Neuro - PCA Study Guide

Central Cord Syndrome

SCI = Damage to the central portion of the spinal cord, disrupting communication between the brain and the rest of the body

• Motor - Characterized by more pronounced weakness in the UE than the LE

  • Screen: Standing at the sink to groom

    • Red Flags: Incoordination in hands as shown by dropping items or inability to open lids

• Sensory - Sensory loss is variable, typically pain and temperature are affected, “cape-like” distribution, extending across the upper back and down the posterior UE

  • Screen: Ask the client to wash their hands and assess their ability to discriminate from warm and cold water

    • Red Flags: Inability to determine hot from cold or tingling/pain with stimuli

• Cognition - Indirect impact on attention, memory and concentration from co-morbidities such as sleep problems and emotional distress that are common in SCI

  • Screen: Perform a simple transfer to assess safety and judgment

    • Red Flags: Not locking brakes or not awaiting assistance to transfer, impulsivity

Anterior Cord Syndrome

SCI = Damage to the anterior portion of the spinal cord, disrupting communication between the brain and the rest of the body

• Motor - Paralysis or weakness in the limbs

  • Screen: Standing/sitting at the sink to perform grooming task

    • Red Flags: Inability to open containers or inability to maintain standing at sink without LOB or dropping items

• Sensory - Loss of pain and temperature sensation below the level of injury

  • Screen: Ask the client to wash their hands to assess their ability to manage the water

    • Red Flags: Inability to discriminate hot and cold water or tingling/pain with stimuli

• Cognitive - Indirect impact on attention, memory and concentration from co-morbidities such as sleep problems and emotional distress that are common in SCI

  • Screen: Ask the client to perform a transfer to assess safety and attention

    • Red Flags: Impulsivity or transferring without assistance or not locking w/c brakes

Posterior Cord Syndrome

SCI = Damage to the anterior portion of the spinal cord, disrupting communication between the brain and the rest of the body

• Perceptual - Loss of proprioception sense

  • Screen: Have client stand at the sink to perform grooming to assess ability to sense bodys position in space

    • Red Flags: Missing the handles when turning water on or missing toothbrush when attempting to squeeze it on

• Motor - Motor function is less affected, however the loss of proprioception can cause ataxia - lack of coordination in voluntary movements

  • Screen: Ask the client to ambulate from one area to another to assess for ataxic movements

    • Red Flags: Ataxic gait patter or LOB’s

• Sensory - Loss of vibration sense and fine touch

  • Screen: Ask the client to perform dressing

    • Red Flags: Inability to detect sock donning or inability to feel shirt texture on their body

Brown Sequard Syndrome

SCI = Damage to one side of the spinal cord, resulting in a distinct pattern of neurological deficits

• Motor - Weakness or paralysis on the same side as the spinal cord damage

  • Screen: Standing at sink to groom

    • Red Flags: Dropping items, inability to stand at sink due to motor deficits, inability to open containers

• Perceptual - Loss of proprioception on the same side as the spinal cord damage

  • Screen: Ask the client to perform dressing task

    • Red Flags: Inability to orient clothing and placing head in arm holes

• Sensory - Loss of pain and temperature sensation on the opposite side of the injury

  • Screen: Ask the client to wash their hands

    • Red Flags: Inability to discriminate between hot and cold water or is not able to feel sensation of water at all

Conus Medullaris

SCI = Neurological condition caused by injury to the conus medullaris, the cone-shaped terminal end of the spinal cord, usually around the T12 to L2 levels

• Motor - LE weakness in BLE (often symmetrical), hyperreflexia

  • Screen: Stand at sink to perform grooming

    • Red Flags: LOB or inability to maintain standing position

• Sensory/Perceptual - Loss of sensation in the perineal area (saddle anesthesia), LE numbness or tingling, pain in low back

  • Screen: Toileting task

    • Red Flags: Over or under wiping or poor awareness of hygiene/soiling

• Cognition - Indirect impact on attention, memory and concentration from co-morbidities such as sleep problems and emotional distress that are common in SCI

  • Screen: Ask the client to perform a transfer to assess safety and attention

    • Red Flags: Impulsivity or transferring without assistance or not locking w/c brakes

Cauda Equina Syndrome

SCI = Rare condition where the bundle of nerves at the end of the spinal cord (called the cauda equina) is compressed or damaged, it is considered a medical emergency requiring surgery to relieve the pressure on the nerves and prevent permanent damage

• Motor - Weakness or paralysis in LE, difficulty walking/standing

  • Screen: Standing at sink to groom

    • Red Flags: Limited standing tolerance or frequent LOB or inability to stand at all

• Sensory - Saddle anesthesia, loss of sensation in inner thighs, buttocks and perineal area, numbness or tingling in LE

  • Screen: Toileting task

    • Red Flags: Over or under wiping or poor awareness of hygiene/soiling

• Perceptual - Due to numbness and tingling in LE, loss of proprioception is noted

MCA Stroke

MCA - Occurs when blood flow through the middle cerebral artery is blocked or reduced, leading to brain tissue damage in the areas of the brain that are supplied by this artery

• Lateral frontal - Executive functioning, planning, carrying out higher cognitive tasks

