Exam 5: Parts 1 and 2 Flashcards by Madelynn Kahl

Is this the order of academics or clinical practice

systems -> normal function -> Dysfunction -> patient problem -> signs and symptoms

academics

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Is this the order of academics or clinical practice

signs and symptoms -> patient problems -> dysfunction -> normal function -> systems

clinical practice

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What does ICF stand for

International classification of function

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Based on the ICF model, what category does a medical diagnosis or movement disorder belong to

health condition

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What is another term for impairments

body structure/function

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What is another work for task

activity

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What are some examples of impairments that belong under the body structure/function category according to the ICF model

ROM
Strength
Sensation/cognition
Proprioception
Muscle tone
Balance/Composite impairment
Postural control
Coordination
Endurance/fatigue
Pain
Body alignment

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What are the two sub categories of the activity category according to the ICF model

abilities and limitations

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What are some examples of abilities and limitations that belong under the activity category according to the ICF model

Bed mobility
Sitting Balance
Standing Balance
Ambulation
Functional mobility/transfers

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What are the two sub categories of the participation category according to the ICF model

abilities and restrictions

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What are some examples of abilities or restrictions that belong under the participation category of the ICF model

parent
care provider
family member/friend
employee/student
recreation participant (sewing, chess playing, swimming, jogging, rock climbing)

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What are the two sub categories under the environmental category of the ICF model

internal +/- and external +/-

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What are some examples of +/- internal environmental factors according to the ICF model

motivation
stress management
comorbidities
attention/focus
intact body structure/function

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What are some +/- external environmental factors according to the ICF model

Home environment/accessibility
access to healthcare (financial or physical)
Family/societal support
Demands of job
Demands of family role
Demands or societal role

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What is a composite impairment

When multiple systems are affecting a specific tasks like balance

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____ is being able to perform a task without assistance

an ability

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____ is performing a task with the help of outside assistance

a limitation

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True or False:

Attention can either be an internal or external environmental factor

True

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What is the definition of a sign

an objection findings of pathology that can be measured with a physical examination

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Are signs objective or subjective

objective

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What is the definition of a symptom

subjective report of experiences associated with the pathology but may not be measured objectively on examination

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Are symptoms objective or subjective

subjective

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In the following example:

“Many patients have decreased endurance following a stroke.”

The ___ is measured and confirmed as a decreased distance walking during a 6 minute walk test

and

The ___ would be reported by the patient as fatigue

sign

symptom

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(negative/positive) signs and symptoms are the presence of new abnormal behaviors

positive

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(negative/positive) signs and symptoms is the loss of normal behaviors

negative

What are some examples of positive signs and symptoms

babinski and clonus | spasticity

What are some examples of negative signs and symptoms

paresis and decreased balance

What is a positive babinski's sign and what age should we expect to see this in

a positive sign is when the big toe dorsiflexes and the other toes flare out. This is normal is children under 6 months, and becomes abnormal after 6 months of age

What is a primary impairment

a direct result of a CNS lesion

What is a secondary impairement

the result of the primary impairment

If there is a lesion in the descending motor pathways, give an example of what primary impairment could happen and what secondary impairment could happen

primary: paresis, spasticity secondary: structural and functional changes in muscles and joints

Are primary or secondary impairments preventable?

secondary

What will occur to the body if there is damage to the motor cortex?

Weakness

Why does weakness occur to the body if there is damage to the motor cortex

Because the primary motor area is located in the motor cortex

____ is the ability to generate sufficient muscle tension to sustain a position or move a body segment

strength

What is the definition of strength

The ability to generate sufficient muscle tension to sustain a position or move a body segment

Strength is influenced by both ____ properties and _____ activation

muscle; neural

What is the term used to describe a total or severe loss of muscle activity

paralysis or plegia

What is the term used to describe mild or partial loss of muscle activity

paresis

What is hemiplegia

weakness or muscle loss on one side of the body

What is paraplegia

weakness or muscle loss in the lower extremities

What is tetraplegia or quadriplegia

Weakness or muscle loss in all four extremities

What type of patient will the term "diplegia" and what does it mean?

CP patients are considered diplegic because they have weakness or muscle loss in both lower limbs due to damage of the 3rd or 4th ventricle

In general, children with CP have greater weakness in their lower extremities than normal developing children. In some cases, a hemiplegic patient might show more strength than a normal child, what is the rational behind this?

