Upgrade to remove ads
Only $2.99/month

Advanced Lab/rehab test 2

Terms in this set (84)

Souque's phenomenon
Elevate the shoulder above 90, with facilitation, causes extension of the wrist
Ramiste's phenomenon
Resistance to abduction or adduction produces a similar response in the opposite limb
Epineurium
Dense connective tissue that surrounds entire nerve including fascicles and blood vessels.
Perineurium
Coarse connective tissue that bundles fibers into fascicles
Endoneurium
Delicate connective tissue around individual nerve fibers in nerve
Fasicles
Bundle of nerve fibers bound by a connective tissue
Class 1 neuropathy: Alternative name, definition, and examples
1. Neuropraxia

2. Involves one form of local blockage. Conduction slows down across that point in the nerve. Conduction above and below the blockage is usually normal.

3. Bell's palsy-facial nerves
3.2 Saturday night palsy-Radial nerve compression in spiral groove
3.3 Carpal tunnel syndrome
3.4 Pressure over the peroneal nerve at the fibular head
Class 2 neuropathy: Alternative name, definition, and define Walerian degeneration
1. Axonotmesis

2. The neural tube is intact, but axonal damage has occurred with Wallerian degeneration distal to the lesion. This may be a progressive condition as a result of long-standing neurapraxia or it may occur from a traumatic lesion. (May not heal completely)

3. Wallerian degeneration- Atrophy in muscle loss associated with loss of innervation, therefore the muscle cells cannot regenerate. As muscle cells degenerate, they are functionally useless (unable to contract to produce movement) fibrosis scar tissue
How quickly does a nerve heal?
1-4 mm per day
Class 3 neuropathy: Alternative name and definition
1. Neurotmesis (Total severance)

2. Involves a total loss of axonal function, with disruption of the neural tube. Conduction ceases below the lesion. Recovery is dependent on proper orientation of axons as they regenerate.
Polyneuropathies
Typically result in sensory changes, distal weakness, and hyporeflexia. Neuropathies can be related to general medical conditions, such as diabetes, alcoholism, renal disease, or malignancies; they may result from infections, such as leprosy or Guillain-Barre syndrome; and they may be associated with metabolic abnormalities, such as malnutrition or the toxic effects of drugs or chemicals. Polyneuropathies may be manifested as axonal damage or demyelination of axons.
Schwann cells
Supporting cells of the peripheral nervous system responsible for the formation of myelin. (Help regenerate a nerve)
Cervical plexus: Nerve root numbers, and what they innervate
1. C1-C4

a) C2- Sternocleidomastoid
b) C3-C4, Branches to trapezius, levator scapulae, middle scalene
c) C4 branch to the anterior scalene
d) Phrenic nerve (C3-C5)- Comes from the cervical plexus and is the sole motor supply for the diaphragm
Brachial plexus: Nerve root numbers contained, and what course it follows
1. C5-T1

a) Runs from the neck to the axilla passing between the clavicle and the first rib

b) The cords form the nerves to the arm, median, ulnar, radial, and musculocutaneous nerve
Lumbosacral plexus nerve root numbers
L1-S5

Innervates the legs
Explain the different clinical signs of Upper and lower motor neuron lesions
Upper: Spasticity, no atrophy or fasicullations, hyperreflexia, and positive for babinski and clonus

Lower: Flaccid, marked atrophy and fasiculations, HYPOreflexia, and no babinski or clonus.
At what level must an injury be to have normal use of the diaphragm?
C-5 Is normal

Diaphragm is weak around C-3 and C-4
If you lose function of the serratus anterior, what nerve must be injured?
The long thoracic nerve, C5-7
Carpal tunnel syndrome: What tests can you use to diagnose this?
Compression of the median nerve as it passes between the ligament and the bones and tendons of the wrist

Phalens
Reverse Phalens
Tinel's sign
Thoracic Outlet Syndrome: What tests can you use to diagnose this?
Compression syndrome of upper limb neurovascular bundle at the level of scalene muscles and first rib.

Signs and symptoms: Muscle weakness, cramps in the forearm, pain in the arm and hand, etc.

