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
