What is optic ataxia?
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A condition characterized by difficulty in reaching for objects using visual guidance.
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What is optic ataxia?
A condition characterized by difficulty in reaching for objects using visual guidance.
What type of hemorrhage is discussed in the case example?
Right temporo-occipital lobar intracerebral hemorrhage (ICH).
How is a dermatome relevant to spinal cord injury?
It helps in assessing sensory function and determining the level of injury.
What is the Modified Tardieu Scale used for?
Assessing spasticity in individuals.
What is visual agnosia?
A disorder where a person cannot recognize objects despite having intact vision.
What is allocentric neglect associated with?
Damage to subcortical structures, particularly the thalamus.
What type of lesion is associated with failure of two-point discrimination?
PPC lesion.
What is the method used to test light touch sensitivity?
Applying a light stimulus such as a wisp of cotton or brushing motion of the fingertips to the skin.
What is sensory ataxia?
A condition that appears with eyes closed in the absence of weakness.
What role does practice play in tool proficiency?
Practice helps develop skills and familiarity with tools.
What does the Line Bisection Test evaluate?
It evaluates spatial neglect by asking individuals to bisect a line.
What is egocentric neglect associated with?
Damage to the perisylvian network, including pre- and postcentral, supramarginal, and superior temporal gyri.
How is extinction tested?
After a confrontation test for visual field is done.
What was the date of the CT scan for the right temporo-occipital lobar ICH?
2018/11/15.
Which pathway is associated with visual agnosia?
The 'what' pathway, also known as the ventral stream.
How can the repositioning test be conducted?
The examiner passively moves one joint on the affected side, and the patient reproduces the movement with the moved limb or the unaffected limb if they are a stroke patient.
What is Unilateral Spatial Neglect (USN)?
A condition where individuals fail to notice stimuli on one side of their environment.
Where is the tuning fork placed during the vibration test?
On a bony prominence, fingertips, or tips of the toes.
What is the difference between paralysis and paresis?
Paralysis refers to complete loss of muscle function, while paresis refers to partial loss of muscle function.
What areas can ataxia affect?
Eye movements, speech, limbs, or trunk.
What does a muscle strength grade of +2 mean?
Muscle contracts but the patient is unable to lift the limb.
What is the sequence of processing in sensorimotor integration?
1→2→3 and 3→2→1.
What does MMT stand for in the context of the Medical Research Council in Australia?
Medical Management Team.
What is apraxia?
Inability to perform previously learned purposeful movements despite having understanding, sensation, and motor function.
What factors cannot account for apraxia?
Inadequate strength, loss of coordination, impaired sensation, attentional difficulties, abnormal tone, movement disorders, intellectual deterioration, poor comprehension, or uncooperativeness.
What commonly causes unilateral apraxia?
Contralateral frontal (especially premotor cortex), parietal (especially posterior parietal cortex), or long association fiber lesions in the dominant hemisphere.
How do tools enhance practice?
By improving precision and reducing physical effort.
What does a score of '1' on the Modified Ashworth Scale indicate?
Slight increase in muscle tone.
What happens to the great toe in the presence of corticospinal lesions?
The great toe dorsiflexes (Babinski sign).
Which test was mentioned in the case example?
Line cancellation test.
What serves as a normal control during the vibration test?
The fingers of the examiner holding the tuning fork.
What is the Modified Ashworth Scale (MAS) used for?
To assess muscle tone.
What should always be done with the patient's eyes during sensory tests?
The patient's eyes should always be closed.
What does the Laterality Index (LI) measure in the Cancellation Test?
The ratio of stars cancelled on the left of the page to the total number of stars cancelled.
What does a muscle strength grade of +5 indicate?
Not able to overcome resistance.
What is the significance of the number 22 in relation to the Medical Research Council?
It refers to a specific classification or guideline within the MMT framework.
What frame of reference does egocentric neglect use?
Across space, using the body as a reference.
Which pathway is associated with optic ataxia?
The 'where' pathway, also known as the dorsal stream.
What are superficial reflexes elicited by?
Stimulating the skin.
What age and gender is the case example?
65-year-old male.
What are examples of tasks affected by constructional apraxia?
Filling in the numbers on a clock face or copying geometric figures.
