1
Q
What is MS?
A
chronic, progressive, demyelinating disease of the CNS
2
Q
What population does MS commonly affect?
A
Female adults (20-50 y/o)
3
Q
Description
- demyelinating lesions impair neural transmission which causes the nerves to fatigue rapidly
- lesions are common in pyramidal tract, dorsal columns, optic tract, periventricular areas of cerebrum, and cerebellar peduncles
- variable course with fluctuating episodes progressing to permanent dysfunction
- transient worsening of symptoms
A
MS
4
Q
The following s/s indicate what diagnosis?
- mild to moderate cognitive impairment
- euphoria
- emotional dysregulation
- dysarthria
- dysphagia
- decreased ROM
- Sensory symptoms (parasthesia, hyperpathia, dysesthesias, trigeminal neuralgia, Lhermitte’s sign)
- diplopia and blurred vision (possible optic neuritis, blind spots (scotoma), and/or nystagmus)
- spasticity and hyperreflexia
- paresis
- ataxia
- intention tremors
- dysmetria
- dysdiadokinesia
- vestibular s/s
- fatigue
A
MS
5
Q
What is the #1 complaint of MS?
A
fatigue
w/ activity and as the day progresses
6
Q
Definition
Subtype of MS that is characterized by discrete attacks of neuro deficits with either full or partial recovery in subsequent weeks or months; periods between relapses are characterized by lack of disease progression
A
relapsing-remitting MS
7
Q
What subtype of MS is common in 85% of cases?
A
Relapsing-remitting
8
Q
definition
subtype of MS characterized by disease progression and a deterioration in function from onset; patient can experience moderate fluctuations in neurological disability but discrete attacks do not occur
A
primary-progressive
9
Q
definition
Subtype of MS characterized by an initial relapsing-remitting course, followed by a change to a progressive course with a steady decline in function, with or without continued acute attacks
A
secondary-progressive
10
Q
definition
Subtype of MS characterized by a steady deterioration in disease from onset but with occasional acute attacks; time between attacks are characterized by continued disease progression
A
progressive-relapsing
11
Q
definition
Subtype of MS that is the first episode of inflammatory demyelination that could become MS if additional activity occurs
A
clinically isolated syndrome (CIS)
12
Q
What type of MS can CIS progress to if a patient continues to have additional activity indicating possible MS?
A
relapsing-remitting
13
Q
What is recommended for diagnosis of MS?
A
brain MRI with gladiolum
spinal cord MRI if brain MRI is non-diagnostic
14
Q
Degeneration of what CNS structures lead to PD?
A
- dopaminergic substantia nigra neurons
- nigrostriatal pathways
- deficiency of basal ganglia corpus striatum
- loss of inhibitory dopamine results in excessive excitatory output from the cholinergic system of the basal ganglia (ACh)
15
Q
Diagnosis
- rigidity
- bradykinesia
- resting tremor
- impaired postural reflexes
- altered gait: shuffling, freezing, festination (involuntary increase in walking speed)
- fatigue
- anxiety and depression
- slow progression with emergence of secondary impairments and permanent dysfunction
- altered cognition
- dysphagia
- orthostatic hypotension
- akathisia (restlessness)
- visual changes
- integumentary changes (edema, circulation, integrity)
- weakness
A
PD
16
Q
What is the Hoehn and Yahr classification used for?
A
staging PD
17
Q
What is stage 1 of Hoegn and Yahr classification?
A
Minimal or absent disability - unilateral symptoms
18
Q
What is stage 2 of Hoegn and Yahr classification?
A
- Minimal bilateral or midline involvement
- no balance involvement
19
Q
What is stage 3 of Hoegn and Yahr classification?
A
- impaired balance
- some activity restrictions
20
Q
What is stage 4 of Hoegn and Yahr classification?
A
- all PD symptoms are present and severe
- standing and walking with assistance
21
Q
What is stage 5 of Hoegn and Yahr classification?
A
confinement to bed or WC
22
Q
What should you examine for when you have a patient taking Levodopa for PD management?
A
fluctuating symptoms (on-off phenomenon)
Common with disease progression and long-term use of levodopa
23
Q
What are adverse effects of levodopa (sinemet)?
A
- n/v
- orthostatic hypotension
- arrythmia
- dyskinesia/involuntary movements
- psychoses/hallucinations
24
Q
What causes presyncope?
A
CVD reducing cerebral perfusion
25
Blurred vision is gaze instability secondary to ______.
