M1-L10: Ax Neurological - Movement Disorders Flashcards
What are the ICF body functions and structures in the neurological assessment item?
What is a deep tendon reflex (DTR)?
- Monosynaptic stretch reflex
- Same mechanism in children as adults
How can Deep Tendon Reflex be tested in older children?
Test using tendon hammer in older children.
How can Deep Tendon Reflex be tested in infants?
Can use finger tips for small infant muscles.
- Just use 3 fingers but still be firm
In a baseline assessment, what are 4 Deep Tendon Reflexes (DTR) that should typically be tested?
- Quads
- Gastrocs
- Biceps Brachii
- Brachioradialis
What does a brisk reflex in the Deep Tendon Reflex (DTR) mean?
hyper-reflexia
- Often seen with high tone
What does a reduced reflex in the Deep Tendon Reflex (DTR) mean?
hypo-reflexia
- Seen with low tone or flaccid paralysis
What happens when there is no response in the Deep Tendon Reflex (TDR)?
No response = try again (relaxed position), get hands pulling apart/clench teeth/ stress balls to raise tone (Gentracic maneouvre)
What is spasticity?
A motor disorder characterised by velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex, as one component of the UMN syndrome
What are 3 features that spasticity is sinificantly influenced by?
- the testing posture,
- the initial length from which the muscle is stretched
- as well as any sensory [or emotional] stimulation
4.
What are 2 pathological mechanism of spasticity?
- Brain or Spinal Cord Injury
- Loss of central inhibition of the spinal reflex arcs, resulting in hyper-excitability of primary motor neurons that are activated by inputs which otherwise would not provoke a response and so result in inappropriate co-activation of muscles
- Segmental hyper-excitability
- Increased reflex sensitivity at the segmental level of the spinal cord -modulated by a complex interaction of varying supraspinal inputs
What is the pathological mechanism of CNS/spinal cord for spasticity?
How is spasticity tested in assessment?
- Move limb passively through ROM at range of velocities
- Slow velocity may not evoke an abnormal reflex
- Abnormal response appears as velocity increases
What are 7 features of increasing spasticity in the assessment (what does it feel like)?
What is the implication of kids with spasticity over a long period of time?
Kids with spasticity over long periods of time will have CONTRACTURE (MSK vs Neurological)
WHat is the criterion validity in spasticity assessment?
Test compliance with concept of spasticity
What are the 3 standarisation in the validity of spasticity assessment?
- Movement velocities
- Testing posture
- Quantification of spasticity
What are 2 features of clarityin scoring systems in the validity of spasticity assessment?
- Scaling
- Terminology
What is the clinical applicability in the validity of spasticity assessment?
Time required to complete testing
Is the orginal scale in Ashworth Scale valid? Why?
Original scale is not valid
Grades the resistance encountered in a specific muscle group by means of passively moving the limb through its ROM
- Not appropriate unless 2 speeds used
When is the Ashworth Scale valid? Why?
Modified Ashworth Scales
- Most have non-specified velocity
- Modified Ashworth – Peacock
- Modified Ashworth – Bohannon
May be valid if 2 speeds used
- NYU Tone Scale -includes slow & fast speeds
- Some others retrospectively modified to add slow and fast speeds
- Still not the preferred scale
What is the Ashworth Scale?
What is the Tardieu (or Held) Scale? What are the 3 things it assesses?
- Passively move the joint at 3 velocities (V1-°©3)
- As slow as possible
- At speed of limb fall under gravity
- As fast as possible
- Rate the intensity and duration of the muscle reaction to stretch (X0-4)
- 0 No reflex
- 1 Only visible contraction
- 2 Contraction with a short catch
- 3 Contract few sec / fatigable clonus (< few sec)
- 4 Contract >few sec / infatigable clonus (>few sec)
- Record the joint angle (Y) where muscle reaction is first felt
What is the Modified Tardieu (or Held) Scale? What are the 3 things it assesses?
- Passively move the joint at 2 velocities (V1 + V3)
- As slow as possible
- As fast as possible
- Sometimes miss speed 2 (if not enough time also this speed is harder to be reliable)
- Rate the intensity and duration of the muscle reaction to stretch (X0-°©4)
- 0 No reflex
- 1 Only visible contraction
- 2 Contraction with a short catch
- 3 Contract few sec / fatigable clonus (< few sec)
- 4 Contract >few sec / infatigable clonus (>few sec)
- Record the joint angle (Y) where muscle reaction is first felt
What are the normal popliteal angle for children aged 1-5+ years old?
