII) resulting in unilateral facial paralysis. - *S&S*: muscles of facial expression on one side are weak/paralyzed, loss of control of salivation or lacrimation, acute onset, commonly preceded by posterior ear pain - Prognosis: most people fully recover within several weeks to months

bell's palsy

temporary *paralysis of the CN VII (facial)* that causes paralysis only on the affected side of the face; condition of the brainstem - Sx: rapid onset of mild weakness to total paralysis on *one side of face, facial droop* and difficulty making facial expressions (e.g. closing eyes, smiling), drooling, pain around jaw in or behind ear on affected side, increased sensitivity to sound on affected side, headache, decrease in ability to taste, changes in amount of tears and saliva you produce

bell's palsy

these adrenergic receptors are stimulated by NE and/or Epi - produce *inhibitory* effects *except in the heart* where they produce excitatory effects

beta (receptors) (beta 1: found primarily in the heart, stimulation of these excites the heart --> increases HR, force of contraction, and conduction velocity of electrical activity; Beta 2: located on most organs, mediate the dilator and inhibitory effects of beta-adrenergic receptor activation; Beta 3: located ONLY on FAT CELLS, excited by circulating Epi, when stimulated these receptors mediate lipolysis)

_________ practice is typical of some drills in which a skill is repeated over and over, with minimal interruption by other activities. This kind of practice seems to make sense in that it allows the learners to concentrate on one particular task at a time and refine and correct it - good for performance (esp during acquisition phase of a task) - does *NOT* promote retention - people who train in this manner perform well in *practice* sessions

blocked (Initially blocked practice may be necessary for skill acquisition, then transitioning to random practice to facilitate generalization, which is the end goal of therapy)

A pt is experiencing left foot weakness and toe drag when walking greater than 10 min for the past 3 months. Muscle spasms and weakness in the right hand are also present for the past 3 weeks. Neuromuscular screening examination reveals 4/5 MMT and fasciculations in the left extensor hallucis longus, left tibialis anterior, and right first dorsal interossei. Reflex testing reveals a 3+ in the right triceps and biceps and a positive right Hoffman's sign. Sensory testing for light touch and vibration of the UEs and LEs is normal. Which of the following health conditions is most consistent with the patient's S&S? a. polyneuropathy b. cervical myelopathy c. myasthenia gravis d. amyotrophic lateral sclerosis

d (ALS) (*fasciculations* = LMN SIGN 3+ reflex = clonus = UMN SIGN ALS is a combo of LMN and UMN signs without sensory loss and with distal to proximal progressive weakness)

What ASIA level would an individual with a SCI resulting in having *motor function preserved in voluntary anal contraction* (VAC) be? This person may meet the criteria for sensory incomplete status (sensory function preserved at S4-S5) and has motor function more than 3 levels below the ipsilateral motor level on either side of the body. *AT LEAST half (or more) of the person's key muscle functions below the neurological level of injury (NLI) have a muscle grade >/= 3.* a. ASIA A b. ASIA B c. ASIA C d. ASIA D e. ASIA E

d (ASIA D) (motor incomplete - Strong)

A child who has athetoid cerebral palsy is MOST likely to exhibit which of the following characteristics? a. Sustained limb posturing b. Low frequency tremor c. Rapid, jerky motions d. Mixed muscle tone

d (Athetoid cerebral palsy is characterized by slow, involuntary, writhing, twisting, "wormlike" movements. Some muscles demonstrate tone that is too high, and others demonstrate tone that is too low.)

Match the 4 primary afferent (sensory) axons with their correct function: -___: pain, temp, itch; unmyelinated -___: proprioception (muscles) ; myelinated -___: skin mechanoreceptors (touch); myelinated -___: pain and temp; myelinated a. A-alpha b. A-beta c. A-delta d. C axons

d (C axons), a (A-alpha), b (A-beta), c (A-delta)

Which of the following techniques is MOST appropriate for treatment of a patient who has low postural tone? a. Slow regular rocking while sitting on a treatment bolster b. Continuous pressure to the skin overlying the back muscles c. Low-frequency vibration to the back muscles d. Joint approximation applied through the shoulders to the trunk

d (Joint approximation applied through the shoulders to the trunk) (answers a-c are all used to decrease postural tone)

When the test depicted in the photograph (PATELLAR DTR) is done bilaterally, there is a normal response on the right and diminished on the left. This result is MOST suggestive of pathology in which of these structures? a. L5 nerve root b. Dorsal column c. Lateral corticospinal tract d. L4 nerve root

d (L4 nerve root)

A patient's examination reveals weakness with scapular upward rotation and protraction. Which of the following nerves is MOST likely affected? a. Axillary b. Subscapular c. Suprascapular d. Long thoracic

d (Long thoracic) (The long thoracic nerve innervates the serratus anterior, which is responsible for upward rotation and protraction of the scapula)

A PT works with a patient on proprioceptive and balance activities due to a history of recent falls. The pt informs the therapist that they have recently been diagnosed with optic neuritis. Which of the following medical conditions should the therapist MOST suspect might be the cause of the patient's clinical presentation? a. Parkinson's b. Guillain-Barre syndrome c. Myasthenia gravis d. Multiple sclerosis

d (MS)

A patient sustained an injury to the cerebellar cortex. Which of the following functions would MOST likely be diminished? a. Initiation of movement b. Upper extremity strength c. Upper extremity sensation d. Rapid alternating arm movements

d (Rapid alternating arm movements) (Rapid alternating arm movements test for dysdiadochokinesia, the term used to indicate impaired ability to perform these movements. Patients who have cerebellar lesions would be most likely to experience this impairment.)

An 18-year-old patient who has a traumatic brain injury exhibits mild cognitive deficits, poor head and trunk control, and slowly healing pressure injuries on the ischial tuberosities. The patient has good voluntary movement and motor control in the right arm but has significantly increased tone and poor functional use of the left arm. Which of the following methods of wheelchair pressure relief is BEST for the patient? a. Manual recline b. Power recline c. Manual tilt-in-space d. Power tilt-in-space

d (Tilt systems do not create shearing forces on the ischial tuberosities or sacrum, and power tilt-in-space will allow independence in pressure relief without causing shear forces on the buttocks.; manual tilt-in-space requires assistance from another person for pressure relief)

This assesses the ability to stabilize vision as the head moves. Examiner holds a target in front of patient at a distance of 3 ft. Pt asked to move head in horizontal and vertical planes while maintaining focus on the target. - moving the head stimulates the semicircular canals in the ear and activates this reflex - Otoliths cause the eyes to move in the opposite direction of the head but at the same speed - this reflex allows the head and eyes to work together to retain visual acuity despite head turning - this reflex allows gaze stability (when the head turns but the eyes remain focused) - used when screening for a concussion

VOR (vestibulo-ocular reflex) (VOR deficits result in: poor gaze stabilization, increase likelihood of double or blurry vision with positional changes, dizziness, spontaneous nystagmus, visual fatigue VOR deficits not common with strokes - if present, the person likely had a PCA stroke)

_____________ area is the region of the brain that is important for language development. It is located in the *temporal lobe* on the left side of the brain and is responsible for the *comprehension of speech*. - damage to this area of the brain can result in not being able to comprehend language (written or spoken) but being able to speak (words put together make no sense) (*FLUENT APHASIA*)

Wernicke's (fluent aphasia = impaired auditory comprehension and fluent speech that is of normal rate and melody)

An individual with a complete SCI resulting in a total absence of sensory and motor function in the lowest sacral levels (S4-S5) is classified as what ASIA level? a. ASIA A b. ASIA B c. ASIA C d. ASIA D e. ASIA E

a (ASIA A)

What is the major parasympathetic nerve that provides innervation to the visceral organs in the thorax: a. CN X (vagus) b. CN VIII (vestibulocochlear) c. CN V (trigeminal) d. CN XI (accessory)

a (CN X - vagus)

A 77-year-old female patient who has a long history of taking antiparkinsonian medications exhibits random, rapid, and jerky movements. Which of the following terms BEST describes these movements? a. Chorea b. Dysmetria c. Segmental dystonia d. Abnormal synergies

a (Chorea is a type of dyskinesia that is often observed as a side effect of antiparkinsonian medication and that typically emerges with prolonged use of such medications. Chorea is characterized by involuntary, rapid, irregular, and jerky movements.)

If you suspect a patient has an anterior or posterior canal BPPV, you should perform the ___________ test. If correct, treat with ____________. a. Dix-Hallpike, CRP b. Supine head turn, BBQ roll (lempert) c. Epley maneuver, Dix-Hallpike d. Dix-Hallpike, BBQ roll (lempert) e. Supine head turn, CRP

a (Dix-Hallpike, CRP) (CRP = Epley maneuver = treatment for BPPV)

A patient who has a spinal cord injury reports having spastic (reflex) bowel function. Which of the following descriptions BEST characterizes the patient's neurologic injury? a. Injury above spinal segments S2-S4, leaving spinal defecation reflexes intact b. Injury at or below spinal segments S2-S4, leaving spinal defecation reflexes intact c. Injury above spinal segments S2-S4, abolishing spinal defecation reflexes d. Injury at or below spinal segments S2-S4, abolishing spinal defecation reflexes

a (Injury above spinal segments S2-S4, leaving spinal defecation reflexes intact)

Monte presents with a recent middle cerebral artery (MCA) and right upper extremity spasticity but can perform some motions out of synergy. The therapist would like to continue improving the patient's mobility and activation of the muscles out of synergy. Which of the following is the BEST intervention to address the current impairment? A. Lift pattern with right arm leading B. Bilateral PNF UE D2 Extension C. Chop pattern with left arm leading D. Rhythmic rotation in sidelying position

a (Lift pattern with right arm leading) (UE synergy: GH ADD, elbow flexion, forearm pronation Lift pattern = D2 flexion - GH ABD, elbow extension, forearm supination "right arm leading" = right arm is moving into the lift pattern, Left arm may be grabbing on to the right UE and *assisting* moving through that pattern Bilateral PNF = both UEs doing the motions independently, unlikely that this patient will have the right strength/coordination/voluntary control for the involved UE to perform correctly without assistance D2 extension = GH ADD & forearm pronation Chop pattern = D1 extension "left arm leading" = left arm is the one going through the PNF motion with the right UE holding on to the left - this will put the R UE in GH ADD and forearm pronation [D2 extension] Rhythmic rotation - used to reduce spasticity, tone, rigidity; VERY PASSIVE; good for the trunk)

Prior to administering treatment for an ischemic stroke, particularly a thrombolytic stroke, doctors must ensure the stroke is not hemorrhagic in nature (at the risk of increasing the damage by causing further bleeding). Which of the following is the best tool for identifying strokes and differentially diagnosing if they're ischemic or hemorrhagic in nature? a. MRI b. PET scan c. X-ray d. spinal tap

a (MRI) (can also use CT scans, MRI more often used now because MRIs are better at detecting ischemic damage)

Palsy of which of the following cranial nerves would MOST likely lead to the presentation of torticollis in a child? a. Trochlear nerve (CN IV) b. Facial nerve (CN VII) c. Vestibulocochlear nerve (CN VIII) d. Hypoglossal nerve (CN XII)

a (Ocular torticollis may result from a lesion to the trochlear nerve. Damage to the trochlear nerve results in diplopia. Patients will frequently compensate for the diplopia by tilting the head anteriorly and laterally toward the side of the normal eye.)

A patient who has multiple sclerosis reports increasing problems related to urinary incontinence. The patient experiences constant leaking of small amounts of urine and has a sensation of the bladder not being fully emptied after voiding. The patient MOST likely has which of the following conditions? a. Overflow incontinence caused by an underactive detrusor muscle b. Stress incontinence caused by anxiety about the disease c. Urge incontinence caused by detrusor muscle spasms d. Functional incontinence due to mobility changes

a (Overflow incontinence caused by an underactive detrusor muscle) (The symptoms fit the description for overflow incontinence. In patients who have multiple sclerosis, overflow incontinence is usually the result of a hypotonic or underactive detrusor muscle.)

