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Neuromuscular Physical Therapy Chapter Part 1

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38.

-70mV Abducens (CN VI) Abducens (CN VI) Abnormal posturing, bilateral flaccidity if herniation has occurred Abstraction

Resting membrane potential: positive on outside, and negative on the inside. What is the value of the resting membrane potential on the inside? Which cranial nerve is responsible for lateral eye movement and proprioception? Inability to turn eye out is an impairment of which cranial nerve? Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of Motor performance a late sign of increased ICP is?

125. 126. 168.

70.

A therapist shows a patient a two cans of sodas. A can of regular Coca-Cola and a can of regular Pepsi. The therapis asks the patient what are the differences and similarities between the two objects. What cognitive function is being tested? Bases on definition and task,what type of cognitive function is being assess? - Defined as the ability to reason in an abstract rather than a literal or concrete fashion. i.e., discuss how two objects are similar or different As part of the mental status examination assessment of of level of consciousness is important. It is important to determine if the patient is alert, lethargic, obtundent stuporous, or coma. - Patient responds appropriately, can open eyes, look at the examiner, respond fully and appropriately to stimuli. Patient is completely awake, aware of all stimuli and able to interact meaningfully with clinician. Based on the above description, Identify which level of consciouness it represents? There are several different type A nerve fibers,which are large myelinated fibers and conduct the fastest. Which type of A fibers is responsible for proprioception, somatic motor? Condition defined as unequal pupils A patient at a rehab center was told at a request of a therapist to use deodorant before the coming to therapy session. The patient replied to the therapist " I am sorry, I did not I had a strong smell, I could not smell at all anything". This condition of inability to detect smells is called? This condition is characterized by inability to detect smells. It is seen with frontal lobe lesions of patients with dysfunction of impairment of the CN I (Olfactory) Motor pathway for ipsilateral VOLUNTARY movement. This is the function of which tract? It contains cell bodies that give rise efferent (motor) neurons: Alpha motor neurons to effect muscles and gamma motor neurons to muscle spindles. Ascending tract (sensory pathways) that convey crude touch

69.

Abstraction

50.

Alert

43.

Alpha Anisocoria Anosmia

116. 104.

102.

Anosmia Anterior corticospinal tract Anterior horn cells Anterior spinothalamic tract Apneustic breathing Apraxia

160.

24.

29.

155.

Abnormal respiration marked by prolonged inspiration; acoompanies damage to upper pons. This is called? Comes from the greek word praxis = work, act, deed. A = no. It is characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. Another definition: It is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked, even though: - The request or command is understood - They are willing to perform the task - The muscles needed to perform the task work properly - The task may have already been learned (flocculonodular lob) connects with vestibular system and is concerned with equillibrium and regulation of muscle tone helps coordinate vestibulo-occular reflex

95.

21.

Archicerebellum

72.

Attention

A therapist ask a patient to recall up to seven numbers in order presented. Then asks, can you spell backwards bottle, then fork, garden (using small words, and then ask progressively longer words) What cognitive function is being tested? As part of neurological examination, testing of cognitive function is important to assess attention, orientation, memory, abstract thought, and the ability to perform calculations or construct figures. Bases on definition and task,what cognitive function is being assess? - It is defined as the ability to attend to a specific stimulus or task. The patient is asked to repeat a series of numbers or letters, spelling words forward and backward There are several different nerve fiber types, A, B and C fibers. This type of nerve fiber is small, myelinated and conduct less rapidly; preganglionic autonomic. Which nerve fiber type is? Identify the following cortical sensations test - Test the ability to identify similar size/shaped objects placed in the hand with different gradations of weight (eyes closed) Which part of the brain is this? Masses of gray matter deep within the cerebral hemispheres including: - the corpus striatum (caudate nucleus and lenticular nuclei - amygdalid nucleus, and claustrum - lenticular nuclei are further divided into the putamen and globus pallidus Forms an associated motor system (extrapyramidal system) with other nuclei in the subthalmus and midbrain A therapist asks a patient to smile, show your teeth,frown,raise eyebrows, wrinkle brows, purse lips, puff out both cheeks and close eyes tightly; however, he is unable to control the facial muscles which produce the above movements on the right side, but no problem with his left side. As a result of this paralysis, the patient's face looks and feels stiff or pulled to one side. He also presents with drooling and drooping of the face, such as the eyelid or corner of the mouth. has trouble closing one eye. In addition other symptoms that this patient presents are: Dry eye or mouth, headache,loss of sense of taste(anterior 2/3 of tongue),sound that is louder in one ear (hyperacusis),twitching in face. The patient's wife added that he has difficulty eating and drinking, and that food falls out of one side of the mouth. Based on the above description, the patient's condition is called? There are several different type A nerve fibers,which are large myelinated fibers and conduct the fastest. Which type of A fibers is responsible for touch and pressure? Possible dysfunction or impairments of cranial nerve II (optic nerve) include?

