Impaired Motor Control

Question 1

Motor Control

Answer 1

Ability to regulate or direct movements

Question 2

What do motor control impairments usually result from?

Answer 2

a result of a disease or health condition and NOT a result of the normal aging process

Question 3

Neural control

Answer 3

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

Question 4

Gross motor control

Answer 4

Ability to make large, general movements

Question 5

What does gross motor control require?

Answer 5

proper coordination and function of muscle, bones, and nerves

Question 6

Cerebellum

Answer 6

correction of movement and coordination

Question 7

Basal ganglia

Answer 7

selection of desired movements, initiation of movements, and inhibition of competing movements

Question 8

Brainstem

Answer 8

postural control and basic/ gross movements

Question 9

Motor cortex

Answer 9

planning, initiation, and direction of voluntary movements

Question 10

Primary motor cortex

Answer 10

initiates signals that are involved in execution of movement

Question 11

Secondary motor cortices

Answer 11

additional areas involved in motor function

Question 12

Corticospinal tract

Answer 12

Arises at the primary motor cortex and ends at specified areas of the spinal cord
Primary pathway for controlling voluntary movement

Question 13

Subconscious pathway

Answer 13

allows for subconscious control of muscle tone, balance, eye, hand, and upper limb position

Question 14

or system impairments that contribute to motor control deficits in elderly

Answer 14

Motor System Impairments

Sensory System Impairments

Question 15

Motor System Impairments

Answer 15

Paresis
Abnormal tone
Fractionated movement deficits
Ataxia
hypokinesia

Question 16

Sensory System Impairments

Answer 16

Somatosensory loss

Perceptual deficits

Question 17

Paresis

Answer 17

Reduced ability to voluntarily activate the spinal motor neurons
Problem is usually movement execution&raquo_space; associated with wide range of neurologic conditions

Question 18

Primary system for paresis

Answer 18

corticospinal system

Question 19

Hypotonicity

Answer 19

Decreased resistance to passive movement and decreased or absent stretch reflex response

Question 20

Flaccidity

Answer 20

severe form of hypotonicity in which there is no muscle tone present

Question 21

Hypotonicity is seen in patients with:

Answer 21

Peripheral nerve damage
Polio
Degenerative neuromuscular disease
Acutely after a stroke that affects the cerebellum or corticospinal system

Question 22

Hypertonicity

Answer 22

Increase in muscle tone
Increased resistance to passive movement and an increased stretch reflex response
Loss of supraspinal inhibition to the spinal cord

Question 23

Hypertonicity seen in patients with:

Answer 23

Spinal cord injury
Traumatic brain injury
Multiple sclerosis
Cerebral palsy

Question 24

Spasticity

Answer 24

velocity-dependent resistance to passive movement
Typically stronger in one direction over another
Versus rigidity (rigidity is NOT velocity or direction dependent)

Question 25

Fractionated Movement Deficits

Answer 25

Inability to make isolated movements Associated with CNS dysfunction Damage to the corticospinal system resulting in decreased ability to selectively activate muscles

Question 26

Motricity Index

Answer 26

Provides a standard MMT score that is objective | Uses standard MMT of 3 specific UE and 3 specific LE segments

Question 27

Motricity Index UE segments:

Answer 27

shoulder abduction, elbow flexion, pinch grip

Question 28

Motricity Index LE segments:

Answer 28

hip flexion, knee extension, ankle dorsiflexion

Question 29

Modified Ashworth Scale

Answer 29

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

Question 30

Finger-Thumb Opposition

Answer 30

Patient is asked to touch the thumb to the tips of each finger rapidly Assesses fractional movement deficits

Question 31

Finger-to-Nose Test

Answer 31

Patient is asked to touch the examiner’s finger then touch his or her own nose about 10 times rapidly Assesses ataxia

Question 32

Perceptual deficits in sit to stand:

Answer 32

shifts toward weaker side, pushes away from midline, resist correction to midline

Question 33

Hypokinesia in sit to stand

Answer 33

limited or slow preparatory movements, falls if support is moved, freezes during attempt

Question 34

Lyle’s decision rule with action arm reach test:

Answer 34

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

Question 35

Canadian Occupational Performance Measure

Answer 35

Used to detect change in clients self-perception of occupational performance over time in the areas of self-care, productivity, and leisure

Question 36

FIM scale

Answer 36

Used to assess functional mobility | Most used in inpatient rehab facilities

Question 37

FIM scoring

Answer 37

Scores range from 18 (lowest) to 126 (highest) indicating level of function

Question 38

FIM dimensions:

Answer 38

``` Eating Grooming Bathing Upper body dressing Lower body dressing Toileting Bladder management Bed to chair transfer Toilet transfer Shower transfer ```

Question 39

Reintegration to Normal Living Index

Answer 39

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”

Question 40

3 key questions to guide rehab prognosis and treatment

Answer 40

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?

Question 41

Motor Learning

Answer 41

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

Question 42

Best way to promote functional recovery?

Answer 42

Multiple studies have shown that task-specific activities are the best way to promote functional recovery

Question 43

Age-Related Changes for muscle Performance:

Answer 43

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

Question 44

Muscle Protein Synthesis

Answer 44

Stimulated by feeding and resistance exercise Stimulated 40-100% over resting rate with exercise For improvements, synthesis must exceed muscle protein breakdown

Question 45

Protein Requirements in Elderly

Answer 45

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

Question 46

Frailty:

Answer 46

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

Question 47

Frail Elderly Exercise Prescription

Answer 47

3x/week 3 sets of 8-12 reps Start 20% 1RM, progress to 80% of 1RM No adverse events/injuries reported

Question 48

Program 1 Volume considerations:

Answer 48

1 RM = 50 pounds leg press 3 sets of 8, 3x/week, 10 pounds (20% 1 RM) Total volume = 720

Question 49

Program 2 Volume Considerations

Answer 49

1 RM = 50 pounds leg press 3 sets of 8, 1x/week, 30 pounds (60% 1RM) Total volume = 720

Question 50

Where to start frail elderly resistance training?

Answer 50

20% 1 RM