NPTE Neuromuscular Flashcards

Terms Definitions
Myotatic reflex stimulus
muscle stretch
Myotatic reflex arc
Afferent Ia from muscle spindle to alpha MN and back to muscle
Myotatic reflex function
maintenance of muscle tone, support agonsist muscle contraction, provide feedback about muscle length
Myotatic reflex testing
Via an inhibitory IN the myotatic reflex inhibits the antagonist
Reciprocal inhibition
Myotatic reflex effect on synergistic muscles
Inverse myotatic reflex stimulus
muscle contraction
Inverse myotatic reflex arc
Afferent Ib from GTO via inhibitory IN to muscle
Function of inverse myotatic reflex arc
provides agonist inhibition, decreases force of agonist, stretch protection reflex
Allows muscle tension to come under control of descending pathways
Gamma reflex loop
Gamma reflex loop path
excite gamma MN causing muscle spindle contraction then increased stretch sensitivity and increased firing from spindle afferents then conveyed to alpha MNs
Flexor withdrawal reflex stimulus
cutaneous sensory stimuli
Flexor withdrawal reflex arc
cutaneous receptors via Ins to flexor muscles
Flexor withdrawal reflex arc function
protective withdrawal mechanism
Crossed extension reflex stimulus and response
noxious stimuli – Flexors excited with extensor inhibition, opposite on CL side
Crossed extension reflex function
coordinates reciprocal limb activities such as gait
3 elements of Glasgow Coma Scale
eye opening, motor response, verbal response
Scoring of GCS
3-8 severe, 9-12 moderate, 13-15 minor
State defined by no eye opening even to pain, failure to obey commands, inability to speak
Return of sleep/wake cycles, normalization of basic functions, lack of cognitive responsiveness
Vegetative state
Central language DO with speech is awkward, restricted, interrupted, produced with effort
Expressive aphasia (Broca’s, nonfluent, motor)
Expressive aphasia result of
L hemisphere – Broca’s area
Impairment of volitional articulatory control 2/2 cortical dominant hemisphere lesion
Verbal apraxia
Impairment of speech production
Central language DO where spontaneous speech preserved/smooth while auditory comprehension impaired
Receptive or Wernicke’s aphasa
Receptive aphasia is result of damage to
Posterior frist temporal gyrus of L hemisphere (Wernicke’s area)
Severe aphasia with impairments in comprehension & production of language
Global aphasia
Periods of apnea followed by gradually increasing depth/frequency of respirations
Cheyne Stokes respiration
Cheyne Stokes caused by
depression of frontal lobe and diencephalic dysfunction
Increased rate and depth of respirations
Hyperventilation can be caused by dysfunction of
lowere midbrain and pons
Abnormal respiration with prolonged inspiration
Apneustic breathing
Apneustic breathing is result of damage to
upper pons
Elevation of temperature may be damage to
hypothalamus or brainstem
Signs of meningeal irritation
Kernig’s sign, Brudinski’s sign, guarding in neck flexion, photophobia, disorientation, restlessness, persistent HA that increases with head down, altered vitals, weakness
Kernig’s sign
meningeal irritation. Supine with flexed hip/knee to chest then extend knee.
Brudzinski’s sign
meningeal irritation. Supine, flex neck. Causes flexion of hips/knees
Increased ICP leads to
restless, confused, decr LOC, incr BP, widening pulse P & slowed pulse, Cheyne-Stokes, elevated temp, HA, vomiting, unequal pupils, slowed PLRs, dilated pupils*, papilledema, weakness, hemiplegia, Babinski, decorticate or decerebrate rigidity, seizures
Joint position sense
test for ability to perceive joint position at rest in response to passive positioning
movement sense
vibration sense with tuning fork
Combined cortical sensation testing
discriminative sensory tests including Steriognosis, Tactile Localization, Two Point Discrimination, Bilateral Simultaneous Discrimination, Barognosis, Graphesthesia, Texture recognition
ID familiar objects by touch
Two point discrimination
ability to recognize one or two blunt points applied to skin simultaneously
ability to differentiate weights
ability to ID numbers, letters or symbols traced on skin
Homonymous hemianopsia
loss of half of visual field in each eye contralateral to side of cerebral hemisphere lesion
body scheme disorder – unable to ID body parts or relations to each other
Unilateral neglect
patient ignores one side of body and stimuli from that side
severe neglect or denial of severity of condition
Figure ground discrimination
spatial relations syndrome with lack of ability to pick out object
Form constancy
pick out object from array of similar shapes but different sizes
Spatial relations
pt duplicates a pattern of 2-3 blocks
Topographical disorientation
navigation of a familiar route
Vertical disorientation
inability to accurately determine what is upright
inability to recognize familiar objects with one sensory modality
inability to perform voluntary learned movements in the absence of loss of sensation , strength, coordination, attention, or comprehension. Breakdown in conceptual or motor production system or both
Ideomotor apraxia
cannot perform task on command, but can do independently
Ideational apraxia
cannot perform the task at all, either on command or independently
Clasp-knife response
marked resistance to PROM suddenly gives way
maintained stretch stimulus produces cyclical spasmodic contraction, usu plantar flexors or wrist flexors
DF of great toe with fanning of other toes with stroke to lateral bottom of foot
Babinski indicates
corticospinal (pyramidal) tract disruption
increased DTRs
Lead pipe Rigidity
uniform throughout range
Cogwheel rigidity
interrupted by series of jerks
Decerebrate posturing
increased tone in extension, seen in brainstem lesions between superior colliculus and vestibular nucleus
Decorticate posturing
UEs in flexion, LEs in extension, seen in brainstem lesions above superior colliculus
arching back of head back and heels with UEs rigidly flexed. Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning
Plantar reflex
Normal is PF of toes in response to stroking lateral sole of foot from calcaneus to 5th met, S1-2, tibial nerve
Abdominal reflex
T6-L1, lateral to medial scratching of skin to umbilicus in each of 4 quadrants should cause deviation of umbilicus to stimulus
Cremasteric reflex
L1-L2, stroking of skin on inner thigh elevates testicle, lost in SCI and Corticospinal lesions
Sources of fatigue
CNS/central fatigue, neural/myoneural fatigue, muscle contractile failure
CNS/Central fatigue
Neural/myoneural junction fatigue
MS, Post Polio syndrome, GBS, myasthenia gravis
Muscle contractile failure fatigue
metabolic changes at muscle, muscular dystrophies
Extrapyramidal disorders (basal ganglia dysfunction)
Tics, Chorea, athetosis, tremors, myoclonus
spasmodic contractions of specific muscles
relatively quick twitches or dancing movments
slow, irregular, twisting movements, esp in UEs
continuous quivering mvmt, rhythmic, oscillatory observed at rest
single, quick jerk
Cerebellar disorders cause
intention tremors
Cortical disorders cause
seizures, tonic/clonic convulsive mvmts
impaired ability to associate muscles together for complex mvmt
impaired ability to judge distance or range of movement
impaired ability to perform rapid alternating movements
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