A patient had a cerebrovascular accident 6 months ago. The patient is unable to perform volitional fractionated movements in the hemiparetic lower extremity. The patient's goal is to be able to walk short distances. Which of the following treatments is MOST appropriate for the patient? a. Perform body-weight-supported treadmill training. b. Use assistive devices to maximize functional gait. c. Perform quadriceps strengthening in the hemiparetic leg. d. Perform static standing balance activities.

a (Perform body-weight-supported treadmill training.) (Body-weight-supported treadmill training has been shown to be effective in allowing intensive practice of gait in individuals who have a cerebrovascular accident. Use of a harness allows for a safe environment to practice a complex motor task for a patient with severe neuromuscular impairment. - Although balance training is an important component, it is not the best option. Balance training does not allow the patient to directly practice the skill of walking.)

Which of the following structures provide active compression of the urethra? a. Pubococcygeus, iliococcygeus, and puborectalis b. Pubococcygeus, obturator internus, and puborectalis c. Iliococcygeus, puborectalis, and pubovesical ligament d. Pubococcygeus, iliococcygeus, and anococcygeus ligament

a (Pubococcygeus, iliococcygeus, and puborectalis - these muscles maintain continence)

When reaching to grasp a glass of water, a patient overreaches and knocks the glass over. Upon further examination, the patient also displays difficulty with finger-to-nose touching. The patient's condition is MOST likely caused by a lesion of which of the following neuroanatomical structures? a. Spinocerebellum b. Cerebrocerebellum c. Vestibulocerebellum d. Cerebellar peduncle

a (Spinocerebellum) (Spinocerebellar lesions result in a limb ataxia, such as dysmetria. Dysmetria is described as the inability to accurately move an intended distance, which would result in a patient overreaching for a target such as a cup.)

A patient who has amyotrophic lateral sclerosis (ALS) exhibits severe lower extremity weakness and moderate upper extremity weakness. The patient has been increasingly dependent for activities of daily living. Which of the following interventions is MOST appropriate for the patient? a. Education in positioning principles b. Fitting with ankle-foot orthoses c. Education in manual wheelchair propulsion d. Strength training of the upper extremities

a (The patient descriptors align with Stage 5 amyotrophic lateral sclerosis. A physical therapist should educate the family and patient on proper positioning and turning principles to avoid skin breakdown.)

A patient has diplopia, dysphagia, and bilateral weakness of the lower extremities. The patient also has loss of vibratory sense, two-point discrimination, and position sense. There are no signs of personality changes or aphasia. Which of the following arteries is MOST likely affected? a. Basilar b. Anterior cerebral c. Middle cerebral d. Posterior cerebral

a (Vertebral [basilar] arteries supply the brainstem and cerebellum. Lesions of these arteries usually manifest as unilateral or bilateral weakness of extremities and loss of vibratory sense, two-point discrimination, and position sense. Diplopia, homonymous hemianopsia, dysphagia, dysarthria, nausea, and confusion may also occur.)

Damage to the parietal lobe impacts: a. ability to process and distinguish sensory info, difficulty with overall body awareness b. memory dysfunction (retrograde/anterograde amnesia), receptive aphasia, difficulty recognizing music pitch and rhythm c. impulsivity, behavioral control issues, expressive aphasia d. none of the above

a (ability to process and distinguish sensory info, difficulty with overall body awareness)

Stimulation of the sympathetic nervous system through the: a. Alpha adrenergic receptors inhibit the GI tract and beta receptors excite the heart b. Alpha adrenergic receptors excite the GI tract and beta receptors inhibit the heart c. Alpha adrenergic receptors excite the heart and beta receptors inhibit the GI tract d. Alpha adrenergic receptors inhibit the heart and beta receptors excite the GI tract

a (alpha adrenergic receptors inhibit the GI tract and beta receptors excite the heart)

An 18 year old college student is brought to the ER by his roommate. He has not been feeling well for several days, but recently developed worsening fever, neck stiffness and sensitivity to light. Examination of the cerebrospinal fluid shows many neutrophils. The most likely diagnosis is: a. Bacterial meningitis b. Brain abscess c. Cerebral edema d. Subarachnoid hemorrhage

a (bacterial meningitis) (The patient has symptoms of meningitis, including fever, stiff neck, and sensitivity to light. In patients with bacterial meningitis, the CSF will have an increased white blood cell count, with a predominance of neutrophils.)

Which of the following methods is MOST appropriate for handling a 1-year-old child who has cerebral palsy and who exhibits strong extensor tone in the trunk and extremities? a. Carrying the child in sitting position b. Carrying the child over one's shoulder c. Keeping contact with the back of the child's head d. Picking the child up under the upper extremities

a (carrying the child in sitting position) (The sitting position promotes visual attending, use of the upper extremities, and social interaction. A flexed posture is preferred so the shoulders are forward. A child who exhibits extensor posturing should be carried in a symmetric position that does not allow axial hyperextension and keeps the hips and knees flexed)

Radiographic imaging of a patient who has severe neck pain reveals bony growths in the intervertebral foramen between C2 and C3. Which of the following muscles would MOST likely be affected by this condition? a. Diaphragm b. Supraspinatus c. Latissimus dorsi d. Serratus anterior

a (diaphragm) (The diaphragm is innervated by the phrenic nerve [C3-C5])

A PT is working with a pt with early MG with a focus on improving endurance, strength, and community participation. Which of the following signs are most consistent with exacerbation of MG and a need to stop or modify an exercise session? a. double or blurred vision, decreased voice projection, and difficulty with repetitive STS b. dyspnea, syncope, and cold hands and feet c. hyperreflexia, muscle spasms, and an inability to stand on one foot with eyes open d. increased muscle and joint pain, inability to sleep, and irritability

a (double or blurred vision, decreased voice projection, and difficulty with repetitive STS)

A PT analyzes the gait of a child with spastic diplegia CP in the school setting. Based on this diagnosis, which muscle group is MOST likely to be shortened? a. Hip Adductors b. Knee extensors c. Hip Abductors d. Ankle dorsiflexors

a (hip ADD)

You are doing an initial eval on a patient who had a stroke. During the interview, you note that the patient has minimal expressive aphasia as well as seems to be agitated and in denial of any deficits. The patient lacks the ability to regulate emotions and says what they are thinking without hesitation or regard to people's feelings. Upon physical examination, you observe hypertonic hemiparesis on the right leg with a flexor withdrawal synergy. The patient has minimal weakness in the right arm, but lacks finger or thumb control. In sitting, the patient leans to the left and tends to sit in a posterior pelvic tilt. Based off this presentation where did this patient's stroke most likely occur? a. Left ACA b. Right ACA c. Left MCA d. Right MCA e. PCA f. Thalamus

a (left ACA) (Clues: communication issues/aphasia = left side, behavioral issues = frontal lobe, right side hemiparesis, LE involvement > UE involvement)

C fibers carry this type of info: a. pain b. proprioception c. mechanosensory d. electromagnetic

a (pain)

A pt is recovering from surgical resection of an acoustic neuroma and presents with symptoms of dizziness, vertigo, horizontal nystagmus, and postural instability. To address these problems, what should the PT POC incorporate? a. repetition of movements and positions that provoke dizziness and vertigo b. Hallpike's exercises to improve speed in movement transitions c. Static balance exercises on a level surface with eyes open d. prolonged bedrest to allow vestibular recovery

a (repetition of movements and positions that provoke dizziness and vertigo) (in patients with unilateral vestibular pathology, habituation training [use of positions and movements that evoke symptoms] will encourage the vestibular system to recalibrate. Good recovery can generally be expected with gradual progression of exercises.)

A pt recovering from a partial SCI reports lack of feeling in the more-affected hand. Monofilament testing reveals lack of ability to tell when the stimulus is being applied (only 1 correct response out of 5 tests). What additional sensory tests should the therapist perform? a. test for sharp sensation b. test for 2-pt discrimination c. test for vibration d. test for joint proprioception (thumb up/thumb down)

a (test for sharp sensation - spinothalamic pathway; all the rest are dorsal column pathway)

these adrenergic receptors are stimulated by NE and/or Epi. - produce *excitatory* effects *except in the GI tract*, where the produce inhibitory effects

alpha (receptors) (alpha 1 receptors: primary receptor on effector organs and tissues mediating alpha-adrenergic responses; alpha 2 receptors: also located on effector organs and tissues, produce effects similar to alpha 1 receptors; alpha 2 receptors are located on PRESYNAPTIC noradrenergic terminals - when these receptors are stimulated by NE additional neural release of NE is inhibited)

____________ = set of signs and symptoms linked to the impaired function of the lower cranial nerves, typically caused by *damage to their LMNs or to the lower cranial nerve* itself. The impacted cranial nerves are a set of nerves that arise straight from the brainstem and include *cranial nerves IX (glossopharyngeal), X (vagus), XI (accessory), and XII (hypoglossal)*. - *S&S*: wide variety of symptoms based on the cranial nerve that is damaged. For example, cranial nerve IX ( glossopharyngeal) is involved in salivation, swallowing, and the gag reflex. If cranial nerve IX is injured, it can lead to difficulty swallowing (dysphagia) and a reduced gag reflex. Common signs and symptoms of damage to the other cranial nerves include difficulty chewing, nasal regurgitation, slurred speech, difficulty in handling secretions, aspiration of secretions, altered vocal ability (dysphonia) and difficulty articulating words (dysarthria).

bulbar palsy

What is the MINIMUM width of a doorway that allows clearance for a standard wheelchair? a. 28 inches (71 cm) b. 30 inches (76 cm) c. 32 inches (81 cm) d. 36 inches (91 cm)

c (32 inches [81 cm])

this phase of motor learning involves the person beginning to demonstrate more refined movement, from having practiced. The *"how to do"* phase/decision. The learner... - requires less verbal info - makes smaller gains in performance - exhibits conscious performance - makes many adjustments - has awkward and disjointed movements - takes a long time - can focus on "how to do" instead of "what to do" - visual cues less important, *proprioceptive cues very important*

associative (stage; aka "motor stage")

this movement disorder is characterized by irregular, uncoordinated movements caused by a change to the cerebellum. - potential causes: brain tumors, stroke, cerebellar atrophy

ataxia (this movement disorder is characterized by irregular, uncoordinated movements caused by a change to the cerebellum. - potential causes: brain tumors, stroke, cerebellar atrophy - this disorder [or its symptoms] clues to something being centrally wrong and that you should refer out)

this phase of motor learning involves the person can perform the skill in most environments with less cognitive involvement; The *"how to succeed"* phase/decision - motor skill performed almost unconsciously - error free movement occurs - dual tasking is possible without detriment to performance - more efficient movement patterns occur - there is a return to the cognitive phase if error occurs, but the skilled learner is able to analyze the error and self-correct

automatic (autonomous stage)

___________ __________ is a condition that emerges after a spinal cord injury, usually when the injury has occurred *at or above the T6 level. The higher the level of the spinal cord injury, the greater the risk*. This leads to an uncoordinated autonomic response that may result in a potentially life-threatening hypertensive episode when there is a *noxious stimulus below the level of the spinal cord injury*. This is a medical emergency!! - Massive uncompensated CV reaction of the sympathetic NS to noxious stimuli below level of lesion (most often sacral tracts) - *sympathetic NS is overreacting to a stimuli*, but the parasympathetic NS cannot respond (w/ vasodilation, etc.) so *BP rises* - *Causes*: distended bladder/bladder infection, bowel problems, decubitis ulcers, ingrown toenails, restrictive clothing, stretching hamstrings (stimulates genitals), exposure to high temperatures

autonomic dysreflexia (or autonomic hyperreflexia)

What ASIA level would an individual with a SCI resulting in *having sensation but not motor function* below the neurological level of injury be? *Intact sensation includes the sacral segments* (S4-S5). This person has NO motor function preserved more than 3 levels below the motor level on either side of the body. a. ASIA A b. ASIA B c. ASIA C d. ASIA D e. ASIA E

b (ASIA B) (Sensory incomplete, motor complete injury)

Which of the following functional tests would be MOST appropriate to verify that a patient lacks figure-ground discrimination? a. Have the patient find an object, such as a toothbrush, among similarly shaped objects. b. Have the patient locate a white button on a white shirt. c. Ask patient to identify an object, such as a key, with eyes closed. d. Ask the patient to reach for a bright blue paper located on a white desk.

b (An impairment in figure-ground discrimination is the inability to visually distinguish a figure from the background in which it is embedded. A functional test that can be given to the patient to assess figure-ground discrimination is to ask a patient to point out a white button on a white shirt. Compensatory techniques to be used with patients who lack figure-ground perception are placing red tape over the Velcro strap of the shoe to aid the patient in locating it or using bright red tape to mark the edges on stairs.)

