Motor Control Impairments Flashcards
What occurs when tone has a neural versus non neural cause?
Neural: alpha motor neurons more sensitive to input
Non neural: stiffness due to immobilization/atrophy
What is a diagnostic indicator of UMN problem?
stretch sensitive hyper tonicity
How do we examine tone?
Passive movement of limbs at varying speeds: min, mod, severe tone or modified ashworth scale or tardieu
Is there really clinical importance to examining tone? possibly no because it may not really help patients identified problems
What is modified ashworth scale?
0 no increase in tone
1 slight increase, catch at end of ROM
1+ slight increase, catch followed by minimal resistance throughout less than half of ROM
2 marked increase, part easily moved
3 considerable increase, passive movement difficult
4 affected part rigid in flexion or extension
9 unable to test
What is treatment for hypertonicity?
Pharmacological: baclofen, valium, botox
Surgical: nerve block or cut
PT: slow, sustained stretching (short term effect)
What can be done to address non neural causes of tone?
positioning, weight bearing, splints, casts
What is reflex inhibiting?
Put someone in stretch and then make them work while they hold the stretch.
Activate GTO’s autogenic inhibition.
Temporary but allows for practice
What are systems involved in CNS pathology Passive ROM?
Neural factors: reflex stiffness
Non-neural factors: effect of immobilization, limb inertia Newton’s first law, heterotopic ossification, effect of aging, pain, arthritis, scoliosis
What are interventions for decrease in passive ROM?
stretching, splinting, serial casting, joint mobilization, heat modalities, surgical release
What is research for stretching as an intervention to improve passive ROM?
In health people: 30 sec holds over 15 min effective at increasing ROM
Recent stroke: daily positioning for 30 min effective to prevent contracture, not effective in reducing contracture
What is research on splinting in treating passive ROM?
Static hand splints: no benefit in preventing contracture following stroke, decreases function, increases pain
Dynamic hand orthosis: case reports promising
Other dynamic splints: research is variable
What are advantages and disadvantages of serial casting in treating PROM?
Effective at improving ROM in people with CP and TBI.
Disadvantages: higher risk of adverse events, difficult technique/skill requirements, impaired function during casting
What is research on joint mobs as treatment for PROM?
Increases PROM but no functional change with use of ankle joint mobilization in people with stroke.
Research on heat modalities for PROM?
Ultrasound effective at increasing ROM in healthy subjects.
Limited research on hot packs- increased ROM in wrist in stroke
Precaution with sensory/communication/cognition deficits
What is usefulness of surgical release when treating PROM?
Tendon lengthening used in kids with CP (Achilles or hamstring)
Achilles tendon lengthening in people with diabetic neuropathy to prevent pressure ulcers
Resection of HO
Recurrence rates common
Need to examine function carefully
What are Brunnstrom stages of synergy?
1: no movement
2: involuntary only
3: abnormal synergy only
4: isolate one joint
5: isolate 2 joints
6: isolate all joints
7: normal movement
What is treatment for synergy/activation problems?
Task specific: modify task to make it easier or harder, modify target constraints
Practice with varied timing or force demands
LE: standing, transfers, gait
UE: manipulation and dexterity (finger tapping, pick up various objects, drawing/writing, turn pages use phone/keyboard)
What are peripheral and central factors for muscle strength and power?
Peripheral: length tension properties, viscoelasticity
Central: motor units, firing rate, sequencing, postural stabilization
What happens to muscle performance with CNS pathology?
Decreased force production: inadequate input to alpha mn (hemi, para, tetra- plegia)
Secondary factors: incoordination, spasticity/synergy patterns, sensory loss, atrophy loss, endurance/fatigue
Muscle spindle performance: alpha gamma co-activation
What are examination techniques for muscle weakness?
Valid concept? (consider synergy and standard MMT positions)
CVA: hemiplegia (strong vs. weak side)
Options: AROM/MMT, hand held dynamometer, isokinetic dynamometer
What is treatment for muscle weakness?