60.

Attention

41.

B fiber Barognosis

198.

17.

Basal Ganglia

130.

Bell's palsy

44.

Beta Blindness, myopia, presbyopia, homonymous hemianopsia Blurred vision, diplopia, and decreased visual acuity Brain stem reflexes Broca's area Broca's motor aphasia

107.

165.

Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of vision an early sign of increased ICP is?

173.

These reflexes are those regulated at the level of the brain stem, such as pupillary, pharyngeal, and cough reflexes, and the control of respiration; their absence is one criterion of brain death. These are called? This area of the brain controls the motor aspect of speech Part of the neurological examination, is the assessment of speech and language. Aphasias can be divided into fluent aphasias and non-fluent aphasias. It is a central language disorder in which speech is typically awkward, restricted, interrupted, and produced with effort. Typically the result of a lesion involving the 3rd. frontal convolution of the left hemisphere. Example of a normal speech: It's been 5 years since I have the stroke. I feel fine now, I am able to drive my car to the store, and to my relatives' house. Speech impairment: ah...man..strooke.. uh..I.. geez. ... Drive car... uhh........I.. five yearshh.....housess... This type of speech impairment is called?

9. 94.

158.

Bruzdzinski's sign

This is a test for CNS infection or meningeal irritation. - Patient in supine flex neck to chest (+) causes flexion of hips and knees (drawing up) suggests meningela irritation. This is called? There are several different nerve fiber types, A, B and C fibers. This type of nerve fiber is the smallest, unmyelinated, slowest conducting fiber. Which nerve fiber type is? Bases on definition and task,what type of cognitive function is being assess? - Defined as the ability to perform verbal or written mathematical problems (add,substract,multiply or divide whole numbers). i.e., 8 4 =?; 7+5 =? etc.. A physical therapist asks a patient to perform the following mathematical operations. 9+3 =?; 4+7=? 8 4 =?; 7 - 4 =? etc... Also the therapist aske to count backward from 100 by 7s. What cognitive function is being tested? A period of apnea lasting for 10 - 60 seconds followed by gradually increasing depth and frequency of respirations. Accompanies depression of FRONTAL LOBE and diencephalic dysfunction A period of apnea lasting 10 - 60 secons followed by gradually increasing depth and frequency of respiration; accompanies depression of frontal lobe and diencephalic dysfunction. This is called As part of the mental status examination assessment of of level of consciousness is important. It is important to determine if the patient is alert, lethargic, obtundent stuporous, or coma. - Patient cannot be aroused, eyes remain closed; no response to external stimuli or environment. Patient is unrousable and non-verbal. Based on the above description, Identify which level of consciouness it represents? Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of Level of consciousness, a late sign of increased ICP is? Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of Level of consciousness, an early sign of increased ICP is? A physical therapist ask a patient (verbal command) to draw house and tree next to it. Also the therapist shows a picture of a red barn with white fences around it, and ask can you draw this picture in the best possible way you could? What cognitive function is being tested? Bases on definition and task,what type of cognitive function is being assess? - Defined as the ability to construct a 2D or 3D figure or shape. i.e., Draw a figure after a verbal command or reproduce a figure from a picture Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of Motor performance an early sign of increased ICP is? Descending fiber systems (motor pathways) Arise from primary motor cortex, descend in brainstem, cross in medulla (pyramidal decussation) - Important for voluntary motor control Changes in body position, especially the transition from a recumbent position to a sitting position often stimulate increased alertness. Other stimuli that can be used to stimulate alertness include:?

42.

C fiber Calculation

65.

67.

Calculation

6.

Cheyne-Stokes respiration Cheyne-stokes respiration Coma

153.

54.

162.

Coma

161.

Confusion, restlessness, lethargy

68.

Construction

66.

Construction

167.

Contralateral paresis

32.

Corticospinal tracts

55.

daiylight, radio or television sound, or a cold cloth on the forehead Delta Deviation of the tongue towards the right side

46.

There are several different type A nerve fibers,which are large myelinated fibers and conduct the fastest. Which type of A fibers is responsible for pain, temperature and touch? A patient with RIGHT hypoglossal nerve (CN XII) involvement presents to the clinic. The therapist ask the patient to protrude his/her tongue. During protrusion, the tongue will deviate towards which side?

152.

74.

