Modifited Ashworth Scale
Measures spasticity
0 = no increase in muscle tone
1 = sightl increase in tone (catch/release, min resistance at EROM)
1+ = slight incrase in tone (catch folowed by min resistance for remainder (less than 1/2) of ROM)
2 = more marked increase in tone through most of ROM
3 = considerable incrase in tone, PROM difficult
4 = rigid in flexion or extension
Purpose of semicircular canals
responsd to movement of head motion
Purpose of otolith organs
Measure effects of gravity and movement with regard to acceleration/decceleration
VOR
vestibulo-occular reflex
- allows to head/eye coordination
- supports gaze stability
VSR
vestibulospinal reflex
- attempt to stabilize body/control movement
- assists with stabiltiy while head is moveing
- coordinates trunk during upright posture
Atomatic Postural Strategies
- Ankle: 1st used, small range, slow velocity perturbation, distal to proximal contraction at ankle to control sway
- Hip: greater force challenge or perturbation through hip/pelvis, hips move opposite the head, proximal to distal contraction to counteract LOB
- Suspensory: lower COG during standing/ambulation for better control
- Stepping: unexpected challenge/perturbation during static standing that place COG outside BOS, LE step, UE reach
Peripheral Vertigo (4)
- Episodic/short duration
- Automic symptoms present
- Precipitating factor
- Pallor, sweat, N/V, auitory fullness, tinnitus
Causes of Peripheral Vertigo
- BPPV
- Meniere’s disease
- Infection/Trauma/Tumor
- Metabolic diosders
- Acute alcohol intoxication
Central Vertigo (3)
- Autonomic symptoms less severe
- Loss of consciousness can occur
- diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria
Causes of Central Vertigo (5)
- Meningitis
- Mingraine HA
- Ear infection/Trauma/Tumor
- Cerebellar degernation disorders
- MS
BPPV most commonly affects which canal?
Posterior
Spontaneous Nystagmus
- Caused by imbalance of vestibular signals
- Due to acute vestibular lesions, lasts 24 hours
Peripheral nystagmus
Occurs with peripheral vestibular lesion and is inhibitis when the patient fixates their vision on an objects
Central nystagmus
Occus with a central lesion of the brainstem/cerebellus and is not inhibited by visual fixation on an object
Positional nystagmus
- Induced by change in head position
- Semicircular canals stimulate the nystagmus, typically only lasts a few seconds
Gazed evoked nystagmus
- occurs when the eyes shift from a primary to alternate position
- caused by inability to maintain stable gaze
- indicative of CNS pathology such as TBI and MS
Central vs. Peripheral Nystagmus
- Direction
- Visual Fixation
- Vertgio
- Length of symptoms
- Etiology
- C = bi/unilateral, P = unilateral with fast movement opp side of lesion
- C = no inhibitation, P = inhibit nystagmus and vertigo
- C = mild, P = significant
- C = may be chronic, P = min, day, week, finite period, recurring
- C = demyelination, vascular, cancer/tumor, P = meniere’s, vascular, trauma, toxicity, infection of inner ear
Fluent Aphasia (5)
- Frequently involves temporal lobe
- Word ouput/speech production functional
- Rhythmic but empty speech, lacks substance,
- Use paraphasia and neologisms
- Types: Wernicke’s, Conduction
Non-fluent Aphasia (5)
- Frequently involves frontal lobe
- Poor word output and articulation
- Dysprosodic speech with content present and syntatical words impaired
- Increased effort for speech
- Types: Broca’s, Global, Verbal Apraxia, Dysarthria
Wernicke’s (Receptive) Aphasia (4)
- Lesion in posterior region of superior temporal gyrus
- Comprehension impaired
- Good articulation with paraphasias
4, Impaired writing and naming ability
Conduction Aphasia (4)
- Lesion in supramarginal gyrus or arcuate fasciculus
- Intact fluency, comprehension, and reading
- Severe impairment with repetition
- Impaired writing and word finding
Broca’s (Expressive) Aphasia (4)
- Lesion in 3rd convolution of frontal lobe
- Intact auditory/reading comprehension
- Impaired repetition and naming skills, paraphasias common
- Frustration of language skills
Wernicke’s vs. Broca’s Aphasia: Motor impairment
Wernicke: not typical due to distance of lesion from motor cortex
Broca: typical due to proximity to motor cortex
Global Aphasia (4)
- Lesion in frontal, temporal, or parietal lobes
- Impaired comprehension, maing, writing, and repetition skills
- May involuntarily verbalize without correct context
- May use nonverbal skills to communicate
