Term
| what is the maximum score of the glasgow coma scale |
|
Definition
|
|
Term
| what is the minimum score of the glasgow coma scale if you're alive |
|
Definition
|
|
Term
| what are the 3 categories of the glasgow coma scale |
|
Definition
| eye opening, best motor response, verbal response |
|
|
Term
| what is the range of eye opening in the glasgow coma scale |
|
Definition
| no response, to pain, to speech, spontaneous |
|
|
Term
| what is the range of best motor response in the glasgow coma scale |
|
Definition
| no response, extensor response, abnormal flexion, withdraws, localizes, follows motor commands |
|
|
Term
| what is the range of verbal response in the glasgow coma scale |
|
Definition
| no response, incomprehensible sounds, inappropriate words, confused conversation, oriented |
|
|
Term
| what is the point of using the glasgow coma scale |
|
Definition
|
|
Term
| what is the point of the ashworth scale |
|
Definition
| determine spasticity and tone |
|
|
Term
| what is the best grade of the Modified Ashworth Scale |
|
Definition
| 0: no increase in muscle tone |
|
|
Term
| what is the 2nd best grade of the Modified Ashworth scale |
|
Definition
| 1+ Slight increase in muscle tone manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM |
|
|
Term
| what is a grade 2 on the Modified Ashworth scale |
|
Definition
| more marked increase in muscle tone through most of the ROM but affected part easily moved |
|
|
Term
| what is a grade 3 on the Modified Ashworth scale |
|
Definition
| considerable increase in muscle tone; passive movement difficult |
|
|
Term
| what is a grade 4 on the Modified Ashworth scale |
|
Definition
| affected part rigid in flexion or extension |
|
|
Term
| what is the worst grade of the Modified Ashworth Scale |
|
Definition
|
|
Term
| when would someone lose the entire right eye's visual field |
|
Definition
| damage to the right eye's retina or optic nerve |
|
|
Term
| describe bitemporal hemianopsia |
|
Definition
| damage to the optic chiasm affects the fibers that cross. All you will see is what comes from the fibers that don't cross (you lose what the nasal retinas see.) You have tunnel vision because you can't see out at the peripheries |
|
|
Term
| what is a common cause to damage of the optic chiasm resulting in bitemporal hemianopsia |
|
Definition
|
|
Term
| describe homonymous hemianopsia |
|
Definition
| damage to one optic tract results in loss of sight of the opposite visual field. |
|
|
Term
| if you have homonymous hemianopsia because of damage to the right optic tract, what will you be able to see |
|
Definition
| you will be able to see left nasal field and right temporal field: you can see to the right only (blindness of the left visual field) |
|
|
Term
| describe superior homonymous quadrantoanopsia |
|
Definition
| damage along a portio of the optic radiations results in partial anopsias |
|
|
Term
| describe homonymous hemianopsia with macular sparing |
|
Definition
| damage to primary visual cortex results in loss of large area of visual field with macular sparing |
|
|
Term
| what should be considered first in a physical therapy evaluatoin of neurological disorders |
|
Definition
| functional issues/concerns and goals of the patient and/or family |
|
|
Term
| after determining functional problems, what is the next step of a pt eval for neurological disorders |
|
Definition
| try to determine which impairments contribute to the functional problems. |
|
|
Term
| after determining functional problems and impairments, what should be done next in a PT eval |
|
Definition
| identify which impairments and functional limitations can be changed with PT and use this to plan your intervention |
|
|
Term
| what information should you get in a patient's history |
|
Definition
| nature of the problem; circumstances/time frames/environmental factors; results of radiology/EMG/NCV; surgeries; medications/treatment; social history; equipment |
|
|
Term
| what are the components of a PT examination |
|
Definition
| vitals, PROM, movement control, posture, function |
|
|
Term
| what is the order of components of a neurological exam |
|
Definition
| mental status/communication, vitals, motor screen, function, gait, sensation, reflexes, cranial nerves, cerebellar |
|
|
Term
| what is involved in mental status component of neurological PT exam |
|
Definition
