A 56-year-old patient experienced sudden headache and vomiting during lunch, and was diagnosed with stroke after being sent to the hospital with right hemiplegia and left facial nerve palsy. The most likely location of the lesion is the basal ganglia. Stroke patients with left hemiplegia and sensory impairment on the left side and more flexible lower limbs compared to upper limbs on the affected side likely have a lesion in the middle cerebral artery. A 55-year-old male with sudden right hemiplegia and urinary incontinence was diagnosed with an embolic stroke; after two months, the right upper limb recovered nearly normally but the right lower limb remained markedly weak, indicating a likely lesion in
This document describes the six cardinal positions of gaze and nine diagnostic positions of gaze defined by specific eye muscle movements. It then discusses the different types of eye movements including fixation, vestibulo-ocular reflex, optokinetic, smooth pursuit, saccades, and vergence. The roles of the cerebral cortex, cerebellum, cranial nerve nuclei, and brainstem pathways in generating and modulating different eye movement types are outlined. Clinical tests to evaluate various eye movement abnormalities are also summarized.
Left hemiplegia is total paralysis of the arm, leg, and trunk on the left side of the body, most commonly caused by stroke which damages the right cerebral hemisphere. Symptoms include loss of control over movements, difficulty walking and swallowing, and numbness on the left side of the body. The goals of physiotherapy rehabilitation are to restore lost abilities, prevent complications, and improve quality of life through mobility exercises, activities of daily living training, orthotics, and addressing issues like spasticity, swallowing, and incontinence. Rehabilitation uses both conventional therapies like range of motion exercises and neurophysiological approaches focused on muscle re-education, neurodevelopment, and motor relearning.
Mechanism of balance & vestibular function test Dr Utkal MishraDr Utkal Mishra
This powerpoint elaborates the mechanism of balance & anatomy of vestibular apparutus. It also depicts the anatomy & physiology of haircells in detail. I also explained the vestibular function tests used for diagnosis of various vestibular disorders.
This document outlines the components of a general neurological assessment, including subjective and objective assessments. The subjective assessment involves taking a neurological history and headache/present complaint. The objective assessment examines various neurological functions like speech, mental status, sensory function, motor function, coordination, gait, and functional status. Key parts of the neurological exam include tests of consciousness, cranial nerves, reflexes, muscle tone/strength, and higher cognitive functions. The assessment aims to identify impairments, activities, and participation based on the ICF model of functioning.
Assessment of vestibular function testSomnath Saha
This document discusses tests used to assess vestibular function, including both clinical tests and laboratory tests. It first provides an overview of anatomy related to the vestibular system. It then describes various clinical tests such as spontaneous nystagmus, fistula tests, Romberg tests, and gait analysis. Laboratory tests discussed include caloric testing, electronystagmography, optokinetic testing, rotation testing, and galvanic testing. The goal of these tests is to evaluate the vestibular system both peripherally and centrally in order to diagnose causes of dizziness and imbalance.
The document discusses electronystagmography (ENG), which tests eye movements using electronic recordings. It lists the main tests done with ENG, including gaze tests, optokinetic nystagmus tests, positional tests, and caloric tests. The caloric test induces nystagmus using temperature changes to evaluate vestibular system function. The document also lists various eye movement findings that can be detected through ENG testing, such as nystagmus, dissociations, dysrythmias, and positional nystagmus.
This document describes the six cardinal positions of gaze and nine diagnostic positions of gaze defined by specific eye muscle movements. It then discusses the different types of eye movements including fixation, vestibulo-ocular reflex, optokinetic, smooth pursuit, saccades, and vergence. The roles of the cerebral cortex, cerebellum, cranial nerve nuclei, and brainstem pathways in generating and modulating different eye movement types are outlined. Clinical tests to evaluate various eye movement abnormalities are also summarized.
Left hemiplegia is total paralysis of the arm, leg, and trunk on the left side of the body, most commonly caused by stroke which damages the right cerebral hemisphere. Symptoms include loss of control over movements, difficulty walking and swallowing, and numbness on the left side of the body. The goals of physiotherapy rehabilitation are to restore lost abilities, prevent complications, and improve quality of life through mobility exercises, activities of daily living training, orthotics, and addressing issues like spasticity, swallowing, and incontinence. Rehabilitation uses both conventional therapies like range of motion exercises and neurophysiological approaches focused on muscle re-education, neurodevelopment, and motor relearning.
Mechanism of balance & vestibular function test Dr Utkal MishraDr Utkal Mishra
This powerpoint elaborates the mechanism of balance & anatomy of vestibular apparutus. It also depicts the anatomy & physiology of haircells in detail. I also explained the vestibular function tests used for diagnosis of various vestibular disorders.
This document outlines the components of a general neurological assessment, including subjective and objective assessments. The subjective assessment involves taking a neurological history and headache/present complaint. The objective assessment examines various neurological functions like speech, mental status, sensory function, motor function, coordination, gait, and functional status. Key parts of the neurological exam include tests of consciousness, cranial nerves, reflexes, muscle tone/strength, and higher cognitive functions. The assessment aims to identify impairments, activities, and participation based on the ICF model of functioning.
Assessment of vestibular function testSomnath Saha
This document discusses tests used to assess vestibular function, including both clinical tests and laboratory tests. It first provides an overview of anatomy related to the vestibular system. It then describes various clinical tests such as spontaneous nystagmus, fistula tests, Romberg tests, and gait analysis. Laboratory tests discussed include caloric testing, electronystagmography, optokinetic testing, rotation testing, and galvanic testing. The goal of these tests is to evaluate the vestibular system both peripherally and centrally in order to diagnose causes of dizziness and imbalance.
