Therx packet #1

PTA roles for Neuro patient involvement

contribute to progress notes and re-evals, help obtain info for pt history, follow through with collections of tests and measures

vital signs

BP, HR, RR, SpO2, temp.


visual inspection, general movement patterns (more abnormal), ease of movement, general affect, communication skill

arousal stages

alert, lethargic, obtunded, stuporous, comatose, vegetative state


is what it is, alert and aware


awake, but sleepy


hard to wake up, then confused


react only to noxious stimuli (sternal rubs)


no sleep/wake cycle, non-responsive to any type of stimulation

vegetative state (minimally conscious state)

unconscious, varying sleep/wake cycle
prefer over comatose


awareness of the environment, ability to focus

ways to test cognition

orientation, memory, following commands, higher cognitive functions, standardized assessments


A & O x ______
person, place, time, situation
1 2 3 4


word recall, day to day events (short term mem)
birthdays and anniversaries (long term mem)

following commands

can they follow commands? steps to a task?

higher cognitive functions

math, reasoning, judgement and intuition

standardized assessments

mini-mental exam (in class)

is impulsive good or bad?

bad, not safe with potential movements

what does sensation provide about?

environment, body, and the relationship of the environment to the body. (walking on ice)

where does sensory info get processed?

in CNS (brain) leads to selection of movement strategy or modification

what does a loss of sensation cause?

issues with functional activities and movements

what is regulation of movement dependent on?

sensory afferent (incoming to the brain) information

define proprioception

sense positions

define kinesthisia

the awareness of the movement


measurable force exerted by a mm or a group of mm to overcome a resistance in one maximal effort


ability to sustain forces repeatedly or generate forces over a period of time
will affect functional ability
poor endurance leads to fatigue


no tone


low tone


high tone


type of hypertone
lead pipe

lead pipe

resistance throughout ROM and does not depend on velocity


ratcheting and catchy through the movement


high tone plus velocity dependent
clasp knife response
faster joint moves=increase in resistance

clasp knife response

resist-resist-lets go like a pocket knife


the wiggle dance, twisting, writhing movements-

ashworth 0

no increase in mm tone

ashworth 1

slight increase in mm tone, manifested by a catch and release of by minimal resistance at the end of the ROM when the affected parts is moved in flexion or extension

ashworth 1+

slight increase in mm tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

ashworth 2

more marked increase in mm tone through most of the ROM, but affected parts easily moved

ashworth 3

considerable increase i mm tone, passive movement difficult

ashworth 4

affected parts rigid in flexion or extension


too much upper motor neuron


not enough lower motor neuron

plantar reflex normal

curl toes and point foot

plantar reflex abnormal (babinski sign)

flexion of big toe and fanning of less toes

upper motor neuron

increase tone (spasticity), hyperreflexia, clonus, babinski sign, voluntary movements (elaine dancing)

lower motor neurons

decreased or absent tone. decreased or absent reflexes, voluntary movements-weak or absent

what are normal synergies?

patterns of movement that tend to go together i.e. PNF patterns

what is an abnormal synergy?

stereotypical movements that may be present and elicited in a patient with neurological insults

UE flexion synergy

scapular retraction, shoulder ABduction, elbow flexion, forearm supination and finger flexion
strongest is elbow flexion

UE extension synergy

scapular protraction, shoulder DDuction, IR, elbow extention and finger/wrist flexion, and pronation
strongest is shoulder ADduction and pronation

LE Flexion Synergy

hip flexion, shoulder Abduction, ER, knee flexion, ankle dorsiflexion and inversion
strongest is hip flexion

LE extension synergy

hip[ ext. ADduction IR knee ext. ankle plantar flexion toe plantar flexion and inversion
strongest ADD knee ext and ankle pf

CN 1


CN 2


CN 3

Oculomotor (motor)

CN 4

trochlear nerve

CN 5

trigeminal nerve

CN 6

Abducens (motor)

CN 7

facial nerve

CN 8

vestibulocochlear nerve

CN 9

glossopharyngeal nerve

CN 10

vagus nerve

CN 11

accessory nerve

CN 12

hypoglossal nerve

athetosis and where it comes from

writhing movements and basal ganglia

akinesia and where it comes from

inability to initiate movement (parkinsons) and basal ganglia


over estimation of distance or range of a movement


under estimation of distance or range of a movementq

non equilibrium coordination testing

finger to nose, pronation/supination, pointing and past pointing, toe to examiners finger, heel on shin

equilibrium coordination testing

standing normal to narrowing bases
standing eyes open to eyes closed
tandem standing
walking; straight, sideways, backwards, grapevine

balance/postural stability

COG is maintained within the boundaries of the BOSf

what are the two ways sensory input is utilized?

1. reactive - catch yourself when you slip on the ice
2. anticipatory- see the ice and you choose to walk differently to keep from falling


center of gravity


base of support


limits of stability

static balance

stationary balance

dynamic balance

balance with movement


weight bearing and body part positioning. ex. standing and walking


judge what is upright


head position relative to gravity and head movement

what do the somatosensory, vision, and vestibular influence?

shape motor response to help with balance and provide information to CNS

what does the CNS system do to process

processes this info and initiates conscious and unconscious adjustments

what is the limit of stability LOS?

maximum angle of vertical that can be tolerated without LOB loss of balance

what mm kicking with peturbation from the front

trunk flexors kick in

what mm kick in with peturbation from the back

back mm kick in

what mm kick in with peturbation from the side

ADductors and lateral flexors kick in

what leg parts kick in first with a push


what leg parts kick in second with a push


what leg parts kick in third with a push

stepping to accommodate outside BOS shift