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05 - Tests and Measurements > 05-05c: Tone, Motor Control > Flashcards

05-05c: Tone, Motor Control Flashcards

1
Q

Definition of tone

A
  • Resistance of muscle to passive elongation or stretch (PROM)
  • Not a contracture
  • Not voluntary resistance to movement
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2
Q

Reasons for Tone

A
  • Physical inertia
  • Intrinsic mechanical-elastic stiffness of muscle and connective tissue
  • Reflex muscle contraction (tonic stretch reflex)
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3
Q

What affects tone

A
  • Voluntary effort
  • Anxiety and pain
  • Position and interaction of tonic reflexes
  • Ambient temperature (cold facilitates, warm inhibits)
  • Medication
  • State of arousal
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4
Q

Hypertonia

A

Increased tone about normal resting levels

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5
Q

Hypotonia

A
  • Decreased tone below normal resting levels
  • Low tone can include flaccidity
  • Diminished resistance to passive stretch
  • Stretch reflexes are dampened or absent
  • Limbs “floppy”, easily moved
  • Associated with LMN lesions
  • Can use quick stretch to activate spindle fire
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6
Q

Dystonia

A
  • Impaired or disordered tonicity
  • Involuntary movements involving large portions of the body
  • Hyperkinetic movement disorder
  • Associated with CNS lesions involving basal ganglia; inherited conditions; Neurodegenerative diseases (Parkinson’s); Metabolic disorders; Torticollis; Writer’s cramp
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7
Q

Types of hypertonicity (2)

A

Spasticity, Rigidity

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8
Q

Spasticity

A
  • Characteristic of UMN lesions
  • Velocity dependent resistance to passive stretch (larger and quicker the stretch, the stronger the spasticity)
  • Clasp-knife response (sudden inhibition or letting go; sudden release)
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9
Q

Chronic spasticity may result in…

A
  • Contractures
  • Abnormal posturing
  • Deformities
  • Functional limiations
  • Disability
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10
Q

Clonus

A
  • Cyclical, spasmodic alternation of muscular stretch of a spastic muscle
  • Normal; common in plantar flexors, wrist and jaw
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11
Q

Clonus Scale

A 
1 = no clonus
2 = minimal clonus (1-2 beats)
3 = moderate clonus (3-9 beats)
4 = sustained clonus (10+ beats)
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12
Q

Rigidity

A
  • Lesions of basal ganglia
  • Characteristic of uniform resistance throughout the entire ROM
  • Velocity independent resistance to passive ROM
  • Leadpipe: Heavy load makes high resistance
  • Cogwheel: Catch-release jerkiness, commin in UE movements in pts with Parkinson’s; May have tremor on top of rigidity
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13
Q

Chronic rigidity may result in…

A
  • Stiffness
  • Inflexibility
  • Significant functional limitations
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14
Q

Spasticity vs. Rigidity

A
  • Spasticity: Increase in muscle tone (velocity dependent)

- Rigidity: No effect in tone (not velocity dependent)

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15
Q

Decorticate Rigidity

A
  • Results from severe brainstem involvement (BI)
  • Pt is in coma
  • Abnormal flexor pattern
  • UE in flexion (elbow, wrist, fingers, shoulder adduction), LE in extension (Ext, IR, PF)
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16
Q

Decerebrate Rigidity

A
  • Results from severe brainstem involvement (BI)
  • Pt is in coma
  • Abnormal extensor pattern
  • UE in extension (elbow ext, wrist flex, fingers flex, forearm pronation, shoulder adduction), LE in extension (Ext, IR, PF)
17
Q

Tone Scale

A 
0 = No response (flaccidity)
1+ = Decreased response (hypotonia)
2+ = Normal
3+ = Exaggerated response (mild to moderate hypertonia)
4+ =  Sustained response (severe hypertonia)
18
Q