What is the posterior parietal cortex (PPC) composed of?
Superior and inferior parietal lobules.
What are the two types of rigidity?
Lead-pipe rigidity and cogwheel rigidity.
What is spasticity?
A speed-dependent increase in resistance to passive movement, associated with lesions in the corticospinal tract.
What is the maximum score achievable on the Cancellation Test?
54 points.
What score indicates the presence of USN?
< 44/54.
What does a muscle strength grade of +4 signify?
Able to hold against resistance but the examiner can overcome.
What is the purpose of alternate tapping with the foot?
To measure dysdiadokokinesia.
What is astereognosis?
Inability to identify an object by touch when placed in the hand.
What is a dermatome in the context of anatomy?
An area of skin that is mainly supplied by a single spinal nerve root.
What is passive position sense testing?
The examiner displaces the joint of a finger or toe while the patient reports perceived changes in position with eyes closed.
What should be done if joint position sense is diminished distally?
More proximal limb joints are tested until normal position sense is encountered.
What do altered responses in superficial reflexes indicate?
Disorders affecting the corticospinal tract.
Which areas integrate somatosensory, visual, and auditory information?
Areas 39 and 40.
What type of hemorrhage was noted in the case example?
Bilateral intraventricular hemorrhage (IVH).
What is ataxia?
Impaired coordination resulting from lesions affecting the cerebellum or its connections.
What is the purpose of the Scene Copying Test?
To assess neglect by having individuals copy a scene.
What does the Finger-to-Nose-to-Finger (FNF) test measure?
Coordination and dysmetria by having the patient move their index finger between their nose and the examiner's finger.
What is a characteristic reflex response in lower motor neuron lesions?
Hypoactive reflex.
What happens to auditory processing with an MGN lesion?
It affects auditory perception.
What do muscle tone and reflexes indicate in a neurologic examination?
The state of muscle tension and the integrity of the reflex arc.
What is limb-kinetic apraxia?
Difficulty making precise and fine movements with the fingers, such as tying shoelaces.
What is the Ota Test used for?
To evaluate unilateral spatial neglect through cancellation tasks.
What is the purpose of the alternate heel to knee test?
To assess coordination in both legs.
What is the URL for the Neurological Examination Website?
What does the UBC Medicine Neurology Clinical Skills YouTube video on cranial nerves exam cover?
Cranial nerves exam.
What type of tremor is associated with intention?
Intention tremor.
What syndrome may be caused by neglect (USN)?
Pusher syndrome.
What was the date of the CT scan for the left medial parietal lobe hematoma?
2020/10/19.
What does a score of '4' on the Modified Ashworth Scale indicate?
Affected part is rigid in flexion or extension.
Which gyrus is associated with integrating sensory information?
Supramarginal gyrus.
What type of fibers does the spinothalamic tract consist of?
Small fibers.
What is the role of MGN in sensorimotor integration?
Medial Geniculate Nucleus, involved in auditory processing.
What is evaluated during motor integration in a neurologic examination?
The coordination and execution of voluntary movements.
What is gait apraxia?
Loss of ability to have normal function of the lower limbs, such as walking, not due to loss of motor or sensory functions.
What is a common symptom of sensory integration disorders related to body awareness?
Misperception of body awareness and objects in space.
What is ideational apraxia?
A disorder where individuals cannot carry out a sequence of actions to achieve a goal, often due to a lack of understanding of the task.
What type of test is the break test?
It is not a 'Make test'.
What is the significance of bilateral comparison in sensory testing?
It helps to identify differences in sensation between the two sides of the body.
What reflex is tested at the ankle?
Achilles reflex.
Who are the authors of the Modified Tardieu Scale?
Boyd RN & Graham HK.
What is Dysmetria?
A condition characterized by over- or under-shooting movements.
What is unilateral spatial neglect (USN)?
Failure to attend to space or use the limbs on one side of the body.
What is the significance of mapping dermatomes?
It aids in diagnosing and understanding the extent of nerve damage.
What can affect the sensory distribution in dermatomes?
Spinal cord injuries or diseases affecting the nervous system.
Why is it important to select the right tool for a task?
To ensure safety and effectiveness in completing the task.
What is rigidity in terms of muscle tone?
