NPTE Neuromuscular

Augmented Feedback

externally presented feedback that is added to that normally acquired during task performance

Agnosia

inability to recognize objects with one form of sensation

Akinesia

inability to initiate movement (major component of Parkinson's Disease)

Aphasia

Disturbance of language that results in errors in word choice, comprehension, or syntax. (most commonly seen with lesion to the left cerebral hemisphere)

Apraxia

inability to perform movements previously learned even though there is no loss of strength, coordination, sensation, or comprehension

Ideational apraxia

person no longer gets the "idea" of how to do a routine

Ideomotor apraxia

person cannot do a task on command but can do it spontaneously

Astereognosis

inability to recognize objects by touch. Damage to the cerebral somatosensory association cortex

Asynergia

inability to move muscles together in a coordinated manner

Ataxia

uncoordinated movements, especially gait

Athetosis

slow, involuntary, worm-like, twisting movements

Causalgia

burning sensation, which are painful. (associated with complex regional pain syndrome)

Chorea

rapid, involuntary, jerky movements. (Huntington's chorea)

Clonus

rhythmic involuntary oscillation of a muscle and joint in response to sudden stretch. (upper motoneuron disease)

Decerebrate Rigidity

involuntary contraction of the extensor muscles of the upper and lower extremities because of an injury in the brainstem above the vestibular nucleus and below the red nucleus

Decorticate Rigidity

Contraction of the flexor muscles of the upper extremities with contraction of the extensor muscles of the lower extremities. Results of damage to motor tracts above the red nucleus (midbrain)

Delirium

temporary confusion and loss of mental function. Often a result of illness, drug toxicity, or loss of oxygen.

Dementia

Loss of memory or intellectual functioning.

May be reversible if caused by toxins, drugs, metabolic or psychiatric disorders.

Often slowly progressive and nonreversible with chronic alcoholism, Alzheimer's disease, infarction, Parkinson's disease. etc.

Dysdiadochokinesia

impaired ability to perform rapid alternating movements. (associated with cerebellar disorders)

Dysmetria

inability to judge distances. (cerebellar dysfunction)

Herpes Zoster (shingles)

painful inflammation of the posterior root ganglion, caused by virus, resulting in formation of vesicles along the course of the nerve

Horner's Syndrome

Drooping of the eyelid (ptosis), constriction of the pupil (miosis), and lack of sweating of the ipsilateral face (anhidrosis), occurs secondary to damage to the sympathetic tract (e.g., cervical sympathetic chain ganglion or associated tract in the brain stem)

Hypermetria

Seen with cerebellar dysfunction in which individuals past point or move beyond a specific target

Nystagmus

involuntary eye movement in a horizontal, vertical, or rotational direction. Associated with vestibular, visual, and cerebellar disorders.

Somatagnosia

lack of awareness of the relationship of one's own body parts or the body parts of others.

Visual Acuity

sharpness of vision

Homonymous Hemianopsia

The loss of the right or left half of the field of vision in both eyes. (damage to the contralateral optic tract)

Bitemporal Hemianopsia

deficits of the temporal or peripheral visual field, caused by injury at the optic chiasm. (tunnel vision)

Monocular Blindness

blindness in one eye

Middle Cerebral Infarction

A. most commonly involved stroke

B. contralateral hemiplegia, with sensory and motor deficits in the face and upper extremity greater than LE

C. Contralateral homonymous hemianopsia

D. Infarction in dominant left hemisphere often produce aphasia

E. Infarction of right (non-dominant) hemisphere results in perceptual deficits

F. Occlusion of main stem of middle cerebral artery may result in global aphasia

Anterior Cerebral Infarction

A. LE has greater sensorimotor deficits than UE

B. Urinary incontinence

C. Can result in impairment such as confusion, amnesia, apathy, or short attention span

Posterior Cerebral Infarction

A. Various visual deficits (homonymous hemianopsia, visual agnosia, prosopagnosia)

B. Aphasia and thalamic pain syndrome can also result

C. Can also cause hemiplegia if cerebral peduncle of midbrain involved

Thalamic Pain Syndrome

a condition caused by damage to the thalamus resulting in burning or tingling sensations and possibly hypersensitivity to things that would not normally be painful such as light touch or temperature change

Vertebral-basilar infarction

A. often results in death from the edema associated with the infarct

B. Lesion affects pons, results could be quadriparesis and bulbar palsy or a "locked-in" state whereby the pt communicates by eye blinking

