Neuro 2 Exam 1

Otolith organs detect __ acceleration and position of the head

linear

Severe spinning lasting for seconds to minutes triggered by changing head position most likely indicates __

Benign paroxysmal positional vertigo

No vertigo when sitting or standing still but when walking or turning head dizziness occurs along with poor balance. Symptoms occur every day but are better in the morning and worse at night when tired. Lying down for a little while relieves symptoms. The most likely diagnosis is __

Unilateral vestibular hypofunciton

Afferent neurons from the peripheral vestibular apparatus connects to the brainstem via which cranial nerve?

VIII Vestibulocochlear

Primary function of Vestibular Ocular Reflex

stabilize gaze when head is accelerating and decelerating

When activating the VOR, how would the eyes repsond to the head moving quickly to the LEFT

eyes would rotate to the right at equal velocity

Vestibular nuclei are located in what area of the brain?

Pontomedullary junction

Which disorder can be treated by maneuvers that move Calcium carbonate crystals out of the semicircular canal and back into the utricle

Benign paroxysmal positional vertigo

Oscillopsia and chronic instability but no dizziness is most often indicative of

Bilateral vestibular hypofunction

Acute vestibular syndrome will be evaluated with the HINTS assessment. Which test would most likely rule out a CVA?

Positive Head Impulse Test

Optokinetic Nystagmus

Nystagmus generated by repeated visual motion (environmental) stimulus

A pt presents with signs of acute vestibular syndrome, severe vertigo, nausea and vomiting, which have lasted over 24 hours. Which disorder DOES NOT present at AVS?

CVA

Bilateral vestibular hypofunction

Acute unilateral vestibular hypofunction

MS exacerbation

Bilateral vestibular hypofunction

Medial vestibulospinal tract responsible for

neck response to head movements

Lateral vestibulospinal tract responsible for

postural response to head movement

Vestibulothalamic tract responsible for

Perception of head movement in space

Medial longitudinal fasciculus responsible for

Vestibular ocular reflex

Which principle of neuroplasticity discusses the fact that individuals who want to improve in a certain task should spend considerable time devoted to practicing that task?

Use it and Improve It

Specificity Matters

Transference

Repetition Matters

Specificity Matters

As a treating therapist, you decide to begin gait training with your new patient with stroke (acute) by walking in parallel bars.  As the person advances in ability you then begin gait training with the use of a quad cane then straight cane, and finally without an assistive device.  What principle of neuroplasticity are you following?

Transference

Repetition Matters

Interference

Time Matters

Interference

Peripheral disorders

Meniere’s disease, BPPV

Central disorders

seizure, stroke, head trauma

Yaw

spin in circle

Pitch

frontflip/backflip

Roll

cartwheel

Yaw movements detected by

lateral canal

Pitch movements detected by

ant/post canals

Oscillopsia

stationary objects appear to be moving

Benign Paroxysmal Positional Vertigo

sudden onset, lasts less than 1 minute, vertigo, positional

In vertigo, nystagmus beats __ involved side

towards

In hypofunction, nystagmus beats __ involved side

away from

Rancho level IV

confused/agitated, max assist

focused on basic needs, recognize family sometimes

Rancho level V

confused/inappropriate/non-agitated, max assist

can’t remember so makes things up

Rancho level VI

confused/appropriate, mod assist

knows they are in hospital

Rancho level VII

automatic/appropriate, min assist for ADLs

issues planning activities

Rancho level VIII

purposeful/appropriate, stand by assistance

knows they have memory/thinking issue

Rancho level IX

purposeful/appropriate, stand by assistance on request

Rancho level X

mod independent

Rancho level III

local response, total assist

Rancho level II

general response, total assist

MOI for TBI

falls, self harm, assualt, MVC

Most common MOI for TBI

falls

Types of TBI

external force, acceleration/deceleration, blast, penetrating object

Lesion to either hemisphere in the cerebullum can result in

ipsilateral dysmetria, dysdiadochokinesia, and intention tremor

GCS severe score

3-8 points

GCS moderate score

9-12 points

GCS minor score

13-15 points

Parietal lobe damage often results in these deficits

agnosia, proprioceptive issues, recognition, postural control

Frontal lobe damage often results in these deficits

personality changes, cognitive impairment, language production issues, poor motor planning/execution

Occipital lobe damage often results in these deficits

homonymous hemianopsia

Cerebellum damage often results in these deficits

ataxia, ipsilateral dysmetria, dysdiadochokinesia, intention tremor, poor balance, coordination

Temporal lobe damage often results in these deficits

hearing problems, memory and learning impairments, speech comprehension issues

Best imagining to detect diffuse axonal injury and what you would see on the image

MRI, bleed in corpus collosum and cerebral cortex

Symptoms of diffuse axonal injury

coma, headache, nausea, dizziness, fatigue

Craniotomy

excised bone immediately replaced

Craniectomy

excised bone replaced at a later date

GSP score < _ indicates an ICP should be placed

8

PaCO2 should be maintained at *_to _* mmHg with an ICP in place

35-45

OPTIMAL theory of learning

optimizing performance through intrinsic motivation and attention for learning

3 components of OPTIMAL theory of learning

attentional focus

environmental focus

motivational praise

Use it and improve it should incorporate this principle

overload

Be sure to include _ exercises according to repetition matters principle

UE

Intensity matters suggests target HR should be _ *to _*

70-80%

_ evidence that moderate to high intensity walking and virtual reality will improve walking speed

strong

_ evidence strength training or cycling at moderate to high intensities will improve walking speed

weak

_ evidence that \n body weight supported treadmill training, robotic-assisted training, \n or sitting/standing balance training without virtual reality should NOT \n be performed to improve walking speed

strong

Motor Learning

internal process associated with practice and experience that lead to relatively permanent change in skilled behavior capabilities

Types of feedback

KOP, KOR, transitional

Timing of feedback

bandwidth, summary, faded, delayed, concurrent

Types of practice

constant, variable

HINTS to INFARCT

head impulse negative, changing nystagmus, positive skew deviation

Vestibular adaptation exercises

VOR 1 and 2

Central substitution exercises

gaze stability, imaginary target

Goal duration for vestib exercises

1-2 mins

Goal frequency for vestib exercises

3x / day

Vertigo shows nystagmus towards _ side

hyperactive

Dix Hallpike produced upbeating indicates _ involvement

posterior canal

Dix Hallpike produced downbeating indicates _ involvement

anterior canal

Semont maneuver used to treat this physiology

cupulolithiasis

CRT used to treat this physiology

canalithiasis

Canalithiasis

free floating otoconia, short duration nystagmus (< 1min)

Cupulolithiasis

otoconia adherent to cupula of canals, long duration nystagmus (> 1 min)

Eyes skipping during VOR supression test indicates _ involvement

cerebellum

Positive head impulse test

head turned towards hypofunction, eyes correct back to target

This treatment after positive Dix Hallpike (BPPV)

CRT

This treatment after positive Supine Roll test (lateral BPPV)

log roll

This treatment after positive Head Impulse test

VOR 1 or 2

% double limb support

25

% single limb support

75

% stance phase

60

% swing phase

40

normal hip extension during gait

20

normal hip flexion during gait

25

normal knee extension during gait

5

normal knee flexion during gait

60

normal DF during gait

10

normal PF during gait

15

5 degrees PF prevents

knee buckling

5 degrees DF prevents

knee extension thrust

All orthotics help

foot clearance, step length, cadence

Toe-Off brace prevents

knee buckling

Walk-On assists

DF