Neuro 1- Speech and communication , CNS & Meningeal irritation, ANS etc pages 132- 134 Flashcards

1
Q

What are the types of Expressive Aphasia? 3

A
  1. Nonfluent Aphasis
  2. Verbal Aphasia
  3. Dysarthria
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2
Q

What is the name for Nonfluent Aphasia?

What is Nonfluent Aphasia?

A
  1. Broca’s Motor Aphasia- Expressive Aphasia
  2. It is a central language disorder in which speech is typically awkward, restricted, interrupted and produced with effort.
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3
Q

Where is the location of the lesion in Nonfluent/ Broca’s Aphasis?

A

3rd frontal convolution of the left hemisphere known as Broca’s area

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4
Q

What is verbal apraxia?

A

Impairment of volitional articulatory control secondary to a cortical dominant hemisphere lesion

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5
Q

What is Dysarthria?

What are the signs and symptoms?

A
  1. Impairment of speech production resulting from damage to the CNS or PNS
  2. Weakness, paralysis or incoordination of motor speech system (respiration, articulation, phonation and movements of jaw and tongue)
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6
Q

Types of Receptive Aphasias

A
  1. Fluent Aphasia
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7
Q

What is the name for Fluent aphasia

A

Wernicke’s Aphasia - Receptive Aphasia

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8
Q

What is fluent/ Wernicke’s Aphasia?

A

A central language disorder in which spontaneous speech is preserved and flows smoothly, while auditory comprehension is impaired

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9
Q

Where is the location of the lesion in Fluent / Wernicke’s Aphasia?

A

Posterior 1st temporal gyrus of the left hemisphere, known as Wernicke’s area

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10
Q
  1. What is Global Aphasia?

2. What should a PT examine for in a pt with GA

A
  1. Severe Aphasia

2. Marked impairments in comprehension and production of language

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11
Q

What should a PT examine for in a pt with nonverbal communication?

A
  1. Ability to read and write

2. use pictographs, gestures and symbols to communicate

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12
Q

What are some irregularities to look for when examining the patient’s pulse? 2

A
  1. Bounding

2. Thready (fine, barely perceptible)

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13
Q

What vital signs should a PT examine for when working with patients with neurological conditions? 4

A
  1. Irregularities in pulse
  2. Decrease or increase in BP- HTN >= 140/90 mmHg
  3. Changes in response to activity- normally HR increases in direct proportion to intensity of exercise.
  4. With increasing intracranial pressure, look for changes in HR and BP that occur late.
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14
Q

What is the normal response to activity with SBP and DBP

A

SBP increases

DBP remains the same or decreases moderately (a widening of pulse pressure)

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15
Q

What should a PT examine for during activity, In a patient with increasing intracranial pressure?

A

HR and BP changes that occur late during exercise

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16
Q

What is Cheyne-Stokes respiration?

A

A period of Apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations

Accompanies depression of frontal lobe and diencephalic dysfunction.

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17
Q

What is hyperventilation?

A

Increased rate and depth of respirations. Accompanies dysfunction of lower midbrain and pons

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18
Q

What is Apneustic breathing?

A

Abnormal respiration marked by prolonged inspiration. Accompanies damage to upper pons

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19
Q

In a patient with neurologic damage, what would elevation of temperature indicate? 3

A
  1. Infection
  2. Damage to hypothalamus, or
  3. Damage to brainstem
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20
Q

When examining for CNS infection or Meningeal irritation, are the signs global or focal?

A

Global

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21
Q

Things to look for when examining for CNS infection or Meningeal irritation, (7)

A
  1. Neck mobility
  2. Kernig’s sign
  3. Brudzinski sign
  4. irritability
  5. Slowed mental function
  6. Altered vital signs
  7. generalized weakness
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22
Q

How to examine for NECK MOBILITY in patient with CNS infection or meningeal irritation

A
  1. Patient in supine and flex neck to chest
  2. Positive sign: neck pain with limitation and guarding of head flexion d/t spasm of posterior neck muscles; can result from meningeal inflammation, arthritis or neck injury.
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23
Q

How to perform Kernig’s sign- test for CNS infection or meningeal irritation?