A hemiplegic patient might show more strength and less weakness than a normal developing child because they are over compensating for the other leg and might even vault to clear to nondominant side.

Hemiplegic patients have more weakness (distally/proximally)

distally

In hemiplegic patients, there is a clear difference in strength/weakness between the patients dominant vs nondominant side. Explain why diplegic patients show little to no difference between their dominant or nondominant side

Diplegic patients show no difference between sides because both lower limbs are affected so they both have weakness or paresis

Regarding children with CP, are their hip extensors or hip flexors stronger?

Hip flexors

Regarding children with CP, there will usually always be noticeable weakness in which muscles?

Glutes

In the EMG of isometric testing of quadriceps in typical developing and children with CP, the child with CP showed activation of both the hamstrings and the quadriceps when asked to extend the leg from a flexed position... explain what this is indicative of.

The EMG of children with CP the co-contraction occurring between the hamstring and quadricep. The quadricep has to fight against the activation of hamstring which also demonstrates poor selective control.

What term is defined as a muscle's resistance to passive stretch

muscle tone

What are the two types of muscle tone

hypertonicity and hypotonicity

Spasticity and rigidity are related to (hypertonicity/hypotonicity)

hypertonicity

flaccidity is related to (hypertonicity/hyptonicity)

hypotonicity

Spasticity is described as velocity ______ resistance to passive stretch

dependent

Rigidity is described as velocity _____ resistance to passive stretch

independent

What is the term used to describe a muscle that has absolutely no resistance to stretch

flaccidity

What is the definition of hypertonicity

increased resistance to passive stretch

What is the definition of hypotonicity

decreased resistance to passive stretch

What does the term velocity dependent mean

Speed influences the resistance. The faster you move a muscle, the more resistance you feel

What does the term velocity independent

Speed does not influence the resistance, you can move fast or slow and the resistance will be the same

Is flaccidity velocity dependent or velocity independent

velocity independent

Is spasticity velocity dependent or velocity independent

velocity dependent

Is rigidity velocity dependent or velocity independent

velocity independent

What is the spasticity "trash can" referring to?

Hypotonicity

What is the term that is used to refer to a single diagnosis that is commonly used but actually encompasses multiple separate impairments

trash can

True or False: Spasticity is a term that gets thrown in the "trash can"

true

What type of patients usually present with mild to moderate spasticity

down syndrome patients

Spasticity is often used in the clinic to refer to what what 6 terms

1. Hyperactive stretch reflex 2. Abnormal limb posture 3. Excessive co-activation 4. Associated movements 5. Clonus 6. Stereotypical synergy patterns

Regarding spasticity hypothesis, the primary hypothesis is that changes in the _____ activity produces _____ responses of the segmental stretch reflex

descending; abnormal

Describe the differences between Rymer et al. and Thilmann et al. hypotheses about spasticity

Rymer suggested that when you provide a passive stretch, the body provides resistance to protect itself, so with spasticity there is a decreased threshold. Thilmann suggested that spasticity is actually an early and prolonged activation that is just proactive more than it is active

What is the impact of spasticity on function

During a concentric contraction of the agonist, the antagonist has an excessive activation of the stretch reflex and does not lengthen normally, so the concentric contraction of the agonist is more difficult to complete

What seems to be the biggest problem on function in patients with spasticity

poor selective control

What other problems usually accompany spasticity?

paresis, abnormal reciprocal inhibition, impaired coordination of muscle synergies

____ ____ are coupling of muscle firing into classic patterns of movement that are not ideal

abnormal synergies

True or False: Patient with abnormal synergies can often change the coupling of muscles depending on the task

False, the coupling of motion cannot be changed

What type of abnormal synergy is usually presented in patients after a stroke

an upper flexor synergy

What is the movement being made in an upper flexor syngery

when the elbow flexes, the shoulder will abduct along with some scapular retraction

What is the term used to describe why patients cannot change the coupling of motion with abnormal synergies

Disassociation or a lack of fractionalization

______ is the inability to produce movement in one joint without simultaneously producing movement in another

disassociation

What is the definition of coactivation?

The simultaneous contraction of the agonist and antagonist during functional movement

____ is commonly seen in early learning of skilled movements in neurologically intact children and adults, but diminishes as the skill is learned

coactivation

True or False: Following neurological injury, coactivation is seen again and again or may not diminish with recovery

true