The document discusses electronystagmography (ENG), which tests eye movements using electronic recordings. It lists the main tests done with ENG, including gaze tests, optokinetic nystagmus tests, positional tests, and caloric tests. The caloric test induces nystagmus using temperature changes to evaluate vestibular system function. The document also lists various eye movement findings that can be detected through ENG testing, such as nystagmus, dissociations, dysrythmias, and positional nystagmus.
3rd,4th, 6th nerves
Extraocular muscles
How to examine for ocular motility
Ophthalmoplegia
Diplopia and related disorders
Gaze pathway
How to examine for gaze
Gaze palsy
Types of eye movements
How to examine for EM
Nystagmus and non nystagmus ocular oscillation
Balance requires input from sensory systems like vision and vestibular, processing in the cerebellum and brainstem, and motor output. Disorders can occur from problems with input, processing, or motor function. A careful history is needed to determine the exact nature and location of dizziness or vertigo. Physical exam may reveal sensory issues, eye movement abnormalities, or weakness depending on the site of lesion. Common causes of vertigo include vestibular disorders like acute vestibular failure, benign paroxysmal positional vertigo, and Meniere's disease.
This document summarizes a lecture on attention. It discusses the different types of attention, including alertness, vigilance, and selective attention. It also describes the neurophysiology of attention, including the roles of the reticular activating system, superior colliculus, thalamus, parietal lobe, frontal lobe, and cingulate cortex. Additionally, it covers the topic of neglect, or hemineglect, including its clinical features, sensory-representational, motor-exploratory, and motivational aspects. It concludes with a discussion of the right hemisphere's dominance for spatial attention.
This document discusses vestibular rehabilitation and balance exercises. It notes that management of balance disorders can be challenging, and that untreated balance disorders can greatly impair quality of life. It recommends physical exercises, especially for peripheral vestibular disorders. Various types of balance exercises are described, including Cawthorne-Cooksey exercises, customized programs, Wii games, and home-based video modules. Benefits include reducing dizziness and improving postural control. Indications and contraindications for therapy are provided. Research on a home-based video module for balance exercises in multiple languages is summarized.
This document discusses tests used to assess vestibular function, including nystagmus, caloric testing, fistula testing, optokinetic testing, and galvanic testing. It also covers peripheral vestibular disorders like BPPV and vestibular neuronitis, as well as central causes of nystagmus. Diagnosis and treatment of BPPV is discussed, including Epley's maneuver and surgical options.
This document discusses supranuclear pathways and lesions that can affect eye movements. It begins with the fundamentals of extraocular movements and anatomy of cortical and brainstem centers that control eye movements. It then covers the basic types of eye movements like saccades, smooth pursuit, vestibular-ocular reflex, and vergence movements. It provides a step-wise approach to evaluating eye movement disorders and localizing lesions based on the type of eye movement affected. Supranuclear lesions can cause bilateral eye movement involvement, while specific brainstem lesions impact horizontal or vertical eye movements or specific eye movement types like saccades or vestibular-ocular reflex.
Evidence-Based Practice in Vestibular RehabilitationBrenda Howard
Presented at the Indiana Occupational Therapy Association Fall Conference, October 26, 2013, at IUPUI. This presentation gives occupational therapists a few tools to recognize, begin treatment, and refer patients with vestibular dysfunction, for earlier identification and return to productive living.
Learn more about the types, symptoms and causes of balance disorders. Diagnostic and treatment options such as vestibular rehabilitation and cognitive behavioral therapy will be discussed.
This document discusses the assessment of a 62-year-old male patient presenting with acute vertigo. On examination, he displayed nystagmus, trunk instability, and loss of hearing in his right ear. Imaging showed a transverse petrous fracture involving the labyrinth and semicircular canals. The differential diagnosis includes peripheral vestibular disorders like vestibular neuritis and central causes like stroke. A careful history and examination can help differentiate between peripheral and central causes of vertigo.
This document contains a lecture on neuro-ophthalmology given by Dr. Thomas Bosley. The lecture covers topics including neuroanatomy, examination techniques, common diagnoses, and cranial nerve palsies. Examples are provided of patients demonstrating various neuro-ophthalmic conditions. The summary highlights the breadth of topics covered in the neuro-ophthalmology field, from anatomy and examination to specific diagnoses and patient cases.
In-service project for clinical affiliation with Hingham PT, Inc. (Januay 2014-April 2014)
Review of vestibular system, common diagnosis and how to examine, evaluate and treat.
I also reviewed and supplied the clinic with the Four Step Square Test and Dynamic Gait Index in order to allow them to implement these outcome assessments into their clinic for individuals with balance/vestibular deficits
This case report discusses the evaluation and treatment of a 51-year-old male patient presenting with bilateral benign paroxysmal positional vertigo (BPPV) following a head injury. Examination revealed positive Hallpike-Dix maneuvers bilaterally, indicating involvement of both posterior semicircular canals. The patient underwent canalith repositioning techniques (CRTs) on each side separately, which resolved his vertigo symptoms. He was also given gaze stabilization and balance exercises, which further improved his visual and postural deficits. The case demonstrates that bilateral BPPV can be successfully treated with sequential CRTs on each affected canal.
The document discusses dizziness, its types (vertigo, disequilibrium, pre-syncope, syncope), common causes, diagnostic approach, examination findings, investigations, and treatment. The diagnostic approach involves taking a thorough history and conducting physical examinations like neurological and vestibular tests. Common causes include peripheral vestibular disorders, central nervous system issues, and psychiatric conditions. Treatment is directed at the underlying cause, which may include medication, repositioning procedures, rehabilitation therapy, or lifestyle changes.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
The document discusses paralytic strabismus, including:
1) Hering's law of equal innervation and Sherington's law of reciprocal innervation which are important in diagnosing paralytic strabismus.
2) The sequelae of ocular muscle palsy including overactions and underactions of muscles.
