1. Peripheral Nervous System
    • Efferent fibers: anterior root carying MOTOR info AWAY from CNS
    • Afferent fibers: posterior root carrying SENSATION info TO CNS
  2. Autonomic Nervous System
    • Sympathetic: prepares body for emergency response, norepinephrine, stimulating response
    • Parasympathetic: conserves/restores energy, acetylcholine, inhibitory response
    • impulses often unconcious
    • controls BP, HR, RR, body temp, digestion, metabolism, electrolyte balance
  3. Somatic Nervous System
    • motor nerve fibers send info directly to skeletal muscle wihtout intervening synapses
    • controls voluntary movements and all five senses
  4. Limbic system
    • control and expresses mood/emotion
    • processes and stores recent memory
    • control olfaction and appetite
  5. General Hemisphere Descriptions
    • Left: language, analytical, logical, rational, sequence, language comprehension, express positive emotion
    • Right: nonverbal response, hand-eye coordination, kinesthetic awareness, music, body image awareness, express negative emotions
  6. Hippocampus
    • lower temporal lobe
    • forms and stores new memories (personal & declarative)
    • memory indexer for long term storage
  7. Basal ganglia
    • white matter of cerebrum
    • caudate, puatmen, globus pallidus, substantia nigra, subthalamic nuclei
    • voluntary movement, regulation of autonomic movement, posture, muscle tone, motor response control
    • Parkinson's, Huntingtons, Tourettes, ADD, OCD
  8. Amygdala
    • Temporal Lobe
    • emotional and social processing
  9. Thalamus
    • relay or processing station- sensory & movement with other parts of brain and SC
    • can cause thalamic pain syndrome (spontaneous pain on contralateral side
  10. Hypothalamus
    • receives and integrates info from ANS & assists hormones
    • hunger, thirst, sexual behavior, body temp, adrenal & pituitary gland
  11. Subthalamus
    • regulates movements produced by skeletal muscles
    • associates with basal ganglia & substantia nigra
  12. Epithalamus
    • Secretes melatonin
    • circadian rhythm and internal clock
  13. Midbrain
    • includes tectum and tegmentum
    • relays info passing from cerebrum, cerebellum and SC
  14. Cerebellum
    • Fine tunes movements and assists with posture
    • rapid alternating movements
    • muscle tone
  15. Pons
    • regulates RR
    • orients head to visual and auditory info
  16. Medulla Oblongata
    influences ANS and regulates RR and HR
  17. Typical Problems with Specific Lobe Damage
    • Frontal: paralysis and apraxia to loss of executive functions and goal directed behaviors, Broca's area
    • Parietal: sensory awareness, interpretation, perception, abnormal movement patterns
    • Temporal: short and long term memory, Wernickes, require more demonstrations for therapy
    • Occipital: cortical blindness will affect pt's ability to receive but not perceive visual info
  18. Blood Supply to Brain and Main impairmetnts
    • Anterior Cerebral Artery: paraplegia, incontinence, aphasia, personality changes, apraxia & agraphia, neglect
    • Middle Cerebral Artery (most common): contralateral hemiplegia & sensory impairment, Wernickes or Brocas aphasia, impairments are lobe dependent
    • Posterior Cerebral Artery: thalamic pain syndrome and cortical blindness
    • Vertebral-Basilar Artery: locked in syndrome, coma, vegetative state
  19. Meninges of SC
    • dura mater: outer most meninge
    • arachnoid: middle meninge, surrounds the brain
    • pia mater: inner most meninge, covers contour of brain
    • Meningitis: inflammation of meninges, fever, headache, vomitting, stiff and painful neck, Brudzinski's sign, Kernig's sign
  20. Hydrocephalus
    • increase of CSF (which provides nutrients to CNS)
    • spina bifida, choroid plexus, neoplasm, CP, tumor, meningitis, encephalocele
    • signs of hydrocephalus or blocked shunt: headache, vision change, large veins on scalp, seizures, vomitting, sunsetting
  21. Ascending (sensory) tracts
    • Fasiculus cuneatus & gracilis (posterior & dorsal column): proprioception, vibration, 2 point discrimination, graphesthesia
    • Spinocerebellar tract (dorsal and ventral): joint sense, trunk & LE posture, tension in muscles
    • Spino-olivary tract: cutaneous and proprioceptive organs
    • Spinoreticular tract: reticular formation that influences level of conciousness
    • Spinotectal tract: spinovisual reflexes, eye movements & head orientation to stimuli
