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Neuro Rehab 1 > Impairment Oriented Neuro Exam II > Flashcards

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
Q

what are examples medical management of spasticity

A

meds
injections
surgery

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25
Q

what are you looking for / examining when implementing medical management interventions for spasticity

A

effects of dec tone on function
- find a good balance

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26
Q

main difference between medical management and PT management for spasticity

A

medical management has lasting effects
PT is temporary effects

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27
Q

what is rigidity

A

inc resistance through range and is not velocity dependent
- usually seen in both agonist and antagonist ms groups

28
Q

what cases do you typically see rigidity in

A

basal ganglia lesions
- ex: Parkinsons Disease

29
Q

cogwheel vs lead pipe rigidity

A

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
Q

what are interventions for rigidity

A

splinting - maintain, don’t let get worse
positioning

31
Q

what neurological injuries often present with a decerebrate rigidity

A

lesion of reticular nuclei in MEDULLA
- loss of inhibitory control of cortex and basal ganglia

32
Q

what does decerebrate rigidity look like

A

ext head and neck, UE, LE
ankles in PF
wrist/fingers flexed or fisted

33
Q

what neurological insults often present with a decorticate rigidity

A

severe cerebral injury above red nucleus and basal ganglia
- higher up than decerebrate (medulla level)

34
Q

what does decorticate rigidity look like

A

UE flex
LE ext
ankle PF

35
Q

which is worse: decerebrate or decorticate?

A

decerebrate is worse
- pts can progress from decerebrate to decorticate and it might indicate improving

36
Q

what is dystonia

A

involuntary ms contractions/spasms
- fluctuating inc tone in one or multiple ms groups

37
Q

what can dystonia look like bc of its etiology

A

repetitive twisting or writhing motions and abnormal postures

38
Q

what causes dystonia

A

unknown
- may be genetic, acquired, idiopathic, SE of meds (ex: antipsychotics)

39
Q

what are interventions for dystonia

A

music
PT to avoid sedentary lifestyle

40
Q

what cases are hypotonia associated with

A

LMNL
UMNL

chromosomal abnormalities and genetic disorders (ex: down syndrome)

41
Q

where are LMNL found specifically which cause hypotonia

A

anterior horn cell
peripheral nerve injury

42
Q

what specific UMNL can cause hypotonia

A

acute and transient d/t cerebral or spinal shock

cerebellar lesions

43
Q

what are clinical manifestations of hypotonia

A

reduced resistance to passive stretch
reduced DTRs

poor posture
weakness
dec function
hyperextensibility
altered joint integrity
pain
neurogenic atrophy

44
Q

what is a common injury that presents when there is altered joint integrity d/t hypotonia

A

passive shoulder dislocations/subluxations
- tone of delt and biceps dec and humerus sinks bc of shallow joint

45
Q

what is the examination process for observing muscle tone

A

posture and body position

muscle bulk
- hypotonic&raquo_space; less definition
- hypertonic&raquo_space; well defined

46
Q

what is the examination process for palpating muscle tone

A

hypotonic&raquo_space; loose, squishy
hypertonic&raquo_space; taut, hard

47
Q

to examine a person’s muscle tone, what are the steps

A

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
Q

what are the possible findings when interpreting results from an exam of muscle tone

A

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
Q

what is the next step if you find that hypertonicity is detected upon a muscle tone clinical exam

A

further assess to determine if spasticity or rigidity present

50
Q

you detected hypertonicity in your clinical exam, how do you assess for spasticity

A

quick stretch&raquo_space; inc amt of resistance to passive movement
- usually unidirectional

test for presence of clonus
further assessment via modified ashworth or tardieu

51
Q

you detected hypertonicity in your clinical exam, how do you assess for rigidity

A

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
Q

what are the grades for the modified ashworth scale

A

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
Q

how is the tardieu scale conducted

A

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
Q

how are responses interpreted/recorded for the tardieu scale

A

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
Q

what are the grades of Y for the Tardieu Scale

A

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
Q

what are deep tendon reflexes (DTRs)

A

involuntary, predictable, specific response to stimulus

57
Q

what is a deep tendon reflex a result of

A

stretch-sensitive IA afferents of muscle spindle producing muscle contraction (reflex arc)

58
Q

DTR: in UMN vs LMN syndromes

A

UMN syndrome: inc DTRs associated w hypertonicity

LMN syndrome: dec DTRs associated w hypotonicity

59
Q

what are common sites of DTR and corresponding innervations

A

jaw (CN V)
biceps (C5-6)
triceps (C6-7)
patellar (L2-4)
achilles (S2)

60
Q

what is the scale which assess DTRs

A

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
Q

what are two pathological reflexes

A

babinski
hoffman

62
Q

what are babinski and hoffman reflexes indicative of

A

UMNL

63
Q

what is the Babinski reflex

A

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
Q

what does a positive Hoffman’s indicate

A

hyper reflexia / UMNL

65
Q

how do you test for a Hoffman’s reflex

A

hold hand w wrist slightly ext and fingers partially flex
- hold middle finger in ext, stabilize DIP
- flick nail of middle finger

66
Q

what are a negative and positive response to the Hoffman’s reflex test

A

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
Q

while subtle, when is testing for a Hoffman’s reflex helpful

A

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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