Chrissy Durrough Lugge
Forum Replies Created
-
Posts
-
Hi Kelley! Thanks for this question! Deep brain stimulation can be used for several conditions, including idiopathic Parkinson’s disease, essential tremor, and dystonia. In the Parkinson’s realm, it is only indicated for idiopathic PD (meaning it is not effective for secondary parkinsonism or Parkinson-plus syndromes). Hope this provides some clarification!
Happy Thanksgiving!
Chrissy
Hi Margaret! Yes, this is because the disc herniation is severe and at the L4-5 spinal level. The spinal cord ends at approximately L1-2 spinal level. The associated lower spinal nerves travel distally and exit several levels below. A disc herniation at L4-5 may come in contact with any of the above listed nerves as they travel distally prior to exiting the spinal column.
Let me know if you have any other questions, and happy Thanksgiving!
Chrissy
Hi Erika,
I think you’ve got it! Dopamine can be excitatory or inhibitory depending on its receptor. In the direct pathway, dopamine binds to D1 receptors, which are excitatory. In the indirect pathway, it binds to D2 receptors, which are inhibitory.If you want some more information and/or a different presentation of the pathways, the below website does a nice job of summarizing the direct and indirect pathways. Be careful not to get too “in the weeds” here for exam prep purposes – a basic understanding of the pathways and their impact on movement will likely be sufficient for the NCS exam!
https://www.kenhub.com/en/library/anatomy/direct-and-indirect-pathways-of-the-basal-ganglia
Chrissy
Hi Carla,
I’d focus on the StrokEDGE II recommendations and the Core Outcome Measures. The StrokEDGE II task force reviewed all the measures included in StrokEDGE I in determining their recommendations, so you should cover the most appropriate outcome measures when studying the updated list. There may be a couple unexpected outcome measures on the NCS exam, but the time you would spend chasing those types of questions in your studies will likely be better spent on the bigger topics.
ChrissyHi Erika,
Thanks for this question! Someone with horizontal canal BPPV will present with horizontal nystagmus during the supine roll test that is either geotropic or ageotropic. The direction of nystagmus is determined by the location of the debris in the canal; ageotropic nystagmus is caused by debris that are closer to the ampulla. This page by Timothy Hain describes horizontal/lateral canal BPPV well: https://dizziness-and-balance.com/disorders/bppv/lcanalbppv.htm. This excerpt may answer your question: “In idiopathic cases with geotropic nystagmus the “bad” ear is assigned to the side with the stronger nystagmus. With ageotropic nystagmus, the bad ear is assigned to the side with the weaker nystagmus. The rationale for this pattern is that excitation is stronger than inhibition (i.e. Ewald’s second law). This mechanism was not supported by a recent study of positional alcohol nystagmus on persons who had only one remaining labyrinth (Tomanovic and Bergenius, 2013).”For example, say someone has right horizontal canalithiasis. If their nystagmus is:
– geotropic, they will be more symptomatic/have more nystagmus when their right ear is down.
– ageotropic they will be more symptomatic/have more nystagmus when their left ear is down. In other words, their least symptomatic side is affected.Determining which side is affected is important, as this impacts the selection and direction of repositioning maneuvers.
Hope this helps!
Chrissy
In both of these cases, we have to refer to sensation scoring to determine motor level even though strength is 5/5 in all key muscles. Practice ISNCSCI 4 appears to follow “different rules” because there are key muscles for the most caudal segments with intact sensation. Even though the lowest level with intact sensation is C8, we know motor is intact to at least T1 as determined by muscle testing of the finger abductors. Sensation is impaired at T1 and in all distal segments, so the motor level is T1. You described the rationale for Practice ISNCSCI 5’s scoring well. If there is testable motor function available, then the motor scores will supersede sensory scores for determining motor level.
Here is a previous discussion forum chain regarding Practice ISNCSCI 4 that might also help: http://rehabknowledge.com/forums/topic/isncsci-practice-4/
Let me know if you have any other questions!
Hi Erika! I hope I can help with this! The motor level is defined as “the lowest key muscle function that has a grade of at least 3, providing the key muscle functions represented by segments above that level are judged to be intact (graded as a 5).” In this example, the patient’s elbow flexors (C5) were graded as 2/5, so this cannot be the motor level. There is no formal motor test for C4 on the ISNCSCI; therefore, we assume the motor level is the same as the next highest level with intact sensation. Sensation is normal at C4, which is why the motor level on the left is presumed to be C4. Let me know if I can provide any more clarification!
ChrissyHi Karen! Thanks for pointing this out. This was a direct link to the ANPT website where the resource list was posted, but they must have taken the resource list off the website. The link now opens a PDF with the resource list.
Hi Ellese,
I just resent your certificate of completion to your email. Let me know if you don’t receive it!
Chrissy
Hi Will,
The article linked below has a little more information about man in a barrel syndrome. In summary, “The internal carotid artery supplies blood flow to the anterior two-thirds of the brain via the anterior cerebral artery (ACA) and the middle cerebral artery (MCA). The most distal branches of the ACA and MCA supply brain tissue, including upper extremity motor fibers. In the setting of inadequate blood flow to both sides, the brain, these most distal branches, or watershed zones, do not receive an adequate amount of oxygenated blood, resulting in the death of these cells. Based on the neuroanatomy of these anterior circulation watershed zones, damage to these areas can result in bilateral upper extremity weakness.”
Of note, the literature explains man in a barrel syndrome differently than how it was taught to me. Rather than being marked by proximal UE and LE weakness with preservation of distal strength, man in a barrel syndrome is generally accepted as simply bilateral upper extremity weakness with preservation of strength elsewhere.
Hope this helps!
Chrissy
Hi Adam,
Thanks for this question! The nigrostriatal pathway is active whenever the direct and indirect pathways are active. It is only added later in the slides for clarity and to demonstrate the effect of Parkinson’s disease on the direct and indirect pathways because the substantia nigra (and, therefore, dopamine) are introduced in the nigrostriatal pathway.
Hope this helps!
Chrissy