3) Methods for investigating incomitant strabismus including cover tests, motility examination, and Hess screen plots to identify the affected muscle.
This document provides an overview of vestibular physical therapy in an inpatient setting. It discusses the anatomy and physiology of the vestibular system, common vestibular disorders and their clinical presentations, tools for screening and assessment including tests for nystagmus and balance, diagnosis of benign paroxysmal positional vertigo (BPPV) and treatment techniques, and considerations for referring patients to outpatient vestibular therapy. The presentation aims to equip physical therapists with knowledge of the vestibular system and skills for working with patients experiencing dizziness and imbalance.
This document defines and classifies different types of nystagmus. It discusses the gaze stabilization and gaze alignment systems in the eye and how nystagmus can be pendular or jerk. Nystagmus is also classified as physiological or pathological, congenital or acquired, and peripheral or central. Specific types of nystagmus mentioned include labyrinthine, central, and positional nystagmus. The document provides guidance on clinically assessing a patient for nystagmus.
This document provides an overview of benign paroxysmal positional vertigo (BPPV) and vestibular rehabilitation. It defines BPPV and discusses diagnostic criteria for posterior and lateral canal BPPV. Treatment options discussed include canalith repositioning maneuvers like the Epley maneuver and habituation exercises. Both peripheral and central vestibular signs are outlined to help differentiate causes of dizziness. The goals are to understand clinical practice guidelines for BPPV diagnosis and treatment as well as interventions for peripheral and central vestibular dysfunction.
A 56-year-old patient experienced sudden headache and vomiting during lunch, and was diagnosed with stroke after being sent to the hospital with right hemiplegia and left facial nerve palsy. The most likely location of the lesion is the basal ganglia. Stroke patients with left hemiplegia and sensory loss, with better mobility in the lower limb than the upper limb, likely have a lesion in the middle cerebral artery. A 55-year-old male with sudden right hemiplegia and urinary incontinence was diagnosed with an embolic stroke; after two months, his right upper limb recovered nearly normally but his right lower limb remained weak, indicating a likely lesion in the internal carotid artery.
The document provides guidance on performing a neurological examination. It outlines assessing the cranial nerves, reflexes, motor system, and sensory system. The cranial nerve examination involves testing each nerve individually. Reflex testing grades reflexes on a scale from 0 to 4. The motor exam evaluates muscle strength on a scale from 0 to 5. Finally, the sensory exam tests sensations like pain, touch, and position sense. The goal is to identify which parts of the neurological system may be affected.
3rd,4th, 6th nerves
Extraocular muscles
How to examine for ocular motility
Ophthalmoplegia
Diplopia and related disorders
Gaze pathway
How to examine for gaze
Gaze palsy
Types of eye movements
How to examine for EM
Nystagmus and non nystagmus ocular oscillation
Balance requires input from sensory systems like vision and vestibular, processing in the cerebellum and brainstem, and motor output. Disorders can occur from problems with input, processing, or motor function. A careful history is needed to determine the exact nature and location of dizziness or vertigo. Physical exam may reveal sensory issues, eye movement abnormalities, or weakness depending on the site of lesion. Common causes of vertigo include vestibular disorders like acute vestibular failure, benign paroxysmal positional vertigo, and Meniere's disease.
This document summarizes a lecture on attention. It discusses the different types of attention, including alertness, vigilance, and selective attention. It also describes the neurophysiology of attention, including the roles of the reticular activating system, superior colliculus, thalamus, parietal lobe, frontal lobe, and cingulate cortex. Additionally, it covers the topic of neglect, or hemineglect, including its clinical features, sensory-representational, motor-exploratory, and motivational aspects. It concludes with a discussion of the right hemisphere's dominance for spatial attention.
This document discusses vestibular rehabilitation and balance exercises. It notes that management of balance disorders can be challenging, and that untreated balance disorders can greatly impair quality of life. It recommends physical exercises, especially for peripheral vestibular disorders. Various types of balance exercises are described, including Cawthorne-Cooksey exercises, customized programs, Wii games, and home-based video modules. Benefits include reducing dizziness and improving postural control. Indications and contraindications for therapy are provided. Research on a home-based video module for balance exercises in multiple languages is summarized.
This document discusses tests used to assess vestibular function, including nystagmus, caloric testing, fistula testing, optokinetic testing, and galvanic testing. It also covers peripheral vestibular disorders like BPPV and vestibular neuronitis, as well as central causes of nystagmus. Diagnosis and treatment of BPPV is discussed, including Epley's maneuver and surgical options.
This document discusses supranuclear pathways and lesions that can affect eye movements. It begins with the fundamentals of extraocular movements and anatomy of cortical and brainstem centers that control eye movements. It then covers the basic types of eye movements like saccades, smooth pursuit, vestibular-ocular reflex, and vergence movements. It provides a step-wise approach to evaluating eye movement disorders and localizing lesions based on the type of eye movement affected. Supranuclear lesions can cause bilateral eye movement involvement, while specific brainstem lesions impact horizontal or vertical eye movements or specific eye movement types like saccades or vestibular-ocular reflex.
Evidence-Based Practice in Vestibular RehabilitationBrenda Howard
Presented at the Indiana Occupational Therapy Association Fall Conference, October 26, 2013, at IUPUI. This presentation gives occupational therapists a few tools to recognize, begin treatment, and refer patients with vestibular dysfunction, for earlier identification and return to productive living.
Learn more about the types, symptoms and causes of balance disorders. Diagnostic and treatment options such as vestibular rehabilitation and cognitive behavioral therapy will be discussed.