VOR dysfunction
26
(true/false) Vestibular symptoms are seen in 87% of patients with chronic TBI
FALSE (acute TBI)
| PVH occurs in 19%
27
# diagnosis
Acute infection of vestibular system (bacterial or viral) with prolonged attack of symptoms, persisting for several days to weeks
vestibular neuronitis, labyrinthitis
28
# Diagnosis
episodic vertigo syndrome associated with low to medium frequency sensorineural hearing loss and fluctuating aural symptoms in the affected ear accompanied by vertigo
| Etiology unknown but believed to be accumulation of endolymph
meniere's disease
29
How long do symptoms of vertigo last in those with menieres disease?
20 minutes - 12 hours
30
# Diagnosis
brief attacks of vertigo and nystagmus that occurs with a change in head position
| Can be related to disloged otoconia into the semicircular canal
BPPV
31
What can cause unilateral peripheral vestibular hypofunction (PVH)?
- menieres disease
- BPPV
- trauma
- vestibular neuritis/labyrinthitis
- tumor
32
What kind of injury is the most common cause of SCI in the lumbar spine?
FLX
33
What kind of injury is most common to cause SCI in the cervical spine?
FLX-ROT
34
What spinal areas have the greatest frequency for experiencing SCI?
1. C5
2. C7
3. T12
4. L1
35
What is designated as the lesion level for an SCI?
Most distal **uninvolved** nerve root with normal function
| MMT must be 3+/5
36
What levels cause quadriplegia?
C1-C8
37
What levels cause paraplegia?
| bilateral LEs and trunk
T1-T12
38
What are the levels of the ASIA scale?
A= complete
B= incomplete; sensory function is preserved below neural level
C= incomplete; motor function is preserved below neural level and are **< 3/5**
D= incomplete; motor function is preserved below the functional level and most have a MMT of **3/5 or higher**
E= Normal
39
# Diagnosis
- Loss of centrally located cervical tracts (arm functioning)
- loss of B/B functioning with spasticity
- preservation of peripherally located lumbar and sacral tracts (LE functioning)
Central cord syndrome
40
What MOI typically causes central cord syndrome?
hyperextension injury of the cervical spine
41
# Diagnosis
- ipsilateral loss of tactile discrimination, pressure, vibration, and proprioception (dorsal columns)
- ipsilateral loss of motor function and paralysis below level of lesion (corticospinal tracts)
- contralateral loss of pain and temperature **below** level of lesion (spinothalamic tract)
- bilateral loss of pain and temperature **at** the level of lesion (spinothalamic tract)
Brown Sequard syndrome
42
What MOI commonly causes brown-sequard syndrome?
puncture wounds
43
# Diagnosis
- loss of lateral corticospinal tracts
- loss of spinothalamic tracts
- bilateral loss of motor function (spastic paralysis below level of lesion - lateral corticospinal tracts)
- bilateral loss of pain and temperature (spinothalamic tracts)
Anterior cord syndrome
44
What is preserved with anterior cord syndrome?
- light touch
- proprioception
- sense of positioning
- vibration
| Dorsal columns
45
What is preserved with central cord syndrome?
- proprioception
- discriminatory sensation
46
What is the MOI of anterior cord syndrome?
FLX injury of cervical spine
47
# Diagnosis
- loss of posterior columns
- bilateral loss of proprioception, vibration, pressure ,and epicritic sensations (stereognosis, 2-point discrimination)
- preservation of motor function, pain, and light touch
- rare
posterior cord syndrome
48
What is preserved with posterior cord syndrome?
- light touch
- pain
- motor function
49
# diagnosis
injury below L1 that results in LMN lesion of lumbar and sacral roots
cauda equina injury
50
What does cauda equina injury cause?
- sensory loss
- paralysis
- autonomous or nonreflexive bladder
51
(true/false) There is some capacity for regeneration of motor and sensory functioning with cauda equina injury
true
| incomplete recovery that stops after 1 year
52
# Definition
Sparing of tracts of sacral segments with preservation of perianal sensation, rectal sphincter tone, or active toe FLX
sacral sparing
53
(true/false) voluntary saccadic or smooth pursuit eye exercises should NOT be offered in isolation (without head movement)
true
54
Describe spinal shock.
Phenomenon that occurs after trauma to the spinal cord in which the cord ceases to function below the lesion
## Footnote
absent spinal reflexes, voluntary and autonomic motor control, and sensation
55
how long does it usually take for spinal shock to diminish?
