Chapter 5 Neuromuscular and Nervous System Part 4

Vestibular rehabilitation is targeted for patients with central or peripheral balance disorders and can include _________ and ____________ exercises, ocular motor exercises, habituation training, balance training, center of gravity control, varying environments, visual conditions, and use of gravity to challenge the balance system.

VOR VSR

Deep tendon reflexes elicit a muscle __________ through stimulation of the muscles' tendon through a reflex arc. DTRs are graded from 0 to ______ and results of testing may be indicative of a lesion to the reflex arc or a ____________ lesion.

4+ suprasegmental

Apgar Scale A method objectively reporting the health of a newborn shortly after it is delivered. The score is determined by rating ________ different criteria: APPEARANCE PULSE RATE GRIMACE (reflex irritability) ACTIVITY RESPIRATION Each criterion is graded on a scale from _____-_____, with a score of ________ indicating a normal response.

5 0-2 2 normal

APGAR scores: total scores are calculated at ________ minute and at ______ minutes following birth. A newborn is considered to be in good condition if they have a score of ______-______. A score of _____ or below is considered to be low is an indicator that the newborn requires immediate medical attention.

1 minute 5 minutes 7-10 3 or below

The peripheral nervous system consists of ________ pairs of cranial nerves and ________ pairs of spinal nerves. These nerves all have afferent and efferent fibers for communication between the body and the central nervous system.

12 31

Down Syndrome Down syndrome (trisomy ________) occurs when there is an error in cell division either through nondisjunction (95%), translocation, or mosaicism and the cell nucleus results in _____ chromosomes. Nondisjunction occurs when faulty cell division results in __________ specific chromosomes instead of ______ and extra chromosomes are then replicated for every cell. Translocation occurs when part of a chromosome breaks off during cell division and attaches to another ____________. The total number of chromosomes remains 46, but Down syndrome exists. Mosaicism occurs right after _________________ when nondisjunction occurs in the initial cell divisions. This results in a mixture of cells with _____ and _____ chromosomes. The pair of 21st chromosomes is responsible for Down Syndrome when nondisjunction, translocation, or mosaicism occurs during cell division. The exact etiology of DS is currently unknown. Some theories suggest that an increase in maternal _________ (and age of the _______) may cause predisposition to errors in meiosis. Environmental factors such as virus, paternal age, medical exposure, reproductive medications, and intrinsic predispositions have been associated with down syndrome. Clinical manifestations include _______tonia, flattened nasal bridge, almond-shaped eyes, abnormally shaped _________, Simian line (________ crease), epicanthal folds, enlargement of the _______________, congenital ________ disease, developmental delay, and a variety of musculoskeletal disorders. During pregnancy a female can be tested for Alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estrogen levels (the triple screen). Three diagnostic studies include chorionic villus sampling, amniocentesis, or percutaneous umbilical blood sampling. Detection of Down syndrome occurs in approximately 60-70% of women tested that are carrying a baby with down syndrome. After birth a chromosome analysis called a karyotype can be performed to confirm the suspected diagnosis. In most cases, diagnosis of Down Syndrome is made through the physical attributes that are present at ____________. Chromosomal testing is used to determine the exact chromosomal pathogenesis. Potential manifestations and secondary complications that are associated with Down Syndrome include atlantoaxial instability, sensory, hearing, and visual impairments, umbilical ________, _____________ compromise, and ____________ disease. Physical therapy will not accelerate developmental milestones, but will help the patient avoid compensatory patterns with ________ positioning and __________. A routine of exercise is highly important for a child with down syndrome in order to avoid inactivity and ____________. Positioning and handling are key components in order to maximize proper alignment and to minimize pathological _____________, mal______________, and _________. Physical therapy will assist a child by teaching optimal movement __________ during developmental activities and by improving ______________. Physical therapy will be indicated on an __________________ basis based on level of function and secondary complications. Strengthening and endurance activities should be encouraged within a home program. Individuals with Down Syndrome today have a longer life expectancy secondary to advances in medical care, however, it is still less than standard life expectancy. Higher mortalitiy results from issues such as congenital _______ defecs and gastrointestinal anomalies. _____________ system dysfunction, repeated ______________ infections, onset of leukemia, pulmonary hypertension, and complications from Alzheimer's disease all contribute to a higher overall mortality rate compared to the general population. Prader-Willi syndrome is a genetic disorder that occurs when there is a partial ______________ of chromosome ________. Characteristics include ________tonia, difficulties with _____________ during infancy, _________ stature, __________ appetite, and obesity through childhood. _____________ disabilities also exist.

21 47 3 2 chromosome fertilization 46 and 47 age oocyte hypotonia ears palmar tongue heart birth hernia respiratory Alzheimer's static mobility obesity reflexes malalignment instability patterns strength intermittent heart respiratory deletion hypotonia feeding short excessive learning

Erb's Palsy Muscles affected are supplied by cervical roots ____ and ________ which result in a loss of function of the ___________ ______, ___________, _______________, ___________, and ___________ ___________. Brachial plexus injury in a newborn usually occurs during a difficult delivery, due to a large baby, a breech presentation with a prolonged labor or with the use of __________. Results in ____________ paralysis nicknamed the "_______'s tip deformity" (characterized by loss of shoulder ____________, loss of elbow _________, loss of forearm ____________, and the hand positioned in a _________ grip manner"

C5 and C6 rotator cuff deltoid coracobrachialis brachialis biceps brachii forceps flaccid Waiter's function flexion supination pincher

_____________ is integral to motor learning. Various types of practice include massed and __________ practice; constant and _____________ practice; random and ____________ practice; and whole training and __________ training.

Practice distributed variable blocked part

Duchenne Muscular Dystrophy ____-linked recessive trait manifesting in only ________ offspring while female offspring become carriers. Clinical presentation includes _____________ gait, ________ muscle weakness, _______ walking, pseudohypertrophy of the calf, and difficulty with climbing _____________. There is usually rapid progression of the disease with the inability to ambulate by _____________to ___________ years of age with death occurring as a teenager or less frequently in the _________'s.

X-linked male waddling proximal toe stairs 10 to 12 20s

Superficial reflexes are a response to stimulation of the receptors within the skin. The sensory signal must reach the spinal cord and ascend to the brain for processing. Common superficial reflexes include the ________, corneal, cremasteric, gag, and plantar reflexes. The Babinski reflex is an abnormal ________ reflex.

abdominal plantar

The flexor synergy for the lower extremity includes hip _________ and _________ _________, knee __________, ankle __________ and ___________, and toe _____________. The extensor synergy for the lower extremity includes hip __________, __________ ___________, and _________; knee ___________________; ankle _______________ _______ with _____________, and toe ______________ and ____________.

abduction and lateral rotation knee flexion ankle dorsiflexion and supination extension extension, medial rotation, and adduction extension plantarflexion with inversion toe flexion and adduction

Lower motor neuron lesions are found in nerves or their axons at or below the level of the brainstem. Hypoactive or ________ reflexes, _________, fasciculations, and decreased _____________ are characteristic findings with this form of pathology.

absent atrophy tone

The spinal cord is a component of the CNS and a direct continuation of the brainstem. It serves as a relay for information between the brain and peripheral structures. Spinal nerves each posses __________ and efferent fibers for transmission of information through ascending and descending tracts of the spinal cord.

afferent

From the Circle of Willis, the ________ cerebral artery, ___________ cerebral artery, ___________ cerebral artery, and ________-__________ artery perfuse different regions of the brain will produce impairments with vascular pathology specific to each artery.

anterior middle posterior vertebral-basilar

Carpal Tunnel Syndrome Incidence is higher in females than males with the most common age being from 35-55 years of age. Muscle __________ is often noted in the _________ __________ _______ muscle and later in the _______ muscles. Electromyography studies, ________'s sign, and _________'s test can be used to assist with confirming diagnosis.

atrophy abductor pollicis brevis thenar Tinel's Phalen's

Upper motor lesions are found within the motor cortex, internal capsule, brainstem or spinal cord. Hyperactive reflexes, mild __________, and increased __________ are characteristic findings with this form of pathology.

atrophy tone

Myasthenia Gravis An ________________ disorder that affects transmission of neuromuscular signals. The immune system produces antibodies that attack nerve _______________. Because neuromuscular function is decreased, patients with MG have symptoms of weakness and _________. The pathology associated with myasthenia gravis occurs at the ___________ __________. Normally there are receptors on the motor end plate that accept ________________, which results in the transmission of an action potential. In patient with BG there are fewer receptors on the motor end plate, secondary to the immune system attacking these receptors, which results in an inefficient nerve transmission process. Though there is no known causes for MG, abnormalities with _________ function likely plays a role. The majority of patients with MG have abnormalities of the ____________ (e.g. tumor or hyperplasia), and it is though that dysfunction of this gland may cause an autoimmune reaction within the body. The primary feature of MG is muscle ________________ within the skeletal muscles, with other neurologic findings being normal (e.g. __________, _________). The muscles fatigue rapidly with _________, however, rest quickly improves muscle function. Muscles affected commonly include ___________ muscles and limb musculature (__________ greater than ________). Because the ocular muscles are commonly affected, the patient can experiences ____________ and __________. MG can also affect the muscles involved in facial expression, chewing, swallowing, and ___________. Triggers that may make a patient's symptoms worse include activity, heat, stress, illness, certain medications, menstruation, and pregnancy. A myasthenic crisis refers to an episode in which the _____________ muscles experience paralysis and that patient needs ventilation to assist with respiration. Laboratory testing of the blood can be used to identify the presence of the antibodies that attack the _________ receptors. ___________ can be used to identify the characteristic symptoms of MG, rapid fatigue with repeated muscle stimulation. Edrophonium chloride, a drug that blocks the degradation of acetylcholine, can be administered to determine if symptoms temporarily improve secondary to increased acetylcholine uptake. Imaging studies (e.g. x-ray, CT scan, MRI) may be performed if the presence of a _______ tumor is suspected. Patients with MG are often administered a medication that helps to inhibit acetylcholinesterase, the enzyme that breaks down acetylcholine. Though this medication helps to improve symptoms, it does so temporarily. Other medications, such as corticosteroids, can help suppress the immune system. PT should focus on strength and endurance training with caution to avoid ____________. Therapy may also involve training in _________ Techniques to improve respiratory function. The patient should follow energy ________________ techniques to avoid overexertion. With appropriate treatment, the prognosis for MG is fairly good. Symptoms are generally most severe within the first few ________ of diagnosis. Afterwards, symptoms either plataeu or _____________. Though complete remission is rare, symptoms can be well controlled and patients can experience a high quality of life. Removal of the ________ can result in complete remission of symptoms. Overall, mortality rates are very ___________.

autoimmune receptors fatigue neuromuscular junction acetylcholine thymus thymus weakness reflexes sensation activity ocular proximal greater than distal diplopia and ptosis speech respiratory acetylcholine EMG thymus overexertion breathing years improve thymus low

Erb's Palsy Erb's palsy is a term used to denote an upper brachial plexus injury or palsy that usually results from a difficult ___________. It primarily effects the muscles of the ______________ and __________. The brachial plexus is damaged with the most common avulsion located at ___________'s __________ (which is an area in the ___________ __________ neck). This damages the nerves supplying the ipsilateral upper limb and shoulder. The muscles affected are those supplied by cervical roots _______ and ________: ________, _____ ___________, _________ and ________ ___________, ______________ and partial paralysis of the __________ __________ and the _____________ nerves. The result is a loss of _________ ____________, __________, ___________, _____________, and ________ ____________ function. A brachial plexus injury in a newborn usually occurs during a difficult delivery, due to a large baby with a breech presentation, with a prolonged labor or with the use of ____________. One side of the baby's neck is ___________ which damages the nerves. If the upper nerves are affected the condition is termed ______ ________. One theory suggests that congenital chicken pox or amniotic bands may also produce this condition. When it occurs in adults, the cause typically is an injury that has caused stretching, tearing, or other trauma to the upper brachial plexus network. There are four types of brachial plexus injuries: Avulsion, rupture, neuroma, and neuropraxia. The clinical presentation is a flaccid paralysis that is nicknamed "________'s _______ deformity," characterized by a loss of ___________ function, loss of _________ function, loss of forearm _________, and the hand positioned in a _________ grip manner. An __________ and ____________ may be performed to see if there is any damage to the ___________ and __________ of the neck and shoulder. The physician may also use an _______________ or nerve conduction studies to see if any nerve signals are present in the upper extremity muscles. In complete injuries, motor and sensory nerve conduction studies of __________, _________, and _______ nerves may be conducted. Other testing that may assist with diagnosis includes the active movement scale, ________ shoulder classification, and the Pediatric Outcomes Data Collection Instrument. If amniotic bands were the congenital cause for the brachial plexus injury, the child may exhibit characteristics such as an under-developed __________ or deformed area. The patient may also experience glenohumeral subluxation or dislocation, skeletal _________, poor bone ___________, and learned pattern of non-_______ of the upper extremity. Overall, the chance of a child having a brachial plexus palsy is equally distributed according to gender, gestational age, and race. It occurs frequently in normal and healthy infants. The therapeutic management of a patient with Erb's palsy must begin in infancy (or immediately) in order to achieve optimal functional return. Nerve regeneration remains at __________ speed, however, physical therapy intervention can assist with overall strength and function during recovery. Approximately _______ out of 10 infants with brachial plexus palsy can recovery with conservative treatment. Since nerves grow at a rate of _______ inch per month, it may take several ________ or even ______ for nerves repaired at the cervical spine to reach the muscles of the hand. Klumpke's palsy is the name for the brachial plexus where there is an injury from childbirth affecting the spinal nerves _______, _______, and _________. It is uncommon and can be contrasted to Erb's palsy, which affects ______ and ______. Classically, it produces ___________ and ___________ of the elbow, _____________ of the wrist, _______________________ of the MCP joints, and _________________ of the IP joints allowing for a "_________ hand" posture. The mechanism of injury is traction of the upper extremity while in an _____________ position.

