Random Mix

Question 1

Parkinson’s tremor dominant vs Postural instability and gait disturbances

Answer 1

• Tremor dominant = earlier onset, better prognosis, and cognition intact
• Postural instability and gait = quicker progression, worse prognosis, and cognition IS affected.

Question 2

Progressive supranuclear palsy characteristics PSP

Answer 2

• ocular motor disturbances, unable to move eyes up or down (vertical palsy) c/o blurred vision
• rapid progression
• retropulsion/startle reflex
• Early postural instability / falls
• rigid trunk
• WBOS
• dysarthria/dysphasia
• Levodopa has little to no effect
• caused by damage to the brainstem

Question 3

Differences between parkinson plus syndromes vs idiopathic PD

Answer 3

Parkinson’s Plus:

• lack/decreased response to levodopa
• early onset of dementia
• early onset of postural instability
• marked symmetry of signs early on vs PD starts unilaterally
• trunk involved more than limbs
• ocular signs (vertical gaze and nystagmus)
• early autonomic signs (IE hypotension and incontinence)

Question 4

Multiple Systems Atrophy MSA

Answer 4

• autonomic failure
• severe orthostatic hypotension
• urinary dysfunction
• erectile dysfunction
• sustained gazed evoked nystagmus
• changes in cognition is LESS common
• WBOS ataxic gait
• caused by damage to the basal ganglia, cerebellum, and brainstem

Question 5

cortical basal degeneration CBD

Answer 5

• caused by damage to the frontal lobe, parietal lob, and dopamine in substantia nigra.
• Progressive dementia
• limb apraxia, usually unilateral
• apraxic speech (non-fluent)
• prominent sensory symptoms (alien hand, spatial neglect)
• impaired upward and horizontal gaze
• parkinsonism (rigid trunk, bradykinesia, NO resting tremor, marked dystonia, myoclonus)

Question 6

Lesion to substantia Nigra

Answer 6

Narrow and shuffling gait, decrease arm swing, freezing of gait, falls in late stage of the disease (PD)

Question 7

striatum vs lentiform nucleus

Answer 7

Striatum = caudate and putamen

Lentiform nucleus = putamen and globus pallidus.

Question 8

Damage to the globus pallidus

Answer 8

Causes Huntington’s disease (B athetoid and chorea movements)

Question 9

PD is caused by damage to what structure? How many neurons have to be loss before physical signs?

Answer 9

• damage to basal ganglia, (SNpc) substantia nigra pars compacta (nigra because dopamaine is black on imaging) located in the midbrain
• 60-80% are loss before physical signs

Question 10

Sporadic vs genetic presentation of PD

Answer 10

Genetic PD (10%) = Atypical presentation: younger onset, dystonia, early dementia

Question 11

H&Y scale

Answer 11

0-5: higher is worse (+1.5 and +2.5)
0 = no signs or sx
1 = unilateral sx
1.5 = unilateral plus axial
2 = Bilateral but NO balance sx
2.5 = Bilateral and MILD balance (negative pull test)
3 = mild to moderate progression with Balance deficits
4 = severe disability but still able to stand and walk independently
5 = bedridden or w/c bound if not assisted.

Question 12

non- motor signs/symptoms of PD

Answer 12

• sleep disturbances
• dysautonomia (especially orthostatic hypotension)
• constipation
• cognitive: executive function, memory, motivation, memory, attention, in later stages dementia
• affects the limbic system, depressed dopamine causes: depression, apathy, anxiety, anhedonia (inability to feel pleasure)
• increased dopamine causes (later stages with shrinking therapeutic levels): euphoria, mania, impulsivity, pleasure seeking/risky behavior

Question 13

Evidence based treatment for PD:

Answer 13

Evidence supports: 
- Pace controlled treadmill training
- forced cycling 
- LSVT Loud and Big
- Dance 
- boxing some research 
Mixed evidence: Tai Chi
No evidence yet: yoga, PWR!
Other: include cardiorespiratory training. Dual task helps with single and dual tasks but not balance. Exercise is disease modifying

Question 14

Where do cervical, thoracic, lumbar, and sacral spinal nerves exit

Answer 14

Cervical spinal nerves exit ABOVE the corresponding vertebral body
Thoracic and Lumbar spinal nerves exit BELOW
Sacral spinal nerves exit at the end of the spinal cord (L1-L2)

Question 15

Main nerve for Ankle DF

Answer 15

Anterior Tib innervated by the deep fibular nerve (L4 - S1) . Nerve wraps around fibular head.

