NM 3
most common canal affected by BPPV
posterior
TUG
10 ft <10 sec - independent 10-20 sec - increased fall risk >30 sec - high fall risk
PET for neurological dysfunction
2 and 3D pictures of brain activity
ankle vs hip strategy
ankle - distal to proximal hip - proximal to distal
myasthenia gravis
autoimmune disease at NM junction antibodies block receptors that are needed for acetylcholine uptake, which prevents muscle contraction
tics
sudden, brief, repetitive coordinated movements at irregular intervals Tourette's
etiology of GBS
thought to be autoimmune after previous infection (Epstein-Barr)
examples of anti-spasticity agents
baclofen, diazepam, dantrolene, tizanidine
akinesia
inability to start movement, PD
cog wheel vs lead pipe
lead pipe - constant resistance throughout range cog wheel - catching throughout resistance, phasic
global aphasia
lesion - frontal, temporal, parietal lobes comprehension severely impaired impaired naming, writing, reptition may involuntarily verbalize may use non-verbal skills for communication
conduction aphasia
lesion to supramarginal gyrus, arcuate fasciculus severe impairment with repetition intact fluency and comprehension issues with word finding reading intact, writing impaired
central vertigo
less ANS sx loss of consciousness diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria
Modified Ashworth 0
no increase in muscle tone
verbal apraxia
non-dysarthria and non-aphasic impairment of speech verbal expression impaired bc of motor planning can't initiate learned movement (speech production) even tho they understand the task L frontal lobe lesion
central vestibular lesion
nystagmus - bidirectional or unidirectional no inhibition with fixation mild vertigo may be chronic etiology - demyelination, vascular lesion, cancer / tumor
peripheral vestibular lesion
nystagmus - unidirectional (fast is opposite to lesion) visual fixation will inhibit nystagmus and vertigo significant vertigo can be recurrent and long lasting etiology - Meniere's, vascular disorders, trauma, toxicity, inner ear infection
testing for BPPV
Dix Hallpike
functional reach test
3 trials, take the average
PD etiology
50-79 uo genetics CO toxicity vascular impairment
Fregly-Graybiel Ataxia Test Battery
8 conditions, measuring time spent in test position and number of steps pt takes without falling 5 trials, items based on pass / fail
CTS tissue pressure
> 30 mmHg, normal is 2-10
anterior horn pathology
ALS sensory intact motor weakness / atrophy fasciculations decreased DTR
types of non-fluent aphasia
Broca's, global
what pathologies can cause irreversible dementia
HD, MS, Alzheimer's tuberculosis, AIDS
tx for ALS
Riluzole
vestibulo-ocular retraining
VOR, VSR oculomotor exercises balance and gait exercises habituation training
types of fluent aphasia
Wernicke's, conduction
Guillain-Barre
acute polyneuropathy temporal inflammation and demyelination of PNS, potentially axonal degeneration autoantibodies
Modified Ashworth 4
affected part is rigid
ALS
amyotrophic lateral sclerosis chronic degeneration of UMN and LMN loss of anterior horn cells in spinal cord demyelination of corticospinal and corticobulbar tracts denervation of muscle fibers, muscle atrophy, weakness
EMG for neurological dysfunction
assesses nerve and muscle dysfunction, spinal cord disease records electrical activity from brain / spinal cord to peripheral nerve root can rule out muscle / nerve pathology, denervated muscle, LMN injury
MG etiology
associated with enlarged thymus, diabetes, RA< lupus
S&S of ALS
asymmetrical muscle weakness, fasciculation, cramping, atrophy of hands (weakness goes distal to proximal) incoordination of movement, spasticity, clonus, (+) Babinski fatigue, oral motor impairment, motor paralysis, eventually respiratory paralysis
HD etiology
autosomal dominent 35-55 yo
spinal / lumbar puncture
below L1-L2 for CSF sample commonly done at L3-L4
examples of cholinergic agents
bethanechol, pilocarpine, donepezil, edrophonium, neostigmine, tacrine
prodromal period / aura
can be a period of mild sx before seizure occurs
epilepsy
chronic condition with temporary dysfunction of brain that results in hypersynchronous electrical discharge of cortical neurons