birth shoulder elbow Erb's point anterolateral neck C5 and C6 axillary lateral pectoral upper and lower subscapular suprascapular long thoracic musculocutaneous rotator cuff deltoid coracobrachialis brachialis biceps brachii forceps stretched Erb's palsy Waiter's tip deformity shoulder elbow supination pinch x-ray and MRI bones and joints EMG median, ulnar, and radial Gilbert's extremity deformity growth non-use constant 9 1 inch months or even years C7, C8, T1 C5, C6 flexion and supination extension hyperextension flexion claw hand abducted

Thoracic Outlet Syndrome Describes a group of disorders that presents with symptoms secondary to neurovascular compression of fibers of the _________ plexus. This usually occurs between the points of the interscalene triangle and the inferior border of the axilla. Compression of nerves and blood supply can also occur as they pass over the first __________. Thoracic outlet syndrome results from compression and damage to the ____________ plexus nerve trunks, __________ vascular supply, and/or _______ artery. Nerve injury can result in neura_________ with segmental degeneration and progress to axonotmesis due to continued and unrelieved compression. Contributing factors in the development of thoracic outlet syndrome include the presence of a cervical rib, an abnormal ______ rib, postural deviations or changes, body composition, chronic hyper_______ of the arm, hypertrophy or spasms of the scalene muscles, degenerative disorders, and an elongated cervical ___________ process. Typical symptoms include diffuse pain in the arm most often at ________, paresthesias in the fingers and through the upper extremities, weakness and muscle wasting, poor __________, edema, and discoloration. If the upper plexus is involved, pain will be reported in the neck and may radiate to the _______ and may follow the lateral aspect of the ___________ into the hand. If the lower plexus is involved, pain is reported in the back of the _______ and ____________, which will radiate over the ________ distribution of the hand. A patient's symptoms are usually enhanced with behaviors that aggravate the symptoms such as poor posture, lifting activities, and movements overhead. ______-_____ will confirm the presence of a cervical rib or other bony abnormality. Nerve conduction velocity testing may be valuable if a neuropathy exists. Otherwise, diagnosis relies solely on a thorough history or patients symptoms, provocative testing, and a physical examination. Other testing should be used for differential diagnosis to rule out cervical _____________________, RSD, myofascial pain syndrome, tumor, carpal tunnel syndrome, brachial plexus injury, ulnar nerve compression, and angina. Provocation testing that includes Adson maneuver, Wrist test, Roo's test, Halstead maneuver, Allen test, and the costoclavicular and hyperabduction tests. A patient with TOS may have difficulty sleeping due to excessive pillows or ____________ of the arm. The patient may have difficulty at work with carrying items on the affected side of with driving a _________. PT should focus on pain management, strengthening (especially the _____________, _____ ___________, and __________), joint mobilization, body mechanics, flexibility, and postural awareness. A therapist may utilize modalities such as _____________ ___________ _____________, ultrasound, biofeedback to attain goals. Work site analysis and subsequent activity modification may be necessary to relieve the pain and other symptoms. A patient may benefit from anti-inflammatory agents in combination with PT. If PT management fails, the patient may require surgical decompression of bony or fibrotic abnormalities. The exact type of surgical intervention and approach is chosen by the surgeon based on the symptoms and current damage. Most patients with TOS have positive results from PT interventions are able to return tot heir PLOF within _____ to _____ weeks. However if the patient's symptoms persists for _____ to ________ months, surgical intervention may be warranted. A radial nerve lesion may be caused by direct trauma, excessive traction, entrapment or compression. A patient presents with an inability to extend the __________, __________, and _________. The patient will also present with impaired _________ strength and coordination. ________ is recommended to maintain proper positioning. Passive range of motion is necessary to prevent secondary impairments such as ___________ of the hand.

brachial rib brachial subclavian axillary neurapraxia first hyperabduction transverse night posture face forearm neck shoulder ulnar X-ray radiculopathy malpositioning car trapezius levator scapulae rhomboids TENS 4 to 8 weeks 3 to 4 months wrist, thumb and fingers grip contractures

The central nervous system anatomically consists of the _________ and _________ _______. There are two hemispheres of the brain and each hemisphere includes a frontal, temporal, parietal, and occipital lobe. The brain can also be divided into forebrain, midbrain, and hindbrain. Each area is responsible for interpretation and control of certain biological processes and movement.

brain spinal cord

Incomplete lesions can include anterior cord syndrome, Brown Sequard's syndrome, central cord syndrome, posterior cord syndrome, and _________ _______ injuries.

cauda equina

balance is a state of physical equilibrium with maintenance and control of the ______ of ________. There are somatosensory, visual, and vestibular systems that provide feedback to the CNS regarding balance.

center of gravity

The concepts of development include ______ to _________; gross to ______; mass to ______; and proximal to ________.

cephalic to caudal gross to fine mass to specific proximal to distal

The hindbrain consists of the ____________, __________, and _________ ________. The cerebellum coordinates movement and assists with maintenance of ___________. The pons and medulla assist with control of the body's ___________ functions.

cerebellum pons medulla oblongata balance vital

Alzheimer's disease Progressive neurological disorder that results in deterioration and irreversible damage within the ________ cortex and the __________ areas of the brain. The loss of neurons results from the breakdown of several ___________ that would normally sustain the brain cells. Neurons that are normally involved with ______________ transmission deteriorate within the ____________ cortex of the brain. Postmortem biopsy reveals neurofibrillary ___________ within cytoplasm, _________ plaques, and cerebral ________. Amyloid plaques contain fragmented axons, altered glial cells, and cellular waste that results in an inflammatory response that causes further damage to the nervous system. Amyloid can also cause atrophy of the _______ muscle of the arteries of the brain, predisposing them to _________. The exact etiology of Alzheimer's disease is unknown, however, hypothesized causes include lower levels of neurotransmitters, higher levels of __________ within brain tissue, genetic inheritance, _____________ disease, abnormal processing of the substance amyloid, and virus. Approximately 4.5 million individuals are living with Alzheimer's disease in the United States. The risk of developing Alzheimer's disease increases with age and there is higher incidence in women. The prevalence of Alzheimer's disease is 6% of individuals over 65 and 20% of individuals over 80 years of age. Alzheimer's disease is initially noted by a change in higher cortical functions characterized by subtle changes in ____________, impaired _________, and difficulty with new ________________. These symptoms progress in the early stages and there is a loss of orientation, word finding difficulties, emotional liability, depression, poor judgement, and impaired ability to perform self-care skill. During the middle stages of Alzheimer's disease the patient will develop behavioral and motor problems characterized by neurological symptoms such as aphasia, apraxia, persevertation, agitation, and violent or socially unacceptable behavior that can include wandering. Eventually all ability to learn is lost and long-term memory also disappears. End stage Alzheimer's disease is characterized by severe intellectual and physical destruction. Patients in this stage will present with vegetative symptoms including incontinence, functional dependence, and inability to speak, and seizure activity. Alzheimer's disease presently cannot be confirmed until a postmortem biopsy reveals the neurofibrillary tangles and amyloid plaques. MRI can be used to assess any abnormalities or signs of _________ within the brain that is associated with Alzheimer's disease or to rule out other medical conditions. Single photon emission computed tomography (SPECT) may be used to determine brain activity and predict potential for Alzheimer's disease. Blood work, urine, and spinal fluid may be required to rule out other diseases that may cause signs of dementia. A patient at end-stage Alzheimer's disease is at a high risk for infection and ____________. These patients may experience complications from a persistent vegetative state such as contractures, decubiti, fracture, and _____________ compromise. Drug therapies are usually _______-term in effect lasting ______ to _____ months. During the early stages of Alzheimer's disease a patient should continue with activity as tolerated and utilize a ___________ book or other compensatory strategies at home. The patient should be encouraged to exercise, ambulate, and participate in everyday activities such as folding laundry, making beds, and assisting with dinner in order to avoid restlessness and _____________. Alzheimer's disease is a chronic and progressive disorder and is the ___________ leading cause of death in adults. The typical course of the disease averages between _____ and _____ years. The leading cause of death of a patient with Alzheimer's disease is infection or dehydration.

cerebral subcortical processes acetylcholine cerebral tangles amyloid atrophy smooth rupture aluminum autoimmune memory concentration learning atrophy pneumonia pulmonary short term 6-9 months memory book wandering 4th 7-11

Common pharmacological agents used in the treatment of neurological disorders include antiepileptic agents, antispasticity agents, __________ agents, dopamine replacement agents, and muscle relaxants.

cholinergic

Huntington's disease Also known as Huntington's _____________, is a neurological disorder of the CNS and is characterized by a degermation and atrophy of the ______ ________ (specifically the __________) and _________ cortex within the brain. HD affects the basal ganglia and cerebral cortex of the brain. The ventricles of the brain become enlarged secondary to atrophy of the basal ganglia and there is extensive loss of small and medium sized _______. There appears to be an overall decrease in the quantity and activity of ______________ and ______________ neurons that are produced in these areas. The identified neurotransmitters become deficient and are unable to modulate movement. Loss of neurons create dysfunction in inhibition that results in the symptoms of ______, _______kinesia, and _______________. The ____________ is also believed to contribute to the movement disorders associated with the disease process. HD is genetically transmitted as an ________________ dominant trait with the defect linked to chromosome _____ and to the gene identified as IT-15. The disease is usually perpetuated by a person that has ___________ prior to the normal onset of symptoms and without knowledge that he/she possesses the defective gene. Genetic testing is able to identify the defective gene for HD prior to the onset of symptoms. The average age for developing symptoms ranges between ______ and _____ years, however, symptoms can develop at any age. HD is a disease that produces a ____________ disorder, ___________ dysfunction, and cognitive impairment. The patient will initially present with involuntary ______________ movements and a mild alteration in _________________. Unintentional ___________ expressions such as grimace, protrusion of the _____________, and elevation of the ________________ are common. As the disease progresses gait will become ataxic and a patient experiences choreoathetoid movement of the extremities and trunk. ___________ disturbances and mental _______________ are common. Late stage HD is characterized by a decrease in IQ, dementia, depression, dysphagia, incontinence, inability to ambulate or transfer, and progression from choreiform movements to rigidity. ______________ or __________ may indicate atrophy or abnormalities of the cerebral cortex as well as the ________ ________. _____________ may be used to augment other testing and obtain information regarding blow flow, oxygen uptake, and metabolism of the brain. A DNA marker study may be administered to determine if the autosomal dominant trait is present for HD. Dementia and other psychological changes usually occur after neurological symptoms appear. The emotional disorder worsens with progression and may require admission to a psychiatric facility for severe depression and/or suicidal attempts. Secondary complications that can occur from symptoms of HD include loss of ____________, deformity, pain, communication breakdown, aspiration and choking, fatigue, and weakness from weight loss. HD is a chronic progressive genetic disorder that is fatal within ______ to _____ years after clinical manifestation. Late stages of the disease result in total physical and __________ incapacitation. The patient usually requires an extended care facility due to the burden of care and physical, cognitive, and emotional dysfunction. Athetoid (dyskinetic) cerebral palsy is non-progressive motor disorder caused by central nervous system damage specifically to the ____________ _________. Clinical manifestations include ___________ and involuntary movements, choreiform movements, severe ___________, and an increased risk of aspiratory pneumonia. The involuntary movements will increase with stress and fatigue and subside with sleep. PT intervention should focus on motor control and mobility deficits in order to attaint the highest level of functioning.

chorea basal ganglia striatum cerebral neurons GABA and acetylcholine chorea bradykinesia rigidity thalamus autosomal 4 children 35-55 movement affective choreic personality facial tongue eyebrows speech deterioration MRI or CT basal ganglia PET ROM 15 to 20 years mental basal ganglia slow dysarthria

Motor control is the study of the nature of movement and the ability to direct essential movement. Motor learning is the study of the acquisition or modification of movement. Stages of motor learning include the ____________ stage, ______________ stage, and the ____________ stage. Feedback is imperative for the progression of motor learning.

cognitive associative autonomous

Spinal cord injury refers to permanent damage that can occur to the spinal cord after a sufficient force has been exerted on the spinal cord itself. Motor vehicle accidents have the highest incidence for SCI. There are _________ and ___________ lesions with regard to motor and sensory function.

complete and incomplete

Peripheral nerve fibers may be classified as A, B, or C fibers. A fibers are large and myelinated with a high ___________ speed. B fibers are medium and myelinated with a _________ speed. C fibers are small and unmyelinated or poorly myelinated with a __________ speed.

