Neuromuscular PTA Review
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| Somatosensory Input for Balance | Receptors located in joint, mm's ligaments and skin provide proprioceptive input about length, tension, pressure, pain and joint position; proprioceptive and tactile info from ankles, knees, hips and neck send balance info to brain
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| Somatosensory Input for Balance - Testing | Examination of pressure and vibration; observing pt when changing the surface they are standing on
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| Visual Input for Balance | Visual cues provide for perceptual acuity of verticality, motion of objects & self; environmental orientation; postural sway and head/neck movement; Children rely on it heavily
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| Visual Input for Balance - Testing | Examine quiet standing with eyes open; observe balance strategies to maintain COG with and without visual input; assessment of potential visual problems in neccessary
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| Hemianopsia | Loss of vision on in half the field of vision or 1 or both eyes
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| Pursuits | Allows our eyes to smoothly follow moving targets
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| Saccades | Rapid movement of the eyes between fixation points; voluntary directing of gaze
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| Gaze Control | Controlled by 4 systems: Saccade, pursuit, nystagmus (optokinetic system) and vestibulo-ocular reflex system
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| Acuity | Sharpness of vision
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| Vestibular Input for Balance | Provides CNS feedback of position/movement of head in relation to gravity; labyrinth includes 3 semicircle canals (monitors fluid movement) and 2 otolith organs (measure effects of gravity and movement with regards to acceleration and deceleration;
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| Vestibular Input for Balance - Testing | Examine balance with head movement; many types of assessments
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| Dix-Haulpike Maneuver | AKA Nylen Barany test; determines whether vertigo is connected to certain head movements, which ear is affected and whether it is inner ear/nerve (peripheral) or the brain (Central); tests for otoconia
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| Bithermal Caloric Testing | To test for virtigo, dizziness or hearing loss associated with an antibiotic; cold and/or warm water into ear canal should cause nystagmus; abnormal means there is damage to acoustic nerve, balance sensors of the inner ear or brain
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| Head Thrust Sign | AKA Head Impulse Test; tests vestibule ocular reflex; normal detection of head movement allows eyes to rapidly adjust; this will test that; see slides
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| Vestibulo-ocular Reflex (VOR) | Allows for head/eye movement coordination; supports gaze stabilization through counter head movement
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| Vestibulospinal Reflex (VSR) | Stabilizes body and controls movement while head is moving and trunk is coordinated during up right posture
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| Automatic Postural Strategies | Automatic motor responses used to maintain COG over BOS; ankle, hip, suspensory and stepping
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| Ankle Strategy | elicited by small range, slow velocity movement; distal to proximal mm contractions
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| Hip Strategy | elicited by greater force, challenge or perturbation through hips/pelvis; hips move in opposite direction of head; proximal to distal mm contractions
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| Suspensory Strategy | lowering COG for better control; used when both mobility and stability are required to complete a task
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| Stepping Strategy | Elicited in response to unexpected challenges and perturbations and when COG is outside BOS; LE steps and/or UE's reach to regain COG over BOS
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| Berg Balance Scale | 14 tasks score 0-4 each; Max score is 56; 41-56 =low fall risk, 21-40 medium fall risk, 0-20 high fall risk; can be used 1 time or in succession
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| Fugl-Meyer Sensory-motor Assessment of Balance Performance Battery | Stroke specific performance based impairment index; 7 items scored from 0-2; Max score is 14; ,ax score does not indicate normal mobility
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| Functional Reach Test | Test reach 3x; 24-40 yo = 14.5-17 in, 41-69 yo = 13.5-15 in, 70-87 yo = 10.5-13.5 in; following age category measurement indicates increased fall risk
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| Timed up and Go Test | Tests level of mobility/balance; Sit in a supported chair with feet flat, stand, walk 10 ft, turn and sit again; observe all parts of stability and mobility; Normal - 10 sec or less; Limit of functional independence is 20 sec; High fall risk is 30+ sec
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| Tinetti Performance Oriented Mobility Assessment | Tests standing and ambulating balance and mobility; Max - 16 points for standing and 12 for gait using a 0-1 or 0-2 scale for each item assessed; 28 point max; low fall risk - 24-28; moderate risk - 19-23; high risk - <19
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| Romberg Test | Assessment of balance and ataxia (loss of body control); narrow BOS with arms crossed over chest, eyes open then closed for up to 30 sec; positive or abnormal = instability with eyes closed; ataxia indicates sensory ataxia NOT cerebellar ataxia
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| Sharpened Romberg Test | Same examination with tandem stance with eyes closed for 1 minute
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| Otoconia | Crystals in inner ear moving or staying stagnant abnormally
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| A patient who is stable in standing but not weight shifting has a balance descriptor of | Fair
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| Postural Stability Control | The ability to maintain stability and orientation with the COG over the BOS at rest
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| Aphasia | Acquired neuro impairment of processing for receptive and/or expressive language; associated symptoms - perseveration of speech, severe auditory comprehension impairments, unreliable yes/no answers; use of empty speech w/o recognition of impairments