Divided attention

In testing cognitive function, attention can be subdivided into sustained attention, divided attention, and focused attention. - Defined as the ability to shift attention from one task to another. As therapists, assess ability of dual taks control. (i.e., can the patient perform two activities simultaneously?) Also assess for perseveration (mental inertia) getting stuck on a task. C fibers are the smallest, unmyelinated, slowest conducting fibers, Whic type of C fiber is responsible for pain and reflex responses? Dys = having problem with; Arthr = articulating Impairment of speech production, in the CNS/PNS mechanisms that control respiration, articulation, phonation, and movements of jaw and tongue. It is a condition in which problems occur with the muscles that help you talk; this makes it very difficult to pronounce words. It is unrelated to any problem with understanding cognitive language.Patient may present with a "slur speech", or speak softly or barely able to whisper. This condition is called? Bell's palsy is a condition where facial muscles are paralyzed on the affected side. This is due to a dysfunction of which cranial nerve? A therapist asks a patient to: smile, show your teeth,frown,raise eyebrows, wrinkle brows, purse lips, puff out both cheeks and close eyes tightly. Which cranial nerve is being tested? Which cranial nerve is responsible for Facial expressions, autonomic innervation of lacrimal and salivary glands, and sense of taste of anterior 2/3 of the tongue? A therapist asks a patient to smile, show your teeth,frown,raise eyebrows, wrinkle brows, purse lips, puff out both cheeks and close eyes tightly; however, he is unable to control the facial muscles which produce the above movements on the right side, but no problem with his left side. Which cranial nerve is impaired? A patient presents with ipsilateral paralysis of upper and lower facial muscles, loss of lacrimation, dry mouth, loss of taste of anterior 2/3 of the tongue on the ipsilateral side. Which cranial nerve is affected? Ascending fibers systems (sensory pathways) Dorsal columns/medial lemniscal system (Upper extremity tracts, laterally located) convey sensations of proprioception, vibration and tactile discrimination Ascending fibers systems (sensory pathways) Dorsal columns/medial lemniscal system (Lower extremity tracts, medially located) convey sensations of proprioception, vibration and tactile discrimination There are several different nerve fiber types, A, B and C fibers. This type of nerve fiber is large, myelinated and fast conducting. Which nerve fiber type is? In testing cognitive function, attention can be subdivided into sustained attention, divided attention, and focused attention. - Defined as the ability to stay on a task in presence of detractors. As therapists assess impact of environmental vs. internal detractors. This cognitive function is called? Precentral gyrus: - Primary motor cortex for voluntary muscle activation - Prefrontal cortex: Controls emotions and judgement - Broca's area: Control motor aspect of speech There are several different type A nerve fibers,which are large myelinated fibers and conduct the fastest. Which type of A fibers is responsible for motor to muscle spindles? It is a widely accepted measure of level of consciouness and responsiveness. It relates consciousness to three elements or response. Eye opening (E) with a max possible score = 4, Motor response (M) with a max possible score = 6, and verbal response (V) with a max possible score = 5. Score = (E+M+V) Max score = 15 and lowest score = 3. A score of 8 signifies coma or severe brain injury A severe form of aphasia characterized by marked impairments in comprehension and production of language

47.

Dorsal root Dysarthria

97.

131.

Facial (VII) Facial (VII) Facial (VII) Facial (VII) Facial (VII) Fasciculus cuneatus Fasciculus gracilis A fiber Focused attention

128.

127.

129.

132.

26.

27.

40.

75.

1.

Frontal lobe

45.

Gamma Glasgow coma scale

56.

99.

Global aphasia

141.

Glossopharyngeal (IX)

Which cranial nerve is being tested? - Induce gag with tongue depressor (one side at a time) - Patient phonates a prolonged vowel sound or talks for an extended period oftime. - Listen for voice quality and pitch Loss of gag reflex, dysphagia (difficult swallowing), dysphonia: hoarseness denotes vocal cord paralysis, nasal quality denotes palatal weakness,dry mouth, loss of taste ipsilateral 1/3 of tongue are signs/symptoms of impairment of which cranial nerve? Which cranial nerve is responsible for gag reflex, motor and proprioception of superior pharyngeal muscle, Autonomic innervation of salivary gland, Taste (posterior 1/3 of tongue? Identify the following cortical sensations test - Test ability to identify numbers, letters, or symbols traced on skin, typically the hand. Can you tell me what you feel I wrote on you hand? ( letter B, number 8 etc..) Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. Additional findings during late signs of ICP is/are? Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. Additional findings during early signs of ICP is/are? Defined as the loss of half of the field of view on the same side in both eyes. i.e., the patient cannot see from the left half of the left and right eye. This condition is not a disease itself, but rather, it's a sign of another medical problem such as a stroke, tumor or spinal cord injury. Typically involves, miosis (constriction of pupil), Ptosis (drooping of eyelid), and decreased sweating of the face on the same side. Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of vital signs late signs of increased ICP is/are? Increased rate and depth of respirations; accompanies dysfunction of lower midbrain and pons. This is called? Which cranial nerve is being tested? - Listen to patient's articulation problems - Examine the resting position of the tongue - Ask patient to stick out his/her tongue and observe for midline. (deviation of tongue to weak side on protrusion) - Ask patient to move tongue side to side A therapist ask a patient to stick out the tongue. During protrusion, instead of tongue remaining in midline, the tongue deviates ipsilaterally. Which cranial nerve is impaired? Which cranial nerve is responsible for motor control of pharynx and larynx, and movement and proprioception of tongue for chewing and speech? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient appears to be in a deep sleep and is completely unresponsive to any stimuli. Based on the above description, This patient is said to be at what level/category? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient reacts inconsistently and non-purposefully to stimuli in a nonspecific manner. - Responses are limited and often the same regardless of stimulus. - Responses may be physiological changes, gross body movements, and/or vocalization. Based on the above description, This patient is said to be at what level/category?

