Motor Screen Flashcards
what is motor screen?
*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
what is the primary motor cortex
*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
Supplementary (SMA) and Premotor area (PMA)
Anterior to the primary motor cortex
Requires a higher intensity stimuli for motor response
SMA
-Axons that directly innervate motor units involved in initiation of movement
-Timing
-Sequential tasks
-Action monitoring
PMA
Innervates motor units that control trunk and proximal limb movements
Plan and prepare the body for movement
with the motor system
*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
the motor system also has
*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
The motor system consist of asal ganglia which is ?
-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
what is strength?
-ability to generate sufficient tension in a muscle for posture and movement
Results from musculoskeletal properties of the muscle and the neural activation
what is weakness
*inability to generate normal levels of force
Very common impairment in those with upper motor neuron lesions
what is paresis
*decreased voluntary motor unit recruitment
Difficulty recruiting motor units to generate movement
what is Paralysis
absence of muscle recruitment and inability to generate movement
what is muscle grades
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
what is the process of strength testing
*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.
what is tone?
Muscle tone: muscle’s resistance to passive stretch, caused by output from alpha and gamma motor neurons
what is Spasticity:
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
what is rigidity?
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
what is Hypotonia
reduced stiffness of the muscle when lengthened or moved through range
what are stages of motor recovery?
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
what is the modified ashworth scale?
*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
what is muscle bulk
Observing for bulk and involuntary movements is often overlooked
Bulk can be hypertrophic (too much) or atrophic (wasting)
what is fasiculations
movements under the skin that are small and indicates denervation of the muscle, looks like fish jumping in the skin
what is tremor
rhythmic movement
what is chorea
quick, larger, piano like playing movement
what is dystonia
slower writhing like movement
what is myoclonus
quick jerky moving a joint or limb
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
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
what is hypermetria
overestimation of the force or range of movement needed for a specific task
what is hypometria
underestimation of the required force of range to completed a task
what is dysdiadochokinesia
inability to perform rapid alternating movements.
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
