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Neuroanatomy > Motor Impairments > Flashcards

Motor Impairments Flashcards

1
Q

Apraxia

A
  • Motor planning deficits
  • Often associated with aphasia and is at the same level of severity
  • Inability to perform purposeful movements, loss of coordination, impaired sensation, attention difficulties, abnormal tone or loss of cognition
  • Pt unable to accomplish task
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2
Q

Ideomotor Apraxia

A
  • Pt is unable to perform a task upon commanded but may carry out habitual tasks
    ie: Pt cannot blow out match upon command, but will blow it out spontaneoulsy
  • Pt often perseverates with actions
  • increase success with task performance
    (one step at a time, then combine steps)
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3
Q

Ideational Apraxia

A
  • Is a failure in the conceptualization of the task
  • Pt may not perform either automatically or upon command
  • The pt no longer understands the overall concept of the act (pt may not know what to do with a razor, comb..)
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4
Q

Paresis

A
  • Weakness due to CNS (UMNL)
  • Most significant on the contraleteral side
  • Ipsilateral mm may also be weak
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5
Q

Tonal Abnormalities

A
  • Flaccidity

- Spasticity

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6
Q

Flaccidity

A
  • Absence of mm tone, resulting in a lack of voluntary movement
  • Usually short lived, lasting hours, days, or weeks
  • Persists in small number of pt’s
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7
Q

Spasticity

A
  • Develops in 90% of cases and in predictable patterns (Synergy Pattersn)
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8
Q

UE Flexion Synergy

A
  • Spasticity
  • Scapular Retraction
  • Shoulder: Abd, external rotation
  • Elbow/Forearm: Flexion / Supination
  • Wrist / Finger: Flexion
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9
Q

UE Extension Synergy

A
  • Spasticity
  • Scapular Protraction
  • Shoulder: ADD, Internal Rot
  • Elbow / Forearm: Extension / Pronation
  • Wrist / Finger: Flexion
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10
Q

LE Flexion Synergy

A
  • Spasticity
  • Hip: Flexion, ABD, Exteral Rot
  • Knee: Flexion
  • Ankle: Dorsiflexion, Inversion
  • Toes: Extension
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11
Q

LE Extension Synergy

A
  • Spasticity
  • Hip: Extension, ADD, Internal Rot
  • Knee: Extension
  • Ankle: Plantarflexion, Inversion
  • Toes: Flexion
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12
Q

Neck and Trunk Patters of Spasticity

A
  • Paracervical mm’s spasticity resulting in:
  • Flexion to the hemiplegic side and contralateral rotation
  • Forward head
  • Trunk appears laterally flexed on hemiplegic side
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13
Q

Clonus

A
  • may be present, especially in plantarflexors and wrist flexors
  • Alternating rhythmic contraction and relaxation following stretch
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14
Q

The most common pattern of spasticity is?

A
  • UE Flexion and LE Extension
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15
Q

Dominance of reflexes

A
  • Primitive and tonal
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16
Q

Flexor withdrawl

A
  • Relexes

- Stimulation on sole of the foot produces ankle dorsiflexion and hip/knee flexion

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17
Q

STNR

A
  • Symmetric tonic neck reflex
  • Neck flexion results in UE flexion and LE extension
  • Nexk extension results in UE Extension and LE Flexion
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18
Q

ATNR

A
  • Asymmetric tonic neck reflex

- Head rotation results in jaw side extension and skull side flexion of all extremities

19
Q

TLR

A

Tonic Labyrinthine Reflex

  • Prone causes increase in flexor tone
  • Supine causes increase in extensor tone
20
Q

Grasp

A
  • Pressure in palm produces finger flexion
21
Q

Tonic Lumbar Reflexes “Rotation of upper Trunk to the involved side” results in

A
  • Flexion in involved UE

- Extension of involved LE

22
Q

Tonic Lumbar Relexes “Rotation to the uninvolved side results in

A
  • Extension in involved UE

- Flexion in involved LE

23
Q

Positive Supporting Reaction

A
  • Pressure on the bottom of the hemiplegic foot may produce a strong co-contraction response and increase extensor tone in LE resulting in a rigidly extended and fixed limb with foot in PF and knee possibly in genu recurvatum (knee hyperextension)
24
Q

Associated Reactions

A
  • Abnormal, automatic responses of the involved limbs, resulting from action occurring in some other part of the body by voluntary or reflex stimulatoin
    ie: Voluntary mm contraction
    Coughing
    Yawning
    Sneezing
  • These reactions are easier to elicit in the presence of spasticity and frequently interact with tonic reflexes
25
Q

Souques Phenomenon

A
  • Elevation of involved UE above 150 deg with elbow extended produces finger extension and abduction
26
Q

Raimste Phenomenon

A
  • resisted hip abduction or adduction on the uninvolved produces a similar response on the involved side
27
Q

Decreased function of higher level postural reactions

A
  • Writing
  • Equilibrium
  • Protective Extension
  • Can result in poor posturing, poor balance and / or inability to self correct or make postural adjustments
28
Q

Brunnstrom States of Motor Recovery

A

Stages 1-6

29
Q

Stage 1

A
  • Flaccidity

- No voluntary movement and patient is confind to a bed

30
Q

Stage 2

A
  • Spasticity begins to develop (in synergy patters) in extremities as well as trunk, shoulder and pelvic girdles (still no voluntary movement)
31
Q

Stage 3

A
  • Spasticity increases and reaches its peak

- Pt gains voluntary control of synergies but not necessarily full ROM with movements

32
Q

Stage 4

A
  • Spasticity begins to decline
  • Pt begins movement out of synergy
  • Can place hand behind body, alternate pronation / supination with the elbow at 90 deg flexion and elevation of arm to forward horizontal position
33
Q

Stage 5

A
  • Spasiticity continues to decrease

- Increased muscular control out of synergy (arms raised to a side horizontal position, can bring hand over head)

34
Q

Stage 6

A
  • Spasiticity disappears, coordination approaches normal

- All isolated joint movements available

35
Q

Synergy movements can be useful to initiate______, but they interfere with _________.

A
  • Movements
  • Rehabilitation
    (after stage 1)
36
Q

Muscles typically not involved in synergy patters

A
  • Latissimus Dorsi
  • Teres Major
  • Serratus Anterior
  • Finger Extensors
  • Ankle Evertors
    (much more difficult to activate)
37
Q

Tredelenburg limp

A
  • Weak Abductors

opposite side

38
Q

Scissoring

A
  • Spastic Adductors
39
Q

Abducted Gait

A
  • PF and / or knee extension spasticity
40
Q

Circumduction

A
  • Weak hip flexors

- Foot Drop

41
Q

Steppage Gait

A
  • Marching
  • Good hip flexors
  • Foot drop and or tight gastroc
  • Strong flexion synergy
42
Q

Equinovarus

A
  • Plantarflexion with inversion or varus
  • Due to:
    Tight gastroc or tibialis posterior
    Spastic anterior tibialis, posterior tibialis, toe flexors and gastroc/soleus
    Weak Peroneals and toe extensors
43
Q

Genu recurvatum

A
  • Tight or spastic gastroc and tibialis posterior

Neuroanatomy (43 decks)

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