OSPE(Neurological PT)

(Unobserved)
Station 1
The spinal cord is composed of segments, as indicated by the 31 pairs of spinal
nerves. Each segment has numerous dorsal (posterior) and ventral (anterior)
rootlets that arise from the respective surfaces of the spinal cord. Dorsal rootlets
contain neuronal processes that conduct afferent impulses to the spinal cord,
whereas the ventral rootlets conduct efferent impulses from the spinal cord.
Respective rootlets from each segment unite to form dorsal and ventral roots.
Q-1 What are the three tracts of the spinal cord that can be assessed clinically?
give their location and function.
ANS-1
o Corticospinal tract
o Location: posterolateral cord
o Function: motor innervation
o Dorsal columns
o Location: posteromedial cord
o Function: light touch and proprioception innervation
o Spinothalamic tract
o Location: anterolateral cord
o Function: pain and temperature innervation
Q-2 Name the Ascending tracts which arises from Post. White column
ANS- 1. Fasciculus Gracilius.
2. Fasciculus Cuneatus.
3. coma tract of schiiltz.
Q-3 Write origin of cranial nerves.
ANS- olfactory nerve (CN I) and optic nerve (CN II) originate from the cerebrum.
oculomotor (III) and trochlear nerve (IV) originate from midbrain
trigeminal (V) from pons
abducens, facial, vestibulocochlear (VI-VII-VIII) from Pontine-medulla junction.
glossopharyngeal, vagus, (IX-X) hypoglossal (XII) from medulla oblongata and
accessory (XI) from spinal cord
Q-4 differentiate between Paralysis and Paraplegia
Paralysis is an inability to voluntarily move all or part of your body.
Paraplegia is a term used to describe the inability to voluntarily move the lower
parts of the body.

Q-5 Which facial muscle is not supply by facial nerve? Which nerve involve and
what is the function of that muscle?
ANS- Levator palpebrae superioris muscles, supplied by Oculomotor nerve and
function is elevation and retraction of the upper eyelid.
 Station 2

Q1: This picture is indicating which disease or disorder? Name only

Ans: Parkinson’s Disease

Q2:Shortly brief the neuropathology of this disease in Two lines.

Ans: Parkinson's disease is caused by a loss of nerve cells in the part of the brain
called the substantia nigra. Nerve cells in this part of the brain are responsible for
producing a chemical called dopamine.

Q3:Mention the 5 sign & symptoms of this disease.

 Ans: Slowed movements (bradykinesia).
 Tremor while muscles are at rest.
 Rigidity or stiffness.
 Unstable posture or walking gait.
 Insomnia
Q4: What Physiotherapeutic corrective measures you will use for such type of
patients. Name Any Three.
Ans: Amplitude Training. A specific form of physical therapy for Parkinson's
disease is called LSVT BIG training.
Reciprocal Patterns. Reciprocal movements are side-to-side and left-to-right
patterns, such as swinging your arms while taking steps as you walk.
Balance Work.
Stretching and Flexibility.
Strength Training.

Q5: there are five stages of Parkinson’s disease, described with the most
commonly used Hoehn and Yahr scale:
ANS– Stage one: Symptoms such as tremors or shaking on one side of the body
– Stage two: Tremors or shaking one or both sides of the body; possible
imbalance
– Stage three: Noticeable balance impairment and slowing of motion
– Stage four: Severe symptoms, disability; patient likely needs assistance
– Stage five: Patient may be bedridden or wheelchair bound; needs constant care
 Station 3

Q1: What do you know about Bobath Technique? Describe in one to Two lines.
Ans: It is an interactive process between patients and therapists. Therapy focuses
on the Neuro-muscular system, spinal cord and higher centres to change motor
performance.

Q2: Mention any Three advantages a Physical therapist can take from Bobath
techniques.
Ans:
1. Encouragement of normal movement patterns.
2. Focusing on quality of movement.
3. Normalisation of tone to facilitate active movement.
4. Positioning and posture in lying, sitting and standing.
5. To promote motor learning for efficient motor control in various environments

Q3: What disorders or conditions can be treated by Bobath techniques?

Ans:
1. Cerebral palsy
2. Stroke
3. To improve movement and mobility in patients with damage to their central
nervous system (brain and spinal cord).
4.Parkinsons disease
5. Neurological conditions

Q4: What is the role of Bobath Therapy for Cerebral Palsy?

Ans: Bobath therapy is the most widely adopted physiotherapy approach in
children with CP. The aims of treatment are to influence muscle tone and improve
postural alignment by specific handling techniques, and then to work for better.

Q5: What is the role of Bobath Therapy for Stroke?

Ans:
 STATION 4
41-year-old active duty male service member who sustained head trauma from a
motorcycle accident and underwent multidisciplinary vestibular physical therapy
rehabilitation.

