663 exam 1

when do the three layers in development form? what are they?

around 18 days

From what layer does the neural plate develop?

ectoderm

when does the neural groove develop?

around 20 days

when does the neural tube form? from what structure?

around 22 days from the neural groove

what is disease

biological disruption that produces certain signs and symptoms

what is illness

how an individual experiences their symptoms and how their families respond

what is disability

impairment, activity limitations, or participation restrictions resulting from the health condition

• personal, societal factors

external contextual factors to illness

• disease-related impairments

• demographic factors

• built environment

• social environment

• political environment

internal contextual factors to illness

• values, culture, beliefs

• prior level of function, comorbidities, roles

• personality: coping, resiliency, experiences

• education

• health literacy

• financial resources

types of coping

emotion: feelings around the illness

appraisal: reframing how the situation is understood

problem: taking direct action, therapy, lifestyle choices

gray matter of the brain

outer layer

• cell bodies that process input/controls output

white matter of brain

inner layer

• myelinated axon tracts that communicate with other areas

types of fibers in the white matter

association:

• runs within the same hemisphere

commissural fibers:

• connect cortical areas of R and L hemispheres

projection fibers:

• runs vertically, ascending and descending to and from the spinal cord

what structure separates the two hemispheres of the brain

falx cerebri

what structure connects the two hemispheres for communication?

corpus callosum

what separates the parietal and occipital lobes

parieto-occipital sulcus

what is the illness-constellation model

• Illness affects the individual, family, and others

• incorporates physical symptoms and the human response to the symptoms

• The goal is to regain “normalcy”

• 4-stage process (uncertainty → wellness)

what are the 4 stages of the illness-constellation model

1. Uncertainty

2. disruption

3. striving to regain self

4. regaining wellness

uncertainty stage of the illness-constellation model

• Individual detects/suspects signs of illness

• Individual attempts to make sense of the symptoms

• “something is wrong”

disruption stage of the illness-constellation model

• Acknowledgement of the need for medical intervention

• Relinquished control to others

  • loss of autonomy

• Family begins to accept responsibility

  • patient may distance themselves

  • family become vigilant

• household roles shift

striving to regain self stage of illness-constellation model

• examines the past for why the illness occurred

• attempts to make sense

• begins to build identity amidst change

• strives to preserve a sense of self

• tells story again and again → process of meaning making

• shift focus toward future

• role renegotiation

regaining wellness stage of the illness-constellation model

• Individual takes charge, trusts abilities

• lives within their new limits

• Therapy can highlight wellness and help with gaining independence

• seeks closure and accepts consequences

• family begins to monitor

what are the 5 stages of grief

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

denial stage of grief

• Conscious or unconscious protective response when someone first receives a diagnosis

• Believes the diagnosis is a mistake/perpetuate a false reality

• EARLY DENIAL IS NORMAL

• PT's role is to help create alignment, be specific, reinforce key messages, and define what happened

anger stage of grief

• Patient may lash out with frustration, resentment, and dry sarcasm

• Directed anger toward others (place blame)

• PT: maximize communication, identify source of frustration, keep patient informed → create trust and channel into motivation

bargaining stage of grief

• postpone or distance from the reality of the situation

• exhibits good behavior, makes up for perceived wrongdoing

• “If I could just, then…”

• PT: do not make promises you can’t keep, prepare patient for transitions, steady and consistent

depression stage of grief

• feeling of loss of control, helplessness, withdrawn, no energy when the situation can no longer be ignored