Question 16

Modified Rankin Score

Answer 16

• recommended for acute care stroke and rehab stroke
• score: 0- 5; higher = worse
• 0: no symptoms at all
• 1: no significant disability despite symptoms. Can carry out all usual activities
• 2: slight disability; unable to carryout all previous activities but look after own affairs
• 3: Moderate disability: requires some help but able to walk without assistance
• 4: Moderate - severe disability: unable to walk without assistance and able to attend to own bodily needs without assistance
• 5: severe disability: bedridden and requiring constant nursing care and attention
• 6: Dead

Question 17

What is the highest level of complete SCI where it’s POSSIBLE to perform EVEN transfers Independently

Answer 17

possible at C6 (independent to some assistance)

Question 18

What is the highest level of complete SCI where it’s POSSIBLE to perform UNEVEN transfers Independently

Answer 18

possible at C7 (independent to some assistance)

Question 19

What is the highest level of complete SCI where it’s POSSIBLE to be independent with manual w/c indoors

Answer 19

C6

Question 20

What is the highest level of complete SCI where it’s POSSIBLE to be independent with manual w/c outdoors

Answer 20

outdoors level ONLY = C7

Question 21

What SCI level starts functional ambulation?

Answer 21

Functional ambulation starts at T10

Question 22

Highest SCI level someone could be independent with Ambulation?

Answer 22

T10 -L1 patient could be independent (or require some assistance) to amb with KAFO and AD short distances

Question 23

Highest SCI level for limited household ambulation

Answer 23

T11- T12

Question 24

Highest SCI level for independent house hold ambulation

Answer 24

L1

Question 25

Highest SCI level for limited community ambulation

Answer 25

L1

Question 26

Highest SCI level for full community ambulation

Answer 26

L3

Question 27

nominal vs ordinal vs interval vs ratio

Answer 27

- nominal: yes/no; male/female - ordinal: ranking order with no set intervals IE first, second, third or good, fair, poor - intervals: has set intervals IE temperature, but NO true zero - Ratio: set intervals and true zero. IE ambulation distance and time.

Question 28

symptoms for AICA stroke

Answer 28

- AKA lateral pontine stroke | - symptoms: same side ataxia, contrallateral weakness, contrallateral decreased pain and temperature, vertigo/nausea

Question 29

symptoms for PICA stroke

Answer 29

- aka lateral medullar stroke or wallenberg syndrome - symptoms: same side ataxia, contralateral decreased pain and temperature of the body, same side for face, dysphagia/dysarthria, nausea/vertigo, horners syndrome (ptosis (eyelid droop), mtosis (pupil constriction), and decreased sweating on same side due to sympathetic trunk involvement)

Question 30

definition of therapeutic index

Answer 30

The RATIO between toxic dose in 50% of subjects to the effective dose in 50% of subjects

Question 31

watershed stroke

Answer 31

- ischemia to distal branches of main cerebral arteries, caused by hypofusion - results in proximal weakness with distal strength ok - "barrel man"

Question 32

Lacunar stroke

Answer 32

stroke to distal branches of MCA which supply the basal ganglia and internal capsule - high incident in elderly and with HTN

Question 33

what functions are spared in ALS?

Answer 33

sensory, bowel and bladder, cognition, and ocular motor

Question 34

Primary Lateral sclerosis (PLS)

Answer 34

UMN only; better prognosis then classic ALS but may progress to classic ALS

Question 35

Progressive Spinal Muscular atrophy (PMA)

Answer 35

LMN only

Question 36

typical ALS

Answer 36

UMN early on, followed by LMN signs

Question 37

Chronic inflammatory demyelinating polyneuropathy (CIDP) vs GBS

Answer 37

CIDP has chronic progressive course of 2 or more months or relapsing weakness vs BGS rapidly progresses 2-6 weeks. CIDP is more likely to have sensory signs (paresthesia, pain, loss of somatosensory feedback), CIDP is less likely to have preceding illness; independent amb is often maintained in CIDP, autonomic dysfunction and respiratory insufficiency is less common in CIDP. - FOR BOTH: it's important to monitor overwork weakness and DOMS 1-5 days post activity