S&S of HD
cognitive impairment and decline chorea personality changes ataxia
etiology of cerebellar disorders
congenital malformations hereditary ataxia - Friedrich's (autosomal recessive) spinocerebellar ataxia (autosomal dominant) acquired ataxia (systemic)
Modified Ashworth 3
considerable increase in tone, passive movement is difficult
MG tx
crisis = emergency, may need ventilator drug therapy, immunosuppressive PT wants to optimize breathing, energy conservation long-term corticosteroid use
PT implications for cholinergic agents
decreased HR, dizziness
Huntington's
degeneration and atrophy of BG deficient neurotransmitters unable to modulate movement
MS
demyelination of white matter sx vary depending on location subsequent plaque development - failure of impulse transmission eventually 20-35 yo
cerebral angiography
determines blockages in arteries of brain can diagnose CVA, brain tumor, aneurysm, vascular malformation
examples of muscle relaxant agents
diazepam, cyclobenzaprine, chlorzoxazone
peripheral vertigo
episodic, short duration ANS sx swelling, N/V fullness in ears tinnitus
discography for neurological dysfunction
evaluates integrity and pathology of spinal disc
S&S of MG
extreme fatiguability skeletal muscle weakness the can fluctuate within minutes or over time (ocular muscles first) - proximal then distal hot and cold can exacerbate sx dysphagia, dysarthria, CN weakness ptosis, diplopia risk of osteoporosis
gaze-evoked nystagmus
eyes shift from primary position to alternate position caused by inability to stabilize gaze indicative of central lesion
S&S of Bell's palsy
facial drooping, dryness of eyes, inability to close eyes
Romberg test
feet together EO and EC sharpened Romberg - tandem (non-dominant in front) EO and EC
PPS S&S
focal, asymmetrical motor impairments (slow and progressive) fatigue, muscle atrophy pain, swallowing difficulty
dopamine replacement agents
for PD side effects - arrhythmias, orthostatic hypotension, dyskinesia, mood/behavior changes
anti-spasticity agents
for increased tone / spasticity side effects - drowsiness, generalized muscle weakness, hepatotoxicity, tolerance / dependence
muscle relaxant agents
for muscle spasm side effects - sedation, drowsiness, tolerance / dependence
anti-epileptic agents
for seizure activity side effects - ataxia, behavior changes, blurred vision
non-fluent aphasia - area of leson
frontal lobe, Broca's area
Tinetti
gait and balance components < 19 - high fall risk
etiology of MS
genetics viral infection environment
etiology of ALS
genetics virus metabolic disturbances lead / aluminum toxicity 40-70 yo
myelography for neurological dysfunction
high risk for headache following spinal tap can rule out pathologies to subarachnoid space, SCI, herniated discs, fx, spinal tumors
tx for GBS
hospitalization immunosuppressive meds
chorea
hyperkinesia, brief, irregular, rapid contractions damage to caudate nucleus (HD) ballism - choleric jerks, flailing of limbs (subthalamic nuclei damage)
spontaneous nystagmus
imbalance of vestibular signals to oculomotor neurons that causes a constant drift in one direction that is countered by a quick one in the opposite direction usually after acute vestibular lesion lasts ~ 24 hours
clonus
indicative of UMN involuntary alternating spasmodic contraction precipitated by quick stretch reflex
S&S of Alzheimer's
initial - difficulty with new learning subtle changes in memory / concentration progression - loss of orientation difficulty word finding depression poor judgment rigidity, bradykinesia shuffling gait can't do self-care skills end-stage - severe intellectual and physical destruction incontinence functional dependence inability to speak
hemiballism
involuntary, violent movement of large body part
Dix Hallpike test
long sitting and head rotated 45 degrees rapidly move to supine with head still rotated, then extended 30 degrees off table hold head and observe for nystagmus
etiology of Alzheimer's
lower levels of neurotransmitters higher levels of aluminum in brain issue genetics autoimmune disease abnormal processing of amyloid virus
suspensatory strategy