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| Perseveration of Speech | Repetition of speech or "getting stuck"
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| Fluent Aphasia | Usually involves temporal lobe, Wernicke's area and/or parietal lobe; word production and speech output is functional; empty speech/jargon with prosody; speech lack substance; neologisms
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| Prosody | Sounds and rhythms used in speech and poetry
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| Neologisms | Paraphrases within a word is so severe it is unrecognizable
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| Non Fluent Aphasia | Usually affects frontal lobe of dominant hemisphere; Poor word output; dyprosodic speech, poor articulation; increased effort for speech, content is present but impaired syntactical words
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| Syntactical Words | of or according to syntax; supporting words
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| Wernicke's Aphasia | Lesion to posterior superior temporal gyrus; fluent aphasia AKA receptive aphasia; comprehension impaired (reading/auditory), good articulation; impaired writing; poor naming ability; motor impairment not typical; "word salad"
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| Broca's Aphasia | 3rd convolution of frontal lobe; Non fluent AKA expressive aphasia; most common; intact comprehension; impaired repetition and naming skills; frustration; paraphasias; motor impairment typical
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| Paraphasias | Production of unintended syllables, words or phrases
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| Global Aphasia | Non fluent; usually affects frontal, temporal or parietal lobes; comprehension of reading/auditory is severely impaired; impaired naming, writing, repetition skills; may use non verbal communication
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| Dysarthria | Inability to articulate; Motor disorder of speech caused by upper motor neuron lesion that affects the muscles used to articulate words and create sound; speech i s"slurred"; may affect respiration
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| Treating Aphasia | Co tx or consult with speech therapist; use tactile and visual cues; only 1 person talking at a time; use concise language and yes/no q's; allow adequate response time; cut back on feedback as needed
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| Conduction Aphasia | AKA associative aphasia; intact comprehension; fluent speech; poor repetition; interrupted speech due to difficulty finding words; impaired writing, excessive repetition; intact fluency with good comprehension
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| Agnosia | Inability to interpret information
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| Language Dominant Hemisphere | Typically the left hemisphere; 99% of R handed people and 66% of left handed people
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| Alexia | Inability to comprehend written language
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| Broca's Area | In frontal lobe; responsible for expression of speech
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| Olfactory Nerve (I) | Afferent - smell; nose; Test - identify familiar odors
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| Optic Nerve (II) | Afferent - Sight; eyes; Test - test visual fields
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| Oculomotor (III) | Efferent - Voluntary - levator, superior, medial and inferior recti; inferior oblique; Automatic - smooth mm's; Test - up, down and medial gaze, and reaction to light
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| Trochlear (IV) | Efferent - voluntary - superior oblique mm; Test - down and in gaze
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| Trigeminal (V) | Afferent - touch, pain: skin of face, mucous membranes of nose, sinuses, mouth, anterior tongue; Efferent - voluntary - mm's of mastication; Test - corneal reflex, face sensation, clench teeth and push down on mandible
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| Abducens (VI) | Eye; Efferent - lateral rectus mm; Test - lateral gaze
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| Facial (VII) | Afferent - taste; anterior tongue; Efferent - Voluntary - facial mm's; Automatic - lacrimal, submandibular and sublingual glands; Test - Close eyes tight, smile and show teeth, whistle and puff cheeks, identify familiar tastes
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| Vestibulocochlear (Acoustic Nerve) (VIII) | Afferent - hearing and balance; ear; Test - hear watch ticking, hearing tests, Balance and coordinaiton tests
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| Glossopharangeal (IX) | Afferent - touch, pain of posterior tongue and pharynx; Efferent - Voluntary - select mm's of pharynx; Automatic - Parotid gland; Test - gag reflex, ability to swallow
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| Vagus (X) | Afferent - Touch, pain of pharynx, larynx and bronchi, taste of posterior tongue and epiglottis; Efferent - Voluntary - mm;s of palate pharynx and larynx; Auto - thoracic and abdominal viscera; Test - Gag reflex, ability to swallow, say "ahh"
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| Accessory (XI) | Efferent - Voluntary - SCM and trapezius mm's; Test - resisted shoulder shrug
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| Hypoglossal (XII) | Efferent - Voluntary - mm's of tongue; Test - tongue protrusion with deviation toward injured side
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| Bell's Palsy is the result of damage to which cranial nerve? | Facial (VII)
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| Anosmia | Loss of sense of smell; damage to Olfactory nerve (CNI)
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| Diplopia | Double vision; damage to trochlear nerve (CNIV))
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| Which 2 CN pathways are associated with the corneal reflex? | Afferent trigeminal and efferent facial
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| Which 3 cranial nerves sense taste? | Facial (VII), Glossopharengeal (IX) and Vagus (X)
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| Which 2 cranial nerves require eyes closed during test? | Olfactory (I) and Trigeminal (V)
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| Which 2 nerves originate from mid brain? | Oculomotor (III) and trochlear (IV)
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| How many cranial nerves possess only sensory tracts? | 3 - Olfactory (1), Optic (II) and Vestibulocochlear (VIII)
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| Ptosis | When upper eyelid droops over eye; CN damaged is Oculomotor (III)
