Motor Impairment Flashcards
what is the difference between a sign and symptom?
A sign is something that can be objectively measured by another party
A symptom is the subjective experience of the pt
What is the difference between a primary and secondary impairment?
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)
what is the difference between a positive and negative impairment ?
a positive impairment is the presence of abnormal behavior (increased tone) and negative is the absence of normal behavior ( empty end feel)
What are different examples of neuroanatomy involved for a upper motor and lower motor lesion?
UMN: cortical areas, desc. motor tracts, brainstem , SC proximal to MN
LMN: alpha MN, ventral root, MN pleus , NMJ
What are the major signs associated with UMN?
weakness, hyperreflexia, increased tone
What are the major signs associated with LMN?
weakness, atrophy, fasciculations, decreased reflexes and tone
What do the neural contributions to strength reflect?
number of motor units recruited, types of MUS recruited, changes in discharge frequency
What is weakness in the context of neuropathology?
inability to generate force or inability to correctly and/or adequately recruit or modulate MNs
what do musculoskeletal contributions to weakness seen with neurological injury reflect?
length of internal lever arm, length/tension relationship, cross-sectional area of muscle, type of fibers, and fiber arrangement
What is the difference between paralysis/plegia and paresis?
the mild/mod vs total/profound loss of muscle activity
what are synergies?
muscle /joint movements that occur in stereotypical patterns
What movements are associated with an upper extremity flexor synergy?Think: what actions do you need to eat??
scapular: retraction + elevation
shoulder: abd/ER
elbow: flex/sup
Wrist and finger: flex
What movements are associated with an lower extremity extensor synergy?
Hip :ext/add/IR
Knee:ext
ankle: PF and inversion,
toe: PF
What areas, when damaged, impact the integrity of the stretch reflex?
supraspinal structures involved in theri modulation (much emphasis on lateral corticospinal tract + others)
spinal cord
sensory feedback systems
What is Babinski’s reflex?
toes fan out vs curling in response to stimulus
not normal in adults (flexor-withdrawal)
Define tone. How does it help us maintain a state of readiness?
it is the muscle’s resistance to passive stretch. IT prevents us from falling victim to gravity
what is normal tone influenced by?
physical inertia
intrinsic mechanical elastic stiffness
spinal reflex-tonic stretch (balance of stretch/flex tracts)
cerebellum
what is the difference between hypotonicity and flaccidity?
reduction in ton>floppy against gravity and hard to excite vs complete loss of tone
Why do we see hypotonicity/flaccidity after injury? What types of pathology do we see this reduction in tone with?
cerebellar lesions, LMN injuries, immediate after acute CNS injury but often reverses
What are the general differences between spasticity and rigidity?
spasticity is velocity dependent whereas rigidity is not.
What are the different types of rigidity that can be seen?
*all typically impact flexors most *
lead pipe (constant resistance)
cogwheel (alt instances of resistance and relaxation)
clasp-knife (initial rigidity that goes away )
what structures are commonly associated with spasticity? Rigidity?
PYRAMIDAL TRACTS; BASAL GANGLIA
What is posturing? What is the difference between the two types?
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
some of the major functional implications of increased and decreased tone
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