24 hours
## Footnote
After spinal shock resolves, reflexes return and progressively bbecome stronger resulting in spasticity
56
- HTN
- bradycardia
- severe HA
- anxiety
- constricted pupils
- blurred vision
- flushing and piloerection
- increased spasticity
autonomic dysreflexia
57
What should you do if a person may be experiencing autonomic dysreflexia?
- sit them in upright position
- loosen tight clothing
- examine for blockage of urinary drainage
- monitor BP and HR
58
What WC is most appropriate for those with high cervical lesions (C1-C4)?
- electric WC
- tilt in space seating
- puff and sip control/microswitch
- portible respirator
59
What WC is most appropriate for those with C5 injury?
| preservation of shoulder function and elbow FLX
manual with propulsion aids
## Footnote
Independent for short distances
- may require electric WC for longer distances
60
What WC is most appropriate for patients with C6 or C7 lesion?
| preservation of radial wrist extensors and/or triceps
manual WC with friction-surface rims
## Footnote
independent
61
What would locomotor training result in for those with midthoracic lesions (T6-T9)?
- supervision with short distances
- use of AD
- bilateral KAFO
| may prefer standing devices for physiological standing (standing WC)
62
What would locomotor training result in for those with high lumbar lesions (T12-L3)?
- independence with ambulation on all surfaces and stairs
- independent household ambulation
- WC use for community distances
- bilateral KAFOs
- swing-through pattern or four-point pattern with crutches
- possible use of FES system with reciprocating gait orthoses
63
What will locomotor training result in for those with low lumbar lesions (L4-L5)?
- independent ambulators with bilateral AFOs
- crutches or cane
- may use WC for high-endurance activity
64
What are the absolute contraindications for exercise testing and training in individuals with a SCI?
- autonomic dysreflexia
- severe or infected skin on WB surfaces
- symptomatic hypotension
- UTI
- unstable Fx
- uncontrolled temperature environments
- insufficient ROM for task performance
65
What is another name for ALS?
Lou gehrig's disease
66
# diagnosis
degenerative disease affecting UMNs and LMNs through degeneration of anterior horm cells, descending corticobulbar, and corticospinal tracts.
ALS
67
What is the etiology of ALS?
unknown
| 5-10% genetic
68
# Diagnosis s/s
- progressive disease leading to death within 2-5 years
- muscular weakness progressing from limbs to whole body; atrophy, cramping, muscle fasciculations, twitching (LMN s/s)
- hyperreflexia (UMN s/s)
- spasticity (UMN s/s)
- dysarthria
- dysphagia
- dysphonia secondary to pseudobulbar palsy
- autonomic dysfunction (1/3 of cases)
- respiratory weakness
- depression
ALS
69
What is stage I of ALS?
- Early disease with mild focal weakness
- asymmetrical
- s/s are hand cramping and fasciculations
70
What is stage II of ALS?
- moderate weakness
- start of atrophy
- modified independence with AD
71
What is stage III of ALS?
- severe weakness
- increased fatigue
- mild to moderate functional limitations
- ambulatory
72
What is stage IV of ALS?
- severe weakness and LE wasting
- mild UE weakness
- mod A with AD
- WC user
73
What is stage V of ALS?
- progressive weakness with deterioration of mobility and endurance
- increased fatigue
- moderate to severe weakness of limbs and trunk
- hyperreflexia
- spasticity
- loss of head control
- max A
- use of WC
74
What is stage VI of ALS?
- bedridden
- dependent
- progressive respiratory distress
75
weakness or paralysis of the muscles innervated by the motor nuclei of the lower brainstem
- affects the muscles of the face, tongue, larynx, and pharynx
bulbar palsy
76
What is the etiology of bulbar palsy?
- tumors
- vascular disease
- degenerative diseases
| ... of the lower CN motor nuclei
77
# diagnosis
bilateral dysfunction of the corticobulbar innervation of brainstem nuclei -- UMN lesion analogous to corticospinal lesions disrupting the function of anterior horn cells
pseudobulbar palsy
| similar s/s of bulbar palsy
78
What is another name for trigeminal neuralgia?
Tic Douloreux
79
What is trigeminal neuralgia?
lesion of trigeminal nerve
| can result from compression and occurs in older adults
80
Trigeminal neuralgia has a (gradual/abrupt) onset.
abrupt
81
What is Bell's palsy?
