DTR, UMN, LMN, tone, spasticity Flashcards
1
Q
S/S LMN
A
Decreased tone Decreased reflex Ipsilateral paresis/paralysis Fasciculations and fibrillation Neurogenic atrophy
2
Q
S/S UMN
A
Hyperreflexia
Hypertonicity
Spasticity
Patterned movements and postures
3
Q
Types of reflexes
A
Deep tendon
Or
Abnormal (only present under pathological conditions)
4
Q
Abnormal reflexes indicate
A
UMN disorder
Absence of abnormal reflexes indicate LMN disorder
5
Q
DTR- biceps
A
C5 (C6)
Biceps tendon at cubital fossa
Elbow flexion
6
Q
DTR- brachioradialis
A
(C5) C6
Tendon proximal to radial styloid
Elbow flexion
7
Q
DTR- triceps
A
(C6) C7
Tendon proximal to olecranon
Elbow extension
8
Q
DTR- quadriceps
A
(L2, L3) L4
Patellar tendon
Knee extension
9
Q
DTR- Achilles
A
S1 (S2)
Tendocalcaneus proximal to calcaneus
Ankle plantar flexion
10
Q
Reflex grading - 0
A
Absent
No visible or palpable response
11
Q
Reflex grading - 1+
A
Diminished
Minimal contraction w/ no movement
12
Q
Reflex grading - 2+
A
Normal
Mild contraction w/ minor joint movement
13
Q
Reflex grading - 3+
A
Brisk
Moderate to strong contraction w/ obvious joint movement
14
Q
Reflex grading - 4+
A
Hyperactive
Very brisk, clonus, document # of beats
15
Q
For disorders where fatigue is an issue, perform reflex testing
A
5-6 times.
16
Q
Reflex testing and UMN
A
Hyperreflexic
17
Q
Reflex testing and LMN
A
Hyporeflexic
18
Q
Other UMN clues
A
Patterned movement
Signs of stiffness
Inability to isolate movement from one joint to other
19
Q
Other LMN clues
A
May appear floppy or weak
20
Q
Plantar/babinski reflex
A
- Sharp object to lateral aspect of sole and ball of foot
- norm: toe flexion and adduction
- ab: extension or falling of toes
- S1-S2
21
Q
Abdominal reflex
A
- sharp object abdomen along dermatome
- norm:abdominal muscle contraction
- ab: absence of contraction
- T7-T12
22
Q
Hoffman’s reflex
A
- hold middle finger flick up
- norm: finger rebounds into flexion
- ab: absence of contraction
- UMN
23
Q
Jaw reflex
A
- mouth slightly open, tap chin
- norm: gentle mouth closure
- ab: rapid Ching closure (UMN) or no motion (LMN)
- brisk: Supra nuc lesion
- absent: LMN pathology along CN V
24
Q
Cremasteric reflex
A
- stroke inner aspect upper thigh
- norm: testicular elevation on same side
- ab: no motion detected
- L1-L2
25
Tone
Slow movement w/ assessment of resistance throughout the ROM
26
Spasticity
High velocity movement w/ assessment of resistance throughout the ROM
27
Excessive tone
Hypertonicity often presents in patterns where isolated movement of each joint is difficult
-movement often occurs in patterns
UMN ONLY
28
UMN synergy pattern - shoulder girdle
Flex: elevation and/or retraction
Ext: depression, protraction
29
UMN synergy pattern - shoulder
Flex: abduction to 90, ER or shoulder ext
Ext: *adduction*, IR
30
UMN synergy pattern - elbow
Flex: *flexion*
Ext: extension
31
UMN synergy pattern - forearm
Flex: supination
Ext: pronation
32
UMN synergy pattern - hip
Flex: *flexion*, abduction, ER
Ext: extension, adduction, IR
33
UMN synergy pattern - knee
Flex: flexion
Ext: *extension*
34
UMN synergy pattern - ankle
Flex: dorsiflexion
Ext: plantarflexion
35
UMN synergy pattern - foot
Flex: inversion
Ext: inversion
36
Severe increased tone and MMT
Cannot do standard MMN
| So you do selective movement exam
37
UE synergy pattern
Flexor synergy tends to predominate
38
LE synergy pattern
Extensor synergy tends to predominate
39
What gait phase affected by LE synergy?
