Evaluation of Motor Systems Flashcards
what is Brunnstrom stage 1?
flaccidity
what is Brunnstrom stage 2?
in synergy
some spasticity
what is Brunnstrom stage 3?
marked spasticity
what is Brunnstrom stage 4?
out of synergy
less spasticity
what is Brunnstrom stage 5?
selective control of movement (fractionated movt)
isolated/coordinated
what is Brunnstrom stage 6?
isolated/coordinated movt (fractionated movt)
what is the goal of the motor screen and examination?
to determine WHERE in the process of recovery a PwStroke may be
what three things are included in the motor screen and exam?
1) muscle tone
2) muscle activation
3) muscle strength
what is the muscle tone portion of the motor screening and exam for?
testing for hypotonicity, clinical hypertonicity, spasticity, or rigidity
what is the difference bw rigidity, spasticity, and clinical hypertonicity?
rigidity-velocity independent hypertonicity generally effects both agonist and antagonist; BG pathology
spasticity-velocity dependent hypertonicity; either antagonist or agonist more effected
clinical hypertonicity-stress/effort of movt makes underlying spasticity worse but is not coming from the brain, coming from inefficient movt
what is clinical hypertonicity?
stress/effort of movt makes underlying spasticity worse
not coming from the brain, coming from inefficient movt
what is involved in the the muscle activation portion of the motor screening and exam?
testing for isolated or fractionated irritation of movt, muscles sequencing, timing, or firing
what is involved in the muscle strength portion of the motor screening and exam?
testing for paralysis or weakness on the uninvolved side or on the involved side in the presence of good activation
what are the scales for muscle tone?
mAS
Tardieu
t/f: mAS and Tardieu are used on all pts post stroke
true
are DTRs always tested post stroke?
no, but sometimes
t/f: clonus should always be performed on pts with a stroke
TRUE
why is clonus always tested post stroke?
bc it effects gait when transferring weight onto the ball of the foot during ambulation
are the Babinski and Hoffman reflexes tested post stroke?
NOPE
why aren’t the Babinski and Hoffman reflexes tested post-stroke?
bc they are testing for UMN involvement, but we already know there is UMN involvement post stroke
if reflexes are bw 2-4, what brunnstrom level are they likely in?
Brunnstrom 3
if reflexes are 0, what Brunnstrom level are they likely in?
Brunnstrom 1
if reflexes are bw 1 and 1+, what Brunnstrom level are they likely in?
Brunnstrom 2 (a significant % of pts are here)
what is the Tardieu test?
test for tone
measure goni angle where resistance starts b4 and after intervention
what are 4+ reflexes?
very brisk, hyperactive w/clonus
what are 3+ reflexes?
brisker than average, slightly hyperreflexive
what are 2+ reflexes?
average, expected response, normal
what are 1+ reflexes?
somewhat diminished
what are 0 reflexes?
no response, absent
t/f: DTRs post stroke are NOT an assessment of nerve roots, but of the state of alpha motor neuron pools to determine the degree of underlying hypertonicity
true
what are synkinesias?
involuntary movt accompanying coughing or yawning
when do synkinesias usually occur?
in the flaccid stage post stroke
t/f: associated rxns are a sign of going from Brunnstrom 1 to 2
true
what are associated reactions?
motor overflow w/in and bw extremities
involuntary activation of spastic muscles that can occur in about 30% of hemiplegic strokes
with associated reactions, resisted UE movt on the uninvolved side may result in contraction of the ____ muscles/move on the ____ side
same, involved
with associated reactions, resisted LE movt on the uninvolved side may result in contraction of the ____ muscles/move on the ____ side
opposite, involved
t/f: resisted strong movts (usually proximal)on the involved side can overflow to increase output in weaker muscles (usually distal) on the same side
true
what is muscle activation an assessment of?
active muscle recruitment and voluntary movt
what portion of the motor screen/assessment would involved determining if the pt demonstrates active, isolated (fractionated) movt of the involved extremity?
muscle activation
does the UE tend to go into flexion or extension synergy?
flexion
does the LE tend to go into flexion or extension synergy?
extension
what is the UE flexion synergy?
elbow flexion, pronation, adduction, finger flexion, IR
what is the UE extension synergy?
what is the LE flexion synergy?
hip flexion, knee flexion, ER, DF, abduction
what is the LE extension synergy?
hip extension, knee extension, IR, adduction, PF, inversion
which is better for gait training, if a pt goes into LE flexion or extension synergy?
extension synergy
what does the STREAM (stroke rehab assessment of movt) do?
looks at a series of movt that asks the pt to move in synergy and out of synergy to determine its effects on fxn and tell the Brunnstrom level of recovery
what is a 0 on the STREAM?
flaccid state, (DTRs 0-1)
what Brunnstrom level is associated with a 0 on the STREAM?
1
what is a 1a on the STREAM?
initiating the movt
in synergy
what Brunnstrom level is associated with a 1a on the STREAM?
2
what is a 1b on the STREAM?
initiating the movt
out of synergy
what Brunnstrom level is associated with a 1b on the STREAM?
4
what is a 1c on the STREAM?
full active motion
in synergy
what Brunnstrom level is associated with a 1c on the STREAM?
3
what is a 2 on the STREAM?
selective active motor control
normal motion
what Brunnstrom level is associated with a 2 on the STREAM?
5-6
what is a 0 on the mobility part of the STREAM?
unable to perform the activity
what is a 1a on the mobility part of the STREAM?
able to complete part of the activity independently
w or w/o aid
w/marked deviation
what is a 1b on the mobility part of the STREAM?
able to complete part of the activity independently
w or w/o aid
grossly normal
what is a 1c on the mobility part of the STREAM?
able to complete the full activity
w or w/o aid
w/marked deviation
what is a 2 on the mobility part of the STREAM?
able to complete the activity independently
grossly normal
requires aid
what is a 3 on the mobility part of the STREAM?
able to complete the activity independently
grossly normal
w/o aid
if a section of the mobility STREAM is actively non tested, what do you document?
X
why may a section of the STREAM be actively non tested?
due to pain, ROM deficits, etc
what is the MCID for the UE STREAM?
2.2
what is the MCID for the LE STREAM?
1.9
what is the MCID for mobility in the STREAM
4.8
t/f: the screening of active motor fxn is completed PRIOR to the fxnal assessment
true
what is the order of the active motor test?
PROM and muscle tone
movt on intact side
movt on involved side
what are the 2 subsets of praxis?
ideational apraxia
ideomotor apraxia
what is ideational apraxia?
demo the use of objects
have PT pantomime the UE of an object w/o the real object present
wrong idea of the typical action/object
what is ideomotor apraxia?
imitation of gestures
meaningful and meaningless gestures assessed
what are the 2 aspects of coordination of movt?
accuracy (dysmetria) and timing (dysdiadochokinesia)
how do we test for dysmetria on the LE?
“bring your heel from your opposite ankle to you opposite knee keeping your heel on your shin bone as fast as possible”
how do we test for dysmetria on the UE?
“bring your finger from your knee to your nose as fast as possible”
how do we test for dysdiadochokinesia on the LE?
ask the pt to alternate DF as fast as possible
how do we test for dysdiadochokinesia on the UE?
ask the pt to pronate/supinate hands as fast as possible
