Neuromuscular

what medications are used for acute vertigo (severe), addictions is possible, work by dulling the senses and diminishing CNS system (sedative), and should only be used for a few days -this medication is an antihistamine which is used most common for those w/ dizziness, not meant for chronic conditions, and can stunt their progression of improvement

--BENZODIASEPINES -diazepam (valium) -lorazepam (ativan): shorter half-life; more appropriate for attcks lasting less than 4 hours -meclizine (antivert)

-the brainstem houses CN's ___ - ____ and what are 2 roles of the brainstem -true or false; brain stem strokes are very common and there isn't much CN involvement w/ such strokes -what are common s/s of a brainstem (5) stroke?

--CN 3-12 -regulates vital cardiac and respiratory functions -all motor control for the body flows through brainstem -FALSE; not very common; CN involvement is much higher here -unstable vital signs -decreased consciousness -decreased ability chew and swallow -blurred vision -bilateral weakness, paralysis, numbness or loss of sensation

Match the levels of the GMFCS w/ the following definitions -sit w/ trunk support; w/c for most mobility; walk w/ AD short distances -walk w/ AD; stairs w/ rails/assist; w/c long distances -run, walk, jump, climb stairs w/o assistance or railing -walk w/o assist; assist walking in crowds or inclines; stairs w/ rails; minimal running, jumping, skipping ability -dependent for all positioning and mobility; powered w/c

-4 -3 -1 -2 -5

-rotation greater than _____* is indicative of uncompensated peripheral vestibular dysfunction for the Fukuda step test

-45* -DOES NOT LATERALIZE SIDE

-this type of disease involves loss of ant horn cells in SC and motor cranial nerve nuclei, demylination of corticospinal and corticobulbar tracts, denervation of muscle fibers, muscle atrophy and weakness -is this disease an UMN or LMN disorder -what are 4 RF

-ALS -Both -genetic, virus, toxicity of lead and aluminum, men>women

-tx for ALS is focused on treating sx; what are 2 common drugs and what is their focus -for PT, what type of exercise should be done -death from ALS is typically due to what -what are some signs and symptoms of muscle overwork for ALS(4)

-Ruluzole and Edaravone; decrease glutamate -low level exercise program and don't exercise to point of fatigue -respiratory failure -DOMS -heaviness in extremities -increased muscle fasciculations -prolonged SOB

match the following grades 1,2,3 to the definitions regarding severity of associated pathology w/ TBI's _____: damage to corpus callosum and brainstem white matter _____: microscopic changes noted in the white matter _____: apparent damage to corpus callosum ____ _____: bruising behind ears and result from a basilar skull fx ____ _____: bruising around eyes/face and could be a sign of a basilar skull fx

Grade 3 Grade 1 Grade 2 -battle sign -racoon eyes

-Acetylcholine, serotonin, norepinephrine, and dopamine are all neurotransmitters that get affected w/ aging, what might it look like when each one is affected? -what are 5 things that could lead to memory loss -what are 3 things that could cause dimentia like symptoms but wouldn't lead to a dx of dimentia

-Acetylcholine: memory loss -Serotonin: motor declines -Norepinepherine: diminished motor learning -Dopamine: executive functioning, gait, fine motor -vitamin B12 deficiency, chronic ETOH use, infection (UTI), emotional problems (depression, anxiety, stress), disease -UTI's, medication, metabolic changes (these can be reversible)

-this condition is seen w/ spina bifida; movement of cerebellum and brainstem caudally through the foramen magnum, very common in SB, and sx include apnea-bradycardia, swallowing difficulties, high-pitched cry, ataxia, b&d control issues, spasticity -what are 2 s/s of hydrocephalus and what are s/s of sunt failure -______ _____ when tissue attachments limit movement of SC w/in spinal column; sx include progressive loss of strength or sensation changes-gait impairments-decreased strength and endurance-loss of rom

-Arnold-Chiari Type 2 Malformation -cerebellar ataxia, motor learning deficits -Failure: enlarged head or bulging fontanelles, HA, fever and malaise, decreased activity level and personality changes, changes of appetite and weight loss, vomiting, change in vision, "sun setting" (downward deviation of eyes, incontinence -tethered cord

-what are the major differences of Canalithiasis and Cupulolithiasis and what is the goal of each?

-Canalithiasis: --otoconia become free floating w/ in SCC --latency lasting 3-5 sec and nystagmus and vertigo following latency for 5-45 sec --GOAL: removing of debris from canal -Cupulolithiasis: --otoconia become adherent to cupula of affected SCC, canal becomes gravity sensitive (which isn't normal function of SCC) -onset of vertigo and nystagmus not dependent on flow of fluid and long lasting sx that gradually decay over periods of several minutes --GOAL: dislodging of debris from cupula

-what is the cause of bilateral vestibular hypofunction, common s/s, and what doesn't it include)? -what are the exam findings w/ testing for bilateral vestibular disorders

-Cause: otoxic agents -S/S: oscillopsia, disequilibrium, imbalance, gait ataxia, possible hearing loss, photosensitivity -DON'T HAVE: nystagmus or vertigo +head thrust test bilaterally -Abnormal dynamic visual acuity test (can see fine when head is still and often can't read top line of snellen chart) +caloric testing bilaterally -Postural control loss w/ loss of vision and proprioception

-VOR cancellation is a bed side test of ________ function -which test is considered the crown jewel of VOR testing and is very specific for findings of vestibular loss. -what is considered a positive test for head shaking induced nystagmus -w/ the hyperventilation test, what does a resulting nystagmus imply

-Cerebellar 1) pt uses both hands together and goes w/ own thumb 2) PT places on hands on pt's head and pt maintains fixation on PT's nose and they move back and forth -physical exam; head thrust/head impulse test --eyes will travel with the thrust and then correct -more than 3 beats of post-head shaking nystagmus; unilateral vestibular dysfunction -vertical nystagmus=positive finding for CNS dysfunction -unilateral vestibular hypofunction -CN VII lesion -Cerebellar pontine angle tumor

-______ is a chronic or persistant change in mental processing caused by brain disease or injury that affects memory, thinking, language, judgement, or behavior -this condition has acute onest dementia which is almost always reversible, is acute confusion w/ fluctuation in consciousness and develops quickly -what are 2 good screening tools for mild cognitive impairments and what is the best -for the PT exam of pt's w/ cognitive dysfunction, why is the 6MWT good to use, what is considered the 6th vital sign, and what test correlates well w/ functional status?

-Dimentia -Delirium; agitate, aggressive, combative, don't know what's happening -MoCA: best -MMSE 1. connection between CVD and dementia 2. gait 3. grip strength

-what 2 areas of the brain are affected by ACA syndrome/stroke and what are some associated symptoms that affects these lobes -true or false; ACA syndrome is uncommon due to the redundancy of circulation from R and L system -would it be best to perform WB'ing through UE over a stability ball while performing prone hip extension or quadruped weight shifting forward and backward post ACA stroke?