Q-1 what is nystagmus?

ANS -Nystagmus is a condition where the eyes move rapidly and uncontrollably.
They can move:
side to side (horizontal nystagmus)
up and down (vertical nystagmus)
in a circle (rotary nystagmus)
The movement can vary between slow and fast and usually happens in both eyes.
The eyes may shake more when looking in certain directions. People with
nystagmus may tilt or turn their head to see more clearly. This helps to slow down
the eye movements.

Q-2 physiology of semicircular canal?

ANS- As a person head accelerate through rotation, the endolymph within one or
more of the semicircular canals begin to move and pushes against the cupula
which cause stereocilia to bend

Q-3 Relation of depolarization and acceleration?

ANS-With acceleration through head rotation the stereocilia move towards the
kinocilium increasing the rate of depolarization and with deceleration of head
rotation the stereocilia move away from the kinocilium decreasing the rate of
depolarization.

Q-4When did Semont liberatory maneuver?

ANS-When Hallpike maneuver come positive with vertical nystagmus in posterior
direction and nystagmus is greater than 60 sec i: e cupulolithiasis.

Q-5 Perform deep head hang maneuver.

ANS PERFORM
 STATION 5
The patient is a 65-year-old woman who had a laparoscopic cholecystectomy 3
days prior. She was last seen normal at 10pm before sleep. She awoke at 2am and
was discovered by her husband to have aphasia and right hemiplegia. She was
brought by EMS to the ED at 3:15 am. She was not eligible for Alteplase IV tPA
because of her wakeup stroke and recent surgery. confirmed occlusion of the left
MCA.

Q-1 Write any 3 other expected sign and symptoms of left MCA
ANS- Contralateral hemiparesis involving mainly the UE
Ataxia
Apraxia or Dyspraxia
Dysphagia

Q-2 Write muscles grading scale

1.Flicker of movement
2.Through full range actively with gravity counterbalanced
3.Through full range actively against gravity
4.Through full range actively against some resistance
5.Through full range actively against strong resistance

Q-3 Is there a simple set of stroke symptoms I can remember?

ANS- Yes! When it comes to stroke, the key word is FAST.

 Face: does one side of the person’s face look uneven or drooping?
 Arm: have they lost strength in one arm?
 Speech: are they slurring their words or having a hard time communicating
verbally?
 Time

Q-4 What is the Middle Cerebral Artery?

ANS- The MCAs are vital blood vessels that branch off from the internal carotid
arteries. The internal carotid arteries are branches of the common carotid
arteries. Those are large blood vessels in your neck. The MCA is the largest branch
of the internal carotid arteries. It can be involved in large strokes.

Q-5 Ischemic strokes are the most common, accounting for up to 80% of strokes,
and occur when there is an occlusion of a blood vessel impairing the flow of blood
to the brain.
Ischemic Strokes are divided into:
ANS- Thrombotic - Where a blood clot forms in a main brain artery or within the
small blood vessels deep inside the brain. The clot usually forms around
atherosclerotic plaques.
Embolic - A blood clot, air bubble or fat globule forms within a blood vessel
elsewhere in the body and is carried to the brain.
Systemic Hypoperfusion - A general decrease in blood supply, e.g. 1. in shock 2.
occurring in small vessels (lacunar infarcts) caused by chronic, uncontrolled
hypertension resulting in the pathological entity of lipohyalinosis and
arteriolosclerosis. These strokes occur in the basal ganglia, internal capsule,
thalamus, and pons.
Venous Thrombosis
 STATION 6
Spinal muscular atrophy (SMA) refers to a group of hereditary diseases that can
damage and kill specialized nerve cells in the brain and spinal cord (motor
neurons). Motor neurons control movement in the arms, legs, face, chest, throat,
and tongue, as well as skeletal muscle activity, such as speaking, walking,
swallowing, and breathing.
Q- 1 What are four types of SMA? When it develops?
 ANS Type l (also known as Werdnig-Hoffman disease or infantile-onset
SMA). is usually evident before 6 months of age.
 SMA Type ll is usually first noticed between 6 and 18 months of age.
 SMA Type lll (also known as Kugelberg-Welander disease) is seen after age
18 months.
 SMA Type IV develops after 21 years of age, with mild to moderate leg
muscle weakness and other symptoms.

Q-2 What are the physiotherapy management?

