Physical Therapy Neurological Examination and Management Review

Exactly 1000 vocabulary flashcards for board prep based on neuroanatomy, pathology, and physical therapy principles.

Forebrain Divisions

Categorized into the telencephalon and the diencephalon.

Telencephalon Components

Consists of the cerebrum, hippocampus, basal ganglia, and amygdala.

Cerebrum

The largest portion of the brain, consisting of two hemispheres.

Corpus Callosum

The structure connecting the right and left cerebral hemispheres.

Cerebral Cortex

The outer layer of the cerebrum composed of gray matter.

Cerebral Interior

The inner portion of the cerebrum composed of white matter.

Hippocampus Location

Situated within the lower temporal lobe.

Hippocampus Primary Function

Responsible for memory formation/storage and declarative memory.

Declarative Memory

The conscious recall of facts or events.

Basal Ganglia Composition

Includes gray matter masses such as the caudate and putamen.

Basal Ganglia Functions

Regulates voluntary movement, posture, and muscle tone.

Amygdala Location

Found within the temporal lobe.

Amygdala Primary Function

Handles emotional and social processing, specifically fear and pleasure.

Diencephalon Components

Includes the thalamus, hypothalamus, subthalamus, and epithalamus.

Thalamus Function

A sensory relay station coordinating movement and relaying cortical information.

Thalamus Sensory Exception

Relays all sensory information to the cortex except for olfaction.

Hypothalamus Regulation

Regulates the autonomic nervous system ($ANS$) and homeostasis.

Hypothalamus Homeostatic Functions

Controls hunger, thirst, sleep, and body temperature.

Subthalamus Location

Located between the thalamus and the hypothalamus.

Subthalamus Function

Regulates skeletal movement.

Epithalamus

Contains the pineal gland for circadian rhythm regulation.

Pineal Gland Secretion

Secretes melatonin to regulate sleep-wake cycles.

Midbrain Location

Situated at the base of the brain, connecting forebrain and hindbrain.

Midbrain Components

Consists of the tectum and tegmentum.

Tectum/Tegmentum Function

Relay station and reflex center for visual, auditory, and tactile stimuli.

Hindbrain Components

Includes the metencephalon and myelencephalon.

Metencephalon Structures

Composed of the cerebellum and the pons.

Cerebellum Function

Responsible for fine movement tuning, balance, and coordination.

Cerebellum Damage Signs

Results in ipsilateral ataxia and tremors.

Ipsilateral Ataxia

Uncoordinated movement on the same side as the lesion.

Pons Primary Function

Regulates respiration and head orientation to stimuli.

Myelencephalon Structure

Contains the medulla oblongata.

Medulla Oblongata Vital Functions

Controls autonomic functions including respiration and heart rate.

Medulla Oblongata Motor Function

The site where motor tracts cross to the opposite side.

Frontal Lobe Functions

Voluntary movement, intellect, personality, and speech production.

Primary Motor Cortex

Located in the frontal lobe; responsible for voluntary muscle control.

Broca's Area

Located in the frontal lobe; responsible for speech production.

Parietal Lobe Functions

Processes touch, kinesthesia, vibration, and spatial/visual perception.

Proprioception vs. Kinesthesia

Static position sense vs. direction and extent of movement sense.

Temporal Lobe Functions

Processes auditory information and olfaction.

Wernicke's Area

Located in the temporal lobe; handles language comprehension.

Occipital Lobe Functions

Primary center for visual processing, color interpretation, and depth.

Circle of Willis Primary Vessels

Anterior/posterior cerebral arteries, internal carotids, and communicating arteries.

Anterior Cerebral Artery ($ACA$) Supply

Mainly supplies the frontal lobe.

ACA Occlusion Syndrome

Causes paraplegia and incontinence.

Middle Cerebral Artery ($MCA$) Description

A terminal branch of the Circle of Willis and most common embolus site.

MCA Occlusion Syndrome

Causes contralateral hemiplegia and aphasia.

Posterior Cerebral Artery ($PCA$) Supply

Supplies the thalamus and occipital lobe.

PCA Occlusion Signs

Leads to thalamic pain syndrome and cortical blindness.

Vertebral-Basilar Artery Supply

Provides blood to the brainstem and cerebellum.