142.

Glossopharyngeal (IX)

140.

Glossopharyngeal (IX) Graphesthesia

199.

172.

Headache, vomiting, altered brain stem reflexes (pupillary, pharyngeal, and cough reflexes, and the control of respiration) Headache,seizure, cranial nerve palsy

171.

110.

Homonymouse hemianopsia Horner's syndrome

115.

170.

Hypertension and bradycardia (Cushing's response), altered respiratory pattern, increased temperature Hyperventilation. Hypoglossal (CN XII)

154.

150.

151.

Hypoglossal (CN XII) Hypoglossal (CN XII) I. No Response

149.

86.

87.

II. Generalized Response

88.

III. Localized Response

Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient reacts specifically but inconsistently to stimuli. - Responses are directly related to the type of stimulus presented. - May follow simple commands such as closing the eyes or squeezing the hand in an inconsistent, delayed manner. Based on the above description, This patient is said to be at what level/category? Bases on definition and task,what type of memory (cognitive function) is being assess? - Name three items previously presented after a brief interval (a few seconds to a few minutes) for example, the patient repeats, a red car, black pants, green tomatoes. Located deep within lateral sulcus, it is associated with viceral functions Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of Pupil apprearance an early sign of increased ICP is? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient is in a heightened state of activity. - Behavior is bizarre and non-purposeful relative to the immediate environment. - Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts. - Verbalizations frequently are incoherent and/or innappropriate to the environment; confabulation may be present. - Gross attention to environment to very brief; selective attention is often nonexistent. Patient lacks short and long-term recall. Based on the above description, This patient is said to be at what level/category? Identify the following proprioceptive sensations test - Test the ability to perceive joint position at rest in response to YOUR POSITIONING te patient's limb (up,down, in, out) Bases on definition and task,what type of cognitive function is being assess? - Defined as the ability to reason (according to age and lifestyle). Demonstrate common sense and safety. This is a test for CNS infection or meningeal irritation. - Patient in supine, flex hip and knee fully to chest and then extend knee. (+) causes pain and increased resistance to extending the knee owing to spasm of hamstrings; when bilateral suggest meningeal irritation. This called? Identify the following proprioceptive sensations test - Movement sense: Test the ability to perceive movement in response to YOUR MOVING the patient's limb; Patient can duplicate movement with opposite limb or give a verbal report Motor pathway for contralateral VOLUNTARY fine muscle movement. This is the function of which tract? Ascending tract (sensory pathways) that convey sensations of pain and temperature As part of the mental status examination assessment of of level of consciousness is important. It is important to determine if the patient is alert, lethargic, obtundent stuporous, or coma. - Patient appears drowsy; can open eyes and look at exminer, respond to questions, but fall asleep easily. Arousal with stimuli, that is falls asleep when not stimulated. Decreased awareness, loss of train of thought. Based on the above description, Identify which level of consciouness it represents? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). What levels are called the automatic appropriate level? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). What levels are called the purposeful appropriate level?

62.

Immediate recall

14. 163.

Insula Ipsilateral pupil sluggish to light, ovod in shape, with gradual dilatation IV. Confused-Agitated

89.

194.

Joint position sense

71.

Jugdement Kernig's sign

157.

195.

Kinesthesia

159.

Lateral corticospinal tract Lateral spinothalamic tract Lethargy

28.

51.

84.

Level VII Level VIII

85.

81.