Modified Ashworth Scale

A 
0 = No increase in muscle tone
1 = Slight increase in muscle tone, manifested by catch-release or by min resistance at end of ROM when affected part is moved in flexion/extension
1+ = Slight increase in muscle tone, manifested by a catch, followed by min resistance throughout the remainder (less than half) of ROM
2 = Marked increase in tone through most of ROM, but affected parts easily moved
3 = Considerable increase in tone, passive movement difficult
4 = Affected parts rigid in flexion or extension
  • “Gold standard” for hypertonicity
  • Inability to detect small changes
  • Limited application (only for extremity)
  • Inability to distinguish soft tissue viscoelasticity and neural changes
19
Q

Documentation of tone includes…

A
  • Location
  • Type of tone
  • Symmetrical/Asymmetrical (both sides? one side?)
  • Resting postures (Position at rest)
  • Factors that influence tone (speed of movement, anxiety, pain)
  • Effects of tone on function
20
Q

Development of motor/functional skills

A
  • Mobility
  • Stability
  • Controlled mobility
  • Skill
21
Q

Skill

A

Ability to consistently perform coordinated movement sequences for purposes of attaining an action goal

22
Q

Mobility/Transitional Mobility

A
  • Ability to move through functional ROM (from one position to another independently and safely)
  • Initiating, controlling and terminating movement
23
Q

Stability/Static Postural Control

A

Ability to maintain a position or posture with center of mass (COM) staying over the BOS with body not in motion

24
Q

Controlled mobility/Dynamic balance

A

Ability to move within WB position or rotate around a long axis
- Maintain postural stability and COM over BOS while parts of body are in motion

25
Q

Motor control theory

A
  • Ability to produce, regulate and alter mechanisms that produce movement and control posture
  • Task-specific training to reduce impairment
26
Q

Motor control interventions do…

A
  • Resolve impairment (body, not cellular level)
  • Retrain using functional tasks (reprogram brain)
  • Design/implement recovery strategies
  • Design/implement compensatory strategies (last option when recovery is insufficient)
27
Q

Plasticity/Neuroplasticity

A

Ability to modify or change at the synapse level either temporarily or permanently in order to perform a certain function

  • (neuro) Capacity for brain and nerve cells to repair and change in response to experience or environment
  • allows recovery of function after injury or disease
28
Q

Motor learning

A

Ability to perform movement as a result of internal processes that interact with the environment and produce a consistent strategy to generate the correct movement

  • Relatively permanent changes in ability to perform skilled behavior
  • Includes practice and experience to facilitate (i.e., piano, drumming, typing)
29
Q

Postural control

A
  • Ability of the motor and sensory systems to stabilize position and control movement
  • Maintain posture while performing functional tasks
30
Q

Strategy

A
  • Plan used to produce a specific result or outcome that will influence structure or system
  • Treatment = development of most effective strategies
31
Q

Compensation

A
  • Adoption of alternative behavioral strategies to complete a task
  • Different muscles, movement, adapteive equipment substitute for loss of function
  • AFO, crutches, cane, splints = compensatory devices
32
Q

Motor recovery

A
  • Reacquisition of movement skills lost through injury
  • Movements may be modified, but task completed without compensation
  • Relies on neuroplasticity
33
Q

Fugi-Meyer

A
  • Ordinal scale measures recovery after CVA
  • Brunnstrom’s sequence of recovery
  • Assesses 1) joint movement and pain, 2) balance, 3) UE motor function, 4) sensation, 5) LE motor function
34
Q

Fugi-Meyer Scoring

A
  • Each item scored 0-3
  • Cumulative, max score is 100; can be interpreted as percentage of motor recovery
  • Lower the score, higher the disability
35
Q

Rivermead Motor Assessment

A
  • NDT approach to neurological recovery
  • Self-report
  • 3 sections: 1) Gross function, 2) leg and trunk, 3) arm
  • Each section has subscale of tasks that increase in difficulty
36
Q

Rivermead Motor Assessment Scoring

A
  • 1 for completion of task, 0 for inability

- Can stop test if cannot perform 3 tasks in a row

37
Q

Upright motor control test

A
  • Incorporates upright posture and WB
  • Simulates stance and swing phases of gait
  • Requires 2 people to administer (one to stabilize, one to cue
  • 2 sub tests: Flexion Control (swing phase), Extension Control (stance phase)

05 - Tests and Measurements (21 decks)

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