Bizarre, slow, twisting, writhing involuntary movement, resembling a snake or worm; Produced as a *result of damage to the basal ganglia*. a. Ataxia b. Athetosis c. Agnosia d. Astereognosia

b (Athetosis) (more common in pts with Huntington's) (Ataxia = movement disorder is characterized by irregular, uncoordinated movements caused by a change to the cerebellum. Lack of motor control. Agnosia = inability to perceive sensations through otherwise normal functioning sensory pathways / loss of sensory perception Astereognosia = the loss of the ability to identify objects through touch)

A college student is seen by a PT 3 weeks post-op ORIF for a talus fracture. There was *no known nerve damage* associated with the original injury or surgery. After several treatment sessions the PT notices that the pt's foot pain is *out of proportion* to what is expected at this stage of recovery. The PT observes that the patient's ankle and foot are still markedly swollen, and the skin appears mottled (red and white). The injured foot feels sweaty compared to the unaffected side. What condition should the therapist suspect? a. infection in the ankle joint b. CRPS Type I c. CRPS Type II d. post-traumatic arthritis

b (CRPS Type I - no previous PNS involvement!! also way more common than Type II)

A patient who had a cerebrovascular accident exhibits a flexion synergy of the left upper extremity. To promote good upper extremity movement, a physical therapist should mobilize the patient's scapula toward which of the following directions? a. Upward rotation and retraction b. Upward rotation and protraction c. Downward rotation and retraction d. Downward rotation and protraction

b (Flexion synergy of the upper extremity includes scapular retraction/elevation or hyperextension. In the upper extremity, correct passive range of motion techniques require careful attention to lateral [external] rotation and distraction of the humerus, especially as ranges approach 90° of flexion or more. The scapula should be mobilized on the thoracic wall with an emphasis on upward rotation and protraction to prevent soft tissue impingement in the subacromial space during overhead movements of the arm.)

Which of the following options BEST describes a normal response to the cremasteric reflex test? a. Skin tenses in the gluteal area. b. Ipsilateral scrotum elevation c. Contraction of the anal sphincter muscles d. Umbilicus moves down and toward area being stroked.

b (For the cremasteric reflex text, the patient lies in supine position while the examiner strokes the inner side of the upper thigh with a pointed object. The test result is negative if the scrotal sac on the tested side pulls up. Unilateral absence of this response indicates a lower motor neuron lesion between L1 and L2.)

Which of the following conditions is a lower motor neuron (LMN) condition that will likely present with hypotonia/flaccidity, decreased/absent reflexes, muscle atrophy, and fasciculations? a. Stroke/CVA b. Guillain-Barre (GBS) c. TBI d. SCI

b (GBS) (MS and ALS have predominant UMN signs but can also have some LMN signs)

Which of the following test results is MOST consistent with a T1 spinal cord injury (ASIA Impairment Scale B)? a. Intact sensation on the apex of the axilla, active movement of the elbow flexors against gravity, and absence of anal sensation b. Intact sensation on the medial side of the antecubital fossa, palpable muscle activity of the little finger (5th digit) abductors, and presence of anal sensation c. Intact sensation on the dorsal surface of the proximal phalanx of the middle finger (3rd digit), palpable muscle activity of the wrist extensors, and absence of anal sensation d. Intact sensation on the dorsal surface of the proximal phalanx of the thumb (1st digit), active movement of the wrist extensors against gravity, and presence of anal sensation

b (Intact sensation on the medial side of the antecubital fossa, palpable muscle activity of the little finger [5th digit] abductors, and presence of anal sensation) (The intact sensation on the medial side of the antecubital fossa and contraction of finger abductors is consistent with the T1 dermatome and myotome. In order for an injury to be considered incomplete [ASIA Impairment Scale B], either deep anal sensation or some sensation in the anal mucocutaneous junction must be present.)

A patient who had a cerebrovascular accident has the visual field deficit displayed in the diagram (*LEFT HOMONYMOUS HEMIANOPSIA*). Which of the following conditions is MOST likely to accompany this deficit? a. Diplopia b. Left hemiplegia c. Left ocular pursuit d. Right-sided neglect

b (Left hemiplegia) (A lesion from a cerebrovascular accident produces visual loss and hemiplegia contralateral to the lesion. In this case, a right lesion caused left homonymous hemianopsia as indicated in the diagram, causing a loss of the left half of the visual field. The right lesion would also be responsible for left hemiplegia. Both deficits are contralateral to the lesion)

Which artery is most commonly involved in strokes? a. ACA b. MCA c. PCA d. Basilar artery e. Vertebral artery

b (MCA) (80% strokes occur in MCA, then ACA, then PCA)

What is the most effective form of diagnostic imaging for patients with MS to help determine the level of disease activity? a. PET scan b. MRI c. CT scan d. transcranial sonography

b (MRI)

A patient with low back pain has L4 nerve root impingement. The patient will MOST likely demonstrate which of the following gait deviations? a. Trendelenburg gait b. Foot slap c. Posterior thrust of the trunk at heel strike (initial contact) d. Toe walking

b (The L4 nerve root is the main segmental innervation to the tibialis anterior. The L4 nerve root is also the myotome for ankle dorsiflexion. Impingement of the L4 nerve root would result in foot slap.)

Which of the following objective findings is MOST likely to be present in a patient who has Parkinson disease at Hoehn and Yahr Stage 4? a. Atrial fibrillation b. Erratic respiration c. Increased chest excursion d. Paroxysmal atrial tachycardia

b (erractic respiration) (Erratic breathing is associated with Parkinson disease due to dyskinetic movement patterns of the muscles of respiration.)

A patient with a complete tetraplegia (ASIA A) at the C6 level is initially instructed to transfer using a transfer board (slideboard). With shouders *externally rotated*, how should the remaining UE joints be positioned? a. forearms pronated with wrists and fingers extended b. forearms supinated with wrists extended and fingers flexed c. forearms pronated with wrists and fingers flexed d. forearms supinated with wrists and fingers extended

b (forearms supinated with wrists extened and fingers flexed) (Muscles available with a C6 NLI = traps, biceps, wrist extensors NO TRICEPS [C7], wrist flexors [C7] or finger flexors [C8-T1] a C6 patient uses *tenodesis* grasp - should NOT extend their fingers)

What intervention BEST illustrates selective stretching when working with a patient who has a C6 complete SCI? a. long finger flexors are fully ranged into extension with wrist extension b. hamstrings are fully ranged to 110 deg in supine c. low back extensors are fully ranged in long sitting d. hamstrings are fully ranged in long sitting

b (hamstrings are fully ranged to 110 deg in supine) (ranging hammies and low back in long sitting will result in overstretched low back extensors = decreases stability in long sitting; long finger flexors should NOT be stretched with the wrists in extension to maintain tenodesis grasp)

Damage to the temporal lobe impacts: a. ability to process and distinguish sensory info, difficulty with overall body awareness b. memory dysfunction (retrograde/anterograde amnesia), receptive aphasia, difficulty recognizing music pitch and rhythm c. impulsivity, behavioral control issues, expressive aphasia d. none of the above

b (memory dysfunction [retrograde/anterograde amnesia], receptive aphasia, difficulty recognizing music pitch and rhythm)

Which of the following interventions is MOST appropriate for treatment of a patient who has functional incontinence? a. Developing a voiding schedule b. Removal of clutter within the bathroom c. Abdominal activation exercises in supine position d. Rhythmic contractions of the pelvic floor

b (removal of clutter within the bathroom) (Removing clutter in the bathroom will improve the speed of ambulation to the toilet. Functional incontinence is defined as the loss of urine because of gait and locomotion impairments.)

What ASIA level would an individual with a SCI resulting in having *motor function preserved in voluntary anal contraction* (VAC) be? This person may meet the criteria for sensory incomplete status (sensory function preserved at S4-S5) and has motor function more than 3 levels below the ipsilateral motor level on either side of the body. *Less than half of the person's key muscle functions below the neurological level of injury (NLI) have a muscle grade </= 3.* a. ASIA A b. ASIA B c. ASIA C d. ASIA D e. ASIA E

c (ASIA C) (motor incomplete - weak)

A physical therapist notes that a patient has a fatty mass and an unusual patch of hair on the low back. Which of the following conditions is MOST likely present? a. Arthrogryposis b. Spondylolisthesis c. Spina bifida occulta d. Paget disease

c (An unusual patch of hair on the back may be evidence of a bony defect of the spine. Fatty masses appearing as lumps in the area of the low back may be a sign of spina bifida.)

A patient who has vertigo is observed to have short-duration, upbeating nystagmus with left torsion during the Dix-Hallpike test. Which of the following interventions is MOST appropriate? a. Liberatory maneuver to the left b. Liberatory maneuver to the right c. Canalith repositioning maneuver to the left d. Canalith repositioning maneuver to the right

c (Canalith repositioning maneuver to the left)

A child who has a myelomeningocele at the T7 level has a new onset of vomiting, lethargy, irritability, headache, and increased seizure frequency. What is the MOST likely cause of these signs and symptoms? a. Latex allergy b. Tethered cord c. Shunt dysfunction d. Chiari II malformation

c (shunt dysfunction) (At least 85% of children who have myelomeningocele have hydrocephalus, and 80% to 90% will require a shunt, especially those with high-level lesions. Shunt dysfunction is common, and therapists should be familiar with signs and symptoms for early detection. Early warning signs include the clinical manifestations described in the stem. Tethered cord is a common development in patients who have myelomeningocele, but symptoms typically include spasticity, increased tone, buttock pain, increasing scoliosis, and weakened leg musculature.)

