Neuro Concord

Motor neurone disease (MND)

A progressive neurodegenerative disease that affects upper and lower motor neurons in the brain and spinal cord.

Pathophysiology of MND

Degeneration of motor neurons leads to muscle weakness, wasting, and loss of voluntary movement, with preserved sensation and cognition.

Upper motor neuron signs (in MND)

Spasticity, hyperreflexia, pathological reflexes (e.g., Babinski sign).

Lower motor neuron signs (in MND)

Muscle wasting, fasciculations, weakness, hyporeflexia.

Most common subtype of MND

Amyotrophic lateral sclerosis (ALS).

Bulbar symptoms in MND

Dysarthria, dysphagia, tongue wasting or fasciculations.

Respiratory complications in MND

Progressive respiratory muscle weakness can lead to hypoventilation and respiratory failure.

Role of physiotherapy in MND

Maintain function, manage spasticity and contractures, respiratory support, energy conservation, and assistive equipment prescription.

Prognosis of MND

Progressive and terminal; average life expectancy is 2–5 years post-diagnosis.

Essential components of sitting

Upright trunk alignment, equal weight distribution, feet flat on floor, 90° hip and knee flexion, hands free for balance or activity.

Key impairments affecting sitting

Poor trunk control, decreased lower limb strength, sensory deficits (e.g. neglect, reduced proprioception).

Essential components of sit-to-stand (STS)

Forward momentum generation, anterior pelvic tilt, foot placement under knees, dorsiflexion, concentric hip and knee extension.

Common impairments in STS

Reduced power in quads/glutes, poor coordination, fear of falling, poor balance.

Physio cues for STS

"""Bring your feet back, lean forward like you're going to nose over toes, and push through your legs."""

Essential components of standing

Upright trunk, knees extended (not locked), pelvis level, symmetrical weight bearing, head balanced over shoulders.

Common impairments in standing

Postural sway, asymmetrical weight bearing, ankle instability, fear of falling.

Physio strategies for standing retraining

Use mirror feedback, verbal cues for alignment, task-specific repetition, and progression to dynamic balance tasks.

Phases of gait

Stance phase (60%) and swing phase (40%).

Stance phase events

Heel strike → Foot flat → Mid-stance → Heel off → Toe off.

Swing phase events

Initial swing → Mid swing → Terminal swing.

Key muscles in heel strike

Tibialis anterior, glute max, quads.

Key muscles in toe off

Gastrocnemius/soleus, hip flexors.

Common impairments in hemiparetic gait

Foot drop, knee hyperextension, circumduction, reduced stance time, poor push-off.

Assistive strategies for hemiparetic gait

AFO, cueing, task-specific gait training, FES.

Ischaemic stroke definition

Neurological dysfunction caused by focal cerebral, spinal, or retinal infarction due to lack of blood flow.

Haemorrhagic stroke definition

Bleeding into or around the brain due to vessel rupture; includes intracerebral and subarachnoid haemorrhage.

Main types of haemorrhagic stroke

Intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH).

Most common cause of haemorrhagic stroke

Uncontrolled hypertension.

Transient Ischaemic Attack (TIA)

Temporary neurological dysfunction without infarction; symptoms resolve within 24 hours.

Most common artery involved in stroke

Middle cerebral artery (MCA).

Symptoms of MCA stroke

Contralateral hemiparesis, sensory loss (face/arm), homonymous hemianopia, aphasia (if left), neglect (if right).

Symptoms of ACA stroke

Contralateral leg weakness/sensory loss, executive dysfunction, behavioural changes.

Symptoms of PCA stroke

Contralateral homonymous hemianopia, visual agnosia, memory deficits.

Basilar artery stroke

Can cause locked-in syndrome; high mortality rate.

NIHSS purpose

Quantifies stroke severity and guides treatment decisions.

Frontal lobe functions

Motor control, speech production (Broca's), executive function, impulse control.

Parietal lobe functions

Sensory perception, spatial awareness, calculation, and reading.

Temporal lobe functions

Auditory processing, memory formation, language comprehension (Wernicke’s).

Occipital lobe functions

Visual processing and interpretation.

Cerebellum function

Balance, posture, coordination, fine motor control.

Brainstem function

Regulates vital functions: breathing, heart rate, consciousness.

Basal ganglia function

Initiates wanted movement and inhibits unwanted movement.

Basal ganglia structures

Caudate, putamen, globus pallidus, substantia nigra, subthalamic nucleus.

Parkinson’s disease pathophysiology

Degeneration of dopaminergic neurons in the basal ganglia.

