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195 Cards in this Set

  • Front
  • Back
Left brain
Language
sequence and perform movements,
produce written and spoken language,
analytic,
controlled
logical
rational
mathematical calculations
express positive emotions
process verbally coded information in an organized, logical and sequential manner
Right brain
Non-verbal processing
Holistic processing of information
Art
General concept comprehension
Hand-eye coordination
Spatial relationships
Kinesthetic awareness
Understand music
Understand nonverbal communication
Mathematical reasoning
Express negative emotions
Body image awareness
Barognosis
perceive the weight of different objects in the hand
Graphesthesia
identify a number or letter drawn on skin
Kinesthesia
direction and extent of movement of a joint or body part
Stereognosis
identify an object without sight - using the sense of touch
Allodynia
the sensation of pain in response to a stimulus that would not typically produce pain
Analgesia
absence of pain while remaining conscious
Anesthesia
absence of touch sensation
Causalgia
constant, relentless, burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury
Dysesthesia
distortion of any of the senses, particularly the sense of touch
Hyperpathia
extreme or exaggerated response to pain
Hypesthesia
diminished sensation of touch
Neuralgia
severe and multiple shock-like pains that radiate from a specific nerve distribution
Pullanesthesia
loss of vibration sensation
Chorea
form of hyperkinesia with brief, irregular contractions that are rapid, but not myoclonic
- related to damage to caudate nucleus
- Huntington's disease
Huntington's disease
Degeneration of basal ganglia (primarily the striatum)
Autosomal dominant
Enlarged ventricles
Extensive loss of quantity and activity of gamma-aminobutyric acid (GABA) and acetylcholine neurons
Symptoms include chorea, bradykinesia, and rigidity; affective dysfunction, and cognitive impairment; speech disorders; unintentional facial expressions, tounge protrusion, eyebrow elevation.
Eventually progresses to dementia, depression, dysphagia, incontinence, inability to ambulate/transfer, progression to rigidity
Average age of onset - 35-55 years
Fatal within 15-20 years of onset
Bradykinesia
Abnormal slowness of movement
Dystonia
sustained involuntary muscle contractions frequently causing twisting, abnormal postures, and repetitive movements
Caused by genetic, acquired, secondary to medication; Parkinson's, CP, encephalitis
Athetosis
Movement disorder with slow, twisting, writhing movements in a large amplitude
Primarily in face, tongue, trunk, and extremities
Brief - "merge" with chorea
Sustained - "merge" with dystonia
Common finding in several forms of CP secondary to basal ganglia pathology
Basal Ganglia
Gray matter masses located deep within the white matter of the cerebrum and include the caudate, putamen, globus pallidus, substantia nigra, & subthalamic nuclei.
Collectively responsible for voluntary movement, muscle tone, and control of motor responses.
Dysfunction - Parkinson's, Huntington's, Tourettes, ADD, OCD, addictions.
Agnosia
inability to interpret information
Agraphia
inability to write due to a lesion within the brain; typically found in combination with aphasia
Alexia
inability to read or comprehend written language secondary to a lesion within the dominant lobe of the brain
Anosognosia
The denial or unawareness of one's illness; often associated with unilateral neglect
Apraxia
inability to perform purposeful learned movements or activities even though there is no sensory or motor impairment that would hinder completion of the task
A disorder of motor planning
Constructional apraxia
Inability to reproduce geometric figures and designs. A person is often unable to visually analyze how to perform a task
Decerebrate rigidity
Extension of trunk and all extremities
Characteristic of corticospinal lesion at the level of the brainstem
Decorticate rigidity
Trunk and LE extension, UE flexion
Characteristic of corticospinal lesion at the level of the diencephalon
Corticospinal tract
Descending - pyramidal motor tract
Anterior - ipsilateral voluntary, discrete, and skilled movements
Lateral - contralateral voluntary fine movement
Damage to corticospinal tract results in positive Babinski, absent superficial abdominal reflexes & cremasteric reflex, and loss of fine motor or skilled voluntary movement
Cremasteric reflex
L1-L2
Scratch the skin of the upper medial thigh -> brisk and brief elevation of the testicle on the ipsilateral side
Diencephalon
Located beneath the cerebral hemispheres and contains the thalamus, hypothalamus, subthalamus, epithalamus.