A PT wishes to examine the balance of an elderly patient with a history of falls. The Berg Balance Test is selected. Which area is NOT examined using this test? a. STS transitions b. Functional reach in standing c. turning head while walking d. tandem standing

c (turning head while walking) (BERG = static and dynamic balance in sitting and standing, basically no ambulatory components on this measure)

A therpist suspects that a pt recovering from a MCA stroke is exhibiting pure homonymous hemianopsia. What test should be used to confirm the hemianopsia? a. penlight held approximately 12 inches from the eyes and moved to the extremes of gaze right and left b. penlight held 6 inches from the eys and moved inward toward the face c. visual confrontation test with moving finger d. distance acuity chart placed on a well-lighted wall at a patient's eye level 20 feet away

c (visual confrontation test with moving finger) (pt sits opposite the therapist and is instructed to maintain their gaze on the therapist's nose. The therapist then slowly brings a target [moving finger or pen] in the pt's field of view alternating from the right or left sides. The pt indicates when and where they first see the target)

Match the following *brainstem* structures with the correct description: -___: regulates breathing, HR, BP, digestion, sneezing and swallowing; supplied by anterior spinal & posterior inferior cerebellar artery (PICA) -___: involved in vision, hearing, motor control, sleep & wake cycles, arousal/alertness, and temperature regulation; supplied by superior cerebellar artery (via basilar a.) -___: involved in the control of breathing, communication between different parts of the brain, and sensations such as hearing, taste and balance; supplied by the AICA & pontine arteries (via basilar a.) a. midbrain b. pons c. medulla

c, a, b (stroke or lesion in the brainstem can affect both sides of the body; depends on lesion site and if decussation has occurred more severe damage results in "Locked-in syndrome" which most often results from a lesion in the pons)

This type of incomplete SCI is a resultant of an injury at or below the level of the L1 vertebrae resulting in *peripheral nerve damage, flaccid paralysis* (no spasticity!). Patients with this injury likely present with severe amounts of pain, parasthesia, burning, and tingling. - *Prognosis: EXCELLENT* (peripheral nerves regenerate) - very good SCI to have (most ideal in Dr. James' opinion) - Average clients will NOT regain calf and foot intrinsic strength (d/t degeneration of the myoneural junction over time), and may require orthotics

cauda equina (lesion)

An otherwise healthy young adult who has a C5 spinal cord injury (ASIA Impairment Scale A) is being examined by a physical therapist. Which of the following functional levels is the MAXIMUM that the patient can potentially achieve? a. Dependent transfer to a wheelchair by using an overhead lift b. Independent rolling side to side in bed c. Independent community-level mobility with a manual wheelchair d. Toilet transfer with a sliding board and assistance

d (Toilet transfer with a sliding board and assistance ) (A patient who has a complete injury to C5 still has innervation to the deltoids, biceps, and rhomboids and would potentially be able perform level surface transfers with assistance. A patient who has a C5 spinal cord injury [ASIA Impairment Scale A] can potentially assist with a sliding board transfer with the use of deltoids, biceps, and rhomboids, especially if normal strength is present in all innervated muscles.)

A patient who recently received a new wheelchair reports frequent forward loss of balance and difficulty propelling the wheelchair. Assessment results for the patient are unchanged from previous physical examinations, except for redness over bilateral scapula. The physical therapist should suspect a problem with which of the following components of the wheelchair? a. Seat height b. Rear wheel position c. Seat angle d. Back height

d (back height) (The irritation over the scapulae indicates that a problem with the back height exists. The excessively high back height can prevent the patient from leaning adequately backward and contribute to a forward loss of balance)

A patient who has Bell's palsy would benefit MOST from strengthening of which of the following muscles? a. Masseter b. Temporalis c. Lateral pterygoid d. Frontalis

d (frontalis) (1-3 = trigeminal innervation; 4 = facial innervation)

A new child is moving into a school district and entering 2nd grade. A PT request has been made. In reviewing the chart from the previous school, the PT notes that the child has CP. Using the Gross Motor Function Classification System (GMFCS) for CP, the child is reported at a Level V. The reason for the referral is MOST LIKELY for which of the following goals? a. independent in advanced gross motor skills such as jumping, climbing and riding a bike b. independent and safe in gait and stair climbing using an assistive device c. independent in use of manual wheelchair for primary mobility d. maintaining ROM and skin integrity with use of positioning devices

d (maintaining ROM and skin integrity with use of positioning devices)

Which of the following *is* one of the earliest signs of Guillain-Barré Syndrome (GBS)? a. extreme fatigue b. slowed movements c. tremor d. numbness/tingling in hands and/or feet e. loss of smell f. monocular blindness g. Fasciculations

d (numbness/tingling in hands and/or feet [stocking/glove pattern]) (extreme fatigue, intention tremor, monocular blindness = MS signs slowed movements/bradykinesia, resting tremor, loss of smell = PD signs fasciculations = ALS sign)

You are doing an initial eval on a patient who had a stroke. You note that the patient has no communication difficulties, but seems to have unrealistic expectations about their current abilities. Their midline orientation is "off" and they push toward their weaker side. Furthermore, you observe hypotonic hemiparesis on the left side with some return of their hip musculature. In the LE, the knee tends to buckle or hyperextend and they have no ankle control. In the UE, the patient can recruit the middle deltoid only, otherwise the arm is totally flaccid. In sitting, the patient leans/pushes to the left and tends to sit in a posterior pelvic tilt. Based off this presentation where did this patient's stroke most likely occur? a. Left ACA b. Right ACA c. Left MCA d. Right MCA e. PCA f. Thalamus

d (right MCA) (clues: no communication issues, left side hypotonic hemiparesis, pusher syndrome, UE involvement > LE involvement)

Patients with lesions in the *left* hemisphere typically present with: a. impulsivity b. poor judgement c. overestimate abilities/underestimate problems d. slow and cautious

d (slow and cautious) (LEFT LESION: right side hemiplegia, slow, cautious, hesitant, insight into impairments - frustration RIGHT LESION: left side hemiplegia, impulsive, quick, indifferent, poor judgement, overestimate abilities, underestimate problems)

a posterior or anterior canal BPPV diagnosis can be ruled in or out using the ___________ maneuver - start with the patient in long-sitting - move to supine with the head rotated 45 degrees and extended 30 degrees (Dr. Miller starts rotated to the uninvolved side first becuase she expects the test to be negative and less provocative) - *Positive test* = torsional up-beating nystagmus on affected side (posterior canal), torsional down-beating nystagmus on affected side (anterior canal)

dix-hallpike (Laying patient down with neck extended and *looking to the RIGHT*, if they have an *up-beating torsional nystagmus = RIGHT POSTERIOR CANAL*; if you see a down-beating torsional nystagmus = LEFT ANTERIOR CANAL ^^ regardless if it's a right posterior or a left anterior - paired-, you treat the BPPV the same way)

this pathway from the spinal cord to the brain (*afferent sensory*) is associated with conscious proprioception, fine touch, 2-pt discrimination, stereognosis (ability to perceive the form of solid objects by touch), vibration, and movement sense - Point of decussation: medulla - Lesion at spinal cord BEFORE reach medulla: ipsilateral side will be impacted - Lesion to spinal cord after medulla: contralateral side will be impacted

dorsal column (medial lemniscal)

Name the muscles associated with the following spinal cord level(s): - *T1 (T1-T6)*: __________ - With addition of these two muscles *normal grip* is now possible

dorsal interossei, palmar interossei

This is a condition that occurs when there is an extra copy (trisomy) of chromosome 21 in a baby when they're born due to abnormal cell division of the egg/sperm during development. - *Impairments*: hypotonia, decreased force generation of muscles, congenital heart defects (esp septal), visual and hearing losses, *atlantoaxial subluxation/dislocation (laxity of transverse odontoid ligament* - S&S: decreased strength, decreased ROM, hyporeflexic DTRs and decreased sensation in extremities, persistent head tilt and increase in muscle tone, cognitive deficits can be mild to severe; Gross motor developmental delay, difficulties in eating and speech development d/t low tone, cognitive and perceptual deficits may result in delay of fine motor and psychosocial development

down syndrome (Forceful neck flexion and rotational activities should be limited d/t atlantoaxial ligament laxity [somersaults, diving into pools, contact sports should be avoided])

What ASIA level would an individual be if they previously had deficits from a SCI but are *now normal*? a. ASIA A b. ASIA B c. ASIA C d. ASIA D e. ASIA E

e (ASIA E)

This type of *ischemic* stroke is the cause of 38% of all strokes and is characterized by a blood clot coming from the heart or plaques from any artery getting stuck and preventing flow of blood. These stroke usually have no precursor warnings and occur rapidly (within seconds or minutes). - Causes (generally cardiac in nature): *Atrial fibrillation*, Myocardial infarction - more severe in nature (due to rapid onset) - Most commonly occur in the middle cerebral artery (MCA) - Tx: t-PA (3 hr window), surgery to remove clot and restore blood flow to brain (if 3 hr window has passed), neuroprotective agents, cooling therapy (induced medical coma limits extent of brain injury), anticoagulant therapy, diet and exercise

embolism (embolytic stroke)

Disorder characterized by recurrrent seizures (repetitive abnormal electrical discharges within the brain). Seizures commonly caused by: acquired brain disease or trauma, tumor, stroke, degenerative brain disease (e.g. Alzheimer's), developmental brain defects (low O2 at birth), drug overdose (cocaine, antihistamines), drug withdrawal (alcohol, benzodiazepines), electrolyte disoder (hypo-/hypernatremia, hypoglycemia), hyperthermia, infections (brain abscess, meningitis). Types: - *Generalized/Grand Mal* = involves all areas of the brain (cortex), Sx include dramatic LOC, with stiffening (tonic) then rhythmic (clonic) movements of the UEs and LEs, eyes generally open, altered breathing, urinary incontinence, typically lasts 2-5 min; Post-seizure: consciousness gradually regained, person typically confused, drowsy, and amnesiac (may last several hours) - *Absence/Petit Mal* = posture is maintained, repetitive blinking or other small movements may be present. Typically brief (lasting a few seconds); may occur many times in a day. - *Partial/Focal* = only one part of the brain is involved, symptoms are focal (specific area of the body); - *Complex partial* = person appears dazed or confused, not fully alert or unconscious - *Temporal lobe* = episodic changes in behavior with complex hallucinations, automatisms (e.g. lip smacking, chewing, or pulling on clothing), altered cognitive or emotional function (e.g. sexual arousal, depression, violent behaviors) - *Status epilepticus* = prolonged seizure or series of seizures (lasting > 30 min) with very little recovery between attacks (may be life-threatening medical emergency)

epilepsy (Recognize S&S of seizure and protect pt from injury during seizure. Remain with pt, remove potentially harmful nearby objects, loosen restrictive clothing, do NOT restrain limbs. Establish airway, prevent aspiration [postion pt in sidelying and wait for tonic-clonic activity to subside]. Seek medical and/or nursing assistance ASAP.)

This type of stroke makes up the majority of strokes (88%) and is characterized by *arterial supply to the brain being blocked* (decreased O2 delivery, cyanosis). This can result from atherosclerosis (artery narrowing) or by blood clots moving from the heart; - 4 sub-categories: TIAs, Thrombosis, Embolism, Lacunar strokes - Tx: blood thinners, t-PA, stent retriever to remove clot, anti-coagulant drugs (Heparin, Warfarin, antiplatelet drugs)

ischemic (blood clots from the heart generally are a result of irregular heartbeat [AFib], heart attack [MI], or abnormalities of the heart valves)

Cervical *_____________* is a loss of function in your upper and lower extremities because of *compression of the spinal cord within your neck*. This condition can involve your arms, hands, legs, and bowel and bladder function. Cervical *____________*, often called a "pinched nerve," occurs when a nerve in your neck is compressed or irritated *where it branches away from your spinal cord*. This can cause pain that radiates into your shoulder, as well as muscle weakness and numbness that travels down your arm and into your hand.

myelopathy, radiculopathy

this lobe of the brain is involved with vision - visual info from optic nerve transmitted through the thalamus and into the primary visual cortex

occipital

name the 12 CN in order

olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal

this division of the ANS is *craniosacral* in origin, maintains homeostasis in the body, and involves muscle relaxation + decrease in HR also known as the "D division" - Digestion, Defecation, Diuresis

parasympathetic

this lobe of the brain processes *sensory* information regarding location of body parts (perception) and sensation (touch, pain, temp, pressure, proprioception) - includes the post-central gyrus which is the *primary somatosensory cortex*, the main sensory receptive area for the sense of touch - body orientation and sensory discrimination - Main arterial supply: MCA

parietal (the "where system")

during a head impulse test (HIT), when you give the patient's head a quick gentle thrust to one side, and then to the opposite side. If the patient's eyes *cannot stay on your nose*, this is considered a (central/peripheral) sign

peripheral (and means they probably have a *hypofunction in the side that they aren't able to maintain the gaze* on your nose; e.g. if you thrust their head to the right quickly and they can't keep their gaze on your nose that's a sign of a RIGHT peripheral disorder and vice versa)

