9/11 - Movement Considerations II

Question 1

Abnormal Muscle Tone

Answer 1

hypertonia, hypotonia, spasticity, rigidity

Question 2

Paresis

Answer 2

Motor weakness/abnormal motor control

Question 3

Dysmetria

Answer 3

lack of coordination of movement typified by the undershoot or overshoot of intended position

Question 4

Hypometria

Answer 4

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

Question 5

Hypermetria

Answer 5

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

Question 6

Involuntary movements

Answer 6

tremor, ballismus

Question 7

Abnormal cerebellum

Answer 7

hypotonia, incoordination, intention tremor, impaired error correction affecting motor learning

Question 8

co-activation

Answer 8

primitive/unrefined; normal in early learning

Question 9

coordination

Answer 9

sequencing, timing, and grading of the activation of multiple muscle groups

Question 10

incoordination

Answer 10

movements are awkward, uneven, inaccurate

Question 11

Timing problems

Answer 11

problems initiating movement; slowed execution time; problems terminating movement

Question 12

problems initiating movement

Answer 12

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

Question 13

dysdiadochokinesia

Answer 13

problems terminating a movement

Question 14

dexterity

Answer 14

ability to fractionate fine movement; depends on ability to move and respond to environment; most important in manipulative functions

Question 15

coordination exam: non-equilibrium

Answer 15

finger to nose, heel to shin; quality of movement; subjectively graded 1-5

Question 16

primary impairments of NM system

Answer 16

abnormal muscular tone; motor weakness/abnormal motor control; abnormal synergies; co-activation and coordination problems; involuntary movements

Question 17

Abnormal basal ganglia

Answer 17

hypokinetic disorders (bradykinesia, akinesia); rigidity; resting tremor; hyperkinetic disorders (choreiform, athetoid movements, dystonia)

Question 18

tremor

Answer 18

rhythmic and oscillatory

Question 19

dystonia

Answer 19

sustained muscle contractions, often twisting, repetitive, and abnormal

Question 20

associated movements

Answer 20

unintentional movements of one limb during the voluntary movement of another limb

Question 21

General interventions: Biomechanical

Answer 21

Sensory modalities: icing, vibration, approximation (weak evidence)

Question 22

General interventions: Neurophysiologic

Answer 22

Stretching, serial casting, casts, orthoses

Question 23

General interventions: Muscle Reeducation

Answer 23

Recruitment and type (fast or slow); Alignment issues; Fast and slow speeds
Accuracy; Intensity

Question 24

Hedman temporal sequence

Answer 24

initial conditions preparation initiation execution termination outcome

Question 25

Abnormal muscle tone

Answer 25

hypertonia; hypotonia; spasticity; rigidity

Question 26

Abnormal muscle tone treatment

Answer 26

pharm, surgical, physical

Question 27

Pharma tone treatments - botox

Answer 27

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

Question 28

Surgical tone treatments

Answer 28

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

Question 29

PT tone treatments

Answer 29

Saladin Videos of 
Rhythmic rotation in sidelying
Rotation, Counter Rotation in sidelying
Rhythmic Rotation hooklying
Rhythmic Rotation LEs on ball

Question 30

Weakness and motor control interventions

Answer 30

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

Question 31

CVA secondary effects

Answer 31

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

Question 32

Dodd systemic review

Answer 32

Systematic review that strength training programs improve strength in those with CP without increased spasticity

Question 33

Ada systemic review

Answer 33

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

Question 34

Sullivan and Hedman 2004

Answer 34

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

Question 35

Coordination Interventions

Answer 35

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

Question 36

Timing problems - interventions

Answer 36

Give a time constraint to a task
Metronome
Time an activity
Verbal, visual, manual feedback

Question 37

Scaling problems - interventions

Answer 37

Practice grading force
Faster movements tend to be easier
Repetition of functional activity that will carry over

Question 38

Treatment (intervention) of involuntary movements

Answer 38

Reduced effort/increase efficiency
Weight bearing and approximation
Distal fixation
Limb is weighting-controversial