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Neuromuscular Exam and Rehab Exam 1 > Motor Screen > Flashcards

Motor Screen Flashcards

1
Q

What is the purpose of a motor screen?

A

To assess strength, AROM, PROM, tone, and activation/sequencing
End feel, muscle length, power, endurance
Helps determine if motor deficits are neurological (tone, paresis) or MSK (past or present injuries)

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2
Q

What body regions are part of the peripheral nervous system?

A

Muscles, joints, and their sensory and motor innervation

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3
Q

What are the parts of the central nervous system?

A

Association area
Motor cortex and cerebellum
Brain stem and spinal cord

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4
Q

What is the association area of the CNS?

A

cortex and basal ganglia; movement strategy to best achieve the goal

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5
Q

What is the motor cortex and cerebellum of the CNS for?

A

sequence of contractions, ararnged in space and time, smoothness to achieve goal

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6
Q

What is the brain stem and spinal cord in the CNS for?

A

executions and activation of the motor neurons to generate the movement

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7
Q

Where does information come directly from?

A

motor cortex, spinal cord, and premotor areas

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8
Q

What does NOT have a DIRECT output to the spinal cord?

A

cerebellum and basal ganglion

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9
Q

What guides the motor response?

A

integration of the sensory input informs and guides the motor reasponse

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10
Q

What is the main area that involves motor function?

A

motor cortex

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11
Q

The primary motor cortex has the largest concentration of ______________ _________

A

corticospinal neurons

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12
Q

Where is the primary motor cortex?

A

anterior to the central sulcus

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13
Q

What does the primary motor cortex control?

A

CONTRALATERAL VOLUNTARY movements

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14
Q

What does the primary motor cortex require?

A

stimuli of low response to elicit a motor response

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15
Q

Where is the supplementary and premotor area (SMA and PMA)?

A

anterior to the primary motor cortex

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16
Q

What does the SMA and PMA require?

A

higher intensity stimuli for motor response

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17
Q

What is in the SMA?

A

axons that directly innervate motor units involved in the initiation of movement

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18
Q

What does the SMA control?

A
  • timing
  • sequential tasks
  • action monitoring
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19
Q

What is the PMA innervating?

A

the motor units that control trunk and proximal limb movements

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20
Q

What does the PMA control?

A

planning and preparing the body for movement

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21
Q

What does the motor cortex recieve information from?

A

the somatosensory cortex, the cerebellum and basal ganglia

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22
Q

Where is the somatosensory info relayed directly to?

A

the primary motor cortex from the thalamus

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23
Q

Where does the thalamus relay info to?

A

the cerebellum and basal ganglia which allow integration and appropriate course of action

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24
Q

What does the cerebellum regulate?

A

movement, postural control and muscle tone
- error correcting
- compares command for intended movement transmitted to the motor cortex with the actual movement of the body

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25
Q

What happens if the feedback system does not compare appropriately?

A

the cerebellum gives a counteractive influence

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26
Q

What does the cerebellum to do modify movement?

A

sends signals to the cortex

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27
Q

Where are basal ganglia located?

A

in the cerebral cortex

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28
Q

What are the main basal ganglia?

A
  • caudate nucleus, putamen and globus pallidus
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29
Q

Which basal ganglia are subcortical but still part of the basal ganglia?

A

subthalamic nucleus and substantia nigra

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30
Q

What about muscle tone do the basal ganglia regulate?

A

normal background muscle tone

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31
Q

What do the basal ganglia initate and regulate?

A

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

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32
Q

What is strength?

A

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

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33
Q

What does strength result from?

A

musculoskeletal properties of the muscle and neural activaiton

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34
Q

What is weakness?

A

inability to generate normal levels of force

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35
Q

What kind of lesion is weakness common with?

A

UMN

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36
Q

What is paresis?

A

decreased voluntary motor unit recruitment

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37
Q

What does paresis cause difficult recruiting?

A

motor units to generate the movement

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38
Q

What is paralysis?

A

absence of muscle recruitment and inability to generate movement

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39
Q

What should we do with the trunk to strength test?

A

stabilize the trunk by testing in supine or sitting with back support

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40
Q

What do we ask the patient to do first with strength testing?

A

move the limb through ROM against gravity

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41
Q

What are we observing the initial movement for with strength testing?

A

quality of movement or any compensations (synergy)

42
Q

If a patient cannot perform ROM against gravity, what do we do?

A

put them in a gravity eliminated position

43
Q

What may we need to do during AROM?

A

assist them

44
Q

What has good evidence for stroke patients to improve strength?

A

progressive resistance training

45
Q

What are the 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

46
Q

What is the myotome level and action of the deltoid?

A

C5
- shoulder abduction

47
Q

What is the myotome level and action of the biceps?

A

C5, C6
- elbow. flexion

48
Q

What is the myotome level and action of the triceps?

A

C7
- elbow extension

49
Q

What is the myotome level and action of the wrist extensors?

A

C6, C7
- wrist extension

50
Q

What is the myotome level and action of the wrist flexors?

A

C6, T1
- wrist flexion

51
Q

What is the myotome level and action of grip?