    • Anterior Spinothalamic: light touch and pressure
    • Lateral Spinothalamic: pain and temperature
  22. Descending (motor) tracts
    • Corticospinal anterior: ipsilateral voluntary, discrete, skilled movement
    • Corticospinal lateral: contralateral voluntary, discrete, silled, movement
    • Reticulospinal: voluntary and reflex activity through alpha and gamma motor neurons
    • Rubrospinal: gross postural tone, facilitating flexors, inhibiting extensors
    • Tectospinal: contralateral postural muscle tone
    • Vestibulospinal: gross postural adjustments after head movement, facilitate extensors, inhibit flexors
  23. Peripheral Nerve Classification (A, B, C)
    • A fibers: large & myelinated so high conduction rate- alpha (motor, Golgi organs), beta (touch, kinesthesia), gamma (touch, pressure), delta (pain, touch, pressure, temp)
    • B Fibers: medium & myelinated- fibers of ANS
    • C Fibers: small & poorly myelinated- pain, temp & touch
  24. Cranial Nerves
    • I Olfactory: smell
    • II Optic: sight
    • III Oculomotor: eye movement
    • IV Trochlear: eye movement
    • V Trigeminal: face sensation, jaw movement
    • VI Abducens: lateral eye movement
    • VII Facial: face muscles, taste
    • VIII Vestibulocochlear: hearing and balance
    • IX Glossopharyngeal: taste, gag reflex, swallow
    • X Vagus: taste, gag, swallow, Ahh
    • XI Accesory: SCM and Trap
    • XII Hypoglossal: tongue movement
  25. Superficial Reflexes
    • abdominal reflex: T8-L1, abdominal contraction after touching umbilicus
    • corneal reflex: trigeminal and facial nerves, both eyes will blink when touch 1 with a cotton swab
    • cremasteric reflex: L1-L2, scratch medial thigh and ipsilateral testicle will elevate
    • gag reflex: glossopharyngeal and vagus nerve, stimulate back of throat and will gag
    • plantar reflex: L5-S1, stroke lateral aspect of sole of foot and should get flexion (if you don't = +Babinski sign)
  26. Deep Tendon Reflexes
    • Biceps Tendon: C5-C6
    • Brachioradialis tendon: C5-C6, over radius 2 inches superior to wrist
    • Triceps tendon: C6-C7
    • Patellar tendon: L3-L4
    • Achilles tendon: S1-S2
  27. Reflex grading
    • 0: no response
    • 1+: diminshed
    • 2+: normal
    • 3+: exaggerated
    • 4+: hyperactive
    • (same grading for measuring pulse)
  28. Different sensation (superficial, deep, cortical)
    • Superficial: temp, light touch, pain
    • Deep: proprioception, kinesthesia, vibration
    • Cortical: stereognosis, 2 point discrimination, barognosis, localization of touch
  29. Sensation Terms
    • graphesthesia: identify # or letter drawn on skin
    • kinesthesia: identify direction and extent of movement
    • proprioception: identify static position of extremity
    • stereognosis: identify object without sight
    • barognosis: perceive with of objects
  30. Peripheral Nerve Lesions
    • double crush: 2 seperate lesions on same nerve
    • mononeuropathy: isolated nerve lesion
    • neuroma: abnormal growth of nerve cells
    • peripheral neuropathy: dysfunction of peripheral nerves
    • polyneuropathy: symmetrical diffuse nerve dysfunction (Guillain Barre)
    • wallerian degeneration: degeneration occurring distally to myelin sheath and axon
  31. Classification of nerve injuries (neurotmesis, neurapraxia, axonotmesis)
    • Neuropraxia: mildest form, nerve fibers aren't damaged, symptoms are muscle atrophy/ numbness/ motor loss/ sensory dysfunction/ diminished proprioception-- complete recovery in 4-6 weeks
    • Axonotmesis: more severe, reversible damage to axons, nerve can regenerate distal to lesion at 1 mm per day, distal wallerian degeneration can occur, recovery is spontaneous and spotty
    • Neurotmesis: most severe, irreverible damage, flaccid paralysis and muscle wasting, all motor/sensory lost distal to lesion permanently
  32. UMN vs LMN lesions (S/S)
    • UMN: hyperactive reflexes, mild atrophy from disuse, absent fasiculations (spontaneous contraction under the skin that may be visible), hypertonicity
    • LMN: diminshed reflexes, atrophy, fasiculations present, hypotonicity
  33. UMN & LMN examples
    • UMN: (within cerebral motor cortex, internal capsule, brainstem, SC) CP, hydrocephalus, ALS, CVA, MS, huntington's, TBI, brain tumor
    • LMN: (below level of brainstem) poliomyelitis, ALS, guillain-barre, SC tumors, trauma, progressive muscular atrophy, Bell's palsy, carpal tunnel, SMA
  34. Involuntary movement disorders (tremors, tics, dystonia, athetosis)
