Examination of Motor Function in Neurologic PT Flashcards
what is the name of the dx in which there is damage only to 1/2 of the spinal cord
brown sequard syndrome
s/s of UMN lesion
Hypertonia, rigidity, spasticity
Hyperreflexia, (+) babinski, clonus, primitive reflexes present
Paresis/plegia
Muscle spasms
Disuse atrophy, variable, widespread
Especially in antigravity muscles
Impaired voluntary movements, pathological synergies
s/s of LMN lesion
Hypotonia, flaccidity (floppy)
Hyporeflexia - diminished or absent
Ipsilateral weakness, may be isolated to a nerve root or focal pattern
May see visible fasciculations (muscle twitching); fibrillations seen on needle EMG → we cannot see them with naked eye
Neurogenic atrophy, severe wasting (due to damage of a peripheral nerve)
Movement patterns may appear abnormal due to weakness
the resistance of a muscle to a passive elongation or stretch
tone
what is tone influenced by
physical inertia, intrinsic muscle stiffness, spinal reflexes
occurs following CNS (UMN) injury or disorder
hypertonicity
what are the different types of hypertonicity
spasticity, rigidity, decorticate/decerebrate rigidity
what is the name for the catch-release sensation associated with spasticity
clasp-knife response
velocity-dependent resistance to PROM/stretch
spasticity
what is spasticity associated with
contractures, abnormal posturing, functional limitations, disability
spasticity occurs due to CNS injuries of
pyramidal and brainstem tracts
rhythmic spasmodic contractions in response to a sustained stretch
clonus
where is clonus most common
PFs, jaw, wrist
hypertonic state that is not velocity-dependent
rigidity
what are the two types of rigidity and describe them
- cogwheel: ratchet like resistance, jerkiness
- leadpipe: stiffness, inflexibility throughout ROM
ridigity often occurs with damage to what CNS structures
basal ganglia and extrapyramidal tracts
(Ex: parkinson’s and huntington’s)
UE and LE extension
decerebrate
decerebrate is associated with corticospial tract lesion in the brain stem between what structures
superior colliculus and vestibular nucleus
UE flexion and LE extension
decorticate
decordicate associated with corticospinal tract lesion above what structure
superior colliculus
spasticity occurs due to CNS injuries to what tracts
pyramidal and brainstem tracts
prolonged involuntary twisting/writhing with increased muscle tone
dystonia
sustained abnormal postures due to co-contraction of muscles
dystonic posturing
dystonia is associated with lesions where
basal ganglia
decreased or absent muscle tone (flaccidity)
hypotonia
hypotonia usually seen in LMN disease affecting what
anterior horn cells or peripheral nerves
can also be seen with cerebellar lesions
are cerebellar lesions associated with hyper or hypotonia
hypotonia
factors influencing tone
time of day, volitional effort required, body posture, anxiety, pain, medications, ambient temperature and state of CNS arousal or alertness, and bladder fullness, electrolyte balance, fever/infection will affect tone
the modified ashworth scale is only used to assess what
spasticity ONLY
measuring tone scoring
0 - no response (flaccidity)
1 - decreased response (hypotonia)
2 - normal response
3 - exaggerated response (mild-mod hypertonia)
4 - sustained response (severe hypertonia)
MAS scoring
0: no response
1: slight increase in muscle tone, manifested by a catch and release or minimal resistance at end-range
1+: slight increase in muscle tone, manifested by a catch followed by minimal resistance t/o the remainder (less than ½) ROM
2+: more marked increase in muscle tone through most of ROM, but affected parts easily moved
3+: considerable increase in muscle tone, passive movement difficult
4+: affected parts rigid in flexion or extension
CN associated with nasal cavity and anterior cerebellum
C1
CN associated with Lesions to optic chiasm, optic radiations, midbrain, and visual cortex
2, 3, 4
CN associated with Lesions to pons
5, 6
CN associated with Lesion to junction between pons and medulla
7, 8
CN associated with lesions to medulla
9, 10, 11, 12
CN associated with lesions to C1-5
11
patterns of muscle innervation that corresponds to specific spinal segments
myotomes
loss of muscle bulk (wasting)
atrophy