Where the major motor and sensory tracts synapse. Acts as an interactive site between the CNS and endocrine system, as well as complimenting the limbic system.
Dysarthria
slurred and impaired speech due to a motor deficit of the tongue or other muscles essential for speech
Dysprosody
Impairment in the rhythm and inflection of speech
Emotional lability
characteristic of a R hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation
Fluent aphasia
characteristic of receptive aphasia (wernicke's)
A person with this aphasia speaks normally but uses random or invented words; leaves out key words; substitutes words or verb tenses, pronouns, or prepositions; and utters sentences that do not make sense
Includes Wernicke's Aphasia & Conduction Aphasia
Wernicke's Aphasia
Lesion - posterior region of superior temporal gyrus
Also known as "receptive aphasia"; a type of fluent aphasia
Comprehension (reading/auditory) is impaired
Good articulation, use of paraphasias
Impaired writing
Poor naming ability
Motor impairment not typical due to distance from Wernicke's area to the motor cortex
Broca's Aphasia
Non-fluent aphasia
"Expressive aphasia"
Most common form of aphasia
Frustration and language skill errors
Paraphasias
Production of unintended syllables, words, or phrases during the effort to speak
Most common in patients with fluent forms of aphasia
Conduction Aphasia
Lesion to supramarginal gyrus, arcuate fasciculus.
Severe impairment with repetition.
Intact fluency, good comprehension.
Speech interrupted by word-finding difficulties.
Reading in-tact; writing impaired.
Lesion to supramarginal gyrus, arcuate fasciculus.
Severe impairment with repetition.
Intact fluency, good comprehension.
Speech interrupted by word-finding difficulties.
Reading in-tact; writing impaired.
Global Aphasia
Non-fluent aphasia
Lesion to frontal, temporal, parietal lobes, Comprehension, naming, writing, repitition skills severely impaired.
May involuntarily verbalize, usually without correct context.
Nonverbal skills used for communication
Verbal apraxia
verbal expression is impaired secondary to deficits in motor planning
They are unable to initiate learned movements (articulation of speech) even though the understand the task
Non-fluent aphasia
Lesion varies based on type - typically frontal lobe of dominant hemisphere
Poor word output and dysprosodic speech (impaired rhythm and inflection).
Poor articulation and increased effort of speech.
Content is present, but impaired syntax
Examples - Broca's Aphasia, Global Aphasia, Verbal Apraxia, Dysarthria
Writing is also impaired.
Hemiparesis vs Hemiplegia
Paresis - weakness
Plegia - paralysis
Homonymous hemianopsia
loss of right or left half of field of vision in both eyes
Ideational apraxia
a condition in which an individual is unable to plan movement related to an object because he has lost the perception of the object's purpose.
loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or object
Ideomotor apraxia
a person plans a movement or task, but cannot volitionally perform it. Automatic movement may occur, however a person cannot impose additional movement on command
Neologism
Substitution within a word that is so severe that it makes the word unrecognizable.
Perseveration
repeatedly performing the same segment of a task or repeatedly saying the same word/phrase without purpose
Left sided neglect
most common neglect. Seen with lesion to right inferior parietal or superior temporal lobes
Frontal Lobe - Function
- Voluntary movement - primary motor cortex, precentral gyrus
- Intellect
- Orientation / concentration
- Broca's area - L hemisphere - speech
- Personality - temper, judgement, reasoning, behavior, self-awareness, executive functions
Frontal Lobe - Impairment
- Contralateral weakness
- Perseveration
- Inattention
- Personality changes, antisocial behavior
- Impaired concentration, apathy
- Broca's aphasia (expressive deficits)
- Delayed or poor initiation
- Emotional lability
Parietal Lobe - Function
-Sensation - touch, kinesthesia, vibration, temperature
- Provides meaning for objects
- Interprets language and words
- Spatial and visual perception
Parietal Lobe - Impairment
- Dominant hemisphere (typically L) - Agraphia, Alexia, Agnosia
- Non-dominant hemisphere (typically R) - Dressing apraxia, construcitonal apraxia, anosognosia
- Contralateral sensory deficits
- Impaired language comprehension
- Impaired taste
Temporal Lobe - Function
- Auditory processing and olfaction