-Frontal and Parietal -Contralateral LE motor and sensory more than UE -Bowel and bladder dys. -apathy/lack of spontaneity -neglect -aphasia -gait apraxia -perseveration -true -hip exercise; largest joint affected when compared to the knee

-Pt's who suffer from TBI's can develop what 5 things -_____ ______ is abnormal bone growth in non-skeletal tissues including muscle, tendon, or other soft tissue -what are s/s of this condition -what are some tx considerations of this condition

-HO -Contractures -Skin breakdowns -Seizures -DVT -Heterotopic Ossification -diminished joint mobility, decreased ROM, progressively painful joints, low grade fever, edema, warmth -ROM exercise: PROM, AAROM, AROM, gentle strengthening exercises but should not provoke pain and avoid passive stretching unless indicated

-_______ (______-______) syndrome: •Impacts one half of spinal cord; spares the other half and is typically caused by penetration wounds -what are the two common s/s -____ ____ ____ is rare and due to a compression injury. Sx can include loss of proprioception, 2 point discrimination, stereognosis and motor function is preserved

-Hemi-section (Brown-Sequard's Syndrome •Ipsilateral paralysis and sensory loss •Contralateral loss of pain and temperature sensation -posterior cord syndrome

-this disease leads to degeneration and atrophy of the BG and cerebral cortex, neurotransmitters no longer able to modulate movements and a decrease in GABA and acetylcholine -with this condition, what sx are seen initially and later stages -what are 5 areas of focus for tx in PT -is this disease fatal? if so w/in what time frame

-Huntington's disease -Initially: involuntary choreic movements, mild alteration in personality, grimacing, protrusion of tongue, ataxic gait w/ progression, slurred speech -Later: decrease in IQ, forgetfulness and poor planning and judgement, depression and suicidal attempts, dysphagia, dementia, incontinence, immobility and rigidity -maximize endurance, strength, balance, postural control, and functional mobility *coping strategies and family education w/ posture, seating, assistance w/ transfers -yes; 15-20 years

-what type of tx is not indicated for bilateral vestibular hypofunction and why? -what are 2 types of vestibular exercises used to tx bilateral vestibular hypofunction?

-habituation; vertigo and nystagmus are not present -Gaze stability training (VOR) -Postural stability training: standing on foam w/ eyes open, stand on level ground w/ eyes closed, tandem stance, narrow BOS

-post-polio syndrome is a viral infection resulting in ____ pathology that affects _____ horns -how long do pt's experience PPS after having polio originally -what are some typical s/s of PPS? -what is a PT precaution? -T/F: usually not life threatening unless respiratory system is involved, usually normal lifespan but sx can slowly progress over time

-LMN; anterior -decades after, avg of 25 yrs -slow and progressive weakness or fatigue>1yr -muscle atrophy -muscle and joint pain -breathing, speaking and swallowing issues -asym limb involvement -LLD and contractures -scoliosis and joint malalignment -don't overwork them (low resistance, low intensity strength training, isometrics, CV training) -true

-this type of stroke is the most common type, and affects the lateral surface of the frontal and parietal lobes-internal capsule-optic radiations-and temporal lobe (Wernickes) -what are some s/s of this stroke?

-MCA -contralateral weakness and sensory loss of face and UE w/ lesser involvement in LE -Wernicke's and Broca's aphasia -homonymous hemianopsia -apraxia -neglect -impaired spatial relations and body schema (point to knee when asked to point to hip)

-this unstable disorder has 2 or more episodes of spontaneous vertigo of at least 20-minutes-24 hours; has progressive hearing loss (tinnitus and imbalance as disease progresses), LOW frequency/ asymmetrical hearing loss, feeling of fullness in 1 ear and debilitating attacks? what is a unique event that occurs -this type of unstable vestibular disease is a tumor on the 8th CN, the origin is inf vestib nerve>sup vestib nerve, 3rd most common intracranial tumor; sx include: progressive sensorineural hearing loss-tinnitus and imbalance, vertiginous attacks are NOT common, can only be identified w/ MRI's AND; WHEN DO PEOPLE TYPICALLY FIND THIS OUT -what is the most common cause of superior canal dehiscence and what are 4 s/s?

-Meniere's Disease *Otolithic crisis events of Tumarkin: sudden drop attacks, no warning; NO VERTIGO-feel like they are being pushed -acoustic neuroma -when tumor grows large enough to compress the 7th CN nerve-face goes numb, cannot close eye -Cause: blow to back of head -S/S: sound sensitivity (internal and external; hear themselves walk and blink), hearing loss, pressure sensitivity (sneezing, coughing Valsalva, lifting, BM's), imbalance

-what are 3 disorders that are unilateral vestibular (UNSTABLE) and what is it

-Meniere's disease -acoustic neuroma (vestibular schwannoma) -superior canal dehiscence (SCD) -disorders of the vestibular system that have ongoing or fluctuating symptoms

-_____ _____ is an AI disorder that affects the site of the NMSK junction and motor endplate; antibodies prevent muscle contraction -what is the condition commonly confused with and why? -75% of people who have this have abnormalities of the _____ and name 4 other RF -what are some common s/s of this NMD and what is one unique thing about s/s

-Myasthenia Gravis (MG) -MS; frequent exacerbations w/ stress and overworking -thymus; women (20-30)>men (50-60), hyperthyroidism, diabetes, RA, Lupus -dysarthria -dysphasia -dysphonia -diplopia -daily fluctuations and extreme fatigue -PROXIMAL muscle weakness (rest quickly improves muscle function) -ptosis and facial weakness -NO SENSORY DEFICITS

-what are the most common s/s of MS seen early on -what are some common s/s of MS

-N/T, blurred vision and diplopia -sensory dysfunction (numbness and tingling) -pain: trigeminal neuritis, Lhermitte's sign -visual: optic neuritis, diplopia, nystagmus -weakness -clumsiness -ataxic movements -balance dysfunction -fatigue -emotional lability -depression, dementia, -spasticity: into PF position -tremor: postural and intension -sexual dysfunction -bowel and bladder problems -gait: staggering, uneven steps, uncoordinated, cross step

-dopaminergic drugs could cause what type of cognitive abnormality in pt's w/ PD -levadopatoxicity can cause what? -describe the action of levadopa/carbidopa and what is the most common brand name -name some side effects of levadopa/carbidopa

-OCD/impulse behaviors: binge eating, compulsive hoarding or shopping, hypersexuality, pathological gambling -confusion, hallucinations, delusions and psychosis -L-dopa converted to dopamine in brain to restore DA levels; Sinemet -orthostatic hypotension, dyskinesia/dystonia of the trunk, neck, head and limbs, hallucinations, sleepiness

-this stroke affects the occipital lobe, thalamus, temporal lobe, and cerebral peduncle/midbrain (lateral geniculate and CIII) -what are possible s/s of this stroke? -what are 2 main impairments and describe them?

