session 3: neuro and vestibular and nerves

different types of MS:

relapse-remitting, secondary progressive, primary progressive, and progressive-relapsing

relapses/attackes with partial recovery and stable symptoms between attacks is which MS

relapsing remitting

progresses from relapses and periods of stable symptoms: becomes a continues inc in symp

secondary progressive

constant and steady inc in disability without exacerbations

primary progressive

steady inc in disability with superimposed attacks

progressive relapsing (worst type)

most common form of MS

relapsing-remitting MS

A pt presents to PT with complaints of sudden onset of dizziness and loss of balance which has been severe and present for about 5 days. PT notes pt demon wide BOS during gait and slow speed with dec trunk rotation. she has pos head impulse test. she reports nausea and vomiting with symptoms and reports ringing in her left ear along with mild hearing loss. which of following is most consistent with this presentation?

A- BPPV

B- labyrinthitis

C- vestibular neuritis

D- acoustic neuroma

BPPV- would be seconds long, no more than 1 min and turning out of bed. positive dix hallpike test.

labyrinthitis- inner ear and cochlea (labyrinth) when we see inflammation of this structure we will see hearing deficits and vestibular will see balance loss

vestib. neuritis- an inner ear disorder caused by inflammation of the vestibulocochlear nerve, which disrupts balance signals sent from your ear to your brain.

acousitc neuroma-slow-growing, noncancerous tumor that develops on the main nerve carrying sound and balance information from the inner ear to the brain

BBPV key words

seconds to min, nausea and vomiting, nystagmus, position change

meineres key words

vertigo: min to hrs

tinnitus

loss of hearing

ear fullness

bilat sympt

labryrinthitis key words

vertigo: days to weeks

nausea and vomiting

+ head impulse test

sudden onset

tinnitus and hearing loss unilateral ear

vestibular neuritis key words

vertigo: days to weeks

nausea and vomiting

+ head impulse test

sudden onset

acoustic neuroma (vestibular schwannoma) key words

vertigo: slow onset

tinnitus and hearing loss in affected ear

facial numbness or weakness

treatment: surgery than can work on habituation, gait training, balance

peripheral vs central vestibular

peripheral: BPPV, vestib neuritis, labyrin., acoustic neuroma

central: brain related-CVA, cerebellum

findings: nystagmus=vertical gaze, direction changing, pendular (think the DVD TV thing where ball hits screen to another side of screen)

+saccades, + smooth pursuit, +VOR cancellation

coordination deficits, spasticity

No torsion!

if have posterior canal canalithiasis right side, which direction will eyes go towards:

upbeating torsional same side canal affected so right side

PUP= posterior+ upbeating

a pt reports transient numbness and weakness in R forearm after sleeping with arm compressed against chair. symp begin immed upon waking. on examination, distal pulses and skin color are normal. motor strength and sensation are reduced and begin to improve within hrs, and reflexes are intact. no muscle atrophy is noted? which classification fo nerve injury and associated prognosis is MOSt likely?

A- neurotmesis, required surigical repair

B- axonotmesis, recovery expected over seveeral mths

C- neuropraxia, good potential for full recovery within days to weeks

D-axonotmesis, requires surgical intervention

C

neuropraxia is

segmental demyelinatin, muscle does not atrophy, temporary sensory symptoms

nerve is COMPRESSED

recovery is complete

axonotmesis is

loss of axonal continuity but connective tissue coverings remain intact

wallerian degernation distal to lesion

muscle fiber atrophy and sensory loss

result prolonged compression or stretched

recovery is incomplete-surgery may be required

neurotmesis is

complete severance of nerve fiver

muscle fiver atrophy and sensory loss

result of gunshot or stab wounds

no recovery without surgery

flexion synergy UE is supinated or pronated?

extension synergy of LE-hip IR or ER

UE spasticity is forearm supinated or pronated

for a pt with stroke, in supine, how should the pelvis and knee be positioned at rest

supinated

Typical UE flexion synergy:

Shoulder: flexion + abduction + ER

Elbow: flexion

Forearm: supination

Wrist: flexion

Fingers: flexion

🧠 Memory: "Flexion = bringing it UP → palm UP" → supination

hip IR

Typical LE extension synergy:

Hip: extension + adduction + IR

Knee: extension

Ankle: plantarflexion

Toes: flexion

🧠 Memory: "Extension synergy = leg turns IN" → hip IR

So:

LE extension = hip IR LE flexion = hip ER

pronated

Shoulder adduction + IR → elbow flexion → forearm pronation → wrist/finger flexion

So you can think:

"Spastic UE = palm DOWN" → pronation

knee slight flexion, hip slight retraction