conduction moderate slow

Spinal cord injury -- Complete C7 Tetraplegia Clinical presentation includes impaired __________ and ability to clear secretions, altered _______________ pattern, and poor endurance. Outcomes at this level include independence with feeding, grooming, dressing, self-range of motion, independent manual wheelchair mobility, independent transfers, and independent driving with an adapted automobile. The triceps, extensor pollicis longus and brevis, extrinsic finger extensors, and flexor carpi radialis will remain the lowest innervated muscles.

coughing breathing

Cerebrospinal fluid is clear fluid-like substance that _________ the brain and spinal cord and provides __________ to the CNS. The ventricular system assists to produce and circulate CSF.

cushions nutrients

The Glasgow Coma Scale is used to assess patients with suspected _____ injury in order to classify the injury from mild to severe.

head

Alzheimer's Disease Progressive neurological disease that results in deterioration and irreversible __________ within the ___________ cortex and sub_______ areas of the brain. Disease is initially noted by a change in higher cortical functions characterized by subtle changes in ___________, impaired __________, and difficulty with new ___________. Typical course of the disease averages between ___-____ years with death resulting from infection or dehydration.

damage cerebral subcortical memory concentration learning 7-11

Legislation such as the Individuals with Disabilities Education Improvement Act (IDEA), Rehabilitation Act, and No Child Left Behind Act have provided improved services and benefits for children with disabilities. These laws have been updated and amended to improve services for children with ________.

disabilities

Amyotrophic Lateral Sclerosis Risk is higher in males than females and usually occurs between 40-70 years of age. Clinical presentation may include both upper and lower motor neuron involvement with weakness occurring in a __________ to __________ progression. Average course of the diagnosis is _________-______ years with 20-30% of patients surviving longer than ________ years.

distal to proximal 2-5 years 5 years

Parkinson's disease Degenerative disorder characterized by a decrease in production of ________________ within the _______________ ___________ of the _________ __________. Clinical presentation may include hypokinesia, difficulty initiating and stopping movement, festinating and shuffling gait, bradykinesia, poor posture, and "cogwheel" or "lead pipe" rigidity. Medical management includes dopamine replacement theory (Levopdopa, Sinemet, Madopar) which is designed to minimize bradykinesia, rigidity, and tremor.

dopamine substantia nigra basal ganglia

Anterior cord syndrome An incomplete spinal cord lesion in which the anterior two-thirds of the spinal cord is damaged. Since the __________ columns are not affected, it is considered an ________________ spinal cord injury or syndrome. The mechanism of injury is typically a cervical _________ or through infarction of the anterior spinal __________. A flexion injury to the cervical spine can result in the anterior structures becoming compressed and damaged, specifically the anterior spinal artery. The anterior spinal artery supplies blood to the anterior two-thirds of the spinal cord. Damage to this artery results in decreased perfusion to the spinal tracts that is supplies, including the anterior and lateral _________________ tracts and ______________ tracts. The corticospinal tracts are responsible for _____________ function while the spinothalamic tracts are responsible for ____________ and ___________. Anterior cord syndrome can occur through a traumatic incident that causes compression or damage to the anterior spinal artery, most associated with fracture or ______________. However, decreased perfusion and vascular insufficiencies can also occur through nontraumatic etiologies. Atherosclerosis, external compression such as a disk ________ or mass, and aortic pathology have caused anterior cord syndrome. The patient will typically present with complete loss of ____________ function and loss of __________ and ____________ sensation bilaterally below the level of the lesion due to the damage to the corticospinal and spinothalamic tracts. Sensations controlled through the dorsal columns (e.g. proprioception, vibration) remain intact. Autonomic dysfunction such as loss of ________ and _________ function and _________ function are both likely, though this is dependent on the level of the lesion. ______________ function may also be affected. ____________ is used to determine the location and extent of the injury. _________ may be used to determine if there is a fracture or dislocation of a vertebral segment. ____________ may also be used as it is more sensitive than __________ in detecting injuries to the spine and spinal canal. Initial management will consist of medical ______________ and stabilization of the patient. Pharmacological management is immediate and include methylprednisolone administered in high doses to limit ______________ and secondary damage and improve potential neurological outcomes. An orthosis may be used for continued immobilization if a ____________ fracture has occurred. Most patients with anterior cord syndrome will need to be trained to utilize a wheelchair. PT can assist patients to compensate for the injury, however, only minor improvement in ________ function is anticipated. There can be some level of recovery that occurs for ___-___ years after the initial injury. The prognosis of anterior cord syndrome is best when recovery is noted within the first ______ hours after the injury. Otherwise, the prognosis is poor compared to other spinal cord injury syndromes. It is associated with high mortality and poor functional outcomes.

dorsal incomplete flexion artery corticospinal spinothalamic motor pain and temperature dislocation protrusion motor pain and temperature bowel and bladder sexual Respiratory MRI X-ray CT scan x-ray immobilization swelling cervical motor 1-2 years 24

The meninges are three layers of connective tissue that provide covering and protection of the brain and spinal cord. The ______ mater is the outermost layer, followed by the arachnoid, and the pia mater. Dural spaces are areas normally surrounding meninges that may contain _____________ fluid.

dura cerebrospinal

The flexor synergy for the upper extremity includes scapular _________ and ____________, shoulder ___________ and __________ ___________, elbow ________________, forearm __________________, wrist ___________, and finger and thumb ____________ and ______________. The extensor synergy for the upper extremity includes scapular ___________ and ____________, shoulder __________ and ____________ ____________ , elbow _____________, forearm ________, wrist __________________, and finger and thumb _________ with ____________.

elevation retraction abduction lateral rotation flexion supination flexion flexion and adduction depression protraction adduction medial rotation flexion pronation extension flexion adduction

Autonomic dysreflexia is a common complication of a SCI and is considered a medical __________. An excessive and uncontrolled increase in blood pressure places the patient at risk. A kinked ___________ is the most typical stimulus for this condition.

emergency catheter

Spinal Cord Injury - Complete L3 Paraplegia Patients specifically with a complete lesion at the L3 level typically have at least partial innervation of the gracilis, iliopsoas, quadratus lumborum, rectus femoris, and sartorius. Patients have full use of their upper extremities and have hip flexion, adduction, and knee ____________. There are many additional findings that can exist with a L3 injury including _______ dysfunction, _______________ bladder, and the need for a bowel program. These patients usually present with flaccid paralysis below the level of the lesion are at risk for pain, urinary tract infections, muscle contractures, and pressure sores. The patient may be placed in a thoracolumbar orthosis with restriction of activities or undergo stabilization surgery followed by the use of a TLSO. Once the patient's spine is stable, rehabilitation should be initiated on an inpatient basis for approximately _____ to _____ weeks. Orthotic prescription (KAFOs or AFOs) is recommended once the patient has gained strength to assist with ambulation using ___________. The patient with L3 SCI will usually participate in ____ to ____ weeks of inpatient rehabilitation immediately after injury and stabilization. The patient should be able to function independently from a ___________ level and ambulation level. Outcome is based on the degree of injury, the patient's mental capacity, outside support, emotional stability, motivation, and co-morbidities. There are various outcomes from the spinal cord injuries that occur in the lumbosacral region. Fractures of the thoracolumbar junction can produce a mixture of cord and root syndromes caused by lesions of the conus medullaris and lumbar nerve roots. Complete damage of the conus medullaris presents with no motor function or sensation below ______. Patients with complete damage to the sacral portion of the cord have no control of __________ and __________ function and sacral ___________ paralysis.

extension sexual nonreflexive 4-8 weeks crutches 4-8 weeks wheelchair L1 bowel and bladder motor

Duchenne Muscular Dystrophy Progressive neuromuscular degenerative disorder that manifests symptoms once _________ and _____________ tissues begin to replace muscle that has been destroyed by the disease process. The mutation of the ____________ gene causes the symptoms of DMD. A patient with DMD is born with a mutation in the _________ gene Xp21 that normally codes for the muscle membrane protein ______________. This gene is found on the ____-chromosome and since it is a ________ trait, only males are affected while females are carriers. The lack of dystrophin allows for damage within the sarcolemma with ___________ of the muscle. The mutated gene causes weakening of cell membranes, destruction of ________________, and loss of muscle contractility. The destroyed muscle cells are replaced with ____________ deposits. The etiology of DMD is inheritance as an _____-linked recessive trait. The mother is the silent carrier of this disorder. Since it is a recessive trait, only male offspring will manifest the disorder while female offspring become carriers. Diagnosis of DMD usually occurs between ______ and ____ years of age. The first symptoms include ________ gait, ________ muscle weakness, clumsiness, _____ walking, excessive lordosis, pseudohypertrophy of the ____________ and other muscle groups, and difficulty with climbing ___________. DMD primarily effects the shoulder girdle musculature, pectorals, deltoids, rectus abdominals, gluteals, hamstrings, and calf muscles, and is initially identified when a child begins to have difficulty getting off the floor, needing to use the ____________'s maneuver. During this technique a patient uses his hands to stabilize and walk up his legs in order to attain an upright posture. Approximately _____-third of patients have some form of learning disability secondary to dystrophin abnormalities. The disabilities usually present as subtle cognitive and/or behavioral deficits. There is usually rapid progression of this disease with the inability to ambulate by______ to _____________ years of age. ___________________ is used to examine the electrical activity within the muscles. A muscle biopsy can be performed to determine the absence of _______________ and evaluate the muscle fiber __________. DNA analysis and high serum creatinine kinase levels in the blood also assist with confirming the diagnosis. Clinical examination, current symptoms, and family history are used to assist in the diagnosis, the type, and progression of the disease. Definitive diagnosis is made from clinical findings along with EMGs and muscle biopsy results. Additional findings occur with progression of the disease. Disuse __________, contractures, scoliosis, inability to _____________, weight _______/obesity, cardiac and respiratory impairments, musculoskeletal deformity, and ______________ dysfunction are the most common findings. Respiratory problems and scoliosis progress once the child is utilizing a wheelchair. Once a child presents with impairments, physical therapy should focus on maintaining available ____________, encouraging mobility, adapting to the loss of function, and promoting family involvement in a home program. Orthotic prescription, adaptive devices, and wheelchair prescription are areas that will require attention during the course of the disease. ____________ care will also become a vital part of the plan of care as the patient weakens and strength diminishes. DMD usually affects __________ muscle in the later stages of the disease. Death occurs primarily from cardiopulmonary complications due to cardiac muscle involvement or _________________ muscle dysfunction. Death usually takes place by the time a patient is a teenager or less frequently into their _____'s. Fascioscapulohumeral dystrophy, also known as Landouzy-Dejerine Dystrophy, is a form of muscular dystrophy that is also inherited, but the exact genetic origin is unclear. This disease presents later in a child's life, usually between ___________ and _________ years of age. Characteristics include facial and shoulder girdle __________, weakness lifting the arms over the head, and difficulty closing the __________. This disease is more common in males than females. Females tend to be carriers of the disorder. Lifespan remains normal.

fat and connective tissues dystrophin dystrophin dystrophin X-chromosome recessive contraction myofibrils fatty X-linked two and five waddling proximal muscle weakness toe walking calf stairs Gower's one-third 10 to 12 EMG dystrophin size atrophy ambulate gain gastrointestinal strength respiratory cardiac respiratory 20's seven and twenty weakness eyes

The vestibuloocular reflex supports ___________ stabilization through eye movements that counters movements of the _________. The vesibulospinal reflex attempts to stabilize the ___________ while the ________ is moving in order to manage upright posture.

gaze head body head

Communication disorders can include all forms of aphasia, verbal apraxia, and dysarthria. Aphasia is typically classified as receptive, expressive, or ___________. Treatment will be modified based on the patient's ability to communicate or understand alternative forms of communication.

global

Proprioceptive Neuromuscular Facilitation (PNF) is based on establishing __________ motor patterns within the CNS, allowing for _______ parts to stimulate and strengthen the weaker parts. Treatment emphasizes developmental sequence, mass movement patterns, and diagonal patterns.

gross stronger

Concepts of development Cephalic to Caudal: A person develops __________ and _________ ___________ control prior to ___________ and __________ ____________ control. This is a general skill acquisition from the direction of ______ to ________. Gross to fine: A general trend for ___________ muscle movement acquisition with progression to ___________ muscle skill acquisition. Mass to specific: A general trend for a person to acquire _________ movements and progress towards __________ movements. Proximal to distal: A concept that uses the midline of the body as the reference point. _________ control (__________ stability) is acquired first with subsequent gain in ___________ control (extremities).

head and upper extremity trunk and lower extremity head to toes large small simple complex Trunk midline distal

Epilepsy Chronic central nervous system disorder characterized by epileptic seizures due to abnormal neuronal activity within the brain. Epilepsy has no identifiable etiology in approximately half of the population with the condition. Known conditions that can cause epilepsy include brain injury, infectious disease, genetic influence, and developmental disorders. Injury to the brain can cause abnormal activity of the brain's nerve cells in which the electrical discharge of the neurons becomes __________synchronous. This abnormal neuronal activity precipitates the patient's seizure symptoms. Seizures are often unpredictable and unprovoked and vary widely in their presentation depending on the type of seizure. Symptoms may include ___________ disturbances, staring, loss of consciousness, uncontrollable jerking of the arms and legs, stiffening of muscles, and loss of muscle control. A seizure is the hallmark of epilepsy, though one seizure does not signify that a patient has epilepsy. An ______________ measures electrical activity of the brain and is the most common test used to confirm the diagnosis of epilepsy. It is common for patients to have abnormal brain wave patterns even when they are not experiencing a seizure. Other imaging and laboratory studies such as _______, _______________, and blood tests may be used to identify the cause of the seizures.