    • Tremors: rhythmic, oscillatory movements, can have resting (Parkinsons) /postural (hyperthyroidism) /intention (MS) tremors
    • Tics: brief, repetitive coordinated movements, irregular intervals-- Tourettes
    • Chorea: brief, rapid, irregular contractions -- Huntingtons
    • Dystonia: sustained muscle contraction causing twisting, abnormal postures, repetitive movements -- Parkinsons, CP, encephalitis
    • Athetosis: slow, twisting and writhing movements, large in amplitude, brief = choreoathetosis, sustained = merge w/ dystonia -- CP, basal ganglia pathology
  35. Movement Impairment Terminology
    • akinesia: inability to initiate movement
    • asthenia: general weakness
    • ataxia: inability to perform coordinated movements
    • athetosis: involuntary movements combined with instability of posture
    • chorea: sudden, random, involuntary movements
    • clonus: UMN lesion, spastic contraction elicited by quick stretch reflex
    • cogwheel rigidity: resistance to movement with phasic quality -- Parkinsons
    • lead pipe rigidity: uniform and constant rigidity through ROM-- basal ganglia lesion
    • dysdiadochokinesea: rapid, alternating movements
    • dysmetria: inability to control range of movement
    • fasiculation: muscle twitch, suggesting LMN
    • kinesthesia: inability to perceive direction/extent of movement
    • tremor: involuntary, rhythmic, oscillatory movement
  36. Automatic Postural Strategies
    • 1st: ankle
    • 2nd: hip
    • suspensory: lower COG (squat, knee flexion)
    • stepping: regain new BOS
  37. Peripheral vs. central vertigo
    • peripheral: episodic/short, autonomic symptoms, pallor, N/V, auditory fullness, tinnitus -- BPPV, menieres, infection, DM, alcohol
    • central: autonomic symptoms less severe, loss of consciousness, diploplia, hemianopsia, weakness, numbness, ataxia, dysarthria -- meningitis, migraine, cerebellar degeneration, MS
  38. Benign paroxysmal positional vertigo
    • peripheral
    • episodes of vertigo that occur after change in head position
    • otoconia loosens and travels into the posterior semicircular canal
  39. Balance Outcome Measures
    • Berg Balance: risk for falling, 14 tasks, 56 max score, 45 increased risk of falling
    • Fregley-Graybiel Ataxia Test Battery: 8 test conditions, assess and treat balance dysfunction
    • Fugl Meyer Sensorimotor Assessment of Balance: assess balance for hemiplegia, 14 max score
    • Functional Reach Test: standing balance & risk for fall, 20-40yo normal is 14.5-17 inches
    • Romberg Test: balance and ataxia
    • Timed Up and Go: mobility and balance, walk 10 ft & sit to stands, 10 seconds independent, 30 seconds high risk for fall
    • Tinetti: increased risk for fall, assessing components of gait and sit to stands, max score 28, high risk for fall 19
  40. Fluent vs. Non-fluent Aphasia
    • Fluent Aphasia (Wernickes): aka receptive aphasia, don't really understand what they are hearing/reading and then just babble, are able to talk but have no real substance to what they are saying
    • Non-Fluent Aphasia (Brocas): aka expressive aphasia, can understand everything, but impaired with motor ability and have difficulty speaking
    • Verbal Aphasia: unable to initiate articulation of speech even though they understand task
    • Dysarthria: UMN lesion, speech is slurred
  41. Neuromuscular Pharmacology Management
    • Antiepileptics: reduce or eliminate seizures
    • AntispasticityL promote relaxation
    • Cholinergic Agents: mimics acetylcholine and binds to cholinergic receptor to create response at cellular level
    • Dopamine Replacement Agent (levadopa): relieve symptoms of parkinsons- can cause arrhythmias, hypotension, dyskinesias, want pts to take an hour before PTMuscle Relaxant Agent: promote relaxation in muscles
  42. Alzheimers
    • progressive deterioration and irreversible damage to cerebral cortex and subcortical areas
    • S/S: difficulty learning new and subtle changes, loss or orientation, word finding difficulty, depression, rigidity, poor judgement, shuffling ggait
    • no cure
  43. Amyotrophic Lateral Sclerosis
    • chronic degenerative disease
    • UMN and LMN impairments
    • demyelination oof corticospinal and corticobulbar tracts
    • symptoms vary based off initial lesion
    • S/S: asymmetrical muscle weakness (spreads distal to proximal), fasiculations, cramping, hand atrophy, movement incoordination, spasticity, clonus, positive babinski
