Neurological physiotherapy review -II

Question	Answer
Precentral Gyrus	Part of the frontal lobe. Primary MOTOR cortex for voluntary muscle activation.
Prefrontal Cortex	Controls emotions and judgment.
Broca's Area	Controls motor aspects of speech
Postcentral Gyrus	Part of the parietal lobe. Primary SENSORY cortex for the integration of sensations.
Primary (and Associative) Auditory Cortex	Part of the temporal lobe. Receives & processes auditory stimuli.
Wernicke's Area	For language comprehension.
Primary Visual Cortex	Part of occipital lobe. Receives & processes visual stimuli
Insula	Within the lateral sulcus, for visceral functions.
Limbic System	Consists of limbic lobe, hippocampus, hypothalamus, amygdaloid, and anterior nucleus of thalamus. For feeding, aggression, emotions, endocrine aspects of sexual response.
Basal Ganglia	Forms associated motor system. Occulomotor, skeletomotor, and limbic circuits.
Occulomotor Circuit (cuadate loop)	Functions with saccadic eye movements.
Skeletomotor Circuit (putamen loop)	Controls amplitude & velocity of movement, reinforces a selected pattern while suppressing conflicting patterns; preparation/anticipation for movement.
Limbic Circuit	Organizes behaviours, executive functions, problem solving, motivation and procedural learning.
Thalamus (Diencephalon)	Sensory nuclei to relay information to cerebral cortex. Motor nuclei relays motor information from cerebellum & globus pallidus to precentral motor cortex. Other nuclei also assist in integration of visceral & somatic functions.
Subthalamus	Control of several functional pathways for sensory, motor, and reticular formation.
Hypothalamus	Controls functions of ANS & body homeostasis (temp, eating, water balance, pituitary).
Dorsal Column/Medial Lemniscal	Afferents for proprioception, vibration, tactile discrimination. Fasciculus cuneatus (UE) & Fasciculus gracilis (LE). Tract crosses in the medulla going to thalamus.
Spinothalamic Tracts	Afferents for pain & temp, and gross touch. Tracts ascend 1or2 segments in Lissauer's tract then cross.
Spinocerebellar Tracts	Convey proprioception info from muscle spindles, GTO's, touch, and pressure receptors to cerebellum for control of voluntary movement. Dorsal tract ascends ipsilaterally to ICP. Ventral tract ascends to contra/ipsilateral SCP's.
Spinoreticular Tracts	Convey deep & chronic pain to reticular formation of the brainstem via diffuse polysynaptic pathways.
Plexuses	Cervical (C1-C4), Brachial (C5-T1), Lumbar (T12-L4), Sacral (L4-S3)
Levels of Consciousness (arousal)	Alertness, Lethargy, Obtundation, Stupor, Coma
Glasgow Coma Scale	3 elements (EMV): eye movement, motor response, verbal response. Mild brain injury (13-15), Moderate (9-12), Severe (3-8).
Mini-Mental Status Exam	For cognitive dysfunction. Max score of 30. Mild impairment (21-24), Moderate (16-20), Severe (15 and below).
Rancho Los Amigos Levels of Cognitive Function (LOCF)	Assesses cognitive recovery from TBI. 8 levels: no response (I), decreased response (II, III), confused (IV, V, VI), appropriate (VII, VIII).
Weber's Test	Strike tuning fork & place handle on middle of forehead. Examine for hearing perceived in middle of head or one ear only.
Rinne Test	For air vs. bone conduction. Strike tuning fork & place on mastoid process, then place near external ear canal to check hearing acuity.
Cheyne-Stokes Respiration	Period of apnea lasting 10-60 seconds followed by gradually increasing depth & frequency of respiration.
Tests for Meningeal Irritation	Neck mobility, Kernig's sign, Brudzinski's sign.
Modified Ashworth Scale	6 grades of spasticity. No increase in tone(0). Resistance @ end ROM (1). Resistance through < half ROM (1+). Resistance through most ROM, part still easily moved (2). PROM difficult (3). Rigidity (4).
Common Reflexes	Jaw (CN V), biceps (C5-C6), triceps (C7-C8), brachioradialis (C5-C6), hamstrings (L5-S3), quads (L2-L4), achilles (S1-S2), plantar (S1-S2).
Strength Duration Curve	Strength (intensity) on Y axis, duration (time) on X axis.
Rheobase	Intensity of current to produce a visible twitch.
Chronaxie	Duration of a stimulus twice rheobase that will elicit a muscle twitch. Chronaxie of an intact nerve & innervated muscle is much lower than that of a denervated muscle.
Middle Cerebral Artery (MCA) Syndrome	MCA supplies lateral cortex, BG, and internal capsule. Occlusions produce contralateral sensory loss and hemiparesis with UE more involved than LE. Maybe also Broca's aphasia.
Anterior Cerebral Artery (ACA) Syndrome	The ACA supplies the medial cortex. Occlusions produce contralateral sensory loss and hemiparesis with the LE more involved than UE.