Lesion of facial nerve (CN VII) resulting in unilateral facial paralysis
82
# diagnosis s/s
- muscles of face on one side are weakened or paralyzed (facial droop, altered taste in anterior 2/3 of tongue)
- loss of control over salivation or lacrimation
- acute onset
- maximal severity within a few hours or days
- followed behind pain in the air for 1-2 days
bell's palsy
83
(true/false) sensation is not affected with bell's palsy
true
84
What medications are used to treat bell's palsy?
corticosteroids and analgesics
85
# definition
nerve injury that causes a transient and focal chemical/structural loss of function (conduction block/demyelination)
- often related to compression causing ischemia
- can be rapidly reversed or persist for weeks to month
neurapraxia
86
# definition
focal damage to the axon/myelin and varying degrees of peripheral nerve connective tissue (endoneurium, perineurium, and epineurium)
- seen with increased duration or larger amplitude compression or tension
- traction injuries results in disruption of the peripheral nerve connective tissue
axonotmesis
87
What does axonomesis result in?
Wallerian degeneration within the disrupted axons
## Footnote
axonal regrowth is related to the degree of the connective tissue damage, PMH, and overall health of the patient
88
How much axonal regrowth occurs within a day?
1-3 mm (1inch/month)
89
# definition
Severance of axon/myelin and all the connective tissue structures including the epineurium
- complete loss of nerve function and wallerian degeneration with no connective tissue path
- requires surgical intervention
neurotmesis
90
Describe collateral sprouting.
Intact axons pick up deinnervated terminal targets
91
What happens to muscle fibers if collateral sprouting occurs?
Muscle fiber type switches
| type I - type II
92
(true/false) Both polyneuropathic conditions impact the axon **AND** myelin.
true
| peripheral nerve diseases are more chronic in nature
93
(true/false) old age is a key risk factor in forming a polyneuropathy.
true
94
What test is used for diagnosis of small fiber cutaneous neuropathies?
skin punch biopsy
95
# Diagnosis
Acute inflammatory demyelinating polyradiculoneuropathy presenting with rapid non-symmetric loss of myelin in nerve roots and peripheral nerves (LMN disease)
- muscle weakness has abrupt onset and immediate medical attention is warranted
guillain-barre syndrome (GBS)
96
# diagnosis s/s
- sensory loss/parasthesia
- motor paresis or paralysis; symmetrical distribution of weakness
- dysarthria
- dysphagia
- diplopia
- facial weakness
- progresses within a few days to weeks
GBS
97
There is (less/more) sensory loss than motor loss with GBS
less sensory loss
98
(true/false) GBS can cause full tetraplegia with respiratory failure
true
99
How long does GBS evolve/progress?
few days to weeks
100
How long does it take to recover from GBS?
6 months to 2 years
101
# Diagnosis
Slow progressive muscle weakness occurring in individuals with a confirmed history of acute polio
post-polio syndrome (PPS)
102
When does PPS occur?
after a stable period of functioning (15 years after initial polio diagnosis)
103
What are the signs and symptoms of PPS?
- gradual onset of muscle weakness or fatigue with or without atrophy
- slow progression; new symptoms progressing > 1 yr
- abnormal fatigue
- pain
- decreased endurance
- cold intolerance
- sleep disturbance
104
Those with PPS have (cold/heat) intolerance
cold intolerance
105
Is sensation affected by PPS?
no
106
What is the most common NMJ disorder encountered in clinical practice?
Myasthenia gravis
107
What is the common treatment for hypertonia, dystonia, chronic pain, and muscle spasms?
botulinum toxin
108
# Diagnosis
- females 20-30 y/o
- males = females at 60-80 y/o
- progressive muscular weakness during activity that improves with rest
- fatigue with sustained activity
myasthenia gravis
109
What is the primary impairment reported by patients with myasthenia gravis?
fatigue
110
What are the 4 classifications of myasthenia gravis?
1. ocular myasthenia (confined to extraocular muscles)
2. mild generalized myasthenia
3. severe generalized myasthenia
4. myasthenic crisis
111
What is myasthenic crisis?
myasthenia gravis with respiratory failure
| medical emergency
112
What muscles do general myasthenia gravis involve?
- bulbar muscles (extraocular, facial, muscle of mastication
- proximal limb-girdle muscles
113
How long does it take for myasthenia gravis to progress?
can progress from mild to severe within 18 months
114
When examining for myasthenia gravis, what should you look for indicating involvement of cranial nerves?
- diplopia
- ptosis
- progressive dysarthria
- nasal speech
- dysphagia
- difficult facial expression
- facial droop
115
What is the ice pack test? What is it normally used for?
Used for myasthenia gravis
(+) test is **decreased** ptosis after a 2-minute application of an ice pack to the affected eyelid
116
Are proximal or distal muscles more affected by myasthenia gravis?
proximal muscles
117
Nerve conduction studies on myasthenia gravis show a (increased/decreased) response to repetitive nerve stimulation at baseline
decreased
118
What medications can be used for treatment of myasthenia gravis?
