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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
what are 4+ reflexes?
very brisk, hyperactive w/clonus
26
what are 3+ reflexes?
brisker than average, slightly hyperreflexive
27
what are 2+ reflexes?
average, expected response, normal
28
what are 1+ reflexes?
somewhat diminished
29
what are 0 reflexes?
no response, absent
30
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
31
what are synkinesias?
involuntary movt accompanying coughing or yawning
32
when do synkinesias usually occur?
in the flaccid stage post stroke
33
t/f: associated rxns are a sign of going from Brunnstrom 1 to 2
true
34
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
35
with associated reactions, resisted UE movt on the uninvolved side may result in contraction of the ____ muscles/move on the ____ side
same, involved
36
with associated reactions, resisted LE movt on the uninvolved side may result in contraction of the ____ muscles/move on the ____ side
opposite, involved
37
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
38
what is muscle activation an assessment of?
active muscle recruitment and voluntary movt
39
what portion of the motor screen/assessment would involved determining if the pt demonstrates active, isolated (fractionated) movt of the involved extremity?
muscle activation
40
does the UE tend to go into flexion or extension synergy?
flexion
41
does the LE tend to go into flexion or extension synergy?
extension
42
what is the UE flexion synergy?
elbow flexion, pronation, adduction, finger flexion, IR
43
what is the UE extension synergy?
44
what is the LE flexion synergy?
hip flexion, knee flexion, ER, DF, abduction
45
what is the LE extension synergy?
hip extension, knee extension, IR, adduction, PF, inversion
46
which is better for gait training, if a pt goes into LE flexion or extension synergy?
extension synergy
47
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
48
what is a 0 on the STREAM?
flaccid state, (DTRs 0-1)
49
what Brunnstrom level is associated with a 0 on the STREAM?
1
50
what is a 1a on the STREAM?
initiating the movt in synergy
51
what Brunnstrom level is associated with a 1a on the STREAM?
2
52
what is a 1b on the STREAM?
initiating the movt out of synergy
53
what Brunnstrom level is associated with a 1b on the STREAM?
4
54
what is a 1c on the STREAM?
full active motion in synergy
55
what Brunnstrom level is associated with a 1c on the STREAM?
3
56
what is a 2 on the STREAM?
selective active motor control normal motion
57
what Brunnstrom level is associated with a 2 on the STREAM?
5-6
58
what is a 0 on the mobility part of the STREAM?
unable to perform the activity
59
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
60
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
61
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
62
what is a 2 on the mobility part of the STREAM?
able to complete the activity independently grossly normal requires aid
63
what is a 3 on the mobility part of the STREAM?
able to complete the activity independently grossly normal w/o aid
64
if a section of the mobility STREAM is actively non tested, what do you document?
X
65
why may a section of the STREAM be actively non tested?
due to pain, ROM deficits, etc
66
what is the MCID for the UE STREAM?
2.2
67
what is the MCID for the LE STREAM?
1.9
68
what is the MCID for mobility in the STREAM
4.8
69
t/f: the screening of active motor fxn is completed PRIOR to the fxnal assessment
true
70
what is the order of the active motor test?
PROM and muscle tone movt on intact side movt on involved side
71
what are the 2 subsets of praxis?
ideational apraxia ideomotor apraxia
72
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
73
what is ideomotor apraxia?
imitation of gestures meaningful and meaningless gestures assessed
74
what are the 2 aspects of coordination of movt?
accuracy (dysmetria) and timing (dysdiadochokinesia)
75
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"
76
how do we test for dysmetria on the UE?
"bring your finger from your knee to your nose as fast as possible"
77
how do we test for dysdiadochokinesia on the LE?
ask the pt to alternate DF as fast as possible
78
how do we test for dysdiadochokinesia on the UE?
ask the pt to pronate/supinate hands as fast as possible

DPT 620: Neuro (13 decks)

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