- Wernicke's area - understand and produce meaningful speech
- Memory, understanding language
- Interpretation of other's emotions and reactions
Temporal Lobe - Impairment
- Learning deficits
- Wernicke's aphasia
- Antisocial, aggressive behaviors
- Difficulty with facial recognition
- Difficulty with memory, memory loss
- Inability to categorize objects
Occipital Lobe - Function
- Processing center for visual information - colors, lights, shapes, 3D
Occipital Lobe - Impairment
- Homonymous hemianopsia
- Impaired extraocular muscle movement and visual deficits
- Impaired color recognition
- Reading and writing impairment
- Cortical blindness with bilateral lobe involvement
(Damage to posterior cerebral artery)
Hippocampus
- Forms and stores new memories (declarative)
- Critical for learning language
TEMPORAL LOBE
Amygdala
- Emotional and social processing
- Involved with fear and pleasure responses, arousal, processing of emotional memories
TEMPORAL LOBE
Thalamus
- Processing/relay center
Hypothalamus
- Receives and integrates ANS information
- Regulates hormones
- Controls hunger, thirst, sexual behavior, and sleep
- Regulates body temperature and adrenal/pituitary glands
Subthalamus
(Subthalamic nucleus)
- Associates with basal ganglia and substantia nigra to regulate movements produced by skeletal muscles
Epithalamus
Primarily the pineal gland
- Secretes melatonin and is involved in circadian rhythms
- Some regulation of motor pathways and emotions (associated with limbic system and basal ganglia)
Midbrain
Relay area for information passing from the cerebrum, cerebellum, and spinal cord
- Also a reflex center for visual, auditory, and tactile responses
Cerebellum
- Responsible for fine-tuning movement
- Postuion re and balance
- Rapid alternating movements
- Damage to one side causes ipsilateral deficts - ataxia, nystagms, tremor, hypermetria, poor coordination, balance
Pons
Assits w regulating respiration rate and orientaiton of head in relation to visual and auditory stimuli
Medulla oblongata
ANS activity
HR
RR
Has reflex centers for vomiting, coughing, sneezing
Relays somatic sensory information from internal organs
Controls sleep and arousal
Brainstem
Includes midbrain, pons, and medulla.
Relay station
HR
RR
CN I
Olfactory
Sensory - Smell
Test - Identify familiar odors
CN II
Optic
Sensory - Sight
Test - Test visual fields
CN III
Oculomotor
Motor - Raise eyelid; superior, medial, and inferior recti; inferior oblique muscle of eyeball
- Autonomic - Smooth muscle of eyeball
Test - Upward, downward, medial gaze; reaction to light
CN IV
Trochlear
Motor - Superior oblique muscle
Test - Downward & Lateral gaze
CN V
Trigeminal
Sensory - Touch & pain of skin of face, mucous membranes of nose, sinuses, mouth, anterior tongue
Motor - Muscles of mastication
Test - Corneal reflex, face sensation, clench teeth, push down on chin to separate jaws
CN VI
Abducens
Motor - lateral rectus muscle
Test - lateral gaze
CN VII
Facial
Taste - anterior tongue
Motor - facial muscles
Autonomic - lacrimal, submandibular, and sublingual glands
Test - close eyes tight, smile and show teeth, whistle and puff cheeks, identify familiar tastes (sweet, sour)
CN VIII
Vestibulocochlear (acoustic nerve)
Sensory - Hearing, balance
Test - watch ticking, hearing tests; balance and coordination tests
CN IX
Glossopharyngeal
Sensory - Touch, pain - posterior tongue, pharynx; taste - posterior tongue
Motor - some muscles of pharynx; autonomic - parotid gland
Test- Gag reflex; ability to swallow
CN X
Vagus
Sensation - touch, pain - pharynx, larynx, bronchi. Taste - tongue, epiglottis
Motor - muscles of palate, pharynx, larynx; autonomic - thoracic and abdominal viscera
Test - gag reflex, ability to swallow, say "ahh"
CN XI
Spinal accessory
Motor - SCM and upper trap
Test - resisted shoulder shrug
CN XII
Hypoglossal
Motor - tongue protrusion
Dorsal scapular nerve
C5
Rhomboids
Levator scapulae
Long thoracic nerve
C5, 6, 7
Serratus anterior
Nerve to subclavius
C5, 6 - Superior trunk
Subclavius muscle depresses and protracts scapula; protects brachial plexus and clavicle
Suprascapular nerve
C5, 6 - Superior trunk
Infraspinatus
Supraspinatus
Lateral cord of brachial plexus
Lateral pectoral
Musculocutaneous
Lateral root of median
Medial cord of brachial plexus
Medial pectoral
Ulnar
Medial root of median
Posterior cord of brachial plexus
Upper subscapular
Thoracodorsal
Lower subscapular
Axillary
Radial
Lateral pectoral nerve
From lateral cord of plexus