• Temporal - Memory, auditory processing, language comprehension

• Parietal - Spatial awareness, somatosensory processing

L MCA -

• R-sided hemiplegia/hemiparesis (prominent in face and arm)

• R-sided sensory loss

• Aphasia - Broca’s (expressive) or Wernicke’s (receptive)

• Impaired reading/writing

R MCA -

• L-sided hemiplegia/hemiparesis

• L-sided sensory loss

• L- neglect/inattention

• Impaired judgement

PCA Stroke

PCA - Occurs when blood flow through the posterior cerebral artery is blocked or reduced, leading to brain tissue damage in the areas of the brain that are supplied by this artery

• Occipital lobe - Visual processing

  • Contralateral homonymous hemianopia

  • Screen: Grooming task

    • Red Flags: Neglecting L/R side or missing objects that are in line of sight

• Inferior temporal lobe - Memory, object recognition

  • Inability to recognize objects

  • Memory deficits

  • Screen: During ADL task - Ask the client to tell you what object they are holding (dressing: shirt, sock, jacket etc.)

    • Red Flags: Inability to determine sock from shirt OR inability to name any objects at all

• Thalamus - Sensory relay, Hemiparesis or sensory loss if deep branches are affected

  • Screen: Donning shirt to determine if the Pt can sense textured clothing

    • Red Flags: Inability to determine sensation of clothing without looking OR tingling with stimuli

ACA Stroke

ACA - An ACA stroke occurs when blood flow through the anterior cerebral artery is disrupted, leading to ischemia or infarction.

• Medial frontal lobe (motor planning and initiation)

• Superior medial parietal lobe

• Motor - Contralateral LE weakness, greater involvement of leg than arm/face, apraxia, gait ataxia or difficulty initiating movement (deep branches)

• Sensory - Contralateral sensory loss, LE greater than UE (cortical branches)

• Cognitive - Apathy, lack of initiative and personality changes (executive functioning) (cortical branches)

Parkinson’s Disease

PD - Chronic, progressive neurodegenerative disorder that primarily affects movement due to the loss of dopamine-producing neurons in the substantia nigra - a portion of the basal ganglia in the brain. Leads to a dopamine deficiency, which disrupts motor control pathways

• Motor - Resting tremors, rigidity, akinesia, bradykinesia, postural instability

  • Screen: Standing or sitting to perform grooming task

    • Red Flags: Dropping items due to tremors or LOB

• Cognitive - Slowed thinking, dementia in later stages

  • Screen: Ask the client to perform ADL task

    • Red Flags: Inability to sequence/orient clothing, poor safety in kitchen

• Perceptual - Impaired proprioception, difficulty sensing limb position during ADL

  • Screen: Ask client to don shirt/pants

    • Red Flags: Head going through arm hole or both legs in one pant leg

Huntington’s Disease

HD - Progressive, inherited neurodegenerative disorder that causes a genetic mutation on chromosome 4. HD is an autosomal dominant inheritance, meaning there is a 50% chance of passing it on to your offspring.

• Motor - Chorea: involuntary jerky movements, dystonia, impaired voluntary movement, poor coordination and balance, dysarthria and dysphagia

  • Later stages: Rigidity and bradykinesia

• Cognitive - Difficulty with executive function (planning and organizing), poor attention, memory, decreased judgement and insight

  • Later stages: Progressive dementia

• Perceptual - Difficulty judging distance/depth, trouble with navigation or getting lost in environments

  • This is secondary to cognitive decline associated with HD

Multiple Sclerosis

MS - Chronic, progressive, immune-mediated neurological disorder that affects the CNS - specifically brain and spinal cord. In MS, the immune system mistakenly attacks the myelin sheath, the protective covering around nerve fibers causing demyelination, sclerosis in the CNS, and slowed or blocked nerve signals

• RRMS - Most common, flare ups followed by recovery periods

• SPMS - Starts as RRMS and worsens over time

• PPMS - Steady worsening from beginning, no relapses

• PRMS - Rare; progressive course with occasional relapses

Motor - Weakness, spasticity, balance and coordination issues (ataxia)

Sensory - Numbness or tingling

Cognitive - Memory and attention

Amytrophic Lateral Sclerosis

ALS - (Lou Gehrig’s) is a progressive neurodegenerative disease that affects motor neurons in the brain and spinal cord

UMN - Affects brain and cortex leading to spasticity and hyperreflexia

LMN - Affects brainstem and spinal cord leading to muscle weakness, atrophy and fasciculations (involuntary, localized muscle contractions/twitching)

• Motor - Atrophy, fasciculations, spasticity and hyperreflexia

• Cognition - Executive function limitations and poor judgement

SCI Level

C1-2: Neck flexion/extension/rotation (yes/no)

C3: Neck lateral flexion

C4: Shoulder elevation (shrug)

C5: Shoulder abd. and elbow flexion

C6: Wrist extension (tendodesis)

C7: Elbow extension/wrist flexion/finger extension

C8: Thumb flexion/extension/abduction and finger flexion

T1: Finger abduction

T2-12: Trunk control

L2: Hip flexion

L3: Knee extension

L4: Dorsiflexion (toes up)

L5: Great toe extension

S1: Plantarflexion (toes down)

S2: Knee flexion