What is the static and dynamic (spastic) contracture?
PRAC EXAM QUESTION
What are the LL test positions in the MTS?
What is the dirstibution in the ACPR form?
What are the 3 distributions in clinical observation of spasticity?
- Often more evident proximally
- Reduced movement in affected parts
- No involuntary movements in severely affected parts
What are the 3 secondary effects in clinical observation of spasticity?
- Contractures towards mid position
- Balance reactions affected
- Functional problems e.g.: drinking
- Emotion – frightened by movement
What are 5 factors proposed to increase spasticity?
- Use of spasticity to move
- Associated reactions
- Lack of movement
- Stimulation (internal and external)
- Repetition of movements within the pattern of spasticity
What are 3 types of dyskinesias?
- Dystonia
- Athetosis
- Chorea
What is dyskinesia?
A motor disorder characterized by changes in muscle tone and posture, with a varying element of involuntary movement
What is dyskinesia caused by?
Caused primarily by damage to the basal ganglia
What is dystonia?
Movement disorder - in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both
- More excited/arousal –> more contractions
What is dystonia caused by?
Caused by damage (usually hypoxic–ischemic injury) to the basal ganglia, thalamus, brainstem and/or cerebellum during the prenatal, perinatal, or infantile period
- Cause not well known, but some element of genetic pre-disposition and environmental factors)
Dystonia may be triggered by ______ movement and may overflow into other muscles and can be _____ .
voluntary; painful
Why are people with dystonia quite lean?
High metabolism due to high energy consumption = weight (quite lean)
What is athetosis?
Slow, continuous, involuntary, writhing movements that prevents a stable posture from being maintained
Where is athetosis often seen?
Often seen in the fingers, hands, toes, and
feet and in some cases, arms, legs, neck
and tongue
What is athetosis caused by?
Caused by lesions to the basal ganglia (corpus striatum - which controls movement in relation to motivation – i.e. decision to make, or to suppress a movement) or thalamus
What are the 2 most common causes of athetosis in children?
- intranatal asphyxia
- neonatal jaundice(hyperbilirubinemia)
What is chorea?
(=Greek ‘dancing’) -°© quick, involuntary movements of the feet or hands
an ongoing random appearing sequence of one or more discrete involuntary movements or movement fragments
What is chorea caused by?
In most forms of chorea, an excess of dopamine, the main neurotransmitter used in the basal ganglia, prevents the basal ganglia from functioning normally.
In children, _____ and _____ occur together most often. This is called______.
chorea; athetosis; Choreoathetosis
What are the 2 characteristics of the Hypertonia Assessment Tool?
- Use to identify dystonia v spasticity
- Most important items 1 & 2
What are 6 tools identified in the Dyskinesia Rating Scales?
- Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS)
- Barry Albright Dystonia Scale (BAD) – most common, best for clinic
- Unified Dystonia Rating Scale (UDRS)
- Movement Disorder Childhood Rating Scale (MD-CRS)
- Movement Disorder Childhood Rating Scale for 0 – 3 years (MD-CRS 0-3)
- Dyskinesia Impairment Scale (DIS) – most thorough, best for CP register
What are 2 main tools identified in the Dyskinesia Rating Scales?
- Barry Albright Dystonia Scale (BAD) – most common, best for clinic
- Very short and only covers dystonia
- Dyskinesia Impairment Scale (DIS) – most thorough, best for CP register
- Covers all types of movement disorders
What are the 5 types of ratings in the Dyskinesia Rating Scales?
- Movement severity
- 0 = none;; 1 = slight;; 2 = mild;; 3 = moderate;; 4 = severe
- Movement trigger
- 0 = none;; 1 = on particular action;; 2 = on many actions;; 3 = on action of distant body part/intermittently at rest;; 4 = present at rest
- Movement duration
- 0 = none;; 0.5 or 1 = Occasional (<25% of time);; 1.5 or 2 = Intermittent (25-50%); 2.5 or 3 = Frequent (50-ˇ75%); 3.5 or 4 = Constant (>75%)
- Movement range / extent
- 0 = none;; 1 = mild (<25% ROM);; 2 = moderate (25-50% ROM);; 3 = severe (50-ˇ75% ROM);; 4 = extreme (>75% ROM)
- Disability impact
- 0 = normal;; 1 = slight but independent;; 2 = some ability/needs some help;; 3 = marked difficulty/requires help;; 4 = completely dependent
What is the Barry Albright Dystonia Scale?
- Most simple scale
- Best for use in a busy clinic where repeated measures are needed
