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PHTY3130 M1 > M1-L10: Ax Neurological - Movement Disorders > Flashcards

M1-L10: Ax Neurological - Movement Disorders Flashcards

1
Q

What are the ICF body functions and structures in the neurological assessment item?

A
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2
Q

What is a deep tendon reflex (DTR)?

A
  1. Monosynaptic stretch reflex
  2. Same mechanism in children as adults
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3
Q

How can Deep Tendon Reflex be tested in older children?

A

Test using tendon hammer in older children.

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4
Q

How can Deep Tendon Reflex be tested in infants?

A

Can use finger tips for small infant muscles.

  • Just use 3 fingers but still be firm
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5
Q

In a baseline assessment, what are 4 Deep Tendon Reflexes (DTR) that should typically be tested?

A
  1. Quads
  2. Gastrocs
  3. Biceps Brachii
  4. Brachioradialis
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6
Q

What does a brisk reflex in the Deep Tendon Reflex (DTR) mean?

A

hyper-reflexia

  • Often seen with high tone
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7
Q

What does a reduced reflex in the Deep Tendon Reflex (DTR) mean?

A

hypo-reflexia

  • Seen with low tone or flaccid paralysis
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8
Q

What happens when there is no response in the Deep Tendon Reflex (TDR)?

A

No response = try again (relaxed position), get hands pulling apart/clench teeth/ stress balls to raise tone (Gentracic maneouvre)

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9
Q

What is spasticity?

A

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

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10
Q

What are 3 features that spasticity is sinificantly influenced by?

A
  1. the testing posture,
  2. the initial length from which the muscle is stretched
  3. as well as any sensory [or emotional] stimulation
    4.
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11
Q

What are 2 pathological mechanism of spasticity?

A
  1. 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
  2. Segmental hyper-excitability
    • Increased reflex sensitivity at the segmental level of the spinal cord -modulated by a complex interaction of varying supraspinal inputs
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12
Q

What is the pathological mechanism of CNS/spinal cord for spasticity?

A
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13
Q

How is spasticity tested in assessment?

A
  • Move limb passively through ROM at range of velocities
  • Slow velocity may not evoke an abnormal reflex
  • Abnormal response appears as velocity increases
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14
Q

What are 7 features of increasing spasticity in the assessment (what does it feel like)?

A
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15
Q

What is the implication of kids with spasticity over a long period of time?

A

Kids with spasticity over long periods of time will have CONTRACTURE (MSK vs Neurological)

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16
Q

WHat is the criterion validity in spasticity assessment?

A

Test compliance with concept of spasticity

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17
Q

What are the 3 standarisation in the validity of spasticity assessment?

A
  1. Movement velocities
  2. Testing posture
  3. Quantification of spasticity
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18
Q

What are 2 features of clarityin scoring systems in the validity of spasticity assessment?

A
  1. Scaling
  2. Terminology
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19
Q

What is the clinical applicability in the validity of spasticity assessment?

A

Time required to complete testing

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20
Q

Is the orginal scale in Ashworth Scale valid? Why?

A

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
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21
Q

When is the Ashworth Scale valid? Why?

A

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
22
Q

What is the Ashworth Scale?

A
23
Q

What is the Tardieu (or Held) Scale? What are the 3 things it assesses?

A
  1. Passively move the joint at 3 velocities (V1-°©3)
    1. As slow as possible
    2. At speed of limb fall under gravity
    3. As fast as possible
  2. 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)
  3. Record the joint angle (Y) where muscle reaction is first felt
24
Q

What is the Modified Tardieu (or Held) Scale? What are the 3 things it assesses?

A
  1. Passively move the joint at 2 velocities (V1 + V3)
    1. As slow as possible
    2. As fast as possible
    • Sometimes miss speed 2 (if not enough time also this speed is harder to be reliable)
  2. 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)
  3. Record the joint angle (Y) where muscle reaction is first felt
25
Q

What are the normal popliteal angle for children aged 1-5+ years old?

A
26
Q

What is the static and dynamic (spastic) contracture?

PRAC EXAM QUESTION

A
27
Q

What are the LL test positions in the MTS?