Innervates clavicular head of pec major
Musculocutaneous nerve
From lateral cord of plexus
Biceps
Brachialis
Coracobrachialis
Median nerve
From lateral and medial cords of plexus
Innervates muscles in forearm, except FCU, and five muscles of the hand (thenar muscles plus 1st and 2nd lumbricals)
Medial pectoral nerve
From medial cord of plexus
Pec major - sternal portion
Pec minor
Ulnar neve
Medial cord
FCU
Flexor digitorum profundus
Most hand intrinsics
Upper subscapular nerve
Posterior cord
Subscap
Thoracodorsal nerve
Posterior cord
Lats
Lower subscapular nerve
Posterior cord
Subscap; teres major
Axillary nerve
Posterior cord
Deltoid; teres minor
Radial nerve
Posterior cord
Triceps
Aconeus
Supinator
Wrist extensors
Brachioradialis
Femoral nerve
Anterior compartment of thigh - L2-L4 - knee extension
Quadriceps
Iliacus
Sartorius
Pectineus
Obturator nerve
Medial compartment of thigh - Hip adductors
Adductor longus
Adductor brevis
Adductor magnus
Obturator externus
Gracilis
Inferior gluteal nerve
Glute max
Superior gluteal nerve
Hip abductors
Glute min, med
TFL
LE Innervation from sacral plexus
Hip ER muscles
Piriformis
Superior gemellus
Obturator internus
Inferior gemellus
Quadratus femoris
Sciatic nerve
Exits inferior to piriformis in greater sciatic foramen
Tibial division - Semitendinosus, semimembranosus, biceps femoris ( long head )
Common peroneal division - short head o biceps
Divides into common peroneal and tibial n for lower leg innervation
LE Innervation from lumbar plexus
Psoas major and minor
Quadratus lumborum
Deep peroneal nerve
Innervates lower leg anterior compartment
Tibialis anterior
Extensor digitorum longus
Extensor Hallucis longus
Peroneus tertius
Extensor digitorum brevis
Superficial peroneal nerve
Innervates lateral compartment of lower leg
Peroneus longus
Peroneus brevis
Medial plantar nerve
Abductor hallucis
Lumbrical I
Flexor digitorum brevis
Flexor hallucis brevis
Lateral plantar nerve
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
Dorsal interossei
Quadratus plantae
Adductor hallucis
Lumbrical II, III, IV
Plantar interossei
Tibial nerve
Posterior compartment of lower leg
Gastroc
Plantaris
Soleus
Popliteus
FDL
FHL
Posterior tib
Abdominal reflex
T8-L1
Stroke from each quadrant of abdomen toward umbilicus
Normal - contraction of abdominals and deviation of umbilicus toward stimulus
Corneal reflex
trigeminal and facial nerves
"blink" reflex
Have patient look up and away from you; Stroke the cornea with cotton
BOTH eyes blink
Gag reflex
glossopharyngeal and vagus nerves
Plantar reflex
L5-S1
Stroke foot - toes flex
Babinski reflex - abnormal; CNS lesion
Akinesia
inability to initiate movement; commonly seen in Parkinson's disease
Asthenia
generalized weakness, typically secondary to cerebellar pathology
Athetosis
involuntary movments combined with instability of posture. Peripheral movements occur without central stability
Clasp-knife response
Greater resistance at beginning of ROM of a hypertonic joint
Cogwheel rigidity
resistance to movement has a phasic quality to it; often seen with Parkinson's disease
Dysdiadochokinesia
inability to perform rapidly alternating movements
Dysmetria
inability to control range of a movement and force of muscular activity
Fasciculation
A muscular twitch caused by random discharge of a lower motor neuron and its muscle fibers; suggests a lower motor neuron disease
Can be benign
Hemiballism
involuntary and violent movement of a large body part
Lead pipe rigidity
uniform and constant resistance to ROM; often associated with lesion to basal ganglia
Brown-Sequard
Typically traumatic (Stab)
Spinal cord hemisection
IL paralysis and loss of vibratory/position (corticospinal tract and dorsal column)
CL loss of pain and temp (lateral spinothalamic tract)
Lateral spinothalamic tract
Pain & temp
CL loss
Anterior spinothalamic tract
Crude Touch
CL loss
Dorsal column
Deep touch, 2 point discrimination, vibration, joint position
IL Loss
Anterior cord syndrome
Caused by damage to anterior cord or anterior spinal artery, usually cervical flexion
Loss of motor function and pain/temp sense below lesion due to ventral corticospinal and spinothalamic tracts
Central cord syndrome
MOI usually cervical hyperextension
Damages spinothalamic tract, corticospinal tract, and dorsal colums
UE>LE deficits
Motor > sensory deficits
Posterior cord syndrome
MOI - compression of posterior spinal artery
Loss of pain perception, proprioception, two-point discrimination, and stereognosis.