Naming SCIs: - Designate _______ vs ________ if the sides are different - Designate ________ vs _________ if the function is different - _________ = impairment/loss of motor and/or sensory function in the UEs, LEs, trunk and pelvic organs (resulting from a lesion in the cervical spinal cord) - *The level of SCI is named after the LAST LEVEL IN WHICH MOTOR AND SENSORY FUNCTION ARE COMPLETELY NORMAL*

right, left, sensory, motor, quadriplegia (tetraplegia)

*Bowel dysfunction* is one of the common problem associated with SCIs. The two types of bowels are areflexic and reflexic. - __________ bowels occur in those with *intact S2-S4 reflex arches*. In this, the anal sphincter remains taut and relaxes involuntarily when the rectum is distended - patients can get into a bowel routine in which every day or every other day a suppository with anal/digital stimulation can lead to a bowel movement

reflexic (bowels) (Management: diet and routine!!!! - fiber, fiber, fiber babyyyyy; routine, routine, routine babyyyyyy)

Rules for naming a SCI: 1) Determine ____________ level for right and left sides. Use pain and touch (they run in two different tracts - spinothalamic and dorsal column). Named for the most distal (lowest) level in which sensation is intact for *both*. 2) Determine __________ level for right and left sides. This level is defined as the *lowest key muscle group that tests a grade 3 or above*, provided that the next highest segment tests a 5. Where there is not a myotome test (i.e. T2-T12) motor and sensory are presumed to be the same. 3) Determine the ____________ = the most caudal (lowest) segment of the cord with intact sensation *AND* antigravity (3 or more) muscle function strength (provided that there is normal sensory and motor function above that level) 4) Determine if the injury is _________ or __________ based on the presence or absence of sacral sparing (based on voluntary anal contraction, S4-S5 sensory scores, and deep anal pressure)

sensory, motor, NLI (neurological level of injury), complete, incomplete (Also record any zone of partial preservation - only done with complete SCIs ◦This is any remaining sensory or motor function present below the level of the injury.)

CN I (olfactory) is a (motor/sensory/motor and sensory) nerve - Not always tested in clinics, but may be tested in hospitals - dysfunction of this nerve is one of the earliest Sx of what disease?

sensory, parkinson's (Not a lot of clinics have smell charts; close your eyes, close off one nostril, see if the Pt can ID the smell)

mneumonic device to remember cranial nerve function (sensory/motor/both)

some say marry money but my brother says big brains matter more

This is a disorder of sensorimotor control that presents as intermittent or continuous resistance to stretching by a muscle due to abnormally increased tension, with increased DTRs - A condition of increased muscular tone causing stiff and awkward movements (can involve altered timing, amount, or speed of muscle contraction) - *velocity-dependent* - uni-directional resistance (happens during one movement but not during return from that movement) - UMN sign (lack of central inhibition)

spasticity (a spastic muscle is a weak muscle) (*override from CNS* keep getting message from brain to fire a muscle, increase of ACh in the NMJ, leading it to be spastic)

this movement disorder associated with the basal ganglia has rhythmic or semi-rhythmic oscillations; 3 types - - Resting (occurs when limb relaxed; Parkinson's) - Postural (occurs when limb is held in a position and disappears at rest; e.g. Essential) - Intention/Ataxic (occurs when Pt attempts to move limb)

tremor

*_____________* = lesion of trigeminal nerve (CN V) usually from compression in older adults with an abrupt onset. - *S&S*: brief neurogenic pain (stabbing/shooting) along the distribution of the trigeminal nerve, mandibular & maxillary divisions, UNILATERAL Sx, autonomic instability (exercerbation by stress, cold; relieved by relaxation).

trigeminal neuralgia

T/F: *Majority* of people who develop Guillain-Barré Syndrome (GBS) have something that causes the person's *immune system to become compromised* preceding the development of GBS such as a *respiratory infection*, pneumonia, EBV, or GI illness

true (body's response to infection goes haywire causing the immune system to attack the myelin sheath and peripheral neurons) (another example: swine flu; a lot of people after getting the swine flu vaccination ended up getting GBS. These people didn't get swine flu but had enough of an autoimmune reaction that they ended up developing GBS)

What areas of the body does the MCA supply sensation and motor to (according to the sensory and motor homunculus)

trunk, UEs, head (face, throat, tongue) (MCA syndrome: contralateral hemipelgia with UE > LE involvement, contralateral hemisensory loss with UE > LE involvement, homonymous hemianopsia; may also have motor aphasia, and/or sensory ataxia)

Testing the _________ __________ involves holding numbers up on your fingers even with patient's ears and slowly bring one hand into patient's peripheral vision field until they say they can see your hand, ask if they can see how many fingers you're holding up, if they don't know move your hand further forward into until they can decipher how many fingers you're holding up; - test both sides - test high and low - *what CN is this test associated with?*

visual field, CN II (optic)

A PT is evaluating a pt who had a recent SCI. The patient presents with intact sensation in the lateral shoulders, lateral forearms, and thumbs. Myotomal testing reveals 5/5 strength for elbow flexors, 3+/5 wrist extensors, and 1/5 for elbow extensors and finger flexors bilaterally. According to the ASIA form, which of the following should be documented into the patient's medical record? A. C6 B. C5 C. C7 D. C8

A (C6 - named for the lowest NORMAL sensation bilaterally AND 3/5 muscle function level)

Clinical consequences of occlusion of the ________ include *contralateral loss of sensation and motor control to the LE*; Broca's aphasia/Mutism; gait apraxia (inability to perform learned/familiar movements; person won't know how to advance their foot), urinary incontinency - 10% of strokes affect this artery - may see frontal lobe signs (lack of spontaneous behavior, motor inattention, amnesia) - Supplies areas of the brain involved with motor function of the genitals, LEs, hips, and trunk

ACA

This condition is a progressive degenerative brain disease and is the most common form of dementia. It is characterized by *amyloid plaque deposits, tau protein tangles*, and neuronal death/brain atrophy. - Risk factors: increased age, family history, head injury, poor CV health, physical and social inactivity - Mild, moderate, and severe stages (typically each stage lasts a few years) - NOT a normal part of aging

AD (Alzheimer's disease) (progressive mental deterioration that can occur in middle or old age [onset: 70+ yrs], due to generalized degeneration of the brain. It is the most common cause of premature senility.- progressive loss of neurons [gray matter] and connections [white matter])

This is a fairly rare, irreversible progressive nervous system disease that affects neurons in the brain and spinal cord, causing loss of muscle control. It often begins with muscle twitching and weakness in a limb, or slurred speech. Eventually, this condition affects control of the muscles needed to move, speak, eat and breathe. There is no cure for this fatal disease. :( - Neurons in motor cortex (UMN), brain stem, and anterior horn cells in the spinal cord (LMN) stop relaying messages to muscles - Dx: late 50's-early 70's (peak age: 62 y/o) - degeneration of both UMN and LMN - affects all races and ethnic groups - Affects men more than women- does NOT effect cognition - can be passed on (hereditary) or develop sporadically

ALS (amyotrophic lateral sclerosis) (amyotrophic = atrophy of muscle fibers as their corresponding anterior horn cells degenerate lateral sclerosis = hardening of the anterior and lateral columns of the spinal cord as the motor neurons degenerate and are replaced by fibrous astrocytes) (With ALS, the PT's role changes slightly and becomes highly focused on anticipating the progressive nature of the disease and planning for the future [regarding adaptive equipment, home modifications, and life changes] as well as addressing more psychological support and working a lot with the caregiver)

this structure of the brain facilitates smooth movement (through a direct or indirect pathway); selection and initiation of willed movements; Strongly interconnected with the cerebral cortex, thalamus, and brainstem. - associated with a variety of functions, including *control of voluntary motor movements*, procedural learning, habit learning, eye movements, cognition, and emotion - comprised of striatum (caudate and putamen), globus pallidus (internal and external), substantia nigra, and subthalamic nucleus

BG (Basal ganglia)

The _____________ score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born.

Apgar (Appearance - skin color Pulse Grimace - reflex irritability Activity - muscle tone Respiration)

This type of *cerebral palsy* is characterized by low postural tone with poor balance, stance and gait are wide based, intention tremors of the hand, uncoordinated movement, ataxia follows initial hypotonia, poor visual tracking, nystagmus, speech articulation problems, may occur with spastic or athetoid CP

Ataxic (cp)

This type of *cerebral palsy* is characterized by involuntary, slow writhing movements, with generalized decreased muscle tone (floppy baby syndrome). This is a result of *BASAL GANGLIA* involvement. - Poor functional stability especially in proximal joints - Ataxia and incoordination when child assumes upright position, with decreased BOS and muscle tone fluctuations - Poor visual tracking, speech delay, and oral motor problems - Tonic reflexes (e.g. asymmetrical tonic neck reflex, ATNR, symmetrical tonic neck reflex, STNR, and tonic labyrinthe reflex, TLR) may be persistent, blocking functional postures and movement.

Athetoid (CP)

___________ is one of the *most common causes of vertigo* — the sudden sensation that you're spinning or that the inside of your head is spinning. - Caused by otoconia falling into the SCC - causes *brief (~30 seconds*) episodes of mild to intense dizziness - usually triggered by sudden specific *changes in the position of your head* - Classic signs when patient says: "I rolled out of bed, got up, and I was SUPER dizzy", "when I got into bed and laid down I was SUPER dizzy", "I looked up/down and get super dizzy" - the patient MUST have a head movement occur with the dizziness in order for it to be this condition - Most common vestibular disorder (if under 50 y/o cause is likely TBI or concussion; if older than 50 y/o cause is usually idiopathic) - usually unilateral

BPPV (Benign paroxysmal positional vertigo) (BPPV: feeling INTENSELY dizzy for 30 seconds-1 min, especially with head movement - getting up from bed, laying down, looking up/down, and then just feeling really cruddy after)

This is a 14-item objective measure designed to assess static balance and fall risk in adult populations; individually scored 0-4; max score = 56; - *increased falls risks if score is < 45* - ICF: Activity

Berg (balance scale)

_________ area is involved in the *expressive aspects of spoken and written language* (production of sentences constrained by the rules of grammar and syntax). It is located in the *left* side of the *frontal lobe*. - damage to this area of the brain can result in the *inability to speak*, or difficulty forming words even though vocal cords, larynx, muscles, and innervation is normal; can still comprehend/perceive language

Broca's

This type of incomplete SCI is caused by a penetrating injury to the vertebral column resulting in damage to ~1/2 of the spinal cord and the other half remaining normal. - Causes: stabbing wounds, gunshot wounds, unilateral facet lock injuries, burst Fx at the lateral body of the vertebrae - *Results in: ipsilateral* loss of position & vibration sense, *ipsilateral* hemiparesis, & *contralateral* loss of pain & temp sensation - *Prognosis*: very good. Nearly all patients regain ambulatory abilities (may need AFO/cane), majority regain hand function, all regain bladder function, and majority regain bowel function

Brown sequard syndrome

A PT is treating a pt with a suspected CN XI injury. Which of the following would be the LEAST likely found during a routine examination? A. Atrophy, fasciculations, and ipsilateral weakness B. Inability to shrug the ipsilateral shoulder C. Inability to turn the head contralaterally D. Weakness of the contralateral SCM and trapezius

D (CN innervation = ipsilateral side accessory nerve = traps and SCM)

This diagnosis consists of a group of permanent developmental motor disorders due to a *non-progressive* injury or abnormal fetal brain development. It is usually a result of prenatal PVL (necrosis of white matter in brain near ventricles) or IVH (hemorrhage in brain into ventricles) - Prevalence: common - Screen/Dx: Cranial US (for PVL or IVH), MRI (abnormalities in brain, BG, and/or thalamus); Dx ~12 mo if lucky; Movement Assessment in Infants (MAI) - Physical characteristics: low birth wt, spasticity, mono-, hemi-, quadri-, tri-, or diplegia, varying gross motor function, gait abnormalities - Assoc. Conditions: sensory issues (proprioception), cognitive impairments, seizures, visual impairment, emotional/conduct disorders, hyperactivity, incontinence, communication disorders - Life Span: varies (early death usually a result of seizures or respiratory issues)