 Assessment of the patient with neuromuscular disease and particularly with
SMA is of great importance. Looking at baseline function, joint range and
power will assist the physiotherapist to follow on the progression of the
condition.
 Orthotics
 Splinting
 Taping
 Management of contractures
 Exercise and activity

Q-3 Differential diagnosis of SMA

ANS-3 Neuromuscular conditions:
 Duchenne Muscular Dystrophy
 Amyotrophic Lateral Sclerosis
Congenital Myopathies:
 congenital myotonic dystrophy,
 congenital myasthenic syndrome
Q-4 What are 3 signs of muscular dystrophy?
ANS-
 Frequent falls.
 Difficulty rising from a lying or sitting position.
 Trouble running and jumping.
 Waddling gait.
Q-5 Write types of muscles dystrophy other than Duchene
ANS
 Myotonic.
 Facioscapulohumeral (FSHD).
 Congenital.
 Limb-girdle.
 STATION 7
67-year-old woman presented at our medical department with left
hemithorax paresthesia with irradiation to her left arm. She had no history
of trauma. She was admitted to the clinical department with rheumatologic
disorder. A Chest X-Ray was performed for evaluation of pulmonary
involvement that has suggested the presence of an accessory left rib.
Computed Tomography was performed to characterize the parenchymal
findings, demonstrating an anomalous origin of the first left rib, which
began from the fusion of C7 and T1.
The combination of radiological and clinical findings suggested thoracic
outlet syndrome (TOS).

Q-1 What is thoracic outlet syndrome?

ANS- The term thoracic outlet syndrome (TOS) indicates compression of
one or several of the neurovascular structures crossing the thoracic outlet.
Thoracic outlet is bounded by the first thoracic vertebra, the superior
border of the manubrium sterni anteriorly, and the first rib and costal
cartilage laterally. The structures passing through this area and into the
upper limb are the subclavian artery and vein, and the nervous structures
of the brachial plexus.

Q-2 What structures compress the brachial plexus?

ANS- Direct compression can occur at:
 Scalene triangle
 Cervical rib/first rib
 Pectoralis minor
 Costoclavicular space
 Unstable humeral head in an anterior/inferior position
Q-3Write the names of nerve arising from medial cord of brachial plexus
ANS-
 Medial pectoral nerve
 medial root of the Median nerve
 Medial cutaneous nerve of the arm
  Medial cutaneous nerve of the forearm
 Ulnar nerve

Q-4 Myotomes of upper extremity

ANS-
 C5- shoulder abduction.
 C6– Elbow flexion Wrist extension
 C7 – Elbow extension
 C8 – Thumb Extension and wrist ulnar deviation
 T1 – Finger abduction
Q-5 What are the functional implications of TOS
ANS-
 Difficulty with overhead activities
 Pain with repetitive occupational fine motor tasks such as typing
 Pain/difficulty with prolonged seated postures
 Difficulty carrying a bag on the ipsilateral side
 Inability to sleep on the affected side
 STATION 8
A 20-year old female with CRPS Type-I had sequential spread to all four
limbs despite different treatment modalities, including medical therapy,
nerve block, radiofrequency ablation and surgical sympathectomy.

Q-1 how many types of CRPS? Discuss briefly

ANS
 Type 1 occurs after an illness or injury that did not directly damage a
nerve in the affected area
 Type 2 follows a distinct nerve injury

Q-2 Classification of nerve injuries?

ANS
 First degree: A reversible local conduction block at the site of the injury
 Second degree: There is a loss of continuity of the axons (the
“electrical wires”) within the nerve.
 Third degree: There is damage to the axons and their supporting
structures within the nerve. In this case, recovery is difficult to predict.
 Fourth degree: In this case, there is damage to the axons and the
surrounding tissues sufficient to create scarring that prevents nerve
regeneration.
 Fifth degree: These injuries are usually found in laceration or severe
stretch injuries. The nerve is divided into two.

Q-3 What is Wallerian degeneration?

Wallerian degeneration is an active process of retrograde degeneration of
the distal end of an axon that is a result of a nerve lesion. It occurs between 7 to
21 days after the lesion occurs. After the 21st day, acute nerve degeneration will
show on the electromyograph.

Q-4 What are the symptoms of spinal accessary nerve injury?

 ANS Pain around the shoulder, weakness, difficulty with abduction and
overhead activities, and sagging of the shoulder; radicular pain caused by traction
from the drooping shoulder may also occur.
Q-5 accessary nerve is XI cranial nerve similarly facial nerve is also a cranial
nerve VII is supplies to the facial muscles. What are the branches of facial nerve
and area of innervation?
ANS
 Frontal (temporal): The muscles of the forehead
 Zygomatic: The muscles involved in forceful eye closure
 Buccal: The muscles involved in moving the nostril, upper lip,
spontaneous eye blinking, and raising the corner of the mouth to
smile.
 Marginal mandibular branch: The muscles involved in depressing
the lower lip
 Cervical: lower chin muscle (platysma), often tensed during facial
hair shaving. It also lowers the corner of the mouth.