9/11 - Movement Considerations II Flashcards
Abnormal Muscle Tone
hypertonia, hypotonia, spasticity, rigidity
Paresis
Motor weakness/abnormal motor control
Dysmetria
lack of coordination of movement typified by the undershoot or overshoot of intended position
Hypometria
a condition of cerebellar dysfunction in which voluntary muscular movements tend to result in the movement of bodily parts (as the arm and hand) short of the intended goal
Hypermetria
a condition of cerebellar dysfunction in which voluntary muscular movements tend to result in the movement of bodily parts (as the arm and hand) beyond the intended goal
Involuntary movements
tremor, ballismus
Abnormal cerebellum
hypotonia, incoordination, intention tremor, impaired error correction affecting motor learning
co-activation
primitive/unrefined; normal in early learning
coordination
sequencing, timing, and grading of the activation of multiple muscle groups
incoordination
movements are awkward, uneven, inaccurate
Timing problems
problems initiating movement; slowed execution time; problems terminating movement
problems initiating movement
Time between the persons decision to move and the movement itself; Requires ability to overcome inertia, gravity, and antagonistic restraint; Deficits could be in ROM, force production, motivation, postural control
dysdiadochokinesia
problems terminating a movement
dexterity
ability to fractionate fine movement; depends on ability to move and respond to environment; most important in manipulative functions
coordination exam: non-equilibrium
finger to nose, heel to shin; quality of movement; subjectively graded 1-5
primary impairments of NM system
abnormal muscular tone; motor weakness/abnormal motor control; abnormal synergies; co-activation and coordination problems; involuntary movements
Abnormal basal ganglia
hypokinetic disorders (bradykinesia, akinesia); rigidity; resting tremor; hyperkinetic disorders (choreiform, athetoid movements, dystonia)
tremor
rhythmic and oscillatory
dystonia
sustained muscle contractions, often twisting, repetitive, and abnormal
associated movements
unintentional movements of one limb during the voluntary movement of another limb
General interventions: Biomechanical
Sensory modalities: icing, vibration, approximation (weak evidence)
General interventions: Neurophysiologic
Stretching, serial casting, casts, orthoses
General interventions: Muscle Reeducation
Recruitment and type (fast or slow); Alignment issues; Fast and slow speeds
Accuracy; Intensity
Hedman temporal sequence
initial conditions preparation initiation execution termination outcome
Abnormal muscle tone
hypertonia; hypotonia; spasticity; rigidity
Abnormal muscle tone treatment
pharm, surgical, physical
Pharma tone treatments - botox
Botulinum toxin Type A
Injected directly into the muscle at the motor point
Blocks the neuromuscular junction by reducing the release of Ach
Initial effects in 3-7 days
Wearing off in 4-6 months
Surgical tone treatments
Selective posterior rhizotomy Selected roots of L2-S2 Variable results Risk of reducing function Tendon lengthening, release or transfer Variable results Generally successful for improving ROM Risk of reducing muscle strength Selective posterior rhizotomy
PT tone treatments
Saladin Videos of Rhythmic rotation in sidelying Rotation, Counter Rotation in sidelying Rhythmic Rotation hooklying Rhythmic Rotation LEs on ball
Weakness and motor control interventions
Patient, family and entire team education
Encourage functional use
Consider stationary bicycle with vital sign monitoring
Guarded ambulation if appropriate
PREs of individual muscle groups Task specific training and strength training CVA ? Winstein, 2004
Bimanual Training
FES ? Sullivan and Hedman, 2004
CVA secondary effects
Immobilization and shortened position causes atrophy
Loss of sarcomeres
Accumulation of intramuscular connective tissue
Increased skeletal muscle fat content
Degenerative changes at myotendinous junction
Increase in mechanical spindle stimulation by stretch
Dodd systemic review
Systematic review that strength training programs improve strength in those with CP without increased spasticity
Ada systemic review
Systematic review in those with stroke
Acute, very weak; acute weak; chronic very weak; chronic weak
Strength training is effective early after stroke,
It is not harmful (no increased spasticity)
It may be worthwhile, but adequate strengthening interventions applied to several muscles of a limb and tests need to address this in future research e.g. 10 meter walk or 9 hole peg test
Sullivan and Hedman 2004
Sensory Stimulation 2 hours per day
FES to wrist extensors during a lifting task
15 minutes, twice a day
18 weeks of home exercise and 6 home PT visits
Coordination Interventions
Repetitions of functional movements with increasing demands on accuracy
Assist with knowledge of results and/or knowledge of performance
Weight-bearing activities for LEs
Repetitive non-functional movements
Timing problems - interventions
Give a time constraint to a task
Metronome
Time an activity
Verbal, visual, manual feedback
Scaling problems - interventions
Practice grading force
Faster movements tend to be easier
Repetition of functional activity that will carry over
Treatment (intervention) of involuntary movements
Reduced effort/increase efficiency
Weight bearing and approximation
Distal fixation
Limb is weighting-controversial
