Motor Impairments Flashcards
Apraxia
- 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
Ideomotor Apraxia
- 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)
Ideational Apraxia
- 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..)
Paresis
- Weakness due to CNS (UMNL)
- Most significant on the contraleteral side
- Ipsilateral mm may also be weak
Tonal Abnormalities
- Flaccidity
- Spasticity
Flaccidity
- 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
Spasticity
- Develops in 90% of cases and in predictable patterns (Synergy Pattersn)
UE Flexion Synergy
- Spasticity
- Scapular Retraction
- Shoulder: Abd, external rotation
- Elbow/Forearm: Flexion / Supination
- Wrist / Finger: Flexion
UE Extension Synergy
- Spasticity
- Scapular Protraction
- Shoulder: ADD, Internal Rot
- Elbow / Forearm: Extension / Pronation
- Wrist / Finger: Flexion
LE Flexion Synergy
- Spasticity
- Hip: Flexion, ABD, Exteral Rot
- Knee: Flexion
- Ankle: Dorsiflexion, Inversion
- Toes: Extension
LE Extension Synergy
- Spasticity
- Hip: Extension, ADD, Internal Rot
- Knee: Extension
- Ankle: Plantarflexion, Inversion
- Toes: Flexion
Neck and Trunk Patters of Spasticity
- Paracervical mm’s spasticity resulting in:
- Flexion to the hemiplegic side and contralateral rotation
- Forward head
- Trunk appears laterally flexed on hemiplegic side
Clonus
- may be present, especially in plantarflexors and wrist flexors
- Alternating rhythmic contraction and relaxation following stretch
The most common pattern of spasticity is?
- UE Flexion and LE Extension
Dominance of reflexes
- Primitive and tonal
Flexor withdrawl
- Relexes
- Stimulation on sole of the foot produces ankle dorsiflexion and hip/knee flexion
STNR
- Symmetric tonic neck reflex
- Neck flexion results in UE flexion and LE extension
- Nexk extension results in UE Extension and LE Flexion
ATNR
- Asymmetric tonic neck reflex
- Head rotation results in jaw side extension and skull side flexion of all extremities
TLR
Tonic Labyrinthine Reflex
- Prone causes increase in flexor tone
- Supine causes increase in extensor tone
Grasp
- Pressure in palm produces finger flexion
Tonic Lumbar Reflexes “Rotation of upper Trunk to the involved side” results in
- Flexion in involved UE
- Extension of involved LE
Tonic Lumbar Relexes “Rotation to the uninvolved side results in
- Extension in involved UE
- Flexion in involved LE
Positive Supporting Reaction
- 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)
Associated Reactions
- 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
Souques Phenomenon
- Elevation of involved UE above 150 deg with elbow extended produces finger extension and abduction
Raimste Phenomenon
- resisted hip abduction or adduction on the uninvolved produces a similar response on the involved side
Decreased function of higher level postural reactions
- Writing
- Equilibrium
- Protective Extension
- Can result in poor posturing, poor balance and / or inability to self correct or make postural adjustments
Brunnstrom States of Motor Recovery
Stages 1-6
Stage 1
- Flaccidity
- No voluntary movement and patient is confind to a bed
Stage 2
- Spasticity begins to develop (in synergy patters) in extremities as well as trunk, shoulder and pelvic girdles (still no voluntary movement)
Stage 3
- Spasticity increases and reaches its peak
- Pt gains voluntary control of synergies but not necessarily full ROM with movements
Stage 4
- 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
Stage 5
- Spasiticity continues to decrease
- Increased muscular control out of synergy (arms raised to a side horizontal position, can bring hand over head)
Stage 6
- Spasiticity disappears, coordination approaches normal
- All isolated joint movements available
Synergy movements can be useful to initiate______, but they interfere with _________.
- Movements
- Rehabilitation
(after stage 1)
Muscles typically not involved in synergy patters
- Latissimus Dorsi
- Teres Major
- Serratus Anterior
- Finger Extensors
- Ankle Evertors
(much more difficult to activate)
Tredelenburg limp
- Weak Abductors
opposite side
Scissoring
- Spastic Adductors
Abducted Gait
- PF and / or knee extension spasticity
Circumduction
- Weak hip flexors
- Foot Drop
Steppage Gait
- Marching
- Good hip flexors
- Foot drop and or tight gastroc
- Strong flexion synergy
Equinovarus
- 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
Genu recurvatum
- Tight or spastic gastroc and tibialis posterior