Vertebral-Basilar Occlusion Results

Can cause Locked-in Syndrome, Wallenberg Syndrome, or coma.

Locked-In Syndrome

Conscious state with paralysis of all muscles except vertical eye movement.

Locked-In Syndrome Etiology

Usually caused by basilar artery occlusion affecting the pons.

Wallenberg Syndrome

Lateral medullary syndrome caused by vertebral artery or $PICA$ occlusion.

Wallenberg Syndrome Symptoms

Vertigo, ataxia, dysphagia, hoarseness, and sensory deficits.

Apraxia

Inability to perform learned, purposeful movements despite physical capacity.

Ideomotor Apraxia

Patient understands the task but cannot perform it on command.

Ideomotor Apraxia Intervention

Breaking tasks into components and providing tactile cues.

Ideational Apraxia

Inability to formulate the correct sequence of steps for a task.

Ideational Apraxia Intervention

Therapy focusing on structured environments and step-by-step guidance.

Constructional Apraxia

Inability to reproduce geometric figures or designs.

Constructional Apraxia Association

Often associated with right-sided parietal lobe damage.

Verbal Apraxia

Communication disorder involving effortful, broken speech.

Verbal Apraxia Management

Use of concise sentences and allowing extra processing time.

ASIA Impairment Scale ($AIS$)

Clinical standard for classifying the severity of spinal cord injuries ($SCI$).

$AIS$ Level $A$

Complete: No motor or sensory function in sacral segments $S4-S5$.

$AIS$ Level $B$

Sensory Incomplete: Sensory but no motor function below neurologic level.

$AIS$ Level $C$

Motor Incomplete: Most key muscles below neurological level are $< \frac{3}{5}$.

$AIS$ Level $D$

Motor Incomplete: At least half of key muscles below level are $\ge \frac{3}{5}$.

$AIS$ Level $E$

Normal: Motor and sensory functions are normal.

Motor Testing Level $C5$

Biceps.

Motor Testing Level $C7$

Triceps.

Motor Testing Level $L3$

Quadriceps.

Motor Testing Level $S1$

Plantar flexors.

Sensory Landmark $C7$

Middle finger.

Sensory Landmark $T4$

Nipple line.

Sensory Landmark $T10$

Umbilicus.

Sensory Landmark $S1$

Lateral heel.

Autonomic Nervous System ($ANS$) Purpose

Regulates involuntary functions and maintains homeostasis.

Sympathetic Division

The 'fight or flight' response using norepinephrine.

Parasympathetic Division

The 'rest and digest' response using acetylcholine.

Autonomic Dysreflexia

Emergency in $SCI$ at/above $T6$ caused by noxious stimuli.

Autonomic Dysreflexia Triggers

Often caused by a kinked catheter or full bladder.

Functional Balance Requirements

Integration of sensory ($visual, vestibular, somatosensory$), motor, and cognitive systems.

Muscle Spindles

Receptors detecting muscle length and stretch.

Golgi Tendon Organs ($GTO$)

Receptors detecting tendon tension.

Joint/Cutaneous Receptors

Provide information on vibration, pressure, and position.

Somatosensory Testing Surface

Challenged by standing on foam or uneven surfaces.

Vestibular System Components

Includes semicircular canals for head motion and otoliths for gravity/acceleration.

Dix-Hallpike Maneuver

Used to assess for nystagmus and diagnose $BPPV$.

Vestibulo-Ocular Reflex ($VOR$)

Stabilizes gaze during head motion.

Vestibulospinal Reflex ($VSR$)

Stabilizes posture.

Visual Dependency in Balance

Children rely more heavily on the visual system than adults.

Hemianopsia

Loss of half of the visual field.

Ankle Strategy

Used for small, slow perturbations; distal to proximal muscle activation.

Hip Strategy

Used for larger, faster perturbations; proximal to distal muscle activation.

Suspensory Strategy

Lowering the center of gravity to increase stability (e.g., crouching).

Stepping Strategy

Occurs when center of mass moves beyond the base of support.

Berg Balance Scale Fall Risk

A score below $45$ indicates an increased risk of falling.

Timed Up and Go ($TUG$) Fall Risk

Score of $\ge 30$ seconds indicates high fall risk.