What is Spasticity?

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What is Spasticity?

The stretchiness of a rubber band

Velocity-dependent increase in stretch reflexes with exaggerated tendon jerks

Velocity-dependent decrease in stretch reflexes with exaggerated tendon jerks

Loss of muscle control

What is the definition of Clonus?

The singular noun for a clone trooper from Star Wars

When the foot does that weird bouncing thing

Involuntary muscular contraction in rapid succession

The process of cloning a clone

Voluntary muscular contraction in rapid succession

When should Stroke pt commence out of bed activity?

ASAP - Time is brain

Within 24hr

Within 48hr

Within 72hr

What is heavier? 1 kg of steel or 1000g of feathers?

Steel because steel is heavier than feathers

1000g of feathers cause 1000 is a bigger number than 1

Define Neural plasticity

Ability of the CNS to adapt to functional demands and the systems capacity to reorganise

Ability of the CNS to adapt to sensory demands and the systems capacity to reorganise

The amount of brain capacity and will power it takes a toddler to not eat play-doh

How the brain re-learns stuff in a functional manner

Select the mechanisms of neural plasticity. (hint: there are 3)

Habituation

Learning and memory

Cellular recovery pre-injury

IQ >100

Cellular recovery post injury

Motor cortex excitation

With TBI, processes of neural plasticity remain the same, however how does the presence of damaged neural environments complicates things?

Oedema & inflammation significantly impair neural function

Oedema, inflammation & altered neuronalexcitability impair neural function

Oedema, inflammation & altered thalamic processes impair neural function

Their brain is now broken and no longer functions how it should

What do you mean?

What are the 3 patterns of cortical re-organisation

Greater degree of bilateral motor cortex activity

Increased recruitment of secondary cortical areas in the non-affected hemisphere

Increased recruitment of secondary cortical areas in the affected hemisphere

Increased Ipsilateral cortical involvement

Greater degree of ipsilateral cortex activity

In TBI, what happens when entire neural circuits are gone?

When they're gone they're gone

Other structures not designed for that purpose must compensate

The brain will repair those circuits over time

If you ask nicely they might come back

Select the common symptoms of Stroke

Dysarthria

Severe pain in the 3rd toe

Acute sensory loss

Halucinations

Sudden or severe headache

Weakness/numbness in face

Weakness/numbness in arm or leg

What are the special questions you should ask a stroke patient?

Double vision

Any thing good on TV today?

Pain levels

Their perception of their current level of function

Select the correct definition of Salience

The neurological condition where patients are involuntarily silent

To induce plasticity the task must be important to the pateint

Training that drives a specific brain function leading to enhancement of that function

The sequel song to the 2011 Hit Sail by Awolnation

When would you know to stop therapy with your patient?

When the patient has completed the session you set out for them

Fatigue and quality of movement begins to decline

You get bored

Repetition is important

Stance phase: Initial contact components include:

Forward pelvis rotation

Centre of mass moving vertically

Centre of mass moving forwards & laterally

Knee flexion via eccentric quads

Knee extension via eccentric Hamstring

Ankle at neutral

Foot everted

Stance phase: Loading response includes:

Weight bear stability + progression of COM

Hip flexion --> extension

Concentric glutes + Hamstring cause Hip extension

Knee flexion via concentric Hamstring

Knee extension via eccentric hamstring

Ankle DF via concentric Tib Ant

Ankle PF via eccentric Tib Ant

Hip flexion via concentric quads

Stance Phase: Mid-stance includes

Progress over stance foot

Knee flexion begins

Stance foot leaves ground

Maintain Limb + trunk stability

Hip Extension

Knee flexion peaks

Knee hyperextends

Ankle moves into active PF

What is the correct order of stance phase

1. Loading response, 2. Initial Contact, 3. Mid Stance, 4. Terminal Stance, 5. Pre-Swing

1. Pre-Swing, 2. Initial Contact, 3. Mid Stance, 4. Terminal Stance, 5. Loading response

1. Initial Contact, 2. Loading response, 3. Mid Stance, 4. Terminal Stance, 5. Pre-Swing

Wait there are phases

Stance Phase: Terminal Stance Components include:

