Lecture 5 Neuromotor Flashcards by Charlene Enriquez

What are the 3 sections of the Glasgow coma scale

Eye opening
Motor response
Verbal response

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What are the score ranges for the Glasgow coma scale

Score range from 3-15

Less than 8 indicates coma

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GCS eye opening grade

1 = none
2= to pain
3= to speech
4= spontaneous

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GCS motor response grading

1= none
2= extension UE LE
3= flexor response
4= withdrawal
5= localizes pain
6= obeys commands

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GCS verbal response grading

1= none
2= incomprehensible
3= inappropriate
4 = confused
5= oriented

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What is the population for ranchos los amigos

TBI

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Name all 8 sections of the ranchos los amigos scale

No response
Generalized response
Localized response
Confused and agitated
Confused and inappropriate
Confused and appropriate
Autonomic and appropriate
Purposeful and appropriate

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What is the clasp knife response

Occur during rapid movement
Spastic catch (high resistance) followed by sudden inhibition (relaxation) in response to a stretch stimulus

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What is the modified ashworth scale (MAS) for

Used to assess muscle spasticity

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What is the range for the MAS

6 point scale
Range 0-4

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Equipment needed for the MAS

Mat / plinth

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Population tested for the MAS

Adults and children with CNS lesion
Cerebral palsy
MS
Pediatric hypertonia
SCI
CVA
TBI

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What are the limitations for the MAS

Inability to detect small changes in
Inability to distinguish btw soft tissue viscoelastic and neural changes
Problems with psychometric properties (unequal distance of scores) - not on set intervals

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What does a grade 0 mean for MAS

No increase in muscle tone

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What does a grade 1 mean for MAS

Slight increase in muscle tone
Manifested by a catch and release or by minimal resistance at the end of the ROM when affected part(s) is moved in flexion or extension

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What does a grade of 1+ mean for MAS

Slight increase in muscle tone
Manifested by catch
Followed by minimal resistance throughout the remainder (less than half) of the ROM

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What does a grade 2 mean for the MAS

More marked increase in muscle tone through most of the ROM but affected parts easily moved

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What does a grade 3 mean for MAS

Considerable increase in muscle tone passive movement difficult

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What does a grade 4 mean for MAS

Affected part(s) rigid in flexion or extension

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What are the DTR rating scale

0 = no reflex
1+ = minimal or depressed response
2+ = normal response
3+ = overly brisk response
4+ = extremely brisk response with clonus

*** Drastic change if there’s is a 2 level difference **

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What does a positive Babinski test indicate

UMN lesion

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Wha are the normal and abnormal responses for Babinski

Normal = no reaction or flexion of the toes
Abnormal = great toe extends and other toes splay

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(T/F) Babinski test should be performed bilaterally

True

(T/F) in infants, flexion is a normal Babinski response

False its extension

What are the normal and abnormal responses for a Hoffman test

Normal = no reaction from the thumb or other fingers Abnormal = thumbs flexes and ADDucts and other fingers flex Perform test bilaterally

What are the cranial nerves

Oh oh oh to touch and feel very good vagina so heavenly 1. Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Vestibularcochlear 9. Glossopharyngeal 10. Vagus 11. Spinal/accesory 12. Hypoglossal

Where to beginning to test proprioception

Begin dismally at DIPS Work proximally through each joint

What does the 9 hole peg test measure

Measures fine motor control

Population tested for the 9 hole peg test

Healthy subjects Brain injury Stroke Parkinson’s disease

How to start the 9 hole peg test

Both hands will be tested, dominant hand first Stop watch starts when the patient touches the first peg Stop watch stops when the patient places the last peg back in the container

What is the dizziness handicap inventory

Evaluate the self perceived handicapping effects imposed by dizziness

How many items does the dizziness handicap inventory consist of

25 items - self reported questionnaire

What are the 3 domains for the dizziness handicap inventory

1. Functional (9 questions, 36 points) 2. Emotional (9 questions, 36 points) 3. Physical (7 questions, 28 points)

How is the dizziness handicap inventory graded

Answers are grade 0 (no), 2 (sometimes), and 4 (yes) Items scores are summed Ranges from 0-100

What does a high score mean for the dizziness handicap inventory

Higher score indicates higher perceived handicap due to dizziness

What is mild, moderate, and severe grades for the dizziness handicap inventory

Mild = 0-30 Moderate = 31- 60 Severe = 61-100

What are the levels of consciousness (LOC) (starting from conscious to coma)

Full consciousness Confusion Lethargy Obtunded Stupor Coma

What is tone

The resistance of muscle to passive elongation or stretch

What is spasticity

Manifestation of hypertonicity in which the resistance to PROM is rate or velocity dependent Usually a sign of UMN lesion

Examiners use what kind of motion to evaluate spasticity

Passive motion

Why do we screen deep tendon reflexes? (DTR)

Diagnose central (UMN) vs peripheral (LMN) disorders

(T/F) tendon should be tested on slight stretch

True

For the biceps brachial tendon, what is the primary/contributing nerve root and expected response for DTR

C5 / C6 (contributing) Expected response = elbow flexion

For the brachioradialis, what is the primary/contributing nerve root and expected response for DTR

C6 / C5 (contributing) Expected: Elbow flexion

For the triceps, what is the primary/contributing nerve root and expected response for DTR

C7 / C6 (contributing) Expected: elbow extension

For the patella, what is the primary/contributing nerve root and expected response for DTR

L4 / L2,L3 (contributing) Expected: knee extension

For the Achilles , what is the primary/contributing nerve root and expected response for DTR

S1 / S2 (contributing) Expected: ankle plantar flexion

Hypertonic DTR is a pathological sign to what?

The CNS

What is flexor withdrawal reflex

Secondary pathological response occurs if patient reflexively withdraws the foot by flexing hip and knee when the plantar surface of the foot is stroked

What is face validity

Test appears to measure what it says Subjective Ex: numeric pain scale - straightforward

What is Content validity

Test fully represents the domain it intends to measure Ex: berg balance

What is construct validity

Test accurately measures a theoretical concept Ex: TUG w/ gait speed, LE strength and fall risk = all theorectical for mobility

What is criterion validity

Test results align with “gold standard” Ex: 6MWT measures VO2 max = measures accuracy

What is concurrent validity

Specific type of criterion validity, results correlate with another establish measure at the same time Ex: 10 meter walk test and 6MWT both assess functional walking ability results correlate when measures IN THE SAME SESSION

What is predictive validity

Test predicts future outcomes of behavior Ex: berg - lower score are highly correlated with future risk of falling