| check level of consciousness, orientation, communication, and memory. May be assessed through history taking |
|
|
Term
| when to check vital signs |
|
Definition
| at baseline and then after exercise |
|
|
Term
| what to check for in motor screen component of neurological PT examination |
|
Definition
| ROM, tone, voluntary movement abilities, strength |
|
|
Term
| if sensation is intact distally, do you need to test proximally? |
|
Definition
|
|
Term
| for what disorder should a very detailed sensory testing including dermatomes be performed |
|
Definition
|
|
Term
| when is checking reflexes most useful |
|
Definition
| when diagnosis has not yet been established |
|
|
Term
| when to test cranial nerves |
|
Definition
| only when indicated by patient history or diagnosis and not yet reported in medical record |
|
|
Term
| when to do cerebellar tests |
|
Definition
| if patient's diagnosis suggests possible cerebellar involvement (brain injury, tumor, or cerebellar artery CVA |
|
|
Term
| what is the continuum of mental alertness/consciousness |
|
Definition
| alert, lethargic, obtunded, stuporous, comatose |
|
|
Term
| what are 3 ways to test alertness/consciousness objectiely |
|
Definition
| glasgow coma scale, continuum, level of consciousness |
|
|
Term
| what to determine in level of consciousness |
|
Definition
| non-focal, non-lateralizing |
|
|
Term
| how to test and document orientation |
|
Definition
| ask for person, place, location, situation. Always be specific in documenting which ones they answered and how specifically |
|
|
Term
| should you check memory if you can't verify |
|
Definition
|
|
Term
| what are some ways to check memory |
|
Definition
| ask for last even recalled, immediate recall, give 3 words then ask them to recall in 3 minutes, test longterm memory by asking birthdate/hometown/age |
|
|
Term
| how to test attention span |
|
Definition
| how accurately do they follow directions, digits forward/backward, read a few sentences and ask them to raise hand on certain words, distractibility |
|
|
Term
| how to test general knowledge/presence of dementia |
|
Definition
| ask president, state, capital, governor |
|
|
Term
| how to test calculation ability |
|
Definition
| serial 7's, percentages, # quarters in a dollar |
|
|
Term
| how to test abstract thinking |
|
Definition
| simple proverbs, what would you do if…. |
|
|
Term
| other things to test in mental status |
|
Definition
| presence of hallucinations, delusions, phobias, compulsive behavior, personality, affect, behavior, cooperation, judgement |
|
|
Term
| who does the formal speech evaluation |
|
Definition
|
|
Term
| how to assess communication/language if a patient doesn't respond to questions or speak spontaneously |
|
Definition
| try yes/no questions and check ability to follow commands |
|
|
Term
| what are other terms for non-fluent aphasia |
|
Definition
| Broca's, expressive, oral motor |
|
|
Term
| what brodmann's areas are damaged in broca's aphasia |
|
Definition
|
|
Term
| what are the indicators of Broca's aphasia |
|
Definition
| non-fluent, restricted vocabulary, aware of deficits, delayed responses, perseveration |
|
|
Term
| what are other terms for fluent aphasia |
|
Definition
|
|
Term
| in what lobe of the brain is broca's |
|
Definition
|
|
Term
| in what lobe of the brain is Wernicke's |
|
Definition
|
|
Term
| are broca's and wernicke's typically in L or R side of brain |
|
Definition
|
|
Term
| what are the symptoms of Wernicke's aphasia |
|
Definition
| hyperfluency, empty speech, little awarenss |
|
|
Term
|
Definition
| loss affects both Wernicke's and Broca's, combining elements of the 2 with severe deficits. |
|
|
Term
|
Definition
| inability to name objects |
|
|
Term
|
Definition
|
|
Term
|
Definition
| impaired ability to write |
|
|
Term
|
Definition
| motor planning problem; usually seen with parietal lobe injury |
|
|
Term
| what is dysarthria (describe0 |
|
Definition
| problems with oral-motor mechanism due to CN involvement. Speech is difficult to understand. Slurring may be due to meds or disease/injury |
|
|
Term
| what motor things to look for in observation |
|
Definition
|
|
Term
| how to look for atrophy specifically |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| high tone, spastic, rigid |
|
|
Term
| is hypertonia or hypotonia associated with decerebrate/decorticate posturing |
|
Definition
|
|
Term
|
Definition
