Motor Function Flashcards
Motor Control
Ability to regulate or direct the mechanisms essential to movement
Motor Skills
Learned through interaction and exploration of the environment
Are motor and sensory functions connected?
Yes. Motor and sensory brain areas are right next to each other. Lots of cross communications. Sensory stimulation is important for motor development.
Motor Program
Abstract representation of movement that results in production of coordinated movement sequence (riding a bike)
Motor plan
Idea or plan for purposeful movement that is made up of several component motor programs (AKA complex motor program)
Motor memory
a.k.a. PROCEDURAL memory
recall of motor programs or subroutines.
What does procedural memory include information on?
Initial movement conditions
Sensory situation
Specific movement parameters
Outcome of movement (KoR)
Neuroplasticity
Neural modifiability. short term change (efficiency/strength of synaptic connections), long term change (organization and numbers of neural connections)
Motor Learning
Internal processes associated with practice or experience leading to relatively permanent changes in capacity for skilled behavior (sit up, stand, walk, etc)
What does associative learning do?
predicts relationships. One stimulus to another (classical conditioning), ones behavior to consequence (operant conditioning)
Feedback
Response-produced information received during or after the movement; monitor output for corrective actions
Feedforward
Sending signals in advance of movement to ready the system; allows for anticipatory adjustments in postural activity
Factors that influence motor control
Task
Individual
Environment
What would you test for mental status in an exam?
Memory
Orientation
Level of consciousness
Executive or higher cognitive function
Ascending reticular activating system (RAS)
Exerts an excitatory influence on the cerebral cortex to maintain the alert state.
Receives input from all afferent systems [tactile, thermal, vestibular, auditory, chemical]
Levels of consciousness
Alert Lethargic Obtunded Stupor Coma
Lethargic
Slow to respond, drowsy
If you are lethargic it doesn’t take much to get them to an alert state, maybe just say their name
Obtunded
Dull, blunted response, difficult to arouse, appears confused
May need to pat on the back or pat their feet. Feet is what you do in the hospital.
Stupor
Semiconscious, aroused only with intense stimuli (sternal rub, nail bed pressure)
Coma
no response to stimuli at all
What is oriented x3 & x4?
Time*
Place*
Person*
Circumstance
Attention
the ability to focus and maintain one’s consciousness on a particular stimulus or task without being distracted by other stimuli
How can attention be tested?
asking pt to repeat short lists of numbers/letters or objects. Inability to repeat six items indicates attention problems
Types of attention
Selective
Sustained
Alternating
Divided
Sustained attention
vigilance, time on task. “undivided” attention
Alternating attention
Attention flexibility, able to pay attention to two things at one time
Divided attention
Performing two tasks simultaneously. I.e. walkie-talkie test
Declarative memory
recall of facts/events
Immediate memory
recall after a few seconds
Short term memory
Recall minutes to days
Long term memory
recall years, general knowledge
Amnesia
Wake up and can’t remember who you are
Anterograde amnesia
i.e. post traumatic amnesia
Poor new learning
Retrograde amnesia
Unable to remember previous learning
Tip of tongue phenomena
Seems to be retrieval problems
Language functions
Spontaneous speech, fluency, comprehension, repetition, naming and word finding, reading and writing.
Dysarthria
Hard to get words out, problem with articulation. Timing, vocal quality, pitch, volume, breath control.
Fluent/Wernicke’s aphasia
Not using real words. neologisms, circumlocutions, not sure if they understand what you are saying
Non-fluent/Broca’s aphasia
Could have no language, could be stuck on a word/phrase or two, anomia, almost always understand but can’t verbalize.
Calculation ability
very simple addition for example. Basic life skill type of math
Fund of knowledge
that persons experiences and learning. Whole experiences/concrete knowledge
Constructional ability
copy figures, shapes, clock.
Gnosia/Agnosia
could involve any of 5 senses. Lack of knowing
Ideomotor apraxia
mv’t automatic, not on command [dominant hemisphere damage (frontal, parietal); perseveration] can’t do it on command but can when you need something
Ideational apraxia
purposeful mv’t not possible, not on command, not when you want to do something.
Yerkes-Dodson Law
a.k.a inverted U theory of arousal. Motor performance vs. emotional arousal. moderate arousal = maximum performance. Finer skill on lower side, larger gross on upper side
Closed loop system of motor control
Uses feedback from sensory system, somatosensation
Open loop system of motor control
Does not use feedback or error detection. Rapid or well learned movements.
Tone
Resistance of muscle to passive stretch, while attempting to maintain muscle relaxation.
What affects tone?
physical inertia, intrinsic mechanical-elastic stiffness of muscle/CT, reflex muscle contraction
Spasticity
Hypertonic motor disorder characterized by
velocity-dependent resistance to passive stretch
Clasp-knife response
Slow moving and resistance at first then you hit a point where it is moving much better. Difficult at first, then you’ve overcome the resistance.