C. Other vertebral artery symptoms can include vertigo, coma, diplopia, nausea, dysphagia, ataxia, and various cranial nerve impairments

Anterior Inferior Cerebellar Artery Infarction

Results in unilateral deafness, loss of pain and temperature on the contralateral side, paresis of lateral gaze, unilateral Horner's syndrome, ataxia, vertigo, and nystagmus

Superior Cerebellar Infarction

Severe ataxia, dysarthria (loss of muscle articulation control), dysmetria, and contralateral loss of pain and temperature

Posterior Inferior Cerebellar Infarction

Results in Wallenberg's syndrome, which is characterized by vertigo, nausea, hoarseness, dysphagia, ptosis, and decreased impairment of sensation in the ipsilateral face and contralateral torso and limbs. Horner's syndrome might also appear

Wallenberg's Syndrome

Posterior Inferior Cerebellar Artery (PICA) thrombosis "Medullary Syndrome", Ipsilateral: ataxia, facial pain & temp; Contralateral: body pain & temp

Upper Extremity Flexion Synergy

Scapular retraction/elevation, shoulder abduction, ER, elbow flexion, forearm supination, wrist and finger flexion

Lower Extremity Flexion Synergy

Hip flexion, abduction, external rotation

Knee flexion

Ankle dorsiflexion, inversion

Toe dorsiflexion

Upper Extremity Extensor Synergy

- Scapula: Depression and protraction

- Shoulder: Medial rotation and adduction

- Elbow: Extension

- Forearm: Pronation

- Wrist and Finger: flexion

Lower Extremity Extensor Synergy

- Hip: Extension, medial rotation, and adduction

- Knee: Extension

- Ankle: Plantar flexion with inversion

- Toes: flexion and adduction

Right Hemisphere affected (left hemiparesis)

a) problems with spatial relationships and hand-eye coordination

b) Irritability, short attention span

c) cannot retain information, difficulty learning individual steps

d) poor judgement affecting personal safety

e) diminished body image with left-sided neglect

f) quick and impulsive

Left Hemisphere affected (right hemiparesis)

a) apraxia

b) difficulty starting and sequencing task

c) perseveration

d) easily frustrated with high levels of anxiety

e) inability to communicate verbally

f) cautious and slow

Augmented Feedback

information about a performance that supplements sensory feedback and comes from a source external to the performer

Rancho Los Amigos Level of Cognitive Function: I

No response. Completely unresponsive to any stimuli

Rancho Los Amigos Level of Cognitive Function: II

Generalized response. Pt reacts inconsistently and nonspecifically to stimuli

Rancho Los Amigos Level of Cognitive Function: III

Localized response. Pt reacts inconsistently but specifically to stimuli

Rancho Los Amigos Level of Cognitive Function: IV

Confused/agitated. Ft is in a heightened state of activity. Behavior is bizarre and nonpurposeful relative to immediate environment. Recall and attention span are poor.

Rancho Los Amigos Level of Cognitive Function: V

Confused-inappropriate. Pt able to respond to simple commanded but not do complex tasks. Memory is impaired. Verbalization is inappropriate.

Rancho Los Amigos Level of Cognitive Function: VI

Confused-appropriate. Pt is dependent upon external input but can perform consistently. Memory improved

Rancho Los Amigos Level of Cognitive Function: VII

Automatic-appropriate. Can perform automatically and appropriately in structured environments. Judgement remains impaired.

Rancho Los Amigos Level of Cognitive Function: VIII

Purposeful-appropriate. Pt acts appropriately though not perfectly. May have some problems in stressful or unusual circumstances.

Glasco Coma Scale (GCS)

Eye opening: spontaneous to none

Best motor response: follows commands to abnormal response to no response

Verbal response: oriented to inappropriate to no response.

Score 8 or less indicative of traumatic brain injury

Level of arousal: alert

Pt is awake and attentive to normal levels of stimulation.

Level of arousal: Lethargic

Pt appears drowsy and may fall asleep if not stimulated in some way. Pt may have difficulty in focusing or maintaining attention.

Level of arousal: obtunded

Pt is difficulty to arouse from a somnolent state and is frequently confused when awake. Interactions with therapist may be limited

Level of arousal: Stupor

Pt responds only to strong, generally noxious stimuli and returns to the unconscious state when stimulation is stopped.

Level of arousal: coma

Pt cannot be aroused by any type of stimulation

Paraplegia

Only lower extremities are involved, resulting in weakness (paraparesis) or paralysis

Tetraplegia

All four extremities are involved. Also known as quadriplegia or quadriparesis (weakness)

What are some activities associated with CI-C3 level?