This document discusses the assessment of a 62-year-old male patient presenting with acute vertigo. On examination, he displayed nystagmus, trunk instability, and loss of hearing in his right ear. Imaging showed a transverse petrous fracture involving the labyrinth and semicircular canals. The differential diagnosis includes peripheral vestibular disorders like vestibular neuritis and central causes like stroke. A careful history and examination can help differentiate between peripheral and central causes of vertigo.
This document contains a lecture on neuro-ophthalmology given by Dr. Thomas Bosley. The lecture covers topics including neuroanatomy, examination techniques, common diagnoses, and cranial nerve palsies. Examples are provided of patients demonstrating various neuro-ophthalmic conditions. The summary highlights the breadth of topics covered in the neuro-ophthalmology field, from anatomy and examination to specific diagnoses and patient cases.
In-service project for clinical affiliation with Hingham PT, Inc. (Januay 2014-April 2014)
Review of vestibular system, common diagnosis and how to examine, evaluate and treat.
I also reviewed and supplied the clinic with the Four Step Square Test and Dynamic Gait Index in order to allow them to implement these outcome assessments into their clinic for individuals with balance/vestibular deficits
This case report discusses the evaluation and treatment of a 51-year-old male patient presenting with bilateral benign paroxysmal positional vertigo (BPPV) following a head injury. Examination revealed positive Hallpike-Dix maneuvers bilaterally, indicating involvement of both posterior semicircular canals. The patient underwent canalith repositioning techniques (CRTs) on each side separately, which resolved his vertigo symptoms. He was also given gaze stabilization and balance exercises, which further improved his visual and postural deficits. The case demonstrates that bilateral BPPV can be successfully treated with sequential CRTs on each affected canal.
The document discusses dizziness, its types (vertigo, disequilibrium, pre-syncope, syncope), common causes, diagnostic approach, examination findings, investigations, and treatment. The diagnostic approach involves taking a thorough history and conducting physical examinations like neurological and vestibular tests. Common causes include peripheral vestibular disorders, central nervous system issues, and psychiatric conditions. Treatment is directed at the underlying cause, which may include medication, repositioning procedures, rehabilitation therapy, or lifestyle changes.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
The document discusses paralytic strabismus, including:
1) Hering's law of equal innervation and Sherington's law of reciprocal innervation which are important in diagnosing paralytic strabismus.
2) The sequelae of ocular muscle palsy including overactions and underactions of muscles.
3) Methods for investigating incomitant strabismus including cover tests, motility examination, and Hess screen plots to identify the affected muscle.
This document provides an overview of vestibular physical therapy in an inpatient setting. It discusses the anatomy and physiology of the vestibular system, common vestibular disorders and their clinical presentations, tools for screening and assessment including tests for nystagmus and balance, diagnosis of benign paroxysmal positional vertigo (BPPV) and treatment techniques, and considerations for referring patients to outpatient vestibular therapy. The presentation aims to equip physical therapists with knowledge of the vestibular system and skills for working with patients experiencing dizziness and imbalance.
This document defines and classifies different types of nystagmus. It discusses the gaze stabilization and gaze alignment systems in the eye and how nystagmus can be pendular or jerk. Nystagmus is also classified as physiological or pathological, congenital or acquired, and peripheral or central. Specific types of nystagmus mentioned include labyrinthine, central, and positional nystagmus. The document provides guidance on clinically assessing a patient for nystagmus.
This document provides an overview of benign paroxysmal positional vertigo (BPPV) and vestibular rehabilitation. It defines BPPV and discusses diagnostic criteria for posterior and lateral canal BPPV. Treatment options discussed include canalith repositioning maneuvers like the Epley maneuver and habituation exercises. Both peripheral and central vestibular signs are outlined to help differentiate causes of dizziness. The goals are to understand clinical practice guidelines for BPPV diagnosis and treatment as well as interventions for peripheral and central vestibular dysfunction.
A 56-year-old patient experienced sudden headache and vomiting during lunch, and was diagnosed with stroke after being sent to the hospital with right hemiplegia and left facial nerve palsy. The most likely location of the lesion is the basal ganglia. Stroke patients with left hemiplegia and sensory loss, with better mobility in the lower limb than the upper limb, likely have a lesion in the middle cerebral artery. A 55-year-old male with sudden right hemiplegia and urinary incontinence was diagnosed with an embolic stroke; after two months, his right upper limb recovered nearly normally but his right lower limb remained weak, indicating a likely lesion in the internal carotid artery.
The document provides guidance on performing a neurological examination. It outlines assessing the cranial nerves, reflexes, motor system, and sensory system. The cranial nerve examination involves testing each nerve individually. Reflex testing grades reflexes on a scale from 0 to 4. The motor exam evaluates muscle strength on a scale from 0 to 5. Finally, the sensory exam tests sensations like pain, touch, and position sense. The goal is to identify which parts of the neurological system may be affected.
A neurological examination evaluates the functioning of the nervous system, including sensory, motor, and cognitive abilities. It involves tests of mental status, cranial nerves, motor skills, sensation, reflexes, and cerebellar function. The purposes are to identify or rule out nervous system diseases, aid diagnosis, guide treatment, and monitor changes over time. Nurses are responsible for ensuring a calm environment, accurately documenting exam findings, and informing doctors of any changes.
The document provides guidance on performing a neurological assessment to identify abnormalities. The assessment involves gathering information on symptoms, medical history, and conducting a mental status exam, cranial nerve assessment, reflex testing, motor and sensory exams, and evaluating coordination and gait. The goal is to screen for neurological disorders and determine the location and components affected. The assessment uses basic equipment and involves systematically testing various reflexes, sensations, strengths, and movements.
This document provides information on examinations for neurological disorders. It discusses investigations like imaging scans and spinal taps. It lists risk factors like age, hypertension, and smoking. It describes different causes of neurological issues like stroke, tumors, and encephalitis. It then details various parts of a neurological exam including Kernig's sign, reflexes, and deep tendon reflexes of the biceps, triceps, supinator, knees, and ankles.