Motor preserved
ASIA Impairment Scale
A = complete - no sensory or motor function preserved in sacral segments S4-S5
B = sensory incomplete - sensory but not motor function preserved below level to S4-S5
C = Motor incomplete - motor preserved below, key muscles below have less than 3/5
D = Motor incomplete - motor preserved below, key muscles greater than or = 3/5
E = normal
Neurapraxia
Mildest
All structures in tact
Recovery 4-6 weeks
Most common - pressure injury
Axonotmesis
Level II Injury
Reversible damage to axons - regen. 1mm per day
Sheath and supporting structures in tact
Wallerian degeneration may occur
Spontaneous recovery - spotty to no recovery
May require surgery
Traction compression, crush injuries
Neurotmesis
Most severe nerve injury
All structures damaged; nerve transection
Irreversable
Total loss of sensation and flaccid paralysis
Surgery may help - sensory returns before motor
Anterior horn cell pathology
- sensory component in tact
- motor weakness and atrophy
- fasciculations
- decreased DTR
Example: ALS, polio
Muscle pathology
- sensory component in tact
- motor weakness; fasciculations are rate
- normal or decreased DTR
Example: muscular dystrophy
Neuromuscular junction pathology
- sensory component in tact
- motor fatigue is greater than actual weakness
- normal DTR
Example: myasthenia gravis
Peripheral nerve pathology (mononeuropathy)
- sensory loss along nerve route
- motor weakness and atrophy in a peripheral distribution; may have fasciculations
Example: trauma
Peripheral polyneuropathy
- sensory impairments; "stocking glove" distribution
- motor weakness and atrophy; weaker distally than proximally; may have fasciculations
- decreased DTRs
Example: diabetic peripheral polyneuropathy; GBS
Spinal nerve root pathology
- dermatomal deficits
- motor weakness in an innervated pattern
- may have fasciculations
- decreased DTR
Example: disc herniation
Modified Ashworth Scale
For spasticity
0 - no increased muscle tone
1 - slight increase; "Catch" and release or minimal resistance at end-range
1+ - slight increased throughout whole ROM
2 - affected parts movable but with marked increase in tone
3 - passive movement difficult
4 - rigid
Antiepileptic Agents
Side effects - ataxia, skin issues, behavioral changes, GI, headache, blurred vision, weight gain
- Clonazepam, valproic acid, gabapentin (neurontin)
Antispasticity Agents
Promote relaxation by binding to CNS or directly to muscle cells
Side effects - drowsiness, confusion, headache, dizziness, generalized weakness, tolerance/dependence
Implications - sedation; loss of function due to decreased tone
- baclofen, valium (diazepam), dantrolene
Cholinergic Agents
Mimic acetylcholine and bind directly to cholinergic receptor
Indications - glaucoma, dementia (alzheimer's), post-op decreased GI motility, myasthenia gravis
Side effects - GI, impaired visual accomodation, bronchoconstriction, bradycardia, flushing, parasympathic effects
Implications - Decreased HR/dizziness
Dopamine Replacement Agents
Parkinson's
Side effects - arrhythmias (levodopa), GI, orthostatic hypotension, dyskinesias, mood and behavioral changes, tolerance
Implications - Schedule therapy 1 hr after levadopa. Monitor BP for hypotension
- levodopa, amantadine
Muscle Relaxing Agents
For muscle spasm
Side effects - sedation, drowsiness, dizziness, nausea, vomiting, headache, tolerance, dependence
- diazepam, flexeril, paraflex
Brunnstrom Stages of Recovery
1 - No movement
2 - Appearance of synergies, Beginning of spasticity.
