NPTE Studycast Physical Therapy
21 – Neuro – Vestibular Disorders
Vestibular Disorders Host: Jimmy McKay, PT, DPT Featured Guest; Alicia Flach, PT, DPT, NCS Notes by Alexis Lancaster Vestibular Disorders What is it? Disruption that can occur from vestibular apparatus (inner ear) through the cranial nerve to the CNS where the information is processed Any disruption along this path will cause a vestibular disorder Anatomy Peripheral vestibular system BPPV: problems within the vestibular apparatus, specifically semicircular canal Creates sensation of moving,...
20 – Neuro – Cauda Equina
Episode 20: Cauda Equina Syndrome Host Jimmy McKay Featured guest Bridget Ripa Notes Alexis Lancaster Cauda equina: “horse’s tail” What is it? Injury to lumbar and sacral spinal nerve roots within the canal Presentation Variable lower extremity paralysis Sensory loss Bowel and bladder dysfunction Causes Trauma, pelvic crush (MVA), child birth could precede it Differential diagnosis Other spinal cord syndromes Transverse myelitis MS Spinal infarct Spinal tumor Special tests CT, MRI Clinical...
19 – Neuro – Central Cord Syndrome
Episode 19: Central Cord Syndrome Host Jimmy McKay Featured guest Bridget Ripa Notes Alexis Lancaster What is it? Damage to the central portion of the spinal cord How does it happen? Hyperextension of the cervical spine is the typical cause Inflammation or pressure on the cord centrally Anatomy/Presentation Tricky Damages spinothalamic, corticospinal, and dorsal columns Upper extremities weaker than lower extremities Greater motor deficits than sensory deficits The sensation of the sacral...
18 – Neuro – Brown Sequard Syndrome
Episode 18: Brown Sequard Syndrome Notes by Alexis Lancaster, SPT What is it? Damage to one side of the spinal cord Mechanism of injury: MVA, gunshot wound, stab wound Impairments/presentation: Ipsilateral losses: proprioception, vibration, deep touch, discriminative touch, and voluntary motor control Contralateral losses: pain, temperature, crude touch Differential diagnosis: Other spinal cord injuries (see above impairments list and differentiate this way) MS Spinal infarct Spinal tumor...
17 – Neuro – Posterior Cord Syndrome
Episode17: Posterior Cord Syndrome Notes by Alexis Lancaster, SPT What is it? Damage to the posterior cord itself Occlusion of posterior spinal artery Very rare Differential diagnosis Any of the other spinal cord syndromes (anterior/brown sequard/central cord) Clinical presentation Isolated loss of proprioception, vibration, & discriminative touch Special tests Clinical presentation stated above CT/MRI for confirmation Treatment ICF model Medical management Bowel/bladder program Motor...
15 – Neuro – Autonomic Dysreflexia
Episode 15- Autonomic Dysreflexia What is it? Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above) The stimulus can be noxious or non-noxious Usually it is a noxious stimulus Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via...
14 – Neuro – Huntington’s Disease
Episode 14: Huntington’s Disease Host Jimmy McKay Featured guest Bridget Ripa Notes by Alexis Lancaster What is it? Inherited, an autosomal dominant trait Causes degeneration to specific brain regions Huntington’s disease gene is on chromosome 4 and it produces the Huntington protein that’s found throughout the body Signs/Symptoms Symptoms can present at any age Symptoms can include physical, cognitive, and psychiatric signs & symptoms The disease is divided into 5 stages Preclinical, early,...
12 – Neuro – Orthostatic Hypotension
Episode 12: Orthostatic Hypotension NPTE Studycast Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Notes by Alexis Lancaster, SPT What is it A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position Causes Cardiovascular system, BP, blood supply to the brain Signs & Symptoms: Physical signs: pallor, diaphoresis, loss of consciousness (potentially) Symptoms pt will report: dizziness, light-headedness, faintness, nausea...
11 – Neuro – TIA
TIA – Transient Ischemic Attack Notes by Nick O'Hanlon, SPT What is it? The same underlying mechanism as an ischemic stroke; with the main difference being the duration of symptoms is significantly less In other words, a brief episode of neurological dysfunction caused by ischemia (lack of blood supply) to the brain No tissue death occurs Signs and Symptoms Clinically presents like a stroke, but can also look like: a seizure disorder, tumor, migraines, or hypoglycemia Stroke symptoms –...
9 – Neuro – Heterotrophic Ossificans
Episode 9: Heterotopic ossification (HO) featured guest Bridget Ripa Notes by Alexis Lancaster What is it? The formation of bone inside soft tissue structures, where it’s not supposed to be It is extra-articular, so it occurs outside of the joint capsule What is involved? How does it happen? Exact pathophysiology is unknown Usually comes from a period of immobilization or traumatic injury to that bone or to the affected area of the body Presentation Swelling, redness, warm to the touch...
8 – Neuro – Spasticity
Episode 8: Spasticity Featured expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Notes by Alexis Lancaster, SPT What is it A type of tone Two types of tone exist: hypotonic and hypertonic Spasticity is a velocity-dependent resistance to stretch: this is the biggest difference between “tone” in general and “spasticity” Can lead to synergistic movement patterns Anatomy You won’t see spasticity unless there has been an injury to the CNS or the motor neuron Typical presentation of synergies when you...