-PCA syndrome -contralateral pain and temp sensory loss -contralateral hemiplegia -ataxia -athetosis or choreiform movement -anomia -memory loss -visual agnosia, agraphia -prosopagnosia (loss of facial recognition) -ipsilateral gaze -double vision, lack of accommodation 1. thalamic pain syndrome: abnormal sensation of pain, temp, touch, proprioception, perceived pain can be debilitating) 2. cortical blindness

-How is Lewy Body Dementia different than PD and what are sx of it -Onset of cognitive issues in pt's w/ LBD happen w/in ______ and don't often have a ____

-PD: cognitive deterioration characterized by Lewy bodies in the SN; develops late in PD -fluctuating cognitive function -memory impairments -visualspatial deficitis -hallucinations -sleep disorders -autonomic dysfunction -1 year, tremor

List common causes and s/s of peripheral vertigo and central vertigo

-Peripheral: --S/S: short duration, autonomic sx, pallor, sweating, nausea/vomiting, tinnitus, auditory fullness, mixed horizontal and torsional, unidirectional w/ gaze testing, better w/ visual fixation, significant vertigo --Cause: BBPV, Meniere's, infection, trauma/tumor, metabolic disorders, drunk -Central: S/S: less autonomic sx, loss of consciousness, neuro sx of diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria, vertical or torsional beating, direction change w/ gaze testing, worse or no change w/ visual fixation (better when removed), mild vertigo, sx may be chronic, beats toward direction they are looking (look R beat R, look L beat L)

-what are some s/s of a L hemispheric stroke (dominant)? -what are some s/s or a R hemispheric stroke (non-dominant)?

-R sided weakness and paralysis -decreased processing -increased frustration (affects positive emotions) -possible aphasia and dysphagia and motor apraxia -decreased discrimination between R and L -R hemianopsia -L sided weakness and paralysis -decreased attention span, awareness and judgment (consequences of actions) -emotional lability -impulsivity -memory deficits and perceptual memory of time and place -L inattention -decreased spatial orientation -lack of perception of self and environment

-_______ is hearing loss that is caused by a dysfunction in the inner ear, cochlea, or CN VIII. What are 2 major complaints? -_______ is hearing loss that occurs when the passage of sound is blocked in either the ear canal or middle ear. What are 2 major complaints?

-Sensorineural (ototoxicity, normal aging, TBI, loud noises or explosions, congenital dysfunction, acoustic neuroma, Meniere's) 1) soft sounds are difficult to hear, loud sounds muffled 2) high pitched frequency sounds inaudible -Conduction (ear wax, middle ear infection, abnormal bone growth in middle ear, abnormal growth of tissue in middle ear) 1) soft sounds are difficult to hear regardless of pitch 2) loud sounds may present muffled

-____ ____: developmental abnormality due to insufficient closure of neural tube by 28th day of gestation; occurs in low thoracic, lumbar or sacral regions and affects CNS, MSK, urinary system. Is this typically a UMN or LMN -look at different types in one note -what are some typical s/s of SB?

-Spina Bifida; LMN -motor and sensory loss below level of lesion, hydrocephalus, Arnold-Chiari Type 2 Malformation, osteoporosis, hip dysplasia, clubfoot, scoliosis, tethered cord, latex allergy, bowel and bladder dysfunction, skin break down, passive behaviors

-what typically causes compression of the trigeminal nerve w/ trigeminal neuralgia and what condition is it commonly associated w/? -TN can be _____ or _____ -Episodic sx's can be sudden pain (sharp, stabbing, jolting), spasms or tics which can be caused by what 4 things

-Tumor or blood vessel -Associated w/ demyelination (MS) -Women over 50 -unilateral or episodic -touch, sound, shaving, oral care

-what are common s/s of ALS? -Describe what LMN and UMN issues would be seen -what direction do sx progress? -what are 3 things that are preserved?

-UMN and LMN involvement -fatigue -oral motor impairment -DYSARTHRIA, dysphonia, DYSPHAGIA -motor paralysis -eventual respiratory paralysis -Lower: asymmetric muscle weakness, fasciculations, cramping, atrophy in hands -Upper: incoordination of movement, spasticity, clonus, positive Babinski -distal to proximal -Preserved: sensations, eye movement, bowel and bladder function

-this type of stroke affects the lateral aspect of the pons and midbrain, cerebellum, medulla, thalamus, occipital cortex -what are some common s/s

-Vertebral-basilar artery stroke -loss of consciousness -hemiplegia or tetraplegia -comatose, coma, vegetative state -inability to speak -locked in syndrome -vertigo -nystagmus -dysphagia -dysarthria -syncope -ataxia

-what type of syndrome can be caused from a posterior inferior cerebellar (PICA) artery stroke; this leads to a infarction of the ____ ____ -what are 4 areas of potential damage? -what are associated s/s?

-Wallenberg Syndrome (lateral medullary syndrome): -lateral medulla 1) CNIX: Glossopharyngeal: dysphagia 2) CNX: Vagus: dysphonia 3) cerebellum/peduncles: IPSILATERAL limb and gait ataxia 4) vestibular nuclei: vertigo, nystagmus, nausea -Ipsilateral facial pain and temp impairment from Trigeminal nerve involvement (CN V) -Ipsilateral ataxia --CONTRALATERAL pain and temp impairment of body -Miosis (excessive constriction of eye) -vertigo, nystagmus, nausea -dysphagia, dysphonia, diplopia

-Alzheimer's includes the deterioration of _______ transmission and development of what 2 things -true or false; people w/ AD typically die of aspiration pneumonia secondary to loss of swallowing late in the disease -what are 5 common RF of AD -when can AD be confirmed? -what are 5 tx strategies for AD

-acetylcholine; amyloid plaques and neurofibrillary tangles -true -increased age -genetic -female>men -race (African Americans, Hispanics) -aluminum in brain -until postmortem biopsy -meds to inhibit acetylcholinesterase -control behavior change -set up environment so pt has success -encourage daily tasks -empower, educate and monitor caregivers for burnout

-which structure of the semicircular canals contain sensory tissue for head movement, ARE THE ONLY SECTION THAT have hair cells, and detect angular accel of the head -what degree are the A and P canals and name the 3 pairs that all 6 work in