Heel begins to leave the ground

Body progresses beyond supporting foot

COM is at its lowest

COM is at its highest

Hip passively extends maximally

Hip actively extends maximally

Passive Ankle PF

Ankle PF concentrically

Knee hyperextends

Knee reaches near full Extension

Stance Phase: Pre-swing

Ends at Toe-off

Hip flexion

Knee Extension

Knee flexion

Ankle PF

Ankle DF

Positions limb for swing and accelerate progression

What is the correct sequence for Swing phase

1. Mid Swing, 2. Terminal Swing, 3. Initial Swing

1. Initial Swing, 2. Mid Swing, 3. Terminal Swing

1. Initial Swing, 2. Mid Swing, 3. End Swing

1. Initial Swing, 2. End Swing

Swing Phase: Initial Swing components include:

Aims: foot clearance + progression of following limb

Aims: Not trip over

Active hip flexion

Momentum causes hip flexion

Peak Knee flexion

Knee extension

Concentric Tib Ant for DF

Eccentric Gastroc for DF

Swing Phase: Mid Swing components include:

Momentum generated Hip, Knee & Ankle flexion

Momentum generated Hip flexion, knee extension, & ankle DF

Momentum generated Hip flexion & knee extension

Concentric DF via Tib Ant

Eccentric DF via Gastroc

Swing Phase: Terminal Swing components include:

Aims to complete limb advancement

Prepares for for stance

Eccentric Hip flexion via Hamstring/Glute max

Eccentric knee Extension --> Concentric Knee Extension via Quads

Concentric knee Extension --> Eccentric Knee Extension via Quads

Eccentric Ankle PF

Ankle DF for heel strike

What is the definition of a stroke? (May have multiple answers)

Sudden death of brain cartilage

Sudden death of brain cells in localised area

Caused by lack of O2 due to blockage or rupture

Gradual death of brain cells in localised area

Caused by lack of CO2 due to blockage or rupture

The phase of the combustion cycle is designated by the sequential strokes of the piston (intake, compression, expansion, exhaust)

True or False: penumbra is salvageable brain area

False

True

What is the cell death process during stroke?

Still unknown

ATP depletion --> Ca mediated cytokinetic reactions causing excitatory neurotransmitters to fail

ATP depletion --> membrane pump fails --> Ca mediated cytotoxic reactions & release of excitatory neurotransmitters

Increase in CO2 in the penumbra post stroke causes ATP depletion and cell death as a consequence

Select the options which categorise a Total Anterior Circulation Syndrome (TACS)

Large middle cerebral artery infarct

Posterior middle cerebral artery infarct

Contains all of the following: higher cerebral dysfunction, Homonymous Hemianopia & motor sensory deficit

Has only one of the following: higher cerebral dysfunction, Homonymous Hemianopia & motor sensory deficit

Neglect is never present, but will express ataxia

Will present with neglect & Apraxia

Presents with Aphasia

Not that big of a deal compared to other strokes

Select the options which categorise a Partial Anterior Circulation Syndrome (PACS)

Middle cerebral Artery branch occlusion

Posterior cerebral Artery branch occlusion

Poor Prognosis

Good prognosis

2 out of the 3 following: higher cerebral dysfunction, Homonymous Hemianopia & motor sensory deficit

Contains all of the following: higher cerebral dysfunction, Homonymous Hemianopia & motor sensory deficit

High motor/sensory deficit

Limited motor/sensory deficit

Select the options which categorise a Posterior Circulation Syndrome (POCS)

Infarct in Middle cerebral Artery and/or cerebellum

Infarct in posterior cerebral artery, brain stem, or cerebellum

Occlusion in the posterior cerebral artery

Cranial nerve palsy

Contralateral motor/sensory deficit

Conjugate eye movement issues

Cerebellar dysfunction

Isolated Homonymous Hemianopia

Select the options which categorise a Lacunar Syndrome (LACS)

