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Neuromuscular Rehabilitation > Clinical Implications of Movement Disorders > Flashcards

Clinical Implications of Movement Disorders Flashcards

1
Q

What does distribution refer to?

A

Where in the body you see impairments

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2
Q

What does degree/severity refer to?

A

How significant the impairments are and how they impact function

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3
Q

What are the types/stages of movement?

A

Initiation, sustaining, terminating movement

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4
Q

What is quadriplegia/tetraplegia?

A

Whole body is involved in varying degrees

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5
Q

What is diplegia?

A

Whole body distribution, but LEs are more impacted than UEs

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6
Q

What is hemiplegia?

A

One side of the body is involved (1/2 of face, UE, and LE)

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7
Q

What is monoplegia?

A

One extremity is involved

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8
Q

What is paraplegia?

A

Involvement of the trunk and LEs to varying degrees

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9
Q

How does paresis differ from plegia?

A

Paresis is less severe and refers to slight weakness, but the words are often used interchangeably

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10
Q

How do you qualify the degree/severity of tone?

A

Narrative descriptors of mild, moderate, and severe

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11
Q

How do you quantify the degree/severity of tone?

A
  • Modified Ashworth Scale
  • Modified Tardieu Scale
  • Wilson-Howle Assessment of Motor Tone
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12
Q

What structures are/may be involved when a patient presents with spasticity?

A
  • Motor cortex
  • White matter projections between corticosensorimotor areas of the brain
  • Pyramidal system
  • Corticospinal tracts
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13
Q

What are some hallmarks of spasticity?

A
  • Hypertonicity
  • Increased tension when lengthened
  • Muscle is firm upon palpation
  • Increased DTR
  • Clonus
  • Increase in tone with increased velocity and position change
  • Atypical firm end-feel
  • Increased co-contraction/decreased reciprocal inhibition
  • Presence of primitive reflexes
  • Disuse atrophy
  • Distribution asymmetrical
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14
Q

What determines the severity of spasticity?

A

General health, excitability, strength of stimulus, and amount of neural damage

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15
Q

What structure is involved when a patient present with rigidity?

A

Basal ganglia

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16
Q

What are some hallmarks of rigidity?

A
  • Continuous or intermittent hypertonicity
  • Sustained muscle contraction
  • Increased tension upon lengthening
  • Firm upon palpation
  • No change in tone with changes in velocity or position
  • Atypical firm end-feel
  • Symmetrical distribution
  • Increased co-contraction/decreased reciprocal inhibition
  • Disuse atrophy
  • Lead-pipe rigidity throughout ROM
17
Q

What is akinesia?

A

Type of rigidity that results in no movement of affected limb

18
Q

What is hypokinesia?

A

Type of rigidity that results in less movement or smaller movements

19
Q

What is bradykinesia?

A

Type of rigidity that results in slow movements

20
Q

What is decorticate posture?

A
  • Movement characteristic of rigidity
  • Involvement of cortex
  • UEs are flexed, LEs are extended
21
Q

What is decerebrate posture?

A
  • Movement characteristic of rigidity
  • Involvement of cortex and midbrain
  • UEs extended, LEs extended
22
Q

What is opisthotonic posture?

A
  • Movement characteristic of rigidity
  • Involvement of cortex, midbrain, and brainstem
  • Extreme extension positioning
23
Q

What are some hallmarks of hypotonicity/atonia?

A
  • Decreased tone of muscle groups
  • Decreased tension when lengthened
  • Soft upon palpation
  • Decreased DTR/MSR and potential changes with rate/velocity of movement and position
  • Hypermobility at elbows and knees
  • Symmetrical presentation (sometimes asymmetrical)
  • Decreased co-contraction and reciprocal inhibition
  • Atrophy, weakness, and decreased endurance
24
Q

Which structures are involved/damaged in a patient who presents with hypotonicity?

A
  • UMN system
  • Cerebellum
  • Unknown sites

(Seen in conditions such as Fragile X Syndrome, Prader-Willi Syndrome, Down Syndrome, Cri Du Cath Syndrome)

25
Q

What observations help you to determine that a child has hypotonicity?

A
  • Sinking into support surface
  • Wide BOS
  • Unable to maintain head in midline
  • Absence of physiological flexion (in babies)
26
Q

What are some hallmarks of dystonia?

A
  • Fluctuating tone that increases to a level that is severe and sustained (gets stuck in positions for hours at a time involving mostly large axial muscles)
  • Increased tension upon lengthening
  • Firm upon palpation
  • Increased DTR/MSR
  • Decreased PROM with firm end-feel
  • May be mixed with athetosis
27
Q

Which structures are involved/damaged in a patient who presents with dystonia?

A

Basal ganglia

(Seen in conditions such as Cerebral Palsy, Torsion Dystonia, Dystonia Musculorum Deformans)

28
Q

What are some hallmarks of athetosis?

A
  • Fluctuating/changeable/unfixed muscle tone (varies from high tone to low tone)
  • Characterized by slow writhing movements
  • Asymmetrical distribution
  • Decreased co-contraction, increased reciprocal inhibition
  • Primitive reflexes present
  • Decreased strength
  • Function at end-range, difficulty maintaining midrange
29
Q

Which structures are involved/damaged in a patient who presents with athetosis?

A
  • Basal ganglia
  • Extrapyramidal system

(Seen in conditions such as Cerebral Palsy, Lesch-Nyhan Syndrome)

30
Q

True or False
When a patient presents with athetosis, it is usually a pure presentation

A

False
Athetosis is not usually pure can present in many ways: non-tension athetoid, dystonic athetoid, choreoathetoid, tension athetoid)

31
Q

What are some hallmarks of chorea?

A
  • Decreased and fluctuating muscle tone
  • “Dance” of involuntary jerky/rapid movements that are simple or complex
  • Variable distribution
  • Will use fixation to gain stability
  • May be seen alongside other presentations
32
Q

Which structures are involved/damaged in a patient who presents with chorea?

A

Basal ganglia

(Seen in conditions such as Cerebral Palsy, Huntington Chorea, Syndenham Chorea)

33
Q

What are some hallmarks of ataxia?

A
  • Low postural tone (slightly below average)
  • Abnormalities of volitional movement (dyssynergia, asynergia, decompensation, dysmetria, dysdiadochokinesis, intention tremor, titubation)
  • Hypermobility
  • May have primitive reflexes
  • Somatosensory concerns
34
Q

Which structures are involved/damaged in a patient who presents with ataxia?

A

Cerebellum
Sensory Tracts

(Seen in conditions such as Cerebral Palsy, Friedreich’s Ataxia, Ataxia Telangectasia, Angelman’s)

35
Q

What are some hallmarks of apraxia?

A
  • Impairment of voluntary, learned movement that is not caused by a cognitive impairment or motor diagnosis
  • Challenges with sequencing and timing
  • Mild hypotonicity
35
Q

Which structures are involved/damaged in a patient who presents with apraxia?

A

Cerebellum
Other CNS structures

(Seen in conditions such as Developmental Coordination Disorder)

Neuromuscular Rehabilitation (12 decks)

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