Motor Screen Flashcards

1
Q

what is motor screen?

A

*To assess strength, active ROM, and passive ROM, tone, activation/sequencing

*Also included in MSK screen for ROM, end feel, muscle length, power, endurance

*Help determine if motor deficits are neurological (tone, paresis) or MSK (past or presents injury)

*May require additional positioning to fully assess (gravity eliminated)

*May also need to be done in a functional movement pattern

*Limitations to testing may be secondary to cognitive/attention/communication deficits

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2
Q

what is the primary motor cortex

A

*has the largest concentration of corticospinal neurons

-Anterior to the central sulcus and controls CONTRALATERAL VOLUNTARY movements
Requires stimuli of low response to elicit a motor response

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3
Q

Supplementary (SMA) and Premotor area (PMA)

A

Anterior to the primary motor cortex
Requires a higher intensity stimuli for motor response

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4
Q

SMA

A

-Axons that directly innervate motor units involved in initiation of movement
-Timing
-Sequential tasks
-Action monitoring

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5
Q

PMA

A

Innervates motor units that control trunk and proximal limb movements
Plan and prepare the body for movement

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6
Q

with the motor system

A

*Motor cortex receives information from the somatosensory cortex, the cerebellum, and basal ganglia

-Somatosensory information is relayed directly to the primary motor cortex from the thalamus

-Thalamus also relays information to the cerebellum and basal ganglia which allow integration and appropriate course of action

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7
Q

the motor system also has

A

*The cerebellum regulates movement, postural control, and muscle tone.

-Error correcting

-Compares the command for the intended movement transmitted to the motor cortex with the actual movement of the body

-If input from the feedback system does not compare appropriately, the cerebellum gives a counteractive influence.

-Cerebellum sends signals to the cortex to modify the movement

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8
Q

The motor system consist of asal ganglia which is ?

A

-Located in the cerebral cortex

-Main nuclei Caudate nucleus, putamen, globus pallidus

-Subthalamic nucleus and substantia nigra are subcortical but part of basal ganglia

Maintains normal background muscle tone

-Initiation and regulation of intentional movement, planning and executing motor responses, facilitation of desired responses while inhibiting others, accomplish automatic movements and postural adjustments

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9
Q

what is strength?

A

-ability to generate sufficient tension in a muscle for posture and movement

Results from musculoskeletal properties of the muscle and the neural activation

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10
Q

what is weakness

A

*inability to generate normal levels of force

Very common impairment in those with upper motor neuron lesions

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11
Q

what is paresis

A

*decreased voluntary motor unit recruitment

Difficulty recruiting motor units to generate movement

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12
Q

what is Paralysis

A

absence of muscle recruitment and inability to generate movement

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13
Q

what is muscle grades

A

0: no contraction

1: visible muscle twitch but no movement of the joint

2: weak contraction and unable to overcome gravity

3: weak but able to overcome gravity but not able to take additional resistance

4: weak but able to overcome gravity and some resistance but not full

5: Able to overcome gravity and full resistance

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14
Q

what is the process of strength testing

A

*Stabilize the trunk by testing in supine or sitting with back support

*Ask the patient to move the limb through ROM against gravity
-Observe for the quality of movement or any compensations (synergy)

*If patient cannot perform this against gravity, have them move to a gravity eliminated position

*You may also need to assist them in AAROM

*Graded same as in MSK

*Good evidence for progressive resistance training in stroke patient to improve strength.

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15
Q

what is tone?

A

Muscle tone: muscle’s resistance to passive stretch, caused by output from alpha and gamma motor neurons

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16
Q

what is Spasticity:

A

is velocity-dependent increase in tonic stretch reflex

*Dysfunction of the corticospinal tract

*Exaggerated tendon jerks from hyperexcitability of the stretch reflex

*Common in upper motor neuron lesions

*Can be related to abnormal posturing, excessive co-activation of muscles, associated reactions, clonus, and synergies

17
Q

what is rigidity?

A

is a increased resistance to passive movement but IS NOT velocity dependent

-Due to disruption or disease of the basil ganglia

-Lead pipe: consistent resistance to movement through entire range

-cogwheel: alternating episodes throughout range, catching

18
Q

what is Hypotonia

A

reduced stiffness of the muscle when lengthened or moved through range

19
Q

what are stages of motor recovery?

A

Stage 1: Flaccid paralysis: no movement is elicited

Stage 2: Early Synergy: facilitatory stimuli will elicit partial range synergies and appear in associated reactions, little voluntary movement

Stage 3: voluntary control of the synergy movement and spasticity has further developed

Stage 4: Some isolated out of synergy movement emerges

Stage 5: independence of synergy but spasticity continues to decreases and isolated joint movements are more apparent

Stage 6: patterns appear near normal

*Progression is apparent through the stages but recovery is highly individualized

*Some patients experience full recovery from mild involvement while others experience severe involvement with incomplete recovery

*Recovery can plateau at ANY stage

20
Q

what is the modified ashworth scale?

A

*Scale used to assess alterations in muscle tone

*Tested when the muscle is fully at rest

*Tone can be treated with pharmacology, surgery and PT

-Approximation, traction, quick stretch for low tone

***study the scale

21
Q

what is muscle bulk

A

Observing for bulk and involuntary movements is often overlooked

Bulk can be hypertrophic (too much) or atrophic (wasting)

22
Q

what is fasiculations

A

movements under the skin that are small and indicates denervation of the muscle, looks like fish jumping in the skin

23
Q

what is tremor

A

rhythmic movement

24
Q

what is chorea

A

quick, larger, piano like playing movement

25
what is dystonia
slower writhing like movement
26
what is myoclonus
quick jerky moving a joint or limb
27
what is coordination?
*Involves multiple joints and muscles that are activated at the appropriate time and with certain force *Assess timing, sequencing, accuracy, and movement efficiency *Commonly seen with lesions in motor cortex, basal ganglia, and cerebellum *Synergy: abnormal patterns of movement secondary to lack of ability to move a single joint without simultaneously generating movement in other joints -Flexion of the UE: scapular retraction and elevation, shoulder abduction and ER, elbow flexion, forearm supination and wrist and finger flexion -Extension of the LE: hip extension, adduction and IR, knee extension, ankle PF and inversion, to PF
28
coordination: dysmetria
*problems judging distance or range of movement -Inability to scale forces to meet the tasks coordination is Common in patients with cerebellar dysfunction
29
what is hypermetria
overestimation of the force or range of movement needed for a specific task
30
what is hypometria
underestimation of the required force of range to completed a task
31
what is dysdiadochokinesia
inability to perform rapid alternating movements.
32
how do you assess coordination?
*Is the movement jerky? Slow? Fluid? Smooth? *Finger to nose/alternating finger to nose: -Contralateral finger to nose or alternate each finger to nose -Pronation/supination Alternating turning palms up and down *Rebound test -Elbows flexed and the therapist applies manual resistance for an isometric contraction. Resistance is suddenly released-the triceps should contract to keep from having rebound *Heel to shin The heel is slide up and the contralateral shin To treat: repetition of functional task specific movements and WB activities