Examining motor fxn Flashcards
In what kind of brain lesions will you observe low tone?
LMN = nerve roots and peripheral injury UMN = with initial spinal shock for SCI or stroke, but then transitions to high tone
A hyperactive tendon response indicates what lesion?
UMN
A score of 2 on the MAS means what?
2 = more marked increase in muscle tone through most of ROM, affected part easily moved
1 = slight increase in tone, minimal resistance at end of ROM 1+ = slight increase in muscle tone, minimal resistance through less than half ROM 3 = considerable increase in tone, passive movement difficult 4 = rigid
Is rigidity velocity dependent?
no
In SCI, what kind of DTRs would you expect?
hyperreflexic
What kind of CNS disorder has lead-pipe rigidity?
parkinsonism -> can be cogwheel or ratchet-like resistance to movement
If a patient is ataxic, what could the location of the lesion be?
cerebellum
Compare/contrast dysmetria/dysdiadochokinesia
dysdiadochokinesia = inability to perform rapidly alternating movements
dysmetria = unable to judge distance/range of a movement
How do you test dysmetria?
finger to nose then pencil
How do you test dysdiadochokinesia?
try to pronate/supinate quickly with one hand in the palm of another
Do people with a cerebrellar lesion/stroke have spasm?
no not typically
With stroke, what is the location of the lesion in the brain? (think cortex/tracts)
cerebral cortex corticospinal tracts
What do voluntary movements with stroke look like?
dyssynergic = abnormal timing/coactivation/activation, fatigueability
What do voluntary movements with parkinson’s look like?
bradykinesia/akinesia (lack of spontaneous and automatic movements)
Rigidity is associated with what CNS disorder?
parkinson’s
A patient you’re seeing has increased tone and sustained posturing in rigid extension of all four limbs and trunk/neck. What would you call this?
decerebrate
- for lesions between superior colliculus and vestibular nucleus
A patient has increased tone and has sustained posturing of the limbs in flexion and LEs in extension - what is this called?
decorticate
Your patient has prolonged, severe spasms of muscles during your session, causing them to throw their head, back, and heels into extension, while their arms and hands are rigidly flexed. What could be going on?
opisthotonos - seen in severe meningitis, tetanus, epilepsy
Is Guillian-Barre a LMN or UMN issue?
LMN
What kind of lesion produces rapid, focal, severe muscle wasting?
LMN (neurogenic atrophy)
- UMN is variable disuse atrophy
What would a 2+ on the reflex scoring scale indicate?
2+ = visible movement of extremities
0 = absent 1+ = tone change, no visible movement of extr 3+ = exaggerated, full movement 4+ = oligatory and sustained movement, lasting for >30s
Do we typically see proximal or distal muscle weakness with neuropathies?
distal (proximal with myopathies)
What’s the typical pattern of spasticity at the hip?
extended, IR, adducted (scissoring)
What type of sitting posture is associated with spasticity?
sacral sitting
What type of ankle position is typically associated with spasticity, and what muscles are involved?
equinovarus (pf, inv)
- gastroc
- tib posterior
Your patient with stroke has a lot of upper extremity spasticity noted in his chart, what do you expect his shoulder joint to look like? (assume extension)
adducted, IRed, depressed
What does the STNR reflex look like?
- flexion of the head produces flexion of the UEs with extension of the LEs
- extension of the head produces extension of the UEs and flexion of the LEs
HEAD GOES WITH UPPERS
Fatigue is present in many different neuro syndromes. Which ones are characteristic for fatigue d/t issues at the neural/myoneuronal junction?
- MS
- post polio
- GBS
- myasthenia gravis
Depleted Ca2+ stores cause fatigue in what neurological disorder?
DMD
Describe overwork weakness from post-polio or DMD.
prolonged decrease in absolute strength and endurance d/t excessive activity of partially denervated muscle
When looking at voluntary movement control, describe what factors you should be watching for.
1) quality of movement patterns… synergistic?
2) timing and appropriateness of movement in response to stimulus
3) are movements symmetrical?
4) able to easily vary contraction type? eccentric/concentric/iso
5) adequate control of multiple body segments, postural stabilization?
Intention tremor is commonly seen in what kind of disorders?
cerebellar disorders -> intention tremor when attempting voluntary movement
Evidence of tics, athetosis, chorea, or resting tremors indicate damage to what part of the brain? What do all of these behaviors have in common?
extrapyramidal disorders, basal ganglia dysfunction
all of these are involuntary movements
Your patient who has a L sided lesion CVA exhibits typical extension synergy in both his RUE and RLE. Describe what this looks like.
RUE extension = scap protracted, shoulder add*/IR, elbow ext, forearm pronation, wrist/finger flexion
RLE extension = hip ext/add/IR, knee ext, ankle PF*/inv
Your patient with a R sided CVA exhibits typical flexion synergy in his LUE/LLE. Describe this.
LUE flexion = scap retract/elevated, shoulder abd, ER, elbow flexion, forearm sup, wrist/finger flex
LLE flexion = hip flex/abd/ER, knee flex, ankle DF/inv
If a patient requires hand held assist to maintain balance, this automatically puts them in what balance rating category?
fair to poor
fair = min assist in static, can turn head and trunk without LOB with HHA poor = mod-max assist static, can't turn or do anything
Describe good from normal balance rating.
good = limited postural sway in static; can pick object off floor normal = none; can shift weight easily in all directions
What’s a typical TUG score?
normal intact adults: <10s
- 11-20s is normal for frail elderly
What’s a high risk for falls score on the TUG?
> 30s = high risk
<20s = increased risk for falls
What’s a score that indicates higher risk for falls on the Berg?
<45/56 = increased risk for falls
1 point drop indicates 6-8% increase in fall risk for those who score 54-46
How is the tinetti scored? (aka POMA)
max score is 28, with <19/28 at high risk for falls, 19-24 = mod risk
- looks at walking, sternal nudge, turn 360, bend over, timed rise, and a few others similar to berg
What is an increased risk of falls score for the DGI?
<19/24
What is a requirement to be able to take the HiMAT test?
HiMAT = high level mobility assessment tool
- need to be independent walking for 20m without gait aids
