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Impairment Oriented Neuro Exam II Flashcards

1
Q

what are 3 ways that muscle tone is defined

A
  1. measure of tension in muscle at rest
  2. resistance of ms to passive elongation or stretch
  3. slight residual contraction or steady-state contraction at rest in neurotypical people
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2
Q

why do we want our muscles to maintain a slight residual contraction at rest

A

allows you to initiate any movement immediately
- without this, there would be a delay to movements - like starting a car vs car is idling

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3
Q

what does muscle tone support functionally

A

posture

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4
Q

what is an important function that muscle tone provides

A

provides reflexive, energy efficient base for movement

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5
Q

what is muscle tone influenced by (2)

A
  1. intrinsic mechanical or elastic properties of ms and connective tissue
  2. reflex ms contractions / tonic stretch reflex of intrafusal fibers
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5
Q

what is muscle tone influenced by (2)

A
  1. intrinsic mechanical or elastic properties of ms and connective tissue
  2. reflex ms contractions / tonic stretch reflex of intrafusal fibers
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6
Q

what tracts are involved in muscle tone

A

motor
- reticulospinal
- vestibulospinal
- rubrospinal
- corticospinal

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7
Q

what are the two main categories of atypical muscle tone

A

hypertonia
hypotonia

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8
Q

what is hypertonia and what is the common cause

A

inc tone
UMNL (brain or SC)

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9
Q

what is hypotonia and what are causes of this

A

dec tone

LMNL
acute UMNL
cerebellar lesions

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10
Q

what is the physiology behind and clinical presentation of hypertonia (3)

A

inc excitability of alpha motor neurons

associated w inc DTRs

enhanced excitatory synaptic input
- muscle spindle
- GTO

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11
Q

what are two specific types of hypertonia

A

spasticity
rigidity

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12
Q

what is spasticity

A

involuntary, VELOCITY DEPENDENT, inc resistance to passive elongation

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13
Q

what cases do you typically see spasticity in

A

pyramidal tract lesions
- CP
- CVA
- MS
- TBI

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14
Q

what is the clasp-knife phenomenon associated with spasticity

A

strong resistance to initial passive movement followed by a releases of resistance

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15
Q

what is clonus

A

cyclical, spasmodic alternating ms contraction (aka beating) in response to sustained stretch

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16
Q

where is clonus typically seen and why is this significant

A

at ankle when achilles on stretch
- makes walking difficult bc of elongation in terminal stance

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17
Q

what are negative impacts of spasticity (in general terms)

A

secondary impairments
activity limitations

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18
Q

what are secondary impairments typically seen in patients w spasticity

A

contractures
issues at joint itself
skin breakdown

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19
Q

what activity limitations do you typically see in patients w spasticity

A

difficulty walking / exercises
hard to participate in ADLs overall

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20
Q

what are positive impacts of spasticity

A

passive postural support

may contribute to function in presence of reduced motor control
- ex: extensor tone in standing

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21
Q

what are exacerbating factors of spasticity

A

infections
pressure sores
DVT

other factors: temp, fatigue, positioning, bladder distention, bowel impaction

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22
Q

describe PT management of spasticity

A

procedural interventions:
- modalities (heat, ice, estim)
- positioning, stretching, splinting, casting
- RRo and deep pressure

TEMPORARY EFFECT

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23
Q

why would we want to modify spasticity tone if the effect is temporary

A

pain relief
improve QOL/function
keep activating ms
keep joint integrity
prevent contractures
prevent condition from getting worse