A
  1. Patient positioned in supine; flex hip and knee fully to chest, and extend knee.
  2. Positive sign: causes pain and increased resistance to extending the knee due to spasm of hamstring; bilateral, suggests meningeal irritation.
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24
Q

How to perform Brudzinski’s sign- test for CNS infection or meningeal irritation?

A
  1. Patient is positioned in supine; flex neck to chest.

2. Positive sign: causes flexion of hips and knees (drawing up); suggests meningeal irritation.

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25
Q

what to examine for in pts with slowed mental function-CNS infection or meningeal irritation?

A

Examine for persistent headache, which is increased in head-down position.

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26
Q

Things to look for when examining for increased intracranial pressure, secondary to cerebral edema and brain herniation (8)

A
  1. Altered level of consciousness
  2. Altered vital signs
  3. Headache
  4. Vomiting- secondary to irritation of vagal nuclei. CN X
  5. Pupillary changes- CN 3 signs
  6. Papilledema at entrance of eyes
  7. Progressive impairment of motor function
  8. Seizure activity
27
Q

What is the progression for altered level of consciousness? (4)

A
  1. Restlessness and confusion, to
  2. Decreased level of consciousness, to
  3. unresponsiveness, to
  4. Coma
28
Q

Altered vital signs to look for in patients with increased intracranial pressure secondary to edema and brain herniation

A
  1. Increased BP; widening pulse pressure & slowing of pulse
  2. Irregular respirations including periods of apnea
  3. Cheyne-Stokes respirations; elevated temperature
29
Q

Pupillary changes to look for in patients with increased intracranial pressure secondary to edema and brain herniation (2)

A

CN 3 signs (occulomotor)

  1. Ipsilateral dilation of pupil- unequal pupils
  2. Slowed reaction to light progressing to fixed dilated pupils (a poor prognostic sign)
30
Q

What are the progressive motor functional impairments to look for in patients with increased intracranial pressure secondary to edema and brain herniation

A
  1. Weakness
  2. hemiplegia
  3. Positive Babinski response
  4. Decorticate or Decerebrate rigidity
31
Q

Autonomic Nervous System is divided into

A
  1. Sympathetic (Fight or flight)

2. Parasympathetic (rest and digest)

32
Q

Components of the Sympathetic Nervous System

A
  1. Activated in stressful situations, producing an arousal reaction
  2. Widespread effects
  3. Inhibits salivation and tearing
  4. Dialates pupils (mydriasis)
  5. Accelerates HR and output
  6. Constricts or dilates blood flow in skeletal muscles
  7. Constricts blood flow to skin and viscera
  8. Relaxes airways
  9. Stimulates secretion of epinephrine and norepinephrine from adrenal medulla
  10. Decreases peristalsis, intestinal motility; inhibits digestion
  11. Increases sweating
  12. Stimulates glucose production and release
  13. Relaxes urinary bladder
33
Q

Components of the Parasympathetic Nervous System

A
  1. Conservation and restoration of body energy and homeostasis (system balance)
  2. Effects are localized and short-acting
  3. Stimulates salvation and tearing
  4. Constricts pupils
  5. Slows HR
  6. Dilates blood vessels in gut
  7. Constricts airways
  8. Stimulates pancreas to release insulin and digestive enzymes
  9. Stimulates digestion
  10. Stimulates urinary bladder to contract
34
Q

Three ways to test superficial sensations

A
  1. Pain- sharp/dull sensation to dull/sharp stimuli with paper clip
  2. Temperature- hot/cold sensation in response to hot/cold stimuli with test tubes filled with hot or cold water
  3. Touch- touch/ non-touch in response to slight touch stimulus (cotton ball or no touch)
35
Q

Three ways to test proprioception (deep) sensations

A
  1. Joint position sense
  2. Kinesthesia (movement sense)
  3. Vibration sense (pallesthesia)
36
Q