This document discusses various theories of motor control and development, including primitive reflexes, hierarchical models, and systems theories. It provides details on specific primitive reflexes like Moro and ATNR. Clinical approaches discussed include Rood, Brunnstrom, NDT/Bobath, PNF, and task-oriented therapy. No single theory captures everything, so therapists combine elements from multiple frameworks in their dynamic systems approach to intervention.
The Brunnstrom Approach is a neurodevelopmental treatment approach for stroke rehabilitation developed in the 1970s. It involves 6 stages of motor recovery: 1) flaccidity, 2) appearance of spastic synergies, 3) semi-voluntary movement, 4) combining movements, 5) complex voluntary movement, 6) restoration of normal movement. Treatment progresses the patient through these stages using reflexes, associated reactions, proprioceptive stimuli and resistance training. Evaluation assesses motor function, sensory loss, and spasticity through tests of range of motion, grasp, and speed of movement. The goal is to facilitate normal motor control and functional use of the affected limb.
1. The neurological examination document outlines the process and components of examining a patient's nervous system, including terminology, indications, and aspects of the exam such as level of consciousness, cranial nerve function, motor function, and reflexes.
2. Nurses play an important role in conducting and documenting the neurological exam. This includes setting up equipment, assessing vital signs, performing tests of mental status, cranial nerves, motor skills, sensation, and reflexes, and communicating findings to doctors.
3. The goal of the neurological exam is to determine if there is any disease or abnormality present in the nervous system by thoroughly assessing multiple domains of neurological function.
This document provides information on neurologic assessment. It begins by outlining the learning objectives which focus on describing the structure and function of the central and peripheral nervous systems, differentiating between pathologic changes that affect motor and sensory function, and comparing the sympathetic and parasympathetic nervous systems. It then provides detailed descriptions of the assessment of mental status, cranial nerves, motor function, sensation, and diagnostic tests for neurologic disorders. The assessments are aimed at identifying neurologic dysfunction.
Cerebral palsy (CP) is the most common motor disability in childhood. It is caused by non-progressive brain damage early in development and results in impaired movement and posture. Common symptoms include stiff/floppy muscles, poor head/trunk control, and developmental delays in rolling, sitting, crawling, etc. Diagnosis involves assessing risk factors, medical history, neurological exam, and developmental tests. While there is no cure, treatment aims to improve function through physical, occupational, speech and other therapies, orthotics, surgery, and special education. Managing complications and providing support are also important aspects of care.
The Brunnstrom approach is a motor recovery model developed for stroke patients. It is based on the theory that development occurs in reverse order after stroke. The approach uses reflexes and primitive movement patterns to facilitate recovery of voluntary movement. Treatment progresses from reflex movements to voluntary movements to functional movements. Facilitation techniques are reduced as the patient gains voluntary control. The main goals are to move the patient through Brunnstrom's stages of recovery from flaccid to near normal movement. Bed positioning, mobility, and facilitation techniques target specific synergies and are used early in recovery.
Cerebral palsy is a heterogeneous disorder of movement and posture caused by a non-progressive brain injury early in development. It presents with a wide variety of motor impairments and can be classified anatomically (e.g. hemiplegia) or physiologically (e.g. spastic, athetoid). Risk factors include prenatal, perinatal, and postnatal insults. Treatment involves both non-operative measures like medication, bracing, and physical therapy as well as operative interventions like tendon lengthening and osteotomies to prevent or treat deformities when they interfere with function. Prognosis depends on the extent and location of brain injury.
The Brunnstrom approach is a physical therapy technique developed by Signe Brunnstrom for patients with hemiplegia. It uses reflexes and primitive movements to facilitate voluntary movement by progressing through normal developmental stages. The approach assesses tonic reflexes, associated reactions, sensory function, and classifies motor recovery into 6 stages. Exercises aim to elicit synergies and facilitate movement using proprioceptive and exteroceptive cues.
1. The supranuclear control centers for eye movements include the brainstem, cerebellum, basal ganglia, and cerebral cortex. The brainstem centers determine how the eyes move while the cortex determines when and where the eyes move.
2. Important brainstem centers include the PPRF, MLF, NPH, riMLF, and INC which control horizontal, vertical, and torsional eye movements through connections to the cranial nerve nuclei. Lesions can cause gaze palsies, nystagmus, and impaired gaze holding.
3. Other centers control smooth pursuit, vergence, and the vestibulo-ocular reflex. Supranuclear disorders can impair sacc
This document provides an overview of cerebral palsy, including:
- Cerebral palsy is caused by non-progressive damage to the developing brain that causes motor impairments. Common types include spastic diplegia, hemiplegia, and quadriplegia.
- Insults can occur prenatally, perinatally, or postnatally from factors like genetic disorders, infections, or trauma.
- Treatment is multidisciplinary and may include medications, physical therapy, bracing, and surgery to address secondary deformities like contractures. Surgical procedures are aimed at improving function, mobility, and care.
A neurological examination evaluates the functioning of the nervous system and is divided into eight components: mental status, cranial nerves, motor examination, sensory examination, coordination, reflexes, and gait. It assesses various aspects such as sensation, motor skills, reflexes, coordination, and cognitive functioning to determine if there is any impairment or disease present in the nervous system. The exam involves testing various cranial nerves, motor strength, sensory perception, coordination, and reflexes through activities like following commands, distinguishing sensory stimuli, and evaluating gait. The goal is to localize any issues and understand the nature of any neurological abnormalities.
