1
Q
level of consciousness: alert
A
- awake and attentive to normal levels of stimulation
- interactions with therapist are normal and appropriate
2
Q
level of consciousness: lethargic
A
- appears drowsy and may fall asleep if not stimulated
- interactions may get diverted
- may have difficulty in focusing or maintaining attention
3
Q
level of consciousness: obtunded
A
- difficult to arouse from somnolent state and is frequently confused when awake
- repeated stimulation is required to maintain consciousness
- interactions with therapist may be unproductive
4
Q
level of consciousness: stupor (semi-coma)
A
- responds only to strong, generally noxious stimuli and returns to the unconscious state
when stimulation is stopped - when aroused, unable to interact with therapist
5
Q
level of consciousness: coma (deep-coma)
A
- cannot be aroused by any type of stimulation
- reflex motor responses may or may not be seen
6
Q
somatosensory pathways
A
- peripheral receptors are stimulated
- info transmitted along afferent nerves to spinal cord
- within spinal cord, messages ascend either:
- posterior column- light touch, pain + temp
- spinothalamic tract - crude touch, pain + temp
- light touch, pain + temp
- spinothalamic contralateral within SC
posterior columns cross at medulla - continue to ascend to thalamus, synapse + project info to somatosensory cortex where info is processed
7
Q
purpose of somatosensory testing
A
- type of injury
- extent of injury
- disease process
8
Q
guillain-barre syndrome
A
- nonprogressive autoimmune
- causes demyelination of axons in PNS
- slows or blocks neural conduction along motor + sensory pathways
9
Q
analgesia
A
complete loss of pain sensitivity
10
Q
astereognosis
A
inability to recognize the form and shape of objects by touch
11
Q
causalgia
A
painful, burning sensations, usually along the distribution of a nerve
12
Q
hypoalgesia
A
decreased sensitivity to pain
13
Q
hyperalgesia
A
increased sensitivity to pain
14
Q
hyperesthesia
A
increased sensitivity to sensory stimuli
15
Q
hypoesthesia
A
decreased sensitivity to sensory stimuli
16
Q
pallanesthesia
A
loss or absence of sensibility to vibration
17
Q
paresthesia
A
abnormal sensation such as numbness, prickling, or tingling, without apparent cause
18
Q
thermoanesthesia
A
inability to perceive sensations of heat and cold
19
Q
31 pairs of spinal nerves that exit spinal cord :
A
- cervical : 8
- thoracic : 12
- lumbar : 5
- sacral : 5
- coccygeal : 1
20
Q
dorsal root contains
A
afferent sensory fibers
21
Q
ventral root contains
A
efferent motor fibers
22
Q
dermatome
A
sensory distribution
23
Q
myotome
A
motor distribution
24
Q
C1/C2 myotome
A
cervical flexion/extension
25
C3 dermatome
lateral neck
26
C3 Myotome
cervical lateral flexion
27
C4 dermatome
over clavicle
28
C4 myotome
shoulder elevation
29
C5 dermatome
lateral upper arm (deltoid)
30
C5 myotome
shoulder abduction
31
C6 dermatome
thumb
32
C6 myotome
elbow flexion, wrist extension
33
C7 dermatome
middle finger
34
C7 myotome
elbow extension, wrist flexion
35
C8 dermatome
medial border of hand, little finger
36
C8 myotome
thumb extension, finger flexion
37
T1 dermatome
medial forearm
38
T1 myotome
finger abduction + adduction
39
L1 dermatome
anterior groin
40
L1 myotome
none
41
L2 dermatome
middle to upper anterior thigh
42
L2 myotome
hip flexion
43
L3 dermatome
middle to lower medial thigh
44
L3 myotome
knee extension
45
L4 dermatome
medial aspect of foot to great toe
46
L4 myotome
ankle dorsiflexion, ankle inversion
47
L5 dermatome
central dorsum of foot to middle toe
48
L5 myotome
great toe extension
49
S1 dermatome
lateral aspect of foot and ankle
50
S1 myotome
hip extension, ankle plantar flexion, ankle eversion
51
S2 dermatome
middle of posterior thigh
52
S2 myotome
knee flexion, ankle plantar flexion
53
monosynaptic reflex
one afferent (sensory) component and one efferent (alpha motor) component
that communicates via one synapse within the anterior horn of spinal cord