3 - Synergies are performed voluntarily; spasticity increases
4 - Spasticity begins; movement patterns not dictated solely by synergies
5 - Further dec in spasticity; independence from synergy patterns
6 - Isolated joint movements performed with coordination
7 - Normal
UE Flexor Synergy Pattern
Scapular elevation and retraction
Shoulder abduction and ER
Elbow flexion
Forearm supination
Wrist flexion
Finger flexion with adduction
Thumb flexion with adduction
UE Extensor Synergy Pattern
Scapular depression and protraction
Shoulder IR and adduction
Elbow extension
Forearm pronation
Wrist extension
Finger flexion and adduction
Thumb flexion and adduction
LE Flexor Synergy Pattern
Hip abduction and ER
Knee flexion
Ankle DF / supination
Toe extension
LE Extensor Synergy Pattern
Hip extension, IR, and adduction
Knee extension
Ankle PF / inversion
Toe flexion and adduction
Concussion grades
1 - no LOC, some confusion. Symptoms resolve in 15'. Athlete should return after 1 week of rest
2 - Confusion lasting longer than 15'. Poor concentration, retrograde amnesia. CT scan indicated if symptoms worsen. Return to play deferred until 2 weeks of rest and no symptoms on exertion.
3 - Any LOC. Emergency transport required for full neurological evaluation. Hospitalization may be warranted. Rest for 1 symptom free month. May result in coma.
Ranchos Los Amigos Levels of Cognitive Functioning
I. No Response
II. Generalized Response - non-purposeful responses
III. Localized Response - specific but inconsistent responses. May follow simple commands such as squeeze hand, open eyes.
IV. Confused-Agitated - Heighted state of activity; bizarre and non-purposeful behavior. Limited attention
V. Confused-Inappropriate - able to respond to simple commands; verbalization inappropriate and confabulatory
VI. Confused-Appropriate - goal directed behavior present but dependent on external input or direction. Responses may be incorrect from memory deficit but are appropriate to the situation
VII. Automatic-Appropriate - Goes through daily routine but often robot-like
VIII. Purposeful-Appropriate - :)
Anterograde amnesia
inability to create new memory. Usually last to recovery after comatose state
Post-traumatic amnesia
time between injury and when the patient is able to recall recent events. Patient does not recall the injury of events up until this point of recovery. Post-traumatic amnesia is used as an indicator of the extent of damage.
Retrograde amnesia
Inability to remember events prior to injury.
Glascow Coma Scale
8 or less - severe injury
9-12 - moderate injury
13-15 - mild injury

EYE OPENING (E)
Spontaneous - 4
To speech - 3
To pain - 2
Nil - 1

BEST MOTOR RESPONSE (M)
Obeys commands - 6
Localizes pain - 5
Withdraws - 4
Abnormal flexion - 3
Extensor response - 2
Nil - 1

VERBAL RESPONSE (V)
Oriented - 5
Confused conversation - 4
Inappropriate words - 3
Incomprehensible words - 2
Nil - 1
Alzheimer's Disease
Progressive deterioration to cerebral cortex
Acetylcholine transmission decreased
Neurofibrillary tangles and amyloid plaques
Medication given to inhibit acetylcholinesterase
ALS
Chronic degenerative disease with UMN and LMN impairments
Weakness and muscle atrophy from anterior horn and cranial nerve cells (distal to proximal)
Typical onset - 40-70 years of age
Bell's palsy
Temporary Facial nerve paralysis
Commonly 15-45 years
GBS
Guillain-Barre Syndrome
Temporary acute polyneuropathy
Inflammation and demyelnation of peripheral nerves
Autoimmune?
Motor weakness distal to proximal, sensory impairment, respiratory paralysis. Often symmetrical
Recovery - 3-12 months up to 1 year
Multiple Sclerosis
Demyelination of brain and spinal cord
Symptoms vary based on location and extend of demyelination
Highest incidence - 20-35 years
15 years from onset - 50% require wheelchair
Most patients live for many years
Suicide not uncommon
Myasthenia Gravis
Autoimmune
Neuromuscular junction
Symptoms range from mild to severe
Extreme fatiguability and skeletal muscle weakness that can fluctuate within minutes or even an extended period.