Tests:
EAST/Hands up Test
Adson manuever
Allen manuever
Costoclavicular test
Provocative elevation test
Damage to what nerve causes drop foot?
Common Peroneal nerve
Damage to what nerve causes drop wrist?
Radial nerve
Signs and symptoms of median nerve damage?
Aching pain in the forearm exacerbated by repetitive use

If carpal tunnel syndrome is present, paresthesia and dysesthesia are more common.
Signs and symptoms of ulnar nerve damage
Commonly there is isolated motor weakness without any sensory loss. When this is seen in the ulnar distribution, ulnar neuropathy should be immediately suspected. Hypothenar muscles are often involved, but if the lesion is distal enough, these muscles may be spared.
Signs and symptoms of radial nerve damage
High radial nerve lesions typically present with weakness of wrist extension and finger extension. Occasional cases of crutch palsy, in which the radial nerve is injured at the axilla, will present with triceps weakness as well as more distal involvement. Sensory complaints usually involve the dorsum of the hand, although this distribution is variable.
29 is a trick question. The answer is in the question. VERY SIMPLE!
29 is a trick question. The answer is in the question. VERY SIMPLE!
What are the causes of stroke?
1. Thrombosis (blood clot)
2. Embolus (abnormal particle; air, or part of a clot)
3. Hemorrhage (excessive bleeding)
Difference between afferent and efferent impulses. Which part of the spinal cord do each go to?
Posterior: Sensory/Afferent (go to the brain)
Anterior: Motor/ Efferent (leave the brain)
Risk factors for stroke
HTN, Heart disease, diabetes mellitus, Arteriovenous malformation (tangled arteries), as well as others (TIA, atrial fibrillation, left ventricular hypertrophy, congestive heart failure, cigarette smoking, coronary artery disease, alcohol consumption, cocaine use, obesity, and high serum cholesterol.)
homonymous hemianopsia
A vision field disorder in which the patients experience loss of vision in the contralateral half of one eye and temporal half of the eye corresponding the hemiplegic side
Visual agnosia
inability to recognize objects
thalamic pain syndrome
a condition caused by damage to the thalamus resulting in burning or tingling sensations and possibly hypersensitivity to things that would not normally be painful such as light touch or temperature change
aphasia
impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).
Dysarthria
difficulty forming words
Dysphagia
difficulty swallowing
Flaccidity
Hypotonicity; is present immediately after a stroke and is due to cerebral shock. It is generally short-lived, lasting hours, days, or weeks. Flaccidity may persist in a small number of patients with lesions restricted to the primary motor cortex or the cerebellum
Spasticity
Hypertonicity; emerges in about 90% of the cases and occurs on the side of the body opposite the lesion predominately in antigravity muscles. The effects of spasticity involve restricted volitional movement, static posturing of the limbs, and in severe cases, the development of contractures.
How do you determine the level of lesion?
The last functioning level with a 3+ muscle strength
Philum terminale
A delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris.
Where does the spinal cord end?
Approximately L2
What part of the spinal cord comes after L2?
None, it is the cauda equina, which is just a collection of peripheral nerves
What is the most common non-traumatic spinal cord problem found at birth, name the specifics and their definitions
Spina bifida

1. Occulta- asymptomatic

2. Meningocele- Meninges protrude but not the chord itself, has some weakness

3. Myelomeningocele- Membrane and spinal cord protrude out the back, can lead to paraylis
Most common way to fracture a neck?
Neck flexion
Where is the thermoregulatory center? What level of the spinal cord would be too high?
hypothalamus; Must be lower than a T-6 for proper thermoregulation. Hypothalamus can no longer regulate sweating below level of lesion.