Levels I Levels II, III Levels IV, V, VI Limbic circuit

Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). What levels are called the no response level? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). What levels are called the decreased response levels? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). What levels are called the confused levels? Originates in prefrontal and limbic areas of cortex to Basal Ganglia, to prefrontal cortex functions to organize behaviors (executive functions, problem solving, motivation) and for procedural learning (repeating a complex activity over and over again until all of the relevant neural systems work together to automatically produce the activity). Part of the brain concerned with: - instincts and emotions contributing to preservation of the individual. - basic functions inlcude: feeding, aggression, emotions, and endocrine aspects of sexual response Bases on definition and task,what type of memory (cognitive function) is being assess? - Recount past events (i.e., Where were you born?; Where did you grow up?) Mini-mental status examination or MMSE. A score between 21 - 24 indicates? Produced by Folstein, Folstein, and McHugh, in 1975. aka as Folstein test. It is a brief 30-point questionnaire test that is used to screen for cognitive impairment. Includes screenings items for orientation, registration, attention, calculation, recall and language. The max possible score is 30 points, and a score 15 indicates severe impairment. This test is called Using the glasgow coma scale. A score between 13 - 15 signifies what? Using the glasgow coma scale. A score between 9 - 12 signifies what? Mini-mental status examination or MMSE. A score between 16 - 20 indicates?

82.

83.

20.

5.

Limbic system

64.

Long-term memory Mild cognitive impairment Mini-mental status examination Minor brain injury Moderate brain injury Moderate cognitive impairment Motor (efferent) fibers Myopia Neck mobility

78.

76.

57.

58.

79.

48.

These fibers originate from motor nuclei (cranial nerves) or anteior horn cells (spinal nerves). These are?

108. 156.

Defined as impaired far vision This is a test for CNS infection or meningeal Irritation. - Patient in supine, flex neck to chest. (+) sign = pain in the neck with limitation and guarding of head flexion resulting from spasm of posterior neck muscles; can result from meningeal inflammation,arthritis, or neck injury. This is called? Receives input from corticopontecerebellar tracts and olivocerebellar fibers -It is concerned with the soomth coordination of voluntary movements, ensures accurate force, direction and extent of movement - Important for motor learning sequencing of movements, and visually triggered movements - May have a role in assisting cognitive function and mental imagery Supports cells that do not transmit signals; important for myelin and neuron production;maintenance of K+ levels and reuptake of neurotransmitters after neural transmission at synapses Mini-mental status examination or MMSE. A score 25 indicates? As part of the mental status examination assessment of of level of consciousness is important. It is important to determine if the patient is alert, lethargic, obtundent stuporous, or coma. - Patient can open eyes, look at examiner, but responds slowly and is confused; demonstrates decreased alertness and interest in environment. Difficult to arouse, requires CONSTANT stimulation for all activities. Based on the above description, Identify which level of consciouness it represents?

23.

Neocerebellum

37.

Neuroglia No cognitive impairment Obtundation

77.

52.

4.

Occipital lobe Occulomotor (CN III) Occulomotor (CN III)

Primary visual cortex: receives/processes visual stimuli Visual association cortex: process visual stimuli If a patient is exhibiting absence of pupillary constriction, Ptosis (drooping of eyelid), unequal pupils; Horner's syndrome this condition is likely to be an impairment of which cranial nerve? Which cranial nerve is being tested? - Gaze: Hold objects (e.g., pen) at arm's length from the patient, and hold the patient's head steady. Ask the patient to follow the object with a full horizontal, vertical and diagonal gaze. Which cranial nerve is being tested? - Pupil reaction to light: Shine a flashlight into one eye and observe bilateral pupil reaction. Normal is bilateral pupil constriction occurs with flashing into one eye. Also hold an object about 10 cm from the patient's eye and ask him/her to look at the near object and to look off into the distance. Watch for pupil constriction with near object and pupil dilation with distance objects. Which cranial nerve is responsible for eyelid elevation, pupil constriction (pupillary reflexes), visual focusing, upward, downward inward and infero-medial eye movement? Caudate loop: originte in frontal and supplementary motor eye fields projects to caudate functions with saccadic eye movements Which cranial nerve is responsible for sense of smell Which cranial nerve is being tested in the following example? - Have the patient close one nostril, and ask him/her to sniff a mils smelling substance and identify it. (e.g., coffee, vanilla etc.) A patient at a rehab center was told at a request of a therapist to use deodorant before the coming to therapy session. The patient replied to the therapist " I am sorry, I did not I had a strong smell, I could not smell at all anything". Which cranial nerve is being affected? Which cranial nerve for central and peripheral vision? Which cranial nerve is being tested? - Acuity: Have patient cover one eye, and ask patient to read a visual chart (snellen eye chart) - Fields: Have patient cover one eye, and hold an object (e.g., pen cap) at arm's length from the patient in his or her peripheral field. Hold the patient's head steady. Slowly move the object centrally, and ask the patient to state when he or she first sees the object. Repeat the process in all quadrants Bases on definition and task,what cognitive function is being assess? - It is defined as the ability to orient to person, place and time - Identify name, age, current date, and season, birth date, present location, town etc... Identify the following proprioceptive sensations test - Vibration sense: Test proprioceptive pathways by applying vibrating tunning fork or pressure only (sham vibration) on bony areas Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of Pupil apprearance a late sign of increased ICP is? Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Decreases force of contraction Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Constrict pupils Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Decreases blood pressure Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Constricts bronchi

114.

