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Motor Examination Flashcards

1
Q

Describe the difference between a sign and a symptoms.

A 
Sign = an objective measurement (BP, ROM, MMT, Reflexes)
Symptom = subjective reporting; patient report/feelings (pain, dizziness, nausea, anxiety)
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2
Q

Describe a primary impairment.

A

A direct effect of a pathology or lesion.

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3
Q

Describe a secondary impairment.

A

Developed as a result of the original problem.

Example = bed sore

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4
Q

What does a positive pathology presentation tell you?

A

That there is a presence of abnormal behavior.

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5
Q

What does a negative presentation of pathology tell you?

A

That there is an absence of normal behavior.

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6
Q

What type of signs do you see with an UMN lesion?

A
  1. Weakness
  2. Increased reflexes
  3. Increased tone
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7
Q

What type of signs do you see with a LMN lesion?

A
  1. Weakness
  2. Atrophy
  3. Fasciculations
  4. Decreased reflexes
  5. Decreased tone
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8
Q

What do the neural contributions of strength reflect?

A
  1. Number of motor units recruited
  2. Type of motor units recruited
  3. Discharge frequency
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9
Q

What do the MSK contributions to strength reflect?

A
  • Length of movement arm of the muscle
  • Length/tension relationship of the muscle
  • Cross-sectional area of muscle
  • Type of muscle fiber
  • Fiber arrangement
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10
Q

Describe weakness in the context of neuropathology.

A
  • The inability to generate force, which leads to loss of movement, loss of power.
  • The inability to correctly and/or adequately recruit or modulate motor neurons, leads to lack of muscle activity/immobility.
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11
Q

What may neurologically induced weakness result from?

A
  1. Cortical lesion
  2. Lesion in descending pathways.
  3. Peripheral nerve injury
  4. Synaptic dysfunction at neuromuscular junction
  5. Damage to muscle tissue
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12
Q

Does the extent and distribution of weakness depend on the extent and location of a lesion?

A

Yup.

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13
Q

What is paralysis or plegia?

A

Total or profound loss of muscle activity.

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14
Q

What is paresis?

A

Mild or partial loss of muscle activity.

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15
Q

Describe the different names of distribution for paralysis/plegia/paresis.

A 
Mono = one limb
Hemi = one side
Para = one half
Quad/tetra = whole body
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16
Q

What is a synergy?

A

When muscle/joint movements occur in stereotypical patterns. Can have flexor and extensor patterns.

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17
Q

Describe a flexor synergy (UE).

A

Scapula retraction and elevation, shoulder abduction and ER, elbow flexion, supination, wrist and finger flexion.

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18
Q

Describe a extensor synergy (LE).

A

Hip extension, adduction, IR, knee extension, ankle PF and inversion, toe PF.

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19
Q

What muscular actions would you perform for myotomes C5, C6, and C7?

A

C5 = shoulder abduction

C6 = elbow flexion, wrist extension

C7 = elbow extension, wrist flexion

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20
Q

What muscular actions would you perform for myotomes C8, T1, L1-L2?

A

C8 = finger flexion, thumb extension

T1 = finger adduction

L1-L2 = hip flexion

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21
Q

What muscular actions would you perform for myotomes L3, L4, L5, and S1?

A

L3 = knee extension

L4 = ankle dorsiflexion

L5 = great toe extension

S1 = plantarflexion

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22
Q

What position should you test myotomes in?

A

Seated!

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23
Q

Do you grade myotome testing?

A

Heck no! Looking for the duration that the patient can hold the position.

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24
Q

For reflex abnormalities (stretch reflex dysfunction), what structures might we see damage to?

A
  1. Supraspinal structures involved in reflex modulation = **corticospinal tract, reticulospinal tract, rubrospinal tract, and vestibulospinal tracts; also cerebellum.
  2. Spinal cord = interneurons and motor neurons
  3. Sensory feedback systems.
25
Q

What type of injury typically presents hyporeflexia (areflexia)? What neuroanatomy is damaged?

A

Lower motor neuron injury.

Damaged = alpha motor neurons and/or sensory neurons.

26
Q

What type of injury typically presents hyperreflexia? What neuroanatomy is damaged?

A

Upper motor neuron injury.

Damaged = supraspinal structures and/or spinal cord structures.

27
Q

What are the grades for deep tendon reflexes?

A 
0 = absent
1+ = hyporeflexia
2+ = normal 
3+ = hyperreflexia
4+ = hyperreflexia + non-sustained clonus
5+ = hyperreflexia + sustained clonus
28
Q

With the babinski’s reflex, what type of reaction would be expected for a positive and negative test?

A

Positive = fanning (extension) of toes

Negative = curling (flexion) of toes

29
Q

Describe tone.

A

Characterized by a muscle’s resistance to passive stretch. It represents a state of slight residual contraction in normally innervated, resting muscle.

