CVA Impairments 1: motor based Flashcards
Mild ipsilateral weakness can be seen post-CVA and is most notably observed in ________________
proximal muscles
Common patterns of weakness between muscle pairs:
Ext > flex (EXCEPT: DF > PF)
ER > IR
ABD > ADD
Evertors > Inverters
Motor control
the underlying substrates of neural, physical, and behavioral aspects of movement
Reactive (feedback) and proactive (feedforward) movement is associated with
motor control
Motor Plan
an idea or plan for purposeful movement that is made up of component motor programs.
Motor program
An abstract representation that when initiated results in the production of a coordinated movement sequence.
Motor learning
A set of internal processes associated with feedback or practice leading to relatively permanent changes in the capability for motor skills.
Motor Recovery
the reappearance of motor patterns present prior to CNS injury performed in the same manner as prior to injury
Motor compensation
The appearance of new motor patterns resulting from changes in CNS
Adaptation and substitution are associated with
motor compensation
Common impairments of motor control
Abnormal synergies and apraxia
UE flexion synergy
- Scapular retraction/elevation or hyperextension
- Shoulder ABD, ER
- Elbow FLEX*
- Forearm supination
- Wrist finger flexion
LE Flexion synergy
- Hip flexion*, abd, ER
- Knee flex
- Ankle DF, Inversion
- Toe DF
UE Extension Synergy
- Scapular protraction
- Shoulder ADD*, IR
- Elbow EXT
- Forearm pronation
- Wrist and finger FLEX
LE Extension Synergy
- Hip EXT, ADD*, IR
- Knee EXT
- Ankle PF*, Inversion
- Toe PF
Apraxia
Inability to plan and execute purposeful movements that cannot be accounted for by any other reason.
Ideomotor Apraxia
Inability to produce movement on command but able to move automatically, conceptualization of task remains intact.
Ideational apraxia
inability to produce movement on command or automatically, complete breakdown of conceptualization of task
Stage 1 of Motor Recovery
period of flaccidity immediately following acute episode.
Stage 2 of Motor Recovery
- limb synergies/components may appear
- minimal voluntary movement
- spasticity begins
Stage 3 of Motor Recovery
- Voluntary control of movement synergies
- Increase spasticity (may become severe)
Stage 4 of Motor Recovery
- Movement combos that do not allow the paths of synergy are mastered (difficult > ease)
- Spasticity begins to decline
Stage 5 of Motor Recovery
- More difficult movement combos are learned
- Synergies start to lose their dominance over motor acts.
Stage 6 of Motor Recovery
- Disappearance of spasticity
- Individual joint movements become possible and coordination approaches normal
What four factors have a significant influence in a patient’s progression through the stages of motor recovery
- Initial weakness
- Presence of spasticity
- Cognitive deficits
- Access to rehab
Why is MMT not the best option to evaluate with a post-CVA patient?
MMT requires selective capacity (ability to isolate a single joint movement)
The MDC for UE and LE of the Fugl-Meyer Assessment is
UE 5.4 points
LE 5 points
The MCID for the Fugl-Meyer Assessment for UE/LE is:
10 points for both
The MCID of the Rivermead Motor Assessment is
3 points
If unable to complete graded exercise testing what is the recommended exercise intensity and modifications to compensate for intensity.
Light to moderate exercise is recommended w/increased frequency and duration
Dysynergia
fragmented movement patterns (movements occur in sequence of component parts rather than a single and coordinated smooth output)
Asynergia
loss of ability to associate muscles together for complex movements
Ataxia
uncoordinated movements that manifest when voluntary movements are attempted
Classification of ataxia:
Cause or Location (limb, truncal, gait)
What is tone
muscle’s resistance to passive stretch
Describe the progression of tone abnormalities with an UMN injury
temporary hypotonia (Acute) > development of spasticity (subacute/chronic)
Common UE areas of spasticity
Scapula retractors, downward rotators
Shoulder IR, adductors
Elbow flexors
Forearm pronators
Wrist/hand flexors, finger adductors
Common LE areas of spasticity
Hip adductors, IR, extensors
Knee flexors
Ankle/foot PF, inverters, toe flexors
Primitive and tonic reflexes can return in patients with
extensive brain damage
