MOD 5: Motor Functioning

Question 1

What are the 3 different types of disabilities associated with motor functioning

Answer 1

1. Congenital (present at or before birth):

Examples: Cerebral palsy, spina bifida, muscular dystrophy.

2. Acquired (present after birth):

Examples: Spinal cord injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, fibromyalgia.

3. Amputation: Loss of a limb or body part impacting motor function.

Question 2

What are the key differences between individuals with congenital vs acquired motor functioning disabilities in terms of physical and psychological factors?

Answer 2

Physical Factors:

Acquired: Individuals may have higher muscle tone and prior physical activity experience, making it easier to regain strength.
Congenital: Likely have lower baseline physical activity levels, making it harder to develop physical skills and strength.

Psychological Factors:

Acquired: May struggle more with rejoining activities, feel loneliness, and compare current performance to pre-injury abilities.
Congenital: Likely more familiar with resources and support systems, as they’ve had access since birth, while those with acquired disabilities may be less aware of available resources.

Access to Resources:

Congenital: Often have long-term rehabilitation teams and access to resources from an early age.
Acquired: May face challenges accessing resources, especially if the disability is acquired in young adulthood (ages 18-21) when pediatric services are no longer available.

Question 3

What is cerebral palsy (CP), and what causes it?

Answer 3

Cerebral palsy is a group of permanent disorders affecting movement and posture, causing activity limitations. It is caused by non-progressive disturbances in the developing fetal brain.

Question 4

What are some common comorbidities associated with cerebral palsy beyond motor dysfunction?

Answer 4

Cerebral palsy is often accompanied by sensory, perceptual, cognitive, communication, and behavioral disturbances, as well as epilepsy and secondary musculoskeletal problems.

Question 5

how does CP affect males vs females

Answer 5

equally

Question 6

cause of CP

Answer 6

Cerebral palsy (CP) results from a series of causal pathways, meaning that there is not one single cause, but rather a combination of factors that lead to the brain disturbances responsible for the condition.

Question 7

symptoms of CP

Answer 7

• Muscle tightness or spasticity
• Involuntary movement
  Disturbance in gross motor skills
• Difficulty with fine motor skills
• Difficulty in swallowing and problems with speech
• Abnormal perception and sensation

Question 8

What are the 3 classifications of CP?

Answer 8

1. Topographical
2. Neuromotor
3. Functional

Question 9

what is the topographical classification of CP comprised of?

Answer 9

categorizes based on what limbs are affected, and how severely

Plegia=paralysis
Paresis= weakened

Quadriplegia: all 4 limbs paralyzed
Diplegia: all 4 limbs involved, both legs more severely affected than arms(legs paralyzed, arms weakened)
Hemiplegia: one side of body is affected, arm usually more impacted(paralyzed) than leg
Triplegia: 3 limbs involved,usually both arms and leg
Monoplegia: only one limb is affected, usually an arm

Question 10

what is affected by a quadriplegic topographical classification ?

Answer 10

all 4 limbs are paralyzed

(plegia=paralysis)

Question 11

what is affected by a diplegia topographical classification ?

Answer 11

all 4 limbs involved, both legs more severely affected than arms(legs paralyzed, arms weakened)

Question 12

what is affected by hemiplegia topographical classification ?

Answer 12

one side of body is affected, arm usually more impacted(paralyzed) than leg

Question 13

what is affected by triplegia topographical classification ?

Answer 13

3 limbs paralyzed,usually both arms and leg

Question 14

what is affected by monoplegia topographical classification ?

Answer 14

only one limb is paralyzed , usually an arm

Question 15

What is the neuromotor classification of CP?

Answer 15

Spastic
- increased muscle tone (hypertonia), causing stiff and jerky movements.
- Increased muscle tone
Stiff limbs

non spastic
- hypotonia
- decreased or fluctuating muscle tone, leading to more involuntary and uncontrolled movements.
- Decreased muscle tone
Loose, floppy limbs

Question 16

What is Spastic (Pyramidal) Cerebral Palsy, and how common is it?

Answer 16

Spastic CP is the most common type, accounting for about 80% of cases.
- involves hypertonia, causing jerky movements and hyperactive stretch reflexes, primarily affecting the flexors and internal rotators.

Question 17

What part of the brain is affected in Spastic (Pyramidal) Cerebral Palsy?

Answer 17

• motor cortex and the pyramidal tract
• leading to hypertonic muscle responses and motor control issues.

Question 18

What are the common symptoms of Spastic (Pyramidal) Cerebral Palsy?

Answer 18

Hypertonic muscles
Jerky movements
Intellectual disability, seizures, and perceptual disorders
Mild to severe spasms
Contractures and bone deformities due to flexors and internal rotators being primarily affected.