CP (cerebral palsy) (during gait the combo of excessive hip flexion, adduction, and IR produces a scissoring pattern. This type of gait deviation results primarily due to the presence of spasticity.) (non-progressive disorder of the CNS resulting in impairments in posture and volitional movement. CP is an umbrella term used to describe movement disorders due to brain damage acquired in utero, during birth or infancy. It is classified by extremity involvement and muscle tone. Spastic diplegia describes an UMN lesion in the motor cortex of the cerebrum involving the trunk and LEs with the UEs affected to a lesser degree) (PVL = periventricular leukomalaciaIVH = intraventricular hemorrhage) (Most common type of CP: Spastic CP - results from a fixed lesion in motor cortex Athetosis = involves BG and "writhing movement" Ataxia = cerebellar lesion, "drunken sailor's gait, looks jittery)

This condition often develops following trauma or disuse. - *Type I (reflex sympathetic dystrophy*) - MOST COMMON TYPE, intense pain throughout the limb (UE or LE) but does *NOT involve specific damage to the PNS*. - *Type II (causalgia*) - involves specific damage to the PNS (e.g. radiculopathy, neuropathy) typically resulting in both overt motor and sensory neuropathic S&S - *S&S*: intense and diffuse pain, continuous burning or throbbing pain, hyperalgesia and allodynia (pain felt during normal non-painful activities), decreased movement of the affected area, cold sensitivity, edema in painful area, changes in skin temp color and texture, hyperhidrosis, changes in hair and nail growth, atrophy and risk of osteoporosis

CRPS (complex regional pain syndrome) ( PT goals & interventions: movement!!! [type II may require more PROM/AAROM], desensitization training, aerobic exercise [pain management], neuroscience pain edu)

This is a rare fatal genetic disease of progressive weakness of skeletal and respiratory muscles cause by an X-linked mutation (Xp21 gene; *males get it, females carry it*). This mutation results in an absence of dystrophin protein which leads to the breakdown of muscles (*progressive weakness and loss of function*). Life span: 20-30 y/o - Physical characteristics: *progressive proximal muscle weakness*, (+) Gower's sign, restricted mobility/inactivity, language delay, clumsy, wide BOS/waddling gait, PF and hip flexor contractures. Frequent falls, trouble getting up or running, toe walking - PT goals & interventions: maintian mobility as long as possible (recreational & functional activities; maintain strength and cardiopulm function). Maintain joint ROM/PROM (prone standers, standing frames, night splints). E-stim in younger pts for muscle contractility. Edu and family support. *DO NOT EXERCISE AT MAXIMAL LEVEL* (may injure muscle tissue/overwork injury); Supervise use of adaptive equipment as needed. - Most common cause of death = cardiorespiratory failure

DMD (Duchenne Muscular Dystrophy)

_________ posture is indicative of damage in the upper pontine of the brain and is characterized by upper extremities extended at the elbows, wrists are flexed, arms are close to the sides, and the legs are extended. - *more ominous sign of brain stem damage / most severe* - When stroke or brain injury occurs in the brain stem it can affect both sides of the body (dependent on lesion site and if decussation has occurred)

Decerebrate (posture) (D*e*c*e*r*e*brat*e* - *extension*)

___________ posture is indicative of damage in the upper midbrain and is characterized by upper extremities flexed at the elbows and held closely to the body, and the legs being extended - When stroke or brain injury occurs in the brain stem it can affect both sides of the body (dependent on lesion site and if decussation has occurred)

Decorticate (posture) (-"flexor posturing" or "mummy baby" [think Egyptian mummy preservation] -ADD of arms [arms fold to chest]; flexion of elbows and wrists)

*___________* is a nerve condition in the shoulder and arm that results in weakness or loss of muscle function. The brachial plexus is a group of five nerves that connect the spine to the arm and hand. These nerves allow your shoulder, arms and hands to feel and move. If these brachial plexus nerves don't work well due to stretching or tearing, the condition is called a *brachial plexus* palsy. Typically this results from a *traction injury during birth*. The infants arm will be in a *waiter's tip* position (arm at side, elbow extended, wrist flexed). - this is the most common type of brachial plexus palsy - *Motor loss*: GH ABD, flexion, elbow flexion, wrist extension - Sensory loss: lateral aspect of arm, thumb and potentially index finger

Erb's palsy (C5-C6 upper arm paralysis Klumpke's paralysis = C8-T1 lower arm paralysis)

Name the muscle(s) associated with the following spinal cord level: - *C6*: __________ - This muscle is key for achieving *tenodesis grip/grasp*

ECRL (extensor carpi radialis longus) (Tenodesis grasp: Kinsesiological effect that will cause the fingers to flex when the wrist is moved from neutral to extension, and the fingers to extend when the wrist is moved from a neutral position to flexion Used as a functional advantage for clients with: spinal cord injury at the C6-C7 level radial nerve palsy)

T/F: If you notice signs and symptoms of a SCI patient experiencing autonomic dysreflexia, you should immediately lower the head of the bed or raise their legs to redirect blood flow to the brain and heart.

FALSE (you should immediately ELEVATE the person's head or move them into a sitting position to cause hypotension/drop their BP!!!)

Frontal stroke signs can be identified using the acronym FAST, what does each letter stand for?

Face (unilateral drooping), Arms (UE weakness), Speech (dysarthria, slurring), Time (time to call da ambulance!!)

*_____________ cerebellar* lesion: central vestibular Sx (ocular dysmetria, poor eye pursuit, dysfunctional VOR, impaired hand-eye coordination), gait/trunk ataxia, little change in tone/dyssynergia of extremities.

Flocculonodular

TEST: Position the subject's relaxed hand ensuring slight extension at the wrist and partial flexion of the fingers. Hold the subject's partially extended middle finger between your index and middle finger, ensuring you stabilize the proximal IP joint. Perform a *sharp and forceful flick of your thumb, making contact with the nail of the subject's middle finger*. - Normal response: The subject's finger will flex immediately followed by relaxation. - *Positive test*: is characterized by flexion and adduction of the thumb and flexion of the index finger. This would potentially indicate an *UMN lesion*

Hoffman's sign

This is a *rare, inherited* disease that causes the progressive breakdown (degeneration) of neurons in the brain. It has a broad impact on a person's functional abilities and usually results in movement, cognitive and psychiatric disorders. - *Avg Onset: 30's-40's* - Autosomal dominant disorder (single gene disorder) - Early signs: subtle changes in personality, cognitive and physical skills; irritability, apathy, anxiety, depression, OCD, psychosis - Dx: made based on S&S and family history, MRI and CT scan can show loss of brain volume - cognitive and motor components deteriorate at different rates (one can be worse than the other initially) - no cure :(

Huntington's (Motor Sx: increased reflexes, decreased balance, decreased strength Sensory Sx: increased sensitization to touch, constant eye movement, hearing changes - less common Psychiatric Sx: mood and mental status changes Cognitive Sx: loss of memory, reasoning, and language skills)

What areas of the body does the ACA supply sensation and motor to (according to the sensory and motor homunculus)

LEs (legs, feet, toes), genitals (ACA syndrome: contralatera hemiplegia with LE > UE involvement, contralateral hemisensory loss with LE > UE involvement, *urinary incontinence*, Apraxia, problems with bi-manual tasks may also be less mobile/akinetic, and/or less verbal/mutism)

Flaccid paralysis, asymmetrical weakness, cramping with voluntary movement in the early morning and fasciculations are _______ signs. Spasticity, (+) Babinski, and (+) Hoffman's are _________ signs

LMN, UMN (UMN: nerves located in the brain cortex, CNS issue LMN: located in the spinal cord, PNS issue)

This test identifies dysfunction of spinal cord (myelopathy) and/or an upper motor neuron lesion. Patient is long sitting on table. Passively flex patient's head and one hip while keeping knee in extension. Repeat this step with other hip (+) TEST: pain/electric sensation shooting down back or into legs

Lhermitte's sign

This is an autoimmune disorder, in which an abnormal response of the body's immune system is directed against the CNS. Within the CNS, the immune system causes inflammation that *damages the myelin sheath* that covers axons of nerves. This damage to myelin and nerve fibers leads to messages within the CNS being altered or stopped completely. - Produces a variety of neurological Sx depending on area of damage (e.g. spasticity, B&B dysfunction, cognitive difficulties, depression, fatigue, visual problems, vertigo) - damaged areas develop scar tissue (aka plaques or lesions) which give the disease its name - *S&S*: spasticity, B&B dysfunction, fatigue, visual problems, vertigo, depression, gait abnormalities, (+) Lhermitte's, Charcot's triad (dysarthria - difficulty w/ speech; nystagmus; intention tremor) - Sx exacerbated by external heat - 4 types (Relapsing-Remitting, Progressive-Relapsing, Primary Progressive, Secondary Progressive)

MS (multiple sclerosis) (autoimmune disorder, T cells w/ ligand cross BBB opening pathway, inflammatory response, B cells attack myelin sheath, macrophages attack oligodendrocytes. Regulatory T cells stop attack on myelin sheath & oligodendrocytes leading to remyelination. Average onset is 20-40 y/o; affects white women the most; risk factors: smoking, low vit. D, obesity)

the pupillary light reflex is a good test for what condition that may be undiagnosed; If a patient has this condition their pupils will produce the opposite response of what is normal - when light is shown in their eye the pupil will dilate and the opposite eye will constrict --> RED FLAG

MS (mutiple sclerosis)

a dense network of neurons found in the core of the *brainstem*; it arouses the cortex and screens incoming information - brain area that plays a key role in *arousal/alertness*, regulating wakefulness and sleep-wake cycles - damage to this area may result in deep sleep, lethargy, or coma

RAS (reticular activating system) (Activates every portion of the brain; often involved in stroke and TBI Stroke: people feel just so fatigued, as a therapist you keep them upright as much as possible [this activates the RAS; sitting up, standing up])

This is the *most common type of MS*. It is characterized by a period of exacerbation and a period of remyelination. During the exacerbation period damage to myelin sheaths is occurring and the pt will be experiencing symptoms (e.g. vision loss/abnormalities, muscle weakness, loss of B&B). During remyelination/remission periods the pt's Sx seem to improve and they display reduced disability. A pt may go months/years without a period of exacerbation, but they *never* fully return to baseline levels of functioning.

