Chp 8 Neuro Flashcards
Specificity vs sensitivity
Validity vs. Realiabilitty
Validity, test accuractely measures the paramter of performance being examined (concurrent, predictive, prescriptive)
Reliability, consistency in results of single examiner over repeated trials or mutli raters
Sensitivity, time a method of analysis correctly identifies true abnormailites
Specificity, time a method of analysis correctly identifiesa an abnormmality as being
Key elements of a motor function examination (LOAMH)
Level of consciousness
Full, lethargy, obtundation, stupor, coma (Glasgow Coma Scale: eye opening, best motor response, verbal 3-15 (8).
Orientation
Time, place, person
Attention
Selective attention, sustained, alternating, divided dual
Memory
Declarative (explicit memory of facts/events), Procedural (implicit memory of motor info, schema)
Immediate, Short term, Long term
Higher cognitive functions
Things to check when checking bodily response levels this section includes vitals.
Arousal Hyperalertness HR BP RR Blow flow to muscles Digestive functions Glucose mobilized Dilated pupils Sweaty
Things you test when testing sensory just think what you senses are
Sensory integrity and integration Visual Vestibular Proprioceptive Tactile
Somatosenation (skin and musculoskeletal info)
Closed loop——————-open loop processing system
What the physical therapist usally checks ?????? think like MMT etc
Joint integrity, postural alignment and mobility
ROM
Soft tissue flexibility
what is TONE defined as
Tone (postural tone)
Is defined as the resistance of muscle to passive elongation when at rest
Degree of residual contraction
Due to physical inertia, intrinsic stiffness, tonic stretch reflexes
What is abnormal tone and what is it usally caused by and where in the body is typically affected
Spasticity, hypertonic motor disorder characterized by velocity dependent resistance to passive stretch
Clasp knife response, sudden letting go
Arises from injury to corticospinal pathways (pyramidal tracts) as part of an UMN syndrome
Clonus, spasmodic alterations resulting from stretch
Babinski sign
what is the dystonia caused by similar to abnormal tone but affected in a different region
Dystonia, hyperkinetic movement disorder
Disordered tone and involuntary movements of large portions of the body
Movement are similar to athetoid movements with twisting/writhing movements
CNS lesions basal ganglia, neurodegenerative disorders
Decerebreate vs decoriate vs Opisthotonus,
Decorticate and decerebrate rigidity,
Decorticate, abnormal flexor response with UE flexed, LE extended
Decerebrate, abnormal extensor response trunk and limbs in full extension
Opisthotonus, extension of neck and trunk muscles
So how do we examine tone?
Observation of resting posture and palpation
Passive motion testing
Active motion testing
What influences tone?
Volitional effort Stress Interaction of tonic reflexes Medications General health Environmental temp State of CNS ie arousal/alertness
Whats the ashworth grading scale grades for Tone it goes 0-4
0 no response 1+ hypotonia 2+ normal 3+ exaggerated 4+ sustained response
Look at spastic hypertonia using
“Modified Ashworth Scale” Table 8.2 p236
Pendulum test (seated or lying drop test leg)
Whats muscle performance, strength, Power
Muscle performance (capacity to generate forces)
Strength, “measureable force exerted by a muscle to overcome a resistance to one max effort”
Power, “work produced per unit of time or the product of strength and speed”
So what do we see in neuro patients?
Didn’t bother adding the atrophy slides but what are the MMT grades like 1,2.3,4,5 explain each one
, no contraction 1, trace no motion 2, poor gravity minimized position BUT full ROM 3, fair full ROM against gravity 4, good break test at end range 5, normal cannot be broken
How do we test endurance and fatigue
Muscle endurance, “ability to sustain forces repeatedly or to generate forces over a period of time”
Fatigue, “failure to generate the required or expected force during sustained or repeated contractions”
Visual analog, Borg Scale for ratings of perceived exertion, Modified fatigue impact scale (ch 19 AB)
What does Dr. Zipp define as vounlantary muscle contractions
Decrease degrees of freedom
Develop functionally linked synergies that are spatially/ temporally organized
So what makes synergies abnormal?
Abnormal mass synergies- obligatory, highly stereotyped mass patterns
Selective isolated joint movements become disorded
Look at table 8.7
table 8,7 pg 246
Nature of task (table 13.2) pg 481 what 4 categories does it cover?
Mobility
Static postural control, stability
Dynamic postural control, controlled mobility
Skill, adaptability to closed motor skills (environments), open motor skills, dual tasks
What things do we look for in postural control
Stability that COG is in between BOS Orientation, control for relative positions of body parts by skeletal muscles Balance, COM is within BOS Anticipatory postural control Adaptive postural control
Sensory afferents——————motor effectors
CNS
What things affect stability
Cone of stability AP 12%, ML 16% (4 in)
Height and foot length influence AP
Distance between feet and height for ML
Steadiness
Postural sway
Sway envelope
COF vs COP
COF, uses vertical forces
COP, uses vertical and horizontal shear forces
How do we stay upright yes we use our visual field. What two types of visual fields do we have?
Focal vs. Ambient
Sensory Organization
Visual proprioception
Focal vision/acuity-cognitive/explicit vision)
Ambient vision- sensorimotor/implicit vision)
CNS testing tell me two test PT’s use
Nashner, “Clinical Test for Sensory Interaction in Balance”
Examines body sway during quiet standing under 6 sensory conditions
Six enviormental conditions in which we test balance
Condition 1- eyes open, stable surface (baseline reference)
Condition 2- eyes closed, stable surface
Condition 3- visual conflict with moving environment, but stable surface
Condition 4- eyes open, moving surface
Condition 5- eyes closed, moving surface
Condition 6- visual conflict with moving environment, but moving platform
Motor Strategies for correcting balance perturbations
Figure 8.3 p 253
Ankle strategy- sway with activation of opposite muscle groups
Hip strategy- sway with activation of same side muscle groups
Stepping strategy- realigns the BOS under the COM
Look and see if present, delayed, inappropriate, abnormal, absent
Dynamic posturography “Movement Coordination Test” by Nasher
Motor Strategies for correcting balance perturbations
Figure 8.3 p 253
Ankle strategy- sway with activation of opposite muscle groups
Hip strategy- sway with activation of same side muscle groups
Stepping strategy- realigns the BOS under the COM
Look and see if present, delayed, inappropriate, abnormal, absent
Dynamic posturography “Movement Coordination Test” by Nasher
Functional Balance Tests
Focus on static balance, dynamic balance, functional mobility
Table 8.9 p 254
Evidence Box 8.2 p 255 group activity