Testing proprioception - joint position sense

A

Tests the ability to perceive joint position at rest in response to your positioning your patient’s limb (up or down, in or out)

37
Q

Testing Kinesthesia (movement sense)

A

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

38
Q

Testing vibration sense (pallesthesia)

A

Test proprioceptive pathways by applying vibrating tuning fork or pressure only (sham vibration) on bony areas

39
Q

Six ways to test combined (cortical) sensations

A
  1. Stereognosis
  2. Tactile Localization
  3. Two-point discrimination
  4. Baragnosis
  5. Graphesthesia
  6. Bilateral simultaneous stimulation
40
Q

What is Stereognosis?

A

Ability to identify familiar objects placed in the hand by manipulation and touch.

41
Q

What is Tactile localization?

A

Ability to identify location of a touch stimulus on the body by verbal report or pointing

42
Q

What is two-point discrimination?

A

Ability to recognize one or two blunt points applied to the skin simultaneously; determine minimal distance on skin where two points can still be distinguished in ml using and aesthesiometer (the two tips must be applied simultaneously)

43
Q

What is Baragnosis?

A

Test ability to identify similar size/shaped objects placed in the hand with different gradations of weight.

44
Q

What is Graphesthesia?

A

The ability to identify numbers, letters, symbols traced on skin, typically the hand

45
Q

What is Bilateral Simultaneous Stimulation

A

The ability to identify simultaneous touch on the two sides/segments of the body.

46
Q

What is Somatognosia AKS body scheme disorder

A

A deficiency in the awareness of parts on one’s own body.

47
Q

What is Homonymous Hemianopsia?

A

Loss of half of visual field in each eye, contralateral to the side of a cerebral hemisphere lesion

48
Q

How to test for Homonymous Hemianopsia?

A

Slowly bring two fingers from behind head into the patient’s visual field while asking the patient to gaze straight ahead; the patient indicates when and where the fingers first appear.

49
Q

What is visual spatial neglect?

A

AKA as Unilateral Neglect- patient ignores one side of the body and stimuli coming from that side

50
Q

What is Right/Left Discrimination disorder?

A

Patient unable to differentiate between right and left

51
Q

What is Anosognosia?

A

Severe denial, neglect or lack of awareness of severity of condition; PT should determine whether the pt shows severe impairments in neglect and body scheme

52
Q

What is Figure-Ground Discrimination?

A

The ability to separate the elements of a visual image on the basis of contrast (e.g., light, dark), to perceive an object (figure) against a background (ground).

53
Q

What is Form Consistency?

A

The ability to accurately recognize and interpret that a form or object remains the same despite changes in its presentation such as size, direction, orientation, color, texture or context..

54
Q

What is Spatial Relations?

A

The ability to perceive relationships of objects position in space.

55
Q

What is Position in Space?

A

The ability to perceive an object’s position in space in relation to the oneself or the perception of the direction in which an object is turned.

56
Q

What is Topographical Disorientation?

A

Aka topographical agnosia and topographagnosia, is the inability to orient oneself in one’s surroundings as a result of focal brain damage.

57
Q

What is Depth and Distance Imperceptions?

A

The ability to perceive spatial relationships, especially distances between objects, in three dimensions.

58
Q

What is vertical disorientation?

A

Determine whether patient can accurately identify when something is upright.

59
Q

What is Agnosia?

A

The inability to recognize familiar objects with one sensory modality while retaining ability to recognize same object with other sensory modalities.

  • The subject doesn’t recognize an object (clock) by sight but can recognize it by sound e.g. ticking
60
Q

What is Apraxia

A

The inability to perform voluntary learned movements in the absence of loss of sensation, strength, coordination, attention, or comprehension; represents a breakdown in the conceptual system or motor production system or both.

61
Q

What are the two types of Apraxia?

A
  1. Ideomotor

2. Ideational

62
Q

What is Ideomotor Apraxia?

A

Patient cannot perform the task on command but can do task when left on own

63
Q

What is Ideational Apraxia?

A

Patient cannot perform the task at all. either on command or on own