| involuntary movements typically seen in Parkinsons. High oscillations at rest that decrease with movement |
|
|
Term
| describe intention tremors |
|
Definition
| seen in cerebellar disease with regular oscillations that are absent at rest |
|
|
Term
| are essential tremors regular |
|
Definition
| not as regular as resting or intention tremors |
|
|
Term
|
Definition
| rapid, explosive movements, distal or proximal, irregular and upredictable, associated with low tone |
|
|
Term
|
Definition
| slow, writhing, continuous distal movements associated with high tone |
|
|
Term
|
Definition
| similar to athetosis but involves large portions of the body and may result in posturing |
|
|
Term
| general suggestions for testing muscle strength in neuro patients |
|
Definition
| use gross or specific depending on diagnosis; be systematic; use 5/5 system; observe for patterns of weakness; note substitutions |
|
|
Term
| things to focus on in movement control evaluation for neuro patient |
|
Definition
| posture, spontaneous movement, sustainability of positions, stability, isolation of movements |
|
|
Term
| what functional activities should be assessed |
|
Definition
| bed mobility, sitting balance, transfers, standing balance, ambulation, self care, endurance, safety, higher level skills/sports |
|
|
Term
| should you use assistive devices when observing gait |
|
Definition
| observe gait with as little reliance on assistive devices and physical assistance as possible |
|
|
Term
| what to look for in observing gait |
|
Definition
| gait pattern, speed, gait deviations |
|
|
Term
| what are some common gait deviations |
|
Definition
| hemiplegic, spastic, steppage, ataxic, parkinsonian, antalgic, waddling, astasia/abasia |
|
|
Term
| what should environment be like for sensation/perception testing |
|
Definition
| quiet room, avoid fatigue |
|
|
Term
|
Definition
| complete loss of touchsensation |
|
|
Term
|
Definition
| complete loss of pain sensation |
|
|
Term
|
Definition
| partial loss of pain sensation |
|
|
Term
|
Definition
| pain sensation more keenly felt than normal |
|
|
Term
|
Definition
| touch sensation more keenly felt than normal |
|
|
Term
|
Definition
| abnormal spontaneous burning, pricking, numbness |
|
|
Term
|
Definition
| noxious sensation produced by ordinary stimulus |
|
|
Term
| what tract carries pain and temperature to the brain |
|
Definition
|
|
Term
| how to test for pain sensation |
|
Definition
| use broken q tip, begin distally. |
|
|
Term
| where do pain fibers cross |
|
Definition
| at/near entry into spinal cord |
|
|
Term
| what pathway carries light touch and vibration to the brain |
|
Definition
|
|
Term
| is vibration a crossed or uncrossed pathway |
|
Definition
|
|
Term
| how to test for vibration sensation |
|
Definition
| use C 128 tuning fork over bony areas |
|
|
Term
| what pathways carrie proprioception to the brain |
|
Definition
| posterior column and spinocerebellar tracts |
|
|
Term
| how to test proprioception |
|
Definition
| move distal joints first, then move proximally if they can't feel distal; place extremity in one positoin and hve them match with other extremity; thumb find test |
|
|
Term
| how much movement can be detected with an intact proprioception systsem |
|
Definition
|
|
Term
| how to test cortical sensatiosn |
|
Definition
| 2 point discrimination, tactile localization, graphesthesia, stereognosis |
|
|
Term
| what is tactile localization |
|
Definition
| knowing where someone is touching |
|
|
Term
|
Definition
| knowing what letter someone is writing on your skin |
|
|
Term
|
Definition
| ability to identify objects without seeing them |
|
|
Term
| what are some types of perceptual deficits |
|
Definition
| unilateral neglect, right/left discrimination, agnosia, spatial deficits, many more |
|
|
Term
| what is right/left discrimination |
|
Definition
| inability to distinguish right from left |
|
|
Term
|
Definition
| inability to recognize familiar stimuli (visual, tactile, auditory) |
|
|
Term
|
Definition
| inability to recognize own body parts |
|
|
Term
|
Definition
| inability to recognize existence of impairment |
|
|
Term
|
Definition
| inability to identify fingers |
|
|
Term
|
Definition
| inability to recognize faces |
|
|
Term
| define visual spatial agnosia |
|
Definition
| inability to perceive spatial relationships |
|
|
Term
|
Definition
| inability to recognize objects through handling |
|
|
Term
|
Definition