-ampullae -45* anteriorly and posteriorly in the sagittal plane -La and Rp -Ra and Lp -Rh and Lh when one canal is excitatory, the other is inhibited

-right hemiparesis is usually associated w/ ____ and left hemiparesis is usually associated w/ ____ -apraxia is more evident with ___ hemisphere damage and often in combination w/ _____ -what is one thing you want to promote for PT interventions post stroke? -what are 3 intervention ideas for hypertonicity -when considering functional task orientated training you want ______ before _____ and to ______ _______ patterns

-aphasia; neglect -left; aphasia -physical fitness; typically will have CV issues as well -eccentric strengthening of antagonists -preventative positioning -long, sustained stretches -stability before mobility; avoid compensatory patterns (raise bed for sit to stands)

-which syndrome (ACA, MCA, and PCA) is more involved in the arms than the legs, AND, which is more involving for vision

-arms than legs: MCA -vision: PCA

-what does Guillain-Barre Syndrome attack and what are 3 possible RF's -what are 3 typical S/S initially w/ GBS? -when do sx's peak (how long is progression), does it have sudden onset, and what are 3 other sx? -what is the main CN affected w/ GBS and what are 2 other ones -what is one thing you want to make sure of from a PT stand point w/ tx -t/f: recovery can take up to 2 years and majority experience full recovery -what is the order of joint return to function during recovery?

-autoantibodies attack myelin sheath of peripheral nerves -RF: AI response to previous respiratory infection, viral or bacterial infections, Epstein Barr syndrome -peaks w/in 2-4 weeks (SUDDEN ONSET) -distal bil muscle weakness (distal>proximal and LE>UE) -numbness/tingling (distal>proximal) -mild distal sensory impairments -areflexia/hyporeflexia -dysphagia and dysarthria -autonomic dysfunction *possible resp paralysis -CNVII, CNIX, CNX -limit overexertion and fatigue to avoid exacerbation of sx -true -proximal to distal

-for diagnosis of a stroke; a MRI would show a ______ and a CT scan would show a _____ Identify these 4 tests and measures for a stroke: _____: assessment of acute CVA (what is minor, moderate, severe, very severe) _____: assessment of mobility and ADL management _____ _____: assessment scale of physical and social disability or level of impairment ____-____: assessment of physical performance (motor, sensory, balance impairment, pain and ROM)

-blockage; leakage -NIH's --minor: 1-4 --moderate: 5-15 --severe: 16-20 --very severe: >20 scores: >15-->may require SNF Scores: 6-13-->D/C or IRF scores: <5-->D/C home -FIM's -Stroke impact scale -Fugl-Meyer

-difficulty w/ chewing, dysphagia, and dysphonia would be associated w/ disruption of what motor neuron type -fasciculations are associated w/ what motor neuron loss -which cranial nerves are involved in bulbar function (8) -vital capacity and maximal voluntary ventilation _______ over time; and residual volume ______; as a result what 2 things are decreased

-brain stem motor neurons (Bulbar) -LMN -3, 4, 5, 6, 7, 9, 10, 12 -declines; increases -maximal inspiratory pressure and maximal expiratory pressure

-what is preserved in this injury? -T/F: ACS is best if sx improvement w/in 24 hrs and has some level of recovery after 1-2 years, but ultimately this injury has high mortality and poor functional outcomes -Autonomic Dysreflexia occur w/ lesions at or above ___ -what are some causes of AD? -what are some S/S? -what should you do if AD is suspected?

-cauda equina syndrome -flaccidity, areflexia, bowel and bladder dysfunction, sexual dysfunction, saddle anesthesia, severe back pain -T6 -full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, extreme temp changes, tight clothing, ingrown nail -S/S: HTN, severe HA, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, vasodilation (flushing) above lesion -check catheter, sit pt up (don't lay down), check for other stimuli

-this type of posturing impairment involves extension of trunk and all extremities and is caused by brainstem damage below level of red nucleus and is also seen in pontine strokes -this type of posturing impairment involves trunk and LE extension and UE flexion

-decerebrate -decorticate

what are common s/s of a cerebellar stroke?

-difficulty learning new tasks -decreased balance and coordination -decreased ability for postural adjustment -ataxia (generally on 1 side) -tremor (postural or intention) -hypotonia -nausea -nystagmus

-what 2 forces can cause a MTBI (concussion) -_____ _____: direct lesion sustained at impact of brain under point of contact; first brain contact -______ ______: injury that results on opposite side of brain; lesion due to rebound effect; second brain contact what balance test was developed for concussions

-direct and indirect forces (primary injury) --direct: hit by football player --indirect: car accident and whiplash -coup injury -contra-coup injury -BESS TEST: 6 conditions tested barefoot, score of 0-60 (lower scores are better), and you count the number of errors

-what is the most common cause of Down syndrome and what is a major RF -what are some common s/s of DS? -what is a unique sx?

-extra copy of chromosome 21 -RF: increased maternal age (>35) -intellectual disability, hypotonia, joint and ligamentous hypermobility, flattened nasal bridge and narrow eyelids, small mouth, feeding impairments, flat feet, scoliosis, congenital heard disease, visual and hearing loss, enlarged tongue, developmental delay -Unique: Simian line (palmar crease)

-T/F: spinal muscular atrophy is the progressive degeneration of posterior horn cell -_____ _____ SMA (type _): occurs between birth and 2 months, motor degeneration progresses quicky and life expectancy <1 year -____ ____ SMA: (type _): presents after 6 months-1 year, slower progression, impairment is steady, child can survive into adulthood -_____ SMA (type _): later in childhood (4-17), survive into adulthood -what are 2 main signs and sx of SMA what 2 things are unaffected? -how doe pt's w/ SMA typically die?

-false: anterior -Acute infantile SMA (Type 1 Werdnig-Hoffmann disease) -chronic childhood SMA (type 2) -juvenile SMA (type 3) -progressive muscle weakness and atrophy, diminished or absent DTR -normal intelligence and intact sensation -end-stage respiratory compromise

-what is the most disabling symptom of MS -what type of symptom of MS worsens w/ increased activity -what is the mechanism of emotion/behavioral dysfunction in MS pt's -what can lead to cognitive issues and is very common in MS pt's -worsening of neurological symptoms when the body gets overheated and seen w/ MS

-fatigue -cognitive function -white matter dysfunction w/in frontotemporal area -UTI's -Uhthoff's sign

-what are 5 common s/s of Meningitis and what are 2 signs that you can use to identify it -what is a gold standard way to dx

-fever -HA -vomiting -stiff and painful neck -light sensitivity -Brudzinski's Sign: flexion of neck facilitates flexion of hip and knees -Kernig's sign: pain w/ hip flexion combined w/ knee extension -lumbar puncture

-what is the main focus for any stroke -what is the Cerebral Perfusion Pressure (CPP goal), and how can it be achieved -what level do you want to keep the ICP under and what is normal ranges -what is the critical time window for TPA (used for ischemic strokes)

-focus on reducing intracranial pressure (edema) while maintaining cerbral perfusion ->/=70, normal is 70-90mmHg; either raise MAP or lower ICP -cut off score: <20 -normal: 10-15 --within 3 (up to 4.5 hours) of onset

this OM is used for kids w/ CP, determined by child's usual performance in home, school, and community settings, 0-18 yo. what are the 5 levels -at what age does this most accurately predict adult motor function -by what age do people w/ CP stop seeing improvements -at what age should power mobility be considered for CP -ambulation usually starts by?