Posterior Cerebral Artery (PCA) Syndrome	Occlusions may cause contralateral homonymous hemianopsia, contralateral sensory loss, involuntary movements and more.
Fugl-Meyer Assessment of Physical Performance	Scoring of movements 0(can't perform),1,2(fully performed). Includes subtests of UE, LE, balance, sensation, ROM, and pain.
Motor Assessment Scale	Measures functional capabilities using eight categories and provides criteria for scoring performance.
Guidelines to promote learning in patients with LEFT hemisphere lesions	1) develop appropriate communication base (words, gestures, pantomime; assess level of understanding) 2) give frequent feedback & support 3) do not UNDERESTIMATE ability to learn
Guidelines to promote learning in patients with RIGHT hemisphere lesions	1) use verbal cues (demonstrations or gestures may be confusing) 2) give frequent feedback & focus on slowing down/controlling movement 3) focus on safety 4) avoid cluttered spaces 5) do not OVERESTIMATE ability to learn
Recovery Stages from Diffuse Axonal Brain Injury	Coma (1), unresponsive vigilance/vegetative (2), mute responsiveness/minimally (3), confusional (4), emerging independance (5), intellectual/social competence (6)
PT for Ranchos Levels of Cognitive Function (levels I-III): decreased response	Maintain skin integrity, respiratory status, PROM & contracture prevention, etc. Provide sensory stimulation. Position upright to promote arousal & proper body alignment.
PT for Ranchos Levels of Cognitive Function (levels IV-VI): mid-level recovery	Prevent overstimulation, provide structure/consistency (schedule, logs, etc.). Task specific training. Simplify complexities, offer options. Provide assitance. Emphasize safety & behavioral managemnet. Model calm, focused behavior.
PT for Ranchos Levels of Cognitive Function (levels VII-VIII): high-level recovery	Promote independence, assist in re-integration, improve postural control & balance, encourage active lifestyle & improved cardiovascular endurance.
ASIA Impairment Scale: A	Complete, no motor or sensory function below the level.
ASIA Impairment Scale: B	Incomplete: sensory but not motor function preserved below the level.
ASIA Impairment Scale: C	Incomplete: motor function is preserved below the level & most key muscles have muscle grade <3.
ASIA Impairment Scale: D	Incomplete: motor function is preserved below the level & most key muscles have muscle grade >3 (or equal to).
ASIA Impairment Scale: E	Normal: motor & sensory function is normal
Wheelchair prescription for patients with high cervical lesions (C1-C4)	Pts require electric w/c with tilt in space or recline seating, microswitch or puff-and-sip controls. (portable respirator may also be attached).
Wheelchair prescription for patients WITH cervical lesions, shoulder function & elbow flexion (C5)	can use a manual w/c with propulsion aids (projections, etc.) independently for short distances on smooth, flat surfaces. May choose electric w/c for distances & energy conservation.
Wheelchair prescription for patients WITH cervical lesions, radial wrist extensors (C6)	Independent with manual w/c with friction surface hand rims.
Wheelchair prescription for patients WITH cervical lesions, triceps (C7)	Same as C6 but with greater propulsion.
Wheelchair prescription for patients WITH hand function (C8-T1 and below)	Manual w/c with standard hand rims.
Categories of Multiple Sclerosis	Relapsing-remitting, primary progressive, secondary progressive, progressive-relapsing.
Hoehn & Yahr Stages of Parkinson's: Stage I	Minimal or absent disability with unilateral symptoms
Hoehn & Yahr Stages of Parkinson's: Stage II	Minimal bilateral or midline involvement, no balance involvement
Hoehn & Yahr Stages of Parkinson's: Stage III	Impaired balance, some restrictions in activity
Hoehn & Yahr Stages of Parkinson's: Stage IV	All symptoms present and severe; stands and walks only with assistance
Hoehn & Yahr Stages of Parkinson's: Stage V	Confinement to bed or wheelchair
Wallerian degeneration	Degeneration of the axon and myelin sheath distal to the site of injury
Neurapraxia (Class 1)	Injury to a nerve that causes transient loss of function (conduction block ischemia, compression injury, etc.). Nerve dysfunction may be rapidly reversed or last a few weeks.
Axonotmesis (Class 2)	Injury to the nerve interrupting the axon, causing loss of function and Wallerian degeneration. No disruption to the endoneurium, so regeneration is possibe. (crush injury).
Neurotomesis (Class 3)	Cutting of the nerve with complete severance of all structures & complete loss of function. Regeneration unlikely without surgery (terminal ends can't meet).
Bulbar Palsy	Weakness or paralysis of the muscles innervated by motor nuclei of lower brainstem, affecting the muscles of the face, tongue, larynx and pharynx.
Guillain-Barre syndrome	Acute ascending polyneuropathy: polyneuritis with progressive muscular weakness that develops rapidly, but is recoverable in 6-24 months
Amyotrophic Lateral Sclerosis (ALS)	Degeneration of anterior horn cells and corticobulbar & corticospinal tracts. Typically death in 2-5 years.