RRMS (relapsing remitting MS)

This type of *ischemic* stroke is the cause of 50% of all strokes and develops in a matter of minutes, hours or days. These strokes occur frequently at places where arteries branch and where plaques may have narrowed the arteries for years. - over half (60%) of these strokes occur while the person is sleeping (e.g. pt goes to sleep fine and wakes up with hemiplegia) - artery is being progressively blocked - pts usually have HTN, diabetes, or vascular disease elsewhere - *3 hour window* following onset of Sx for a person to get treatment - Tx: *t-PA*, intra-arterial t-PA (via catheter), anti-coagulants/anti-platelet drugs, neuroprotective agents, cooling therapy (induced medical coma limits extent of brain injury) - Must ensure stroke is not hemorrhagic in nature before administering treatment/medications (via CT and MRI)

Thrombosis

This results if there is any injury to the brain in the frontal cortex or any of their motor tracks; The nerves to the muscles from the spinal cord are often intact, but the inhibition and initiation from the brain is lost. - characterized by spastic paralysis, increased tone, and hyperreflexia

UMN lesion (Upper Motor Neuron lesions everything goes UP! Weakness [+]Reflexes [⬆]Tone [⬆]Babinski [+]Spastic paralysis [+]) (motor function can be retained in the form of increased tone, but without the voluntary initiation we normally see) (following the initial insult/injury there is often a period of shock, in which all muscle tone is low and the limb often appears flaccid/heavy/limp; it tends to take days-weeks to go from initial flaccidity to transition to spasticity)

During DTRs, *hyperreflexia* is associated with a/an (UMN/LMN) problem, and *diminished/absent* reflexes is associated with a/an (UMN/LMN) problem

UMN, LMN (UMN - MS, TBI, SCI, CVA, ALS LMN - Huntington's, GBS)

Match the following descriptions with the correct correlating stage from the H&Y Staging Scale for Parkinson's: -___: mild disability, usually unilateral; more inconvenient than disabling; pts usually able to continue regular work and activities with minimal accommodation; e.g. "oh I just noticed my arm wasn't moving while I was walking" -___: moderately severe generalized dysfunction; significant slowness; equilibrium impairments in standing and walking; more falls start occurring -___: completely dependent for ADLs; may not be able to stand and walk even with assistance; difficulty swallowing; communication deficit; 20% have dementia -___: bilateral Sx; both posture and gait are affected; shuffling festinating gait; minimal disability; begin to stoop forward -___: significant disability requiring assistance with ADLs; increased bradykinesia, postural instability (falling), rigidity (lead pipe), and festinating gait a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5

a, c, e, b, d

ANS Receptors -The ___________ pathway is otherwise known as the *sympathetic* nervous system. The other one is the __________ pathway which is also regarded as the *parasympathetic* nervous system these two still differ (in fact their actions oppose each other) because of the following: 1. *Adrenergic* involves the use of the neurotransmitters __________ and ____________, while *cholinergic* involves ______________. 2. Adrenergic is called the sympathetic line (SNS) while cholinergic is called the parasympathetic line (PNS). 3. In general, cholinergic effects or symptoms are like the 'digest and rest' while adrenergic effects are congruent to the 'fight or flight' response symptoms. 4. _________ and __________ receptors are part of the cholinergic line, while ________ and ________ receptors are involved in the adrenergic line.

adrenergic, cholinergic, NE (norepinephrine), Epi (epinephrine --> aka adrenaline), ACh (cholinergic), nicotinic (cholinergic), muscarinic (cholinergic), alpha (adrenergic), beta (adrenergic)

This type of incomplete SCI is most often caused by compression of the anterior spinal artery (can be d/t aortic insufficiency, atherosclerosis, *disc herniation*, trauma, or *teardrop/"burst" fractures of the vertebral body*). This leads to insufficient profusion to the anterior 2/3 of the spinal cord (which houses the spinothalamic tract and majority of the corticospinal tract) - *Extremely poor prognosis for return of motor function* (+ B&B and sexual function) - Bilateral flaccid paralysis and sensation loss due to loss of gray matter AT level of injury; spastic paralysis with voluntary motor and (pain and temp) sensory loss BELOW level of injury - Posterior (dorsal) column function remains intact bilaterally (conscious proprioception, stereognosis, deep pressure)

anterior cord syndrome (no motor return below level of injury)

this condition is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement. Both the desire and the capacity to move are present but the person simply cannot execute the act.

apraxia (Ideational = the inability to conceptualize, plan, and execute the complex sequences of motor actions involved in the use of objects used in everyday life - e.g. person may pick up a toothbrush to comb hair or when handed the proper object have no concept of motor planning basic activities Ideomotor = a condition where a person plans a movement or task, but cannot volitionally perform it. Automatic movement may occur, however, a person cannot impose additional movement on command)

Bowel dysfunction is one of the common problem associated with SCIs. The two types of bowels are areflexic and reflexic. - __________ bowels are characterized by the defecation reflex remaining intact, but the stronger *parasympathetic defecation reflex is lost* so the *bowel will not empty reflexively* (this can lead to fecal impaction - Hardened stool that's stuck in the rectum or lower colon due to chronic constipation.)

areflexic (bowels) (Management: diet and routine!!!! - fiber, fiber, fiber babyyyyy; routine, routine, routine babyyyyyy)

A pt has continued intense (10 out of 10) pain in the left foot and ankle 6 months after sustaining an ankle sprain. A recent MRI of the foot and ankle are normal. The pt reports "that all activity is painful" and that they periodically get sporadic pain at rest. The pt denies overt numbness, tingling, or weakness in the bilateral LEs. On examination, the pt has no signs of inflammation but does have diffuse hyperalgesia and intense pain with light touch. These findings are most consistent with which of the following pain mechanisms? a. Nociceptive pain b. Neuropathic pain c. Central sensitization d. Peripheral sensitization

c (Central sensitization) (Central sensitization occus with increased excitatory and decreased inhibitory neural signaling in the CNS resulting in hypersensitivity. This process occurs even though there is no current evidence of actual or threatened tissue damage in the periphery [nociceptive pain] or a lesion or disease in the somatosensory system causing the pain [neuropathic pain]. This pt exhibits various S&S of Central sensitization to include intense and nonlocalized pain, sporadic pain at rest, allodynia, and secondary hyperalgesia Nociceptive pain is typically associated with an acute or ongoing disease process that activates peripheral nociceptors. Nociceptive pain is localized to the area of tissue damage and has a linear relationship with the level of activity and specific aggravating factors. Neuropathic pain involves damage to the somatosensory system and is associated with radiating pain, numbness, or tinging in dermatomal or specific nerve distribution. Peripheral sensitization may enhanceor prolong pain in the injured area and contribute to central sensitization, but it is not associated with secondary hyperalgesia)

Jimmy is a 3-year old child who presents with L2 myelomeningocele and significant cognitive impairment. The therapist would like to select the best orthotic for home ambulation. Which of the following orthotics would BEST address the therapist's goal? A. Reciprical Gait Orthosis (RGO) B. Bilateral Ankle-Foot Orthoses (AFO) C. Hip-Knee Ankle-Foot Orthosis (HKAFO) D. Parapodium

c (HKAFO) (RGO is used with spina bifida patients as well who have hip flexor weakness, but and RGO requires some level of cognitive effort [e.g. weight shifting] in order to use it; An RGO allows the user to create reciprocal [forward and backward] movement of the legs, and to regulate their gait while walking. It is meant to assist those with paralysis of the lower trunk, hips and lower extremities stand and walk. Parapodium: upright standing, not used for ambulation; used for pre-gait activities; IS considered an orthotic technically) (myelomeningocele = spina bifida basically)

Chorea-type movements are noted during an initial gait assessment of a patient referred to physical therapy following a stroke. This clinical finding is indicative of a lesion in the: a. cerebellum. b. thalamus. c. basal ganglia. d. limbic system.

c (Hyperkinetic disorders such as chorea arise from a pathological condition of the basal ganglia.)

The following symptoms are most characteristic of a stroke in which loction? - Contralateral sensory loss, involuntary movements (choreoathetosis, tremor, hemiballismus), homonymous hemianopsia, transient contralateral hemiparesis. May also have visual disturbances such as visual agnosia, dyslexia, or oculomotor nerve palsy. a. ACA b. MCA c. PCA d. Midbrain e. Medulla

c (PCA)

A patient displays upbeating and right torsional nystagmus during a right-sided Dix-Hallpike test. The patient MOST likely has a pathological condition affecting which of the following structures? a. Left posterior canal b. Left horizontal canal c. Right posterior canal d. Right horizontal canal

c (Right posterior canal)

When treating a patient who has transient upbeating nystagmus and left ocular torsion, canalith repositioning maneuvers should be targeted to which of the following structures? a. Right posterior semicircular canal b. Right superior semicircular canal c. Left posterior semicircular canal d. Left superior semicircular canal

c (The canalith repositioning maneuver for the left posterior semicircular canal is performed to move free-floating debris in the posterior semicircular canal back into the vestibule, thus resolving the signs and symptoms of nystagmus and dizziness. Debris in the left posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or left ocular torsion.)

The test shown in the photograph (JAW REFLEX TEST) should be used for assessment of which of the following structures? a. Cartilage b. Ligament c. Cranial nerve d. Peripheral nerve

c (The test in the photograph is the jaw reflex test, which tests the integrity of the trigeminal nerve [CN V], which is a cranial nerve.)

You are doing an initial eval on a patient who had a stroke. You quickly realize the patient has some form of expressive aphasia, but luckily no cognitive impairments as they appear to understand their position in space and have insight into their deficits. During the physical exam you observe hypotonic hemiparesis on the right side with some return to their hip musculature. In the LE, the knee tends to buckle or hyperextend and they have no ankle control. In the UE, the patient can recruit the middle deltoid only, otherwise the arm is totally flaccid. In sitting, the patient leans to the left and tends to sit in a posterior pelvic tilt. Based off this presentation where did this patient's stroke most likely occur? a. Left ACA b. Right ACA c. Left MCA d. Right MCA e. PCA f. Thalamus

c (left MCA) (clues: communication issues/aphasia, right-side hemiparesis, UE involvement > LE involvement)

Which of the following is NOT an early sign or symptom of Parkinson's: a. Facial masking b. Bradykinesia c. Numbness/Tingling d. Decreased arm swing during gait e. Stooped posture or scoliosis

c (numbness/tingling) (Early signs of PD: Facial masking [expressionless], retro LOB when pulled backward and forward LOB while walking, Bradykinesia, Tremor, Festinating gait w/ decreased UE swing and en bloc turning, increased incidence of scoliosis) (Festinating gait = A quickening and shortening of normal strides characterize festinating gait. While the steps are quicker, the stride is shorter, causing this to be a very inefficient gait, which can be frustrating and tiring for the person experiencing it.) (en bloc turning = Turning 'en bloc, rather than the usual twisting of the neck and trunk and pivoting on the toes, is when PD patients keep their necks and trunks rigid, requiring multiple small steps to accomplish a turn.)

What is the leading cause of death in ALS pts? a. Heart failure b. Kidney failure c. Respiratory failure d. Liver failure

c (respiratory failure) (chest and diaphragm muscles get involved and person is no longer able to breathe - not reversible and will likely be an ALS pt's cause of death) (respiratory function and skin protection from pressure wounds = *major key with ALS patients*)

This is the most common type of incomplete SCI and almost always occurs as a consequence of a traumatic injury. - *Causes*: anterior and/or posterior *cord compression*, acute hyperextension injuries, chronic or congenital conditions that result in *progressive stenosis*, spondylosis, osteophytes (create 'pincer' effect), or damage from microvascular compromise of the center of the spinal cord - many (~77%) patients with this type of incomplete SCI regain ambulation (one of the better incomplete SCIs to have) - *Pathophysiology*: central gray matter is compromised first (d/t its higher metabolic and perfusion needs - makes this area more at risk during periods of compromised circulation), central white matter is also compromised, any hemorrhage or edema that begins in the center of the spinal cord and spreads to the periphery - *resolution occurs in opposite manner* (outside moving inward) - Sacral tracts are least affected in this lesion in all but the posterior (dorsal) columns - Prognosis: progress may stop at any time, 2nd most ideal SCI to have in Dr. James' opinion

central cord syndrome (Injury: starts centrally and moves peripherally Recovery: begins on the outside of the cord and moves medially/towards the center) (flaccid paralysis at level of injury, spastic paralysis BELOW level of injury)

this brain structure's function is to sequence muscle contractions; *coordination, balance*, equilibrium - "small brain within the brain"; *motor learning*; new motor programs created to ensure smooth movement - lesions to this area result in motor deficits on the ipsilateral side of the body; ataxia (uncoordinated and inaccurate movements), dyssynergia (decomposition of synergistic multijoint movements), and dysmetria (overshoot or undershoot target)

cerebellum (Cerebellum is involved in BALANCE AND COORDINATION + sequencing muscle contraction for smooth movement. Lesions to this area result in motor deficits on the IPSILATERAL side of the body. Also results in motor learning impairments [decreased anticipatory control, feedback, and learning delays]. Ataxia = uncoordinated, inaccurate movements. Dyssynergia = decomposition of synergistic multi-joint movements. Dysmetria = overshoot or undershoot a target.)

