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DPT 620: Neuro > Evaluation of Motor Systems > Flashcards

Evaluation of Motor Systems Flashcards

1
Q

what is Brunnstrom stage 1?

A

flaccidity

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2
Q

what is Brunnstrom stage 2?

A

in synergy

some spasticity

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3
Q

what is Brunnstrom stage 3?

A

marked spasticity

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4
Q

what is Brunnstrom stage 4?

A

out of synergy

less spasticity

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5
Q

what is Brunnstrom stage 5?

A

selective control of movement (fractionated movt)

isolated/coordinated

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6
Q

what is Brunnstrom stage 6?

A

isolated/coordinated movt (fractionated movt)

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7
Q

what is the goal of the motor screen and examination?

A

to determine WHERE in the process of recovery a PwStroke may be

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8
Q

what three things are included in the motor screen and exam?

A

1) muscle tone

2) muscle activation

3) muscle strength

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9
Q

what is the muscle tone portion of the motor screening and exam for?

A

testing for hypotonicity, clinical hypertonicity, spasticity, or rigidity

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10
Q

what is the difference bw rigidity, spasticity, and clinical hypertonicity?

A

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

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11
Q

what is clinical hypertonicity?

A

stress/effort of movt makes underlying spasticity worse

not coming from the brain, coming from inefficient movt

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12
Q

what is involved in the the muscle activation portion of the motor screening and exam?

A

testing for isolated or fractionated irritation of movt, muscles sequencing, timing, or firing

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13
Q

what is involved in the muscle strength portion of the motor screening and exam?

A

testing for paralysis or weakness on the uninvolved side or on the involved side in the presence of good activation

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14
Q

what are the scales for muscle tone?

A

mAS

Tardieu

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15
Q

t/f: mAS and Tardieu are used on all pts post stroke

A

true

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16
Q

are DTRs always tested post stroke?

A

no, but sometimes

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17
Q

t/f: clonus should always be performed on pts with a stroke

A

TRUE

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18
Q

why is clonus always tested post stroke?

A

bc it effects gait when transferring weight onto the ball of the foot during ambulation

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19
Q

are the Babinski and Hoffman reflexes tested post stroke?

A

NOPE

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20
Q

why aren’t the Babinski and Hoffman reflexes tested post-stroke?

A

bc they are testing for UMN involvement, but we already know there is UMN involvement post stroke

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21
Q

if reflexes are bw 2-4, what brunnstrom level are they likely in?

A

Brunnstrom 3

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22
Q

if reflexes are 0, what Brunnstrom level are they likely in?

A

Brunnstrom 1

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23
Q

if reflexes are bw 1 and 1+, what Brunnstrom level are they likely in?

A

Brunnstrom 2 (a significant % of pts are here)

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24
Q

what is the Tardieu test?

A

test for tone

measure goni angle where resistance starts b4 and after intervention

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25
Q

what are 4+ reflexes?

A

very brisk, hyperactive w/clonus

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26
Q

what are 3+ reflexes?

A

brisker than average, slightly hyperreflexive

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27
Q

what are 2+ reflexes?

A

average, expected response, normal

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28
Q

what are 1+ reflexes?

A

somewhat diminished

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29
Q

what are 0 reflexes?

A

no response, absent

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30
Q

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

A

true

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31
Q

what are synkinesias?

A

involuntary movt accompanying coughing or yawning

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32
Q

when do synkinesias usually occur?

A

in the flaccid stage post stroke

33
Q

t/f: associated rxns are a sign of going from Brunnstrom 1 to 2

A

true

34
Q

what are associated reactions?

A

motor overflow w/in and bw extremities

involuntary activation of spastic muscles that can occur in about 30% of hemiplegic strokes

35
Q

with associated reactions, resisted UE movt on the uninvolved side may result in contraction of the ____ muscles/move on the ____ side

A

same, involved

36
Q

with associated reactions, resisted LE movt on the uninvolved side may result in contraction of the ____ muscles/move on the ____ side

A

opposite, involved

37
Q

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

A

true

38
Q

what is muscle activation an assessment of?