hyper mood EEG MRI CT scan

Epilepsy Injury to the brain can cause abnormal activity of the brain's nerve cells in which the electrical discharge of the neurons become ____________synchronous, resulting in epileptic seizures. Symptoms vary widely depending on the type of seizure (e.g. tonic, clonic) and may include _________ disturbances, staring, loss of consciousness, uncontrollable jerking of arms and legs, stiffening of muscles, and loss of muscle control. An electroencephalogram measures electrical activity of the brain and is the most common test used to confirm the diagnosis of epilepsy.

hyper mood EEG

Central Cord Syndrome An incomplete spinal cord lesion that most often results from a cervical ______________ injury. Symptoms are secondary to damage to the ____________ aspect of the spinal cord. CCS usually occurs from a _____ but can occur from other forms of trauma such as a ___________. The spinal cord sustains _______ into the central _____ matter that causes damage to the centrally located cervical tracts. Injury is caused by a ligamentum _____________________ (hyperextension) injury or otherwise form ___________ compression of the cord due to ________________ formation. Studies often reveal _____ disruption in the __________ columns at the level of the injury with preservation of the _________ matter. The most common mechanism of injury from CCS is a hyperextension injury of the cervical spine. Other potential contributing factors in the development of CCS include cervical ________, narrowing or congenital defects of the spinal canal, tumor, rheumatoid arthritis, or syringomyelia. CSS predominantly affects the population over 50 years of age with a greater incidence in men. CCS presents with motor loss that is greater in the _______________ extremities than the _________ extremities and is most severe _______ in the upper extremities. This presentation is due to the damage that occurs within the central location of the spinal cord. Sensory loss found below the level of the lesion is usually ________, but can be variable. Lumbar, thoracic, and cervical components proceed _____________ in order towards the center of the spinal cord. Sacral segments are usually unaffected since they are located _______ within the spinal cord. Bowel and bladder functions resolved in 55-85% of patients with CCS after ____ months. ________________ is used to assess spinal cord impingement from bone or disk. _________ _______ of the spine will assess spinal canal compromise and the degree of impingement. _____ can be utilized to assess potential fractures, dislocations, and degree of spondylotic deterioration. Each patient with CCS will present differently based on location and the extent of injury to the spinal cord. Potential side effects and complications include autonomic _________, spasticity, neurogenic bladder and bowel, allodynia, and pressure ulcers. Anterior cord syndrome normally affects ______-______ of the spinal cord and can occur from a cervical ___________ injury or anterior spinal artery _________________. There is a complete loss of _______ function as well as ______ and ________ below the level of the lesion due to damage of the ______________ and _________________ tracts. Preservation of the _____________ columns allow for intact vibration and proprioception. ACS has the worst prognosis for all spinal cord syndromes.

hyperextension central fall MVA bleeding gray flavum anterior osteophyte axonal lateral gray spondylosis upper lower distally limited medially laterally 6 MRI CT scan X-ray dysreflexia two-thirds flexion embolization motor pain temperature corticospinal spinothalamic posterior

Central cord syndrome An incomplete spinal cord lesion that most often results from a cervical __________ injury. Clinical presentation involves __________ loss that is greater in the _____________ extremities than the ___________ extremities. Most common incomplete spinal cord lesion accounting for approximately 30% of all incomplete forms of tetraplegia.

hyperextension motor upper lower

Primitive reflexes are elicited with a predictable stimulus that causes a predictable response until the time when the primitive reflex is _________. When reflexes do not integrate, there is typically interference with progressing through developmental milestones.

integrated

The cerebrum consists of gray matter on the surface and white matter ___________, while sulci and fissures demark the specific lobes.

interiorly

Tremors, tics, chorea, dystonia, and athetosis are all forms of movement disorders that present with __________ movements.

involuntary

A patient presents with predictable patterns of impairment when ___________ occurs secondary to CVA in the left hemisphere, right hemisphere, brainstem, or cerebellum.

ischemia

Cerebral vascular accident Types of CVA include ____________ stroke (thalamus, embolus, lacunar) and ___________ stroke (intracerebral, subdural, subarachnoid). Left CVA may present with weakness or paralysis to the right side, impaired ___________, heightened _____________, aphasia, dysphagia, and motor __________. Right CVA may present with weakness or paralysis to the left side, poor __________ span, impaired awareness and ___________, ___________ deficits, ____________ deficits, emotional ___________, and ___________ behavior.

ischemic hemorrhagic processing frustration motor apraxia poor attention span judgement memory spatial emotional liability impulsive

Superficial sensations include light touch, temperature, and pain. Deep sensations include _____________, proprioception, and vibration. Cortical sensations include localization of touch, bilateral simultaneous stimulation, two-point discrimination, stereognosis, and barognosis.

kinesthesia

The nervous system is composed of specialized cells that function to receive, integrate, control, and transmit information throughout the body. Components of the nervous system include the CNS, PNS, autonomic nervous system, somatic nervous system, and _____________ system.

limbic

Neurological rehabilitation may incorporate a variety of treatment based on the patients pathology and goals. The variety of constructs base each of the theories of rehabilitation on their particular interpretation of motor control and __________ learning.

motor

Guillain-Barre Syndrome results in _________ weakness in a ___________ to ______________ progression, ___________ impairment, and possible ____________ paralysis. Etiology of the disease is unknown, however, it is hypothesized to be an _____________________ response to a previous respiratory infection, influenza, immunization, or surgery Majority of patients experience full recovery, 20% having neurologic deficits, and 3-5% of patients die from ________________ complications.

motor distal proximal sensory respiratory autoimmune respiratory

The somatic nervous system regulates body movement through __________ and _________ neurons that transmit information from the brain to muscle fibers throughout the body. The SNS controls ____________ movement, influences the __________ senses, and is responsible for reflex arcs such as __________ ________ _______.

motor sensory voluntary 5 deep tendon reflexes

Bell's Palsy Refers to an acute onset of __________ and ___________ deficits in structures supplied by the ____________ nerve. Primarily affects the muscles associated with __________ expression, however, it can also impact ________ and _________ production. Is a self-limiting condition that is not life-threatening with majority of patients experiencing a spontaneous recovery that occurs within _________ to ____________.

motor and sensory facial facial saliva and tear weeks to months

Bell's Palsy Acute onset of _________ and ___________ deficits in structures supplied by the __________ nerve. Bell's palsy is typically the result of abnormal pressure on the ____________ nerve, commonly associated with edema or inflammation. It primarily affects the muscles of __________ expression, however, it can also impact _________ and _______ production. The facial nerve is sometimes referred to as the nerve of facial expression. It is associated with taste sensation on the __________ aspect of the tongue and voluntary motor control of most facial muscles. The nerve originates in the brainstem, traveling with the _______________ nerve around middle ear structures before exiting through the ____________ foramen and passing through the ___________ gland where it divides into ________ major branches. The etiology of Bell's palsy is typically viral and most frequently caused by the herpes simplex virus, though it has been linked to the Epstein-Barr virus, varicella zoster virus, and HIV. After initial exposure, the virus may remain dormant for a period of time. Once reactivated, it produces and travels along the nerve, infecting the __________ cells that surround the nerve. The immune system's __________ response produces abnormal pressure on the nerve resulting in subsequent symptoms. The onset of Bell's palsy may occur suddenly or progress over a few ________. Symptoms typically affect only one side of the face and often begin with a feeling of generalized _______________ or tightness. A facial ______________ is the most recognizable characteristics of the condition. Other symptoms include difficulties with motor skills that may interfere with eye and mouth closure, eating, and facial expressions. Decreased _________ sensation, altered _______ and ________ production, and increased ____________ sensitivity may also be reported. An __________ or ______________ scan may assist in identifying the presence of an infection or structural abnormality which may be the cause of pressure on the facial nerve. For patients who are unable to fully close an affected eye or have reduced __________ production, protective measures must be taken to prevent permanent eye injury. Lubricating eye drops or ointments may be necessary. Eye protection is especially important during sleep to shield the eye from debris and injury that may cause corneal scratching. The majority of patients experience a spontaneous recovery which may occur in a matter of _________. Depending on the severity of the condition, full recovery can take up to ___________ months. Once recovery is complete, patients do not typically have residual functional deficits of the condition. Though uncommon, long-term complications may occur. These may include an altered sense of _________, partial to total __________ due to nerve damage, synkinesis resulting from abnormal nerve regeneration or partial to complete _____________ due to eye injuries.

motor and sensory facial facial facial saliva and tear anterior vestibulocochlear stylomastoid parotid 5 Schwann inflammatory days stiffness droop taste tear and saliva auditory MRI or CT tear weeks 6 taste paralysis blindness

The ASIA impairment scale is widely used for assessment of a patient with SCI. This tool classifies complete versus incomplete lesions along with key _________ to test.

muscles

Down Syndrome Clinical manifestations include hypotonia, flattened _________ bridge, Simian line (__________ crease), epicanthal ____________, enlargement of _____________, and developmental __________. Detection occurs in approximately 60-70% of women tested that are carrying a baby with Down Syndrome. Exercise is essential for a child with Down Syndrome in order to avoid inactivity and ___________

nasal palmar folds tongue delay obesity

Spina Bifida - Myelomeningocele Congenital __________ tube defect that generally occurs in the ___________ spine but can also occur at the sacral, cervical, and thoracic levels. Spinal bifida has three classifications that include spina bifida - occulta (incomplete fusion of the __________ vertebral arch with no neural tissue protruding), spina bifida - meningocele (incomplete fusion of the posterior vertebral arch with neural tissue/__________ protruding outside the neural arch), and spina bifida - myelomeningocele (incomplete fusion of the posterior vertebral arch with both meninges and ________ ________ protruding outside the neural arch). Spina bifida - myelomeningocele is characterized by a sac or cyst that protrudes outside the spine and contains a herniation of meninges, cerebrospinal fluid, and the spinal cord through the defect in the vertebrae. The cyst may or may not be covered by ________. Spina bifida results from the failure of the neural tube closure by day _____ of gestation when the spinal cord is expected to form. Approximately 75% of vertebral defects are found in the lumbar/sacral region, typically _____-______ with injury to the structures that level and below. Defects can also occur in the cervical or thoracic spine, however, this is rare. Prenatal care including recommended amounts of _________ acid, especially in the first 6 weeks of pregnancy, appears to be the most effect way to prevent neural tube defects. Impairments associated with myelomeningocele include ______ and ______ loss below the vertebral defect, _________cephalus, Arnold-Chiari type II malformation, ______foot, scoliosis, bowel and bladder dysfunction, and learning disabilities. The higher the neural lesion the worse the prognosis is for survival. The infant will require surgical intervention to close the lesion and in 90% of the cases a ____ is required for ___________cephalus. Approximately _______-thirds of children with myelomeningocele and shunted hydrocephalus have normal intelligence and the other third demonstrate only mild retardation. Regardless of intelligence, children with myelomeningocele exhibit difficulties with perceptual abilities, attention, problem solving, and memory. Prior to birth a fetal ____________ may identify the myelomeningocele defect in the spine. Prenatal testing of alpha-fetoprotein in the blood will show an elevation in levels that indicate a probable neural defect at approximately week 16 of gestation. At birth an obvious sac will be present over the spinal defect. Spinal films and _______________ can evaluate for the presence of defects and hydrocephalus. Immediately after birth, an infant with myelomeningocele has an increased risk for meningitis, hemorrhage, and hypoxia, however, surgical intervention may significantly reduce the risks. Ongoing additional findings with myelomeningocele include hydrocephalus, clubfoot, neuropathic fracture, visual problems, osteoporosis, kyphosis, __________ dislocations, and latex allergy. A patient with myelomeningocele has a near normal life expectancy as long as the patient receives consistent and thorough health care. Functional outcome of the patient depends on the level of injury, the amount of associated impairments, and the caregiver support that is provided. Anencephaly is a condition that is characterized by a failed closure of the __________ end of the neural tube. The cerebral hemispheres do not form and some neural tissue may protrude through the defect. This type of neural tube defect cannot be repaired. Many infants with this condition are stillborn, while others only survive a short time after birth.

neural lumbar posterior meninges spinal cord skin 28 L5-S1 folic acid motor and sensory hydro club shunt hydrocephalus two-thirds ultrasound CT scan hip cranial

Spina Bifida - Myelomeningocele Classifications include occulta (incomplete fusion of the posterior vertebral arch with no ______ tissue protruding), meningocele (incomplete fusion of the posterior vertebral arch with ________ tissue/meninges protruding outside the neural arch), and myelomeningocele (incomplete fusion of the posterior vertebral arch with both ___________________ and __________ _____________ protruding outside the neural arch). Approximately 75% of vertebral defects are found in the lumbar/sacral region most often at ____-_____. Prenatal testing of alpha-fetoprotein (AFP) in the blood will show an elevation in levels that indicate a probable neural tube defect at approximately week 16 of gestation.