If able to move against gravity: progressive resistive exercise for power/strength training, task specific training
Deconditioning: weakness as a secondary impairment
What is treatment for weakness if someone has no active movement?
0 or 1 on MMT scale: insufficient alpha motor neuron input
Facilitation techniques: utilize stretch reflex pathway for autogenic facilitation, tapping, vibration, quick stretch, activating only alpha mn
Task specific training: modify task/environment, trying to activate alpha and gamma mn via voluntary movement pathways
What is treatment for 2 or 3 MMT grades?
Person lacks anti-gravity muscle power, possibly only activating alpha mn
Use gravity eliminated positions: begin PREs
Task specific training: modify task/environment
What is task specific training for a weak patient?
Modify task/environment= easier
Skill acquisition strategies: immediate feedback; manual guidance (learning + safety); blocked practice, little variation; motivation important
What is goal for task specific training in weak patients?
Maximize patient initiated activity to promote motor recovery/plasticity
How can we progress task specific training?
Progression: make task harder
Repetition without repetition as an exercise
Strength training: overload principle, %1 RM, low repetition, rests
What are exam techniques for possible coordination CNS pathologies?
Finger to nose, knee to ankle, rapid alternating movements, nine hole peg test (only if there is active movement)
Speed and accuracy component
What is coordination and how is it accomplished?
Ability to carry out any motor task precisely and quickly: motor system interacts with changing environment, sensory cortex, motor cortex, visual system, cerebellum
Multiple joints and muscles activated together at appropriate time to work together: normal movement trajectory, smooth bell shaped velocity profile
What is intervention for coordination CNS pathology?
Task specific training: modify task, modify target constraints, modify timing or force demands
UE: manipulation and dexterity
LE: gait
Use of weights
Role of strength
PNF patterns
Frenkels exercise: reciprocal movements of hands/feet, trace shapes and numbers
What are parts of the exam for unilateral neglect?
Observation: avoids crossing midline, difficulty with self care, ADLs
OT role
What is treatment for unilateral neglect?
Task specific training: modify task/environment
Video/mirror/prism/eye patch
Encourage movement, cross midline
Minimize verbal feedback
Mental imagery practice, “lighthouse”
Adaptive: slow pace, put important items on strong side, use marker for visual scanning
What are other perceptual CNS disorders?
Pusher syndrome: lean towards weak side
Apraxia: motor planning disorder
Alien hand syndrome: grasping behavior without conscious awareness of patient
Locked in syndrome: unable to communicate or move but cognitively intact
What is the Fugl Meyer?
Test of motor control
What is STREAM?
Stroke Rehab Assessment of Movement
Looks at strength, tone, synergy, etc to get a score
UE, LE, and functional movements
There is a shorter form: S-STREAM
What are advantages and disadvantages of PNF?
Advantages: readily modifiable to allow facilitation or resistance, fits with guideline for strength training
Disadvantages: complex, indirect functional relevance
What are PNF trunk strengthening?
Alternating isometrics: hold position with isometric resistance or agonists followed by antagonists
Rhythmic stabilization: modification of AI with isometric resistance provided in rotation motion
Functional positions: sidelying, sitting, standing
What is NDT?
Neurodevelopmental treatment
There are requirements for normal movement: normalize tone, automatic reactions, isolated movement
Better for pediatrics, not so much for adults because the positions aren’t functional
What are advantages and disadvantages of NDT?
Advantages: readily modifiable to allow facilitation, useful if manual guidance needed
Disadvantages: complex, strength not assessed, limited functional relevance
What are advantages and disadvantages of task specific training?
Advantages: readily modifiable to increase or decrease difficulty, based on contemporary models–> function
Disadvantages: cognitive impairments, unable to do task
What is evidence for task specific training?
Constraint induced movement therapy for UE recovery
Body weight supported treadmill training
Functional electric stimulation/FES orthotics
