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7209 Movement Disorder > constraints on motor control > Flashcards

constraints on motor control Flashcards

1
Q

Apraxia

A

inability to carry out an intended movement even thought sensation, movement ability, and coordination are all capable of functioning properly

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2
Q

apraxia is considered

A

primary perceptual impairment

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3
Q

apraxia is associated with damage to what side of the brain

A

left

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4
Q

pt. with spatial relation disorders will have difficulty with

A

perceiving relationships b/w
- self w/ other objects
- other objects and self
multiple objects

(position in space)

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5
Q

Body image and body scheme disorders are described as

A

decreased awareness of body parts, their relationship to each other, and the environment

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6
Q

an example of body image/ body scheme disorders is

A

unilateral neglect

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7
Q

unilateral neglect

A

an inability to perceive and respond to stimuli on one side of the body

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8
Q

perception

A

is making sensory information meaningful

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9
Q

what is an example of perception with the body

A

verticality

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10
Q

what is the difference b/w visual vertical and postural vertical

A

postural vertical is somatosensory information determined without visual input

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11
Q

patient with vestibular deficits may have difficulty with

A
  • gaze stabilization
  • posture
  • balance
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12
Q

where can vestibular damage occur

A

in the cortex or the periphery

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13
Q

patients with visual deficits may have difficulty with

A
  • depth perception
  • visual fields
  • acuity
  • oculomotor control
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14
Q

list the locations of somatosensory lesion

A
  • dorsal column/medial lemniscus
  • anterolateral lesion
  • somatosensory cortex lesion
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15
Q

dorsal column/medial lemniscus lesion

A

loss of

  • discriminative touch
  • light touch
  • kinesthesia
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16
Q

anterolateral lesion

A

loss of

  • pain
  • temperature
  • coarse touch
  • kinesthesia
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17
Q

somatosensory cortex lesion

A

loss of

  • proprioception
  • two point discrimination
  • sterognosis
  • touch localization
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18
Q

sterognosis

A

is being able to identify an object based on the perception of its structure

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19
Q

list primary neuromuscular impairments

A
  • paresis

- spasticity

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20
Q

paresis

A

weakness from loss of cortical drive

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21
Q

what is a constraint

A

anything that constrict, restrain, restrict, limit the individual

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22
Q

constraints w/n the individual are known as

A

impairments

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23
Q

Primary Cognitive System Impairments

A
  • arousal/level of consciousness
  • attention
  • orientation
  • memory
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24
Q

how does level of consciousness/arousal correlate to movement

A
  • must be alert enough to respond to environmental stimuli
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25
Q

how does attention correlate to movement

A
  • inability to focus on task affects motor learning
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26
Q

selective attention

A

ones ability to attend to something w/o becoming distracted

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27
Q

orientation impairments can be described as

A

lack of situational awareness

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28
Q

what do most people lose orientation to ?

A

place and time

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29
Q

memory impairments

A

decreased ability to process, store, and retrieve info

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30
Q

what should you do when treating patients with a decreased response time

A

slow down, lots of pauses, and give them time to process what you are saying

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31
Q

Primary Neuromuscular impairments affecting the motor system

A
  • mm weakness
  • coordination problems
  • involuntary movements
  • abnormalities of mm tone
  • abnormal synergies
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32
Q

synergy

A

pattern of movement

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33
Q

mm weakness

A

inability to generate adequate level of force

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34
Q

paralysis/plegia

A

total/severe loss of mm activity

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35
Q

primary mm weakness is a result of

A

lesions in descending motor paths –> inability to recruit and or modulate motor neurons

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36
Q

Neural aspects of force production

A
  • # of motor units recruited
  • type of motor unis recruited
  • frequency of discharge
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37
Q

musculoskeletal aspects of force production

A

prolonged paresis or disuse can cause secondary changes to muscle tissue such as atrophy

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38
Q

describe the difference b/w weakness in UMN lesion and weakness in ortho patients

A

in a neuro pt. the capacity to generate force in an isolated mm does not predict the mm ability to work with other mm like it does for ortho pt.

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39
Q

describe an example of positioning affecting mm

A

STNR (head and arms go together, lower body does the opposite

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40
Q

in neuro pt. weakness may be

A

in the delivery or lack of delivery to the mm not in the mm directly

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41
Q

why is MMT not the best test for neuro pt.

A

b/c MMT test mm ability to function in isolation

- neuro pt. are unable to isolate the mm

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42
Q

how does change in body positon influence change in reflex, tone, and synergies in an abnormal pt.

A

a pt. may have anti-gravity movement in one position but not in the other.