A

active muscle recruitment and voluntary movt

39
Q

what portion of the motor screen/assessment would involved determining if the pt demonstrates active, isolated (fractionated) movt of the involved extremity?

A

muscle activation

40
Q

does the UE tend to go into flexion or extension synergy?

A

flexion

41
Q

does the LE tend to go into flexion or extension synergy?

A

extension

42
Q

what is the UE flexion synergy?

A

elbow flexion, pronation, adduction, finger flexion, IR

43
Q

what is the UE extension synergy?

A
44
Q

what is the LE flexion synergy?

A

hip flexion, knee flexion, ER, DF, abduction

45
Q

what is the LE extension synergy?

A

hip extension, knee extension, IR, adduction, PF, inversion

46
Q

which is better for gait training, if a pt goes into LE flexion or extension synergy?

A

extension synergy

47
Q

what does the STREAM (stroke rehab assessment of movt) do?

A

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

48
Q

what is a 0 on the STREAM?

A

flaccid state, (DTRs 0-1)

49
Q

what Brunnstrom level is associated with a 0 on the STREAM?

A

1

50
Q

what is a 1a on the STREAM?

A

initiating the movt

in synergy

51
Q

what Brunnstrom level is associated with a 1a on the STREAM?

A

2

52
Q

what is a 1b on the STREAM?

A

initiating the movt

out of synergy

53
Q

what Brunnstrom level is associated with a 1b on the STREAM?

A

4

54
Q

what is a 1c on the STREAM?

A

full active motion

in synergy

55
Q

what Brunnstrom level is associated with a 1c on the STREAM?

A

3

56
Q

what is a 2 on the STREAM?

A

selective active motor control

normal motion

57
Q

what Brunnstrom level is associated with a 2 on the STREAM?

A

5-6

58
Q

what is a 0 on the mobility part of the STREAM?

A

unable to perform the activity

59
Q

what is a 1a on the mobility part of the STREAM?

A

able to complete part of the activity independently

w or w/o aid

w/marked deviation

60
Q

what is a 1b on the mobility part of the STREAM?

A

able to complete part of the activity independently

w or w/o aid

grossly normal

61
Q

what is a 1c on the mobility part of the STREAM?

A

able to complete the full activity

w or w/o aid

w/marked deviation

62
Q

what is a 2 on the mobility part of the STREAM?

A

able to complete the activity independently

grossly normal

requires aid

63
Q

what is a 3 on the mobility part of the STREAM?

A

able to complete the activity independently

grossly normal

w/o aid

64
Q

if a section of the mobility STREAM is actively non tested, what do you document?

A

X

65
Q

why may a section of the STREAM be actively non tested?

A

due to pain, ROM deficits, etc

66
Q

what is the MCID for the UE STREAM?

A

2.2

67
Q

what is the MCID for the LE STREAM?

A

1.9

68
Q

what is the MCID for mobility in the STREAM

A

4.8

69
Q

t/f: the screening of active motor fxn is completed PRIOR to the fxnal assessment

A

true

70
Q

what is the order of the active motor test?

A

PROM and muscle tone

movt on intact side

movt on involved side

71
Q

what are the 2 subsets of praxis?

A

ideational apraxia

ideomotor apraxia

72
Q

what is ideational apraxia?

A

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

73
Q

what is ideomotor apraxia?

A

imitation of gestures

meaningful and meaningless gestures assessed

74
Q

what are the 2 aspects of coordination of movt?

A

accuracy (dysmetria) and timing (dysdiadochokinesia)

75
Q

how do we test for dysmetria on the LE?

A

“bring your heel from your opposite ankle to you opposite knee keeping your heel on your shin bone as fast as possible”

76
Q

how do we test for dysmetria on the UE?

A

“bring your finger from your knee to your nose as fast as possible”

77
Q

how do we test for dysdiadochokinesia on the LE?

A

ask the pt to alternate DF as fast as possible

78
Q

how do we test for dysdiadochokinesia on the UE?

A

ask the pt to pronate/supinate hands as fast as possible

DPT 620: Neuro (12 decks)

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