the ________ is involved with *balance and coordination* while the __________ is in charge of the body's *involuntary responses*

cerebellum, brainstem

a movement disorder that causes rapid involuntary, irregular, unpredictable muscle movements. The disorder can make you look like you're dancing or look restless or fidgety.

chorea (associated with Huntington's) (Chorea: rapid, involuntary, non-stereotypical, semi-purposeful [some reference uses non-purposeful], dance-like movements that involved the distal muscle group more than proximal. Ballismus: rapid, involuntary, non-stereotypical, non-purposeful, relatively more violent flinging movement, that involved the proximal muscle group more than distal.)

this test is for a neurological condition that occurs when nerve cells that control the muscles are damaged. This damage causes involuntary muscle contractions or spasms. - rapidly flex foot into dorsiflexion - positive finding = foot keeps moving - Flex the dorsal foot upward. Positive test = 5 or more uncontrollable shaking of the dorsal foot

clonus

this phase of motor learning involves the person relying on visual input and verbal instruction as well as trial and error to guide learning; *what to do* decision - Goal: understand the overall concept of the skill to be learned - learner relies on feedback to direct future movement attempts - learner demonstrates rapid improvement in performance - instruction, guidance, slow-mo drills, video analysis, augmented feedback, and other coaching techniques are highly effective during this stage

cognitive (stage)

what are the 3 phases of motor learning

cognitive, associative, automatic (autonomous)

A ________ spinal cord injury results in a *total absence of sensory and motor function* in the lowest sacral levels (S4-S5). This type of injury can be caused by a complete severing of the spinal cord, a transection of the spinal cord, or vascular impairment to the cord. - professionals should make this diagnosis 48 hours-1 weeks post injury once the person has recovered from "spinal shock" - in this type of injury nerve roots are often damaged as they exit the foramen (peripheral nerve injuries will heal & function likely regained within 6 months of injury) - No potential for recovery with this type of injury

complete (no motor or sensory function below area of lesion)

This is the most common type of TBI and is caused by a mild blow to the head, either with or without loss of consciousness and can lead to temporary cognitive symptoms. It can also be a result of a violent shaking of the head and body. - the blood vessels in the brain may become stretched or torn (hemorrhage); cranial damage can also occur - A person may or may not experience a brief loss of consciousness (not exceeding 20 minutes). A person may remain conscious, but feel "dazed" or "punch drunk". - S&S: headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears (tinnitus), sleepiness, and excessive fatigue.

concussion

Early on in ALS pts will usually have ________________, which are rapid involuntary twitching of resting muscle without movement of limb - If you see this occurring in a patient who does not have a Dx of ALS, you should refer them to a neurologist or MD to have this checked out

fasciculations

this lobe of the brain is involved with higher order processing of info; the "doing" lobe - combines different modalities of sensory info (e.g. vision with touch/pain) - contains the pre-central gyrus which is the *primary motor cortex* (controls voluntary sk. muscle activity) - involved with problem solving, cognition, behavior, reasoning, delayed behavior, etc. - Contains *Broca's area (speech production*)

frontal (lobe)

This type of stroke makes up the other 12% of strokes and is characterized by *bleeding in the brain* leading to compression (from pressure) that results in anoxia of the brain tissue and brain damage. Can be caused by AV malformations, weakness of arterial walls, aneurysms, or head injuries. - 2 sub-categories: Hypertensive, aneurysm - Tx: lowering arterial BP to prevent further bleeding (but this also exacerbates the decreased delivery of O2 to the already hypoxic brain tissue)

hemorrhagic

_______________ = loss of half of the visual field in each eye, *contralateral to the side of the cerebral hemisphere lesion*

homonymous hemianopsia (right CVA may result in LEFT homonymous hemianopsia and left hemiplegia and vice versa)

this structure of the diencephalon serves visceral, ANS, and endocrine functions; controls body temperature, hunger, emotional states (rage, hate, aggression), thirst, sex drive, fatigue, sleep, and circadian rhythms. - synthesizes and secretes neuro-hormones

hypothalamus

A ________ spinal cord injury is one in which there is *partial preservation of sensory or motor function below the neurological level and in the lowest sacral segment (S4-S5)*. This type of lesion indicates that some viable neural white matter tracts are crossing the area injured and innervating more distal segments. - Damage from the original injury frequently precedes secondary damage to the spinal cord (including hemorrhage, edema, ischemia, and hypoxia) - secondary damage is usually complete within 24-72 hrs post trauma - 2 steroids have been used for neuroprotection in this type of SCI (dexamethasone & methylprednisolone) - 5 different types of this lesion (central cord syndrome, anterior cord syndrome, brown sequard syndrome, conus medullaris syndrome, & cauda equina lesions)

incomplete (Some of the tracts are getting through in the white matter [sacral tracts are the furthest out - they will be the first to get return of function])

Name the condition based off the following information - Etiology: wide range of factors - Risk factors: *DM*, renal failure, alcohol abuse, systemic autoimmune disease (e..g Lupus), autoimmune disease - nerve (e.g. GBS), nutritional imbalancee (e.g. Vitamin B12), hereditary, infections (e.g HepB/C), certain cancers, meds (chemotherapy), toxins (radiation, pesticides), idiopathic. Risk factors lead to segmental demyelination (GBS), axonal degeneration (alc abuse), most of the time this condition impacts BOTH myelin and axons and are more chronic in nature. - *S&S*: sensory, motor, and autonomic (e.g. hair loss, vasculature) changes in a *distal to proximal (glove and stocking*) pattern, older age, weakness/atrophy (glove and stocking pattern), poor/altered balance and gait (especially with EC/taking away visual input). Important to test both small (pain, temp) and large (2-pt, touch, vibration, proprioception) neural fiber involvement as impairments may vary.

peripheral neuropathy (PT goals & interventions: maintain and/or improve balance, gait, strength, and endurance to maximize community participation. Prevent secondary complications [fall risk, foot deformities, skin ulcers]. Decrease pain associated with small fiber [spinothalamic] neuropathy [TENs]. Recovery interventions [postural stability, balance strategies, balance/gait training]. Compensatory strategies [ADs/orthotics, skin checks, fall prevention - night light, cane, etc.])

During a mini mental exam to check if a patient is alert and oriented, what 3 components are asked about? - mini-mental exams can be used to determine if pt is alert and oriented or be a status exam (asks about these 3 components + more; more comprehensive exam)

person (e.g. what is your name?), place (e.g. do you know where you are?), time (e.g. do you know what day/month/season it is?) (documented as A&Ox3 if the pt is oriented to all 3, A&Ox2 if they are only oriented to 2/3, and A&Ox1 if they are only oriented to 1 of the 3 things)

Bulbar palsy is sometimes confused with *______________* palsy, which is the result of damage to the *UMNs*. While the two conditions share many of the same symptoms, the condition that is not bulbar palsy is often characterized by the *atypical expression of emotion displayed by unusual outbursts of laughing or crying, called emotional lability*. Other S&S of this condition include the absence of facial emotions, a spastic and pointed tongue, and an *exaggerated jaw jerk*. Meanwhile, with bulbar palsy, an individual's emotions usually remain unaffected.

pseudobulbar (palsy)

When testing the ____________ _________ __________ the Pt should be in darkened room (pupils should be dilated), the therapist then flashes pen or phone light in one eye (should constrict while the other remains dilated), then switch sides - be sure to swing light low to allow pupils time to recover - should NOT have patient's cover their opposite eye during this test - *what CN is this test associated with?*

pupillary light reflex, CN II (optic)

Spatial disorder affecting vertical perception often as a result of a midline shift. Significant lateral deviation toward the hemiplegic side; *More common in patients with a right CVA*. - posterolateral thalamus likely involved - 3 features: spontaneous body posture (pt orients body tilted toward weak side), increase of pushing force by spreading of nonparetic extremities from body, & resistance of passive correction of posture (in sitting and standing) -Intervention/Tx: use of mirror (taped with straight lines), small wedge under left lateral thigh, weight shift across midline, facilitation techniques for trunk control

pusher syndrome (pt wants to push their weight towards their weaker/neglected side) (R stroke: midline shift, neglected side feels like its not bearing weight so they push towards their weak side trying to "equalize" weight bearing)

________ practice involves practicing several unrelated motor tasks in an irregular order - makes initial performance harder - may actually degrade performance during practice - much *better for retention* - forces learner to regenerate the solution to a motor problem over and over again (likely the reason that longer term learning / retention occurs)

random

Neural tube defect resulting in vertebral and/or spinal cord malformation. Elevated serum or amniotic alpha-fetoprotein, amniotic ACh in prenatal period and sonogram are used for detection. Types: - *Occulta* = NO spinal cord involvement - *Cystica/asperta* = visible or open lesions (cystica = contained in cyst). - *Meningocele* = cyst includes CSF, cord intact - *Myelomeningocele* = cyst includes CSF and herniated cord tissue - Neural tube defect linked to maternal *decreased folic acid*, infection, hot tub soaks, and exposure to teratogens (e.g. alcohol, valproic acid). - *S&S*: abnormal tuft of hair, a birthmark, or protruding spinal cord tissue, B&B issues (bowel obstruction, constipation), muscle weakness/stiffness, hyperreflexia, urinary incontinence; Kyphoscoliosis, shortened hip flexors and ADD, flexed knees, pronated feet, developmental delay

spina bifida (PT interventions: parent edu about positioning, handling, and exercise; include prone positioning to avoid hip flexor shortening; hip ROM/PROM, used adaptive equipment/orthotics as necessary for sitting, early standing, and ambulation/mobility, facilitate functional motor development [including appropriate developmental activities], edu parents regarding shunt malfunction [S&S: increased irritability, decreased muscle tone, seizures, vomiting, bulging fontanels, HA, and redness along shunt tract])

this pathway from the spinal cord to the brain (*afferent sensory*) is associated with unconscious proprioception, golgi tendon organs, touch and pressure info to cerebellum

spinocerebellar (tract; ventral and dorsal)

this pathway from the spinal cord to the brain (*afferent sensory*) is associated with pain, temperature, and (some) touch - Point of decussation: spinal cord - Lesion at level of spinal cord or anywhere below the medulla: contralateral sensation is lost

spinothalamic (tract)

this division of the ANS is *thoracolumbar* in origin, energy consuming, and involves muscle contraction + increased HR also known as the "E division" - Exercise, Excitement, Emergency, & Embarrassment

sympathetic

The PNS is divided into sensory and motor divisions. The motor division is then further divided into *somatic* (voluntary; sk. muscles) and *autonomic* (involuntary; glands, smooth muscles/organs) divisions. What two divisions the ANS further broken down into?

sympathetic, parasympathetic

What is the current most popular medication used for treating thrombolytic strokes?

t-PA (tissue plasminogen activator; must be given within 3-4.5 hours of onset of stroke; best results if given within 90 min) (tPA provides better outcomes for stroke pts and fewer have severe outcomes if they have this treatment)

this lobe of the brain is involved with *language, learning, memory*, and conscious smell perception; the "What is it?" system - includes the *primary auditory cortex* (allows us to perceive auditory info/sounds), hippocampus (memory), and *Wernicke's area (language comprehension*)

temporal (Left temporal: language, interpretation [Wernicke's], facial recognition, hyposexuality Right temporal: primary auditory cortex, sounds, rhythm, music, visual performance, emotional expression, hypersexuality)

this structure is the largest portion of the diencephalon that serves as a *relay center* through which sensory nerves transmit signals from the spinal cord and brainstem on the way to the cerebral cortex - receives afferent and efferent input - *gateway for info going into the brain* - regulates levels of consciousness - Blood supply: PCA (and its branches)

thalamus