Neuro

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jessiekate22
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171315
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Neuro
Updated:
2012-09-17 05:16:42
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  1. What is a watershed infarct?
    - where no defined area if the cause of a bleed. shared eg MCAand ACA
  2. What is hemiplegia?
    - complete loss of movement
  3. What is hemiparesis?
    - weakness
  4. What is aphasia?
    - difficulty with language
  5. What are possible primary impairements from stroke?
    • - motor- ataxic
    • - sensory- tactile, kinaesthetic, visual, vestibular,
    • - language- aphasia
    • - perceptual- congitive- slow processing, attention, memory
    • - behaviour- positive, negative
  6. What causes mm weakness?
    • - decrease in descenging inputs to lower motor neuron
    • - decreased number of motor units activated
    • - decreased motor unit discharge rate
    • - dsrupted motor unit synchronisation
  7. How will a pt present with hemiparesis?
    • - slowness in force generated
    • - altered length tension relationship
    • - deficient force output: generation and sustained
    • - stroke pts can sustain a forced contraction
  8. What are the usual patterns for hemiparesis weakness?
    - usually UL flexors weaker than extension
  9. What is dexderity?
    • - is the ability to carry out a motor task precisely, quickly, rationally and deftly with flexibility with respect to the changing environment
    • - hard to assess as it relies on strength
  10. What are the presentationsof problems with dexterity?
    • - loss of smoothness
    • - indirect trajectories
    • - disrupted inter-jt coordination
  11. What are ptterns of synergistic movements?
    • - both loss ofstrength and dexterity probably contribute to abnormal synergies
    • - actions are perormed in the most biomechanically effective manner given the impairements- response give coordination and strength comb
    • - flexor or extensorsynergies in both UL and LL
  12. When people go to do a mvoemetn they auto go into flexor syngery, what is this movement?
    • - scapular elevation and retraction
    • - shoulder flexion and abduction
    • - elnow flexion
    • - frearm supination
  13. When people go to do a mvoemetn they auto go into extensor syngery, what is this movement?
    • - scap protraction
    • - shoulder adduction and internal rot
    • - elnow extension
    • - forearm pronation
  14. What are positive motor impairements?
    • - spasticity 
    • - extensive motor activity- effor tone, iradation, assocatied reactions
  15. What is spacticity?
    • - velocity dependent while moving jt
    • - develops over time (flaccid 4-6 weeks) but will develop over time
  16. LMN- spasticity occurs sooner
  17. Effort tone- trying so hard pt recruit everything
  18. Irradation- no specific activation trying to activate on emm it spills over to the other mm
  19. Associated reactions- eg when doing something else eg walking arm moves upinto contracted position 
  20. WHat are the positive motor impairments: Involventary movements disorders?
  21. Sensory impairements what are you test?
    • - tactile and kinaethetic
    • - sensory loss is complex and mulitfactorial 
    • - you cannot predict sensory recovery
    • - it common in > 60% of stroke pts
  22. What are the tests used to assess tactile problems?
    • - texture discrimination 
    • - 2 point discrimination
    • -point localisation
    • - sensory inattention (perceptual rivarly)
    • - light touch
    • - pressure
    • - vibration
  23. What are the tests used to assess kinaesthetics?
    • - proprioception
    • - sense of movement
    • - sense of heaviness
    • - pain
    • - temp
    • - stereognosis (recognise objects being placed in hand)
    • - graphaesthis (sensation of writing on hand)
  24. What are implications of sensory impairments?
    • - decreased ability to pick up and manipulate objects
    • - decreased ability to use an appropriate level of force during grasp and manipulation (esp without vision)
    • - dereased spontaneous use of hand because of lack of input
    • - implications for functional lower limb, or feel amount of wiehgt through it or detect mm contraction
    • - safety implications (wounds, burns)
    • - inability to integrate sensory feedback results in imapired ability to learn new motor skills
    • - learn non- use- may be nothing wrong withmotor control, pt doesnt have sensation and dont use it. Pt limb gets weak and brain- use it or lose it
    • - if you tie up a god arm they have to use a bad one
  25. How can you tell if a pt has sensory impairements- vestibular?
    • - vertigo and nausea
    • - disorientation to gravity (pusher syndrome) = oreintation of vertical and favour bad side
  26. Visual sensory imapirements
    • - incidence of homonomous hemianopia 8.3% in stroke survivors
    • - visuo- spatial neglect
  27. Sesnory impairements: Vision picture
  28. What are the primary impairements?
    • - motor
    • - sensory impairements
  29. What are secondary MS impairments?
    • -length associated- contracture, stiffness
    • - use- asociated- disue atrophy, oedema, subluxation (missuse handling)
    • - pain- trauma induced (handling), injury induced (pt conflict self)
  30. What is a contracture?
    • - loss of passive jt range, it involves shortening and stiffness
    • - mm immobilised in a shortene position demonstrated- a loss of scromeres in series, an increase proportion of connective tissue in mm
  31. What mm are at risk of mm contractures?
    • - gastrocs
    • - hip flexors
    • - hamstrings
    • - neck mm
    • - wrist flexors
    • - finger flexors
  32. Secondary MS Impairments: stiffness
    • - altered ratio of connective tissue to mm tissue
    • - increased number of actin-myosin cros links
    • - behaviour and type of extra-sacromeric proteins
    • - decreased connective tissue extensibility due to tissue dehydration
    • - decreased lubrication causing adhesions between collagen fibres
  33. How can you prevent contracture?
    • - having adequate length
    • - even tho mm is stiff
  34. What accors with mm atrophy?
    - keep moving mm
  35. How does mm atrophy occur?
    • - overtime with disuse
    • - motor unit changes
    • - decrease number of motor units
    • - decrease of type 2- fast twitch, phasic mm fibres- used for speed movts fatigue quickly
    • - increase number of type 1, slow twitch fibres
    • - change in recruitment order
    • - decrease mm cross- sectional area
  36. Pt assessment
    • - history on file
    • - subjective history and observation
    • - motor screen
    • - sensory screen
    • - functional tests (MAS)
    • - dexterity
    • - balance
    • - reflexes
    • - spasticity
    • -vision
    • - cranial nerves

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