neural neural meninges spinal cord L5-S1

Acute injury to a peripheral nerve will produce ____________ (the mildest form of injury with axons preserved and recovery rapid and complete), axonotmesis (more severe injury with __________ damage, potential for spontaneous recovery), and neurotmesis (most severe damage, axon and __________ are damaged, ____________ injury, no spontaneous recovery, surgery may allow for some recovery).

neuropraxia reversible myelin irreversible

Cerebral palsy is an umbrella term used to describe a group of non-___________ movement disorders that result from brain damage. CP is the most common cause of permanent disability in children. There is a wide variety of neurological damage that can occur with injury. Autopsy reports have indicated lesions that include _________ below the lining of the __________________, damage to the _______________ nervous system that caused neuropathy and anoxia, and _______________ that caused ______________. Hypoxic and ischemic injuries disrupt normal metabolism that results in global damage to the developing fetus. CP is classified by neurological dysfunction and extremity involvement. Spastic CP involves ______________ motor neuron damage; athetoid CP involves damage to the ___________ ___________. The etiology may be multifactorial and is sometimes unknown. Risk factors are categorized as prenatal (80%) or perinatal and postnatal cases. Prenatal risk factors include ________ incompatibility, maternal ________________, __________________, infection, diabetes, and chromosome abnormalities. Perinatal factors include multiple or premature births, breech delivery, low birth weight, prolapsed cord, placenta abruption, and asphyxia. Postnatal factors include CVA, head trauma, neonatal infection, and brain tumor. The most common causative factor of CP is prenatal cerebral ________. CP is the most common neurological impairment seen in children (following intellectual disability). CP is a neuromuscular disorder of posture and controlled movement, however, clinical presentation is highly variable based on the area and extent of CNS damage. A child may present with high ____________, low ______, or athetoid movement. CP is classified as monoplegia, hemiplegia, and quadriplegia. CP is also classified as mild, moderate, and severe. General characteristics include __________ delays, abnormal muscle _________ and motor control, reflex abnormalities, poor ___________ control, high risk for hip _______________, and balance impairments. Intellect, vision, hearing, and perceptual skills are usually altered in conjunction with CP. If CP is suspected through clinical findings, including ____________, an ___________ may be performed. _____-____ of the hip may rule out ________ dislocation. Blood and urine tests can be used to investigate a _______________ cause of CP. Observation usually will diagnose CP secondary to the observed outward characteristics. If a patient is going to ambulate, this will usually occur by the age of ________. Prognosis of mild to moderate CP is a near normal lifespan. 50% of children with severe CP die by the age of ___________. Arthrogryposis multiplex congenita (AMC) occurs in _________ and is also considered to be _______-________________. AMC is a neuromuscular syndrome classified into three forms. The infant is born with multiple ____________ and may have _________ bands that developed in place of muscle. A patient with AMC should have a normal life expectancy and is typically of normal intelligence. It is usually difficult for these individuals to live independently due to their level of physical disability.

non-progressive hemorrhage ventricles central hypoxia encephalopathy upper basal ganglia Rh malnutrition hypothyroidism hypoxia tone tone developmental tone postural dislocation seizures EEG x-ray shoulder metabolic 8 10 utero non-progressive contractures fibrous

Vestibular disorders Occurs when there is a disruption of the _________ information processed by the inner ear and brain with respect to the body's control of ___________ and ________ movements. Typically, disease or injury to these processing areas will result in a vestibular disorder, however, genetic, environmental, and idiopathic etiologies have been recognized as well. Vestibular disorders are classified as either peripheral (e.g. dysfunction of the ___________ or vestibular structures in the inner ear) or central (e.g. dysfunction of the _________ system in processing __________ and __________ information) with the majority of cases diagnosed as peripheral. Ear infection, whiplash injury, and head injury are among the most common causes of vestibular disorders in younger individuals. The clinical presentation of a vestibular disorder may vary greatly. Symptoms may be intermittent or persistent presenting as either a single attack or repeatedly over time. In many cases, symptoms will diminish or resolve without __________________ as the body either heals of ____________ for deficits. Typical characteristics can include vertigo, dizziness, nausea, altered balance, auditory changes, and difficulties with cognition, memory, or coordination. A vestibular disorder is typically diagnosed based on a patient's past medical history and a clinical examination. _________ may be utilized to rule out soft tissue abnormalities such as tumor, acoustic neuroma, or CVA. Depending on the patient's presentation, laboratory blood and allergy testing may also assist in ruling out differential diagnoses. Vestibular testing typically emphasizes assessment of the vestibuloococular reflex (e.g. dix-hallpike, electronystagmography, videonystagmography) and an assessment of balance reactions (e.g. gait on varied surfaces, postural sway with eyes closed). Auditory testing is typically performed formally by an audiologist. Long term suppression of symptoms is not typically recommended since the body must experience symptoms in order to develop compensatory strategies. Nutritional counseling typically emphasizes regulation of the body's fluid balance to stabilize the volume and electrolyte concentrations of the inner ear's endolymph fluid. Vestibular rehab includes specific PT interventions designed to assist the patient to habituate (e.g. become less sensitive) to symptoms through adaptation, substitution, cognitive, and symptom prediction. Activities to retrain balance reactions, proprioception, and the ________________ reflex are typically key components of a treatment plan. Symptoms of orthostatic hypotension may include dizziness, blurred vision, confusion, and loss of balance. The symptoms are typically triggered by a change in body position that temporarily reduces blood flow to the brain. Though symptoms may mimic some vestibular disorders, they are not vestibular in origin and typically resolve quickly as blood pressure adapts to the change in position.

sensory balance eye auditory nervous spatial balance intervention compensates MRI vestibuloocular

The limbic system is found within the brain and is involved with control and expression of mood, processing, memory, appetite, and ___________. Lesions to this area can produce aggression, fearlessness, alterations in motivation, and other behaviors.

olfactory

Traumatic brain injury is classified as either __________ or ____________ with primary and secondary brain damage. Primary injuries typically consist of coup and contrecoup lesions with secondary injury typically due to an epidural or subdural _________.

open or closed hematoma

A cerebrovascular accident is a specific event that results in a lack of __________ to a specific area of the brain secondary to ischemia or hemorrhage. CVAs are typically termed a __________ stroke, stroke in ________, ________ ischemic attack, ischemic stroke or hemorrhage.

oxygen evolution transient

Polyneuropathy Characterized by damage or disease that affects multiple ___________ nerves. The most common etiology of polyneuropathy is diabetes mellitus. Other causes include advanced age, certain drugs, __________abuse, AIDS, environmental toxins, and inherited neurological conditions. Polyneuropathy typically affects peripheral nerves, especially _________ in the extremities, though it can also affect ______ nerves and nerves of the _______________ nervous system. Polyneuropathy can affect solely the sensory nerves, soley the motor nerves, or both. Neuropathy may involve damage to the axon, the myelin ____________, or the nerve's cell ___________ depending on the cause of the neuropathy. Polyneuropathy often starts in the ____________ lower extremities, typically symmetrically, and may progress to include the hands and more proximal portions of the limbs. Symptoms include numbness, tingling, and pain in a "______________" and "___________" pattern. Additional symptoms include loss of position and vibration sense as well as __________. If motor nerves are affected, the condition will involve muscle ____________, and possibly __________. Autonomic symptoms include constipation, loss of bowel and bladder control, and ____________ hypotension. EMG and nerve conduction testing are often used to determine the location and extent of nerve damage. Other lab tests (e.g. __________tests) may be performed to determine the cause of the neuropathy.

peripheral alcohol distally cranial autonomic sheath body distal glove stocking ataxia weakness atrophy orthostatic blood

Polyneuropathy Characterized by damage or disease that affects multiple ____________ nerves, which is most commonly caused by __________ ___________. Often starts in the ___________ extremities, generally _________________, and may progress to include the hands and more proximal portions of the limbs. _________ and nerve conduction testing are often used to determine the location and extent of nerve damage.

peripheral diabetes mellitus distal symmetrically EMG

Cauda Equina Syndrome Considered to be a ________________ nerve injury and results from damage and loss of function involving _________ or more nerves of the cauda equina. CES is associated with numerous mechanisms of injury and typically presents as a complex of symptoms. The spinal cord typically extends to __________, terminating with the _________ _________________. Paired lower lumbar, sacral, and coccygeal nerve roots extend beyond the conus medullaris and are termed the cauda equina. The cauda equina provides sensory innervation to the "saddle area" of the lower extremities, lower extremity motor innervation, parasympathetic innervation to the __________ and _________________, and voluntary control over the associated ___________. The nerves of the cauda equina are more susceptible to damage than most other nerve root pairs due to poorly developed protective _________________ and the tendency to form edema even with mild injury. CES may result from any source of compression on the cauda equina nerve roots, including spinal structure pathology (e.g. ruptured disk, fracture, stenosis), trauma (e.g. fall, gunshot wound), infectious conditions (e.g. abscess or tuberculosis), tumor or iatrogenic factors. CES may develop slowly or rapidly depending on the underlying pathology. For patients with gradual onset, diagnosis may be difficult since early symptoms may be poorly defined or mimic other conditions. Altered reflexes, pain, and decreased strength and sensation are common symptoms. Other symptoms can include severe _________ pain, functional impairment, diminished sensation in the ___________ distribution, bowel and bladder dysfunction, and ___________ dysfunction. ___________ studies are able to identify the widest range of potential etiologies as they are able to best delineate soft tissue structures and pathology. Compression due to bony abnormalities, such as narrowed disk spaces, altered bony alignment or arthritic changes are more readily identified with __________ imaging or a _________. Surgical and medical interventions are typically directed toward nerve root ______________. Though CES is not fatal, it can signal a surgical emergency since delayed intervention may limit long-term _____________. CES is a self-limiting condition, however, the longer a patient is symptomatic prior to ___________, the less likely the patient is to achieve a complete ____________. Morbidity is typically associated with long-term effects including weakness and bowel and bladder dysfunction. Other complications may include the development of decubitus ulcers or thrombus formation.

peripheral two L1 conus medullaris bowel and bladder sphincters epineurium back saddle sexual MRI x-ray or CT decompression outcomes intervention recovery

Multiple Sclerosis Characterized by demyelination of the myelin sheaths that surround nerves within the brain and spinal cord resulting in ___________ development, decreased nerve ____________ velocity, and eventual failure of impulse transmission. Clinical symptoms may include ___________ problems, paresthesias, sensory changes, clumsiness, weakness, ataxia, balance dysfunction, and fatigue. Intervention includes regulation of activity level, relaxation, and energy conservation techniques, normalization of tone, balance activities, gait training, and core stabilization.

plaque conduction visual

Multiple Sclerosis Produces patches of demyelination that decreases efficiency of nerve impulse transmission. Symptoms vary based on the location and the extent of demyelination. MS is characterized by demyelination of the myelin sheaths that surround the nerves within the brain and spinal cord. Myelin breakdown results in __________ development, decreased nerve conduction velocity, and eventual failure of impulse transmission. Lesions are scattered throughout the central nerve system and do not follow a particular ___________. The exact etiology of MS is unknown. Genetics, viral infections, and environment all have a role in the development of MS. It is theorized that a slow acting ___________ initiates an autoimmune response in individuals that have environmental and genetic factors for the disease. The incidence of MS is higher in ____________ between the ages of 20-35 and is nearly twice as common in women as in men. There is also a higher incidence of MS in _________ climates. MS can be classified as relapse-remitting (85%), secondary-progressive, and primary-progressive. Initial symptoms can include ____________ problems, paresthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction, and fatigue. The frequency and intensity of _______________ may indicate the speed/course of the disease process. ____________ may assist with observation and establishing a baseline for lesions, evoked potentials may demonstrate slowed nerve conductions, and CSF can be analyzed for an elevated concentration of gamma globulin and ________ levels. Guidelines indicate that a ___________ definitive diagnosis of MS can be made if a person experiences __________ separate attacks and shows evidence of _____ separate lesions. Other diagnoses (having specific criteria) include __________-supported definite MS, ____________ probable MS, and ______________-supported ________ MS. As the disease advances exacerbations leave greater ongoing disability and the length of remissions decrease. Ongoing symptoms can include emotional liability, depression, dementia, psychological problems, spasticity, tremor, weakness, paralysis, sexual dysfunction, and loss of bowel and bladder control. A home care regiment should include a _____maximal exercise/endurance program. Exercise in the ______________ when the patient is rested is advisable to avoid fatigue. The patient may need frequent rest periods throughout the day and may benefit from breaking a task into smaller ______________ to avoid fatigue. Ongoing ambulation and mobility activities are important to maintain endurance and prevent ___________ atrophy. __________c therapy may also be beneficial to this population. Factors that influence exacerbations include __________, stress, and trauma. Dystonia is a neurologic syndrome that presents with involuntary and sustained muscle contractions that cause _________ movements. Idiopathic dystonia has a genetic basis and accounts for _____-_____ of all cases. Secondary dystonia usually results from brain damage or CNS damage. There are no definitive tests to diagnose dystonia. Treatment is based on current symptoms and includes pharmacological intervention, PT, and occasional surgical intervention. Prognosis is based on age of onset and spontaneous remission occurs in 25-30% of the cases.

plaque pattern virus Caucasian temperate visual exacerbations MRI protein clinical 2 2 laboratory clinically laboratory, probable submaximal morning steps disuse aquatic heat repetitive two-thirds