Ocular muscles are typically affected first
Remissions and exacerbations
Myasthenia gravis "crisis" - medical emergency involving respiratory muscles
Parkinson's Disease
Degenerative disorder involving decreased DOPAMINE in corpus striatum and substantia nigra of basal ganglia
Parkinsonism - these symptoms as a secondary effect of another disease
Initially - resting tremor
Progresses to hypokinesia, difficulty starting and stopping movement (akinesia), festinating gait, cogwheel / lead pipe rigidity, "freezing", no facial expression
Medical tx - dopamine replacement therapy (Levodopa, sinemet, madopar)
Post-polio syndrome
Lower motor neuron pathology - anterior horn cell
Involves slow and progressive weakness, fatigue, muscle atrophy, pain and swallowing issues
ATNR
Birth to 6 months
Head position - turned to one side ->
Face side - extended
Scalp side - flexed
Spine curved toward face side
Birth to 6 months
Head position - turned to one side ->
Face side - extended
Scalp side - flexed
Spine curved toward face side
STNR
6-8 months
Head in flexion - arms flexed, legs extended
Head in extension - arms extended, legs flexed
6-8 months
Head in flexion - arms flexed, legs extended
Head in extension - arms extended, legs flexed
Tonic Labyrinthine Reflex
Birth to 6 months
Based on position of labyrinth in inner ear (head position)
In supine - body and extremities in extension
In prone - body and extremities in flexion
Galant reflex
2 months
Lateral flexion of trunk toward stimulus
2 months
Lateral flexion of trunk toward stimulus
Palmar grasp
4 months
Pressure on ulnar side of hand - flexion of fingers
Interferes with ability to voluntarily release objects
Plantar grasp
3 months
Pressure on base of toes -> toe flexion
Interferes with ability to stand with feet flat, balance, and wt shift
Rooting reflex
9 months
Touch on cheek - turn head to same side with mouth
open
Moro reflex
5 months
Head drops into extension suddenly -> arms abduct, fingers open, then cross into adduction; cry
5 months
Head drops into extension suddenly -> arms abduct, fingers open, then cross into adduction; cry
Startle reflex
5 months
Loud, sudden noise -> similar to Moro response but elbows remain flexed and hands closed
Positive support reflex
2 months
Weight placed on balls of feet when upright -> stiffening of leg and trunks into extension
Interferes with standing, walking, balance reactions, and can lead to PF contracture
2 months
Weight placed on balls of feet when upright -> stiffening of leg and trunks into extension
Interferes with standing, walking, balance reactions, and can lead to PF contracture
Walking (stepping) reflex
2 months
Support upright with soles of feet on firm surface
Reciprocal flexion/extension of legs
Interferes with development of smooth, coordinated reciprocal gait
2 months
Support upright with soles of feet on firm surface
Reciprocal flexion/extension of legs
Interferes with development of smooth, coordinated reciprocal gait
Newborn to 1 month
Physiological flexion
Lifts head briefly
Rolls partly to side from supine
Reflex standing/walking
Hands fisted
Jerky arm movements
Head lag on pull to sit
2-3 months
Lifts head 90 degrees briefly
Chest up in prone with some weight through forearms
ATNR influence is strong
Legs kick
Variable head lag in pull to sit
Rolls prone to supine
Needs full support to sit
Grasp is reflexive
4-5 months
Bears weight on extended forearms
Rolls from supine to SL
Feet to mouth
Sits alone for brief periods; head steady, turns head
Grasps and releases toys
6-7 months
Rolls from supine to prone
Lifts head in supine
Sits up without assistance
SIts independently
Voluntary release of objects to transfer between hands
May crawl backward
8-9 months
Does not tolerate supine
Pulls to stand on furniture
Crawls forward
Cruises (walks along furniture)
10-11 months
Stands without support briefly
Half-kneel
Creeps on hands and feet (bear walk)
Fine-pincer grasp developed
12-15 months
Walks without support-fast, backward, sideways
Throws ball in sitting
Creeps upstairs
16-24 months
Walking upstairs - both feet on each step
Picks up toy from floor
2 years
Rides tricycle
Walks backward and on tip-toe
Runs on toes
Descends stairs reciprically
Catches ball
3-4 years
Walks line, hops on one foot
Jumps
Runs fast and avoids obstacles
5-8 years
Skips
Hand preference is evident
Prints well, beginning to write cursive
Jump with rhythm (hopscotch)
Arthrogryposis Multiplex Congenita
non-progressive
thought to occur during first trimester in utero
involves fibrosis of muscles and structures within the joints
leads to contractures, dislocation of joints, and muscle atrophy
non-progressive
thought to occur during first trimester in utero
involves fibrosis of muscles and structures within the joints
leads to contractures, dislocation of joints, and muscle atrophy
Cerebral Palsy
"umbrella term" used to describe movement disorders due to brain damage in utero, birth, or infancy
Non-progressive
Can be caused by lack of oxygen, maternal infections, drug or alcohol abuse, prematurity, brain injury, etc
Spastic - lesion in ...