Increased tone over the entire range of motion, associated with basal ganglia disorders.
What does VPLN stand for in the context of sensorimotor integration?
Ventral Posterolateral Nucleus, related to somatosensory processing.
What are the signs of lower motor neuron lesions?
Weakness, muscle atrophy, decreased muscle tone, hypoactive reflex, and fasciculation.
What does LGN refer to in visual processing?
Lateral Geniculate Nucleus, responsible for visual information.
What sensations are transmitted by the dorsal column-medial lemniscus tract?
Proprioception, vibration, and light touch.
What is ideomotor apraxia?
A condition where individuals have difficulty executing movements on command, despite understanding the task.
What does the Egocentric perspective refer to in USN testing?
It focuses on the individual's own position in space.
What is the role of MCA in blood supply?
Middle Cerebral Artery, supplies blood to lateral aspects of the brain.
What does PCA refer to in the context of blood supply?
Posterior Cerebral Artery, supplies blood to the occipital lobe.
Which major muscles are assessed in the upper extremities (UE) during MMT?
Elbow flexors and extensors.
What is the Scene Copying Test used to evaluate?
It assesses the ability to copy a scene, indicating spatial awareness.
What is extinction in the context of sensory integration disorders?
Failure to perceive a visual or tactile stimulus when applied bilaterally, even though it can be perceived when applied unilaterally.
What does the Modified Ashworth Scale assess?
Muscle tone and resistance to passive movement.
What is the duration of the UBC Medicine video on motor, sensory, and reflexes exams?
15:59.
What is Terminal tremor?
A type of tremor that occurs at the end of a movement.
What does Dysdiadochokinesia refer to?
Impaired magnitude and rhythm of movements.
What was the effect of the hemorrhage on the right lateral ventricle?
Obliteration of the right lateral ventricle and midline shift.
What is Albert’s Test used for?
To assess Unilateral Spatial Neglect through line crossing.
What sensations are transmitted by the spinothalamic tract?
Pain, thermal sensations, and light touch.
What type of fibers does the dorsal column-medial lemniscus tract consist of?
Large fibers.
What are the cortico-subcortical loops involved in sensory integration disorders?
Loops involving the posterior thalamus and putamen of the non-dominant hemisphere.
What is the Clock Drawing Test used for?
To assess unilateral spatial neglect (USN).
What comparisons should be made during sensory testing?
Compare between the two sides of the body, distal and proximal parts, dermatomes, and lesioned and intact regions.
What does coordination refer to in a neurologic examination?
The ability to use different parts of the body together smoothly and efficiently.
What does MMT stand for in the context of muscle assessment?
Manual Muscle Testing.
What is the Star Cancellation Test designed to assess?
It evaluates the ability to cancel out specific stimuli, indicating neglect.
Which spinal levels are assessed for light touch sensation?
C2C8 and L1S2.
What does the Muscle Stretch Reflex (Deep Tendon Reflex, DTR) test?
The integrity of the sensory-motor loop to and from the spinal cord (Ia → α MN).
In which journal was the Modified Tardieu Scale published?
European Journal of Neurology.
What is the significance of the Tardieu Scale in clinical assessments?
It helps in quantifying the degree of spasticity.
What frame of reference does allocentric neglect use?
Within the object, using the object as a reference.
What is constructional apraxia?
Inability to draw accurate representations of external space.
What is the normal response of the plantar reflex?
Plantar flexion of the toes when stroking the sole of the foot.
What are the two types of spatial neglect?
Egocentric and Allocentric.
What is the function of the intraparietal sulcus?
It is involved in sensory integration.
What is the main task of the Cancellation Test?
The patient must cross out all the small stars on a sheet of paper.
Which lobule is associated with area 39?
Angular gyrus.
How is the Heel-Knee-Shin (HKS) test performed?
The supine patient runs the heel of one foot smoothly up and down the opposite shin while keeping the heel in contact with the shin.
What does alternate tapping with the palm and dorsum of the hand measure?
Dysdiadokokinesia.
How does muscle tone differ between upper and lower motor neuron lesions?
Upper motor neuron lesions show increased muscle tone, while lower motor neuron lesions show decreased muscle tone.
What is assessed under sensory function in a neurologic examination?
The ability to perceive sensory stimuli such as touch, pain, and temperature.