54
deep tendon reflex scale
grade 0 : no reflex
grade 1+ : minimal or depressed response
grade 2+ : normal response
grade 3+ : overly brisk response
grade 4+ : extremely brisk response with clonus (invol. repetitive back and forth motion)
55
hypotonic DTR's
result from injury or compression along
the nerve pathway
causes:
- bulging or herniated disc
- prohibits normal transfer of the reflex
message (incoming and/or outgoing)
- advanced stenosis of intervertebral foramen
- peripheral nerve injury
- peripheral nervous system disorder
56
hypertonic DTR's
sign of central nervous system pathology
causes:
- known brain or spinal cord pathology
- findings are usually bilateral
57
spasticity
motor disorder characterized by a velocity-dependent increase in muscle tone with increased resistance to stretch
*clasp knife response
injury to descending motor pathways from the cortex or brainstem, producing disinhibition of spinal reflexes with
58
hyperactive tonic stretch reflex
(spasticity)
- slow gentle stretch, causes an exaggerated, sustained contraction
- there is a loss of inhibitory control from the brain
59
reciprocal inhibition
(spasticity)
automatic relaxation of a muscle (antagonist) when the opposing muscle
(agonist) contracts
- when you bend your elbow
* biceps (agonist) contracts
* triceps (antagonist) must relax
60
modified ashworth scale
gold standard used to assess muscle spasticity in patients with lesions of the CNS
Procedure:
- examiner uses passive motion to assess resistance to passive motion due to spasticity
61
modified ashworth scale grades + description
grade 0 : no increase in muscle tone
grade 1 : slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM when affected part(s) is moved in flexion or extension
grade 1+ : slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
grade 2 : more marked increase in muscle tone though most of the ROM, but affected part(s) easily moved
grade 3 : considerable increase in muscle tone, passive movement difficult
grade 4 : affected part(s) rigid in flexion or extension
62
rigidity
hypertonic state characterized by stiffness and resistance to movement that is independent of the velocity of movement
increase in muscle tone causing greater resistance to passive movement; greater in flexor muscles
63
leadpipe rigidity
constant increase in muscular tone and stiffness of affected muscles
uniform, constant resistance as limb is moved
64
cogwheel rigidity
coexistence of rigidity with tremor producing stiffness and a jerkiness when a body part is manipulated
- commonly seen in UE movements
series of brief relaxations or “catches” as limb is passively moved
65
flaccidity
- abnormally low tone or absent muscular tone
- resistance to passive movement is diminished and the extremities are easily moved
- lower motor neuron (LMN) syndrome
^^^ results from lesions that affect the anterior horn cell
and peripheral nerve
symptoms of:
▪ decreased or absent tone
▪ decreased or absent reflexes
▪ paresis
▪ muscle fasciculations
▪ neurogenic atrophy
66
motor deficits identified emphasize the influence of the cerebellum on :
- equilibrium
- posture
- muscle tone
- initiation + force of movement
67
ataxia
- used to describe loss of muscle coordination
- may affect gait, posture, and patterns of movement
68
asthenia
generalized muscle weakness associated with cerebellar lesions
69
dysarthria
disorder of the motor component of speech articulation. The speech pattern is typically slow and may be slurred, hesitant, with prolonged syllables and inappropriate pauses.
70
dysdiadochokinesia
impaired ability to perform rapid alternating movements. This deficit is observed in movements such as rapid alternation between pronation and supination for the forearm
movements are irregular, with a rapid loss of range and rhythm especially as speed is increased
71
dysmetria
inability to judge the distance or range of movement.