"umbrella term" used to describe movement disorders due to brain damage in utero, birth, or infancy
Non-progressive
Can be caused by lack of oxygen, maternal infections, drug or alcohol abuse, prematurity, brain injury, etc
Spastic - lesion in motor cortex of cerebrum; UMN
Athetoid - lesion of basal ganglia; cerebellum/cerebellar pathways
Down Syndrome
Trisomy 21 (genetic abnormality)
Risk increased with advanced maternal age
Mental retardation, hypotonia, joint hypermobility, etc
Trisomy 21 (genetic abnormality)
Risk increased with advanced maternal age
Mental retardation, hypotonia, joint hypermobility, etc
Duchenne Muscular Dystrophy
Progressive disorder caused by absence of a gene required to produce dystrophin and nebulin.  Cell membranes weaken, myofibrils are destroyed, and contractility is lost.
Fat and connective tissue eventually replaces musle, and death occurs from c...
Progressive disorder caused by absence of a gene required to produce dystrophin and nebulin. Cell membranes weaken, myofibrils are destroyed, and contractility is lost.
Fat and connective tissue eventually replaces musle, and death occurs from cardiopulmonary failure prior to age 25, usually in the teenage years.
X-linked recessive trait
Child's mother is a silent carrier and only male offspring will manifest the disease
Manifests between 2 and 5 years of age
Prader-Willi Syndrome
Genetic - partial deletion of chromosome 15
Small hands, feet, sex organs
Hypotonia, almond-shaped eyes, obesity, constant desire for food.
Coordination impairments, mental retardation
Genetic - partial deletion of chromosome 15
Small hands, feet, sex organs
Hypotonia, almond-shaped eyes, obesity, constant desire for food.
Coordination impairments, mental retardation
Spina Bifida
Developmental abnormality due to insufficient closure of neural tube by 28th day of gestation.
Affects CNS, musculoskeletal, and urinary systems
Spina Bifida Occulta - fusion of spinous process.  Spinal cord and meninges remain in tact
Spina Bi...
Developmental abnormality due to insufficient closure of neural tube by 28th day of gestation.
Affects CNS, musculoskeletal, and urinary systems
Spina Bifida Occulta - fusion of spinous process. Spinal cord and meninges remain in tact
Spina Bifida Cystica - cyst-like protrusion
- Meningocele - herniation of meninges and CSF into sac that protrudes through vertebral defect. Spinal cord remains in canal
- Myelomeningocele - severe. Spinal cord extending through defect in vertebrae. May or may not be covered by skin
PT involves family ed on positioning, handling, ROM/ther ex, skin care, adaptive equipment and orthotic/wheelchair prescription
Spinal Muscular Atrophy
Progressive degeneration of anterior horn cells
Autosomal recessive
Type 1 - occurs before month 2.  rapid motor degeneration, life expectancy less than 1 year
Type 2 - occurs 6 mon- 1 year with slower progression.  Child can survive to adultho...
Progressive degeneration of anterior horn cells
Autosomal recessive
Type 1 - occurs before month 2. rapid motor degeneration, life expectancy less than 1 year
Type 2 - occurs 6 mon- 1 year with slower progression. Child can survive to adulthood
Type 3 (Juvenile SMA) - Onset 4-17 years; typically survive into adulthood
Progressive muscle atrophy, diminished or absent DTR, normal intelligence, in-tact sensation, end-stage respiratory compromise