    • later on focus on quality of life and caregiver training
  44. Bell's Palsy
    • temporary unilateral facial paralysis
    • demyelination or axonal degeneration of facial nerve
    • S/S: assymetrical facial appearance, eye drooping, eye dryness, inability to close eyelid
  45. Carpal Tunnel
    • compression of median nerve in carpal tunnel
    • etiology: repetitive use, RA, pregnancy, DM, hypothyroidism, wrist sprain
    • S/S: sensory change and parasthesia
    • treatment: splinting, ergonomic measures, corticosteroid injections
  46. Cerebellar Disorders
    • Congenital malformation
    • Hereditary ataxia: friedreichs ataxia
    • spinocerebellar ataxia
    • acquired ataxia
  47. Diabetic Neuropathy
    • nerve ischemia from microvascular disease from hyperglycemia on neurons
    • S/S: weakness and sensory distributions occur distally in symmetrical pattern
  48. Epilepsy
    • chronic conduction causing dysfunction of brain resulting in seizures
    • want to time seizures, if greater than 5 minutes CALL 911
  49. Guillain Barre Syndrome
    • acute polyneuropathhy
    • temporary inflammation and demyelination of peripheral nerves' myelin sheaths
    • motor weakness in distal to proximal progression
    • sensory impairment and possible respiratory paralysis
    • peaks within 2-4 weeks of onset
    • can be life threatening with respiratory impairment
  50. Huntington's Disease
    • degeneration and atrophy of basal ganglia and cerebral cortex
    • autosomal dominant- doesn't show up till 35-55 yo
    • movement disorder the includes affective dysfunction and cognitive impairments
    • involuntary choreic movements, mild personality alteration, grimacing, protrusion of tongue, ataxia
  51. Multiple Sclerosis
    • patches of demyelination of myelin sheaths in brain and SC decreasing nerve impulse transmission
    • S/S: visual problems, paresthesia, sensory change, clumsiness, weakness, ataxia, balance dysfunction, fatigue
    • have exacerbations and remissions
  52. Myasthenia Gravis
    • autoimmune disease affecting transmission of nerve impulses at neuromuscular junction
    • antibodies block receptors for acetycholine uptake preventing muscle contraction
    • DM, RA, lupus
    • S/S: extreme fatiguability and muscle weakness, dysphagia, dysarthria
    • can be a medical emergency if have sudden respiratory difficulty, swallowing issues, or labored talking- need anticholinesterase
    • typically on long term corticosteroids (can cause secondary osteoporosis and muscle wasting)
  53. Parkinson's Disease
    • decrease in dopamine from basal ganglia
    • S/S: resting tremor, festinating gait (shuffling), akinesia, cogwheel or leadpipe rigidity, freezing, mask like appearance of face
  54. Post Polio Syndrome
    • LMN pathology affecting anterior horn cells previously affected by polio, compensated reinnervation fails and results in ongoing muscle denervation
    • S/S: slow and progressive weakness, fatigue, muscle atrophy, pain, swallowing issues
    • emphasize lifestyle modification, adaptive equipment, functional independence
  55. Left hemisphere CVA characteristics
    weakness, R side paralysis, increased frustration, decreased processing, possible aphasia and dysphagia, possible motor apraxia, decreased discrimination, right hemianopsia
  56. Right hemisphere CVA characteristics
    • weakness
    • L side paralysis
    • decreased attention span
    • left hemianopsia
    • decreased awareness and judgement
    • memory deficits
    • decreased abstract reasoning
    • impulsive behaviors
    • decreased spatial orientation
  57. Brainstem CVA characteristics
    • unstable vitals
    • decreased conciousness
    • decreased swallowing ability
    • weakness/paralysis on both sides
  58. Cerebellum Characteristics
    • decreased balance & coordination
    • ataxia
    • nausea
    • nystagmus
    • decreased ability for postural adjustment
  59. Synergy Patterns
    • result when higher centers of brain lose control
    • have flexor/abduction/supination and extensor/adduction/pronation synergy patterns of UE and LE
  60. Seven Stages of Recovery (synergy patterns)
    • 1: no volitional movement initiated
    • 2: basic limb synnergies, spasticity begins
    • 3: synergies performed voluntarily, spasticity increases
    • 4: spasticity decreases, movement outside synergy patterns
    • 5: spasticity decreases, movement independent of synergy patterns