- acetylcholinesterase
- corticosteroids
- immunosuppressants
## Footnote
Alternative treatments: plasmapheresis or thymectomy
119
What is plasmapheresis?
removal of blood with filtering and separation of the cellular elements within the plasma
120
What is the mechanism of botulinum toxin?
decreases the release of ACh resulting in flaccidity and/or hypotonia (dependent on dose)
## Footnote
binds presynaptically to high-affinity sites on cholinergic nerve terminals
121
What are the adverse side effects of botulinum toxin?
- weakness of unintended muscles
- flaccidity
- dysphagia
- local hemotoma
- generalized fatigue
- dry mouth
- dizziness
- pain
- flu-like symptoms
| complications are dependent on the muscles injected
## Footnote
higher risk of complications when head, neck, and trunk muscles are involved
122
(true/false) myopathic disorders are classified as inherited or acquired.
true
## Footnote
inherited (muscular dystrophy)
acquired (inflammatory myopathies, infectious myopathies (HIV), toxic/drug related myopathy, systemic disease myopathy)
123
What do acquired myopathies result in?
Muscle cell structure and/or metabolism dysfunction
124
# diagnosis
- muscle cramps and pain with exertional fatigue
- progression of weakness from proximal to distal muscles
- difficulty with overhead activity and getting in/out of chairs
- pelvic girdle weakness w/ associated gait deviations
- normal sensation
myopathic disorders
## Footnote
- joint pain with polymyositis
- skin changes with dermatomyositis
125
What lab tests can confirm myopathy?
Elevated:
- creatine kinase
- aldolase
- lactate dehydrogenase
- liver function enzymes
## Footnote
To identify the etiology:
- metabolic panel
- thyroid hormone
- PTH
- sedimentation rate
- C-reactive protein
126
(true/false) EMG test can be normal in those with mild myopathies
true
127
What is meningitis?
inflammation of the meninges of the CNS
| typically caused by infection
128
# diagnosis
- fever
- HA
- stiff neck
- irritability
- mental confusion
- light sensitivity
- increased HR and RR
- sleepiness
- sluggishness
meningitis
129
What special test in used in diagnosis of meningitis?
kerning's sign
| along with other dural stretches
130
What medications are used for meningitis?
- corticosteroids
- anticonvulsants
- antiviral medication
131
What is primary encephalitis caused by?
virus that infects the brain
Examples:
- can be mosquito-borne
- can be tick-borne
- rabies virus
132
What causes secondary encephalitis (post-infection encephalitis)?
faulty immune system reaction resulting from an infection in another area of the body
- immune system attacks the brain
133
What are the symptoms of mild encephalitis?
No symptoms
OR
flu-like symptoms
134
(true/false) severe cases of encephalitis are not deadly
false
## Footnote
s/s include:
- confusion
- agitation
- hallucinations
- Sz
- muscle weakness
- paralysis
- loss of sensation
- LOC
135
What is the treatment for mild encephalitis?
- bedrest
- fluids
- anti-inflammatory drugs
- antiviral medications
136
What is transverse myelitis?
Inflammation of a section of the spinal cord
- myelin is damaged with interruption of signals that the spinal cord sends to the body
137
What causes transverse myelitis?
- infection: bacterial, viral, fungal
- immune system disorder
- autoimmune inflammatory disorders
- myelin disorders
138
How long does it take for transverse myelitis to develop?
hours to weeks
| gradual
139
# diagnosis
- gradual progression
- affects both sides of body below level of affected spinal lesion (although can affect only one side)
- pain (sharp, shooting along level of lesion)
- abnormal sensation
- weakness or paralysis
- stiffness/tightness/painful muscle spasms
- fatigue
- B/B dysfunction
- sexual dysfunction
transverse myelitis
140
When does recovery occur for transverse myelitis?
Most recovery occurs within first 3 months and can continue up to 2 years
| 1/3 of patients have permanent disability
## Footnote
relapsing or recurrent transverse myelitis can occur
141
Relapsing or recurrent transverse myelitis can occur when what diagnosis is found to be the cause?