A

C7, C8
- Finger flexion

52
Q

What is the myotome level of finger extension/abduction?

A

C7, C8/C8, T1

53
Q

What is the myotome level and action of the hip flexors?

A

L1, L2
- hip flexion

54
Q

What is the myotome level and action of the knee extensors?

A

L3, L4
- extends knee

55
Q

What is the myotome level and action of the knee flexors?

A

L3, L4
- flexes knee

56
Q

What is the myotome level and action of the ankle DFs?

A

L4, L5
- dorsiflexes ankle

57
Q

What is the myotome level and action of the ankle PFs?

A

S1
- plantarflexes ankle

58
Q

What is muscle tone?

A

muscles resistance to passive stretch caused by output from alpha and gamma motor neurons

59
Q

What is spasticity?

A

VELOCITY-DEPENDENT increase in the tonic stretch reflex
- dysfunction of the corticospinal tract
- exaggeration tendon jerks from hyperexcitability of the stretch reflex
- common in UMN lesions
- can be related to abnormal posturing, excessive co-activation of muscles, associated reactions, clonus, and synergies

60
Q

What is rigidity?

A

Increased resistance to passive movement but is NOT VELOCITY DEPENDENT
- due to disruption or disease of the basal ganglia

61
Q

What is lead pipe rigidity?

A

consistent resistance to movement through the entire range

62
Q

What is cogwheel rigidity?

A

alternating episodes throughout range, catching

63
Q

What is hypotonia?

A

reduced stiffness of the muscle when lengthened or moved through the range

64
Q

What is stage 1 of motor recovery?

A

flaccid paralysis: no movement is elicited

65
Q

What is stage 2 of motor recovery?

A

Early synergy: faciliatory stimuli will elicit partial range synergies and appear in associated reactions, little voluntary movement

66
Q

What is stage 3 of motor recovery?

A

voluntary control of the synergy movement and spasticity has further developed

67
Q

What is stage 4 of motor recovery?

A

some isolated out-of-synergy movements emerge

68
Q

What is stage 5 of motor recovery?

A

independence of synergy, but spasticity continues to decrease, and isolated joint movements are more apparent

69
Q

What is stage 6 of motor recovery?

A

patterns appear near normal

70
Q

When can motor recovery plateau?

A

at any stage

71
Q

What is the modified ashworth scale?

A

a scale used to assess alterations in muscle tone

72
Q

When can muscle tone be tested?

A

when the muscle is fully at rest

73
Q

What can tone be treated with?

A

pharmacology, surgery and PT

74
Q

What is often overlooked during a PT screen?

A

observing to bulk and involuntary movement

75
Q

What are the two kinds of bulk?

A

hypertrophic (too much) or atrophic (muscle wasting)

76
Q

What are fasciculations?

A

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

77
Q

What are tremors?

A

rhythmic movement

78
Q

What is chorea?

A

quick, larger piano-playing movement

79
Q

What is dystonia?

A

slower, writhing like movement

80
Q

What is myoclonus?

A

quick, jerky moving a joint or limb

81
Q

What is the type of paralysis with UMN injuries?

A

spastic

82
Q

What is the type of paralysis with LMN injuries?

A

flaccid

83
Q

What is the type of atrophy with UMN injuries?

A

no disuse atrophy

84
Q

What is the type of atrophy with LMN injuries?

A

severe atrophy

85
Q

What do DTRs do with UMN injuries?

A

increased

86
Q

What do DTRs do with LMN injuries?

A

absent

87
Q

What kind of injury have absent pathological reflexes?

A

LMN

88
Q

What kind of injury has fasciculation and fibrillation?

A

LMN

89
Q

What does coordination involve?

A

multiple joints and muscles that are activated at the appropriate time and with a certain force

90
Q

What should we assess with coordination?

A

timing, sequence, accuracy and movement efficiency

91
Q

When are coordination issues commonly seen? (which lesions)

A

motor cortex, basal ganglia, and cerebellum lesion

92
Q

What is synergy?

A

abnormal patterns of movement secondary to lack of ability to move a single joint without simultaneously generating movement in other joints

93
Q

What is synergy in the UE (flexion)?

A

scapular retraction and elevation, shoulder abduction and ER, elbow flexion, forearm supination and wrist/finger flexion

94
Q

What is the most common synergy in the LE? (extension)

A
  • hip extension, adduction and IR, knee extension, ankle PF and inversion, to PF
95
Q

What is dysmetria?

A

problems judging distance or range of movement
- inability to scale forces to meet the tasks

96
Q

What is hypermetria?

A

overestimation of the force or range of movement needed for a specific task

97
Q

What is hypometria?

A

underestimation of the required force or range to complete a task

98
Q

What is dysdiadochokinesia?

A

inability to perform rapid alternating movements

99
Q

What are some tests to assess coordination?

A
  • finger to nose
  • pronation/supination
  • rebound test
  • heel to shin
100
Q

How do we treat coordination?

A

repetition of functional task-specific movements and WB activities

Neuromuscular Exam and Rehab Exam 1 (11 decks)

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