Neuromuscular 1

basic map of concept

Focuses on assessing vestibular input in regard of acceleration/deceleration.  

Based on PTA exam book

Assesses patient's risk for fall (do not confuse this with Tinetti) 14 tasks, based on a scale from 0-4  Max score of 56  < 45 indicates increased risk for falls 

Specifically for balance in patients with hemiplegia.  7 items, scored on 0-2  Max score of 14, even with a prefect score patients will still have balance issues 

Assesses standing balance and risk for falls  3 trails with calculated average at the end  Ranges  20-40 years = 14.5-17 inches  41-69 years = 13.5-15 inches  70-87 years = 10.5-13.5 inches  Below appropriate range of age group = increase risk risk of falling 

Assesses visual, vestibular, and somatosensory  Test with eyes open versus close  Compensation of vision will indicate a mild lesion of the vestibular or somatosensory input  Sharpen Romberg can also be done with heel-to-toe stance 

Assesses mobility and balance  10 feet for test  Ranges  Independence = 10 secs or less  Mod I = 20 secs or more  High risks for falls = 30 secs or more 

Assess increased risks for falls (do not confuse this with Berg) First section assesses balance and second section assesses gait  All tasks are scored from 0-2  Max score of 28  As score decreases, risk of falls increases  Score that is lower than 19 is a high risk for fall 

Common with 

Also known as non-fluent aphasia 

Based on PTA exam book

Based on PTA exam book

Focus on static sitting grades for PTA exam. 

Based on PTA exam book

Based on PTA exam book

Based on PTA exam book

Based on PTA exam book

Based on PTA exam

Based on PTA exam book

Peripheral nerves (PNS)  31 pairs  Contains sensory, motor, and autonomic neurons  Most PNS have a ventral root (efferent[motor]) and dorsal root (afferent[sensory]) component  This is the basic of a reflex since it does not reach the brain to be process only a reactions to the spinal cord  Simple anatomy terms: Axon = part of the nerve where impulses travel away  Dendrites = Area of nerve where impulses are received   Motor unit = all of the muscles innervated by this nerve  Myelin = lipid sheaths that protect neuro-pathways and increase conductivity  Nerve conduction velocity = speed of nerve impulse  Neruons ​​​​​​​= Nerves basically  Nodes of ranvier = a gap between nerves of nerves to tissues where impulses jumps to the next  Saltatory conduction = the action potential when jumping from node to node where decrease salts = increase conductivity  Schwann cells = form of myelin that is only in the PNS Types of fibers  A fibers  Large fibers  Highly myelinated  High conductivity  B Fibers  Medium fibers  Reasonable myelination  Reasonable conductivity  C Fibers  Small fibers  Low myelination  Low conductivity 

Dermatomes and Myotomes  https://quizlet.com/220086237/data-collection-1-myotome-joint-resistance-flash-cards/    https://quizlet.com/220083500/data-collection-1-dermatomes-locations-flash-cards/

Based on PTA exam book

Dermatomes origins and myotomes weakness  C2 OCCIPUT, temple, and forehead  Weakness include sternocleidomastoid C3 ENTIRE NECK, cheek, mandible, and temporal area  Weakness include Trapezius C4 CLAVICULAR AREA, shoulder, and upp scapular area  Weakness include Trapezius and leavator scap  C5 DELTOID AREA, anterior aspect of arm, and based of thumb  Weakness include supraspinatus, infraspinatus, DELTIOD, and biceps  C6 ANTERIOR ARM RAIDATING TO THUMB SIDE  Weakness include BICEPS, SUPINATOR, and wrist extensors  C7 Along index/long/ring finger   Weakness include TRICEPS and wrist extensors  C8 Along ring/little finger   Weakness include THUMB EXTENSION  T1 Medial aspect of fore arm  No rooted weakness (if so it is due to diseases)  L1 Groin  No rooted weakness  L2 Front of thigh to knee  Weakness include PSOAS and hip adductors  L3 Medial lower leg  Weakness include QUADS and psoas  L4 Dorsum of foot to big toe  Weakness include ANTERIOR TIB and extensor hallucis  L5 Dorsum of foot to 2nd to third toe  Weakness include DORSIFLEXION and extensor hallucis  S1 Lateral aspect of foot and plantar aspect  Weakness include CALF, hamstring, PLANTAR FLEXORS, and peroneals  S2 Posterior medial leg  Same as S1 without peroneals 

CNS Brain, spinal cord, and Brain stem  Function: Main control center  Protected by meninges, cerebral spinal fluid, skull and vertebra  Types of matter  White matter is "inside" the brain that are umyelinated neurons  Gray matter is "outside" with myelnated neurons  PNS 12 Cranial nerves and 31 pairs of spinal nerves (5 cervical, 12 Thoracic, 5 lumbar, 5 sacral, 1 coccygeal)  Function: Anterior root  Carries info away from CNS in spinal nerves (Efferent)  Posterior root  Carries info towards CNS in spinal nerves (Afferent)  Autonomic nervous system (ANS) Sympathetic division Emergency response  Fight or flight  Norepinephrine neurotransmitter to create a response   Parasympathetic division  Relaxation Restores energy  Acetylcholine neurotransmitter to relax the body 

