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Neuroscience > Motor Impairment > Flashcards

Motor Impairment Flashcards

1
Q

what is the difference between a sign and symptom?

A

A sign is something that can be objectively measured by another party
A symptom is the subjective experience of the pt

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2
Q

What is the difference between a primary and secondary impairment?

A

primary impairment comes as a direct result of the pathology or lesion (ex. weakness, atrophy, tone) but secondary comes as as result from the original problem (atrophy, skin breakdown)

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3
Q

what is the difference between a positive and negative impairment ?

A

a positive impairment is the presence of abnormal behavior (increased tone) and negative is the absence of normal behavior ( empty end feel)

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4
Q

What are different examples of neuroanatomy involved for a upper motor and lower motor lesion?

A

UMN: cortical areas, desc. motor tracts, brainstem , SC proximal to MN
LMN: alpha MN, ventral root, MN pleus , NMJ

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5
Q

What are the major signs associated with UMN?

A

weakness, hyperreflexia, increased tone

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6
Q

What are the major signs associated with LMN?

A

weakness, atrophy, fasciculations, decreased reflexes and tone

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7
Q

What do the neural contributions to strength reflect?

A

number of motor units recruited, types of MUS recruited, changes in discharge frequency

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8
Q

What is weakness in the context of neuropathology?

A

inability to generate force or inability to correctly and/or adequately recruit or modulate MNs

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9
Q

what do musculoskeletal contributions to weakness seen with neurological injury reflect?

A

length of internal lever arm, length/tension relationship, cross-sectional area of muscle, type of fibers, and fiber arrangement

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10
Q

What is the difference between paralysis/plegia and paresis?

A

the mild/mod vs total/profound loss of muscle activity

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11
Q

what are synergies?

A

muscle /joint movements that occur in stereotypical patterns

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12
Q

What movements are associated with an upper extremity flexor synergy?Think: what actions do you need to eat??

A

scapular: retraction + elevation
shoulder: abd/ER
elbow: flex/sup
Wrist and finger: flex

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13
Q

What movements are associated with an lower extremity extensor synergy?

A

Hip :ext/add/IR
Knee:ext
ankle: PF and inversion,
toe: PF

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14
Q

What areas, when damaged, impact the integrity of the stretch reflex?

A

supraspinal structures involved in theri modulation (much emphasis on lateral corticospinal tract + others)
spinal cord
sensory feedback systems

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15
Q

What is Babinski’s reflex?

A

toes fan out vs curling in response to stimulus

not normal in adults (flexor-withdrawal)

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16
Q

Define tone. How does it help us maintain a state of readiness?

A

it is the muscle’s resistance to passive stretch. IT prevents us from falling victim to gravity

17
Q

what is normal tone influenced by?

A

physical inertia
intrinsic mechanical elastic stiffness
spinal reflex-tonic stretch (balance of stretch/flex tracts)
cerebellum

18
Q

what is the difference between hypotonicity and flaccidity?

A

reduction in ton>floppy against gravity and hard to excite vs complete loss of tone

19
Q

Why do we see hypotonicity/flaccidity after injury? What types of pathology do we see this reduction in tone with?

A

cerebellar lesions, LMN injuries, immediate after acute CNS injury but often reverses

20
Q

What are the general differences between spasticity and rigidity?

A

spasticity is velocity dependent whereas rigidity is not.

21
Q

What are the different types of rigidity that can be seen?

A

*all typically impact flexors most *

lead pipe (constant resistance)
cogwheel (alt instances of resistance and relaxation)
clasp-knife (initial rigidity that goes away )

22
Q

what structures are commonly associated with spasticity? Rigidity?

A

PYRAMIDAL TRACTS; BASAL GANGLIA

23
Q

What is posturing? What is the difference between the two types?

A

posturing is rigidity at rest caused by injury around red nucleus
injury at/above RN»decorticate: UE flex, LE ext
injury below RN»decerebrate:UE/LE ext

24
Q

some of the major functional implications of increased and decreased tone

A

increased: abnormal posturing, misalignment, high risk for injury during prolonged rest, bbias w/ recruitment and increased risk of synergistic movement’ destabilization w/ position change
decreased: fall into gravity and risk during dynamic tasks

25
Q

Define dystonia. How does it present?

A

involuntary movement due to damage to descending drive- constant coactivation of agonist and antagonist

26
Q

what scale is used to measure tone?rigidity?

A

Modified Ashworth scale- is normal (no hypertonia)- describe type but there is no gradient

27
Q

what are tremors?

A

small, oscillatory, often uni-directionally distal
resting or action tremors
postural:maintains body part v gravity; intention: produced w/ purposeful movement

28
Q

what is choreiform

A

involuntary, rapid irregular and jerky movement- huntington’s and PR medication AEs

29
Q

what is athetosis?

A

slow, writing and twisting movement, UE>LE, common in CP

30
Q

what are the 3 components of coordination?

A

sequencing, timing, grading

31
Q

Define incoordination

A

awkward, uneven and inaccurate movement found w/ motor cortex, basal ganglia and cerebellar lesions

32
Q

What are the functional implications of incoordination related to movement grading?

A

dysmetria-poor path of movement
hypermetria- overshooting
hypometria - undershooting

33
Q

What are the functional implications of incoordination related to movement timing?

A

increased reaction times, slower movement, difficulty terminating, rebound phenomenon (trust fall adjustment), dysdiadochokinesia (inability fo rrapid alt motions)

34
Q

What are the functional implications of incoordination related to movement sequencing?

A

abnormal synergies
coactivation
impaired. inter-joint coordination

35
Q

what 3 components are you looking for in a coordination test?

A

speed, accuracy, and fluidity

36
Q

UE Coordination tests

A

finger to nose (3 ways in full ext ) , rapid alt movement, rebound test, thumb opposition (tips, not pads) , fixation (extend and hold)

37
Q

LE Coordination Test

A

heel to shin
rapid alternating movements
ankle circles
fixation

38
Q

What are some common causes of musculoskeletal pain seen after neurological injury?

A

synergistic movements
muscle asymmetry
ROM and alignment problems
decreased movement efficiency

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