Examining motor fxn

Question 1

In what kind of brain lesions will you observe low tone?

Answer 1

LMN = nerve roots and peripheral injury
UMN = with initial spinal shock for SCI or stroke, but then transitions to high tone

Question 2

A hyperactive tendon response indicates what lesion?

Answer 2

UMN

Question 3

A score of 2 on the MAS means what?

Answer 3

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

Question 4

Is rigidity velocity dependent?

Answer 4

no

Question 5

In SCI, what kind of DTRs would you expect?

Answer 5

hyperreflexic

Question 6

What kind of CNS disorder has lead-pipe rigidity?

Answer 6

parkinsonism -> can be cogwheel or ratchet-like resistance to movement

Question 7

If a patient is ataxic, what could the location of the lesion be?

Answer 7

cerebellum

Question 8

Compare/contrast dysmetria/dysdiadochokinesia

Answer 8

dysdiadochokinesia = inability to perform rapidly alternating movements

dysmetria = unable to judge distance/range of a movement

Question 9

How do you test dysmetria?

Answer 9

finger to nose then pencil

Question 10

How do you test dysdiadochokinesia?

Answer 10

try to pronate/supinate quickly with one hand in the palm of another

Question 11

Do people with a cerebrellar lesion/stroke have spasm?

Answer 11

no not typically

Question 12

With stroke, what is the location of the lesion in the brain? (think cortex/tracts)

Answer 12

cerebral cortex corticospinal tracts

Question 13

What do voluntary movements with stroke look like?

Answer 13

dyssynergic = abnormal timing/coactivation/activation, fatigueability

Question 14

What do voluntary movements with parkinson’s look like?

Answer 14

bradykinesia/akinesia (lack of spontaneous and automatic movements)

Question 15

Rigidity is associated with what CNS disorder?

Answer 15

parkinson’s

Question 16

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?

Answer 16

decerebrate

- for lesions between superior colliculus and vestibular nucleus

Question 17

A patient has increased tone and has sustained posturing of the limbs in flexion and LEs in extension - what is this called?

Answer 17

decorticate

Question 18

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?

Answer 18

opisthotonos - seen in severe meningitis, tetanus, epilepsy

Question 19

Is Guillian-Barre a LMN or UMN issue?

Answer 19

LMN

Question 20

What kind of lesion produces rapid, focal, severe muscle wasting?

Answer 20

LMN (neurogenic atrophy)

- UMN is variable disuse atrophy

Question 21

What would a 2+ on the reflex scoring scale indicate?

Answer 21

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

Question 22

Do we typically see proximal or distal muscle weakness with neuropathies?

Answer 22

distal (proximal with myopathies)

Question 23

What’s the typical pattern of spasticity at the hip?

Answer 23

extended, IR, adducted (scissoring)

Question 24

What type of sitting posture is associated with spasticity?

Answer 24

sacral sitting

Question 25

What type of ankle position is typically associated with spasticity, and what muscles are involved?

Answer 25

equinovarus (pf, inv)

• gastroc
• tib posterior

Question 26

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)

Answer 26

adducted, IRed, depressed

Question 27

What does the STNR reflex look like?

Answer 27

• 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

Question 28

Fatigue is present in many different neuro syndromes. Which ones are characteristic for fatigue d/t issues at the neural/myoneuronal junction?

Answer 28

• MS
• post polio
• GBS
• myasthenia gravis

Question 29

Depleted Ca2+ stores cause fatigue in what neurological disorder?

Answer 29

DMD

Question 30

Describe overwork weakness from post-polio or DMD.

Answer 30

prolonged decrease in absolute strength and endurance d/t excessive activity of partially denervated muscle

Question 31

When looking at voluntary movement control, describe what factors you should be watching for.

Answer 31

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?

Question 32

Intention tremor is commonly seen in what kind of disorders?

Answer 32

cerebellar disorders -> intention tremor when attempting voluntary movement

Question 33

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?

Answer 33

extrapyramidal disorders, basal ganglia dysfunction

all of these are involuntary movements

Question 34

Your patient who has a L sided lesion CVA exhibits typical extension synergy in both his RUE and RLE. Describe what this looks like.

Answer 34

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

Question 35

Your patient with a R sided CVA exhibits typical flexion synergy in his LUE/LLE. Describe this.

Answer 35

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

Question 36

If a patient requires hand held assist to maintain balance, this automatically puts them in what balance rating category?

Answer 36

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

Question 37

Describe good from normal balance rating.

Answer 37

good = limited postural sway in static; can pick object off floor
normal = none; can shift weight easily in all directions

Question 38

What’s a typical TUG score?

Answer 38

normal intact adults: <10s

- 11-20s is normal for frail elderly

Question 39

What’s a high risk for falls score on the TUG?

Answer 39

> 30s = high risk

<20s = increased risk for falls

Question 40

What’s a score that indicates higher risk for falls on the Berg?

Answer 40

<45/56 = increased risk for falls

1 point drop indicates 6-8% increase in fall risk for those who score 54-46

Question 41

How is the tinetti scored? (aka POMA)

Answer 41

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

Question 42

What is an increased risk of falls score for the DGI?

Answer 42

<19/24

Question 43

What is a requirement to be able to take the HiMAT test?

Answer 43

HiMAT = high level mobility assessment tool

• need to be independent walking for 20m without gait aids