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43
Q

tone vs. synergy

A
  • tone is observed in a resting state

- synergy is observed during movement

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44
Q

coordination impairment is a classic disorder involving what brain structures

A
  • Basal ganglia

- cerebellum

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45
Q

coordination

A

sequencing, timing, grading of activation of multiple mm groups

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46
Q

incoordination

A

movements that are awkward, uneven, or inaccurate

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47
Q

incoordination is associated with lesions in the

A
  • motor cortex
  • basal ganglia
  • cerebellum
  • proprioceptive system
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48
Q

incoordination is influenced by

A

peripheral factors (change in mm, tendons, fatigue)

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49
Q

automatic postural reactions of the LE for normal sequencing

A

ankle –> knees–> hip –> trunk

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50
Q

co activation causes the body to become

A

rigid

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51
Q

sequencing problems include

A
  • activation of mm/ groups in wrong sequence
  • activation of mm/groups inappropriate for the action
  • co-activation
  • impaired inter-joint coordination
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52
Q

impaired inter- joint coordination

A

movement decomposition or movement at one joint at a time

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53
Q

inter joint coordination impairments is associated with damage to what part of the brain

A

cerebellum

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54
Q

timing problems

A

problems initiating movement

  • increase reaction time
  • delayed movement time
55
Q

timing problems can occur in what kinds of pt.

A
  • CVA
  • TBI
  • PD
56
Q

timing problems may be a result of

A
  • inadequate force generation (weakness)
  • decreased rate of force generation (power)
  • cognitive factors
  • altered sensory input/perception

decreased

  • ROM
  • motivation
  • postural control
57
Q

slowed movement time may be seen in pt. with

A
  • CVA
  • PD
  • CP
  • cerebellar damage
58
Q

problems terminating a movement is seen in pt. with

A

cerebellar lesions

59
Q

problems terminating movement may be due to

A
  • inability to stop mm contraction/ control force production
  • cognition
  • sensory deficit
  • poor posture
  • pt. with preservation problems
60
Q

dysmetria

A

inability to scale force, problem judging distance or range

61
Q

dysmetria is a classic _____ impairment

A

cerebellar

62
Q

hypometria is seen with

A

BG lesions- PD

63
Q

hypermetria is seen with

A

cerebellar lesions

64
Q

dysarthria

A

motor disorder of speech production

65
Q

intention tremor is seen with

A

CB damage

66
Q

resting tremor is seen with

A

PD pt.

67
Q

check reflex

A

they can not terminate the motion

68
Q

rebound phenomenon see in

A

cerebellar pt.

69
Q

dysdiadochokinesia

A

difficulty with RAM - rapidly alternating movement

70
Q

dystonia

A

involuntary, sustained mm contractions; twisting and repetitive movements, and abnormal postures

71
Q

dystonia is associated with

A

BG disease progression

- high dosage of antiparkinsonian medication

72
Q

associated movement

A

unintentional movement of one limb during voluntary movement of another

73
Q

tremor

A

rhythmical, involuntary oscillatory movement of a body part

74
Q

choreiform movement

A

involuntary, abrupt, rapid, irregular, jerky movement

75
Q

choreiform movement is associated with

A

huntingtons - BG lesions

76
Q

athetoid movement

A

slow, involuntary writhing and twisting

77
Q

is spasticity and tone the same thing?

A

it is not the same thing but they co occur in pt. with UMN, cortical lesions of the corticospinal tract

78
Q

spasticity in short

A

hyper-reflexia

79
Q

spasticity

A

is velocity dependent stretch reflexes

80
Q

spasticity is a result of

A

hyper excitability of tonic stretch reflexes

81
Q

disinhibiton of spinal reflex

A

loss of cortical drive or direct damage to

  • dorsal reticulo
  • rebro
  • vestibule

…spinal tracts

82
Q

damage to the cortico-reticular fibers after supra-tentorial lesion produces

A

spasticity

83
Q

what do mm spindles tell us

A

how much stretch the mm is experiencing

84
Q

damage to corticospinal tract causes

A

flexor withdrawal reflex

85
Q

what is the compensation for decreased cortical drive

A

increase in stretch reflex gain so a small drive signal produces a larger mm response

86
Q

when is spasticity seen

A

it is not seen immediately after cortical lesion, develops over several weeks after neural damage

87
Q

spasticity is seen to be

A

a sign of neuro plasticity of the brain adapting to a loss of descending control

88
Q

what are the effects of spasticity on motor control

A
  • loss of reciprocal inhibition
  • increased sensitivity of motor neurons
  • increased post action potential depression
89
Q

How are stretch reflexes tested (spasticity)

A
  • passive

- examiner provides a quick stretch stimulus

90
Q

how does spasticity affect volitional movement

A

if a pt. moves too quickly, they can unintentionally trigger the antagonist inducing spasticity