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24
what are examples medical management of spasticity
meds injections surgery
25
what are you looking for / examining when implementing medical management interventions for spasticity
effects of dec tone on function - find a good balance
26
main difference between medical management and PT management for spasticity
medical management has lasting effects PT is temporary effects
27
what is rigidity
inc resistance through range and is not velocity dependent - usually seen in both agonist and antagonist ms groups
28
what cases do you typically see rigidity in
basal ganglia lesions - ex: Parkinsons Disease
29
cogwheel vs lead pipe rigidity
cogwheel - stops, releases for a second and then catches again - pushing through a beating lead pipe - not moving, can't break a lead pipe
30
what are interventions for rigidity
splinting - maintain, don't let get worse positioning
31
what neurological injuries often present with a decerebrate rigidity
lesion of reticular nuclei in MEDULLA - loss of inhibitory control of cortex and basal ganglia
32
what does decerebrate rigidity look like
ext head and neck, UE, LE ankles in PF wrist/fingers flexed or fisted
33
what neurological insults often present with a decorticate rigidity
severe cerebral injury above red nucleus and basal ganglia - higher up than decerebrate (medulla level)
34
what does decorticate rigidity look like
UE flex LE ext ankle PF
35
which is worse: decerebrate or decorticate?
decerebrate is worse - pts can progress from decerebrate to decorticate and it might indicate improving
36
what is dystonia
involuntary ms contractions/spasms - fluctuating inc tone in one or multiple ms groups
37
what can dystonia look like bc of its etiology
repetitive twisting or writhing motions and abnormal postures
38
what causes dystonia
unknown - may be genetic, acquired, idiopathic, SE of meds (ex: antipsychotics)
39
what are interventions for dystonia
music PT to avoid sedentary lifestyle
40
what cases are hypotonia associated with
LMNL UMNL chromosomal abnormalities and genetic disorders (ex: down syndrome)
41
where are LMNL found specifically which cause hypotonia
anterior horn cell peripheral nerve injury
42
what specific UMNL can cause hypotonia
acute and transient d/t cerebral or spinal shock cerebellar lesions
43
what are clinical manifestations of hypotonia
reduced resistance to passive stretch reduced DTRs poor posture weakness dec function hyperextensibility altered joint integrity pain neurogenic atrophy
44
what is a common injury that presents when there is altered joint integrity d/t hypotonia
passive shoulder dislocations/subluxations - tone of delt and biceps dec and humerus sinks bc of shallow joint
45
what is the examination process for observing muscle tone
posture and body position muscle bulk - hypotonic >> less definition - hypertonic >> well defined
46
what is the examination process for palpating muscle tone
hypotonic >> loose, squishy hypertonic >> taut, hard
47
to examine a person's muscle tone, what are the steps
passively elongate the muscle/muscle groups being tested - position: supine to start - manual contact: over bony prominences - limb well supported - ask ab pain - instruct person to relax and not resist/assist - PROM thru entire available range avoid end feel
48
what are the possible findings when interpreting results from an exam of muscle tone
normal: limb easily moved, direction changes easily, responsive, light feeling hypotonic: easy to move, little resistance, floppy, heavy hypertonic: inc resistance to movement, stiff
49
what is the next step if you find that hypertonicity is detected upon a muscle tone clinical exam
further assess to determine if spasticity or rigidity present
50
you detected hypertonicity in your clinical exam, how do you assess for spasticity
quick stretch >> inc amt of resistance to passive movement - usually unidirectional test for presence of clonus further assessment via modified ashworth or tardieu
51
you detected hypertonicity in your clinical exam, how do you assess for rigidity
amt of resistance doesn't change w velocity of stretch - bidirectional test for presence of lead pipe vs. cogwheel no standardized tests or measures (just describe)
52
what are the grades for the modified ashworth scale
0 - no inc in ms tone 1 - slightly inc in ms tone, catch or minimal resistance at end of ROM when affected part(s) moved in flex or ext 1+ - slight inc in ms tone, catch followed by minimal resistance throughout the remainder (less than half) of ROM 2 - more marked inc in ms tone thru most of ROM but affected part(s) easily moved 3 - considerable inc in ms tone, passive movement difficult 4 - affected part(s) rigid in flex or ext 9 - unable to test
53
how is the tardieu scale conducted
measurements take place at 3 velocities V1 = slow as possible, slower than natural drop of limb under gravity V2 = speed of limb falling under gravity V3 = fast of possible, faster than rate of natural drop of limb under gravity
54
how are responses interpreted/recorded for the tardieu scale
responses are recorded at each velocity as X/Y Y - indicates 0-5 rating X - indicates degree of angle at which muscle reaction occurs
55
what are the grades of Y for the Tardieu Scale
0 - no resistance throughout course of passive movement 1 - slight resistance throughout course of passive movement, no clear catch at a precise angle 2 - clear catch at precise angle, interrupting the passive movement, followed by release 3 - fatigable clonus w <10sec when maintaining pressure and appearing at precise angle 4 - clonus >10sec when maintaining pressure and appearing at precise angle 5 - joint is immovable
56
what are deep tendon reflexes (DTRs)
involuntary, predictable, specific response to stimulus
57
what is a deep tendon reflex a result of
stretch-sensitive IA afferents of muscle spindle producing muscle contraction (reflex arc)
58
DTR: in UMN vs LMN syndromes
UMN syndrome: inc DTRs associated w hypertonicity LMN syndrome: dec DTRs associated w hypotonicity
59
what are common sites of DTR and corresponding innervations
jaw (CN V) biceps (C5-6) triceps (C6-7) patellar (L2-4) achilles (S2)
60
what is the scale which assess DTRs
0 - no response, always abnormal 1+ slight but definitely present response - may or may not be normal 2+ normal, typical reflex 3+ brisk response - may or may not be normal 4+ very brisk, always abnormal
61
what are two pathological reflexes
babinski hoffman
62
what are babinski and hoffman reflexes indicative of
UMNL
63
what is the Babinski reflex
PT strokes foot from heel up lateral side to MT heads normal: normal plantar response (toes flex) abnormal: extensor plantar response - toes fan up
64
what does a positive Hoffman's indicate
hyper reflexia / UMNL
65
how do you test for a Hoffman's reflex
hold hand w wrist slightly ext and fingers partially flex - hold middle finger in ext, stabilize DIP - flick nail of middle finger
66
what are a negative and positive response to the Hoffman's reflex test
negative: - sudden flexion of DIP and then release - eliciting stretch reflex of finger flexors positive: - flex and ADD of thumb and index finger (possibly other fingers too)
67
while subtle, when is testing for a Hoffman's reflex helpful
in dx where not seeing typical signs - ex: MS - can have both peripheral and central lesions

Neuro Rehab 1 (27 decks)

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