Definitions of Common Neurological Impairments & Abbreviations used in Rehab

Caudal

Towards the tail

Cephal

Towards the head

Rostral

Towards the head or nose

Plasticity 

The ability to show modification or change

Short-term functional plasticity refers to changes in the efficiency, or strength, of synaptic connections 

Structural plasticity refers to changes in the organisation and number of synaptic connections 

Upper Motor Neuron Weakness

Muscle weakness following a lesion to the descending upper motor neurons of the central nervous (CNS)

Ie. After stroke, spinal cord injury, TBI

Clinical signs: weakness, fatigability, reduced dexterity, hyperreflexia and hyptertonus

Lower Motor Neuron Weakness

Muscle weakness following a lesion below the anterior horn in the spinal cord or along any part of the lower motor neuron in the peripheral nerve

Clinical signs: weakness, fatigability, reduced dexterity, hyporeflexia and hypotonous, flaccid muscles and fasiculation

Fasciculation 

The spontaneous firing of nerves causing visible twitching of muscles 

Flaccidity

Decreased muscle tone which contributes to joint instability, incoordination, poor postural adjustments and decreased functional ability

Palsy

Paralysis

Paraplegia 

Paralysis of both legs 

Tetraplegia (quadriplegia) paralysis

Paralysis of all 4 limbs

Diplegia

Paraplegia, loss of motor function but in the 2 body parts

General Fatigue 

Most common self-reported symptom after a stroke and MS. A general feeling of tiredness and fatigue affecting physical, cognitive and psychological areas 

Motor Fatigue

A decrease in motor performance following repetition of a physical task. Caused by both peripheral and central mechanisms.

Normal Muscle Tone

The force with which a muscle resists being lengthened, underlying “readiness” of muscle to contract

Hypertonus 

Increased muscle tone associated with the UMN lesion. Characterized by a resistance to movement (both active and passive movement) but no velocity component. 

Spasticity

A disorder of sensory-motor control resulting from an UMN lesion presenting as an intermittent or sustained involuntary activation of muscles

Characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. It is one component of the upper motor neurone syndrome

Rigidity 

Increased tone which remains constant throughout the range of movement of a joint, common in Parkinson’s disease. 

Lead pipe and cogwheeling 

Lead-Pipe

A constant resistance to passive movement

Cogwheeling

Ratchet (jerky) resistances to passive movement throughout range of movement

Due to superimposition of tremor on rigidity

Clonus 

Alternate involuntary muscle contraction in rapid succession caused by hyperexcitability of the stretch relfex 

Decerebrate Rigidity

Rigid extension of trunk, neck, and limbs, with limbs adducted and internally rotated

Feet are inverted and plantar flexed; wrist and fingers flexed

Suggests damage to midbrain

Decorticate Rigidity

Rigid extension of the trunk, neck and lower limbs with flexion of the upper limbs

Due to lesions of the thalamus, internal capsule and cerebral white matter

Hypotonia 

Also known as “low tone” 

A loss of resistance during both passive and active movement 

Dyskinesias

Abnormal involuntary movements

Ataxia

Abnormal co-ordination of movements

There are errors in the sequence speed, amplitude or timing of the components of each movement

Dyssynergia 

Decomposition of multi joint movements 

Dysmetria

The inability to use the correct force in executing a movement such that overreaching (hypermetria) and under reaching (hypometria) occur

Dysdiadochokinesia

Inability to perform rapidly alternating movements

Tremor 

Fine or coarse involuntary, rhythmic oscillating movements of any part of the body resulting from the reciprocal contraction of antagonistic muscle groups; an involuntary trembling 

Action Tremor

Tremor that appears during movement of the affected body part

Intention Tremor

Tremor that occurs as a limb nears intended target

Resting Tremor 

A tremor that occurs at rest 

Reduced Dexterity

A loss of fine motor control

Apraxia/Dyspraxia

Inability to execute a skilled or learned motor act, either on command or automatically, not related to motor weakness, sensory loss, incoordination or lack of comprehension

Ideational 

Inability to perform complex task either automatically or on command as he doesn’t understand the concept. There is failure to comprehend, develop or retain the concept of what is desired (the idea or concept of the motor act is lacking) 

Ideomotor

There is an understanding of the concept of task, but the patient is unable to execute it on command. Tasks may be carried out automatically.