lowers COG crouch / squat when you need mobility and stability
EEG for neurological dysfunction
measures electrical activity of the brain baseline, then with stimuli can rule out seizure disorders, brain death, brain tumors, alcoholism, etc
tx for Alzheimer's
meds - alleviate cognitive sx, control behavior change - however, they can have significant side effects PT - maximize function, caregiver education
cholinergic agents
mimic ACH and bind to receptors to activate and create response at cellular level for glaucoma, dementia, post-op decrease in GI mobility, myasthenia gravis side effects - impaired visual accommodation, bronchoconstriction, bradycardia, flushing
Modified Ashworth 2
more marked increase in tone thru most of ROM, still easily moved
S&S of GBS
moto weakness, distal to proximal (distal, symmetrical) sensory impairment (mild, distal) respiratory paralysis disability peaks 2-4 weeks absence of DTR inability to speak / swallow
dysarthris
motor speech disorder MN lesion slurred speech
asthenia
muscle weakness associated with cerebellar disease
muscle PNS pathology
muscular dystrophy motor weakness sensation intact decreased DTR
fasciculation
muscular twitch caused by random discharge of LMN
NM junction pathology
myasthenia gravis motor fatigue > weakness sensation intact normal DTR
when to take Levadopa for max benefit with PT
one hour before
peripheral vs central nystagmus
peripheral - peripheral lesion, inhibited with fixation on an object central - central lesion, not inhibited with fixation
characteristics associated with aphasia that have poor prognosis
perseveration of speech severe auditory comprehension impairments unreliable yes / no use of empty speech without recognition of impairments
Alzheimer's
progressive neurodegenerative disorder deterioration and irreversible damage in cerebral cortex and subcortical areas of brain development of amyloid plaques and neurofibrillary tangles
evoked potentials for neurological dysfunction
records time for an impulse to reach the brain external stimuli used to evoke electrical potentials within the brain can rule out MS, brain tumor, acoustic neuroma, SCI
BPPV
repeated episodes of vertigo that occur when head position changes lasts a few seconds first noted when recumbent nystagmus present
clasp-knife response
resistance during ROM of a hypertonic joint resistance greatest at initiation of range then lessens throughout
tremors
resting - may or may not go away with movement, can increase with stress (PD) postural - with voluntary contraction to maintain posture intention - absent at rest, start with movement (cerebellum, MS)
examples of anti-epileptic drugs
secobarbital, clonazepam, valproic acid, phenytoin, carbamazepine, methsuximide, gabapentin
vertigo
sense of movement and rotation of self or environment sensation of spinning usually can be peripheral or central in origin
Modified Ashworth 1
slight increase in tone catch and release or min resistance at end-range
Modified Ashworth 1+
slight increase in tone catch then min resistance thru reminder of range
athetosis
slow, twisting, writhing movements large amplitude face, tongue, trunk, extremities common with CP
dystonia
sustained muscle contractions that causes twisting, abnormal postures, repetitive movements in PD, CP, encephalitis
PPS tx
sx management
fluent aphasia - area of lesion
temporal lobe, Wernicke's area, parietal lobe
Bell's palsy
temporary unilateral facial paralysis bc of trauma with demyelination / axonal degeneration of facial nerve 15-45 yo
what is a seizure
transient event that is a sx of interrupted brain functioning hallmark sign of epilepsy
VOR
vestibulo-ocular reflex, allows for head / eye movement coordination supports gaze stabilization thru eye movement that centers movements of the head maintains stable image on retina during movement
VSR
vestibulo-spinal reflex stabilizes body and controls movement while head is moving coordinates trunk
etiology of Bell's palsy
viral infection (herpes)
post-polio syndrome
viral infection resulting in neuropathy, anterior horn cells
S&S of MS
visual disturbances ataxia balance dysfunction fatigue sensory changes weakness