-gross motor functional classification system (GMFCS) --walking performance after 6 yo -1: walks w/out limitations -2: walks w/ limitations -3: walks using a hand-held mobility device -4: self-mobility w/ limitations; may use powered mobility -5: transported in manual w/chair -12 y/o -7-9 yrs -12 months -8

-tremors in patients w/ PD tend to start where -with rigidity; which type of muscles are affected, unilateral or bilateral, proximal or distal? -rigidity can be overturned w/ what -do you tend to see brady or akinesia first in PD patients -marked flexion of the trunk is what? -when do you tend to see freezing of gait in pt's w/ PD -another coordination deficit that pt's w/ PD can see is ______ which is secondary to bradykinesia

-hand or foot -postural, unilateral before bilateral, proximal then extremities -purposeful movements -bradykinesia -camptocormia -middle to late -dysdiadochokinesia

-this type of gait pattern has involved arm flex, adducted and IR, pelvis retraction, circumduction of limb, knee hyperextension, equinus foot position -in a hemiplegic gait, the UE has a _______ tone pattern, LE is mostly a _____ tone pattern -what is hypokinesia, bradykinesia, akinesia

-hemiplegic gait -flexion; extension -hypokinesia: shuffling gait, loss of rotation, reduced arm swings -bradykinesia: slowed gait speed -akinesia: freezing; trouble starting and stopping

-your pt. after suffering a TBI is experiencing rapid weight and muscle mass loss, fatigues more often and quicker; what could they be experiencing and what could this be due to -_____ evolves from hypermetabolism, exaggerated glucose use/breakdown of body proteins, leads to significant loss of skeletal muscle (including cardiac)

-hypermetabolism; corticosteroid use, increase epinepherine, NE, glucagon, cortisol, cytokines -hypercatabolism only seen in really sever TBI

-describe pathology process of MS -what are 2 hypothesized causes of MS -what is the most common type of MS -2 spatially and temporally separated clinical attack (6 months apart) and 2 objective lesions on MRI are what type of dx criteria for MS -what is the most suggestive way of dx MS and where are the lesions found

-immune attack>CNS activates T(B) cells>BBB>immune response>damage to myelin and axons -environmental: virus, measles, epstein-barr -genetic -relapsing-remitting: clearly defined relapses followed by remissions -definitive criteria -MRI; ventricles and corpus collosum; NOT SC

-which type of stroke is more common; ischemic or hemorrhagic and which one is a blockage and rupture -what are two types of ischemic strokes and describe them both along w/ how they present

-ischemic is more common -ischemic: blockage -hemorrhagic: rupture -Embolus: travels to cerebral arteries; presents often w/ a H/A and occurs rapidly -Thrombus: blockage from plaque build up; sx appear in minute or over several days during sleep or upon wakening

-what tx shouldn't be done in pt's w/ DS -what are some important tx considerations for pt's w/ DS -what is a good outcome measure to use?

-joint mobilizations -exercise and fitness to avoid obesity, stability and postural control, maximize respiratory function-developmental ability and avoid compensatory patterns, improve participation in life activities, prevent sedentary lifestyle and obesity, bone health (osteopenia and osteoporosis) -GMFM

-what are some causes of CP and what is the most common? -Acquired CP can be caused by what 4 things -what are the classifications of CP?

-lack of O2 during or before birth (most common), Rh incompatibility, multiple or premature births, breeched birth, dugs/alcohol/maternal malnutrition, prolonged labor, DM, hypothyroidism -meningitis, CVA, seizures, brain injury -spastic: hemiplegia, diplegia (mostly legs and a little bit arms), quadriplegia -dyskinetic: athetoid (lots of movements all the time w/ all limbs), dystonic (postured and really stiff all the time) -ataxia: very unstable all the time

-Central cord syndrome is the most common incomplete SC lesion, what does it damage and what is preserved -what is the most common MOI and 1 others -is UE or LE motor function more impaired? -list 5 other s/s -T/F: common for pt's to regain ability ambulate due to limited impact on LE function -what type of walker will need to be used due to poor hand function -what are 2 positive prognostic factors

-lateral columns and preserves gray matter -MOI: --Most common: cervical hyperextension from trauma --congenital or degenerative narrowing of spinal canal (stenosis) -UE (most severe in distal UE) -limited but variable sensory loss, autonomic dysreflexia, spasticity, minimal to no bowel and bladder impairments -true -podium walker -early hand function, little to no LE involvement

-the ____ _____ _____ contributes to righting and equillirbrium reactions and acts mainly on the ipsilateral limbs (mediates vestibulospinal reflex) , the _____ ______ ______ contributes to righting and equilibrium and acts to maintain to keep head upright and engage axial muscles (mediates VOR and VSR reflexes; coordinates eye and head movements that occur together) you need at least _____* rotation and ___-___* extension of the cervical spine in order to perform proper testing

-lateral vestibulospinal tract; medial vestibulospinal tract 45; 10-15

-what tx shouldn't be done w/ CP? -what are 4 types of common gait abnormalities seen w/ CP?

-long term stretching --true equinus: calf spasticity, PF throughout stance and hips/knees extended --tx: solid or hinged AFO -jump knee: like toe walking, spasticity of hamstrings and hip flexors and calf, --tx: solid or hinged AFO, BTX to calf and hamstrings -crouch gait: caused by lengthened heel cord, energy expensive gait patter --tx: GR AFO, btx to hamstrings and hip flexors -scissoring and spastic hemiplegic gait

-describe the pathophys of PD -what would happen if there are lesions on the substansia nigra? -in pd, the SN losese the ability to _____ ______ which causes _________ of the cholinergic system -excessive cholinergic activity can lead to ______ and ______ -loss of dopamine can lead to _____ or ______ -does dopamine cross the BBB?