What does Albert’s Test (Line Crossing Test) evaluate?
It assesses the ability to cross lines on a page, indicating neglect.
What does the Key Cancellation Test involve?
It assesses the ability to cancel out keys on a page, indicating spatial neglect.
What is reposition sense used to assess in a right hemiplegic patient?
The right elbow.
In which journal was Zwinkels A's 2004 article published?
Clinical Rehabilitation.
What is a common example of an object that may be unidentifiable due to astereognosis?
A coin, key, or safety pin.
What does failure of two-point discrimination indicate?
Inability to differentiate between a single stimulus and two simultaneously applied adjacent stimuli.
Which brain structures are most commonly involved in anosognosia?
Parietal and frontal structures in combination.
What are the posture types mentioned in relation to the Modified Ashworth Scale?
Decerebrate and decorticate posture.
Where did the intraparenchymal hemorrhage occur in the case example?
At the right basal ganglia, frontal, parietal, and temporal lobes.
What is hypotonia?
Abnormally decreased muscle tone, associated with LMNs or cerebellar disorders.
What is two-point discrimination?
A sensory test that measures the ability to perceive two distinct points of touch.
What does extinction refer to in a neurologic context?
The inability to perceive stimuli on one side when stimuli are presented simultaneously on both sides.
What is ideational/conceptual apraxia?
Inability to conceptualize a task and impaired ability to complete multistep actions and use objects.
Which areas of the brain are associated with sensory integration disorders?
Superior parietal lobule (SPL) areas 5 & 7 and inferior parietal lobule (IPL) areas 39 & 40.
How should sensory testing proceed if a patient complains of sensory loss?
Testing should begin in the center of the affected area and proceed outward.
What should be tested first in muscle strength assessment?
Passive range of motion (ROM).
What type of inattention is observed in sensory integration disorders?
Inattention to sensory stimuli on the side of the body opposite to the brain lesion.
What is demonstrated during the Cancellation Test?
Canceling out the 2 small stars in the middle.
What does gait assessment involve in a neurologic examination?
The evaluation of walking patterns and stability.
What does a positive Babinski sign indicate?
Possible neurological dysfunction.
What is the focus of Cassidy A's 2016 article?
The clinical assessment of apraxia.
What does sustained 'ankle clonus' indicate?
Highly increased muscle tone.
What role do descending inputs play in DTR?
They modulate the Deep Tendon Reflex.
What is the primary purpose of tools in practice?
To assist in performing tasks more efficiently.
What type of exams are covered in the UBC Medicine video that lasts 8:37?
Coordination, balance, and gait exams.
What types of tools are commonly used in practice?
Hand tools, power tools, and specialized equipment.
What frequency tuning fork is used for the vibration test?
A low-pitched tuning fork at 128 Hz.
What are the signs of upper motor neuron lesions?
Weakness, muscle atrophy, increased muscle tone, hyperactive tendon reflex, and Babinski sign (+).
What is ideomotor apraxia?
Inability to plan or complete motor actions that rely on semantic memory; can perform actions automatically when cued but cannot follow commands or imitate actions.
What does sensory integration refer to in a neurologic examination?
The process by which the brain combines sensory information from different modalities.
What characterizes buccofacial apraxia?
Difficulties with performing purposeful movements with the lips, tongue, cheeks, larynx, and pharynx on command.
What is constructional apraxia?
A disorder characterized by difficulty in assembling or constructing objects.
How much time is allowed to complete the Cancellation Test?
Less than 5 minutes.
What is anosognosia?
Unawareness of a neurologic deficit.
In which conditions does anosognosia most frequently occur?
In association with unilateral right-sided or bilateral lesions of different brain areas.
Who are the authors of the study on the Modified Ashworth Scale?
Bohannon RW et al.
What causes bilateral apraxia?
Bilateral frontal or diffuse cerebral lesions.
What does the patient need to indicate during the light touch test?
Where the stimulus is perceived and how intensely it is felt on both sides.
What is the initial approach in position sense testing?
Testing with larger position changes first, then proceeding to smaller changes.
What does the patient need to indicate during the vibration test?
Whether the vibration is felt and when the feeling goes away.
Which brain regions are associated with the case example?