Guillain-Barre Syndrome or acute ____________________ is a temporary inflammation and demyelination of the peripheral nerves' myelin sheaths, potentially resulting in ____________ degeneration. GBS results in motor weakness in a __________ to _______________ progression, ______________ impairment, and possible ______________ paralysis. The autoantibodies of GBS attack segments of the ______________ sheath of the peripheral nerves. The infecting organism is of similiar structure to molecules found on the surface of myelin sheaths. The antibodies produced attack both the organism of infection as well as the ____________ cells due to the similar structure. This decreases nerve conduction velocity and results in _______ or paralysis of the involved muscles. The demyelination that is initiated at Ranvier's nodes occurs secondary to macrophage response and inflammation, and as a result, destruction of the myelin. The body responds to this process and attempts to repair the damage through Schwann cell division and myelinization of the damaged nerves. ________ fibers are predominantly affected. The exact etiology of GBS is unknown, however, it is hypothesized to be an autoimmune response to a previous ____________ infection, influenza, immunization, or surgery. Viral infections, Epstein-Barr syndrome, cytomegalovirus, bacterial infections, surgery, and vaccinations have been associated with the development of GBS. GBS can occur at any age, however, there is a peak in frequency in the young adult population and again in adults that are between their fifth and eighth decades. Incidence is slightly greater in males than females and in Caucasians than African Americans. A patient with GBS will initially present with distal ______________ motor weakness and will likely experience mild distal _________ impairments and transient paresthesias. The weakness will progress towards the upper extremities and head. The level of disability usually peaks within _____ to ____ weeks after onset. Muscle and respiratory paralysis, absence of deep tendon reflexes, and the inability to __________ or __________ may occur. GBS can be life threatening if there is respiratory involvement. There are multiple subtypes of GBS, but the classic type involves acute onset of symptoms with peak impairment within _____ weeks, followed by a two to four week static period and gradual recovery that can take _____ to _____. GBS can be diagnosed through a ______ ______ sample that contains high _____ levels and little to no ____________. ____________ will result in abnormal and slowed nerve conduction. The patient may also experience _________ floor muscle weakness, deep muscle _______, and ______________ nervous system involvement, including arrhythmia, tachycardia, postural ________________, heart block, and absent ________. Up to 30% of patients require mechanical _____________ during the acute stage. Corticosteroids are controversial and usually ___________________. During the acute state a therapist must limit overexertion and fatigue to avoid ________________ of symptoms. Physical therapy intervention may be required on an ongoing basis to assist with recovery that can last from 3-____ months. Recovery is slow and can last up to _______ years after onset. Although most patients experience full recovery, statistics indicate that 20% have remaining neurologic deficits, 3-5% of patients die from respiratory complications. Polyneuropathy is a progressive condition that affects the nerves. The most common etiology is metabolic conditions such as ________ __________. Polyneuropathy develops slowly, bilaterally, and symmetrically. The first symptom is often _____________ impairment of the distal lower extremities. Pain, diminished deep tendon reflexes, and _________ loss are other symptoms of this condition that is marked by exacerbations and remissions.

polyneuropathy axonal distal to proximal sensory respiratory myelin sheath Schwann weakness motor fibers respiratory symmetrical sensory 2-4 weeks speak or swallow 4 months to years cerebrospinal fluid proteins lymphocytes EMG pelvic floor pain autonomic hypotension reflexes ventilation contraindicated exacerbation 12 two years diabetes mellitus sensory motor loss

The left hemisphere has specific responsibilities including the ability to understand language, sequencing movements, producing written and spoken language, expression of ________ emotions, and the ability to be analytical, controlled, and logical. The right hemisphere has specific responsibilities including nonverbal processing, artistic expression, comprehension of general concepts, spatial relationships, kinesthetic awareness, mathematical reasoning, and body image awareness.

positive

Sciatica Secondary to Herniated Disk A herniated disc is an intervertebral disk that bulges and protrudes postero__________________ against a nerve root. Sciatica is the diagnosis of a compression of the sciatic nerve (L___-S___) secondary to a herniated disc causing a patient's symptoms. Other causes for sciatica include tumor, infection, spondylolisthesis, narrowing of the canal, and blood clots. As a patient gets older there are natural and significant alterations in the composition of the intervertebral disks and supporting structures. In a herniated disk the nucleus ________ has bulged posterolaterally secondary to a weakening of the outer ________ fibrosis and ________ _________ ligament. The sciatic nerve experiences and inflammatory response and subsequent damage secondary to the compression from the herniated disk. The most common contributing factor for this condition is the natural __________ process. Each decade the composition of the annulus ________ and nucleus ___________ is altered and decreases in overall stability. Once there is adequate structural breakdown within the disk, a patient becomes a high risk for injury. A "normal mechanical load on a normal disk" is now an "excessive load on a compromised disk". As expected, sciatica secondary to a herniated is most often seen in patients between 40 and 60 years of age. Sciatica is characterized by low back and _________ pain that typically radiates down the back of the thigh along the sciatic nerve distribution. Sciatic pain occurs from nerve root compression and can be dull, aching, or sharp. Pain may have sudden _______ or develop gradually over time. Early sciatica may involve discomfort or pain limited to the low back and gluteal region. Leg pain can become greater tan the back pain and can radiate the entire length of the nerve to the toes. The patient may also experience intermittent numbness and tingling localized to the dermatomal distribution, limited ______________ range of motion in ________ planes, tenderness to palpation at the segment of ______________, and muscle _____________. Radiologic testing of the spine and electrophysiologic studies are initially performed to assist with diagnosis. Other imaging may include myelogram, discography, CT scan, or MRI. Blood work may assist with differential diagnosis. Sciatica will produce pain that increases with certain positions due to an increase in intradiscal pressure. Pain will increase with ____________ position or when lifting, forward ___________ or ____________. Sneezing and ____________ can also exacerbate the pain. Although a patient may want to stop all activity to relieve pain, prolonged _______ rest is contraindicated and will not relieve pain on a long-term basis. Medical management of sciatica due to a herniated disk includes ________-term bed rest, overall reduction of intradiscal pressure, patient education, PT, medications, and in rare instances surgical intervention. Lifting, squatting, and ___________ are contraindicated due to the significant increase in intradiscal pressure. Most herniations will spontaneously decrease in size with conservative treatment. Research indicates the majority of patients improve within ____ to ____ months of conservative treatment. Healing of the disk can also occur and __________ can reinforce the posterior aspect and __________ fibers so that it is protected from further protrusion. Restoration of functional mobility is plausible, however, surgical intervention may be required if neurological symptoms increase of no progress is made with conservative measures. Spinal stenosis is another condition that can be a causative factors of sciatica. Symptoms that would indicate spinal stenosis include lower extremity with or without ___________, back and leg pain after ambulating a ________ distance, increasing symptoms with continued _______________, and relief of symptoms through _____________. Radiologic results reveal disk narrowing and degenerative ________________. Surgery is only recommended as a last resort when conservative treatment fails.

posterolateral L4-S3 pulposus annulus posterior longitudinal aging fibrosus pulposus gluteal onset thoracolumbar all herniation spasms sitting bending twisting coughing bed short climbing 2 to 4 scarring annular sciatica short ambulation flexion spondylolisthesis

Functional outcomes are anticipated for each level of spinal cord injury. A physical therapist must be able to recognize a patient's _________based on expected functional outcomes.

potential

Huntington's disease Chronic _______________ genetic disorder that is fatal within 15-20 years after clinical manifestation. Characterized by degeneration and atrophy of the __________ _________ (specifically the __________) and ____________ cortex within the brain. Clinical presentation includes enlarged _______________ secondary to atrophy of the ________ _________, mental deterioration, __________ disturbances, and ___________ gait.

progressive basal ganglia striatum cerebral ventricles basal ganglia speech ataxic

Rancho Los Amigos Levels of Cognitive Functioning Scale will also assist to classify the level of injury based on where the patient best meets the criteria for each level. The levels include: 1. No response 2. Generalized response 3. Localized response 4. Confused-Agitated 5. Confused-Inappropriate 6. Confused-Appropriate 7. Automatic-Appropriate 8. Purposeful-______

purposeful appropriate

Bobath developed Neuro-Developmental Treatment based on the hierarchical model of neurophysiologic function. This approach includes facilitation and inhibition of tone, __________ inhibiting postures, ________ points of control, __________ control, and use of ________ during treatment.

reflex key points of control proximal control rotation

Rood's theory of neurological rehabilitation is based on the ____________ __________ model where motor output is the result of past and present sensory input. The goal of homeostasis is achieved using ________ ________ to enhance motor control. Treatment includes ________ stimulation to facilitate or inhibit a response.

reflex stimulus key patterns sensory

Nerve roots from C1 through S4 each innervate a particular region for ____________(dermatome) and for motor innervation (myotome), and provide a pattern of anticipated weakness with impairment.

sensation

Vestibular disorders Occurs when there is a disruption of the __________ information processed by the inner ear and brain with respect to the body's control of ____________ and ___________ movements. Classified as either peripheral or central, with the majority of cases diagnosed as __________ Effects can be quite diverse ranging from spontaneous recovery to permanent disability.

sensory balance eye peripheral

Sciatica secondary to herniated disk The sciatic nerve experiences an inflammatory response and subsequent damage secondary to compression from the herniated disc. Sciatica is characterized by low back and gluteal pain that typically radiates down the back of the thigh along the sciatic nerve distribution. Pain will increase in a ____________ position or when lifting, forward bending, or twisting.

sitting

Traumatic Brain Injury Occurs due to an open head injury where there is a penetration through the skull or closed head injury where the brain makes contact with the __________ secondary to a sudden, violent acceleration or deceleration. brain injury may include swelling, axonal injury, hypoxia, hematoma, hemorrhage, and changes in intracranial pressure High risk groups include ages 0-4, 15-19, ad greater than 65 (males are at greater risk in each category)

skull

Traumatic brain injury Occurs due to an open head injury when there is penetration through the __________ or closed head injury where the brain makes contact with the skull secondary to a sudden, violent ___________ or __________ impact. Traumatic brain injury can also occur secondary to __________ as with cardiac arrest or near __________. Primary damage will occur at the site of impact. Secondary damage occurs as a result of _______________ and ____________ reactions to the trauma. Brain injury may include swelling, axonal injury, hypoxia, hematoma, hemorrhage and changes in ___________ pressure. _____________ and __________ are the two leading causes of TBI. Characteristics of TBI may include altered consciousness (coma, obtundity, delirium), cognitive and behavioral deficits, changes in personality, motor impairments, alterations in tone, and speech and swallowing issues. Diagnostic imaging such as ___________ or ___________ should be performed immediately in order to rule out hemorrhage, infarction, and swelling. _____________ taken of the cervical spine can be used to rule out fracture and potential for subluxation, An ____________, ______________, and cerebral blood flow mapping may be utilized for diagnosis and baseline data. The physician will classify the patient using the ________ __________ ___________ and indicate severe (________), moderate, or mild brain injury. The Rancho Los Amigos Levels of Cognitive Functioning can also be used to classify injury and assist with developing and appropriate plan of care. __________ pressure must be monitored initially since it is at risk to increase or develop hemorrhage. A patient can develop heterotropic ossification, contractures, skin breakdown, seizures, and DVT. A patient with a severe TBI may remain in a persistent vegetative state. Physical therapy will focus on _____________ stimulation and ___________ for comatose patient or _______finding and high-level balance activities for a patient with a mild injury. Physical therapy may include functional mobility training, ___________ modification, serial casting, compensatory strategies, vestibular rehabilitation, task specific activities, wheelchair seating, and pulmonary intervention. Meningitis is a ________________ or ___________ infection that spreads through the ____________ fluid to the brain. The meninges of the brain become inflamed as well as the meningeal membranes. The patient will have a ____________ and may complain of _____________ in the neck. The patient may also show symptoms of confusion, fatigue, and irritability. As the virus progresses the patient may experience __________ and may progress into a ___________. Medical treatment varies based on the causative strain of the virus/bacteria. Mortality ranges 5-25% and approximately 30% have some degree of permanent neurological impairment.

skull acceleration deceleration anoxia drowning metabolic and physiologic intracranial MVA and falls CT scan or MRI X-ray EEG, PET Glasgow Coma Scale coma Intracranial sensory stimulation and PROM pathfinding behavioral viral and bacterial cerebrospinal headache stiffness seizures coma

The peripheral nervous system contains nerves that have sensory, motor, and autonomic responsibilities. Cutaneous sensory end organs include thermoreceptors, nociceptors, mechanoreceptors, chemoreceptors, and photoreceptors that provide feedback through different channels of _____________.