-loss of dopamine-producing cells in the substantia nigra of midbrain; neurotransmitter loss in BG -decrease in dopa and increase in ACH/GABA>indirect loop dominates and substansia nigra loses ability to allow excitation from direct loop (no more modulation); PARKINSON'S DISEASE -produce dopamine; disinhibition -tremor and rigidity -akinesia or bradykinesia -no

-what are 6 type of tx for posterior canal bppv and which one tx's Canalithiasis or Cupulolithiasis -what are 3 tx for HC-BPPV and what is unique about one of them -how do you calculate how long you are in each position **Look at how to perform

-modified epley or Epley: CANAL -Brandt-Daroff Maneuver: CANAL -Modified semont or just semont (liberatory maneuver): CUP -somersault roll over -li maneuver -gans maneuver -BBQ roll -Gufoni Maneuver -Gufoni Maneuver for Ageotropic (cupulothiasis) nystagmus**** used to covert a cupulolithiasis to a canalithiasis of the HC -latency+nystagmus+30 seconds

-what are some clinical features of parkinson-plus syndromes that would differ from PD? -what are some signs that patients w/ PD would present w/?

-no response to PD drugs -bil/symmetrical signs at onset -lack of resting tremor -early onset dementia -visual signs -resting tremor in hands (pill-rolling) or feet that increase w stress and extension and disappears w/ movement or sleep -difficulty w/ rolling over, rising from bed, writing, bathing, dressing -progression leads to hypokinesia -akinesia -festinating/shuffling gait -bradykinesia -dysphagia -stooped posture -cogwheel or lead pipe rigidity -masked like facial expression

-what is an example of a one-off cue and rhythmic cue; both are external cues -what are 2 ways to help tx freezing of gait and improve attention and hypokinesia w/ PD pt's -what is one of the most effective forms of tx for PD gait and how do you set it up?

-one off: look at wall past doorway to decrease freezing, guiding laser -rhythmic: metronome -floor markers and U walker w/ laser -rhythmic auditory stimulation (metronome); set to 25% faster than pt's current gait speed

-when do the hair cells displace in the ampullae and what are they insensitive to -true or false: SCC's only sense angular accel through displacement of the cupula -this otolith organ works in the horizontal plane and horizontal linear accel (riding in a car), otoconia hair cells are on the floor, and active when laying down AND WHAT IS UNIQUE ABOUT IT -this otolith organ works in the vertical plane and vertical linear accel (riding and elevator), otoconia hair cells are on the medial wall -what is the difference between otoliths and hair cells and what do the otolith organs do

-only when you rotate (angular accel or decel); INSENSITIVE TO GRAVITY -true -utricle; *otochonia almost always come from here (the crystals that get displaced) -saccule -otoliths are gravity sensitive -GIVE YOU INFORMATION ABOUT WHERE YOUR HEAD'S AT IN SPACE IN REGARDS TO GRAVITY. DETECT LINEAR ACCELERATIONS OF YOUR HEAD

-what is myasthenia crisis? What can it lead to? what are some possible triggers? what are the s/s? -what are 3 exercise considerations for MG?

-period of fatigue and extreme muscle weakness which lead to resp failure -Possible triggers: fever, stress, resp infection, traumatic injury, certain meds -S/S: labored breathing, unusual unexplained weakness, throat closing -avoid strenuous exercise and stress -avoid prolonged exposure to hot or cold environments -cautiously allow and monitor eccentric based exercises

-in regards to spontaneous nystagmus, what would you see w/ peripheral damage and central damage -abnormal smooth pursuit is a common sign for _____ dysfunction and is has nothing to do w/ ______ function. And how is it always assessed -in regards to gazed evoked nystagmus; _____ dysfunction shows uni-directional nystagmus (not change in direction) and is more prominent w/ fixation removed; _____ dysfunction involves a directional change -abnormal saccades would be indicative of ____ involvement

-peripheral: --mixed horizontal/torsional --present w/ acute lesions, rarely chronic stable lesions --more promininet w/ fixation removed -central: --vertical OR torsional --acute or chronic --more prominent w/ fixation present -central; peripheral; horizontally -peripheral; central -central

-what is the most common cause of a hemorrhagic stroke? -what are 4 common s/s? and when does 50% of death happen? -this type of stroke is a blockage that resolves itself and recurrent ones will lead to strokes? where do most occur?

-poorly controlled/long term HTN -abrupt onset usually during day -severe HA -vomiting -HTN -within 48 hours -TIA's; carotid or vertebrobasilar arteries

-which direction would a patient push towards with pusher's syndrome and give and example -Pt's feel they are oriented upright when they are actually tilted ___* towards weak side -Damage to the _____ ____ nucleus of the thalamus typically causes this -what types of cues do pt's w/ Pusher's Syndrome respond better to and where would you want to place a wedge and why -what are some ways to help tx

-push toward the weak/involved side w/ their strong (unaffected UE) -Pt post R sided stroke pushes w/ R toward L -20* -ventral posterolateral nucleus of the Thalamus -visual environmental and body cues -place wedge under involved side to shorten trunk muscles -visual feedback (mirror) -provide visual vertical reference -work in more upright positions -don't push them in proper direction -allow pt to problem solve

-______ _____ _____ is characterized damage to medullary regions and LOC, impaired swallowing and facia/tracheal damage, and leads to acute respiratory distress syndrome (ARDS) -____ ____ _____ is inflammation of the lung lining, disruption of gas exchange, hypoxia, IS THE LEADING CAUSE OF DEATH IN POST-TBI PT'S, and is most commonly associated w/ other complications such as sepsis, renal or heart failure, HTN -______ ______ _____ _____ occurs when the natural acute response to trauma is ineffective in relieving system inflammation and sx include fever, hyperventilation, extreme elevation in WBC and what can this be if it occurs in multiple organs

-respiratory distress syndrome; intubation, CPAP, ventilator support (lung-protective ventilation) -acute respiratory distress sydrome (ARDS) -systemic inflammatory response syndrome (SRS) -multi-organ dysfunction syndrome (MODS); when in multiple organs

this type of syndrome is see in young people (</=23) and is seen when a second concussion is sustained when still symptomatic, has a mortality and morbidity rate of 50%, has rapid onset of cerebral swelling and brainstem failure (2-5 min) -when can you begin exertional interventions for concussions -at what point during exertional intervention do you have to stop, or go back down a stage

-second impact syndrome -when you have no symptoms at rest -0/10 symptoms for nausea, dizziness, HA, fogginess -if symptoms increase by more than 2 -2/10 > 5/10

-this type of MS is where the disease steadily worsens with or without notable relapses and remissions or plateaus; initially they have RRMS>then steady decline -this type of MS is slowly worsening function over time, no distinct relapse or remissions, tend to be in older individuals and don't have RRMS at first -this type of MS steadily worsens from the beginning w/ superimposed relapses followed by little or no recovery and can continue to worsen between relapses -which type of MS is most deadly and is a very rapid disease leading to death in 1-2 years

-secondary progressive -primary progressive -Progressive-relapsing -malignant

-which muscles are at most risk for contractures w/ CP? -what is a common injury that happens in kids w/ CP -what is a very good tx to do early on for CP -what are some non-muscular sx of CP?