• person grieves for themselves

• PT: find motivation for activities they care about

acceptance stage of grief

• a feeling of ability or resignation

• makes realistic expectations

• the individual becomes an active participant in their lives

• recognizes limits but sees opportunities for growth

structures in the diencephalon

• thalamus

• hypothalamus

• subthalamic nucleus

• epithalamus

structures in the brainstem

• midbrain

• pons

• medulla

map out the general motor and sensory representations in the brain

medial → lateral

• feet, legs, knee, neck, head, arm, face, mouth

primary motor cortex

controls movement execution

role of the premotor cortex

pre-movement planning

• context-dependent action selection

role of the supplementary motor area

Programming of complex, sequential bimanual actions

• internally generated actions or action-based memory

what are the functional areas of the frontal lobe

• dorsal-lateral prefrontal and orbital cortex

• frontal eye fields

• broca’s area

role of the dorsal-lateral prefrontal and orbital cortex

working memory, abstraction, executive, and cognitive functioning, personality, response inhibition

role of the frontal eye fields

Voluntary saccadic eye movement

• visual pursuit

broca’s area

Motor control of speech, articulation, and speech production

limbic system

Functions in processing emotions, declarative memory

• links reward and motivation to behavior

• survival instinct

primary somatosensory cortex

Processes sensory information

• touch, pain, temperature, proprioception

posterior parietal cortex

sensory integration to coordinate spatial awareness, attention, and motor planning

Post-stroke depression risk factors

• pre-stroke history

• personality and coping

• inadequate social support

• high level of disability

• younger age <68yrs old

post-stroke depression symptoms

• Persistent sad or empty mood, hopelessness, pessimism

• guilt, worthlessness, loss of interest, decreased energy, loss of pleasure

• difficult concentrating, making decisions, sleeping, eating

• thoughts of death, suicide

why does PSD matter for PTs

• Reduced adherence to exercise plans

• lower functional recovery and independence

• increased caregiver burden + stress

• higher risk of mortality

role of secondary somatosensory cortex

Processes higher-order tactile information

• texture, shape, size, pain intensity

• tactile memory

role of supramarginal gyrus

• speech articulation and word sound/structure

• object identification

• working memory

• spatial awareness and tool manipulation

role of angular gyrus

• Understanding complex meanings, metaphors, and concepts

• comprehension of written words and language

• episodic memory and navigation

role of primary visual cortex

• receives and processes visual input

• orientation and visual stimuli

• shape, form, location, and motion of objects

role of visual association cortex

interpretation of visual stimuli

• object and face recognition

• spatial processing

• connects visual input to stored memory

functional areas in the temporal lobe

• primary auditory cortex

• wernicke’s area

• parahippocampal gyrus and entorhinal cortex

• hippocampus

role of the primary auditory cortex

process auditory information like pitch, volume, location

role of wernicke’s area

Comprehension of spoken and written language

role of parahippocampal gyrus and entorhinal cortex

• Connection between cortical sensory areas and the hippocampus for memory storage

• track order of events and temporal memory

• maps physical space and navigation (context for memories - where/when)

role of the hippocampus

memory consolidation - short term to long term

what is a stroke

sudden onset of focal neurologic deficit resulting from cardiovascular disease

• CVA

how does age impact stroke prevalence

increases with increasing age

most common form of stroke

ischemic stroke

what is a transient ischemic attack

temporary blockage in flow that fully resolves within 24hrs

what are ischemic strokes

blockages of flow from

• thrombus: clot

• embolus: dislodged thrombus

what type of stroke is more fatal

hemorrhagic CVA

ischemic stroke risk factors

• hypertension, diabetes, high cholesterol

• smoking, drug, alcohol use

• irregular heart rhythm

• lack of exercise, obesity

hemorrhagic stroke risk factors

• hypertension

• increasing age

• black ethnicity

• low LDL (important for vessel walls)

• low triglycerides

identify the kind of stroke

ischemic

identify the kind of stroke

hemorrhagic

how are ischemic strokes managed

• thrombolytics - 4.5 hrs after onset

• intra-arterial thrombectomy - < 6 hrs after onset

• other factors:

  • head of bed flat

  • IV fluids

  • permissive hypertension

how and why is cerebral perfusion maintained/increased

how: head of bed flat, IV fluids, permissive hypertension

• to regain blood flow to the brain

how do hemorrhagic strokes present

progressive symptoms over 48-72 hrs

• headache

• nausea/vomiting

• seizure

• focal neurologic deficits

• herniation symptoms

how is a intracranial hemorrhagic stroke mamanged?

