Impaired Motor Control Flashcards
Motor Control
Ability to regulate or direct movements
What do motor control impairments usually result from?
a result of a disease or health condition and NOT a result of the normal aging process
Neural control
Cooperation of numerous structures within the nervous system (primary motor cortex, nonprimary cortical motor areas, and supplementary motor areas)
Work together to plan and execute voluntary movements
Gross motor control
Ability to make large, general movements
What does gross motor control require?
proper coordination and function of muscle, bones, and nerves
Cerebellum
correction of movement and coordination
Basal ganglia
selection of desired movements, initiation of movements, and inhibition of competing movements
Brainstem
postural control and basic/ gross movements
Motor cortex
planning, initiation, and direction of voluntary movements
Primary motor cortex
initiates signals that are involved in execution of movement
Secondary motor cortices
additional areas involved in motor function
Corticospinal tract
Arises at the primary motor cortex and ends at specified areas of the spinal cord
Primary pathway for controlling voluntary movement
Subconscious pathway
allows for subconscious control of muscle tone, balance, eye, hand, and upper limb position
or system impairments that contribute to motor control deficits in elderly
Motor System Impairments
Sensory System Impairments
Motor System Impairments
Paresis Abnormal tone Fractionated movement deficits Ataxia hypokinesia
Sensory System Impairments
Somatosensory loss
Perceptual deficits
Paresis
Reduced ability to voluntarily activate the spinal motor neurons
Problem is usually movement execution»_space; associated with wide range of neurologic conditions
Primary system for paresis
corticospinal system
Hypotonicity
Decreased resistance to passive movement and decreased or absent stretch reflex response
Flaccidity
severe form of hypotonicity in which there is no muscle tone present
Hypotonicity is seen in patients with:
Peripheral nerve damage
Polio
Degenerative neuromuscular disease
Acutely after a stroke that affects the cerebellum or corticospinal system
Hypertonicity
Increase in muscle tone
Increased resistance to passive movement and an increased stretch reflex response
Loss of supraspinal inhibition to the spinal cord
Hypertonicity seen in patients with:
Spinal cord injury
Traumatic brain injury
Multiple sclerosis
Cerebral palsy
Spasticity
velocity-dependent resistance to passive movement Typically stronger in one direction over another Versus rigidity (rigidity is NOT velocity or direction dependent)
Fractionated Movement Deficits
Inability to make isolated movements
Associated with CNS dysfunction
Damage to the corticospinal system resulting in decreased ability to selectively activate muscles
Motricity Index
Provides a standard MMT score that is objective
Uses standard MMT of 3 specific UE and 3 specific LE segments
Motricity Index UE segments:
shoulder abduction, elbow flexion, pinch grip
Motricity Index LE segments:
hip flexion, knee extension, ankle dorsiflexion
Modified Ashworth Scale
Objective test of motor control impairments
Test uses passive ROM of multiple UE and LE segments at varying speeds
Scale is used to assess spasticity
Finger-Thumb Opposition
Patient is asked to touch the thumb to the tips of each finger rapidly
Assesses fractional movement deficits
Finger-to-Nose Test
Patient is asked to touch the examiner’s finger then touch his or her own nose about 10 times rapidly
Assesses ataxia
Perceptual deficits in sit to stand:
shifts toward weaker side, pushes away from midline, resist correction to midline
Hypokinesia in sit to stand
limited or slow preparatory movements, falls if support is moved, freezes during attempt
Lyle’s decision rule with action arm reach test:
a patient who achieves a “3” on the first (most difficult) item are credited with a 3 on the rest of the items on that scale. If they score less than a 3 they move to the second item (easiest) and if they score a 0 here then they receive a zero for all other parts of the scale
max score of 37
Canadian Occupational Performance Measure
Used to detect change in clients self-perception of occupational performance over time in the areas of self-care, productivity, and leisure
FIM scale
Used to assess functional mobility
Most used in inpatient rehab facilities
FIM scoring
Scores range from 18 (lowest) to 126 (highest) indicating level of function
FIM dimensions:
Eating Grooming Bathing Upper body dressing Lower body dressing Toileting Bladder management Bed to chair transfer Toilet transfer Shower transfer
Reintegration to Normal Living Index
Assessment that quantitatively measures the degree to which individuals achieve reintegration into normal social activities
11 declarative statements, 8 of which address “daily functioning” and 3 that represent “perception of self”
3 key questions to guide rehab prognosis and treatment
What is the likelihood for motor control changes?
What is the likelihood of functional changes?
What is the likelihood that a specific intervention is going to change the expected outcome?
Motor Learning
The acquisition, modification, or reacquisition of movement
Occurs with repetition and sufficient stimulus
Minimum of 6 weeks to achieve a true strengthening response in muscle tissue
Best way to promote functional recovery?
Multiple studies have shown that task-specific activities are the best way to promote functional recovery
Age-Related Changes for muscle Performance:
Decline of body protein reserves
Diminished capacity to meet protein synthesis demands
Loss of muscle mass with gains in fat mass
Preferential atrophy of fast-twitch (type II) fibers
Muscle Protein Synthesis
Stimulated by feeding and resistance exercise
Stimulated 40-100% over resting rate with exercise
For improvements, synthesis must exceed muscle protein breakdown
Protein Requirements in Elderly
0.8 g/kg/day protein recommended for adults
1.0 to 1.3 g/kg/day recommended for elderly
20g to 30 g per meal
Frailty:
Weight loss: 10 pounds or more over year (unintentional)
Self-reported exhaustion 3 or more days/week
Grip strength lowest 20% (<23 pounds women, <32 pounds men)
Walking speed lowest 20% (<0.8 m/s)
Activity lowest 20% (<270 kcal/wk women, <383 kcal/wk men); sitting/lying most of day
3 of 5 meets clinical criteria for frailty
Frail Elderly Exercise Prescription
3x/week
3 sets of 8-12 reps
Start 20% 1RM, progress to 80% of 1RM
No adverse events/injuries reported
Program 1 Volume considerations:
1 RM = 50 pounds leg press
3 sets of 8, 3x/week, 10 pounds (20% 1 RM)
Total volume = 720
Program 2 Volume Considerations
1 RM = 50 pounds leg press
3 sets of 8, 1x/week, 30 pounds (60% 1RM)
Total volume = 720
Where to start frail elderly resistance training?
20% 1 RM