Question 19

what is spastic diplegia characterized by

Answer 19

hyper motor issues (jerky movements, spams) primarily in both legs

Question 20

what is the prevalence of non spastic CP, and what are the subtypes

Answer 20

20% of all CP cases

Athetoid(Dyskinetic)(15%)
Ataxia ~ 5% of non-spastic CP cases

Question 21

What areas of the brain are affected in Non-Spastic (Extrapyramidal) Cerebral Palsy?

Answer 21

• basal ganglia or cerebellum

-causing difficulties with movement coordination and control.

Question 22

How does Non-Spastic CP affect muscle tone and movement?

Answer 22

Difficulties in controlling and coordinating movement
* Ability to speak impacted by physical (not intellectual) impairment
* Weakened and unstable muscle tone (hypotonic) + jerky movements
* Slow or fast, often repetitive, and rhythmic
* Involuntary movements (sleep ceases movements; anxiety/stress worsen movements)
* Skills involving coordinated movement affected (e.g., speech, reaching, grasping)

Question 23

How do external factors like stress or anxiety affect individuals with Non-Spastic CP?

Answer 23

Involuntary movements worsen during anxiety or stress but tend to cease during sleep.

Question 24

What kinds of skills are commonly affected in individuals with Non-Spastic CP?

Answer 24

Skills requiring coordinated movement, such as speech, reaching, and grasping, are significantly impacted due to difficulties with muscle control and coordination.

Question 25

What are the key characteristics of Athetoid (Dyskinetic) Cerebral Palsy?

Answer 25

• 15% of non spastic cases

-* Basal Ganglia
* Involuntary muscle tone fluctuations
Stiff and rigid (hyper) to loose and floppy (hypo) movements
Occur in face, neck, hands, legs, torso, and arms
* Aphasia (impairment in language)
* Severe difficulty in head control
Unable to respond to quick movements from others or
movements requiring accuracy

Question 26

What are the main features of Ataxic Cerebral Palsy?

Answer 26

5% of non-spastic CP cases
* Cerebellum
* Balance deficits
Eye movements and depth perception impaired
Nystagmus (involuntary eye movement)
* Hypotonic muscle tone
* Coordinated and precise movements difficult
* Gait strategies (e.g. ataxic gait)
* Mild forms – ‘clumsy and awkward’
* Difficulties with basic motor skills and patterns – gross and fine motor skills
May favor one hand over the other when reaching/grasping

Question 27

whats the difference between ataxic and athetoid CP?

Answer 27

• Location of Injury: Ataxic CP involves the cerebellum, while Athetoid CP involves the basal ganglia.
• Muscle Tone: Ataxic CP is primarily hypotonic; Athetoid CP shows fluctuating muscle tone.
• Movement Patterns: Ataxic CP leads to balance issues; Nystagmus (involuntary eye movement)

Athetoid CP involves involuntary movements, language disorder (aphasia)

Question 28

what is the GMFCS and its 5 classification levels

Answer 28

general motor function classification system(ALIGNED WITH ICF)
Gross motor functioning on the basis of self-initiated
movement
Sitting
Walking
Wheeled mobility
Distinctions between levels depends on:
Functional abilities
Need for assistive devices/technology (independence)
Quality of movement

5 classification levels:
1. Walks without limitations
2. walks with limitations(use railings, mobility device outside of home)
3. Walks w adaptive equipment assistance (brace, wheeled mobility outdoors)
4. self mobility with limitations, likely to be using a manual or powered mobility, able to sit(w support)
5. severe head and trunk control limitaions, require mandatory assisted tech and physical assistance, self mobility via powered wheelchair

Question 29

What types of TREE Strategies would u use if working with an adult who has ataxia CP and who is classified as GMFS Level 2?
This individual is wanting you to create a fitness program that will enhance their strength and endurance for participating in physical activities with their family.

Answer 29

• ataxia CP: non spastic, hypotonic muscle tone, eye movement impaired, difficulty w basic motor skills, clumsiness, atypical walk pattern
  -GMFCS: 2: walks with limitations(railing)

Be better gross movements, due to lower muscle tone
Ataxia: ‘clumsiness’, atypical walk pattern(cant walk in a straight line) due to hyoptonia due to non spastic CP
Teaching: use visual and verbal cues as well as explain it so they understand what theyre expected to do
Rules: do tasks in a certain order, not a standardized scoring based off of how they do it. How they do it is not important, its all so long as they complete the task/activity
equipment/environment: bigger room, railing in room for themto hold if needed, make sure ground is flat

1. Teaching
   Demonstrate Simple Movements: Show basic movements like marching in place, side stepping, and seated leg lifts. Use clear and slow demonstrations , visualto ensure comprehension.