MS
142
# Diagnosis
Rare and polio-like condition that affects the motor neurons in the gray matter of the spinal cord causing muscles and reflexes to become weak
acute flaccid myelitis (AFM)
143
What population commonly develops acute flaccid myelitis (AFM)?
children
144
What is the etiology of AFM?
unknown
145
Most patients who develop AFM have a prior history of what?
respiratory illness or fever
146
# diagnosis
- sudden onset of arm or leg weakness
- loss of muscle tone
- hyporeflexia
- difficulty moving eyes/eyelids
- facial weakness/drooping
- dysphagia
- pain in neck, back, or limbs
- impaired sensation
- b/b dysfunction
- respiratory failure requiring vent support (severe cases)
Acute flaccid myelitis
147
What can be an early symptom of acute flaccid myelitis?
pain in the neck, back, or limbs
148
(true/false) Those who experience acute flaccid myelitis have full recovery.
false
## Footnote
most regain some strength over time but do not recover to full functioning
149
What are the 2 major criteria to suspect myalgic enephalomyelitis/chronic fatigue syndrome?
1. persistent or relapsing fatigue and reduced physical activity for >6 months
2. 4/8 of symptoms are experienced
150
What are the symptoms of myalgic encephalomyelitis/chronic fatigue syndrome?
- severe/prolonged fatigue
- post exertional malaise (PEM)
- muscle pain (myalgia)
- cognitive impairment
- difficulty sleeping
- sore throat
- HA
- dizziness
- deconditioning, anxiety and depression
- multi-joint pain (anthralgias)
151
What causes AIDS?
acquired and severe depression of cell-mediated immunity
## Footnote
- wide-ranging symptoms
- 1/3 of patients exhibit PNS or CNS symptoms
152
What are the symptoms of AIDS dementia complex?
- confusion
- memory loss
- disorientation
153
What are some s/s of AIDS?
- AIDS dementia complex (ADC)
- motor deficits
- peripheral neuropathy
154
Describe the Gate Control Theory.
Sensation of spinal cord level is contolled by a balance between large fibers (A- alpha and beta) and small fibers (A delta, C)
## Footnote
Possible initiation of counterirritant theory
155
Describe the counterirritant theory.
Temporal summation of large myelinated fibers may block activity of small fibers and pain transmission
156
Describe desending analgesic systems.
Endogenous opiates are produced in the CNS and can depress pain transmission at various sites via presynaptic inhibition
157
(true/false) Areas of the cortex and limbic system function to upregulate or downregulate the descending pain modulation systems
true
158
Describe nociceptive pain.
response to immediate noxious stimuli
| inflammatory pain occurs after tissue damage and increases sensitivity
## Footnote
Ex: ankle sprain
159
Describe nociplastic pain.
persistent pain that arises from altered nociception, despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors, or evidence for disease or lesion of the somatosensory system causing the pain.
| dysfunction of central pain processing (central sensitization)
## Footnote
- diffuse pain and persists beyond normal tissue healing
160
# Definition
Pain due to a stimulus that does not actually provoke pain
allodynia
161
# definition
increased pain sensitivity that occurs directly in the area of damaged or inflammed tissue
primary hyperalgesia
## Footnote
Secondary hyperalgesia: pain sensitivity that occurs in surrounding undamaged tissues (ex: phantom limb pain)
162
When does CRPS often develop?
After disuse or trauma
163
What is another name for CRPS type I?
reflex sympathetic dystrophy
164
What is observed with CRPS I?
intense pain throughout the limb but does **not** involve specific damage to the PNS
165
What is observed with CRPS II?
specific damage to the PNS that results in over motor and sensory neuropathic s/s
166
What is another name for CRPS II?
causalgia
167
What type of CRPS is most common?
Type I
| 90% of cases
168
# diagnosis
- intense and diffuse pain
- continuous burning and throbbing pain
- hyperalgesia and allodynia
- decreased movement of affected area
- cold sensitivity
- edema in painful area
- change in skin temperature, color, and texture
- hyperhidrosis
- change in hair and nail growth
- atrophy
| risk of osteoporosis
CRPS
169
What is fibromyalgia syndrome (FMS)?
Chronic condition with widespread pain and fatigue (> 3 months)
170
What population is commonly diagnosed with fibromyalgia?
females (80-90%)
--> tends to run in families
171
When do symptoms of fibromyalgia begin?
after physical trauma, surgery, infection, or significant psychological stress
## Footnote
Those with the following are more likely to develop fibromyalgia:
- RA
- lupus
- ankylosis spondylitis
172
What are the s/s of fibromyalgia syndrome (FMS)?
- widespread pain (>3 months)
- persistent fatigue
- trigger points
- sleep disturbance
- cognitive changes
- sensory changes (atypical pattern)
- anxiety and depression
| Stress can make symptoms worse
173
What medications can be used for management of fibromyalgia?
