Vocab - Neuromuscular

Frontal Lobe

• thinking, memory, behavior and movement

• intellect, personality, reasoning, behavior, self-awareness, executive functions

Parietal Lobe

• language and touch

• touch, kinesthesia, vibration, meaning for objects, language, words

Temporal Lobe

• hearing, learning and feeling

• auditory and olfaction, speck, memory

Occipital Lobe

• vision/sight

• visual info, light, color, shapes, 3D, cortical blindness with bilateral lobe involvement = blind

Cerebellum

balance and coordination

Brain Stem

breathing, HR, temp

ASIA Impairment scale:

A

= complete

• no motor/sensory function at S4 - S5

ASIA Impairment Scale:

B

= sensory incomplete

• sensory intact, no motor

• sacral sensory sparing

ASIA Impairment scale:

C

= motor incomplete

• some sparing of motor function 3 levels below

  • MMT 3 and below

• sacral motor sparing

ASIA Impairment scale:

D

= motor incomplete

• 50%+ of key muscle functions 1 level below

• More muscle function, most key muscles below injury are stronger (MMT ≥3/5).

ASIA Impairment scale:

E

= normal

Spinal Shock Syndrome

• build up of edema and inflammatory response

• Edema builds 3- 6 days s/p SCI

• Immediate, temporary loss of power, sensation, and reflexes below the lesion

Autonomic Dysreflexia

A dangerous, sudden spike in blood pressure caused by an irritating stimulus below the level of a spinal cord injury (usually at or above T6)

AD S&S

• Severe, pounding headache

• Dangerously high BP

• Flushed face / sweating above injury

• Goosebumps below injury

• Bradycardia

• Nasal congestion

• Anxiety

• Cold, pale skin below injury

If head goes red…

raise the head (AD)

If head goes pale…

raise the tail (OH)

agnosia

the inability to recognize faces, voices, object, or places

apraxia

impairment of voluntary skilled learned movement 

Dix-Hallpike Test

measures the presence of posterior canal BPPV

• do the Epley’s maneuver for tx

To make a wheelie easier, shift the axle…

FORWARD

Median N lesion

• Attempting to make a fist, 1-3 fingers do not flex

• d/t weakness of flexor digitorum superficialis and flexor digitorum profundus on the radial side (innervated by median n.)

ulnar N lesion

• Loss of 3 - 4 lumbricals

  • Hand at rest - 4th and 5th fingers appear flexed

UMN Signs

• Spasticity, clonus, hypertonia, hyper reflexive, positive Babinski sign

LMN signs

• Muscle wasting, flaccidity, hypotonia, hypo reflexive 

• “Lazy Motor Neurons”

Deep Tendon Grading:

0

absent, no reflex

Deep Tendon Grading:

1+

diminished, race, or seen only with reinforcement

Deep Tendon Grading:

2+

active normal response 

Deep Tendon Grading:

3+

brisk, exaggerated response; often with spread to other muscle groups

Deep Tendon Grading:

4+

clonus, very brisk, hyperactive with clonus

Grades 0 - 1 (Deep Tendon Grading) indicates…

indicates a LMN lesion

Grades 3 - 4 (Deep Tendon Grading) indicates…

indicates a UMN

Broca’s Area

• knows what to say, but cannot say it

  • they understand but cannot speak

• affecting the frontal lobe

• “Expressive / Non-fluent aphasia”

Wernicke’s Area 

• talks but words don’t make much sense

  • They DON’T understand but CAN speak

• affecting the temporal lobe

• “Receptive / Fluent Aphasia”

Red

• Median N

• Ape Hand

Blue

• Radial N

• Wrist Drop

Yellow

• Ulnar N

• Claw Hand

What nerve is with Green?

Ulnar N

What nerve is with Blue?

Median N

What nerve is with Purple?

Radial N

spasticity

velocity-dependent increase in muscle tone

Meniere’s Disease 

A disorder of the inner ear caused by excess fluid (endolymph), leading to episodes of vertigo, hearing loss, tinnitus, and ear fullness/pressure.

Blocked Practice 

practice of a single motor skill repeatedly 

Variable Practice 

practice of varied motor skills in which the performer is required to make rapid modifications of the skill in order to match the demands of the task

Random Practice 

practice of a group or class of motor skills in random order

Serial Practice 

• practice of a group or class of motor skills in serial or predictable order

Mobility 

The ability to initiate movement through a functional range of motion

Stability

•  The ability to maintain a position or posture through contraction and tonic holding around a joint. Unsupported sitting w/ midline control is an example of stability through contraction and tonic holding

controlled mobility 

• The ability to move w/in a weight bearing position or rotate around a long axis. Activities in prone on elbows or weight shifting in quadruped are examples of controlled mobility.

Inhibition Techniques define

• decrease tone or calm spastic muscles

• used when a muscle is tight, overactive or spastic

Facilitation Techniques define

• increase muscle activation

• used when a muscle is weak, low tone, or needs to fire

Facilitation Techniques - how to

• Tapping

• Quick stretch

• Approximation

• Weight-bearing

• High-frequency vibration

• Fast movements

Inhibition Techniques - how to

• Prolonged stretch

• Deep pressure

• Slow rocking / rhythmic movement

• Neutral warmth / heat

• Joint traction

• Low-frequency vibration

stupor

general unresponsiveness with arousal from repeated stimuli

obtunded

state of unconsciousness that is a state of sleep, decreased alertness to arousal, delated response to stimuli 

delirum

state on consciousness with disorientation, confusion, agitation, loudness

UE Flexion Synergy Pattern

• Scapula: Retraction

• Shoulder: Abduction, ER

• Elbow: Flexion

• Forearm: Supination

• Wrist/Finger: Flexion

UE Extension Synergy Pattern 

• Scapula: Protraction

• Shoulder: Adduction, IR

• Elbow: Extension

• Forearm: Pronation

• Wrist/Finger: Flexion

LE Flexion Synergy Pattern

• Hip: Flexion, Abduction, ER 

• Knee: Flexion

• Ankle: DF, inversion

LE Extension Synergy Pattern

• Hip: Extension, Adduction, IR

• Knee: Extension

• Ankle: PF, inversion

Median N glide

• Shoulder depression + slight abduction

• Elbow extension

• Wrist/finger extension

• Forearm supination

• Neck side bend away

Radial N glide 

• Shoulder depression + abduction

• Elbow extension

• Forearm pronation

• Wrist/finger flexion

• Shoulder internal rotation

• Neck side bend away

Ulnar N glide 

• Shoulder depression + abduction

• Elbow flexion

• Forearm pronation

• Wrist/finger extension

• Shoulder external rotation

• Neck side bend away

Max score on Berg Balance is …

56 = normal

Berg Balance score of 45 or below = …

high fall risk

Berg Balance score of 40 or below = …

severe fall risk

Who is more prone to get autonomic dysreflexia?

SCI levels T6 and above