swing phase
| When extensors predominate and have knee ext, ankle PF can’t clear floor
40
Selective movement
Isolated movement at a joint not obligated to any movement pattern
So do MMT
41
Selective w/ pattern overlay
Can move selectively at a joint through at least 50% of range before patterned movement occurs and/or moves selective at a joint except under conditions of high challenge (resistance/against gravity)
*do selective movement exam
42
Deviating from patterned movement
Can initiate selective movement at a joint but then moves into pattern prior to moving through 50% of range
*do selective movement exam
43
Completely patterned movement
Completely in patterned synergy
Opposite end from selective movement
Selective movement exam
44
Modified ashworth - 0
No increase in muscle tone
45
Modified ashworth - 1
Slight increase in muscle tone.
| Catch and release or minimal restiance at end of ROM
46
Modified ashworth - 1+
Slight increase in muscl tone
| Catch, followed by minimal restiance through the remainder of ROM
47
Modified ashworth - 2
More marked increase in muscle tone through most of ROM but affected parts easily moved
48
Modified ashworth - 3
Considerable increase in muscle tone, passive movement difficult
49
Modified ashworth - 4
Affected parts rigid
50
Tone - 4+
Sustained repsonse
| Severe hypertonic
51
Tone - 3+
Exaggerated response
| Mild to moderate hypertonia
52
Tone - 2+
Normal response
53
Tone - 1+
Decreased response
| Hypotonia
54
Tone - 0
No response
| Flaccidity
55
Romberg grade
Normal length of time pt is able to balance without unsteadiness/sway is 30 seconds
56
Stop Romberg if
Subject moves their feet on the floor, changes their arm starting position or opens their eyes if applicable
57
Two conditions for Romberg
Eyes open
Then
Eyes closed
58
Romberg cues
1. Remove shoes and socks
2. Stand w/ feet together and arms folded across chest
3. Look straight ahead at a target about 3 ft in front of you
4. Stand as stable as you can in this position for 30 seconds
59
Sharpened Romberg cues
1. ”Please remove shoes and socks.”
2. “Place one foot directly in front of the other so that your heel touches your toe.”
3. “Cross you arms in front of your chest and maintain this position of 30 seconds.”
4. “Repeat test with your eyes closed."
60
Sharpened Romberg grade/score
Normal length of time that patient is able to balance without unsteadiness or sway is 30 seconds
61
Sharpened Romberg stop if
subject moves their feet on the floor, changes their arm starting position or they open their eyes
62
Sharpened Romberg conditions
Eyes opened and closed
63
FIST grades - 4
Independent: Completes the task independently and successfully
64
FIST grade 3
Verbal cues or increased time: Completes the task independently and successfully; may need verbal / tactile cues or more time
65
FIST grade 2
Upper extremity support: Unable to complete task without using upper extremities for support or assistance
66
FIST grade 1
Needs assistance: Unable to complete task successfully without physical assistance
67
FIST grade 0
Dependent: Requires complete physical assistance to perform task successfully, is unable to complete task successfully with physical assistance, or dependent
68
Functional reach cues
1. "Lift your arm to shoulder height and make a fist."
2. "Keep your feet on the floor and do not touch the wall or the ruler as you reach."
3. "Please reach as far forward as you can without losing your balance."
4. "You will perform the test three times and the average score will be recorded."
