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710: Motor Control & Motor Learning > An Overview of Neurologic Impairments > Flashcards

An Overview of Neurologic Impairments Flashcards

1
Q

Describe signs

A

These are objective findings of pathology that can be determined by physical examination

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2
Q

Give an example of sign

A

The presence of nystagmus suggests that a patient has a vestibular disorder

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3
Q

Describe symptoms

A

These are subjective reports associated with pathology that are perceived by patients, but may not necessarily be objectively documented on examination

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4
Q

Give an example of a symptom

A

Dizziness is a common symptoms associated with vestibular pathology

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5
Q

Describe positive signs/symptoms

A

the release of abnormal behavior

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6
Q

Give an example of some positive signs and symptoms

A

The presence of abnormal reflexes such as the Babinski reflex or hyperactive stretch reflexes resulting in spasticity

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7
Q

Describe negative signs/symptoms

A

the loss of normal behaviors

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8
Q

Give an example of some negative signs and symptoms

A

Paresis, the loss of descending control of LMNs

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9
Q

Describe how rehab utilizes positive and negative signs/symptoms

A

Rehab tends to emphasize positive symptoms, such as increased muscle tone, at the expense of negative symptoms, such as loss of strength

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10
Q

What two things contribute to motor control problems in the person with neurological dysfunction?

A

primary and secondary effects

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11
Q

Describe primary effects

A

These are impairments that result from a lesion in the CNS that causes problems in motor, sensory/perceptual and/or cognitive systems

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12
Q

Give a few examples of primary effects

A

Paralysis or spasticity

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13
Q

Describe secondary effects

A

These are impairments that are not directly resulting from the CNS lesion, but developed as a result of the original problems

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14
Q

Give a few examples of secondary effects

A

Changes in the structure and function of muscles, muscle contractures, and decreased joint ROM

*all of which are due to the primary effects of paralysis, spasticity, etc.

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15
Q

What are 3 systems in which neurological impairments can occur?

A
  • action/motor system
  • sensory system
  • perceptual and cognitive systems
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16
Q

The action system includes areas of the nervous system such as what 3 things that perform processing essential to the control of movement?

A
  • motor cortex
  • cerebellum
  • basal ganglia
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17
Q

Damage to the motor cortex results in what?

A
  • motor weakness (paresis)
  • abnormal synergies
  • coactivation
  • abnormal muscle tone (spasticity)
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18
Q

Define weakness

A

The inability to generate sufficient tension in a muscle

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19
Q

Define paralysis/paresis

A

Decreased voluntary motor recruitment that reflects an inability or difficulty in recruiting skeletal motor units to generate torque or movement

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20
Q

Paresis results from a lesion with _____ motor pathways

A

descending

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21
Q

How is motor weakness examined?

A

It is measured isometrically, isotonically, and/or isokinetically either manually or via dynamometer

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22
Q

What are some treatment options for muscle weakness?

A
  • use of electrical stimulation

- strength training

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23
Q

How and why do abnormal synergies develop?

A

Lesions to the corticospinal centers can lead to loss of the ability to recruit a limited number of muscles controlling movement and the ability to control individual joints, which results in the emergence of mass patterns of movement called abnormal synergies.

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24
Q

Abnormal synergies reflect a lack of what?

A

The ability to move a single joint without simultaneously generating movements in other joints (fractionation)

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25
Q

True or False

The return of reflexes precedes the recovery of voluntary movement following stroke.

A

True

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26
Q

Describe Brunnstrom’s 6 stages of recovery from stroke

A

1) flaccid paralysis
2) development of minimal movement in synergies
3) voluntary movement synergy dependent
4) some movements out of synergy
5) movements almost independent of synergies
6) normal movements with normal speed

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27
Q

Define muscle tone

A

a muscle’s resistance to passive stretch

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28
Q

Define spasticity

A

A motor disorder, characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex

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29
Q

Spasticity is a component of ____ motor neuron syndrome

A

upper

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30
Q

List the continuum of muscle tone starting with flaccidity

A

1) Flaccidity
2) Hypotonia
3) Normal
4) Spasticity
5) Rigidity

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31
Q

Define flaccidity

A

The complete loss of muscle tone

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32
Q

Define hypotonia

A

A decreased muscle tone than normal

33
Q

What is the difference between spasticity and rigidity?

A

Spasticity is velocity DEPENDENT, whereas rigidity is velocity INDEPENDENT

34
Q

Spasticity is examined using what scale?

A

The modified Ashworth scale

35
Q

What are some treatment approaches to spasticity?

A
  • pharmacological treatments
  • surgical management
  • physical management
  • strength training
36
Q

What are some drugs that have shown to help treat spasticity?

A
  • Baclofen
  • Diazepam
  • Tizanidine
37
Q

Describe the neurophysiological approaches used physically manage spasticity.

A

These techniques are designed to alter muscle tone by changing the background level of activity in the motor neuron pool of the muscle

38
Q

As the background level of activity in the motor neuron pool increases, the likelihood that the muscle will respond to any incoming stimulus ______.

A

increases

The opposite is also true; as background levels of activity decrease, the muscle is less likely to be activated.