The neurological examination assesses the nervous system and consists of 8 aspects: 1) level of consciousness 2) mental status 3) special cerebral functions 4) cranial nerve function 5) motor function 6) sensory function 7) cerebellar function 8) reflexes. The exam evaluates various mental, sensory, and motor skills to detect abnormalities that could indicate neurological diseases.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Maruthi Prithivirajan, Head of ASEAN & IN Solution Architecture, Neo4j
Get an inside look at the latest Neo4j innovations that enable relationship-driven intelligence at scale. Learn more about the newest cloud integrations and product enhancements that make Neo4j an essential choice for developers building apps with interconnected data and generative AI.
Observability Concepts EVERY Developer Should Know -- DeveloperWeek Europe.pdfPaige Cruz
Monitoring and observability aren’t traditionally found in software curriculums and many of us cobble this knowledge together from whatever vendor or ecosystem we were first introduced to and whatever is a part of your current company’s observability stack.
While the dev and ops silo continues to crumble….many organizations still relegate monitoring & observability as the purview of ops, infra and SRE teams. This is a mistake - achieving a highly observable system requires collaboration up and down the stack.
I, a former op, would like to extend an invitation to all application developers to join the observability party will share these foundational concepts to build on:
A tale of scale & speed: How the US Navy is enabling software delivery from l...sonjaschweigert1
Rapid and secure feature delivery is a goal across every application team and every branch of the DoD. The Navy’s DevSecOps platform, Party Barge, has achieved:
- Reduction in onboarding time from 5 weeks to 1 day
- Improved developer experience and productivity through actionable findings and reduction of false positives
- Maintenance of superior security standards and inherent policy enforcement with Authorization to Operate (ATO)
Development teams can ship efficiently and ensure applications are cyber ready for Navy Authorizing Officials (AOs). In this webinar, Sigma Defense and Anchore will give attendees a look behind the scenes and demo secure pipeline automation and security artifacts that speed up application ATO and time to production.
We will cover:
- How to remove silos in DevSecOps
- How to build efficient development pipeline roles and component templates
- How to deliver security artifacts that matter for ATO’s (SBOMs, vulnerability reports, and policy evidence)
- How to streamline operations with automated policy checks on container images
Securing your Kubernetes cluster_ a step-by-step guide to success !KatiaHIMEUR1
Today, after several years of existence, an extremely active community and an ultra-dynamic ecosystem, Kubernetes has established itself as the de facto standard in container orchestration. Thanks to a wide range of managed services, it has never been so easy to set up a ready-to-use Kubernetes cluster.
However, this ease of use means that the subject of security in Kubernetes is often left for later, or even neglected. This exposes companies to significant risks.
In this talk, I'll show you step-by-step how to secure your Kubernetes cluster for greater peace of mind and reliability.
Essentials of Automations: The Art of Triggers and Actions in FMESafe Software
In this second installment of our Essentials of Automations webinar series, we’ll explore the landscape of triggers and actions, guiding you through the nuances of authoring and adapting workspaces for seamless automations. Gain an understanding of the full spectrum of triggers and actions available in FME, empowering you to enhance your workspaces for efficient automation.
We’ll kick things off by showcasing the most commonly used event-based triggers, introducing you to various automation workflows like manual triggers, schedules, directory watchers, and more. Plus, see how these elements play out in real scenarios.
Whether you’re tweaking your current setup or building from the ground up, this session will arm you with the tools and insights needed to transform your FME usage into a powerhouse of productivity. Join us to discover effective strategies that simplify complex processes, enhancing your productivity and transforming your data management practices with FME. Let’s turn complexity into clarity and make your workspaces work wonders!
GraphSummit Singapore | The Art of the Possible with Graph - Q2 2024Neo4j
Neha Bajwa, Vice President of Product Marketing, Neo4j
Join us as we explore breakthrough innovations enabled by interconnected data and AI. Discover firsthand how organizations use relationships in data to uncover contextual insights and solve our most pressing challenges – from optimizing supply chains, detecting fraud, and improving customer experiences to accelerating drug discoveries.
UiPath Test Automation using UiPath Test Suite series, part 5DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 5. In this session, we will cover CI/CD with devops.
Topics covered:
CI/CD with in UiPath
End-to-end overview of CI/CD pipeline with Azure devops
Speaker:
Lyndsey Byblow, Test Suite Sales Engineer @ UiPath, Inc.
Alt. GDG Cloud Southlake #33: Boule & Rebala: Effective AppSec in SDLC using ...James Anderson
Effective Application Security in Software Delivery lifecycle using Deployment Firewall and DBOM
The modern software delivery process (or the CI/CD process) includes many tools, distributed teams, open-source code, and cloud platforms. Constant focus on speed to release software to market, along with the traditional slow and manual security checks has caused gaps in continuous security as an important piece in the software supply chain. Today organizations feel more susceptible to external and internal cyber threats due to the vast attack surface in their applications supply chain and the lack of end-to-end governance and risk management.
The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
Speakers:
Bob Boule
Robert Boule is a technology enthusiast with PASSION for technology and making things work along with a knack for helping others understand how things work. He comes with around 20 years of solution engineering experience in application security, software continuous delivery, and SaaS platforms. He is known for his dynamic presentations in CI/CD and application security integrated in software delivery lifecycle.
Gopinath Rebala
Gopinath Rebala is the CTO of OpsMx, where he has overall responsibility for the machine learning and data processing architectures for Secure Software Delivery. Gopi also has a strong connection with our customers, leading design and architecture for strategic implementations. Gopi is a frequent speaker and well-known leader in continuous delivery and integrating security into software delivery.
Pushing the limits of ePRTC: 100ns holdover for 100 daysAdtran
At WSTS 2024, Alon Stern explored the topic of parametric holdover and explained how recent research findings can be implemented in real-world PNT networks to achieve 100 nanoseconds of accuracy for up to 100 days.