69
Functional reach grading
1. Distance reached is measured in inches according to the 3rd metacarpal
2. An average of the last two trials is recorded
3. Test is stopped if patient's feet lift up from the floor or they fall forward and require assistance
70
Functional reach values - unable to reach
8x more likely to fall
71
Functional reach values - reach < 6 inches
4x more likely to fall
72
Functional reach values - reach 6-10 inches
2x more likely to fall
73
Functional reach values - reach <10 inches
Subject unlikely to fall
74
Mutidirection reach cues - forward
Lift your arm to shoulder eight and make a first reach foward as far as you can without moving your feet or taking a step
75
Mutidirection reach cues - backwards
Lift your arm to shoulder height and make a fist. Lean back as far as you can without stepping bac
76
Mutidirection reach cues - lateral
Lift your arm to shoulder height and make a fist. Lean back as far as you can without stepping bac
77
Multi directional reach grade/score
Distance reached is measured in inches according to the end of the index finger
Test is stopped if patient's feet lift up from the floor or they fall forward and require assistance
78
Multidirectional reach values - forward
8.9 in
79
Multidirectional reach values - backwards
4.6 in
80
Multidirectional reach values - right lateral
6.2 in
81
Multidirectional reach values - left lateral
6.6 in
82
DGI norms
Max possible score is 24
Scores of 19 or less, related to increase incidence of falls in elderly
-walk a 20 foot path
83
DGI score 3
Normal - walks 20 ft, no AD, good speed, no evidence of imbalance, normal gait
84
DGI score 2
Mild impairment
| Walks 20 ft, uses AD, slower speed, mild gait deviations
85
DGI score 1
Moderate impairment
| Walks 20 ft, slow speed, ab gait, evidence of imbalance
86
DGI score 0
Sever impairment
| Cannot walk 20 ft w/out assistance, severe gait deviations, imbalances
87
DGI change in gait speed
Normal walking speed for about 5 ft
| Slow after additional 5 ft
88
DGI change in speed 3
Normal
Able to smoothly change walking speed without loss of balance or gait deviations. Shows a significant difference in walking speeds between normal, fast, and slow speeds
89
DGI change in speed 2
Mild impairment
Able to change speed but demonstrates mild gait deviations, or no gait deviations. Unable to achieve a significant change in velocity, or uses assistive device(s)
90
DGI change in gait speed 1
Moderate impairment
Makes only minor adjustments to walking speed, changes speed but has significant gait deviations, or changes speed and loses balance but is able to recover and continue walking
91
DGI change in gait speed 0
Severe impairment
| Cannot change speeds, or loses balance and has to reach for wall or be supported by examiner
92
DGI w/ head turns - 3
Normal
| Performs head turns smoothly with no change in gait
93
DGI w/ head turns 2
Mild impairment
Performs head turns smoothly with slight change in gait velocity (i.e., minor disruption to smooth gait path or uses walking aid)
94
DGI w/ head turns 1
Moderate impairment
| Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk
95
DGI w/ head turns 0
Severe impairment
| Performs task with severe disruptions of gait (i.e., staggers outside path, loses balance, stops, reaches for wall)
96
DGI pivot turn 3
Normal
| Pivot and turns safely within 3 seconds and stops quickly with no loss of balance
97
DGI pivot turn 2
Mild impairment
| Pivot turns safely in >3 seconds and stops with no loss of balance
98
DGI pivot turns 1
Mod impairment
| Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn and stop
99
DGI pivot turns 0
Severe impairment
| Cannot turn safely, requires assistance to turn and stop
100
DGI obstacles 3
Normal
| Able to walk around/step over cones safely without changing gait speed; no evidence of imbalance
101
DGI obstacles 2
Mild impairment
| Able to step around/over both cones, but must slow down and adjust steps to clear cones
102
DGI obstacles 1
Mod impairment
| Able to clear cones but must significantly slow speed to accomplish task, or requires verbal cueing
103
DGI obstacles 0
Severe impairment
| Unable to clear cones, walks into one or both cones or requires physical assistance