Talking, mastication, sipping, blowing

Which muscles are key for CI-C3 level?

Face and neck muscles

What type of care for CI-C3 level?

Dependent self-care

What equipment is required for CI-C3 level?

Portable ventilator or phrenic nerve stimulator, power tilt-in-space wheelchair with mouth control, seatbelt for trunk control

What independence can be achieved with CI-C3 level and a lesion at C3?

Wheelchair independence with equipment on smooth surfaces

How do assistive technology devices help at CI-C3 level?

They make interaction with or mastery of the environment feasible

What are the key muscles involved in C4 injury?

Diaphragm, trapezius

What is a common method used for coughing in individuals with C4 injury?

Glossopharyngeal breathing

How can individuals with C4 injury adjust their wheelchair?

Chin control

What adaptive equipment can help individuals with C4 injury with feeding and ADLs?

Mobile arm supports, environmental controls, adapted eating equipment, head or mouth stick

What are the key movements associated with C5 spinal cord injury?

Elbow flexion, supination, shoulder external rotation, abduction to 90 degrees, limited shoulder flexion

Which muscles are key for individuals with C5 spinal cord injury?

Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboids, supinator

What level of assistance is typically required for lower extremity dressing and rolling in C5 spinal cord injury?

Moderate to minimal assistance

How do individuals with C5 spinal cord injury perform transfers?

Dependent, with the aid of a sliding board or swivel bar

What type of wheelchair is recommended for community integration for individuals with C5 spinal cord injury?

Power chair with hand controls (joystick)

What type of wheelchair is recommended for indoor use for individuals with C5 spinal cord injury?

Manual wheelchair with rim projectors

How can individuals with C5 spinal cord injury achieve ischial pressure relief?

With forward lean, but usually dependent

What level of assistance is needed for manual cough technique in C5 spinal cord injury?

Assistance is needed

What are the key movements associated with C6 spinal cord injury?

Shoulder flexion, extension, internal rotation, adduction, scapular abduction, upward rotation, forearm pronation, wrist extension

Which muscles are key for individuals with C6 spinal cord injury?

Extensor carpi radialis, infraspinatus, latissimus dorsi, pectoralis major, serratus anterior, teres minor

What is a long-term goal for assist in individuals with C6 spinal cord injury?

Independence in rolling and unsupported sitting

What mobility aids are recommended for individuals with C6 spinal cord injury?

Manual wheelchair with projections or friction hand rim for household mobility; power wheelchair for community integration

How can stability in transfers be increased for individuals with C6 spinal cord injury?

Locks on casters positioned sideways

What technique can individuals with C6 spinal cord injury use independently for coughing?

Manual cough technique

What level of motivation is required for individuals with C6 spinal cord injury to live without assistance?

Well motivated

What is a possible activity individuals with C6 spinal cord injury can do independently?

Drive automobile with hand controls

What are the key functions of C7 level of spinal cord injury?

Capable of elbow extension, wrist flexion, finger extension

Which muscles are important for individuals with C7 spinal cord injury?

Key muscles: extensor pollicis longus and brevis, extrinsic finger extensors, flexor carpi radialis, and triceps

What level of assist is required in lower extremity exercises is expected for C7 spinal cord injury?

Independent in LE self-range of motion exercises

How can individuals with C7 spinal cord injury achieve community integration using a wheelchair?

Can use manual WC with friction hand rims for community integration with some difficulty on rough terrain

What assistive device may be needed for independent dressing for individuals with C7 spinal cord injury?

Button hook may be required for independent dressing

What mobility task can individuals with C7 spinal cord injury perform related to transportation?

Able to get WC in and out of car

What muscles are key for C8 level of injury?

Extrinsic finger flexors, flexor carpi ulnaris, and flexor pollicis longus and brevis.

What is the functional capability of someone with C8 level of injury?

Capable of full use of all upper extremity muscles except intrinsics of the hand.

What level of assist can someone with C8 level of injury achieve at home?

Independent in living at home except for heavy work. May need tub seat, grab bars, etc. for full independence.

What mobility skills can someone with C8 level of injury have?

May be able to independently go up/down curbs with a manual wheelchair.

What work environment is suitable for someone with C8 level of injury?

Able to work in a building free of architectural barriers.

What are the key improvements seen in T1-T5 spinal cord injury patients?

Capable of full use of UEs, improved trunk control, increased respiratory reserve.