GraphSummit Singapore | The Future of Agility: Supercharging Digital Transfor...Neo4j
Leonard Jayamohan, Partner & Generative AI Lead, Deloitte
This keynote will reveal how Deloitte leverages Neo4j’s graph power for groundbreaking digital twin solutions, achieving a staggering 100x performance boost. Discover the essential role knowledge graphs play in successful generative AI implementations. Plus, get an exclusive look at an innovative Neo4j + Generative AI solution Deloitte is developing in-house.
Communications Mining Series - Zero to Hero - Session 1DianaGray10
This session provides introduction to UiPath Communication Mining, importance and platform overview. You will acquire a good understand of the phases in Communication Mining as we go over the platform with you. Topics covered:
• Communication Mining Overview
• Why is it important?
• How can it help today’s business and the benefits
• Phases in Communication Mining
• Demo on Platform overview
• Q/A
For the full video of this presentation, please visit: https://www.edge-ai-vision.com/2024/06/building-and-scaling-ai-applications-with-the-nx-ai-manager-a-presentation-from-network-optix/
Robin van Emden, Senior Director of Data Science at Network Optix, presents the “Building and Scaling AI Applications with the Nx AI Manager,” tutorial at the May 2024 Embedded Vision Summit.
In this presentation, van Emden covers the basics of scaling edge AI solutions using the Nx tool kit. He emphasizes the process of developing AI models and deploying them globally. He also showcases the conversion of AI models and the creation of effective edge AI pipelines, with a focus on pre-processing, model conversion, selecting the appropriate inference engine for the target hardware and post-processing.
van Emden shows how Nx can simplify the developer’s life and facilitate a rapid transition from concept to production-ready applications.He provides valuable insights into developing scalable and efficient edge AI solutions, with a strong focus on practical implementation.
Cosa hanno in comune un mattoncino Lego e la backdoor XZ?Speck&Tech
ABSTRACT: A prima vista, un mattoncino Lego e la backdoor XZ potrebbero avere in comune il fatto di essere entrambi blocchi di costruzione, o dipendenze di progetti creativi e software. La realtà è che un mattoncino Lego e il caso della backdoor XZ hanno molto di più di tutto ciò in comune.
Partecipate alla presentazione per immergervi in una storia di interoperabilità, standard e formati aperti, per poi discutere del ruolo importante che i contributori hanno in una comunità open source sostenibile.
BIO: Sostenitrice del software libero e dei formati standard e aperti. È stata un membro attivo dei progetti Fedora e openSUSE e ha co-fondato l'Associazione LibreItalia dove è stata coinvolta in diversi eventi, migrazioni e formazione relativi a LibreOffice. In precedenza ha lavorato a migrazioni e corsi di formazione su LibreOffice per diverse amministrazioni pubbliche e privati. Da gennaio 2020 lavora in SUSE come Software Release Engineer per Uyuni e SUSE Manager e quando non segue la sua passione per i computer e per Geeko coltiva la sua curiosità per l'astronomia (da cui deriva il suo nickname deneb_alpha).
Encryption in Microsoft 365 - ExpertsLive Netherlands 2024Albert Hoitingh
In this session I delve into the encryption technology used in Microsoft 365 and Microsoft Purview. Including the concepts of Customer Key and Double Key Encryption.
21. • Poor prognosis associated also with:
– No measurable grasp strength by 4 weeks
– Severe proximal spasticity
– Prolonged “flaccidity” period
– Late return of proprioceptive facilitation
(tapping) response > 9 days
– Late return of proximal traction response
(shoulder flexors/adductors) > 13 days
22. • Brunnstrom (1966, 1970) and Sawner (1992) also described the process of
recovery following stroke-induced hemiplegia. The process was divided
into a number of stages:
• 1. Flaccidity (immediately after the onset)
No “voluntary” movements on the affected side can be
initiated.
• 2. Spasticity appears.
Basic synergy patterns appear.
Minimal voluntary movements may be present.
• 3. Patient gains voluntary control over synergies.
Increase in spasticity.
23. • 4. Some movement patterns out of synergy are mastered (synergy
patterns still predominate).
Decrease in spasticity.
• 5. If progress continues, more complex movement
combinations are learned as the basic
synergies lose their dominance over motor acts.
Further decrease in spasticity.
• 6. Disappearance of spasticity.
Individual joint movements become possible and
coordination approaches normal.
• 7. Normal function is restored.
24. Upper Lower Hand
I flaccid
II
spasticity developing
Associated
movement/reaction
• Little or no active
finger flexion
III
Synergy pattern
Muscle tone
• Triple
extension(lock
knee 、 tip
toe 、 ankle
inversion)
• Mass grasp
• Use hook grasp but
no release
• No voluntary
extension
25. Upper Lower Hand
IV
Block synergy
pattern
• Placing the hand
behind the body
• Elevated the
arm to 水平
• 屈肘可做
supination
坐著時
•Ankle dorsiflexed
•Knee isolated
extened
• Lateral
prehension( 夾虎口
動作 ) , release by
thumb movement
• Semivoluntary
finger extension
V
Block synergy
pattern
• Arm-raised
forward and
overhead
• 伸肘可做
supination-
pronation
站著
•Ankle dorsiflexion
•Knee isolated flexed
•Ankle
Inversion/eversion
• Palmar prehension
掌面抓握
VI
只在 RAM o r 交替
動作異常
可以只動一隻手指
28. Theories for stroke rehabilitation
• Brunnstrom theory
• PNF theory
• Motor relearning theory
• Bobath theory:
– NDT: Neural-Developmental Theory
29. 10/11/15 Jenny 29
Brunnstrom Theory
• Aim
– To encourage the return of voluntary movement in
hemiplegia patient through the use of reflex
activity and a range of sensory stimulation.
– The choice of stimulation varies depending on
which stage the patient has reached in the
recovery process.