stimulation

Parkinson's disease Parkinsonism syndrome is used to describes a group of disorders within _________cortical gray matter of the ___________ ________ that produces a similar disturbance of _________ and voluntary movements. his syndrome occurs as a secondary effect or disorder from another disease process. Parkinson's disease is a primary degenerative disorder that is characterized by a decrease in production of ___________ within the ______________ ______________ portion of the __________ _________. The degeneration of the dopaminergic pathways creates and imbalance between dopamine and ______________. Injury occurs to the ____________ cortical gray matter within the _________ ____________, specifically the __________ ___________ and the ___________ ___________. The basal ganglia store the majority of dopamine and are responsible for _____________ and control of voluntary movement. A patient with Parkinson's disease exhibits degeneration of dopaminergic neurons that results in depletion of dopamine production within the basal ganglia. Change in the neurochemical production damages the complex loop between the basal ganglia and the ___________. Primary Parkinson's disease has an unknown etiology and accounts for the majority of patient with Parkinsonism. Contributing factors that can produce symptoms of Parkinson's disease include genetic defect, toxicity from carbon monoxide, excessive manganese or copper, carbon disulfide, vascular impairment in the striatum, encephalitis, and other neurodegenerative diseases such as _______________ disease or _______________ disease. The majority of patients with Parkinson's disease will initially notice a ____________ tremor in the hands (sometimes called a _______-______ tremor) or feet that increases with stress and disappears with movement or sleep. Early in the disease process a patient may attribute symptoms to "old age" such as balance disturbances, rolling over and rising from _______, and impairment with fine manipulative movements seen in writing, bathing, and dressing. A patient's symptoms slowly progress and often include __________kinesia, sluggish movement, difficulty with initiating (___kinesia) and stopping movement, festinating and shuffling gait, bradykinesia, poor posture, dysphagia, and cogwheel or lead pipe rigidity of skeletal muscles. Patients may also experience freezing during ambulation, speech, blinking, and movements of the arms. A patient with PD will also have a _____-like appearance with no facial _____________. There are no laboratory or imaging studies that initially diagnose PD. ______ or _____ may be used to rule out other neurodegenerative diseases and obtain a baseline for future comparison. Definitive diagnosis is difficult during the early stages of the disease. Parkinson's disease is believed to progress slowly over 25-30 years prior to the onset of pharmacological intervention. A patient may develop a stooped posture and an increased risk for falling. Progression of the disease may result in dysphagia, difficulty with speech, and pulmonary impairment. Greater attention is required for skin care once nutrition and mobility are further compromised. Many patients with Parkinson's disease die from complications of bronchopneumonia. Dopamine replacement therapy (levodopa, Sinemet, Madopar) is the most effective treatment in reducing symptoms of PD such as movement disorders, bradykinesia, rigidity, and tremor. PD does not significantly alter a patient's lifespan if the patient is diagnosed with a generalized form between the _____ and _____ years of age. As the disease progresses, however, there will be an exacerbation of all symptoms and significant loss of mobility. The inactivity and deconditioning allow for complications and eventual death. Wilson's disease is inherited as an autosomal recessive trait and causes a defect in the metabolism of _____________. The accumulation of copper within the erythrocytes, liver, brain, and kidneys produces the associated degenerative changes. The patient presents with hepatic insufficiency, tremor, choreathetoid movements, dysarthria, and progressive rigidity.

subcortical basal ganglia balance dopamine substantia nigra basal ganglia acetylcholine subcortical basal ganglia substantia nigra corpus striatum modulation cerebrum Huntington's disease Alzheimer's disease resting pill rolling bed hypokinesia akinesia mask-like expression CT scan or MRI 50 and 60 copper

The autonomic nervous system consists of two divisions: the _____________ division (generally a stimulating response) and the __________ division (generally an __________ response). Anatomically, the ANS contains portions of the CNS and PNS. Impulses to the ANS typically do not reach the level of consciousness and instead produce automatic responses.

sympathetic parasympathetic inhibitory

Brunnstrom's Movement Therapy in Hemiplegia utilizes _________ patterns to assist with developing movement combinations outside of synergy patterns. Raimiste's phenomenon and Souque's phenomenon are used in treatment along with associated reactions, stages of recovery, overflow, and limb synergies.

synergy

The midbrain is located at the based of the brain above the spinal cord. It consists of the ____________ and _______________ and serves as a ________ area, connecting the forebrain to the hindbrain. It is also a reflex center for _____, __________ and tactile responses.

tectum tegmentum relay auditory visual

Developmental milestones for gross and fine motor skills follow a tentative schedule that children will follow through the ______ years. Developmental delay and other pediatric pathology may cause the child to experience difficulty progressing through milestones.

teenage

The forebrain consists of the _____________ (cerebral cortex, hippocampus, basal ganglia, amygdala) and the _________________ (thalamus, subthalamus, epithalamus, hypothalamus).

telencephalon diencephalon

CVA Occurs when there is an interruption of cerebral circulation that results in cerebral insufficiency, destruction of surrounding brain ______, and subsequent neurological deficit. The ischemia occurs from either a stroke in _____________ (the infarct slowly progresses over _____ to ______ days) or as a __________ stroke (an abrupt infarct with ________ neurological deficits). CVA results from prolonged _____ to an artery within the brain. This condition can cause subsequent neurological damage related to the size and location of the infarct. Disruption of blood flow to a certain artery will lead to damage of a specific area of the brain and its functions. There are different types of CVA that include _________ stroke (thrombus, embolus, lacunar) and _________________ stroke (intracerebral, subdural, subarachnoid). The primary risk factors for CVAs are classified as modifiable and nonmodifiable. Modifiable factors include hypertension, atherosclerosis, heart disease, diabetes, elevated cholestrol, smoking, and obesity. Hypertension is the most prevalent modifiable cause of CVA. Non-modifiable risk factors include age, race, family history, and sex. Age constitutes the greatest risk for CVA, in fact 73% of patients sustaining a stroke are greater than 65 years of age. _______ __________ can confirm an area of infarct in the brain and its __________ origin, however, it can present as ____________ for up to a few days after the event. ________ allows for the diagnosis of ischemia within the brain almost immediately after onset. _____________ can provide information regarding cerebral ________________ and cell function. _______________ identifies areas of diminished _________ flow in vessels and _______________ may identify a _______________ and determine if surgical intervention is necessary. A patient with a left CVA may present with weakness or paralysis to the _________ side, impaired processing, heightened ____________, aphasia, dysphagia, motor _____________, and right ____________.. A patient with a right CVA may present with weakness or paralysis the ___________ side, poor ____________ span, impaired awareness and judgment, spatial deficits, memory deficits, left ________________, emotional ______________, impulsive behavior, and left ___________. Coma and death are the most severe consequences of a CVA. Anticoagulants are contraindicated for ______________________ CVA. ______________ care must also be a priority during acute rehabilitation. There are many approaches to neurological rehabilitation that include, but are not limited to 1) ________________ Neurodevelopmental Treatment (NDT), 2) motor control, 3) ____________'s Movement Therapy in Hemiplegia, 4) Rood, 5) Kabat, Knott, and Voss' Proprioceptive Neuromuscular Facilitation. The effects of a CVA can be quite diverse ranging from spontaneous recovery to permanent disability requiring compensatory strategies and techniques in order to function. The first _____________ months of recovery typically reveals the most measurable neurologic recovery and is usually a good indicator of the long-term outcome. Research indicates that a patient can continue to improve the control of movement and show progress for an average of ________ to ___________ years post CVA. A transient ischemic attack (TIA) is also characterized by a diminished blood supply to the brain, however, it is transient. Although the patient may present with similar symptoms of a CVA, the symptoms last for only a brief period of time. Unlike a CVA, the TIA does not cause ____________ residual neurological deficits. A TIA is an indication, however, of a future risk for a CVA.

tissue evolution one to two completed immediate ischemia ischemic hemorrhagic CT scan vascular negative MRI PET perfusion Ultrasonography blood angiography clot right frustration apraxia hemianopsia left attention inattention liability hemianopsia hemorrhagic Respiratory Bobath's Brunnstrom's 3 months 2-3 years permanent

Therapeutic positioning is essential to obtain maximum function for the pediatric population and is used to facilitate desired movement, inhibit unwanted tonal influences, normalize ______, prevent contractures, enhance midline orientation, and improve _______ capacity.

tone respiratory

Carpal Tunnel Syndrome The carpal tunnel is created by the _________ carpal ligament, the _____________ tuberosity and _________________, the hook of __________ and ___________, and the volar ________________ ligament and volar ligamentous extensions between the carpal bones. The _________ nerve, four flexor digitorum profundus tendons, four flexor digitorum superficialis tendons, and the flexor _____ longus tendon pass through the carpal tunnel. Carpal tunnel syndrome occurs as a result of compression of the median nerve where it passes through the carpal tunnel. The median nerve is injured by compression within the carpal tunnel at the wrist. Normal tissue pressure within the tunnel is ____ to ____ mmHg, but CTS can result in pressure above _________ mmHg, which further increases with flexion and extension of the wrist. The increase in pressure produces ischemia to the nerve. This results in sensory and motor disturbances in the median nerve distribution of the hand. An condition such as edema, inflammation, tumor, or fibrosis may cause compression of the median nerve within the carpal tunnel and result in ischemia. The exact etiology of CTS is unclear, however, conditions that produce inflammation of the carpal tunnel that can contribute to CTS include repetitive use, _________ arthritis, pregnancy, diabetes, trauma, tumor, hypothyroidism, and wrist sprain or fracture. Other etiologies include a congenital narrowing of the tunnel and vitamin B___ deficiency. A patient with CTS will initially present with ___________ changes and paresthesia along the median nerve distribution in the hand. It may also radiate into the upper extremity, shoulder, and ______. Symptoms include _______ pain, weakness of the hand, muscle _______, decreased grip strength, clumsiness, and decreased wrist mobility. Initially, muscle atrophy is often noted in the ______ ____________ ____________ muscle and progresses to the _______ muscles. Electromyography and electroneurographic studies can be used to diagnose a motor ______________ delay along the median nerve within carpal tunnel. __________ is sometimes used to identify inflammation of the median nerve, altered tendon or nerve positioning with the tunnel or thickening of the tendon __________. Provocation testing such as a positive ______________'s sign, a positive _________'s test, and a positive tethered median nerve stress test along with other symptoms will assist to confirm the diagnosis. Advanced CTS can present with muscle ____________ of the hand, radiating pain in the forearm and shoulder, and nerve damage with ______ and ______ loss. Unrelieved compression creates initial _______________ with some ______________ of axons. This results in eventual ______ and Wallerian degeneration within the nerve distribution. The patient may present with ape hand deformity caused by atrophy of the ___________ musculature and first ______ lumbricals. Research indicates that approximately ______% of cases include bilateral involvement. PT includes splinting, carpal mobilization, and gentle stretching. If conservative treatment fails the patient may require surgery to release the carpal ligament and decompress the median nerve. Post-surgical physical therapy intervention should include the use of moist head with electrical stimulation, iontophoresis, cryotherapy, gentle massage, desensitization of the scar, tendon gliding exercises, and active range of motion. A patient should initially avoid wrist ______ and a forceful ______. After four weeks, a patient can progress with active wrist ________, gentle stretching, putty exercises, light progressive resistive exercise, and continued modification of body mechanics. ___________ deviation against resistance should be avoided due to the tendency of irritation and inflammation. Conservative treatment should improve a patient's condition and decrease symptoms of CTS within ____ to ____ weeks. If conservative treatment fails and the patient requires surgical intervention, rehab may last _____ to _____ weeks. Compression in the tunnel of Guyon occurs with inflammation to the ________ nerve between the hook of _______ and the _____________. This condition occurs from tasks such as leaning during extended handwriting, leaning on bike handles while riding, repetitive gripping activities or trauma. The patient will present with paresthesias along the ulnar distribution, weakness and atrophy of the _______ musculature, decreased mobility of the ______________, and impaired grip strength.

transverse scaphoid trapezium hamate pisiform radiocarpal median pollicis 2 to 10 mmHg 30 mmHg RA B6 sensory neck night atrophy abductor pollicis brevis thenar conduction MRI sheath Tinel's Phalen's atrophy motor sensory neurapraxia demyelination axonotmesis thenar 2 50% flexion grasp flexion Radial 4-6 6-8 ulnar hamate pisiform hypothenar pisiform

Thoracic outlet syndrome Results from compression and damage to the brachial plexus nerve ________, __________________ vascular supply, and/or ____________ artery. Contributing factors in the development of the condition include the presence of a cervical rib, an abnormal first rib, postural deviations, hypertrophy or spasms of the _________ muscles, and an elongated cervical _____________ process. Females are at two to three times greater risk than males, with the most common age ranging from ____-____ years of age.

trunks subclavian axillary scalene transverse 30-40 years

Trigeminal Neuralgia Typically the result of abnormal pressure on or irritation of the trigeminal nerve. Common etiologies for abnormal pressure include __________ or a swollen blood __________. Irritation of the nerve is more commonly associated with conditions that cause demyelination such as _________ __________. In some cases, the continuous pulsations and consequent friction of a blood vessel in contact with the nerve can cause ________________ and subsequent symptoms over time. The trigeminal nerve is a mixed sensory and motor nerve that originates in the brainstem and branches into ____________, ______________, and ____________ nerves. Pressure or demyelination injury produces a chronic pain condition which may impact the entire nerve distribution depending on the specific location and severity of the pathology. The most common location of the injury is in the narrow space where the nerve exits the brainstem. Symptoms of trigeminal neuralgia are typically unilateral and may be either episodic or constant. Episodic symptoms most commonly present as a sudden onset of pain described as sharp, jolting, stabbing, or shock-like. Spasms or tics may also occur. Episodic symptoms may be triggered by touch or sound with attacks that often result from activities of daily living such as shaving, chewing, or oral care. Chronic symptoms are more commonly described as persistent aching or burning sensations which may be exacerbated by the same type of daily activities that trigger an episodic attack. Symptoms of either form can be progressive and in severe cases, may be debilitating. Trigeminal neuralgia is more common among women and individuals over the age of 50. Magnetic resonance ____________ utilizes a colored dye to visualize _________ flow near the brainstem and identify vessel pathology that may be causing compression of the trigeminal nerve.