| inability to recognize sounds |
|
|
Term
| define spatial relations deficits |
|
Definition
| impairment in preceiving spatial relations between objects or between self and objects |
|
|
Term
|
Definition
| inability to differentiate foreground from background |
|
|
Term
|
Definition
| inability to distinguish subtle variations in form |
|
|
Term
|
Definition
| inability to interpret concepts of spatila positioning of objects |
|
|
Term
| how to see if a person has difficulty with depth and distance |
|
Definition
| note when pouring liquids or reaching for objects |
|
|
Term
| define topographical disorientation |
|
Definition
| inability to perceive relationships between places (can't find way back to room) |
|
|
Term
|
Definition
| inability to perform certain skilled, purposeful movements in the absence of motor, sensory, or coordination deficits |
|
|
Term
| define constructional apraxia |
|
Definition
| impariment in producing designs by copying, drawing, or constructing |
|
|
Term
|
Definition
| inability to put on clothing correctly or in proper sequence |
|
|
Term
|
Definition
| inability to use, imitate, and understand gestures |
|
|
Term
| define ideational apraxia |
|
Definition
| inability to conceive of how to carry out a movement |
|
|
Term
| define verbal/oral motor apraxia |
|
Definition
| inability to form and organize intelligible words |
|
|
Term
| define unilateral neglect |
|
Definition
| inattention to the affect side of the body |
|
|
Term
| how to test for unilateral neglect |
|
Definition
| observations, draw a clock, draw a person, test for extinction |
|
|
Term
| what is a normal grade deep tendon reflex |
|
Definition
|
|
Term
| what is a hyporeflexive deep tendon reflex |
|
Definition
|
|
Term
| what is a hyperreflexive deep tendon reflex |
|
Definition
|
|
Term
| what is the level of the biceps tendon |
|
Definition
|
|
Term
| what is the level of the tendon DTRq |
|
Definition
|
|
Term
| what is the level of the brachioradialis DTR |
|
Definition
|
|
Term
| what is the level of the quads DTR |
|
Definition
|
|
Term
| what is the level of the achilles DTR |
|
Definition
|
|
Term
| are superficial reflexes normally present |
|
Definition
|
|
Term
| are superficialy reflexes commonly tested by PTs? |
|
Definition
|
|
Term
| what are examples of superficial reflexes |
|
Definition
| corneal, pharyngeal, scapular, abdominal, plantar |
|
|
Term
| what are brainstem reflexes important for |
|
Definition
|
|
Term
| what are the 3 brainstem reflexes |
|
Definition
| oculocephalic, oculovestibular |
|
|
Term
| how to test oculocephalic reflex |
|
Definition
| doll's eyes: turn head. Eyes lag at first then conjugately come to midline. Normally present |
|
|
Term
| how to test oculovestibluar reflex |
|
Definition
| cold water in ear canal. Normal response is tonic deviation of eyes toward stimulus. |
|
|
Term
| what are 3 pathological reflexes |
|
Definition
| clonus, babinski, hoffman's |
|
|
Term
|
Definition
| quick stretch produces repetitive, oscillating contractions. May be sustained or unsustained. Can estimate # of beats. |
|
|
Term
|
Definition
| stroke lateral sole of foot across toes. Positive if hallux extends |
|
|
Term
|
Definition
| flick the middle fingernail. Positive if thumb adducts |
|
|
Term
| are tonic reflexes pathological if present or not present? |
|
Definition
|
|
Term
| who usually tests cranila nerves |
|
Definition
|
|
Term
|
Definition
| olfactory nerve. One nostril at a time. Pungent, common odors like coffee, lemon, vanilla |
|
|
Term
|
Definition
| 1. exam with ophthalmoscope; 2. visual acutiy with Snellen chart; 3. visual fields/hemianopsia |
|
|
Term
| describe CN III, IV, VI testing |
|
Definition
| ptosis, eye movements, PERRLA, EOM intact (follows H) |
|
|
Term
|
Definition
| pupils equla, round, reactive to light, accommodating |
|
|
Term
|
Definition
| motor: clench teeth, palpate masseter, temporalis, pterygoid; sensory: sensation to ophthalmic, maxillary, mandibular |
|
|
Term
|
Definition
| facial motor: facial expressions; facial sensory taste anterior 2/3 tongue |
|
|
Term
| how to differentiate between central and peripheral facial |
|
Definition
| central: lose contralateral lower face muscles; peripheral: lose ipsilateral upper and lower face muscles |
|
|
Term
|
Definition
| vestibulocochlear; cochlear branch = test hearing: whisper, rub fingers; vestibular branch observe saccades, nystagmus, postional effects, caloric tests |