Question 38

GBS test results

Answer 38

- Nerve conduction velocities are abnormal/decreased. - distal compound motor action potential (CMAP) predicts prognosis. poor outcome is CMAP is < 20% of normal at 3-5 weeks - elevated CSF proteins

Question 39

CIDP test results

Answer 39

- elevated CSF protein levels - slowed/decreased nerve conduction velocities - prolonged distal motor latency - partial motor conduction block

Question 40

better prognosis if diagnosis earlier

Answer 40

ALS and MS | also worse prognosis if male for MS

Question 41

ALS test results

Answer 41

- nerve conduction velocity testing: usually normal BUT could be slightly slowed. - EMG: reduction in the number of motor units, fibrillations (small) and positive sharp waves, fasciculations (larger). Signs of reinnervation = long duration polyphasic units

Question 42

MS test results

Answer 42

- MRI of brain and SC will see plaques and atrophy ( need 2 lesions and 2 attacks to dx unless > 1 yr then just 2 lesions) - evoked potentials (visual) - just tells you if optic tract is intact - CSF: oligoclonal bands (just tells you if there is inflammation)

Question 43

EDSS scoring

Answer 43

1 - 10 with .5 increments; Higher = worse 0 - 4.5 = Independent ambulation 5.0 - 7.5 = Impaired / limited ambulation 8.0 - 9.5 = restricted to w/c or bed 10 = dead Ambulation: 5. 0 = 200 meters 5. 5 = 100 meter 6. 0 = unilateral / intermittent assistance 6. 5 = constant or bilateral assistance 7. 0 = 5 meters 7. 5 = steps 0 - 3.5 = normal to mild 4. 0 -5.5 = mild to moderate 6. 0 -7.5 = mod to serve 8. 0 -9.5 = severe

Question 44

Error based learning vs reinforcement learning locations

Answer 44

- Error based learning (error data and trial by error) = cerebellum - Reinforcement learning (No error data; binary outcome only; successful movements will be reinforced) = basal ganglia

Question 45

Feed forward vs feed back mechanism motor responses

Answer 45

- Feed forward (anticipatory / know it's coming) = cerebellar - Feed back (reactionary / don't know it's coming) = brain stem and SC

Question 46

Evidence Based Treatment: Cerebellar

Answer 46

- external cueing (rhythmic auditory stimulation, EMG, and visual biofeedback - case studies for loading trunk (considered compensatory), no evidence for loading limbs - balance training to include static, dynamic, and optokinetic stimulation - dynamic balance and whole body movements over limb coordination - utilize reactive feed back reactions (Brain stem and SC) and reinforcement learning (BG) to compensate for damaged cerebellar

Question 47

Evidence Based Treatment: Cerebellar

Answer 47

- adaptation exercises (VOR retraining): used mostly for unilateral hypofunction - substitution (dissociation of head and eye movement): used for CNS dysfunction and bilateral hypofunction, when there is no vestibular system. - Habituation (desensitization): unilateral hypofunction and central vestibular

Question 48

Evidence Based Treatment: TBI

Answer 48

• Address self efficacy • Increase executive function • Restrict activities/environment first then add distractions and environmental challenges / dual tasks as motor ability improves • Encourage cardiorespiratory fitness program • Address coordination and posture .Address balance deficits because they are more related to h/o falls than attention/dual tasks

Question 49

CIMT protocol

Answer 49

need 10 degrees finger extension, 20 degrees wrist extension, no cog or sensory deficit. Training paretic UE for 6hrs a day x 2 weeks. Restraint of UE 90% of waking hours during this time

Question 50

how to prevent shoulder pain in manual w/c

Answer 50

- Strengthening of posterior shoulder muscles for power and endurance - Strengthening of shoulder external rotators - Stretching anterior shoulder structures - Biofeedback training - Arm ergometry - move wheels forward - push with a semicircular pattern which has more time in push phase vs recovery phase and hands fall below the push rim during the recovery phase. - move the wheels forward, although this makes the w/c less stable.