Forebrain  Cerebrum  Contains the corpus callosum which relays info between the two hemispheres  Has sulci and fissures  Frontal, temporal, parietal, occipital lobes  Midbrain Also known as the reflex center for visual, auditory, and tactile responses.  Hippocampus  Responsible for forming/storing new memories  Basal ganglia  ​​​​​​​Made of gray matter  Responsible for voluntary movement  Regulates autonomic movement, posture, muscle tone, and controls motor response  Produces dopamine  Amygdala  ​​​​​​​Responsible for emotional and social processing (fear, arousal, and processing of memory) Thalamus  ​​​​​​​Relay station for all sensory info  Coordinates sensory perception and movement  Hypothalamus  ​​​​​​​Receives and processes info from ANS Assist with homeostasis  Subthalamus  ​​​​​​​Regulates voluntary movement in skeletal muscles  Epithalamus  ​​​​​​​Secretes melatonin which helps regulation involuntary movement  Circadian rhythms (internal clock, hear beats, etc.  Hindbrain  Cerebellum Responsible for coordination of movements, maintaining posture, and balance through muscle tone and positioning of extremities  Damage to this usually indicates issues on the isilateral side  Brainstem   Pons Regulates breathing rate, orientation of head in relation the sound and vision  Medulla oblongata Made up of white matter  Influences ANS with respiratory rate and heart rate Involves with reflexes of vomiting, sneezing, and coughing  

Based on PTA exam book  LEFT  Language  Logic  Rational  Positive expression of emotions  Sequencing   RIGHT Nonverbal processing  Artistic  Balance awareness (Visual, Vestibular, Somatosensory)  Negative expression of emotions 

Frontal  Function  Primary cortex = voluntary movement  Broca's area  Speech  Concentration  Judgement  Reasoning  Behavior  Impairments  Expressive aphasia  Change in behavior Lack of focus  Poor initiation of movement Anti social  Contralateral weakness (hemipersis)  Parietal  Function  Sensory cortex  Hearing. vision, memory, spatial/visual perception  Wernick's area   Impairment  Contralateral weakness Dominant  Agraphia (difficulty with writing)  Alexia (Inability to read or comprehend words ) Agnosia (Inability to interpret info or sensation ) Non-dominant   Apraxia (Able to understand what the task is but has trouble with performing task due to sequencing issues ) Anosognosia (Impairment of awareness of disease or condition ) Receptive aphasia  Temporal  Function  Auditory cortex  Wernick's area Long term memory   Impairments  Receptive aphasia Difficulty with recognition of familiar faces or objects due to memory deficit  Occipital  Function  Visual cortex Impairment  Homonymous hemianopia (Impairment of vision on same side of both eyeballs usually results in neglect of a side) Diplopia  Or other visual impairments 

Left tract controls RIGHT side of left/right eyeball  Right tract controls LEFT side of left/right eyeball  

Based on PTA exam book

Increase CSF due to poor resorption which causes the brain the increase in size  Can be congenital or idiopathic  This can be usually a secondary affect from another disease or condition  Symptoms  Enlarge head  Headaches  Changes in vision  Large veins on scalp  Behavior changes  Seizures  Vomiting  Incontinence  Alteration in appetite  Downward deviation of the eyes  Treatment  Surgical placement of a shunt  Repeated surgery  Long-term care 

Inflammation of the meninges  Bacterial meningitis  Fatal within a few hours  Acute meningitis  Is extremely fatal and requires medical care immediately  Red flags  Fever  Vomiting  Headaches  Complains of a stiff neck (nuchal figidity)  Pain in lumabr area  Pain in posterior thigh  Sensitivity to light  Brudzinski's sign  Flexion of the neck facilitates flexion of the hips/knees Kernig's sign  Pain with hip flexion combined with knee extension Treatments  Antibiotics  Antimicrobial  Steriods 

(ACA) = Anterior cerebral artery  Supplies the frontal lobe  Typically causes frontal symptoms  Paraplegia  Incontinence  (MCA) = Middle cerebral artery  Supplies frontal/parietal/temporal lobes  Symptoms are depended on lobes affected  Hemiplegia  Sensory impairments  (PCA) = Posterior cerebral artery  Supplies occipital lobe  Symptoms are typically  Thalamic pain syndrome  Abnormal sensation of pain, temperature, touch, and propriocpetion  Cortical blindness  Loss of vision due to occipital damage  Vertebral-basilar artery  Supplies brain stem  Symptoms are server which results in a coma or vegetative state