    • 6: isolated joint movements with coordination
    • 7: normal motor function
  61. Describe the three state model of motor learning
    • Cognitive Stage: initial stage of learning where high concentration of conscious goes to processing the information- large amounts of errors with inconsistent performance
    • Associative Stage: intermediate stage where the person is able to distinguish better what is correct vs. incorrect- decreased errors, skill refinement
    • Autonomous Stage: improves efficiency of activity without great cognitive control- automatic stage, extrinsic feedback very limited
  62. Types of feedback
    • intrinsic
    • extrinsic
    • knowledge of results
    • knowledge of performance
  63. Types of practice
    • massed
    • distributed
    • constant- task under uniform conditions
    • variable- task under varied conditions
    • random- different tasks
    • blocked- practice single task
    • whole training- entire task
    • part training
  64. Different types of learning
    • non-associative: single repeated stimulus (habituation)
    • associative: understand relationship of 2 stimuli (classical/operant conditioning)
    • procedural: learning tasks can be performed without attention- do it out of habit (repetitive practice)
    • declarative: requires attention, awareness, and reflection to obtain knowledge (mental practice)
  65. Neuromuscular Developmental Treatment (NDT)
    • patient should learn to control movement through activities that promote normal movement patterns that integrate function
    • postural control can be learned, is initiated from base of sport, and required for skill development
  66. Brunnstrom Movement Therapy in Hemiplegia
    • encouraged use of synergy patterns during rehab
    • synergies are considered primitive patterns occuring at the spinal cord
    • rarely used now because reinforced synergy patters are very difficult to change
    • developed seven stages of recovery
  67. Levels of Motor Control
    • Mobility: initiate movement through functional ROM
    • Stability: maintain position through cocontraction and tonic holding
    • Controlled Mobility: move within a weight bearing position or rotate around long axis (prone on elbows, quadruped)
    • Skill: consistently perform functional tasks and manipulate environment w/ normal posture reflexes/reactions
  68. Rood (facilitation/inhibition techniques)
    • believed all motor output was result of present and past sensory input
    • goal is to obtain homeostais in motor output and activate muscle to perform a task independent of a stimulus
    • once a response is obtained, the stimulus should be withdrawn
    • facilitation techniques: approximation, joint compression, icing, light touch, quick stretch, resistance, tapping, traction
    • inhibition techniques: deep pressure, prolonged stretch, warmth, prolonged cold
  69. Decorticate vs. Decerebrate Rigidity
    • Decerebrate Rigidity: corticospinal lesion at the brainstem resulting in extension of trunk and extremities
    • Decorticate Rigidity: corticospinal lesion at the dencephalon where trunk and LEs are extended and UEs are in flexion
  70. Specific Incomplete Spinal Cord Lesions
    • Anterior Cord Syndrome: loss of motor function and pain/temp sense below the lesion from damage to corticospinal and spinothalamic tracts
    • Brown-Sequard Syndrome: (hemisection) paralysis and loss of vibratory/position sense on same side from corticospinal tract and dorsal column, loss of pain/temp on opposite side from lateral spinothalmic tract
    • Cauda Equina Injuries: below L1 spinal level, peripheral nerve injury- flaccidity, areflexia, B&B impairment -- full recovery is typical
    • Central Cord Syndrome: damage to spinothalamic, corticospinal and dorsal columns-- UEs have greater involvement than LEs, and greater motor deficits than sensory
    • Posterior Cord Syndrome: loss of pain perception, proprioception, 2 pt discrimination, and stereognosis-- motor function is preserved
  71. ASIA scale
    • A: Complete, no sensory/motor function preserved in sacral segments S4/S5
    • B: Sensory Incomplete, sensory but no motor function is preserved below neurologic level and extends through sacral segments S4-S5
    • C: Motor Incomplete: motor functioned preserved with key muscles having < 3 MMT
    • D: Motor Incomplete: motor function preserved with key muscles having >3 MMT
    • E: sensory and motor functions normal
  72. Complications of SCI
    • DVT