113.

112.

Occulomotor (CN III)

111.

Occulomotor (CN III) occulomotor circuit Olfactory (CN I) Olfactory (CN I)

18.

100. 101.

103.

Olfactory (CN I)

105. 106.

Optic (CN II) Optic (CN II)

61.

Orientation

196.

Pallesthesia

164.

Papilledema, ipsilateral pupil dilated and fixed or bilateral pupil dilated and fixed (if brain herniation has occurred) Parasympathetic nervous system Parasympathetic nervous system Parasympathetic nervous system Parasympathetic nervous system

181.

179.

184.

186.

175.

Parasympathetic nervous system Parasympathetic nervous system Parasympathetic nervous system Parasympathetic nervous system Parasympathetic nervous system Parietal lobe

Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Results in conservation oand restoration of body energy and moeostatsis (system balance) Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Increases glandular secretions Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Increases peristalsis, intestinal motility Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Dilates bronchial arteries Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - The effects are localized and short acting Post central gyrus: - primary sensory cortex for integration of sensation - Receives fibers conveying touch, proprioceptive, pain, and temperature sensations from opposite side of body It contain afferent (sensory) neurons with cell bodies located in the dorsal root ganglia. This area is part of the frontal lobe of the brain for control of emotions and judgements Defined as impaired near vision This area of the temporal lobe that receives/processes auditory stimuli This area is part of the frontal lobe of the brain and is concerned with voluntary muscle activations This area is part of the parietal lobe of the brain and is responsible for integration of sensation. it receives fibers conveying touch, proprioception, pain, and temperature sensation from opposite side of body Located in the occipital lobe, it receives/process visual stimuli Descending fiber systems (motor pathways) Arises in the reticular formation of the brainstem and descends (crossed and uncrossed) in ventral and lateral columns, terminates both on dorsal gray (modifies transmission of sensation, especially pain) and on ventral gray (influences gamma motor neurons and spinal reflexes) This test compares air and bone conduction. Place a vibrating tunning fork on the mastoid process, then close to ear canal; sound heard longer through air than bone. (+) test = sound heard on bone longer than air. This test is called? Descending fiber systems (motor pathways) Assist in motor function Myelinated axons, are axons overed with myelin with small gaps called nodes of Ranvier where myelin is absent. Myelin functions to increase speed of conduction and conserve energy. The action potential jumps from one node to the next. This type of conductions where the action potential jump from one node to the next is called? Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of vision a late sign of increased ICP is? These fibers originate in cells outside of the brainstem or spina cord with sensory ganglia (cranial nerves) or dorsal root ganglia (spinal nerves). Using the glasgow coma scale. A score 8 signifies what? Mini-mental status examination or MMSE. A score 15 Indicates? Bases on definition and task,what type of memory (cognitive function) is being assess? - Recounts words (after a few minutes) or recall recent events (i.e., What did you have for breakfast?)

193.

191.

188.

177.

2.

25. 8. 109. 11. 7. 10.

Posterior horn cells Prefrontal corex Presbyopia Primary auditory cortex Primary motor cortex Primary sensory cortex

13. 35.

Primary visual cortex Reticulospinal system

139.

Rinne's test

34.

Rubrospinal tract Saltatory conduction

39.

166.

The sames as the early signs, but more exaggerated blurred vision, diplopia, and decreased visual acuity Sensory (afferent) fibers Severe brain injury or coma Severe cognitive impairment Short-term memory

49.

59. 80. 63.

19.