|
|
Term
|
Definition
| glossopharyngeal; test swallowing, gag reflex, taste to posterior 1/3 tongue |
|
|
Term
|
Definition
| vagus: test swallowing, gag reflex, hoarseness. Look for symmetry of uvula (uvula deviates to strong side unless both sides are weak, then no deviation.) check palatal reflex. |
|
|
Term
| what is the palatal reflex |
|
Definition
| touch plate, uvula elevates |
|
|
Term
|
Definition
| spinal accessory: motor to SCM and traps |
|
|
Term
|
Definition
| hypoglossal: stick out tongue, will deviate to weak side |
|
|
Term
| what tracts does Romberg test for |
|
Definition
| posterior column and spinocerebellar tracts |
|
|
Term
|
Definition
| close eyes and maintain standing position: positive if patient loses balance or takes a step |
|
|
Term
| what are some cerebellar tests |
|
Definition
| RAM, FNF, H-S, rebound, tandem walking, balance test (look for differences L to R, ataxia) |
|
|
Term
| for the next questions, determine if it is UMN or LMN lesion |
|
Definition
|
|
Term
| may involve brain, spinal cord, or both |
|
Definition
|
|
Term
| may be segmental (spinal root distribution) or peripheral (peripheral nerve distributlion) |
|
Definition
|
|
Term
| generally see decreased tone |
|
Definition
|
|
Term
| generally see increased tone after initial "neural shock" |
|
Definition
|
|
Term
|
Definition
|
|
Term
| atrophy and fasciculations |
|
Definition
|
|
Term
|
Definition
|
|
Term
| decreased superficial reflexes |
|
Definition
|
|
Term
|
Definition
|
|
Term
| pathological refflexes present |
|
Definition
|
|
Term
| pathological reflexes absent |
|
Definition
|
|
Term
| mental status changes may be present |
|
Definition
|
|
Term
| sensory disturbances not sharply defined |
|
Definition
|
|
Term
|
Definition
|
|
Term
| distinct pattern of sensory changes and/or pain |
|
Definition
|
|
Term
| what are the anatomical levels of localization |
|
Definition
| supratentorial, posterior fossa, spinal, peripheral |
|
|
Term
| what are peripheral levels of localization of lesions |
|
Definition
| mononeuropathies, mononeuritis multiplex, polyneuropathies |
|
|
Term
| whata re mononeuropathies |
|
Definition
| lesion involving a single nerve |
|
|
Term
| what is mononeuritis multiplex |
|
Definition
| several individual nerves are involved |
|
|
Term
| describe polyneuropathies |
|
Definition
| usually symmetrical, usually distal limbs |
|
|
Term
| describe presentation of cerebellar lesions |
|
Definition
| difficulty with intentional movements, ataxia, dysmetria |
|
|
Term
| describe presentation of basal ganglia lesions |
|
Definition
| decreased overall movement or excessive, unintentional, meaningless movement |
|
|
Term
| describe presentation of unilateral cortex lesions |
|
Definition
| sensory and motor deficits dominate on contralateral side |
|
|
Term
| describe presentationsof cortex lesions |
|
Definition
| possible aphasia, agnosia, amnesia, apraxia |
|
|
Term
| describe presentations of brainstem lesions |
|
Definition
| unilateral: contralateral sensory and motor but ipsilateral cranial nerves; bilateral: major sensory/motor loss. Lower CN involvement |
|
|
Term
| describe presentations of spinal cord lesions |
|
Definition
| unilateral: contralateral pain and temp loss, ipsilateral motor and proprioceptive loss below lesion; complete: total motor and sensory loss below lesion |
|
|
Term
| describe lesions involving radicular pain |
|
Definition
| involvement is below foramen magnum. Follows nerve root distribution |
|
|
Term
| will peripheral lesions be ipsilateral or contralateral |
|
Definition
|
|
Term
| what is the sequence of recovery for unilateral neglect |
|
Definition
| 1. patient fails to respond to stimulus on contralateral side of lesion or thinks the stimulus is on ipsilateral side; 2. patient responds to stimulus on contralateral side of lesion; 3. patient responds only to ipsilateral stimulus when bilateral stimuli are given; 4. patient responds to bilateral stimuli |
|
|
Term
|
Definition
| stereognosis, graphesthesia, right/left discrimination, draw a person test |
|
|
Term
| what does agraphesthesia indicate |
|
Definition
| left parietal lobe damage |
|
|
Term
| what is left/right discrimination |
|
Definition
| ability to identify left and right |
|
|
Term
| what part of the brain might be damaged in the case of inability to discriminate leftright? |
|
Definition
|
|