tumor vessels multiple sclerosis demyelination ophthalmic mandibular maxillary angiography blood

Cauda Equina Syndrome Considered to be a peripheral nerve injury and results from damage and loss of function involving ______ or more nerves of the cauda equina. May result from compression on the cauda equina nerve roots, including spinal structure pathology, trauma, infectious conditions, tumor or iatrogenic factors. Is a self-limiting condition, however, the longer a patient is ___________ prior to intervention, the less likely the patient is to achieve a complete recovery.

two symptomatic

Anterior Cord Syndrome An incomplete spinal cord lesion in which the anterior ______-______ of the spinal cord is damaged. Occurs through a traumatic incident that causes compression or damage to the anterior spinal __________, most often associated with ________ or dislocation. Typically presents with complete loss of __________ function and loss of _________ and ___________ sensation bilaterally below the level of the lesion due to the damage to _______________ and ___________ tracts

two-thirds artery fracture motor pain and temperature corticospinal and spinothalamic

Trigeminal neuralgia Typically the result of abnormal pressure on or irritation of the trigeminal nerve. Symptoms are typically ____________ and may be either episodic or constant; sudden pain described as sharp, jolting, stabbing, or shock-like or persistent aching aching or burning sensations. Diagnostic testing is often inconclusive with a diagnosis typically made based on the patient's reported symptoms.

unilateral

Spinal Cord Injury Complete L3 Paraplegia Patients possess at least partial innervation of the gracilis, iliopsoas, quadratus lumborum, rectus femoris, and sartorius with full __________ extremity use. Additional findings that can exist include sexual dysfunction, a nonreflexive bladder, the need for a bowel program, urinary tract infections, muscle contractures, and pressure sores. Patients with L3 paraplegia should be able to live independently with education regarding management of their disability.

upper

Cerebral palsy Spastic cerebral palsy involves __________ motor neuron damage; athetoid cerebral palsy involves damage to the ___________ __________. Clinical presentation includes ___________ delays, abnormal muscle ___________ and motor ___________, reflex abnormalities, poor posutral control, and ___________ impairments. ____________ disability and epilepsy are present in 50-60% of children diagnosed with cerebral palsy.

upper basal ganglia motor tone control postural control balance

The brachial plexus innervates the muscles of the _________ extremity while the lower extremity is innervated by the _________ plexus and __________ plexus.

upper lumbar sacral

Amyotrophic Lateral Sclerosis A chronic degenerative disease that produces both ___________ and __________ motor neuron impairments. Demyelination, axonal swelling, and atrophy within the cerebral cortex, premotor areas, sensory cortex, and _______ cortex cause the symptoms of ALS. Rapid degeneration and demyelination occur in the giant ____________ cells of the cerebral cortex and affect areas of the _______________ tracts, cell bodies of the ____________ motor neurons in the _________ matter, ___________ horn cells, and areas within the precentral gyrus of the cortex. The rapid degeneration causes denervation of muscle _________, muscle atrophy, and weakness. The exact etiology of ALS is unknown (90% of all cases), however, there are multiple theories of causative factors that include genetic inheritance as an autosomal dominant trait, a slow acting virus, metabolic disturbances, and theories of toxicity of lead and aluminum. Familial ALS occurs in 5-10% of all cases. Risk for ALS is higher in men and usually occurs between 40 to 70 years of age. Early clinical presentation of ALS may include both ________ and ________ motor neuron involvement. Early lower motor neuron signs include asymmetric muscle weakness, cramping, and atrophy and wasting of muscles. The weakness spreads throughout the body over the course of the disease and generally follows a ____________ to _____________ path. Upper motor neuron symptoms occur due to the loss of inhibition of the muscle. Incoordination of movement, spasticity, clonus, and positive Babinski reflex are some of the indicators of upper motor neuron involvement. ___________ involvement is characterized by dysarthria, dysphagia, and emotional liability. Initially a person may have either upper or lower motor neuron involvement, but eventually both categories are affected. A patient will ALS will exhibit fatigue, oral motor impairment, fasciculations, spasticity, motor paralysis, and eventual _____________ paralysis. There are multiple tests used to assist with diagnosing ALS. ______________ assess fibrillation and muscle __________________. Muscle ____________ verifies _________ motor neuron involvement rather than ________ disease and a spinal tap may reveal a higher ________________ content in some patients with ALS. CT scan will appear normal until late in the disease process. Diagnosis relies heavily on symptoms that determine both upper and lower motor neuron involvement. A patient that presents with motor impairment without __________ impairment is a primary indicator of ALS. During the initial stages of ALS there are various effects on the body. Progression of the disease allows for significant deterioration within the brain and spinal cord and a patient may exhibit paralysis of ________ __________, ___________ impairment, contractures, decubiti, and breathing difficulty requiring ventilatory support. Throughout the course of ALS, however, ____________, ______ movement, and __________ and ________ function remain preserved. A low level of exercise program may be indicated as long as the patient does not exercise to fatigue and promote further __________. ALS is usually a rapid progressing neurological disease with an average course of ____ to ____ years. Research indicates that although there is no structured course of the disease process, if a patient is diagnosed before 50 years of age the disease is usually longer in course. Death usually occurs from _____________ failure. Muscular dystrophy is the term for a group of inherited disorders that are progressive and exhibit degeneration of muscles without __________ or neural impairment. Progressive weakness occurs to the muscle fibers secondary to the absence of __________ within the skeletal muscles. This group of disorders presents early in life and usually shortens life expectancy. Disuse atrophy, muscle deterioration, contractures, and cardiac and respiratory weakness are common characteristics of this disease process. A patient with MD usually dies from respiratory/cardiac complications secondary to the primary disease process.

upper and lower motor neuron impairments temporal pyramidal corticospinal lower, gray anterior fibers upper and lower distal to proximal Bulbar respiratory Electromyography fasciculations biopsy lower muscle protein sensory vocal cords swallowing sensory eye bowel and bladder weakness 2-5 years respiratory failures sensory dystrophin

Spinal Cord Injury - Complete C7 Tetraplegia The majority of traumatic spinal cord injuries result from compression, flexion or extension of the spine with or without rotation. Spinal cord injuries are classified as a concussion, contusion or laceration, and injury results in primary and secondary neural destruction. Traumatic injury to the spinal cord produces a physiological and biochemical chain of events that results in ____________ impairment and permanent tissue and nerve damage. A patient sustains primary damage to the spinal cord and surrounding tissues at the C7 level through disruption of the membrane, displacement or compression of the spinal cord, and subsequent hemorrhage and vascular damage. Secondary damage occurs beyond the level of injury due to biochemicals that are releases as a result of the initial damage. This process destroys adjacent cells and neural tracts due to the acute __________________ and can last for days or even weeks. After injury, C7 is the most ________ segment of the spinal cord that both the motor and sensory components remain ________. MVA, violence, and __________ are the top causes for traumatic spinal cord injury. Spinal ___________, which is the total depression of all nervous system function ________ the level of lesion, occurs immediately following injury and may last for ________. Presentation includes total flaccid paralysis and loss of all reflexes and sensation. Surgical intervention may be required after injury in order to stabilize the spinal cord though ____compression and ____________ at the site of the injury. A ____________ device is commonly used with __________ injuries to stabilize the spine. As spinal shock subsides, a patient will experience and increase in muscle ____________ below the level of lesion and neurologic ______________ reappear. Spasticity will evolve and may become problematic. Autonomic dysreflexia and loss of _________regulation are other impairments that occur secondary to autonomic nervous system dysfunction. A patient with C7 tetraplegia will also present with impaired _________ and ability to clear _____________, altered _____________ pattern, and poor endurance. The patient is at high risk for contractures and impaired skin integrity. _____ of the cervical spine observe the position and damage of the involved vertebrae. The results of imaging determine subsequent medical intervention including stabilization of the spine. A myelogram or tomogram may be useful to confirm the extent of surrounding damage at the level of the injury. The most common complications include ____________ _____________, pressure _________, spasticity, heterotopic ossification, and autonomic ____________. Autonomic dysreflexia is considered a medical ____________ and requires immediate attention to remove the noxious stimuli and lower the ___________ pressure or the patient will be at risk for sub___________ hemorrhage. Other findings that require medical management include sexual dysfunction, respiratory complications, and pain management (neurogenic, central cord, peripheral nerve or musculoskeletal pain). Once a patient is medically stable, inpatient rehab, which is typically _____ to _____ weeks, should initially focus on range of motion, positioning in bed, and respiratory management such as cough, clearance of secretions, postural drainage, and incentive spirometry. Typical outcomes at this level include independence with feeding, grooming, and dressing, self-range of motion, independent __________ wheelchair mobility, independent _________, and independent ________with an adapted automobile. Independent living with adaptive equipment is possible. At this time there is no cure for a complete spinal cord injury, therefore a patient with a complete C7 injury will not regain innervation below this level. The _____________, extensor ________ longus and brevis, extrinsic finger __________, and flexor carpi radialis will remain the lowest innervated muscles. There will be ongoing musculoskeletal and cardiopulmonary deficits that can increase the risk for other health issues. Brown-Sequard's syndrome is a condition that results from injury to one _______ of the spinal cord. Motor function, proprioception, and vibration are lost ___________ to the lesion and vibration, pain, and temperature are absent _____________ to the lesion.

vascular inflammation distal intact falls shock below days decompression fusion halo cervical tone reflexes thermoregulation cough and ability to clear secretions breathing X-rays orthostatic hypotension pressure sore autonomic dysreflexia emergency blood pressure subarachnoid hemorrhage 6 to 8 weeks manual wheelchair mobility transfers driving triceps pollicis extensors side ipsilateral contralateral

Each lobe of the brain has specific responsibilities Frontal: intellect, orientation, ______________ movement, _______'s area, _____________ functions Parietal: receives information associated with _______, kinesthesia, vibration Temporal: ___________ processing, __________'s area, production of meaning __________ Occipital: __________ processing, judgment of _____________, vision in three dimensions.

voluntary Broca's executive touch auditory Wernicke's speech visual distance

Post-polio syndrome 25-50% of patients with poliomyelitis will eventually develop post-polio syndrome Symptoms of post-polio syndrome include muscle __________, atrophy, fatigue, and sometimes muscular or joint pain Treatment is generally multidisciplinary and aimed at controlling symptoms and improving daily function.

weakness

Myasthenia Gravis An autoimmune disorder that affects the transmission of neuromuscular signals Primary feature is muscle __________ within the skeletal muscles, with other neurologic findings being _____________ (e.g. reflexes, sensation) Muscles affected commonly include the ___________ muscles and limb musculature (________ greater than distal)

weakness normal ocular proximal

Post-Polio Syndrome Poliomyelitis is a neurologic condition characterized by asymmetric __________ and/or paralysis caused by a ___________ infection. Vaccines for the virus were created in the 1950s resulting in eradication of the disease in developing countries. However, for patients who had poliomyelitis and recovered, new neuromuscular symptoms can appear years after their recovery. This new onset of weakness is termed post-polio syndrome. The original condition involved a __________ attack on the nervous system, specifically on the _________ horn cells within the spinal cord. With the death of anterior horn cells, the ___________ nerves degrade and the muscles experience ___________. Recovery of strength in these patients was thought to occur secondary to ______________ sprouting to help reinnervate denervated muscles (i.e. a single nerve innervates a ____________ proportion of muscle fibers). Though the collateral sprouting allows for a period of recovery, the increased demands placed on the remaining nerves leads to deterioration of these nerves over time, leading to a new onset of ____________. It is estimated that 25-50% of patients with poliomyelitis will eventually develop post-polio syndrome. It is though that patients who have a more serious initial onset of poliomyelitis (i.e. greater motor involvement) are more likely to develop post-polio syndrome. Women are also more likely to develop post-polio syndrome. The main symptoms of post-polio syndrome include muscle weakness, fatigue, atrophy, and sometimes muscular and joint _________. Weakness can also affect _______ musculature and result in difficulties with breathing and ____________. Post-polio syndrome tends to primarily affect the muscles that were affected during the initial poliomyelitis attack, though it can affect previously unaffected muscles. Pain and weakness generally increase with physical activity and with exposure to the ____________. With the onset of post-polio syndrome, weakness progresses slowly over the course of years and is interspersed with periods of ____________ where there is no progression of symptoms. The diagnosis of post-polio syndrome is a clinical diagnosis confirmed primarily through the exclusion of other similiar diseases. Because the diagnosis is made clinically, through a medical history and physical examination are very important. Intense exercise that leads to fatigue and exhaustion should be avoided since this can result in worsening of symptoms. Patients with post-polio syndrome should be taught __________ conservation techniques to allow for improved function. Training in the use of assistive devices or orthoses may also be necessary. Home care regimen should focus on aerobic exercises as well as strengthening exercises to help improve overall strength and endurance. Exercise is typically performed every other day to allow for adequate rest and recovery. Post-polio syndrome is generally not a life-threatening disease, though this may not be true for those patients who have ___________ involvement.

weakness viral viral anterior motor atrophy collateral larger weakness pain axial swallowing cold stability energy respiratory