Clinical correlations Exam 2

What is the ASIA Scale?

tool used to communicate between providers about the spinal cord injury (American Spinal Injury Association) Impairment Scale

How is the motor level defined in the ASIA scale?

motor level is defined as the lowest key muscle that has a grade of at least 3, provided that the key muscles above are graded as a 5

Category A on the ASIA scale

complete lack of motor and sensory function below the level of injury

Category B on the ASIA scale

Some sensation below the level of injury

Category C on the ASIA scale

some muscle movement is spared below the level of injury but 50% of the muscles below the level of injury cannot move against gravity

Category D on the ASIA scale

most of the muscles that are spared below the level of injury are strong enough to move against gravity

Category E on the ASIA scale

all neurological function has returned

ASIA C

Most common cause of spinal cord injury?

motor vehicle crash

Why is anticipating rehab needs important?

-pt education may prevent secondary complications

-dysfunction in one area can lead to dysfunction in another

-functional needs may change over time

What is DBS surgery?

(deep brain stimulation) very invasive neurosurgical intervention for the treatment of movement disorders (and more)

FDA approved disorders to use DBS on

parkinsons, dystonia, essential tremor and OCD

Do we know exactly how DBS works?

No - thought is that DBS overrides abnormal neuronal activity

Are DBS insertions permanent?

yes, only removed for infection risk

What does MPTP do

kills dopaminergic neurons, induces symptoms similar to parkinsons

_____tremor: High amplitude slower frequency and mostly seen at rest

parkinsons tremor

_____tremor: low amplitude, fast frequency and mostly seen during action

essential tremor

patterned directional and often sustained muscle contractions and causing twisting and repetitive movements or abnormal postures

primary dystonia

Who would be a good candidate for DBS

someone who is responsive to medications, in otherwise good health between ages 7-75

When is DBS appropriate

when other treatments (pharma) are not working, or have stopped working

What is a DBS electrode

platinum wire electrodes connected to a stimulator, the battery is located inside the stimulator

What would be the DBS target in parkinsons disease

-subthalamic nucleus

-globus pallidus interna

Which PD symptoms respond best to DBS

tremors, bradykinesia, cog-wheel rigidity

DBS target for essential tremor

ventral intermediate nucleus of thalamus (unilateral)

What essential tremor symptoms respond best to DBS?

action/postural tremor in upper and lower extremities

What is the DBS target for Dystonia

-subthalamic nucleus

-globus pallidus interna (unilateral or bilateral)

Correct term for the amputated limb

"residual limb"

What is phantom limb phenomena

global feeling that the body part is still present, accompanied by specific sensations or pain

What is Telescoping or Tele-Limb?

the limb is felt in an awkward paralyzed position, can change shape/position, more common in upper limbs

Is amputation is adults or in children more likely to result in phantom limb pain?

adult amputation

Can phantom limb occur in people born without limbs?

yes

In war torn nations, what causes most traumatic amputations?

landmines

Who is more likely to experience pain memory?

people with history of pre amputation limb pain

phantom limb pain memory can be triggered by

depression, stress, anxiety

Which systems are involved in causing phantom limb pain?

CNS and PNS

What occurs in peripheral reorganization?

amputation neuromas (small tumors made of nerve tissue)

highly sensitive and induces actual and phantom pain

up regulated sodium channels in these neuromas

What occurs in spinal reorganization?

Dorsal root ganglion cells show abnormal spontaneous activity and increased sensitivity

when anesthetizing the residual limb does not improve pain, this indicates what?

more central changes have occurred (cortical reorganization)

What is a preventative treatment for phantom limb pain?

pre surgical analgesia (longer pain free period)

2 types of surgical intervention for phantom limb pain

-nerve revision removal of neuromas

-spine stimulator

Name 2 of the main psychological therapies for phantom limb pain

Eye movement desensitization and reprocessing (EMDR)

Mirror therapy

Describe how Virtual Reality works as treatment for phantom limb

computer translates neural impulses into movement of the virtual limb via electrodes placed on muscles, pt repeats movements prompted by the computer

What is meant by cortical reorganization

the areas in the cortex can become "mixed" (example of patient who could feel their amputated fingers when someone touched different areas of their face)