Motor Control

Question 1

Systems of motor control

Answer 1

Role performance, occupational performance tasks, person, environment. Essentially a PEO model. Changes in any of these systems can affect occupational performance tasks and ultimately role performance

Question 2

The primary 4 UE impairments from an Upper Motor Neuron Lesion Resulting from a stroke:

Answer 2

Changes in muscle strength (weakness)

Changes in muscle tone/postural control

Changes in muscle activation (central coordination)

Changes in sensation

Question 3

Most common changes in muscle strength (weakness):

Answer 3

Muscle paralysis (total inability of a muscle to contract for any effective use)
Paresis: Slight or partial paralysis

Question 4

T/F: manual muscle tests are reliable with neurological deficits

Answer 4

False.

Question 5

T/F: When there is weakness in the trunk, it is often accompanied by hypotonicity in an arm or leg

Answer 5

False. When there is weakness in the trunk, it is often accompanied by hypertonicity in arm or leg

Question 6

Loss of muscle strength is strongly influenced by what secondary changes?

Answer 6

Loss of muscle strength is strongly influenced by secondary changes in joint alignment & mobility, muscle & tissue length, and problems with tone & muscle activation

Question 7

What is muscle tone?

Answer 7

Amount of tension in a muscle or resistance of a muscle to passive elongation or strengthing

Question 8

What is postural tone?

Answer 8

A special category of tone referring to overall state of tension in body musculature.
Defines the body’s readiness to move and ability to resist the downward pull of gravity

Question 9

Lower than normal tone; no resistance to passive movement; lower than normal tension at rest/during movement/difficulty resisting force of gravity

Answer 9

Hypotonicity. Associated with muscles that are weak or paralyzed; most common in acute state–may persist

Question 10

Spasticity

Answer 10

Special type of hypertonicity; increased muscle tension associated with unnatural body postures and limb positions caused by changes in the length-tension relationship, postural instability, and active recruitment

1. hyperactive response to quick stretch
2. Velocity-dependent
3. clasp-knife phenomenon
4. must be elicited by doing something to muscle group in the opposite direction

Question 11

Changes in muscle activation arise primarily from:

Answer 11

Changes in muscle activation (central coordination) arise primarily from a brain lesion, but may also be strongly influenced by sensory impairments and secondary problems like changes in joint alignment (and by treatment of course)

Question 12

Changes in muscle activation mean:

Answer 12

1. changes in pattern of muscle activation
2. activates the wrong muscles for the task being performed (changes the sequence of muscle activation or activates too many muscles with inappropriate force)
3. changes in motor control, or the way the brain directs the organization and sequencing of movement

Question 13

Changes in sensation include deficits in these 3 areas:

Answer 13

1. Sensory awareness
   -involves tactile, proprioceptive, and kinesthetic
   sensation
   -Sensory from involved side cannot be perceived or
   identified; ignore or neglect involved side, num or
   asleep, most severe with those having dense flaccid
   paresis and hypotonia
2. Sensory processing and interpretation
   -affects client’s ability to correctly perceive, interpret,
   and respond to sensory input from involved side
   -not sure what is happening to body, confused or
   fearful, overly sensitive
3. Planning and execution of movement:
   -affects the body’s sensory knowledge of movement
   -information about sequencing of joint movements,
   timing, speed, and amount of muscle strength needed
   to achieve the desired result. Stores “memories” in the
   brain and “recognizes” it for when we need it next time

Question 14

Secondary UE impairments from an Upper Motor Nueron Lesion Resulting in a stroke include:

Answer 14

Orthopedic changes
Changes in muscle and soft tissue length
pain
edema

Question 15

Our contemporary understanding of the patient’s motor behavior is grounded in what theory?

Answer 15

Dynamic Systems Theory. This theory proposes that behaviors emerge from the interaction of many
systems -> self-organizing. There are “normal strategies” which limit the degrees of freedom.

We tend to use preferred patterns which are not always “prescribed through
the reflex-hierarchical commend model.” There is a progression which varies
from person to person because person & environmental contexts are different and unique.
CNS changes through life…and there are periods of stability & instability;
CNS damage leads to attempts to use remaining resources to achieve functional goals.
Behaviors emerge from the interaction of many systems.
Behavior is considered to be self-organizing.
Transitions in behavior, phase shifts, are changes from one preferred pattern of coordinated behavior to another.
Motor control parameters are gradable.
There is no inherent ordering of systems in terms of their influence on motor behavior….control parameters shift behavior from one pattern to another…

Question 16

T/F: Client with damaged CNS cannot compensate for the lesion to achieve functional goals

Answer 16

False. Client with damaged CNS attempts to compensate for lesion to achieve functional goals. Behavioral changes reflect attempts to compensate and to achieve a certain task.

-Occupational performance emerges from the personal
and environmental interactions

Question 17

What is critical to max rehabilitation for clients with CNS dysfunction

Answer 17

Providing appropriately challenging tasks and environments for those with CNS dysfunction appears critical to the maximal rehabilitation of our clients. Experimentation with different strategies leads to optimal solution

Question 18

T/F: according to the dynamic systems theory, there is an inherent ordering of systems in terms of their influence on motor behavior

Answer 18

False! There is no inherent ordering of systems in terms of their influence on motor behavior.

