PTA Neurology Concerns (set 1 of 2)

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PTA Neurology Concerns (set 1 of 2)
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PTA Neurology Concerns
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  1. What are the Meninges (membranes) of the brain?
    Dura-firm, outer layer

    Pia-thin inner layer connects to brain itself

    Arachnoid-the layer between pia and dura

    Subarachnoid space between arachnoidand pia containing large blood vessels
  2. What are the 3 major divisions of the brain?
    Cerebrum-thinking portion (cerebral cortex)

    Brain Stem- pons, medulla, midbrain(controls vital life sustaining functions)

    Cerebellum-controls initiation
  3. Afferent (Sensory) Nerve
    A nerve that transmits impulses to the brain for processing.

    Sensory input to spinal nerves go to brain.
  4. Efferent (Motor) Nerve
    Conducts nerve impulses from the brain to the muscles.

    Motor nerves exit from the cord to innervate muscles.
  5. What is the role of Nerve Tracts of the CNS?
    Fiber tracts bringing sensory impulses to the cortex in the cerebrum and those conveying motor impulses from the cortex cross within the brainstem to the opposite side.

    Right side of body registers sensation from the left half of the body and visa versa. This process makes “one side of the brain control the function of the opposite side of the brain”.
  6. Pyramidal Decussation
    An X-shaped crossing, especially of nerves or bands of nerve fibers, connecting corresponding parts on opposite sides of the brain or spinal cord.

    Right side of body registers sensation from the left half of the body and visa versa. This process makes “one side of the brain control the function of the opposite side of the brain”.
  7. 3 Functions of the CNS
    Controls and regulates all mental and physical functions throughout the body.

     Composed of neural tissue that includes both receptors and transmitters (think neuromuscular junction, chemical synapses)

    Dysfunction of neurons in any given area of the brain can disrupt nerve impulses, cognition, perception, uncoordinated movt, and loss of muscle force production
  8. Alexia
    loss of ability to read
  9. Aphasia
    loss of ability to produce or comprehend language
  10. Dyslexia
    difficulty with written language, especially reading
  11. Dysphagia
    difficulty swallowing
  12. Hemiplegia
    paralysis on one side of the body(left/right)
  13. Homonymous hemianopsia
    loss of half of the field of vision in each eye
  14. Nystagmus
    - involuntary movement of the eyes
  15. Saccade
    abrupt rapid small movements of both eyes
  16. AD
    Alzheimer’s Disease
  17. ALS
    Amyotrophic Lateral Sclerosis
  18. CP
    Cerebral Palsy
  19. CVA
    Cerebral Vascular Accident
  20. MCI
    Mild Cognitive Impairment
  21. MS
    Multiple Sclerosis
  22. MD
    Muscular Dystrophy
  23. OBS
    Organic Brain Syndrome
  24. PD
    Parkinson’s Disease
  25. SCI
    Spinal Cord Injury
  26. TBI
    Traumatic Brain Injury
  27. Coma
    unconsciousness and unresponsiveness resulting from disturbance or damage to areas of the brain.
  28. Confabulation
    a behavioral reaction to memory loss in which the patient fills in memory gaps with inappropriate words.
  29. 7 Important Neurological Test and Measures
    • 􀂄Cognition
    • 􀂄 Tone
    • 􀂄 Arousal
    • 􀂄 Gait
    • 􀂄 Function
    • 􀂄 Staging of Disease
    • 􀂄 Sensory Integrity
  30. Deep Tendon Reflexes
  31. Sensory testing includes:
    • 􀂄 Light Touch
    • 􀂄 Pain
    • 􀂄 Pressure
    • 􀂄 Temperature
    • 􀂄 Proprioception
    • 􀂄 Stereognosis - ability to perceive or the perception of material qualities (as shape) of an object by handling or lifting it : tactile recognition
  32. Neurapraxia-
    least severe. Pressure or ischemia to nerve but still intact. Reversible within hours to months of the injury (the average is 6-9 weeks). Wallerian degeneration does not occur
  33. Axonotmesis
    -more severe nerve injury with disruption of the neuronal axon, but with maintenance of the myelin sheath. Due to pressure or stretch. May cause paralysis of the motor, sensory, and autonomic, usu. in crush injury. Wallerian degeneration occurs. Regeneration can occur over months, years.
  34. Neurotmesis
    Most severe nerve injury due to severe contusion, stretch, laceration. Complete loss of motor, sensory and autonomic function. Forms a neuroma over the stump.
  35. Saturday Night Palsy (Radial Neuropathy)
    Substance abuse A group of transient neuromuscular defects affecting a person who falls in a stuporous state in an unnatural position, classically after an alcoholic 'binge', or overdose of sedatives.