- analgesics
- antiseizure drugs
- antidepressants
174
What are the two criteria for diagnosis of fibromyalgia?
1. widespread pain for > 3 months
2. positive tender point exam
175
What techniques can be used for sensory stimulation in those with reduced sensory response?
1. spatial summation (multiple techniques)
2. temporal summation (repeated application of the same technique)
176
When does substitution occur?
When functions are assumed, replaced, or substituted by different areas of the brain using different effectors or body segments
## Footnote
Indication: to offset or adapt to residual impairments and disabilities
177
# Pain type
- Dull ache/pain
- LBP increases with bending/lifting around 30 minutes
- relieved within few minutes of walking
nociceptive pain
178
# Pain type
- dull pain/ache
- shooting/sharp/tingling pain
- increased pain with bending
neuropathic pain
179
# pain type
dull ache/pain is constant
nociplastic pain
180
Out of the following diagnoses, which have CN involvement?
1. ALS
2. polyneuropathy
3. GBS
4. myasthenia gravis
ALS, GBS, myasthenia gravis
181
Severe cases of myasthenia gravis will show what gait deviation?
trendelenburg
182
What gait deviations can be observed in those with ALS?
- asymmetric foot slap/drop
- equinus gait
183
What pulmonary changes occur with any lesion(s) within c3-c5 spinal levels?
- primary inhalation is affected requiring a ventilator or phrenic nerve stimulator to be utilized
- disruption of the intercostal and abdominal muscles can impair forced expiration and inhalation
## Footnote
Following a SCI, tidal volume and vital capacity are reduced along with secondary respiration muscles being utilized more
184
Voluntary B/B control is lost after damage to what segment(s) within the spine?
Sacral cord damage
| S2-S4
185
(true/false) SCI results in infertility in both males and females
False
| Female fertility is unchanged but males are likely to become infertile
186
What cardiovascular changes occur in those who experience SCI?
1. vasodilation
2. orthostatic hypotension
3. bradycardia
| Sympathetic input is lost leading to overall parasympathetic control
187
(true/false) Below the SCI level of lesion, diaphoresis occurs.
False
## Footnote
no sweating occurs below the level of lesion - diaphoresis occurs above the level of lesion
188
What is the most common cause of death due to an SCI? Why?
Respiratory dysfunction
- pt has the inability to cough effectively which allows build-up of secretions = decreased forced expiration
- inadequate inhalation and exhalation reduces the ventilation of the lungs resulting in respiratory dysfunction (PNA, atelectasis, etc)
189
When do DVTs primarily occur in those with SCI?
within first 3 months
| prevention via repositioning, PROM, stockings, and proper positioning
190
When is autonomic dysreflexia most prominent in those with SCI?
within the first 3 years
## Footnote
sudden increase in BP, bradycardia, pounding HA, diaphoresis, and anxiety
191
What is the most common cause of autonomic dysreflexia?
bladder distention
192
What type of breathing is utilized to cough by those who have a C4 injury?
Glossopharyngeal breathing
193
(true/false) those with a C5 injury do not require assistance for manual coughing
false
| they do require assistance
194
(true/false) Those with a C6 injury require assistance for manual coughing technique.
false
| do not require assistance
195
(true/false) those with c6 injuries can drive a car with hand controls.
true
196
(true/false) those with c6 injuries are able to live independently
true
| *if well motivated
197
Where are spinal injuries found if a patient has a spastic (neurogenic) bladder?
Above S2
198
# TYPE OF BLADDER
- bladder contracts and reflexively empties in response to a certain level of filling pressure
- bladder sphincter dyssynergia due to detrusor muscle hyperreflexia
Neurogenic (spastic) bladder
199
What medications can help decrease bladder spasm and leakage in those with a spastic (neurogenic) bladder?
anticholinergics
| blocks Ach release and relaxes the muscles
## Footnote
techniques that can be used:
- manual stimulation
- timed voiding schedule
200
# TYPE OF BLADDER
- no reflex action is present for voiding
- requires use of catheterization every 3-6 hours if not indwelling
Flaccid (autonomous) bladder
201
(true/false) Those with a flaccid bladder respond well to medications such as anticholinergics
false
| requires catheterization
202
Where are spinal injuries found if a patient has a flaccid (autonomous) bladder?
At or below S2
203
Other than catheterization, what other bladder emptying techniques can be used for those with a flaccid bladder?
- Crede maneuver: manual compression on the lower abdomen
- valsalva maneuver
204
What reflex is reponsible for allowing urination?