Provide Step-by-Step
Use Visual Aids: Create visual charts or videos demonstrating exercises and movements, helping reinforce instructions and aiding memory.
Encourage Questions and Feedback: Foster an interactive environment where the individual can express concerns or ask questions about their performance or technique.
2. Rules
Prioritize Safety: Establish a safety rule that emphasizes using supportive devices (e.g., handrails, chairs) during exercises to prevent falls.
-get rid of rules that dont allow using railing for support
Pace Yourself: Encourage the individual to listen to their body and take breaks when needed, especially during endurance activities, to avoid fatigue.
Gradual Progression: Set rules for increasing the difficulty of exercises only when they feel comfortable, such as increasing the number of repetitions or duration after mastering a movement.
Goal Setting: Set realistic goals for each session, like completing 10 minutes of walking without support or performing five repetitions of an exercise with proper form.
3. Equipment
Use Adaptive Equipment:
Ensure Accessibility: Ensure that any fitness equipment used is easy to reach and maneuverable. For instance, using a chair for seated exercises can provide stability and support.
Include Supportive Gear: If applicable, consider using ankle weights for strength training to increase resistance while ensuring they are manageable and comfortable.
Incorporate Fun Equipment: Use accessible equipment like a stability ball for sitting or gentle bouncing exercises, which can improve balance and coordination while being enjoyable.
4. Environment
Choose an Accessible Space: Select a workout space that is flat, spacious, and free of obstacles to prevent tripping hazards, allowing for easy movement.
Create a Comfortable Atmosphere: Ensure the environment is well-lit and ventilated to promote a positive workout experience. Consider using soft music to create a motivating background.
Minimize Distractions: Limit noise and visual distractions in the environment to help the individual focus on exercises and maintain balance and coordination.
Utilize Outdoor Settings: If possible, incorporate outdoor activities in a park or garden where the individual can engage in walking, gentle stretching, or simple exercises while enjoying nature.

Question 30

what does spinal cord injury result from

Answer 30

injury, disease to vertebrae or spinal nerves

Question 31

whats the prevalence of SCI in males v females

Answer 31

70:30

Question 32

in a spinal cord injury, the resulted sensory/motor loss is impacted by 2 things:

Answer 32

1. level of injury
2. severity of lesion in spinal cord(complete or incomplete) like tetraplegia(all limbs) or paraplegia(legs)

Question 33

what are the 3 natures of SCI?

Answer 33

1. Traumatic vs. Non-Traumatic
2. Paraplegia vs. 3. Quadriplegia (tetraplegia)
   Incomplete vs. Complete

Question 34

what are the grades of the American Spinal Injury Association (ASIA)?

ASIA impairment scale

Answer 34

Grade A: complete : no motor or sensory function below level of injury

B: incomplete: sensory but no motor function below level of injury

C: incomplete: motor function preserved below level of injury, but 50% of muscles below level of injury cannot move against gravity

D: complete: motor function preserved below level of injury, most of muscles below level of injury are strong enough to move against gravity

E: motor and sensory function are normal

Question 35

what are some barriers and faciliators to PA of people with motor functioning issues

Answer 35

barriers: spasticity,poor balance, posture, coordination,chronic pain, fatigue, depression,cognitive impairments,bowel/bladder dysfunction(in autonomic dysreflexia, where BP inc and HR slows, caused by UTI)

facilitators: assistive gait devices

Question 36

what are some alternate ways to assess aerobic fitness(other than treadmill?)

Answer 36

arm and wheelchair ergometers, gliders, body weight supported treadmills, treadmill gait trainers

• ambulation training( improving an individual’s ability to walk or move independently) using timed manual wheelchair slalom test

Question 37

what are the PA guidelines for adults with SCI

cardiometabolic health benefits, and fitness benefits

Answer 37

Cardiometabolic Health Benefits:
At least 30 minutes of moderate to
vigorous intensity aerobic exercise
for at least 3 times per week
* At least 20 minutes of moderate to
vigorous intensity aerobic exercise for
at least 2 times per week
* At least 3 sets of 8-10 reps of each
exercise for each major muscle group
for at least 2 days per week

Question 38

what are the PA guidelines for adults with MS

Answer 38

30 min aerobic 2xweek
strength training 2 days/week

Question 39

what are the PA guidelines for adults with CP

Answer 39

aerobic: 20 min, 2x/week, at 60% of peak HR (46-90% vo2max), 8-16 consecutive weeks

Resistance:2-4x/week, 1-3 sets, 6-15 reps, 50-85% 1 rep max, 12-16 weeks, single joint, multi joint, free weight, machine