Skeletomotor circuit

Putamen loop: Originates in precentral motor and postcentral somatosensory areas; - projects to putamen functions to scale amplitude and velocity of movements - reinforces selected pattern, supresses conflicting patterns; preparatory for movement (i.e. motor set, anticipatroy movement) Which cranial nerve is being tested? - Ask a patient to rotate the head or shrug the shoulders (with/without gentle resistance) Weakness/ inability with head turning to the opposite side and ipsilateral shoulder shrug, shoulder droops are signs & symptoms of which cranial nerve impairment? Which cranial nerve is responsible for motor control and proprioception of head rotation, and shoulder elevation (sternocleidomastoid, trapezius)? Ascending tract (sensory pathways) that convey proprioception information from muscle spindles, golgi tendon organs, and touch and pressure receptors to cerebellum for control of voluntary movements Receives input from proprioceptive patways and is concerned with modifying muscle tone and synergistic actions of muscles It is important in maintenance of posture and voluntary movement control Ascending tract (sensory pathways) that convey deep ande chronic pain to reticular formation of brainstem via diffuse polysynaptic pathways Maintenance of Intracranial pressure (ICP) or prompt recognition of elevated ICP is one of the primary goals for anyone caring for a postcraniosurgical patient, or cerebral traum, neoplasm or infection. ICP = the pressure CSF exerts within the ventricles. During observation of vital signs early sign of increased ICP is/are? Identify the following cortical sensations test - Test the ability to identify familiar objects placed in the hand by manipulation and touch. Can you identify this object? (a key, spoon, pencil etc..) Condition where eyes deviate from normal conjugate position i.e., eyes are not properly aligned with each other. one eye might be aligned while the other is either up (hypertropia), down (hypotropia), inward (esotropia), and outward (exotropia). This is called? As part of the mental status examination assessment of of level of consciousness is important. It is important to determine if the patient is alert, lethargic, obtundent stuporous, or coma. - Patient can be aroused from sleep ONLY with PAINFUL or VIGOROUS stimuli; verbal responses are slow or absent; patient returns to unresponsiveness state when stimuli are removed. Demonstrates minimal awareness of self and environment. Unable to complete mental status examination because responses are usually incomprehensible words. Based on the above description, Identify which level of consciouness it represents? In testing cognitive function, attention can be subdivided into sustained attention, divided attention, and focused attention. Defined as the ability to attend to a task without redirection. As therapists determine time on task, and frequency of redirection. Based on definition this is called? Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Breaks down glycogen into glucose - Increases blood sugar levels - Increases blood flow in skeletal muscles - Constricts blood flow to skin and abdomen Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Increases blood pressure and peripheral vascular resistance Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Increases sweating - Reduces glandular secretions Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - The effects are widespread instead of localized Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Decreases peristalsis, intestinal motility

147.

Spinal accessory (CN XI) Spinal accessory (CN XI) Spinal accessory (CN XI) Spinocerebellar tracts Spinocerebellum

148.

146.

30.

22.

31.

Spinoreticular tratcs Stable blood pressure, and heart rate Stereognosis

169.

197.

119.

Strabismus

53.

Stupor

73.

Sustained attention

182.

Sympathetic nervous system

183.

Sympathetic nervous system Sympathetic nervous system Sympathetic nervous system Sympathetic nervous system

192.

176.

190.

189.

Sympathetic nervous system Sympathetic nervous system Sympathetic nervous system Sympathetic nervous system Sympathetic nervous system Sympathetic nervous system Tectospinal tract Temporal lobe

Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Stimulates cortex and medulla, produces hyperalertness Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Increases heart rate and force of contraction Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Constricts bronchial arteries Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Dilates bronchi for maximum respiratory flow Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Activated in stressful situations producing an arousal reaction (flight or fight response) Identify which autonomic nervous system is being described.(Sympathetic or Parasympathetic) - Dilates pupils Descending fiber systems (motor pathways) Arises from superior colliculus (midbrain) and descends to ventral gray; Assists in head-turning responses to visual stimuli Primary auditory cortex: receives/processess auditory stimuli Associative auditory cortex: process auditory stimuli Wernicke's area: language comprehension This fibers interconnect two hemispheres, including the corpus callosum (the largest), anterior commissure, and hipocampal comissure If a patient lost his/her facial sensation, or has numbness, which cranial nerve is involved? A patient demosntrates weakness of muscles of mastication (temporal and masseter muscles). When asked to open his mouth, the jaw not the tongue deviates ipsilaterally. Which cranial nerve is involved? If a patient lost his/her corneal reflex ipsilaterally (involuntary blinking in response to corneal touch), which cranial nerve is involved? Which cranial nerve is responsible for sensation of face, cornea and for mastication (motor: temporal and masseter muscles)? Which cranial nerve is responsible for infero-lateral (downward and lateral) eye movement? Which cranial nerve is being tested? - Patient follows with eyes,(head steady) downward, lateral gaze Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of any external structure, responses are non-purposeful, random, or fragmented. - Demonstrates gross attention to the environment but is highly distractible and lacks the ability to focus attention on a specific task. With structure, may be able to converse on a social automatic level for short periods of time. - Verbalization is often inappropriate and confabulatory. - Memory is severly impaired; often shows inappropriate use of objects; - May perform previously learned tasks with structure, but is unable to learn new information. Based on the above description, This patient is said to be at what level/category? Dysphagia, soft palate paralysis, contralateral deviation of uvula, ipsilateral anesthesia of pharynx and larynx, hoarseness:denotes vocal cord paralysis, nasal quality denotes palatal weakness. All these are signs & symptoms of which cranial nerve impairment?