Sub-cortical stroke

Infarct in the Lacunar artery

Pure motor or sensory stroke

Ataxic Hemiparesis

Dysphasia

Hemianopia

Bilateral Ataxia

Select the characteristics of a RIGHT CVA

L) Hemiparesis/hemiplegia

R) Hemiparesis/hemiplegia

L) Somato-sensory changes

L) hemianopia

R) hemianopia

L) Unilateral Spatial neglect

Bilateral Spatial neglect

Apraxia

Language problems

Trouble writing

Anosognosia: unaware of condition

Astereognosis

Select the characteristics of a LEFT CVA

L) Hemiparesis/hemiplegia

R) Hemiparesis/hemiplegia

R) Somato-sensory changes

L) Somato-sensory changes

L) hemianopia

R) hemianopia

Language Issues

Dysphasia

Dysgraphia

Apraxia

Anosognosia: unaware of condition

Astereognosis

What is Apraxia?

Disorders of the execution of learned movements which is not due to weakness, co-ordination, sensory loss, or incomprehension of or inattention to command

Crippling fear of Axes

Disorders of the execution of unlearned movements which is not due to weakness, co-ordination, sensory loss, or incomprehension of or inattention to command

Disorders of the execution of learned movements which is due to weakness, co-ordination, sensory loss, or incomprehension of or inattention to command

Select the characteristics of Ideomotor Apraxia:

Unable to perform simple tasks, however complex tasks remain intact

Inability to perform purposeful movement on external command, despite fully understanding the task

Can be able to do the task automatically in a natural setting

Movements lack correct force, direction and timing

Can perform seperate movements but can't co-ordinate all steps into integrated sequence

Disorder of Praxis Production System

Select the characteristics of Ideoational Apraxia:

Unable to perform simple tasks, however complex tasks remain intact

Inability to perform purposeful movement on external command, despite fully understanding the task

Actions often overshoot whats necessary or is incomplete

Disorder of the Praxis Conceptual system

Can perform seperate movements but can't co-ordinate all steps into integrated sequence

Name the SCI:

Ischaemic Herniation Syndorme

Sacral Sparing

Anterior Cervical Cord Syndrome

Central cord lesion

Name the SCI:

Unilateral lesion syndrome

Ipsilateral Haematoma

Brown-Sequard Syndrome

Sacral Sparing

Name the SCI:

Central Cord Lesion

Bilateral Sparing Syndrome

Brown-Sequard Syndrome

UMN Lesion

Name the SCI:

Total occlusion Syndrome

Brown-Sequard Syndrome

Anterior Cervical Cord Syndrome

Bilateral UMN Lesion

What is Subjective Visual Vertical

Can we orientate an object to vertical without vision

Can we tell an object is vertical by looking at it

Can we orient our body to vertical without vision

A skatebaord trick on a vertical ramp with eyes closed

What is Subjective Haptic Vertical?

Can we orientate an object to vertical without vision

Can we tell an object is vertical by looking at it

Can we orient our body to vertical without vision

A type of tick that causes paralysis of the nervous system, and has the ability to kill a full grown adult within hours

What is Subjective Postural Vertical

Can we orientate an object to vertical without vision

Can we tell an object is vertical by looking at it

Can we orient our body to vertical without vision

Standing so incredibly still that you cannot be seen by the human eye

What are the 3 main features of Pusher syndrome?

Contralesional tilt of spontaneous body posture

Abduction + Extension of extremities

Adduction + Flexion of extremities

Resistance to passive correction

Ipsilateral tilt of spontaneous body posture

Select the correct definition for Pusher Syndrome:

Someone that uses emotional torture to push those close to them away

Someone that uses extreme brute force to push others away

Pushes strongly to hemiplegic side, resisting any passive correction

Pushes towards non-hemiplegic side, resisting any passive correction

What is the definition of Tone?