Constructional

Impairment in producing designs in 2 or 3D by copying, drawing or constructining on command or spontaneously

Dressing 

Unable to relate clothes to the body 

Akinesia

Absence of movement. Failure to initiate movement due to dysfunction of the basal ganglia

Bradykinesia

Slowness of movement due to dysfunction of the basal ganglia

Autotopagnosia 

Inability to recognize or orients any part of one’s own body 

Caused by parietal lobe lesion 

Hypokinesia

Decreased amplitude and or range of movement - due to dysfunction of the basal ganglia

Synergy/Pattern

A persistent stereotyped combination of movements, usually used in abnormal movement

Can be flexor or extensor

Chorea

Jerky, rapid, involuntary movements involving trunk and proximal limb musculature in particular

Athetosis 

Slow, writhing continuous involuntary movements of the head, trunk and particularly seen in the hands

Dystonia

A movement disorder characterized by sustained or intermittent spontaneous and involuntary muscle contraction causing abnormal, often repetitive movements or postures or both

Dyskinesias

Abnormal involuntary movements

Peripheral Vestibular Disorders

Dysfunction of the peripheral vestibular apparatus and the vestibular nerve

Common conditions include BPPV, unilateral or bilateral vestibular hypofunction and Meniere’s disease

Central Vestibular Disorders

Central lesion that involves vestibular input and key integrative pathways, particularly in the brainstem and cerebellum 

Diplopia

Double vision

Can be monocular or binocular

Can be horizontal diplopia (2 images side by side) or vertical diplopia (1 image one on top of the other)

Hemianopia

Loss of vision for one half of the visual field of one or both eyes

Homonymous heminopia 

Loss of vision on the same side of each eye (ie. one medial and one lateral) 

Bitemporal hemianopia

Loss of vision in lateral field of each eye

Quadrantopia

Loss of vision in one quarter field, upper or lower, medial or lateral

Nystagmus 

Involuntary rhythmic oscillation of the eyeballs in horizontal, vertical or rotary direction. There are various types of nystagmus and can be a result of either peripheral or central vestibular disorders and neurological conditions.

Nystagmus has at least one slow phase. Common forms are jerk nystagmus, see-saw nystagmus and pendular nystagmus 

Jerk Nystagmus

Results as an imbalance of input to the oculomotor neurons

Jerk nystagmus has a slow phase and a fast phase

It is reordered by the direction of the fast component

Commonly seen in peripheral and vestibular disorders

Misperception of Subjective Visual Vertical

Disorder whereby the person cannot perceive if an object is upright

Usually caused by loss of vestibular afferent input unilaterally or damage to the visuo-vestibular pathways

Misperception of Subjective Postural Vertical 

Disorder whereby the person cannot orientate their body to vertical without the use of vision 

Usually caused by either loss of sensory afferent input of trunk or perception of sensory input 

Contraversive Pushing / Lateropulsion

The behavior of some patients after neurological injury, who use their nonparetic extremities to push towards the paretic side

They actively resist any attempt to passively correct their tilted body posture

Underlying cause of this is thought to be a misperception of verticality

Unilateral Spatial Neglect

Failure to report, respond or orient to novel or meaningful stimuli presented to the side opposite a brain lesion

Cannot be explained by either primary sensory or motor deficits

Inattention / Extinction 

Can be sensory or visual 

Can occur on simultaneous stimulation to both sides 

Ie. When attention to stimuli is intact when both eyes are tested separately and no when eyes are tested together, visual inattention is on the affected side 

Agnosia

The inability to recognize objects and symbols through a particular sensory channel (ie. vision, touch)

Lesions in the parietal lobe often cause agnosia or neglect of the contralateral side of the body, objects and drawings

Anosognosia

A form of neglect where the patient fails to recognize the presence or severity of their paralysis 

Most often seen in patients with non-dominant parietal lobe lesions 

Sensory Loss

Loss of sensation associated with damage either to the CNS or PNS

Includes: light touch, deep pressure, two-point discrimination and proprioception

When applied to one side it is referred to as “hemianesthesia”

Hemianesthesia

Loss of sensation on one side of the body

Stereognosis 

The ability to recognize objects by a sense of touch 

Two-Point Discrimination

The distance between 2 points of stimuli when awareness of these two stimuli on affected side of the body first occurs

Test with eyes closed

Paresthesia

Often described as “pins and needles”

Contracture 

Structural changes in the soft tissues over a joint 

Often characterised by shortened muscle lengths, but also ligaments, joint capsules, as well as nerves, blood vessels and skin

Permanent shortening

Learned Non-Use

As a result of moderate or severe impairments, people will often quickly adapt (or compensate) and start overusing the non-affected limbs

Physical Inactivity and Deconditioning

People with neurological conditions face many barriers that make it difficult to remain physically active

This can lead to heart disease, diabetes, obesity and cancer

Aphasia/Dysphasia

Language disroder

Receptive dysphasia is the inability to understand spoken language

Expressive dysphasia is the inability to verbalise 

Often presents in different forms of severity after a dominant hemisphere lesion 

Aphagia/Dysphasia

Unable to swallow/ difficulty swallowing

Dysarthria

Impairments in the articulation of speech due to disturbances in muscular control

Delirium 

Abnormal mental state characterised by inattention, confusion, irritability and inattention 

Habituation

A decrease in responsiveness that occurs because of repeated exposure to a non-painful stimulus

Lability 

Fluctuating emotional changes 

Abulia

Loss of will, impulse and decision-making ability

Preservation

The uncontrollable repetition of a previously appropraite or correct response, even though the repeated response has since become inappropriate or incorrect

Agraphia 

Inability to express thoughts in writing or drawing 

Alexia

Inability to read

Anomia

Inability to name objects