    • ectopic bone: spontaneous formation of bone in soft tissue (usually adjacent to large joints)
    • orthostatic hypotension: systolic BP decreased greater than 20 mmHg
    • pressure ulcers
    • autonomic dysreflexia: sit them up, check for painful stimulus/catheter, call for help- high blood pressure, severe headache, blurred vision, stuffy nose, profuse sweating
  73. Fuctional Outcomes for SCI
    • C1-C5: mod I with power w/c, mod I with manual w/c over smooth for C5, dependent for most other things
    • C6: min to mod I for transfers, min to mod I for weight shift, mod I with power chair, mod I for manualĀ  over smooth, mod to min for manual w/c over rough terrain
    • C7-C8: mod I for smooth or rough terrain, mod I for weight shift (side/forward lean)
    • Paraplegia: mod I for everything except max to min A for ascending steps in manual w/c, household gait with KAFOs
  74. Levels of Consciousness
    • Coma
    • stupor: generally unresponsive
    • obtundity: reduced alertness to arousal, delayed responses
    • delirium: disorientation, confusion, agitation
    • clouding of consciousness: quiet behavior, confusion, poor attention
    • consciousness: alert, aware, oriented
  75. Types of Brain Injury
    • Open- direct penetration
    • Closed- no penetration (concussion, hematoma, drug overdose, drowning)
    • Primary: injury caused by impact- coup (direct lesion of brain from impact) or contrecoup (lesion is rebound effect on opposite side of brain)
  76. Rancho Los Amigos Levels
    • I: no response
    • II: generalized response
    • III: localized response
    • IV: confused/agitated
    • V: confused/inappropriate
    • VI: confused/appropriate
    • VII: automatic/appropriate
    • VIII: purposeful/appropriate
  77. Glasgow Coma Scale
    • 15 possible
    • 8 or less = severe brain injury
    • 9-12 = moderate brain injury
    • 13-15= mild brain injury
    • eye opening (4), verbal response (5), best motor response (6)
  78. Memory Impairments
    • anterograde: inability to create new memory
    • post traumatic amnesia: can't recall events since injury
    • retrograde: inability to remember events prior to injury
  79. Concepts of development
    • cephalic to caudal
    • mass to specific
    • proximal to distal
  80. Arthrogryposis Multiplex Congenita
    • non-progressive
    • restriction in utero allows for fibrosis of muscles and structures within joints
    • cylinder like extremities with minimal definition, contractures, muscle atrophy
  81. Cerebral Palsy
    • movement disorder due to brain damage, non-progressive, before or during birth
    • spastic or athetoid
    • monoplegia, diplegia, hemiplegia, or quadriplegia
  82. Down Syndrome
    • trisomy 21
    • mental retardation, hypotonia, jt hypermobility, narrow eyelids, flat feet, scoliosis, congenital heart disease, respiratory issues
  83. Duechenne Muscular Dystrophy
    • progressive, X-linked recessive trait
    • muscle contractility is lost and all muscle is replaced by fat/connective tissue
    • death usually by 25 from cardiopulm issues
    • progressive weakness, and disinterest in running, falling, toe walking
    • progressive impairment with ADLs and mobility
  84. Prader-Willi Syndrome
    • diagnosed by physical attributes and behavior patterns
    • small hands, feet and sex organs, hypotonia, almond shaped eyes, constant desire for food, coordination impairments
  85. Spina bifida
    • neural tube doesn't close sufficiently by day 28
    • occulta: no associated disability
    • meningocele: herniation of meninges and CSF into sac
    • myelomeningocele: meninges, CSF, and spinal cord extend in sac
    • motor loss below defect, sensory deficits, hydrocephalus, Arnold-chiari, osteoporosis, clubfoot, scoliosis, tethered cord, latex allergy, B&B
  86. Spinal Muscular Atrophy
    • progressive degeneration, autosomal recessive
    • Acute infantile: life expectancy less than a year
    • chronic childhoold: life expectancy into adulthood, slower progression
    • Juvenile SMA: typically survive into adulthood
    • S/S: progressive muscle weakness and atrophy, diminished deep tendon reflexes
  87. Legislation Acts for Children
    • IDEA: individuals with disabilities education improvement act- required children with disabilities to be served in regular school setting
    • No child left behind: requires accountability for all children, including disabled individuals
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