180.

187.

185.

174.

178.

36.

3.

16.

Transverse commissural fibers Trigeminal (CN V) Trigeminal (CN V) Trigeminal (CN V) Trigeminal (CN V) Trochlear (CN IV) Trochlear (CN IV) V. ConfusedInappropriate

123.

124.

122.

120.

117.

118.

90.

145.

Vagus (X)

144.

Vagus (X)

Examine for difficulty swallowing. Have the patient say "ah"; observe motion of soft palate (eleveates) and position of uvula (remains midline). Stimulate back of throat lightly on each side (gag reflex). Which cranial nerve is being tested? Which cranial nerve is responsible for swallowing, proprioception of pharynx and larynx, parasympathetic innervation of heart, lungs, and abdominal viscera? Impairment of volitional articulatory control secondary to a cortical, dominant hemisphere lesion. A person has trouble saying what he or she wants to say correctly and consistently, and it is not related to facial muscle weakness. Vertigo, dysequilibrium,nystagmus, neural deafness, impaired hearing, tinnitus, unilateral conductive loss: sound lateralized to impaired ear, conductive loss: sound heard through bone = or longer than air, sensorineural loss: Sound heard in good ear, sound heard longer through air. All of above conditions are the result of which cranial nerve impairment? Which cranial nerve is reponsible for gaze stability with head rotations? A therapist is testing for lateralization (weber's test). a vibrating tunning fork is placed on top of the head, mid position. The sound of the tunning fork is checked to see if it is heard in one ear or equally in both. This is testing for which cranial nerve impairment? Which cranial nerve is responsible for sense of equilibrium (vestibular branch) and a sense of hearing (cochlear branch)? Testing of the vestibular branch involves the occulocephalic reflex aka Doll's eyes, or vestibular-occular reflex. It is a reflex that is tested by turning the patient's head from side to side, adn watch for eye movement. The eyes movement should be opposite to the direction of the head. Which cranial nerve is being tested? Descending fiber systems (motor pathways) Important for control of muscle tone, antigravity muscles, and postural reflexes. Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient shows goal-directed behavior, but is dependent on external input or direction. - Follows simple directions consistently and shows carryover for relearned tasks such as self-care. - Responses may be incorrect due to memory problems, but they are appropriate to the situation. - Past memories show more depth and detail than recent memory. Based on the above description, This patient is said to be at what level/category? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient appears appropriate and oriented within the hospital and home settings; goes gthrough daily routine automatically, but frequently robot-like. - Patient shows minimal to no confusion and has shallow recall of activities. - Shows carryover for new learning, but at a decreased rate. With structure is able to initiate social or recreational activities; judgment remains impaired. Based on the above description, This patient is said to be at what level/category? Rancho Los Amigos level of cognitive function, assesses cognitive recovery from traumatic brain injury (TBI). - Patient is able to recall and integrate past and recent events and is aware of and responsive to environment. -Shows carryover for new learning and needs no supervision once activities are learned. - May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgment in emergencies or unusual circumstances. Based on the above description, This patient is said to be at what level/category? A therapist places a vibrating tunning fork on top of the head, mid forehead, and ask the patient if sound is heard equally (normal) or if it is heard louder in one ear (lateralized;the defective ear). This test is called? A type of aphasia considered to be a fluent aphasia, receptive aphasia. It is central language disorder in which spontaneous speech is preserved and flows smoothly, while auditory comprehension is impaired. It is the result of a lesion in the posterior first temporal gyrus of the left hemisphere. Individuals with this type of aphasia have difficulty understanding spoken language but are able to produce sounds, phrases, and word sequences. While these utterances have the same rhythm as normal speech, they are not language because no information is conveyed. This is called?

143.

Vagus (X) Verbal apraxia

96.

136.

Vestibulocochlear (CN VIII)

134.

Vestibulocochlear (CN VIII) Vestibulocochlear (CN VIII) Vestibulocochlear (CN VIII) Vestibulocochlear (CN VIII) Vestibulospinal tract VI. ConfusedAppropriate

137.

133.

135.

33.

91.

92.

VII. AutomaticAppropriate

93.

VII. PurposefulAppropriate

138.

Weber's test Wernicke's aphasia

98.

12. 15. 121.

Wernicke's area White Matter Wisp of cotton on the patient's cornea

Area of the temporal lobe of the brain reponsible for language comprehension Myelinated nerve fibers located centrally. This is called? How would you test for cornea reflex?

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