Cardinal signs of Parkinson’s

Bradykinesia, rigidity, resting tremor, postural instability.

MS pathophysiology

Autoimmune demyelination of CNS neurons.

Common MS symptoms

Fatigue, weakness, sensory changes, visual disturbances, ataxia.

Upper Limb MMT areas

Shoulder, elbow, wrist, fingers, thumb.

Lower Limb MMT areas

Hip, knee, ankle.

Sensation test method

Light touch with finger swipe over dermatomes.

Upper limb coordination test

Finger-to-nose test.

Lower limb coordination tests

Toe tapping, heel-to-shin.

Normal systolic BP

100–180 mmHg

Normal diastolic BP

60–90 mmHg

Normal HR

50–100 bpm

Normal MAP

70–105 mmHg

Normal ICP

7–15 mmHg

Critical ICP

25 mmHg (critical), >40 mmHg (risk of herniation)

Normal CPP

60–90 mmHg

NIHSS - What it assesses

Level of consciousness, language, motor and sensory function, visual fields, coordination, speech, inattention.

NIHSS score 0

No neurological deficit.

NIHSS score 1–4

Minor stroke.

NIHSS score 5–15

Moderate stroke.

NIHSS score 16–20

Severe stroke.

NIHSS score 21–42

Very severe stroke.

GCS - What it assesses

Eye opening, verbal response, motor response.

GCS score 13–15

Mild brain injury.

GCS score 9–12

Moderate brain injury.

GCS score 3–8

Severe brain injury / coma.

Cranial Nerve I

Olfactory – Smell (sensory).

Cranial Nerve II

Optic – Vision and pupillary light reflex (sensory).

Cranial Nerve III

Oculomotor – Eye movement, eyelid elevation, pupillary constriction (motor + parasympathetic).

Cranial Nerve IV

Trochlear – Eye movement (superior oblique muscle) (motor).

Cranial Nerve V

Trigeminal – Facial sensation, chewing (mixed).

Cranial Nerve VI

Abducens – Eye movement (lateral rectus muscle) (motor).

Cranial Nerve VII

Facial – Facial expression, taste (anterior 2/3), tears and saliva (mixed).

Cranial Nerve VIII

Vestibulocochlear – Hearing and balance (sensory).

Cranial Nerve IX

Glossopharyngeal – Taste (posterior 1/3), swallowing, salivation (mixed).

Cranial Nerve X

Vagus – Parasympathetic control of heart, lungs, GI tract; voice; sensation (mixed).

Cranial Nerve XI

Accessory – Sternocleidomastoid and trapezius muscle control (motor).

Cranial Nerve XII

Hypoglossal – Tongue movement (motor).

Thrombolysis (rtPA)

Used in ischaemic stroke to dissolve clots; must be given within 4.5 hours of symptom onset.

Contraindication for thrombolysis

Haemorrhagic stroke must be ruled out by CT.

Endovascular clot retrieval (ECR)

Used for large vessel occlusion; can be done up to 24 hours post-onset at certain hospitals.

Post-thrombolysis management

Strict bed rest for 24 hours, monitor for bleeding and neurological status.

Post-ECR management

Bed rest for 4 hours, monitor vitals and neurological signs.

Haemorrhagic stroke treatment

Control bleeding, reduce ICP, stop anticoagulants, possible surgical intervention.

Guillain-Barré syndrome (GBS)

Autoimmune attack on peripheral nerves causing weakness, areflexia, and sensory changes; often starts in legs.

Multiple forms of GBS

AIDP (most common), CIDP (chronic form), Miller Fisher syndrome.

Myasthenia gravis (MG)

Autoimmune attack on acetylcholine receptors; causes fluctuating muscle weakness that worsens with activity.

Myasthenic crisis

Life-threatening respiratory failure due to diaphragm weakness; requires ventilation.

Functional neurological disorder (FND)

Neurological symptoms without structural pathology; due to dysfunction in nervous system.

FND symptoms

Weakness, tremors, blackouts, sensory changes, seizures – not explained by disease but real and distressing.

Key aspects of discharge planning

Patient goals, mobility level, home setup, supports, rehab needs, education.

Discharge flow

Assessment → MDT discussion → Plan supports → Handover/referral.

Is patient safe for discharge?

Ask: Would I let them walk out alone if they were my grandparent?

Agnosia

Inability to recognize objects.

Aphasia

Impairment in language production or comprehension.

Apraxia

Difficulty with motor planning despite intact motor function.

Ataxia

Lack of coordination of voluntary movements.