    The patient has injured his upper arm, usually by sleeping with his arm over the back of a chair, and now presents holding the affected hand and wrist with his good hand, complaining of decreased or absent sensation on the radial and dorsal side of his hand and wrist, and of inability to extend his wrist, thumb and finger joints.
  36. Hydrocephalus
    Abnormal condition in which cerebrospinal fluid collects in the ventricles of the brain

    • Usu. Congenital with abnormally rapid growth of head, bulging fontanelles
    •      *Use shunts to relieve pressure.
    •      *Must protect shunt sites

    In adults is associated with neurological condition
  37. Scoring for Mini-Cog
    Scoring: 1 pt. for each remembered word.

    • 0=Dementia 
    • 1 or 2 with abnormal clock= Dementia
    • 1 or 2 with normal clock = Negative for dementia
    • 3 = Negative for dementia
  38. Cognitive Tests: Mini-Cog
    • 1. quick, valid, reliable 
    • 2. screens for AD

    • Takes 3 minutes.
    • 1. Give patient 3 words to remember: (ex.: ball, house, menu)

    2. Have pt. draw a clock with a particular time on it:(ex.: ten after eleven o’clock)

    3. Have pt. repeat the 3 words
  39. Cognitive Tests: Mini Mental Status Exam (MMSE)
    • 1. Quick, valid and reliable
    • 2. Useful across many dx
    • 3. Affected by depression

    • Screening tool for cognitive impairment
    •      *Older, community dwelling, hospitalized and institutionalized adults.
    •      *Age and education norms available 􀂄


    • 11-question measure
    • *Tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language.
  40. Scoring for the MMSE (Mini-Mental Status Exam)
    Max. score = 30

    • 24-30: Uncertain cognitive difficulties 
    • Note: at 25 pts. have difficulty with forms 

    18-23: Mild Impairment 

    0-17: Severe Impairment

    Score of 20 or less may suggest dementia
  41. Cognitive Tests: JAGS Cognition Screen 2006
    Remote memory: What happened to President Kennedy? Where? Who shot him?

    Recent memory: What happened on 9/11/01?(Buildings or city involved?)

    • Executive Function: 
    •         * Bread is .75/loaf. Buy 2 loaves with $2.00. Change?
    •         *Fish is $8/lb. Buy ½ lb. with $5. Change?

    Language: Name animals in a zoo/jungle/farm(Normal=>10/min.)
  42. Rancho Los Amigos Coma Scale I
    I= No response

    • II=Generalized response
    • -Chewing, sweating, moaning, moving, inc. BP, change in breathing pattern

    • III=Localized response
    • -More awake, turns to stimuli, recognize family, follow simple commands

    • IV=Confused, agitated 
    • - Confused, frightened, thrashing, overreacting, simple acts with help. May need protective room design


    •  V=Confused, Inappropriate, not agitated.
    • Short attn span, easily overloaded, focus on ADLs

    • VI= Confused, Appropriate
    • Can do simple ADL, follow schedule with assist, confused if overwhelmed by noise, hurry, changes in routine. Lack of insight


    • VII=Automatic, Appropriate
    • Can do ADL without help, follow schedule but needs supervision for planning, may be rigid and inflexible

    • VIII= Purposeful , Appropriate
    • Slow, knows he has limits and tries to compensate, can still be overwhelmed; deficits may be hidden to those who did not know him before
  43. Geriatric Depression Scale
    Valid, reliable but designed for older pts.

    • -- www.stanford.edu/-yesavage/GDS
    • -- 15 yes/no questions
    • -- 1point for bolded items
    • -- Translated into 30 languages
    • --Depression can affect cognition and vice versa 
    • Scoring: 
    • 0-5 normal 
    • 5+ depression
  44. Upper Motor Neuron (UMN)
    􀁻 A neuron starting in motor cortex of brain& ending in the medulla or spinal cord.

    􀁻 May cause spasticity
  45. Lower Motor Neuron (LMN):
    􀁻 Motor neurons connecting the brainstem and spinal cord to muscle fibers

    􀁻 Usu. Involves loss of tone, weakness, atrophy
  46. Scissoring Gait/Posture
    • 1. Assoc. with spastic CP, UMN injury 
    • 2. Rigidity and excessive adduction of the leg in swing
    • 3. Plantar flexion of the ankle 
    • 4. Flexion at the knee
    • 5. Adduction and internal rotation at the hip
    • -progressive contractures of all spastic muscles
    • -complicated assisting movements of the upper limbs when walking
  47. Spasticity
    A velocity-dependent condition where certain muscles are continuously contracted.

