Neurological physiotherapy review - I

Question	Answer
Define Ideational Apraxia	Loss of ability to carry out familiar purposeful movmts in the absence of motor/sensory impairment; esp inability to use objects correctly
Define Ideomotor Apraxia	Inability to imitate a learned motor task or behavior
Function of Dorsal Column/Medial Lemniscus Tracts	Discriminatory touch, proprioception, vibration
Function of Spinothalamic Tracts	Pain & Temperature
Presentation of CVA involving Middle Cerebral Artery	Contra hemiplegia UE > LE, loss of sensation in arms/face, Homonymous hemianopsia common
Presentation of CVA involving Anterior Cerebral Artery	Contra hemiplegia LE > UE & sensory loss. Possible mental confusion, aphasia, contra neglect
Presentation of CVA involving Posterior Cerebral Artery	Persistent pain syndrome or contra pain/temp/sensory loss can occur. Homonymous hemianopsia, aphasia, thalamic pain syndrome
Presentation of CVA involving Vertebral-basilar Artery	Often Death due to edema assoc with infarct. If lesion effects Pons, quadriparesis/bulbar palsy or "locked in" state. Vertigo, coma, diplopia, nausea, dysphagia, ataxia
Stage I of Brunnstroms	Flaccidity
Stage II of Brunnstroms	Synergies begin to appear; Spasticity begins to develop, minimal voluntary mvmnt
Stage III of Brunnstroms	Spasticity increases & may become more severe, voluntary control of mvmnt synergy appears
Stage IV of Brunnstroms	Some movement ind of synergies, spasticity begins to decline
Stage V of Brunnstroms	If pt progresses, synergies no longer dominant, mvmnt becomes more complex
Stage VI of Brunnstroms	Spasticity gone; mvmnt & coordination approach normal
Typical UE Flexor Synergy	Scapular elevation & retraction, Shoulder ABD & ER, Elbow Flex, Forearm Supination, Wrist & finger Flex
Typical LE Flexor Synergy	Hip Flex, ABD, & ER, Knee Flex, Ankle DF with inversion, Great toe EXT, Other toes Flex
Typical UE Extensor Synergy	Scapular depression & protraction, Shoulder ADD & IR, Elbow Ext, Forearm Pronation, Wrist & Finger Flex
Typical LE Extensor Synergy	Hip Ext, ADD, & IR, Knee Ext, Ankle PF with inversion, Toe Flex & ADD
4 Ds of Brainstem Dysfunction	Dysphagia, Dysarthria, Diplopia, Dysmetria
Right Hemisphere Perceptual Problems Assoc with Stroke	Hand-eye coordination, irritability, short attention span, difficulty learning, can't retain info, poor judgement affecting safety, diminished body image w/ L side neglect, quick & impulsive, Problems with spacial relationships
Left Hemisphere Perceptual Problems Assoc with Stroke	Apraxia, difficulty starting & sequencing tasks, perseveration, easily frustrated, high levels of anxiety, inability to communicate verbally, cautious & slow
Presentation of in Brown-Sequard Syndrome	Hemi-section of SC; Ipsi weakness/motor paralysis, loss of proprio/vibration/2pt discrimination AND Contra loss of pain/temperature
Presentation of Cauda Equina Syndrome	sensory loss, paralysis, loss of bowel & bladder control
Define Broca's Aphasia	Non-fluent/Expressive Aphasia: speech is awkward, restricted, interrupted, produced with effort; due to lesion of 3rd frontal convolution of L hemisphere
Define Wernick'e Aphasia	Fluent/Receptive Aphasia; spontaneous speech is preserved, flows smoothly; auditory comprehension is impaired
Define Global Aphasia	severe, marked impairments in comprehension & production of language
Which type of tremor will be present with cerebellar disorders?	Intention Tremor
Which type of tremor will be present with Parkinson's Disease?	Resting Tremor
Define Apraxia	inability to perfomr mvmnts previously learned even though there is no loss of strength, coordination, sensation or comprehension
Describe Horner's Syndrome	ptosis of eyelid, constriction of pupil, sweating of ipsi face often accompanying stroke involving ant inf or post inf cerebellar arteries
What is the lowest score possible on the Glascow Coma Scale?	3
What is the highest score possible on the Glascow Coma Scale?	15
What are the five stages of grief, in order? (Kubbler-Ross Model)	Denial, Anger, Bargaining, Depression, & Acceptance
In custom wheelchair fitting, what are the guidelines for measuring for seat height/length?	Measurement taken from user's heel to popliteal fold; 2" added to allow clearance of foot rest
In custom wheelchair fitting, what are the guidelines for measuring seat depth?	Measurement taken from user's post buttock, along lateral thigh to popliteal fold; ~2" subtracting from measure to avoid pressure from edge of seat against popliteal space.