Question 19

What are control parameters?

Answer 19

In dynamic systems theory, control parameters are variables that shift behaviors from one form to another. They do not control the change, but act as agents/catalysts for reorganizing the behavior to a new form.

1. Systems themselves are subject to change
2. No inherent ordering for systems in terms of their influence on motor behavior

Question 20

T/F: According to the dynamic systems theory, normal development does not follow a rigid, task-oriented sequence

Answer 20

True. as the motor milestones suggests; other factors influence the developmental stages.

Question 21

T/F: According to the top-down approach evaluation, evaluations should be primarily at the body functions and structures (impairments level)

Answer 21

False! Evaluations should be primarily at the participation and activities levels rather than the body functions and structures (impairments) level

Question 22

A Top-down approach evaluation that uses the OT Task-Oriented Approach would follow these steps:

Answer 22

Emphasis on role and occupational performance areas:

1. Role Performance (past and future roles)
2. Occupational Performance Tasks: Areas of Occupation
3. Task: Selection and Analysis
4. Person: Performance Skills/Client Factors
5. Environment: Performance Context
   * An approach used in OT based on a dynamic systems model of motor control

Question 23

A non-standard (Observational) assessment of motor behavior based on the NDT approach would assess what?

Answer 23

An NDT approach assess:

1. Foundations for movement
2. Muscle tone
3. Voluntary muscle activity through observation (qualitatively)
4. Assess functional use of the upper extremity.

Example of a non-standardized method, grounded in observation and based on a dynamic systems approach, functional approach and contemporary understanding of motor behavior

Question 24

In an observational assessment of motor control (rooted in NDT approach), how would you assess foundations for movement?

Answer 24

First step of observational assessment of motor behavior

1. Assess foundations for movement
   
   • Soft Tissue integrity
   • Alignment and biomechanics
     - -Trunk: lower, upper, head/neck
     - -Scapula
     - -Shoulder girdle
     - -Upper extremity joints

Question 25

In an observational assessment of motor control (rooted in NDT approach), how would you assess muscle tone?

Answer 25

Second step of observational assessment of motor behavior
(1. Assess foundations for movement)
2. Assess muscle tone
-“Placing” -“High enough to resist gravity, low enough
to allow for movement”
-Observation
-Attempts at voluntary movement

Question 26

In an observational assessment of motor control (rooted in NDT approach,) how would you assess voluntary muscle activity?

Answer 26

(1. Assess foundations of movement)
(2. Assess muscle tone)
3. Assess voluntary muscle activity qualitatively
-Observation of movement patterns
–“Typical” movement components and “missing”
components
–Describe: selective vs. non-selective
-Control in function/occupation
-Note: “conditions of observation”

Question 27

In an observational assessment of motor control (rooted in NDT approach,) how would you assess functional use of the upper extremity?

Answer 27

(1. Assess foundations of movement)
(2. Assess muscle tone)
(3. Assess voluntary muscle activity qualitatively)
4. Assess functional use of the upper extremity
-Use in function:
–no movement
–spontaneous use
–attempts at voluntary use-how? Uses to assist
other extremity, stabilize objects, etc
-Performance skills: positions, reaches, manipulates,
transports, lifts, grasps, etc

Question 28

This assessment measures muscle tone or the resistance to passive movement

Answer 28

Modified Ashworth Scale. It is the most widely used clinical measure of muscle spasticity in patients with neurological conditions. Resistance encountered to passive movement through the full available range on a 5 point scale, with a grade scale of 0, 1, 2, 3, 4. Modified by adding an additional level-incorporation of the angle at which resistance first appears and by controlling the speed of the passive movement with a one-second count (tone, not spasticity)

Question 29

How does the scoring on the Modified Ashworth Scale work?

Answer 29

0: Normal muscle tone (no increase)
1: slight increase in muscle tone, “catch and release” or minimal resistance at end of ROM when limb moved
1+:Slight increase, “catch” followed by minimal resistance through remainder (less than half) of ROM
2: Marked increase through most of ROM, but affected parts are easily moved
3: Considerable increase in tone, passive ROM difficult
4: Rigid in flexion or extension in any motion

Question 30

The 2nd most widely used assessment of motor deficits of persons with CNS impairments

Answer 30

The Fungl-Meyer Assessment. The first most widely used assessment is the Modified Ashworth Scale.

Question 31

This assessment developed to evaluate motor function, balance, some aspects of sensation, and joint function/pain in persons followed a stroke

Answer 31

The Fungl-Meyer Assessment.

Question 32

The Fungl-Meyer Assessment

Answer 32

-A 226-point multi-item scale
-Motor domain: Movement, coordination, and reflex action at the shoulder, elbow, forearm, wrist, hand, hip, knee, and ankle
-3 point scale:
0: cannot perform
1: performs partially
2: performs fully
-Takes about 20 mins and does not require
training/certification

Question 33

These 4 assessments test what?
Motor Assessment Scale (MAS)
Arm Motor Ability Test (AMAT)
Wolf Motor Functional Test (WMFT)
Hand Function/Dexterity Assessments

Answer 33

Motor Control