-shoulder adductors -elbow, wrist, and finger flexors -hip flexors and adductors -knee flexors -ankle PF's -hip subluxation and dislocations -early WB'ing -seizures, hearing, vision, visual spatial and perceptual impairments, cognitive and behavioral issues, impaired speech, respiratory and sleep problems

-what are the primary impairments of Autism Spectrum Disorder? -when is ASD typically first present? -what are the typical s/s of ASD? -what is the main tx goal for ASD?

-social and communication deficits -around 2-3 -non-purposeful speech or absence of speech, diminished facial expression, inability to understand nonverbals, limited interest, lack of empathy, defensiveness or indifference towards sensory stimulation, perseverations, repetitive self-stimulating behaviors, low tone, clumsy -improve social communication and participation -decrease non-purposeful movements and vocalizations -sensory integration (deep pressure over light touch)

-These 2 are cerebellar degenerative disorders: --_____ ______ is genetic, slow progression and symptoms include progressive cerebellar presentation: ataxia, uncoordinated gait, dysarthria, disturbed eye movements, reduced bladder control, vision problems, memory and processing issues, loss of sensation in hands and feet, muscle stiffness and cramping --___________is chronic abuse and symptoms include peripheral neuropathy, cerebellar atrophy -this disorder is a low-lying cerebellar tonsils protrude thorough the foramen magnum; symptoms include: HA, imbalance, aural fullness, tinnitus, vertigo, gait ataxia, spastic quadriplegia, nystagmus (vertical beating down); rehab is not effective and surgery is used for decompression; 5mm displacement below foramen magnum is considered significant

-spino-cerebellar ataxia -EtOH -Arnold Chiari Malformation

-Anterior cord syndrome is an incomplete SC injury which involves damage to the ________ tract and ______ and _____ corticospinal -what is the typical MOI of anterior cord syndrome -what are 2 main s/s of this -what 2 things remain intact? -what is the px of this condition?

-spinothalamic tract (pain and temp -ant and post corticospinal tract (motor) -cervical flexion injuries 1) complete loss of motor function and pain and temp bilaterally 2) bowel and bladder and sexual dysfunction -Proprioception and vibration remain intact -PX: best if sx improve w/in 24 hours but typically high mortality and poor functional outcomes

-name the 3 cerebellar arteries and which one receives blood supply form the basilar or vertebral artery

-superior cerebellar artery: basilar -posterior inferior cerebellar artery: vertebral -anterior inferior cerebellar artery: basilar

-which test should we use to test for horizontal canal bppv and how is the nystagmus named -which way does the geotropic horizontal nystagmus w/ Canalithiasis beat and which way does the ageotropic horizontal nystagmus associated w/ Cupulolithiasis beat -_________: side of increased intensity=side of affected HC -_________: side of lesser intensity=side of affected HC

-supine roll test -named towards the fast phase (geotropicly or ageotropicly) -geotropic: fast phase towards the earth -ageotropic: fast phase away from the earth -geotropic -ageotropic

-Bell's Palsy leads to what and what CN is affected -what may BP be attributed to? -what are 4 s/s of BP -what is the px?

-temporary unilateral facial paralysis due to damage of facial nerve -secondary to viral infection (herpes, Epstein-barr, HIV) -asymmetrical facial appearance w/ "drooping" of eyelid and mouth -potential drooling -dryness of eyes -inability to close eyelid due to weakness -some resolve w/in 2 weeks w/out intervention, will recover w/in a few weeks or up to 6 months

-true or false; carbidopa is an inhibitor that prevents peripheral metabolism of the L-dopa; which allows therapeutic levels to enter brain w/out side effects -what is the primary effects of dopamine replacement therapy (levadopa/carbidopa)? -which drugs can help reduce tremors and is used in early stages -what type of diet can iterfere w/ L-dopa absorption -what usually causes death in pt's w/ PD

-true -reduce bradykinesia and rigidity -anticholinergic drugs; helps to restore balance of acetylcholine and dopamine -high-protein diets -pneumonia (the highest) or cardivoascular disease

-Habituation and Gaze stability training (VOR) are two types of tx for what? -what is the main goal of habituation? -what are the two types of VOR and how should you progress? --what some ways to make it harder

-unilateral vestibular loss -Goal: reduce pt's sx through neural adaptation, occurs by repeatedly provoking undesired response (3-5 reps, 2-3x/day) -VORx1: move head horizontal or vertically while maintaining focus on an object -VORx2: move head and target in opposing directions while maintaining gaze on target and target in focus -Progress from 1>2 -Harder: change background color, texture, pattern

-what are 3 disorders seen w/ unilateral vestibular disorders (FIXED), AND what are 5 common s/s -what would you find positive with their sx?

-vestibular neuritis, anterior vestibular artery ischemia, labyrinthitis -S/S: nausea/vomiting, nystagmus, vertigo, disequilibrium, postural instability + spontaneous nystagmus --increased w/ blocked fixation --presen up to 7 days post onest, decreasing and becoming negligible over time +gaze evoked nystagmus-lasts longer than spontaneous --increaed w/ blocked fixation +head thrust test +fukuda step test +caloric testing

-what is a common cause of VN and Labyrynthitis? -what are 4 signs and sx of vestibular neuritis, anterior vestibular artery ischemia, and labyrinthitis? -what does vestibular neuritis and vestibular artery ischemia have in common that labyrinthitis does not?

-viral or bacterial infection -S/S: spontaneous onset of vertigo (days in duration), imbalance, nausea, vomiting -VN and VAI: no auditory sx -Labyrinthitis: has auditory sx (tinnitus, hearing loss)

-generally, what is the most common CN symptom seen w/ brainstem strokes, what are 3 common CN nerve symptoms, and what symptom do you not typically see -______ nerve controls eyelid movement and ability to focus on an object; damage to this nerve displays as ____ __ ____ symptoms -what sign of a brainstem stroke is very key to a differential dx and explain it

-vision 1) upward drifting in affected eye (CN IV) 2) dilated pupil (CN III) 3) double vision (CN III, CN IV, CN VI) -typically don't see hearing issues -oculomotor; down 'n out (down and lateral) -"crossed signs" ("mixed signs") -ipsilateral motor and sensory CN AND contralateral hemianesthesia and hemiplegia

