Motor Function Testing Flashcards
What is the definition of muscle tone?
the muscles resistance to passive movement during the resting state
state of readiness in a muscle at rest which provides background level of tone for a person to function efficiently.
Is someone’s tone lower when they are led down or when they are stood up?
when they are led down
What are the non neural factors effecting muscle tone?
compliance or stiffness of soft tissue
viscosity of muscle
muscle length
What are the neural factors effecting muscle tone?
activation of contractile properties of muscle
controlled by nervous system
specifically, alpha motor neurone in spinal cord
Why is low tone bad?
damage to upper or lower motor neurones
muscles are flaccid, which can cause subluxation
Why is high tone bad?
spasticity- associated with damage to upper motor neurones, muscles tense, increased resistance is seen with as increase in speed of passive movement.
rigidity- associated with parkinsons, muscles are tense, no change in resistance with increased speed of passive movement
What are upper motor neurons?
carry motor information down from brain and synapse with anterior horn, after this is the lower motor neurons
What are the 4 tracts of the upper motor neuron?
corticospinal tract
medial reticulospinal tract
latera reticulospinal tract
vestibulospinal tract
What has the biggest influence on the activity of the alpha motor neuron?
corticospinal tract/upper motor neurone
What are the two causes of low tone?
upper motor neurone
so alpha motor neurone turned down which leads to low tone
damage to lower motor neurone, (compression on nerve root, severing of peripheral nerve)
What causes spasticity?
damage to upper motor neurone which causes low tone, but then over time the alpha motor neurone gets tuned up and more sensitive to stretch.
What causes rigidity?
BG influences movement
BG has influence on brainstem which has reticular formation, which has a role in regulating tone
because alpha motor neurone hasnt been sensitised, the tone wont change if limd is moved passively or slowly
What types of tones should passive movement be tested fast and slow on?
slow-all of them (flaccid will be heavy) (spasticity gets intermittent spasms but not in rigidity)
fast- spasticity and rigidity (not low because risk injury)
how/procedure to test tone?
just give muscles a bit of a squeeze, and feel the muscle, is it floppy? or tense?
then do passive movements, then first move slowly and then fast if not flaccid, through full ROM unless flaccid.
can test these in different movements depending on the muscles.
Precautions and contraindications?
recent surgery
joint instability
severe pain
What structures and processes are being assessed?
upper motor neurones
muscles
basal ganglia
alpha motor neurone
How to tell whether the measurement is normal?
feel the muscles for stiffness or they feel really loose and flaccid, then compare this to the other side or how the muscles should feel
How to assess muscle tone in the trunk?
observe and palpate
get them to touch points on your hand and move around, get 2nd therapist for support-instead of passive movements as quite hard for trunk
can also get them to o active assisted. -slouching down and then up in good posture.
What are we measuring and why? (myotome testing)
if the pt is presenting with muscle weakness, use myotome testing to see whether the weakness is caused by a neurological deficit
What principles are used in carrying out the technique? (myotome testing)
see if significant weakness caused by damage to main nerve root
ask pt to push against therapist resistance
How to tell whether the measurement is normal? (myotome testing)
feel for the amount of power that they have-significant weakness that’s not due to pain inhibition
comparing to the other side (C3 down, but remember dominant side may be slightly stronger)
on oxford scale 1-5
Precautions and contraindications? (myotome testing)
acute muscle injury
recent surgery
severe pain (this can cause the muscle weakness instead)
What structures/processes are being assessed? (myotome testing)
muscles (weakness)
spinal cord nerve root (lesion)
intervertebral disc (herniation pressing on spinal roots)
Upper limb myotome procedure? (myotome testing)
apart from C1 and C2 everything is tested on both sides.
C1-cervical flexion (palm against forehead)
C2-cervical extension (palm against back of head)
C3-lateral cervical flexion (palm on temple)
C4-shoulder girdle elevation (hand on top of shoulder girdle)
C5-shoulder abduction (hand on distal humerus)
C6-elbow flexion (one hand under olecranon, another on top of forearm)
C7-elbow extension (one hand on olecranon and the other underneath forearm)
C8-thumb extension (pt elbow at 90 degrees and thumb on top of pt, make sure elbow flexion isnt present aswell)
T1-finger ab/duction (same position as C8, link fingers with pt and ask them to squeeze your fingers as you pull upwards, for abduction index finger and thumb outside of fingers and ask pt to splay them out)