Micturition (S2-S4)
205
what s/s accompany a lesion to the archicerebellum?
| vestibulocerebellum
- ataxia (trunk and gait)
- dyssynergia
- hypotonia
- central vestibular systems
206
What s/s accompany a lesion in the spinocerebellum?
- hypotonia
- weakness
- fatigue
- ataxia (trunk and gait)
207
What s/s accompany a lesion in the neocerebellum?
| cerebrocerebellum
UNILATERAL
- intention tremor
- dysdiadokinesia
- dysmetria
- dyssynergia and asynergia
208
What symptoms accompany an occlusion within the ICA?
The ICA supplies both the MCA and ACA. So the s/s of each syndrome can occur
--> (commonly s/s of MCA with reduced consciousness)
- can result in massive edema, brain herniation, and/or death
209
What areas are affected if there is an occlusion in the verebrobasilar artery?
- cerebellum
- pons
- medulla
210
What s/s accompany vertebrobasilar artery syndrome?
**Locked in syndrome**:
- no *horizontal* eye movement
- pseudobulbar palsy due to CN V-XII paralysis
- tetraplegia
211
How can you differentiate between symptoms of a SCI and a CVA?
An SCI will never affect the face
| CVA is above the midbrain and will affect the face
212
Lesions within the cerebellum will have (ipsilateral/contralateral/bilateral) symptoms
ipsilateral symptoms
| ataxia, dysdiadokinesia, dysmetria, dyssynergia, dysphasia
213
Those with pusher syndrome will push towards what side of the body?
towards the affected side
214
What CN is affected by MS?
CN II
CN V may be affected resulting in trigeminal neuralgia
## Footnote
CN II symptoms:
- optic neuritis
- diplopia
- afferent pupillary defect (Marcus gunn pupil)
215
Is MS a UMN or LMN disorder?
UMN
| demyelination of the CNS
216
(true/false) MS commonly affects the cerebellum
true
217
What type of bladder and bowel is present in those with MS?
mixed bowel and bladder
## Footnote
Has characteristics of both a flaccid and spastic bowel and bladder
218
What is the most common B/B complaint that accompanies MS?
constipation
| Fatigue is the #1 overall complain
219
What are the unique s/s for MS?
"LUCC"
Lhermitte's sign
Uhthoff's phenomenon
Charcot's Triad
CN II involvement
220
What is uhthoff's phenomenon?
Neurologic S/S become worse when pt is in a hot environment
221
What is charcot's triad?
"SIN"
Scanning speech (dysarthria)
Intention tremor
Nystagmus
| commonly seen in those with MS
222
(true/false) Those with MS experience trigeminal neuralgia
true
223
What are common causes of death in those with MS?
UTI and/or respiratory infections
224
What is the mnemonic for the classic symptoms of PD?
"TRAP"
Tremor (resting --> will have pill rolling presentation)
Rigidity (often asymmetrical and involves the proximal muscles - can progress to face and extremities)
Akinesia (cannot initiate movement)
Postural Instability
| Pt may also have bradykinesia
225
what is hypophonia?
decreased volume of speech
| commonly seen with PD
226
What is micrographia?
smaller writing
| commonly seen with PD
227
What is bradyphrenia?
slowing of thought process
228
In those with PD who are using levodopa/carbidopa (Sinemet), how do you know if the patient is in the "On phase" or "off phase"?
On phase: dyskinesia
(involuntary, repetitive, smooth movements that affect large muscles)
off phase: dystonia
(prolonged, involuntary movements/spasms that are painful)
229
(true/false) s/s of ALS are pure motor
true
230
What outcome measure is used as a staging tool for alzheimer's?
MMSE
## Footnote
21-25 : mild dementia
< 9 : profound dementia
231
When is the common onset of alzheimer's disease?
After age 65
NPTE
flashcards
Decks in class (22)
# Cards
-
MSK218
-
MSK testing163
-
Gait, prosthetics/orthotics, AD Rx169
-
MSK differential Dx297
-
Therapeutic interventions204
-
Safety and protection70
-
Medications60
-
Miscellaneous109
-
NM208
-
NM differential Dx231
-
Cardiovascular and lymphatic system251
-
Cardiovascular differential diagnosis73
-
Pulmonary121
-
Pulmonary differential diagnosis60
-
Integumentary231
-
Immune and GI systems210
-
Reproductive, renal and urological systems146
-
endocrine and metabolic systems68
-
Pediatrics175
-
Geriatrics87
-
Final Frontier readings256
-
Final Frontier 265