• blood pressure control

• reverse coagulopathy - more clotting

• intracranial pressure management

• surgical management

posterior fossa decompression

removal of the occiput in case of potentially fatal brainstem compression

what can impact the neurological findings after a stroke

• size of lesion

• location of lesion

• amount of collateral blood flow

symptoms of acute stroke

• weakness

• numbness

• difficulty with speech

• confusion

• altered vision

• ataxia

• impaired gait

• vertigo

• headache

upper motor neuron syndrome

• spastic paralysis

• weakness depends o

athetosis

slow, involuntary, writhing movements of hands, feet, or face

• UMN injury

• 
  

signs of lower motor neuron syndrome

• flaccid paralysis

• muscle atrophy

• hyporeflexia

positive = exaggerated normal functions

negative = diminished normal functions

positive UMN syndrome signs

• spastic paralysis

• hyperreflexia

• altered muscle tone

• athetosis

• dystonia

• emergence of primitive reflexes

negative UMN signs

• fatigue

• dyscoordination

• impaired motor planning and control

most common location for an ischemic stroke

middle cerebral artery

left middle cerebral artery (MCA) syndrome symptoms

• R hemiparesis

• R sensory loss

• aphasia

• R visual field cut

• L gaze pereference

right middle cerebral artery (MCA) syndrome symptoms

• L hemiparesis

• L sensory loss

• neglect/anosognosia

• L visual field cut

• R gaze preference

how is vision impacted with a lesion in the R optic nerce

monocular loss on the right

• no vision from the R eye

how is vision impacted with a lesion in the optic chiasm

Bitemporal loss (loss of lateral aspects of both eyes)

what is anosognosia

complete unawareness of illness or condition

How is vision impacted by a lesion in the R lateral geniculate (after chiasm)

homonomous hemianopia

• loss of L aspects of both eyes

what is ACA syndrome?

anterior cerebral artery syndrome

• contralateral weakness - most prominent in the LE

• contralateral sensory loss - most prominent in the LE

• abulia

• gaze preference - tendency or inability to lool toward one side

• incontinence

what is abulia

severe lack of willpower, initiative motivation

characteristics of central PCA syndrome

• visual field cut

• thalamic involvement: weakness, sensory changes, anesthesia

• hemiballismus

what is hemiballismus

Sudden, violent, involuntary flinging or writhing motions

• seen in central PCA syndrome

characteristics of peripheral PCA syndrome

• amnesia

• alexia without agraphia

• visual deficits

characteristics of basilar artery syndrome

• altered mental status/sedation

• cranial nerve deficits, weakness, anesthesia

• pons: tetraplegia, coma, locked-in syndrome

cerebellar stroke characteristics

• nystagmus

• dizziness

• nausea/vomiting

• ipsilateral ataxia

how are hemorrhagic strokes described by?

depth and location

subarachnoid hemorrhage

bleeding into subarachnoid space

• aneurysms and vascular malformations are most common

• usually a transient BP rise

Susceptible to rerupturing and spewing of blood - potential hydrocephalus

most common subarachnoid hemorrhage sites

• anterior communicating artery

• posterior communicating artery

• middle cerebral artery

lacunar CVA

characteristics are ischemic and hemorrhagic

• pure motor, pure sensory, ataxic hemiparesis, clumsy, mixed sensory

name the 3 stages of stroke recovery

• acute/early: attributed partially to spontaneous recovery (initially)

• late

• chronic

what contributes to spontaneous neurological improvements

• reduction of edema

• absorption of damaged tissue

• improved vascular flow

• damaged areas of brain circumvented

is age a factor in stroke recovery

no

what is a PTs main goal in the acute phase of stroke rehab?

mobilization

• up and out of bed

• centered around important mobility skills

• get them home safely

what is motor control?

the ability to plan, execute, and adapt goal-directed movement

• optimize accuracy, coordination, and efficiency

• dependent on multiple symptoms

how is motor control observed?

by watching initiation, execution, and termination of a task

• quality, coordination, and precision

• compensations