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Functional Neurology
Published in James Crossley, Functional Exercise and Rehabilitation, 2021
The spinal cord has various functions, including helping control blood pressure, heart rate and body temperature. The spinal cord acts as the primary reflex center, coordinating incoming and outgoing information from tissues and generating movements through a range of simple spinal reflexes. Reflexes can be extremely useful, especially in making rapid adjustments, which is important for safety and for protecting us from harm.
Peripheral neurological
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Practise eliciting reflexes to ensure that you know where the tendons lie anatomically. Hold the tendon hammer down the shaft, away from the head, and swing it purposefully. Reflexes can be described as: (pathologically) brisk (+++) — upper motor neurone lesionsnormal (++)reduced (+)absent (–)present only with reinforcement, i.e. teeth clenching (±).
Neurologic Diagnosis
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Ask the patient to open his or her mouth and to say “Ah.” Inspect the palate and uvula, using a tongue depressor if necessary, and if the palate moves to one side, this indicates a lesion of the vagus nerve (motor to the soft palate) on the contralateral side. If the palate does not move well, this may be due to a bilateral supranuclear, nuclear, or infranuclear vagus nerve lesion, a disturbance of the neuromuscular junction, or muscle function. The gag reflex occurs with touching the back of the throat each side with a tongue depressor whereupon the soft palate reflexly elevates and is either present or not (sometimes absent in normal).
Structural validity and internal consistency of a hypothesized factor structure of the Fugl-Meyer Assessment of the upper extremity
Published in Topics in Stroke Rehabilitation, 2023
Yuta Tauchi, Makoto Kyougoku, Yuho Okita, Takashi Takebayashi
First, the original form could not be used to assess all models; the model with the best fit was the 30-item form (4-factor, 30 items: Model 5). This finding strongly supported the multidimensionality of the FMA-UE form,13,19,20 and the three reflex items (biceps, triceps, and normal reflex items) were unnecessary, as shown in previous studies.5,13,19,20 Reflexes are involuntary movements through which an individual automatically elicits a response to a stimulus; reflexes are susceptible to mental stress and spasticity.19,20 The presence of reflex items is unacceptable in the FMA-UE form, which assesses voluntary upper extremity movements. In addition, two items (items 1 and 2) appeared to be within nominal scales1; hence, the confusion with scaling the different variables using either the two-scoring or three-scoring method (items 3–33) made it difficult to statistically estimate the factor structure of the original form.19,20 In the statistical analysis, it is always estimated by removing the reflex items, thereby suggesting that the reflex items were not needed. CFA confirmed that the reflex items were unnecessary in the FMAUE-J form; therefore, pure upper extremity function can be assessed by adopting the factor structure of the 30-item form, excluding three reflex items.
Dysfunction of the stress response in individuals with persistent post-concussion symptoms: a scoping review
Published in Physical Therapy Reviews, 2022
Gerard Farrell, Sizhong Wang, Cathy Chapple, Ewan Kennedy, Angela Spontelli Gisselman, Kesava Sampath, Chad Cook, Steve Tumilty
There is some evidence for quantifiable dysfunction of the ANS when assessing HRV, alpha amylase, or the PLR. Despite mixed results, there was a general trend for HRV metrics to change along the course of recovery or predict poor neurobehavioral or cognitive performance. HRV is thought to be a proxy measure of cardiac autonomic tone [76], reflecting the inhibitory actions of the parasympathetic nervous system on HR through the vagus nerve [77]. Mixed results in HRV studies may exist due to heterogeneous populations, methodology, measurement tools, or metrics utilised. The sole study investigating alpha amylase showed a decreased response to exercise in the acute stage compared to one-month post-concussion. This dampened response of alpha amylase to exercise also predicted the presence of more symptoms at one-month post-concussion. Alpha amylase is a proxy measure of the ANS [78], specifically the sympathetic nervous system (SNS) [79]. The PLR was shown to be dysfunctional in PPCS compared to concussed individuals and controls. This reflex is involved in normal accommodation and pupillary constriction of the eye, and is controlled by both components of the ANS [80]. The results of these studies are promising, but due to the limited number of studies investigating these markers, further research is required.
In memoriam: Henry Szczȩsny Schutta, MD (1928–2020)
Published in Journal of the History of the Neurosciences, 2021
The neurological examination: When in doubt, examine the patient.Being able to find subtle abnormalities on the neurologic exam is not the sign of a good neurologist; what is important is knowing what to do with the findings.In neurology you can throw out one finding that doesn’t fit, but the proof of a good neurologist is knowing which one to throw out.Do not refer to “deep tendon reflexes” (they are neither deep nor related to tendons); they should be referred to as muscle stretch reflexes.