Injury to corticospinal pathways/pyramidal tracts.
part of UMN syndrome
UMN syndrome tests
Hyperactive stretch reflexes, involuntary flexor/extensor spasms, clonus, plantar reflex (babinski), oppenheim, exaggerated cutaneous reflex, chaddocks reflex, loss of automatic control
Leadpipe rigidity
the limb is just straight, its possible to create a Fx before you move someone with leadpipe rigidity. Avulsion Fx not uncommon .
Basal ganglia system problem.
Cogwheel rigidity
lots of resistance, it will finally give but only a little bit. It doesn’t just get to a place and then give like clasp knife. Commonly seen in patients with Parkinson’s Disease
Decorticate rigidity
Sustained posturing UE flexion, LE extension (PF, IR, adduction)
Disinhibition of red nucleus, facilitation of rubrospinal tract
Disruption of corticospinal tract
Lesion at diencephalon above superior colliculus
Decerebrate rigidity
Sustained posturing UE & LE extension (UE wrist and fingers still flexed)
Lesion between superior colliculus and vestibular nucleus
Opisthotonus
Sustained contraction of neck and trunk extensors
Cant leave them alone in a chair because they can fall out of their chair, tone pushes them forward.
Hard to work with; can’t really sit alone, hard to transfer, etc.
Hypotonia
Flaccidity: nothing working
Decreased or absent tone
Decreased resistance to passive stretch, decreased or absent stretch reflexes
Part of lower motor neuron (LMN) syndrome
Children with Downs syndrome often have this
LMN syndrome
Lesion in anterior horn cell, peripheral nerve
Symptoms in LMN syndrome
Decreased or absent tone Decreased or absent reflexes: dulled or no Paresis Muscle fasciculations/fibrillations Neurogenic atrophy
Examination of tone
Observation
Palpation
PASSIVE motion testing
Active motion testing
Grades of Tone
0 - no response (flaccidity 1+ - decreased response (hypotonia) 2+ - Normal 3+ - Exaggerated response (hypertonia) 4 + - Sustained response (rigidity)
What is the modified Ashworth Scale used for?
Examination of tone/spasticity for the UE only> would test at slow velocity and fast and document both scores
What numbers are on the modified Ashworth scale?
0, 1, 1+, 2, 3, 4
Grade 1 on modified Ashworth scale?
Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension.
Grade 1+ on modified Ashworth scale?
Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
Grade 2 on modified Ashworth scale?
More marked increase in muscle tone through most of the ROM but affected part(s) easily moved
Grade 3 on modified Ashworth scale?
Considerable increase in muscle tine, passive movement difficult
Grade 4 on modified Ashworth scale?
Affected part(s) rigid in flexion or extension
What do you look for when examining force control?
ability to:
initiate, sustain, regulate, terminate force
timing/speed/direction control
Deep tendon reflex grades
0-5+ (all plus)
none, hypo, normal, hyper, clonus 1-3 beats, >3 or sustained response
Flexor Withdrawl
Opposite of typical LE extensor synergy. ABduction, ER, flexion.
What are associated reactions?
Involuntary movements of the resting extremity
Types of atrophy
neurogenic, disuse
What does an active restraint with MMT indicate? passive?
abnormal synergies or reflexes
contracture
Categories of motor skills
mobility, static postural control, dynamic postural control, skill
Static postural control
COM over BOS at rest – not moving but standing/balancing
Dynamic postural control
COM over BOS with body movement
Walking, reaching, twisting.
Skill
Coordinated distal movement with proximal segment stabilized. (typing, piano, etc.)
Closed motor skill
Performed in a stable, non-changing environment
Open motor skill
Performed in a variable, changing environment
This is better for the person, they can perfect it and do it in different environments.
How to you test limits of stability?
maximum distance able to lean in any direction without loss of balance
Clinical test for sensory interaction in balance?
Nashner’s Foam and Dome.
Righting reactions
orient head in space and body to head and support surface Optical RR Labyrinthine RR Body on head RR Neck on body RR Body on body RR
Equilibrium reactions
Looking for reactions to maintain COG over BOS before using protective extension or stepping strategy
Types of balance strategies
Ankle, hip, stepping
suspensory
Fixed support strategies
Ankle, hip, suspensory
Change in support strategies
Stepping, protective extension
How to measure performance changes?
FIM (lower score = more assistance) 0-7. 5 or lower need another person
Qualitative changes, error scores, reduced effort and concentration.
Retention tests
Patient demonstrates skill after period of not practice (retention interval)
Transfer tests
the gain (or loss) in capability for performance in one task as a result of practice or experience on some other task
Positive transfer
enhancement or gain of ability
Negative transfer
diminishes ability
Generalizability
Extent to which practice on one task contributes to the performance of other, related skills.
Resistance to contextual change
Adaptability required to perform a motor task in altered environmental situations
Learning styles
Auditory
Visual
Verbal
Kinesthetic
Step-by-step, procedural
Global/intuitive