A
28
Q

What is the dirstibution in the ACPR form?

A
29
Q

What are the 3 distributions in clinical observation of spasticity?

A
  1. Often more evident proximally
  2. Reduced movement in affected parts
  3. No involuntary movements in severely affected parts
30
Q

What are the 3 secondary effects in clinical observation of spasticity?

A
  1. Contractures towards mid position
  2. Balance reactions affected
  3. Functional problems e.g.: drinking
  4. Emotion – frightened by movement
31
Q

What are 5 factors proposed to increase spasticity?

A
  1. Use of spasticity to move
  2. Associated reactions
  3. Lack of movement
  4. Stimulation (internal and external)
  5. Repetition of movements within the pattern of spasticity
32
Q

What are 3 types of dyskinesias?

A
  1. Dystonia
  2. Athetosis
  3. Chorea
33
Q

What is dyskinesia?

A

A motor disorder characterized by changes in muscle tone and posture, with a varying element of involuntary movement

34
Q

What is dyskinesia caused by?

A

Caused primarily by damage to the basal ganglia

35
Q

What is dystonia?

A

Movement disorder - in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both

  • More excited/arousal –> more contractions
36
Q

What is dystonia caused by?

A

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)
37
Q

Dystonia may be triggered by ______ movement and may overflow into other muscles and can be _____ .

A

voluntary; painful

38
Q

Why are people with dystonia quite lean?

A

High metabolism due to high energy consumption = weight (quite lean)

39
Q

What is athetosis?

A

Slow, continuous, involuntary, writhing movements that prevents a stable posture from being maintained

40
Q

Where is athetosis often seen?

A

Often seen in the fingers, hands, toes, and

feet and in some cases, arms, legs, neck

and tongue

41
Q

What is athetosis caused by?

A

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

42
Q

What are the 2 most common causes of athetosis in children?

A
  1. intranatal asphyxia
  2. neonatal jaundice(hyperbilirubinemia)
43
Q

What is chorea?

A

(=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

44
Q

What is chorea caused by?

A

In most forms of chorea, an excess of dopamine, the main neurotransmitter used in the basal ganglia, prevents the basal ganglia from functioning normally.

45
Q

In children, _____ and _____ occur together most often. This is called______.

A

chorea; athetosis; Choreoathetosis

46
Q

What are the 2 characteristics of the Hypertonia Assessment Tool?

A
  1. Use to identify dystonia v spasticity
  2. Most important items 1 & 2
47
Q

What are 6 tools identified in the Dyskinesia Rating Scales?

A
  1. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS)
  2. Barry Albright Dystonia Scale (BAD) – most common, best for clinic
  3. Unified Dystonia Rating Scale (UDRS)
  4. Movement Disorder Childhood Rating Scale (MD-CRS)
  5. Movement Disorder Childhood Rating Scale for 0 – 3 years (MD-CRS 0-3)
  6. Dyskinesia Impairment Scale (DIS) – most thorough, best for CP register
48
Q

What are 2 main tools identified in the Dyskinesia Rating Scales?

A
  1. Barry Albright Dystonia Scale (BAD) – most common, best for clinic
    • Very short and only covers dystonia
  2. Dyskinesia Impairment Scale (DIS) – most thorough, best for CP register
    • Covers all types of movement disorders
49
Q

What are the 5 types of ratings in the Dyskinesia Rating Scales?

A
  1. Movement severity
    • 0 = none;; 1 = slight;; 2 = mild;; 3 = moderate;; 4 = severe
  2. 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
  3. 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%)
  4. Movement range / extent
    • 0 = none;; 1 = mild (<25% ROM);; 2 = moderate (25-50% ROM);; 3 = severe (50-ˇ75% ROM);; 4 = extreme (>75% ROM)
  5. Disability impact
    • 0 = normal;; 1 = slight but independent;; 2 = some ability/needs some help;; 3 = marked difficulty/requires help;; 4 = completely dependent
50
Q

What is the Barry Albright Dystonia Scale?

A
  1. Most simple scale
  2. Best for use in a busy clinic where repeated measures are needed

PHTY3130 M1 (20 decks)

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