    • -Hypertonicity
    • -Clonus
    • -Scissoring
    • -Contactures (cx)
    • -Exaggerated deep tendon reflexes (DTR)
    • -Muscles Spasms
  48. Hypertonicity
    -increased muscle tone
  49. Clonus
    -a series of rapid muscle contractions
  50. Scissoring
    -involuntary crossing of the legs
  51. Contractures(cx)
    - Disfiguring tight joints
  52. Ashworth Scale of Spasticity
    0 No increase in tone

    1 Slight increase in muscle tone w/ catch & release or min. resistance at end of ROM in flex. or ext.

     1+ Slight increase in muscle tone=a catch, followed by minimal resistance throughout rest of ROM

    2 More marked increase in muscle tone through most of the ROM, but affected part's) easily moved

    3 Considerable increase in muscle tone, PROM difficult w/ rigidity in flexion or extension
  53. Purpose of staging diseases
    Stages help with prognosis and setting goals
  54. Parkinson’s Stages:

    United P.D. Rating Scale (UPDRS)
    --Usually paired with Hoehn & Yahr stages
    • Score: 0-55 higher score= more disability
    • Part 1: Mental status, mood, behavior
    • Part 2: ADL
    • Part 3: Motor function 
    • Part 4: Complications including medications
  55. Hoehn and Yahr PD Stages
    • Lower score better
    •  
    •  Largely supplanted by UPDRS.
    •  
    •  Either can be used to set goals.

     UPDRS and H&Yahr Stages are often used with an ADL scale.
  56. Types and Stages of MS
    Benign MS

     Relapsing/Remitting MS

     Secondary/Progressive MS

     Primary/Progressive MS

     Progressive/Relapsing MS
  57. Symptoms of MS
    • Altered Sensation
    • Balance & Coordination Problems
    • Bladder Problems
    • Bowel Problems
    • Cognitive & Emotional Disturbances Fatigue Weakness
    • Heat sensitivity
    • Pain
    • Spasticity
    • Speech Dysfunctions
    • Visual Disturbances
  58. Stroke
    occurs suddenly and is a life-changing and devastating vascular event that causes damage to brain tissue

     can lead to long-term disability with direct and indirect costs of 63 billion annually

     a consequence of changes in both the function of the heart and the integrity of the blood vessels supplying blood to the brain

     embolus from the heart or extra cranial circulation lodges in an intracranial vessel. Can also result from a rupture of a vessel in the subarachnoid space (SAH) or intracerebral tissue (ICH)
  59. TIA
    Transient Ischemic Attack - Mini-strokes

    Temporary Symptoms-about 24 hrs.

    1. May go unrx’d and undiagnosed

    • 2. Warning of bigger things to come 
    •   - Massive CVA
    •   - Multi-infarct Dementia
  60. What are the signs and Symptoms of a stroke?
    • Signs
    •  Trouble Walking
    •  Weakness on one side
    •  Trouble Seeing
    •  Trouble Speaking

    • Symptoms
    • Can you smile?
    • Can you lift your arms up over your head? Can you speak a coherent sentence?
  61. What is an Ischemic stroke?
    Ischemic (clot) strokes - the most common type of strokes. treated with t-PA that dissolves blood clots obstructing blood flow to the brain.

    The window of opportunity: 3 hours to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes
  62. What is a Stroke? 2 Major Types?
    • Its a Cerebral Vascular Accident (CVA)
    • Types:
    •   1. Ischemic: Clot; Most common
    •   2. Hemorrhage: Bleed; Aneurysm; Ballooning blood vessel in danger of rupturing

    Similar sx from: Pressure from tumor or subdural hematoma
  63. Describe tone changes after a stroke?
    • May be flaccid (no tone) at first and progress to spastic
    •      -First 3 months very important
    •      -Flaccid sx take longer to plateau than pts. with early spasticity

    • UE improvement at 6 months:
    •     -best predicted by the motor deficit at 1 month despite rehab during months 1-6
  64. 9 visual problems after a stroke?
    • Loss of visual field (homonymous hemianopsia)
    •   --loss of half of the field of vision in each eye

    Dry eyes - dec. blink rate or poor closure. Rx with art. tears

    Visual Spatial Disorders and Visual Neglect- May come with loss of visual field. Usu. To left. Makes amb. risky

    • Vertigo, Dizziness & Impaired Eye Movements
    •   - May be related to brain stem injury.
    •   - Nystagmus occurs
    • Double vision- Control centers CN III, IV, VI

    Eyestrain and difficulty in reading-field loss, loss of smooth saccades, alexia

    Light sensitivity-amber lenses may help

    Visual hallucinations - flashes, flickering, figures

    Impaired visual memory - faces, objects, letters

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