Parietal, temporal lobes, and thalamus.
What is egocentric neglect?
A condition where individuals fail to notice objects on one side of their body, often assessed through tasks like star cancellation and clock drawing.
What is allocentric neglect?
A condition where individuals neglect objects in the environment, assessed through tasks like line bisection and scene copying tests.
Where should sensory testing begin in relation to the body?
Sensory testing should begin distally, at the toes and fingers.
What does a Laterality Index (LI) of 0 ~ 0.46 indicate?
USN in the left hemispace.
What does a Laterality Index (LI) of 0.54 ~ 1 indicate?
USN in the right hemispace.
What is the importance of comparing distal and proximal regions during sensory tests?
It helps to assess the extent of sensory deficits accurately.
What sense is tested in the fingers and toes?
Vibration sense.
What additional hematoma was noted in the case example?
Hematoma at the left medial parietal lobe.
What types of information do Areas 5 and 7 integrate?
Somatosensory information.
Which disorders are associated with the symptoms mentioned?
Cerebellar or basal ganglia disorders.
What additional signs may accompany the Babinski sign?
Fanning of the toes, dorsiflexion at the ankle, and flexion at the thigh.
What does a muscle strength grade of +0 indicate?
Paralysis.
What does a muscle strength grade of +1 signify?
Minimal muscle contraction.
What is a characteristic reflex response in upper motor neuron lesions?
Hyperactive tendon reflex.
What is the purpose of cranial nerve function testing?
To assess the integrity and function of the cranial nerves.
What is oculomotor apraxia?
Difficulty moving the eye, especially with saccade movements that direct the gaze to targets.
What is optic ataxia?
Impaired visual-guided movements.
What is the difference between 'impaired' and 'normal' sensation?
Sensory testing should differentiate between 'impaired' and 'normal' sensation.
What is the order of testing stimuli strength during sensory tests?
From big/strong to small/light stimuli.
Which muscles are assessed for shoulder flexion strength?
Shoulder flexors (C5,6).
What does the Apples Cancellation Test assess?
It evaluates the ability to cancel out apple images, indicating neglect.
Which lobule is associated with area 40?
Inferior parietal lobule.
What do the Clock/Flower Drawing Tests assess?
They assess spatial neglect through drawing tasks.
What does a muscle strength grade of +3 indicate?
Able to hold the limb against gravity.
What is the Babinski sign and its significance?
A positive Babinski sign indicates upper motor neuron lesions.
What is the significance of the DCML pathway?
It is involved in sensory information transmission.
What does constructional apraxia refer to?
Impaired visuomotor transformation.
Are primary sensory modalities intact in patients with sensory integration disorders?
Yes, primary sensory modalities like touch are intact.
What reflex is tested to assess the biceps?
Biceps reflex.
What does HKN stand for in leg assessments?
Heel-Knee test.
What aspects are evaluated in motor function during a neurologic examination?
Strength, coordination, and the ability to perform movements.
What is constructional apraxia?
Difficulty in organizing and constructing objects or drawings.
What is the purpose of the Allocentric perspective in USN testing?
It considers the external environment and objects in space.
What is important to consider when applying resistance during muscle strength testing?
The level arm.
What does the Line Bisection Test measure?
It measures the ability to accurately bisect a line, indicating spatial awareness.
Which reflex is associated with the quadriceps?
Quadriceps reflex.
What is fasciculation and in which type of lesion is it observed?
Fasciculation is involuntary muscle twitching, observed in lower motor neuron lesions.
What is evaluated in the stance component of a neurologic examination?
The ability to maintain balance and posture.
What does FNF stand for in motor assessments?
Finger-Nose-Finger test.
What does ALA stand for in the context of blood supply?
Anterior Limb of the Internal Capsule.
What are the major muscles assessed in the lower extremities (LE) during MMT?
Knee flexors and extensors.
What is assessed in passive position sense?
Right index finger DIP, PIP, MP, and right wrist.
Who is the author of Examination (II)?
Pei-Fang Tang, PhD, PT.
What is assessed in the mental status component of a neurologic examination?
Cognitive functions such as memory, attention, and orientation.
Which institution is associated with Pei-Fang Tang?
School and Graduate Institute of Physical Therapy, National Taiwan University.
