Neuro

• Efferent fibers: anterior root carying MOTOR info AWAY from CNS
• Afferent fibers: posterior root carrying SENSATION info TO CNS

• 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

• motor nerve fibers send info directly to skeletal muscle wihtout intervening synapses
• controls voluntary movements and all five senses

• control and expresses mood/emotion
• processes and stores recent memory
• control olfaction and appetite

• 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

• lower temporal lobe
• forms and stores new memories (personal & declarative)
• memory indexer for long term storage

• 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

• Temporal Lobe
• emotional and social processing

• relay or processing station- sensory & movement with other parts of brain and SC
• can cause thalamic pain syndrome (spontaneous pain on contralateral side

• receives and integrates info from ANS & assists hormones
• hunger, thirst, sexual behavior, body temp, adrenal & pituitary gland

• regulates movements produced by skeletal muscles
• associates with basal ganglia & substantia nigra

• Secretes melatonin
• circadian rhythm and internal clock

• includes tectum and tegmentum
• relays info passing from cerebrum, cerebellum and SC

• Fine tunes movements and assists with posture
• rapid alternating movements
• muscle tone

• regulates RR
• orients head to visual and auditory info

influences ANS and regulates RR and HR

• 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

• 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

• 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

• 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
• BLOCKED SHUNT = MEDICAL EMERGENCY

• 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

• 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

• 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

• 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

• 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)

• 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

• 0: no response
• 1+: diminshed
• 2+: normal
• 3+: exaggerated
• 4+: hyperactive
• (same grading for measuring pulse)

• Superficial: temp, light touch, pain
• Deep: proprioception, kinesthesia, vibration
• Cortical: stereognosis, 2 point discrimination, barognosis, localization of touch

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 1st: ankle
• 2nd: hip
• suspensory: lower COG (squat, knee flexion)
• stepping: regain new BOS

• 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

• peripheral
• episodes of vertigo that occur after change in head position
• otoconia loosens and travels into the posterior semicircular canal

• 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

• 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

• 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

• 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

• 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

• temporary unilateral facial paralysis
• demyelination or axonal degeneration of facial nerve
• S/S: assymetrical facial appearance, eye drooping, eye dryness, inability to close eyelid

• 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

• Congenital malformation
• Hereditary ataxia: friedreichs ataxia
• spinocerebellar ataxia
• acquired ataxia

• nerve ischemia from microvascular disease from hyperglycemia on neurons
• S/S: weakness and sensory distributions occur distally in symmetrical pattern

• chronic conduction causing dysfunction of brain resulting in seizures
• want to time seizures, if greater than 5 minutes CALL 911

• 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

• 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

• 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

• 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)

• decrease in dopamine from basal ganglia
• S/S: resting tremor, festinating gait (shuffling), akinesia, cogwheel or leadpipe rigidity, freezing, mask like appearance of face

• 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

weakness, R side paralysis, increased frustration, decreased processing, possible aphasia and dysphagia, possible motor apraxia, decreased discrimination, right hemianopsia

• weakness
• L side paralysis
• decreased attention span
• left hemianopsia
• decreased awareness and judgement
• memory deficits
• decreased abstract reasoning
• impulsive behaviors
• decreased spatial orientation

• unstable vitals
• decreased conciousness
• decreased swallowing ability
• weakness/paralysis on both sides

• decreased balance & coordination
• ataxia
• nausea
• nystagmus
• decreased ability for postural adjustment

• result when higher centers of brain lose control
• have flexor/abduction/supination and extensor/adduction/pronation synergy patterns of UE and LE

• 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

• 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

• intrinsic
• extrinsic
• knowledge of results
• knowledge of performance

• 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

• 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)

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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 manual  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

• 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

• 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)

• I: no response
• II: generalized response
• III: localized response
• IV: confused/agitated
• V: confused/inappropriate
• VI: confused/appropriate
• VII: automatic/appropriate
• VIII: purposeful/appropriate

• 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)

• anterograde: inability to create new memory
• post traumatic amnesia: can't recall events since injury
• retrograde: inability to remember events prior to injury

• cephalic to caudal
• mass to specific
• proximal to distal

• non-progressive
• restriction in utero allows for fibrosis of muscles and structures within joints
• cylinder like extremities with minimal definition, contractures, muscle atrophy

• movement disorder due to brain damage, non-progressive, before or during birth
• spastic or athetoid
• monoplegia, diplegia, hemiplegia, or quadriplegia

• trisomy 21
• mental retardation, hypotonia, jt hypermobility, narrow eyelids, flat feet, scoliosis, congenital heart disease, respiratory issues

• 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

• diagnosed by physical attributes and behavior patterns
• small hands, feet and sex organs, hypotonia, almond shaped eyes, constant desire for food, coordination impairments

• 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

• 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

• 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