A word Skinny people use to justify their lack of muscle mass

Sensation that is encounted as a joint is passively moved through a range of motion

Sensation that is encounted as a joint is actively moved through a range of motion

Muscle's resistance to over stretch

Definition of Unilateral Spatial Neglect:

Failure to report, respond or orient to stimuli presented to the same side of brain lesion

Failure to report, respond or orient to stimuli presented to the opposite side of brain lesion

Not studying content on the belief it will not be in the exam

Skipping leg day

Types of Neglect: What is Inattention/Extinction

Failure to respond to stimuli on affected side only when non-affected side is also being stimulated

Failure to respond to stimuli on affected side when non-affected side is not being stimulated

Neglecting that dinosaurs went extinct via meteor

Failure to recognise the severity of their paralysis

Types of Neglect: Anosognosia

Failure to respond to stimuli on affected side when non-affected side is not being stimulated

Disturbed perception of client's own body parts

Failure to recognise the severity of their paralysis

British term for snogging someone's nose

Types of Neglect: Autopagnosia

Neglecting cars who have a automatic gear box

Failure to recognise the severity of their paralysis

Disturbed perception of people's body parts

Disturbed perception of client's own body parts

What does Occulomotor Nerve control:

Up + down + Medial eye movement

Up but not down eye movement

Medial and down

Abduction + up + down

What does the Trochlear nerve do?

Moves eyes Up + Down + medially

Down + Lateral

Medially + down

Adduction

What does Abducens Nerve do?

Abducts eye

Up + down eye movement

This is not a real nerve

Adducts eye

What is the role of Otolith Organs?

Sense Linear Acceleration + orientation of head with respect to gravity

Sense Linear Acceleration

Unblurr vision with movement

What is the purpose of Vestibulo-Occular Reflexes:

Unblurr vision with head movement

Sense Linear acceleration

Detects elevation (i.e. Going up an elevator)

This is not a real thing

What is Vestibular Neuritis?

Degeneration of neurons within Vestibular system

Inflammation of vestibular Apparatus

Degeneration of Semi-circular canals

Inflammation of the vestibular nerve

Select common Symptoms of Vestibular Neuritis:

Acute onset of Rotary Vertigo

Symptoms eased by head movement

Exacerbated by head movement

Postural imbalance

Uncontrollable Sneezing fits

Hearing Loss

Horizontal-rotary Nystagmus beating to affected side

Horizontal-rotary Nystagmus beating away from affected side

What is Meniere's Disease?

Disorder of Vestibular Apparatus due to backed up fluid

Disorder of inner ear function due to backed up fluid

Disorder of Mens ears

Loss of hearing due to immune system attacking ocular nerves

Select common symptoms seen in Meniere's Disease

Spontaneous Vertigo

Constant Vertigo

Lack of aural symptoms

Aural Symptoms

Blocked nose

Hair loss

What is Nystagmus?

Voluntary movement of the eyes

When the eyes flicker

Twitching of the eye in response to staring for too long

Involuntary movement of the eyes

What are Habituation Programs used for?

Designed for patients with motion sensitivity issues

Relocating animals who's homes have been destroyed or lost

Patient's with impaired sensation

Eye-stuff

What is Benign Paroxysmal Positional Vertigo

When you drink too much on a night out and get dizzy

A condition where dislodged Otoconia float into semi-circular canals

A type of vertigo

A condition where dislodged Otoconia float into Vestibular aparatus

What is Canalithiasis?

Otoconia is adherent to the cupula

Otoconia is freely mobile in the canal

The process of creating a canal

Select the symptoms of BPPV:

Vertigo <1min

Vertigo >1min

Light Headedness

Imbalance

Nausea

Motion Sensitivity

Attacks come with sustained postures

Attacks come with change of head position

What would you use a Hallpike-Dix Test

Anterior SCC

Posterior SCC

Anterior + Posterior SCC

Horizontal SCC

What would you use a Roll-Test for?

Anterior SCC

Posterior SCC

Posterior + Anterior SCC

Horizontal SCC

What Nystagmus would you expect for Right Posterior SCC

Down beating + Right Torsional

Up beating + Right Torsional

Down beating + L) torsional

Up beating + L) torsional

What Nystagmus would you expect for a Left Anterior SCC

Down beating + Right Torsional

Up beating + Right Torsional

Down beating + L) torsional

Up beating + L) torsional

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