30
Q

What is hypotonicity?

A

The reduction in passive resistance to lengthening. Collapse into gravity and are harder to excite.

31
Q

What are common pathologies that cause hypotonicity?

A 
Cerebellar lesions
Down syndrome
Muscular dystrophies
Late stage ALS
Post polio
Acute CNS injuries
32
Q

What are the 2 types of hypertonicity?

A

Spasticity and rigidity

33
Q

What is spasticity?

A

Velocity-dependent increase in resistance to passive movement.

34
Q

What causes spasticity?

A

A result of damage to descending pyramidal tracts. A loss of inhibitory effect on tonic stretch reflex.
- can be associated with clonus.

35
Q

Is clonus typical in distal or proximal extremeties?

A

Distal extremities more so than proximal.

36
Q

What is rigidity?

A

Heightened resistance to passive movement of the limb, independent of the velocity of the stretch.

37
Q

What causes rigidity?

A

Commonly seen with basal ganglia dysfunctions

38
Q

Where is rigidity predominantly seen?

A

In flexors!

39
Q

Describe the 3 different categories of rigidity?

A

Lead pipe = constant resistance to movement throughout the entire ROM.

Cogwheel = alternating episodes of resistance and relaxation

Clasp-knife = initial rigidity with sudden absence throughout remainder of range.

40
Q

What is posturing?

A

Rigidity at rest.

41
Q

Describe decorticate rigidity.

A

Presents as UE flexion, LE extension/IR/PF.

Caused by a brainstem lesion above red nucleus.

42
Q

Describe decerebate rigidity.

A

Presents as UE and LE extension.

Caused by a brainstem lesion below red nucleus.

43
Q

What do we use to measure spasticity?

A

Modified Ashworth Scale

44
Q

What is dystonia?

A

Syndrome dominated by sustained muscle contractions. Causes twisting, repetitive movements, abnormal postures.

  • Coactivation of agonist/antagonist
  • Primarily seen with damage to basal ganglia
  • Can happen focally, segmentally, hemibody, or generalized/whole
45
Q

What are tremors?

A

Rhythmic, involuntary oscillatory movement of a body part. Can be intermittent or constant, sporadic or as a sequelae to disease of injury.

46
Q

Describe a resting tremor

A

Occurs in body part that is not voluntarily activated, relaxed

47
Q

Describe an action tremor

A

Any tremor that is produced by voluntary contraction of a muscle.

Postural tremor = person maintains a part of body against gravity.
Intention tremor = produced with purposeful movement.

48
Q

What is choreiform?

A

Involuntary, rapid, irregular and jerky movements.

Seen with huntington’s disease; side effect of PD medications.

49
Q

What is athetosis?

A

Slow, writhing and twisting movements. typically seen in UE more than LE.
Common in cerebral palsy.

50
Q

What are the critical components of coordination?

A

Sequencing, timing, and grading

51
Q

What is incoordination?

A

Movements that are awkward, uneven, inaccurate. A disruption of sequencing, timing, and grading.
- Loss of coupling between synergistic joints and muscles

52
Q

What type of injuries present with incoordination?

A

Lesions with motor cotrex, basal ganglia, cerebellar lesions, and proprioceptive lesion.

53
Q

What are the grading/scaling dysfunctions of incoordination?

A

Dysmetria = issues with the path of getting to destination.

Hypermetria = overshooting past target

Hypometria = undershooting the target

54
Q

List the functional implications of incoordination in regards to timing difficulties.

A
  1. Increased reaction times
  2. Slowed movement times
  3. Difficulties terminating movement
  4. Rebound phenomenon = doesn’t happen in normal timing
  5. Dysdiadokokinesia = inability to do rapid alternating movements
55
Q

List the activation and sequencing problems of incoordination.

A
  1. Abnormal synergies
  2. Coactivation
  3. Impaired inter-joint coordination
56
Q

Coordination test focus on movement capabilities. What areas of movement do they focus on?

A
  1. Reciprocal motion = the ability to reverse movement between opposing muscle groups.
  2. Movement composition = movement control achieved by synergistic muvle groups acting together
  3. Movement accuracy = the ability to gauge or judge distance and speed of voluntary movement
  4. Fixation of limb holding = the ability to hold the position of an individual limb or limb segment.
57
Q

When testing coordination, what are the 3 components that you are looking for?

A

Speed, fluidity, and accuracy

58
Q

What are the 5 coordination assessments performed for upper extremity?

A
  1. Finger-to-nose
  2. rapid alternating movements
  3. Rebound test
  4. Thumb opposition
  5. Fixation
59
Q

What are the 4 coordination assessments performed for lower extremity?

A
  1. Heel-to-shin
  2. Rapid alternating movements
  3. Ankle circles
  4. Fixation

Neuroanatomy (18 decks)

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