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| Homonymus Hemianopsia | Visual field loss on left or right side of visual field in 1 or both eyes; CN damaged is - Optic (II)
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| Rinne Test | Hearing Test to evaluate unilateral hearing loss; compares conduction of sounds transmitted by air and then by bone with a tuning fork; normal ratio is 2:1 (air:bone)
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| Trigeminal Nerve (V) Branches | Opthalmic, Maxillary and Mandibular
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| Snellen Chart | Eye chart; tests Optic nerve (II)
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| Nerve commonly affected when pt has nystagmus | Vestibulocochlear (VIII)
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| Plexus Sequencing from Proximal to Distal | Roots, trunks, divisions, cords, nerves
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| Which artery is used for anatomy of brachial plexus? | Axillary; lateral, medial and posterior cords are named according to their position in relation to the axillary artery
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| Pronator Syndrome | The median nerve passes through 2 heads of pronator teres and gets pinched; affects sensory and motor function of medial nerve
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| Which nerve weakness gives rise to scapular winging? | Long thoracic nerve; serratus anterior weakness
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| Efferent vs Afferent | Motor vs Sensory; Ventral vs Dorsal
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| Motor Control | Study of the nature of movement OR the ability to regulate and direct essential movement
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| Motor Learning | The study of the acquisition or modification of movement; learning vs performance; provides guidelines for appropriate use of feedback, prioritizes the use of practice; transfer of learning across tasks and environments
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| 3 Stage Model of Motor Learning | Cognitive, Associative and Autonomous
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| Cognitive Stage of Motor Learning | Initial stage of learning; High concentration of conscious processing; begin problem solving; a controlled environment is ideal; Characterized by: lots of errors, inconsistent, high rep, high level of cognition
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| Associative Phase of Motor Learning | Intermediate stage of learning; starting to link info and action; closed environment progress to less structured and open environments; less external feedback and more internal/proprioceptive feedback; Characterized by: refinement and lots of practice
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| Autonomous Phase of Motor Learning | Final Stage of Learning; improves efficiency through cognitive control; success in variable environment; Characterized by: automaticity, mostly error free, automatic, not distracted, little to no extrinsic feedback, internal feedback is dominant
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| Feedback for Motor Learning | Imperative for improvement of motor learning; allows for correction and adaptation; reduction of feedback over progression is best
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| Intrinsic (Inherent) Feedback | All feedback comes form self; mostly sensory
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| Extrinsic (augmented) feedback | Typically verbal or tactile from someone else; during or after performance
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| Knowledge of Results | extrinsic; Terminal; outcome of most current performance vs goal
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| Knowledge of Performance | Extrinsic; refers to expected movement patter and outcome; QUALITY of movement
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| Practice for Motor Learning | Repeated performance of an activity to learn or perfect a skill; physical practice allows for experience and kinesthetic support; mental practice can help
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| Massed Practice | Large amounts of practice with minimal rest
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| Distributed practice | Rest time is equal to or greater than practice time
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| Constant Practice | Practice of a given task under uniform conditions
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| Variable Practice | Practice of a given task under variable conditions
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| Random Practice | Varying practice among different tasks
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| Blocked Practice | Consistent practice of single task
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| Whole Training | Practice of an entire task
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| Part Training | Practice of an individual component or selected components of a task
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| Closed System Model | Nervous system is an active participant, not just a reaction
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| Habituation | Decrease in response that will occur as a result of consistent exposure to non painful stimuli
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| Non Associative Learning | a single repeated stimuli (habituation, sensitization)
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| Associative Learning | gaining understanding of relationship between 2 stimuli; causal relationships (classical or operant conditioning)
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| Procedural Learning | learning tasks that can be done without cognition of it; forming movement habits; developing a habit through repetitive practice
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| Declarative Learning | Requires attention, awareness, and reflection in order to attain knowledge that cna be consciously recalled; mental practice
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| Open System Model | single transfer of info without any feedback loop; nervous system awaiting stimulus
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| Plasticity | Ability to modify or change at the synapse level; temporary or permanent in order to perform a specific function
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| Concurrent Feedback | Providing feedback while task is performed
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| feedforward control | Dependent on experience; signals sent before movement for anticipatory response
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