91
Q

what is an example of spasticity affecting volitional movement

A

rapid weight loading on a spastic ankle can cause clonus

92
Q

how can patients with spasticity affecting their volitional movement counteract this

A

move slower

93
Q

what is the problem with anti-spasticity medication

A

they are not selective

  • inters w/ agonist and antagonist ability to contract
  • reduce motor learning
94
Q

what patients can benefit from anti-spasticity medication

A
  • pt. whose function is severely restricted

- pt. whom increasing strength/motor learning is not a primary goal

95
Q

abnormal tone (hypertonia)

A

tonic ongoing contraction of mm or mm groups at REST

- motor over-activity

96
Q

what is the difference b/w hypertonia and spasticity

A

hypertonia has nothing do with velocity (doesn’t require any mm stretch)

97
Q

what causes hypertonia

A

damage to corticospinal tract and damage/decreased cortical drive to BG

98
Q

hypertonia is sensitive to

A

mm stretch and length

99
Q

how can you temporarily decrease hypertonia

A

sustained stretch, prolonged lengthening

100
Q

how does prolonged stretch decrease tone

A

sustained stretch is inhibitory action

101
Q

flaccidity

A

too little tone at rest

102
Q

how does tone fluctuate

A
  • position of limb and body
  • effort, pain
  • temperature
  • stress
103
Q

how is tone tested

A
  • limb is passive

- examiner provides a slow stimulus

104
Q

what are we looking for when we test for tone

A

resistance to slow, even passive movement

105
Q

how does tone affect volitional movement

A
  • easier for pt. to move mm concentrically, difficulty w/ eccentric movement or relaxation
  • difficult to move in opposite direction of hypertonic mm
106
Q

why is it difficult to move in the opposite direction of hypertonic movement

A
  • failure of reciprocal inhibition

- tonic drive to antagonist may exceed drive to agonist

107
Q

for a pt. with high tone which mm contraction is easier

A

concentric mm contraction

108
Q

what happens if you can reduce the effort need in a pt. with high tone

A

pt can perform the motion little better but may still compensate

109
Q

abnormal synergies

A

characterized by mass movement and inability to isolate or fractionate joint motion from one another

110
Q

abnormal synergies are common in

A

patients with UMN lesion

111
Q

what causes abnormal synergies

A

abnormal co-activation of all mm in a normal synergistic group

112
Q

how are abnormal synergies tested

A
  • limb is ACTIVE
    examiner request pt. do volitionally move the limb – in a synergy
  • out of synergy
113
Q

associated reactions

A

involuntary motion in one part of the body with volitional movement of another part of the body

114
Q

associated reaction is AKA

A

overflow phenomenon

115
Q

can associated reactions occur bilaterally?

A

yes

  • if hemiplegic, movement is abnormally synergistic
116
Q

how do we test for associated reactions

A

observation

  • request effortful, resisted movement on the non-hemiplegic side
  • works with if pt. attention is elsewhere
117
Q

rigidity occurs at what level

A

the level of basal ganglia

118
Q

normal tone

A

readiness to move

119
Q

describe the order of the tone figure

A

flaccidity > hypotonia> normal> hypertonia

120
Q

hypertonicity on the tone scale

A

increased resistance to passive movement

121
Q

hypertonicity is seen

A

later during recovery in Stroke, TBI pt.

122
Q

hypotonia on the tone scale

A

decreased resistance to passive movment

123
Q

hypotonia is seen in what kinds of pt.

A
  • down syndrome

- spinocerebellar lesions

124
Q

hypotonia is seen

A

earlier during recovery in stroke, TBI pt.

125
Q

flaccidity on the tone scale

A

complete loss of tone, no resistance to movement

126
Q

flaccidity is seen in what kind of pt.

A
  • neural shock

- peripheral n. injury

127
Q

flaccidity is seen

A

in the acute phase of pt. with stroke, TBI

128
Q

what is a DTR

A

quick stretch of mm spindle

129
Q

describe the order of the hyper-reflexia figure

A

absent > hypo-reflexia > normal > hyper reflexia (true spasticity)

130
Q

describe the order of the abnormal synergies figure (brunnstromm)

A

no voluntary motion > volitional movement weak w/ incomplete synergies > synergistic movement only, full synergies possible > some out of synergy motion possible > independence from synergies> normal

131
Q

task demands

A
  • stability
  • transitions
  • mobility
  • manipulation
  • concurrent tasks (divided attention)
132
Q

environment demands

A
  • surface
  • visual
  • closed/open
  • predictable/variable
  • stationary/in motion
  • distractions
133
Q

the difficulty of an activity depends on what

A
  • individual abilities and constraints
  • demands of task
  • the support or challenge provided by the environment

7209 Movement Disorder (3 decks)

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