In custom wheelchair fitting, what are the guidelines for measuring seat width?	Measurement taken at widest space of user's buttock or thighs; 2" added to measure to provide space for bulky clothing, orthoses, or clearance of trochanters from arm rest side panel
In custom wheelchair fitting, what are the guidelines for measuring back height?	Measurement taken from seat of chair to floor of axilla with user's shoulder flexed to 90; 4" subtracted from measure to allow final back height to be below inf angle of scapula
In custom wheelchair fitting, what are the guidelines for measuring arm rest height?	Measurement taken from seat of chair to olecronan process with user's elbow flexed to 90; 1" added to this measure
Averages sizes for adult wheelchair	16" seat depth/ 18" seat width/ 20" seat height/length
ADA Required Maximum Width of Doorways	32"
ADA Required Maximum Depth of Doorways	24"
ADA Required Hallway Clearance	36"
ADA Required Height of Toilet	17-19" from floor to top of toilet
ADA Requirement for Accessibility of Hotel Rooms	~ 2% of total rooms must be accessible
ADA Requirement for Grab Bar Placement	33-36" from floor level
ADA Requirement for Bathroom Sink Height	Not less than 29"
Define Astereognosis	Inability to recognize objects by touch alone
Define Ataxia	Uncoordinated movement, especially gait
Define Athetosis	Slow, involuntary, worm-like, twisting motions. Usually seen in forms of cerebral palsy.
Define Causalgia	burning sensations, which are painful. Often associated with Complex Regional Pain Syndrome type I (aka Reflex Sympathetic Dystrophy)
Define Chorea	Rapid, involuntary jerky movements. Seen esp in Huntington's chorea
Define Decerebrate Rigidity	Contraction of the extensor muscles of the UEs with contraction of extensor muscles of the LEs
Define Decorticate Rigidity	Contraction of the flexor muscles of the UEs with contraction of the extensor muscles of the LEs
Define Delirium	Temporary confusion and loss of mental function. Often a result of illness, drug toxicity or lack of oxygen. Often reversible
Define Dysmetria	Inability to judge distances. Seen esp in cerebellar dysfunction
Define Reciprocal Inhibition	Inhibition of muscles antagonistic to those being facilitated. Essential for coordinated movement.
Define Somatagnosia	A lack of awareness of the relationship of one's own body parts or body parts of others.
Damage to the Optic Nerve will cause...	Blindness in one eye (monocular)
Damage to the optic chiasm will cause...	Bitemporal Hemianopsia; a visual deficit on the outside halves of both eyes
Damage to the contralateral optic tract will cause...	Homonymous Hemianopsia; a visual deficit of either the right or left halves of both eyes
Facilitation or Inhibition: Quick Stretch	Facilitation
Facilitation or Inhibition: Joint Approximation	Facilitation
Facilitation or Inhibition: Prolonged static muscle stretch	Inhibition
Facilitation or inhibition: Tapping of muscle belly or tendon	Facilitation
Facilitation or Inhibition: Neutral Warmth	Inhibition
Facilitation or Inhibition: Prolonged Icing	Inhibition
Most appropriate communication for Receptive Aphasia	Use word repetition and manual cues to assist in communicating desired actions during rehab (Wernicke's)
Most appropriate communication for Expressive Aphasia	Phrase questions for simple "yes" or "no" responses to avoid confusion & frustration. (Broca's)
Most appropriate communication for Global Aphasia	Use symbolic gestures to reduce chance of overestimating patient's ability to understand speech
Spinothalamic Tracts carry...	Ascending tracts that carry conscious pain, temperature, crude touch, and pressure.
Spinocerebellar Tracts carry...	Ascending tracts that carry unconscious proprioception to cerebellum which is responsible for coordination.
Dorsal column/Medial Lemniscus pathways carry...	Ascending tracts that carry discriminative touch and proprioception.
Corticospinal Tracts carry...	Descending tracts originating in cerebral cortex and responsible for voluntary motor control.