Ability to shiver is lost
TIA stroke
Temporary interruption of blood supply to the brain. Symptoms may last for only a few minutes or for several hours, BUT do not last more than 24 hours total. After the attack, there is no damage or permanent neurological dysfunction.
Minor stroke
Occurs when stable, but minor deficits are present
Major stroke
Occurs when stable, usually severe defects are present
Deteriorating stroke
Refers to the patient whose neurological status is deteriorating after admission to the hospital. This change in status may be due to cerebral or systemic causes.
Young stroke
Term used to describe a stroke affecting individuals below the age of 45. They may have better potential for recovery.
orthostatic hypotension
Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions
(Worse for spinal cord pt.'s)
diaphragmatic breathing
breathing with the use of the diaphragm to achieve maximum inhalation and slow respiratory rate.
Glossopharyngeal breathing
"Frog breathing"
Use tongue to push air into airway - swallow air.
USED FOR: High SC injury (if ventilator fails)
Ways to help spinal cord pt.'s breath
Strengthening exercises
Stretching exercises
Assisted coughing
Abdominal support
Postural drainage
IPPB (Intermittent positive pressure breathing)
Complications of SCI: Autonomic dysreflexia
Acute onset of autonomic activity caused by noxious stimuli below the level of lesion
Initiates a mass reflex resulting in elevation of BP: MEDICAL EMERGENCY!

Occurs in lesions above T6

Uncommon after 3 years post injury
Complications of SCI: Heterotopic bone formation
Osteogenesis in soft tissues below level of lesion

Typically occurs near large joints (hips or knees)

Symptoms- swelling, erythema, warmth, increased ROM

May cause ankylosis
Complications of SCIs: contractures
Due to spasticity, flaccidity, or faulty positioning
Complications of SCI: DVT
Abnormal blood clot in vessel (thrombus)

Related to loss of normal "muscle pumping"

Signs- Swelling, erythema, heat
Complications of SCI: Pain
Acute, traumatic pain

Nerve root pain

Spinal cord dysesthesias

Musculoskeletal pain
Complications of SCI: Osteoporosis
Due to changes in calcium metabolism in bone
Complications of SCI: Renal calculi
Large concentration of calcium in urine
-Predisposition to stone formation

Treatments include: dietary management and early mobility
Dermatomes
An area of the skin supplied with sensory fibers of a spinal nerve
Stimulatory or Inhibitory- Quick Stretch
Stimulatory
Stimulatory or Inhibitory-Light touch
Stimulatory
Stimulatory or Inhibitory- Maintained touch
Inhibitory
Stimulatory or Inhibitory- Joint Approximation
Stimulatory (stimulates extensors)
Stimulatory or Inhibitory- Joint traction
Stimulatory (stimulates flexors)
At what level can a para be taught to walk?
T-8
C1-3 supplies what muscles?
Mostly facial muscles, but a little bit of diaphragm
C4 supplies which muscles?
Diaphragm and trapezius
C-5 supplies what muscles?
Deltoid and biceps brachii
C-6 supplies what muscles?
Wrist extensors
C-7 Supplies what muscle? Why is this significant?
Triceps; if they have this, they can assume prone on arms
C8-T1 supply what muscles?
Hand and fingers; fine motor skills
T2-T8 supplies what muscles?
The chest muscles
T6-T12 supplies which muscles?
The abdominal muscles
L1-S1 supplies which muscles?
Muscles of the leg
S1-S2 supply which muscles?
Toe and foot muscles
S3 supplies which muscles?
Bowel and bladder muscles
How many degrees of hip flexion must there be for a pt. to safely long sit?
100
Anterior cord syndrome
Cause: Flexion injury
Areas Affected: Bilateral motor paralysis, loss of pain and temperature sensation, and no loss of vibration, proprioception, and kinesthesia
Central cord syndrome
Cause:
Hyperextension injuries
Congenital or degenerative narrowing of the spinal canal

Clinical features:
Motor loss is greater than sensory loss
Upper extremities more involved than lower extremities
Posterior cord syndrome
Rare: Damage is to the posterior column only!

Cause: Late stage syphilis

Clinical features:
Loss of proprioception/kinesthesia
No motor paralysis
No loss of pain and temperature sensation
No loss of light touch
Brown-Sequard Syndrome
Cause: Stab wound or gunshot wound

Clinical features ipsilateral to lesion:
Motor paralysis
Loss of light touch, vibration, proprioception, kinesthesia

Contralateral to the lesion
Loss of pain and temperature sensation
What occurs from a stroke in a few hours to weeks?
Day 1: In the first few minutes, the lack of blood flow sets off a chain of pathoneurological events that are possibly reversible for the first 3 hours

Day 3-4: Brain reaches its maximum accumulation of fluid

Week 3: Most swelling now disappears.
YOU MIGHT ALSO LIKE...