Week 5: Assessment Motor Control - PPT Flashcards
“control of both movement & posture”
Motor control
What is part of motor control?
Fluid interrelationships Stability and mobility Proximal & distal musculature Agonists and antagonists Balance Parameters of movement – spatial, temporal…
T/F: Function-Based Stroke Rehabilitation, p.81)…
-suggests that motor behavior emerges from persons’ multiple systems interacting with unique tasks and environmental contexts…more interactive or heterarchical and emphasizes the role of the environment.
True
What are system model of motor control?
regulation system environmental commanding musculoskeletal comparing sensorimotor
What is part of person in model?
Client factor, skills, patterns (cognition, psychosocila, sensorimotor)
what is part of environment?
context and activity demand (physical, socioeconomic, cultural)
What happens when someone has an upper motor neuron lesion like stroke?
Changes in muscle strength (weakness)
Changes in muscle tone/postural control
Changes in muscle activation (central coordination)
Changes in sensation
Most common change is weakness after stroke
Most common changes: muscle paralysis and or paresis (slight or partial paralysis)
Muscle weakness varies depending on the starting position of the body, length of the muscle, and specific action muscle is being asked to perform
Manual muscle tests are unreliable with neurological deficits
Loss of muscle strength is strongly influenced by secondary changes in joint alignment & mobility, muscle & tissue length, and problems with tone & muscle activation
Can be in trunk or in extremities
T/F: manual muscle test are reliable with neurological deficits
False.Manual muscle tests are unreliable with neurological deficits
TF: we see that when there is weakness in the trunk, it is often accompanied by hypertonicity in an arm or leg.
true
– amount of tension in a muscle or resistance of a muscle to passive elongation or stretching
muscle tone
special category, referring to overall state of tension in body musculature
postural tone
greater than normal, increased resistance to passive movement; may be located in muscles which can be actively contracted (active stiffness)
hypertonicity
lower than normal; no resistance to passive movement; lower than normal tension at rest/during movement; difficulty resisting the force of gravity
hypotonicity
associated w/muscles that are weak or paralyzed; most common in acute state – may persist.
hypotonicity
leads to atypical patterns of muscle activation; may also develop in muscles in constant positions of shortness…
Hypertonicity
– special type of hypertonicity; increased muscle tension associated with unnatural body postures and limb positions caused by changes in the le
Spasticity – special type of hypertonicity; increased muscle tension associated with unnatural body postures and limb positions caused by changes in the le
- hyperactive response to quick stretch
- velocity-dependent
- clasp-knife phenomenon
- must be elicited by doing something to muscle group in the opposite direction
spasticity
– usually involves tactile, proprioceptive, and kinesthetic sensation.
Sensory Awareness
Dynamic Systems Theory
Behaviors emerge from the interaction of many systems.
Behavior is considered to be self-organizing.
Transitions in behavior, phase shifts, are changes from one preferred pattern of coordinated behavior to another.
Motor control parameters are gradable.
There is no inherent ordering of systems in terms of their influence on motor behavior….control parameters shift behavior from one pattern to another…
This theory proposes that behaviors emerge from the interaction of many
systems -> self-organizing. There are “normal strategies” which limit the
degrees of freedom.
Dynamic systems theory
phase shifts
Transitions in behavior are called phase shifts where 1
preferred behavior is chosen over another; ie…walking faster and faster and
then running!
are variables that shift behaviors from 1 form to another.
They do not control the change, but act as agents/catalysts for reorganizing the behavior
to a new form,
Control parameters are variables that shift behaviors from 1 form to another.
They do not control the change, but act as agents/catalysts for reorganizing the behavior
to a new form,
Systems themselves are subject to change
No inherent ordering of systems in terms of their influence on motor behavior
T/F: Client with damaged CNS attempts to compensate for the lesion to achieve functional goals.
true
TF: Systems and CNS are heterarchically organized
true
T/F;Providing appropriately challenging tasks and environments for those with CNS dysfunction appears critical to the maximal rehabilitation of our clients.
true. Experimentation with different strategies leads to optimal solution
Changes over time are caused by multiple factors/systems such as maturation & the nervous system,
biomechanical constraints & resources, & the influences of the social environment. Behavioral changes reflect
attempts to compensate and to achieve a certain task.
Recovery is variable because personal characteristics & environmental factors are unique for each person
This theory also believes that normal development does not follow a rigid, task-oriented sequence,
as the motor milestones suggests; other factors influence the developmental stages…
Dynamic systems theory
Emphasis on the role and occupational performance areas
- Role Performance (past and future roles)
- Occupational Performance Tasks: Areas of Occupation
- Task: Selection & Analysis
- Person: Performance Skills/Client Factors
- Environment: Performance Context
Task Oriented Approach
- Assess foundations for movement - alignment and biomechanics)
- Assess muscle tone - “placing” “high enough to resis gravity, low enough to allow movement, attempts at voluntary movement”
- Assess voluntary muscle activity through observation (qualitatively) - movement patterns “typical” “missing”
- Assess functional use of the upper extremity (performrmance skills)
Non-Standardized (Observational) Assessment of Motor Behavior: Based on the Neurodevelomental Treatment (NDT) Approach
grounded in observation and based on a dynamic systems approach, functional approach and contemporary understanding of motor behavior
non standardized method
What do you think conditions of observation could be?
Temperature Weather Setting People around Not feeling well/sleepy Family present? Roommate present? Before or after medications given?
Although the test was developed and described as a measure of spasticity, AS MODIFIED…the scale is a measure of muscle tone or the resistance to passive movement.
Modified Ashworth Scale
Measure of spasticity/tone
Most widely used
. The MAS measures resistance during passive soft-tissue stretching.
The MAS is done in supine (this will garner the most accurate and the lowest score; any tension anywhere in the body will increase spasticity);
· Because spasticity is “velocity dependent” (the faster the limb is moved, the more spasticity is encountered), the MAS is done moving the limb at the “speed of gravity.” This is defined as the same speed a non-spastic limb would naturally drop. In other words, fast;
· The test is done a maximum of three times for each joint. If it is done more than three times the short-term effect of a stretch impacts the score;
MAS Scale?
0 Normal muscle tone (no increase)
1 Slight increase in muscle tone, “catch and release” or minimal resistance at end of ROM when limb moved
1+ Slight increase, “catch” followed by minimal resistance through remainder (less than half) of ROM
2 Marked increase through most of ROM, but affected parts are easily moved
3 Considerable increase in tone, passive ROM difficult
4 Rigid in flexion or extension (any motion)
Developed to evaluate motor function, balance, some aspects of sensation, and joint function/pain in persons following a stroke
Fugl-Meyer Assessment
2nd most widely used assessment of motor deficits of persons with CNS impairments
Fugl-Meyer Assessment
226-point multi-item Likert-type scale
Motor domain: movement, coordination, & reflex action at the shoulder, elbow, forearm, wrist, hand, hip, knee, & ankle
3-point scale: 0= cannot perform, 1= performs partially, 2=performs fully
Takes approximately 20 minutes and does not require training/certification
Fugl-Meyer Assessment