-_____ test is for unilateral hearing loss; _____ loss will cause the sound to be heard best in the abnormal ear and ______ loss will cause the sound to be heard best in the normal ear --Use 256Hz or 512 tuning fork, strike it and place on top of pt's head equidistant from pt's ears; ask which ear sound is heard louder _____ test is for air conduction vs. bone conduction; ____ loss= the bone conduction is heard longer than the air conduction sound and _____ loss=air conduction is heard longer than bone conduction and reports sound has stopped before tuning fork quits vibrating. ALSO what is considered normal --use 512Hz tuning fork, strike it and place on mastoid and have pt report when sound is no longer heard. Once pt can't hear, place fork 1-2cm away from auditory canal then have them report when they can't hear it

-weber; conductive; sensorineural -if only heard on one side; implies neural hearing loss (cochlea or 8th CN) -rhine; conductive; sensorineural -Normal: air conduction time is twice as long as bone conduction

what does codes 01-06 represent on the IRF-PAI

01: dependent: helper does all effort, pt does none, OR assistance of 2 or more helpers is required 02: substantial/maximal assist: helper does more than half of effort; lifts or hold trunk or limbs 03: partial/moderate assistance: helper does less than half of effort; lifts holds, or supports trunk or limbs 04: supervision or touching assistance: helper provides verbal cues or touching/steadying assistance as pt completes activity. assistance may be provided intermittently throughout 05: setup or clean up assistance 06: independent

-in terms of assist; what would 01-06 be

01: total assist 02: max assist 03: min and mod assist 04: CGA 05: stand by assist 06: mod I or I

-what 3 areas that could be damaged when the superior cerebellar artery is damaged in a cerebellar stroke and what are common symptoms of each

1) Cerebellum/peduncles: IPSILATERAL ataxia (mild trunk, severe limb and gait, vertigo/dizziness, nausea, vomiting, dysarthria, dysmetria, optokinetic nystagmus; MORE SEVERE ATAXIA HERE 2) medial lemniscus/spinal lemniscus (midbrain): CONTRALATERAL sensory loss (touch, pain, temp) 3) corticospinal fibers (pons): CONTRALATERAL paresis

which test for bppv tests for torsional up-beating nystagmus (posterior canal) and torsional down-beating nystagmus (anterior canal) which test for bppv tests for geotropic nystagmus (horizontal canal Canalithiasis) and ageotropic nystagmus (horizontal canal Cupulolithiasis) true or false; the more you do the tests for bppv, the more the nystagmus will go away

1) dix-hallpike test 2) roll test true

consider the following eye movements during testing for BPPV and what is the canal affected and name: 1) torsion up-beating nystagmus towards the side of head you are testing 2) horizontal geotropic (towards the ground) 3) horizontal ageotropic (away from the ground) 4) torsion down-beating towards the side you are testing

1) posterior canal bppv (Canalithiasis or Cupulolithiasis) 2) horizontal canal bppv (Canalithiasis) 3) horizontal canal bppv (Cupulolithiasis) 4) anterior canal (Canalithiasis or Cupulolithiasis)

-list the type of disorders seen w/ the type of nystagmus 1) pure horizontal 2) pure vertical 3) pure torsional 4) combination of torsional and directional

1) unilateral vestibular dysfunction 2) central dysfunction 3) central dysfunction 4) BPPV

-give the term to the following 3 cases: 1)I am spinning or the room is spinning 2)I can't get my eyes to pinpoint something 3)I'm fine but if someone walks in front of me, I get dizzy Fill in the blank: __________: resets the eyes during prolonged rotation and directs gaze towards the oncoming visual scene (also symptoms w/ dysfunction of the inner ear) ___________: maintains image of a small moving target on the fovea (center of the retina - region of highest visual acuity). ___________: rapid eye movement that brings the object of interest into the fovea.

1) vertigo 2) oscillopsia 3) visual vertigo/dizziness -Nystagmus (quick phase) -smooth pursuit -saccades

-list 4 types of therapy that have been shown to help w/ MS -what type of training is better for MS, continuous or intermittent?

1. external focus of attention: away from internal cues 2. aquatic therapy: done in cooler temps 3. BWS system therapy: less taxing 4. hippotherapy: horse therapy -intermittent: -rest at first signs of movement difficulty and/or subjective noting of fatigue -DO NOT wait until fatigue is obvious -vital signs can be taken but not always accurate

-what are 3 primative reflex signs due to frontal lobe dysfunction that can be seen in patients w/ PD -_____ decreased facial and eye movements, flat affect look -_____form of bradykinesia, small "cramped" handwriting -_____ slowness of mental activity; difficulty coming up w/ answer -_____ intense handling or sorting of objects

1. glabellar reflex: tap forehead and they don't stop blinking 2. palmomental reflex: stroking palm causes contraction in muscles in chin 3. applause sign: clap more than 3 times when told to clap only 3 times -hypomimia -micrographia -bradyphrenia -punding

-this condition is typically from a brachial plexus injury from birth w/ the most common muscles being affected by C5 and C6 (loss of RC, deltoid, brachialis, coracobrachialis, biceps). It can be cause by a breeched baby, prolonged labor, or difficult delivery. Common s/s include flaccid paralysis ("waiter's tip deformity"), loss of shoulder function, elbow flexion, loss of forearm supination, and hand positioned in pinch grip manner. What is this? -if conservative tx doesn't work in __-__ months, then surgery is considered and full AROM may not come back -__/10 recover w/ conservative tx and what is another PX fact

Erb's Palsy -3-4 months -9/10 -nerves grow 1in per month, may take years for nerve from C-spine to reach hand

this syndrome is attributed to damage of the posterior inferior cerebellar artery, and involves damage to the postganglionic sympathetic neuron damage, CN V-sensory portion, and the 2nd order spinothalamic neurons; what is the syndrome and what are the common symptoms associated with it

Horner's syndrome 1) postganglionic sympathetic neuron damage: IPSILATERAL ptosis, miosis, anhidrosis 2) CN V-sensory portion: IPSILATERAL facial sensory loss 3) 2nd order spinothalamic neurons: CONTRALATERAL loss of pain and temp in extremities

if the anterior inferior cerebellar artery is damaged; what is this syndrome called, where do you suspect to see damage (3 areas) and name the symptoms for each area of damage

lateral pontine syndrome 1) vestibular nuclei: vertigo, nystagmus, nausea, falling 2) cochlear nucleus: IPSILATERAL tinitus and deafness 3) trigeminal nucleus: IPSILATERAL sensory loss to face; ipsilateral paresis of muscles of masication (dysarthria, dysphagia)

this syndrome is associated w/ a basilar artery stroke and resultant ventral pons damage, it is characterized by quadriparesis and loss of bilateral V-XII CN function (except 8), horizontal gaze palsy, inability to speak or activate facial muscles, but the control of vertical eye movement-cognitive function-and hearing are maintained

locked in syndrome (brainstem stroke)