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NeuroRehab > DTR, UMN, LMN, tone, spasticity > Flashcards

DTR, UMN, LMN, tone, spasticity Flashcards

1
Q

S/S LMN

A 
Decreased tone
Decreased reflex
Ipsilateral paresis/paralysis
Fasciculations and fibrillation
Neurogenic atrophy
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2
Q

S/S UMN

A

Hyperreflexia
Hypertonicity
Spasticity
Patterned movements and postures

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3
Q

Types of reflexes

A

Deep tendon
Or
Abnormal (only present under pathological conditions)

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4
Q

Abnormal reflexes indicate

A

UMN disorder

Absence of abnormal reflexes indicate LMN disorder

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5
Q

DTR- biceps

A

C5 (C6)
Biceps tendon at cubital fossa
Elbow flexion

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6
Q

DTR- brachioradialis

A

(C5) C6
Tendon proximal to radial styloid
Elbow flexion

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7
Q

DTR- triceps

A

(C6) C7
Tendon proximal to olecranon
Elbow extension

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8
Q

DTR- quadriceps

A

(L2, L3) L4
Patellar tendon
Knee extension

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9
Q

DTR- Achilles

A

S1 (S2)
Tendocalcaneus proximal to calcaneus
Ankle plantar flexion

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10
Q

Reflex grading - 0

A

Absent

No visible or palpable response

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11
Q

Reflex grading - 1+

A

Diminished

Minimal contraction w/ no movement

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12
Q

Reflex grading - 2+

A

Normal

Mild contraction w/ minor joint movement

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13
Q

Reflex grading - 3+

A

Brisk

Moderate to strong contraction w/ obvious joint movement

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14
Q

Reflex grading - 4+

A

Hyperactive

Very brisk, clonus, document # of beats

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15
Q

For disorders where fatigue is an issue, perform reflex testing

A

5-6 times.

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16
Q

Reflex testing and UMN

A

Hyperreflexic

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17
Q

Reflex testing and LMN

A

Hyporeflexic

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18
Q

Other UMN clues

A

Patterned movement
Signs of stiffness
Inability to isolate movement from one joint to other

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19
Q

Other LMN clues

A

May appear floppy or weak

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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
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21
Q

Abdominal reflex

A
  • sharp object abdomen along dermatome
  • norm:abdominal muscle contraction
  • ab: absence of contraction
  • T7-T12
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22
Q

Hoffman’s reflex

A
  • hold middle finger flick up
  • norm: finger rebounds into flexion
  • ab: absence of contraction
  • UMN
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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
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24
Q

Cremasteric reflex

A
  • stroke inner aspect upper thigh
  • norm: testicular elevation on same side
  • ab: no motion detected
  • L1-L2
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25
Q

Tone

A

Slow movement w/ assessment of resistance throughout the ROM

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26
Q

Spasticity

A

High velocity movement w/ assessment of resistance throughout the ROM

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27
Q

Excessive tone

A

Hypertonicity often presents in patterns where isolated movement of each joint is difficult
-movement often occurs in patterns

UMN ONLY

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28
Q

UMN synergy pattern - shoulder girdle

A

Flex: elevation and/or retraction

Ext: depression, protraction

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29
Q

UMN synergy pattern - shoulder

A

Flex: abduction to 90, ER or shoulder ext

Ext: adduction, IR

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30
Q

UMN synergy pattern - elbow

A

Flex: flexion
Ext: extension

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31
Q

UMN synergy pattern - forearm

A

Flex: supination
Ext: pronation

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32
Q

UMN synergy pattern - hip

A

Flex: flexion, abduction, ER

Ext: extension, adduction, IR

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33
Q

UMN synergy pattern - knee

A

Flex: flexion
Ext: extension

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34
Q

UMN synergy pattern - ankle

A

Flex: dorsiflexion

Ext: plantarflexion

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35
Q

UMN synergy pattern - foot

A

Flex: inversion

Ext: inversion

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36
Q

Severe increased tone and MMT

A

Cannot do standard MMN

So you do selective movement exam

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37
Q

UE synergy pattern

A

Flexor synergy tends to predominate

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38
Q

LE synergy pattern

A

Extensor synergy tends to predominate

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39
Q

What gait phase affected by LE synergy?

A

swing phase

When extensors predominate and have knee ext, ankle PF can’t clear floor

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40
Q

Selective movement

A

Isolated movement at a joint not obligated to any movement pattern
So do MMT

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41
Q

Selective w/ pattern overlay

A

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

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42
Q

Deviating from patterned movement

A

Can initiate selective movement at a joint but then moves into pattern prior to moving through 50% of range
*do selective movement exam

43
Q

Completely patterned movement

A

Completely in patterned synergy
Opposite end from selective movement
Selective movement exam

44
Q

Modified ashworth - 0

A

No increase in muscle tone

45
Q

Modified ashworth - 1

A

Slight increase in muscle tone.