72
gait ataxia
ambulatory patterns that typically demonstrate a broad base of support
- upright stance stability is often poor, and the arms may be held away from the body to improve balance
- stepping patterns are irregular in direction and distance
- gait patterns tend to be unsteady (postural instability) and irregular with deviations from an intended forward line of progression
73
hypotonia
- decrease in muscle tone
- diminished resistance to passive movement will be noted, and muscles may feel abnormally soft and flaccid
- diminished deep tendon reflexes (DTR) also
may be noted
74
nystagmus
rhythmic, quick, oscillatory, back-and-forth movement of the eyes. It is typically apparent as the eyes move away from midline to fix on an object in either the medial or lateral field
75
tremor
involuntary oscillatory movement resulting from alternate contractions of opposing muscle groups
76
intention tremor (kinetic)
oscillatory movement during voluntary motion; increases as the limb nears target; diminished or absent at rest
77
postural tremor (static)
exaggerated oscillatory movement of the body in standing posture or of a limb held against gravity
78
basal ganglia motor deficit characteristics:
- slowness of movement
- involuntary, extraneous movement
- alterations in posture and muscle tone
79
akinesia
inability to initiate movement as seen in the late stages of Parkinson’s disease
- associated with fixed postures (freezing episodes)
80
bradykinesia
decreased amplitude and velocity of voluntary movement
- examples include decreased arm swing; slow, shuffling gait; difficulty initiating or changing direction of movement; lack of facial expression; or difficulty stopping a movement once begun.
*bradykinesia is characteristic of
Parkinson’s disease
81
chorea
involuntary, rapid, irregular, and jerky movements involving multiple joints
choreiform movements demonstrate irregular timing, are most apparent in the upper-extremities (UEs) and cannot be voluntarily inhibited; it is associated with Huntington’s disease
82
dystonia
involves sustained involuntary contractions of agonist and antagonist muscles, causing abnormal
posturing (dystonic posture) or twisting movements
most common in trunk and extremity musculature but also may affect the neck, face, and vocal cords.
83
hemiballismus
large-amplitude sudden, violent, flailing motions of the arm and leg of one side of the body primary involvement is in the axial and proximal musculature of the limb
84
hyperkinesis
abnormally increased muscle activity or movement
85
hypokinesis
decreased motor response especially to a specific stimulus
86
resting tremor
involuntary, rhythmic, oscillatory movement observed at rest
87
age-related changes affecting coordinated movement
- decreased strength
- slowed reaction time
- decreased ROM
- postural changes
88
sarcopenia
age-associated loss of skeletal muscle mass (decreased cross-sectional area), as well as
changes in the ability of muscle tissue to regenerate
direct impact on:
- strength
- endurance
- mobility
- ability to perform smooth controlled motor responses
89
alternate nose-to-finger tests what impairment
- dysdiadochokinesia
- intention tremor
90
pronation/supination tests what impairment
- dysdiadochokinesia
91
heel-on-shin tests what impairment
- dysmetria
92
lower extremity motor coordination test , tests what impairment
- dysdiadochokinesia
- intention tremor
93
CN I + its type and function
olfactory
- sensory
- smell
94
CN II + its type and function
optic
- sensory
- vision
- contralateral pupillary reaction to light
95
CN III + its type and function
oculomotor
- motor
- eyelid opening
96
CN IV + its type and function
trochlear
- motor
- diagonal downward-medial movement of eye
97
CN V + its type and function
trigeminal
- sensory
- sensation to face
- motor
- jaw clenching , lateral movement of eye
98
CN VI + its type and function
abducens
- motor
- lateral deviation of eye
99
CN VII + its type and function
facial
- sensory
- taste for salty, sweet, sour on anterior 2/3 tongue
- motor
- facial movements, expressions
- closing eyelid
- closing mouth
100
CN VIII + its type and function
vestibulocochlear
- sensory
- hearing + balance/equilibrium
101
CN IX + its type and function
glossopharyngeal
- sensory
- posterior portions of eardrum + canal
- taste for sour, bitter posterior 1/3 of tongue
- motor
- control of pharynx
102
CN X + its type and function
vagus
- sensory
- pharynx + larynx
- motor
- palate, pharynx, larynx
103
CN XI + its type and function
spinal accessory
- motor
- sternocleidomastoid + trapezius
104
CN XII + its type and function
hypoglossal
- motor
- tongue
UTHSC PEP
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