loss of functional mobility, develops slowly over time (weeks to months)
disuse atrophy
what muscles does disuse atrophy typically occur
antigravity muscles
associated with LMN, usually occurs rapidly within 2-3 weeks
neurogenic atrophy
muscle force exerted by a muscle or group of muscles to overcome resistance under specific circumstances
strength
work produced by a muscle per unit of time (strength x speed)
power
inability to generate sufficient levels of force - occurs in both UMN and LMN pathologies
weakness
partial weakness, both UMN and LMN lesions
paresis
absence of muscle strength (no voluntary movement), mostly UMN pathology
plegia
what population was MMT originally developed for and what population is it not valid for
- polio (LMN)
- not validated for UMN because may have pathologic synergies, spasticity, contractures
MMT estimated grade for muscles with visible contraction but cannot overcome gravity or move through ROM
poor
MMT estimated grade for muscles can move against gravity but cannot manage any resistance
fair
MMT estimated grade for muscles can move against gravity and can take moderate resistance
good
MMT estimated grade for muscles can move against gravity and can take strong resistance
normal
ability to sustain forces repeatedly or generate force over time; determines functional capacity
muscle endurance
overwhelming sustained sense of exhaustion and decreased capacity for physical and/or mental work at the usual level
fatigue
limit of endurance beyond which no further performance is possible
endurance
ways to examine fatigue
- self-reported instruments
- performance-based activities (timed tests)
- sub-max isokinetic testing
functionally linked muscles/muscle groups that work together cooperatively to produce an intended action
synergies
what type of synergy is most common in UE
flexor
what type of synergy is most common in LE
extensor
Breaking down the parts of an activity to examine where deficits are occurring
task analysis
spasticity occurs due to CNS injuries of
pyramidal and brainstem tracts
what are the 3 functions of the vestibular system
- stabilize visual images on fovea of the retina during head movement to allow clear vision
- Maintaining postural stability especially during movements of the head
- Provides CNS with exact information used for spatial orientation of the head in 3 dimensions
what structure gets deflected due to endolymph movement
cupula
what do the superior and inferior vestibular N individually innervate
- Sup: ant and horizontal SCC and utricle
- Inf: post SCC and saccule
which way would the nystagmus be in you spin R and then stop
L nystagmus (L excited and R inhibited)
what direction is the nystagmus named by
named based on the fast phase (excitatory)
what is the first thing you have to do before performing vestibular tests
clear C/s
what does the head impulse/head thrust test assess
VOR
describe a positive head impulse/thrust test and what can a positive test indicate
inability to keep fixation on nose and they need saccadic eye movements to refocus on your nose → MUST occur every time
- the side that is affected is the side your are turning their head to
Ex: L side - L VOR intact = eyes look R when turn head L; L VOR not intact = eyes look L and follow movement of the head
(+) could be indicative of UVL, BVL, or central
what does the head shake test assess
imbalance between sides; assesses if firing rate of both sides is equal
describe a positive head shake test and what would a positive test indicate
nystagmus for at least 3 beats and dizziness
- Nystagmus toward the intact/active side
- Ex: L damage = R nystagmus
norm: no nystagmus
Positive indicated UVL
Will not be positive with BVL
what does the dix-hallpike assess and which canals
BPPV
anterior and posterior SCC
describe a postive dix-hallpike and which side are you testing
nystagmus in the direction indicative of anterior or posterior SCC BPPV
testing the side/ear that is down
what type of issue is BPPV
mechanical
what does the roll test assess and which canals
horizontal BPPV
horizontal SCC
describe positive roll test and the different type of ways to describe the nystagmus
nystagmus and vertigo (lateral beating nystagmus)
Geotropic: fast phase toward floor
Ageotropic: fast phase toward ceiling