Catch and release or minimal restiance at end of ROM

46
Q

Modified ashworth - 1+

A

Slight increase in muscl tone

Catch, followed by minimal restiance through the remainder of ROM

47
Q

Modified ashworth - 2

A

More marked increase in muscle tone through most of ROM but affected parts easily moved

48
Q

Modified ashworth - 3

A

Considerable increase in muscle tone, passive movement difficult

49
Q

Modified ashworth - 4

A

Affected parts rigid

50
Q

Tone - 4+

A

Sustained repsonse

Severe hypertonic

51
Q

Tone - 3+

A

Exaggerated response

Mild to moderate hypertonia

52
Q

Tone - 2+

A

Normal response

53
Q

Tone - 1+

A

Decreased response

Hypotonia

54
Q

Tone - 0

A

No response

Flaccidity

55
Q

Romberg grade

A

Normal length of time pt is able to balance without unsteadiness/sway is 30 seconds

56
Q

Stop Romberg if

A

Subject moves their feet on the floor, changes their arm starting position or opens their eyes if applicable

57
Q

Two conditions for Romberg

A

Eyes open
Then
Eyes closed

58
Q

Romberg cues

A
  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
Q

Sharpened Romberg cues

A
  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
Q

Sharpened Romberg grade/score

A

Normal length of time that patient is able to balance without unsteadiness or sway is 30 seconds

61
Q

Sharpened Romberg stop if

A

subject moves their feet on the floor, changes their arm starting position or they open their eyes

62
Q

Sharpened Romberg conditions

A

Eyes opened and closed

63
Q

FIST grades - 4

A

Independent: Completes the task independently and successfully

64
Q

FIST grade 3

A

Verbal cues or increased time: Completes the task independently and successfully; may need verbal / tactile cues or more time

65
Q

FIST grade 2

A

Upper extremity support: Unable to complete task without using upper extremities for support or assistance

66
Q

FIST grade 1

A

Needs assistance: Unable to complete task successfully without physical assistance

67
Q

FIST grade 0

A

Dependent: Requires complete physical assistance to perform task successfully, is unable to complete task successfully with physical assistance, or dependent

68
Q

Functional reach cues

A
  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
Q

Functional reach grading

A
  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
Q

Functional reach values - unable to reach

A

8x more likely to fall

71
Q

Functional reach values - reach < 6 inches

A

4x more likely to fall

72
Q

Functional reach values - reach 6-10 inches

A

2x more likely to fall

73
Q

Functional reach values - reach <10 inches

A

Subject unlikely to fall

74
Q

Mutidirection reach cues - forward

A

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
Q

Mutidirection reach cues - backwards

A

Lift your arm to shoulder height and make a fist. Lean back as far as you can without stepping bac

76
Q

Mutidirection reach cues - lateral

A

Lift your arm to shoulder height and make a fist. Lean back as far as you can without stepping bac

77
Q

Multi directional reach grade/score

A

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
Q

Multidirectional reach values - forward

A

8.9 in

79
Q

Multidirectional reach values - backwards

A

4.6 in

80
Q

Multidirectional reach values - right lateral

A

6.2 in

81
Q

Multidirectional reach values - left lateral

A

6.6 in

82
Q

DGI norms

A

Max possible score is 24
Scores of 19 or less, related to increase incidence of falls in elderly

-walk a 20 foot path

83
Q

DGI score 3

A

Normal - walks 20 ft, no AD, good speed, no evidence of imbalance, normal gait

84
Q

DGI score 2

A

Mild impairment

Walks 20 ft, uses AD, slower speed, mild gait deviations

85
Q

DGI score 1

A

Moderate impairment

Walks 20 ft, slow speed, ab gait, evidence of imbalance

86
Q

DGI score 0

A

Sever impairment

Cannot walk 20 ft w/out assistance, severe gait deviations, imbalances

87
Q

DGI change in gait speed

A

Normal walking speed for about 5 ft

Slow after additional 5 ft

88
Q

DGI change in speed 3

A

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
Q

DGI change in speed 2

A

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
Q

DGI change in gait speed 1

A

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
Q

DGI change in gait speed 0

A

Severe impairment

Cannot change speeds, or loses balance and has to reach for wall or be supported by examiner

92
Q

DGI w/ head turns - 3

A

Normal

Performs head turns smoothly with no change in gait

93
Q

DGI w/ head turns 2

A

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
Q

DGI w/ head turns 1

A

Moderate impairment

Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk

95
Q

DGI w/ head turns 0

A

Severe impairment

Performs task with severe disruptions of gait (i.e., staggers outside path, loses balance, stops, reaches for wall)

96
Q

DGI pivot turn 3

A

Normal

Pivot and turns safely within 3 seconds and stops quickly with no loss of balance

97
Q

DGI pivot turn 2

A

Mild impairment

Pivot turns safely in >3 seconds and stops with no loss of balance

98
Q

DGI pivot turns 1

A

Mod impairment

Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn and stop

99
Q

DGI pivot turns 0

A

Severe impairment

Cannot turn safely, requires assistance to turn and stop

100
Q

DGI obstacles 3

A

Normal

Able to walk around/step over cones safely without changing gait speed; no evidence of imbalance

101
Q

DGI obstacles 2

A

Mild impairment

Able to step around/over both cones, but must slow down and adjust steps to clear cones

102
Q

DGI obstacles 1

A

Mod impairment

Able to clear cones but must significantly slow speed to accomplish task, or requires verbal cueing

103
Q

DGI obstacles 0

A

Severe impairment

Unable to clear cones, walks into one or both cones or requires physical assistance

NeuroRehab (33 decks)

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