30. Brunnstrom Theory
• Treatment
– The process is employed until the primitive
synergies are established, then facilitation is used
to develop some voluntary control.
– The preparation for walking should be
emphasized early but that extensive walking
should be postponed in order to avoid the
development of a poor gait pattern
31. 10/11/15 Jenny 31
PNF Theory
• Proprioceptive Neuromuscular Facilitation
• Primary for the patient with neuromuscular
dysfunction
• Aim
– to promote movement and functional synergies
of movement by maximizing peripheral inputby maximizing peripheral input
32. 10/11/15 Jenny 32
PNF Theory
• Basis of practice
– People who move normally have passed through a
developmental sequencedevelopmental sequence
– Diagonal and spiral patternsDiagonal and spiral patterns of active and passive
movements are encouraged
• Treatment
– Providing appropriate sensory stimulus
– Following activities in a developmental sequence
• Patterns and techniques
33. 10/11/15 Jenny 33
Motor relearning Theory
• By Carr and Shepherd
• Aim
– To enable the disabled person to learn how toto learn how to
perform or improve performanceperform or improve performance of actions critical
to everyday life.
– Utilizing theories of learningtheories of learning, in particular the use
of practice and knowledge of results to encourage
people to learn and self monitor
– Knowledge of biomechanics for analyzing
movements and performance of tasks
34. 10/11/15 Jenny 34
Motor relearning Theory
• Basis of practice
– The motor control of posture and movement are
interrelated and that appropriate sensory input will help
modulate the motor response to a task
– The program is based on
• Elimination of unnecessary muscle activity
• Feedback
• Practice
• The link between postural adjustment and movement
• Task analysis and measurement are viewed as
essential elements of the framework.
35. 10/11/15 Jenny 35
Motor relearning Theory
• Treatment
– Movement analysis and training follow the four steps
• Analysis of the task
• Practice of the missing components
• Practice of the task
• Transference of training
– A series of task has been chosen because learning by
normal subjects has been shown to be task-specific with
minimal carry-over from one activity to another
36. 10/11/15 Jenny 36
Bobath theory: NDT
• Aim
– To improve the quality of movement on the affected sidethe quality of movement on the affected side
– Key point controlKey point control is to allow patients the experience of
normal afferent input
• Basis of practice
– The movement will be abnormal if it stems from a
background of abnormal toneabnormal tone
– Performing abnormal movements will reinforce more
abnormal movements
– Tone could be influenced by altering the position or
movement of proximal joints of the body
37. 10/11/15 Jenny 37
Bobath Theory: NDT
• Treatment
– Treatment centre around the facilitation of
corrected movement by a therapist who handles
the body at key points of controlkey points of control
– In recent years treatment has become more activeactive
, dynamic and functionally directed, dynamic and functionally directed..
– Movement are not isolated to individual joints but
take place in patterns
38. 10/11/15 Jenny 38
Bobath theory: NDT
– To help the patient to gain control over the
released patterns of spasticity by their own
inhibition
• Auto-inhibition
– Give patient normal kinematics sensation input to
facilitated normal posture and movement
– Muscle strengthening is notnot viewed as part of
treatment
– There are no set “Bobath exercise”
47. POSTSTROKE SHOULDER PAIN
• 70–84% of stroke patients with hemiplegia have
shoulder pain with varying degrees of severity.
• The majority (85%) will develop it during the
spastic phase of recovery.
• The most common causes of hemiplegic shoulder
pain are complex regional pain syndrome type I
(see below) and soft tissue lesions (including
plexus lesions).
49. Complex Regional Pain Syndrome
Type I (CRPS Type I)
• Also known as reflex sympathetic dystrophy
[RSD], shoulder-hand syndrome, or Sudeck
atrophy.
• Disorder characterized by
– sympathetic-maintained pain
– related sensory abnormalities
– abnormal blood flow
– abnormalities in the motor system
– and changes in both superficial and deep structures
with trophic changes.
50.
51. Stages
• Stage 1 (acute): Lasts 3 to 6 months.
– burning pain
– diffuse swelling/edema
– exquisite tenderness
– hyperpathia and/or allodynia
– vasomotor changes in hand/fingers (increased nail
and hair growth, hyperthermia or hypothermia,
sweating).
52. Stages
• Stage 2 (dystrophic): Lasts 3 to 6 months
– pain becomes more intense and spreads proximally
– skin/muscle atrophy
– brawny edema
– cold insensitivity
– brittle nails/nail atrophy, decreased ROM,
– mottled skin
– early atrophy, and osteopenia (late)
53. Stages
• Stage 3 (atrophic):
– pain decreases
– trophic changes occur: hand/skin appear pale and
cyanotic with a smooth, shiny appearance, feeling
cool and dry
– bone demineralization progresses with muscula
weakness/atrophy, contractures/flexion
deformities of shoulder/ hand, tapering digits
– no vasomotor changes.
55. Shoulder Subluxation
Treatment
•Shoulder sling use is controversial.
– Pros: may be used when patient ambulates to support extremity (may prevent
upper extremity trauma, which in turn may cause increase pain or predispose
to development of RSD).
– Cons: may encourage contractures in shoulder adduction/internal rotation,
elbow flexion(flexor synergy pattern).
•Other widely used treatments for shoulder subluxation:
– Functional electrical stimulation (FES)
– Arm board, arm trough, lapboard—used in poor upper-extremity recovery,
primary wheelchair users.
– Arm board may overcorrect subluxation.
– Overhead slings—prevents hand edema (may use foam wedge on arm
board).
Uses primitive reflexes to initiate movement and encourages the use of mass patterns in the early stages of motor recovery
Manual guidance is used as a support or for demonstration and, not for providing sensory input
Unwanted activities are limited by choosing an appropriate level of activity.