39
Q

Describe some physical management techniques to treating spasticity

A
  • joint approximation
  • joint traction
  • prolonged icing
  • low frequency vibration
40
Q

What are the 3 categories of signs and symptoms of cerebellar pathology?

A
  • hypotonia
  • ataxia/coordination problems
  • action/intention tremor
41
Q

True or False

The capacity to generate force in a single muscle does not predict the ability of that muscle to work together with other muscles to perform a specific task

A

True

42
Q

Define dysmetria

A

Problems in judging the distance or range of a movement

43
Q

Define hypometria

A

Underestimation of the required force or range of movement needed for a specific task

44
Q

Define Hypermetria

A

Overestimation of the force of range of movement needed for a specific task

45
Q

Describe an intention tremor

A

A tremor that occurs during the performance of a voluntary movement, and is characterized by pathology of the cerebellum and its afferent and efferent pathways

46
Q

When is an intention tremor most marked?

A

At the end of a movement, when the patient attempts to brake a movement

47
Q

Pathology in the basal ganglia results in one of what 2 things?

A
  • hypokinetic disorders

- hyperkinetic disorders

48
Q

What is the best example of hypokinetic disorder?

A

Parkinson’s Disease

49
Q

What are the 4 characteristics of Parkinson’s Disease?

A
  • bradykinesia, akinesia, hypokinesia
  • rigidity
  • resting tremor
  • postural instability
50
Q

Define bradykinesia

A

The time which is taken to execute a task-specific movement once it has been initiated (movement time) is slow

51
Q

Define Akinesia

A

Reduced ability to initiate movement

52
Q

Define hypokinesia

A

Movements are decreased in amplitude

53
Q

What is the best example of hyperkinetic disorder?

A

Huntington’s Disease

54
Q

Define chorea

A

involuntary, rapid, irregular and jerky movements that result form basal ganglia lesions

55
Q

Define athetoid movements

A

Slow, involuntary, writhing and twisting movements

56
Q

Define dystonia

A

A syndrome dominated by systained muscle contractions, frequently causing twisting and repetitive movements of abnormal postures

57
Q

What are 3 kinds of deficits that result from impairments in the sensory system?

A
  • Somatosensory deficits
  • Visual deficits
  • Vestibular deficits
58
Q

What does a lesion in the dorsal column-medial lemniscal system result in?

A

Loss of discriminative touch, including light touch and kinesthetic sense.

59
Q

What does a lesion in the anterolateral spinothalamic system result in?

A

Loss in pain sensibility and the ability to detect thermal changes, in addition to more coarse touch and kinesthetic discrimination

60
Q

What does a lesion of the somatosensory cortex result in?

A

Loss of discriminative sensations, such as proprioception, two-point discrimination, stereognosis, and touch localization

61
Q

Somatosensory effects are _____ to the side of the lesion

A

contralateral

62
Q

Describe Fess’s hierarchy of sensory functioning from the lowest level to the highest

A
  • Detection
  • Discrimination
  • Quantification
  • Recognition
63
Q

A lesion of the optic nerve results in what?

A

loss of vision in ipsilateral eye

64
Q

A lesion of the optic chiasm results in what?

A

loss of vision in the temporal visual fields from both eyes (bitemporal hemianopsia or tunnel vision)

65
Q

A lesion of the optic tract, temporal lobe, or parietal lobe results in what?

A

loss of vision in contralateral visual fields in both eyes (homonymous hemianopsia)

66
Q

What visual characteristic is critical for functional skills?

A

Depth perception

67
Q

Vestibular afferent information is essential for what 3 things?

A
  • gaze stabilization
  • posture and balance
  • our conscious sense of orientation in space
68
Q

What is the most common cause of vertigo?

A

Benign Paroxysmal Positional Vertigo (BPPV) due to displacement of otoconia into the posterior semicircular canal

69
Q

How are vestibular deficits assessed?

A

via the Dix Hallpike maneuver

70
Q

How are vestibular deficits treated?

A
  • Canalith Repositioning Maneuver

- habituation exercises

71
Q

Damage to which lobe of the brain results in perceptual impairments?

A

the parietal lobes

72
Q

What is perception responsible for?

A

integrating sensory inputs into meaningful information

73
Q

Define body scheme/image

A

The awareness of body parts and their relationship to one anther and the environment

74
Q

Define apraxia

A

The inability to carry out purposeful movement in the presence of intact sensation, movement, and coordination

75
Q

Describe ideomotor apraxia

A

Movement may occur automatically but cannot be performed on command

76
Q

Describe ideational apraxia

A

Purposeful movement is not possible either automatically or on command

77
Q

Describe why patients with primary sensory impairments will have some cognitive/perceptual problem.

A

Because intact sensation is a necessary prerequisite for perception

78
Q

What are 4 strategies for modifying treatment to accommodate patients with cognitive problems

A
  • Reduce confusion: use concise and clear instruction
  • Improve motivation: work on important and relevant tasks
  • Improve problem-solving ability: begin with simple tasks and gradually increase task complexity
  • Encourage declarative and procedural learning

710: Motor Control & Motor Learning (14 decks)

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