Motor Tone and Coordination (Lecture)

Question 1

What does a motor assessment include?

Answer 1

ROM (active and passive)

Flexibility (muscle length)

Strength (individual or muscle groups, based on spinal nerve root innervations, innervations ie myotomes, function, or task activity)

tone and deep tendon reflexes (DTR)

coordination (movement control/smoothness)

involuntary movements (tics, tremors, ballistic, and choreic movements)

Question 2

define tone

Answer 2

Question 3

what is tone important for (incl 3 main areas) and what is it necessary for?

Answer 3

Question 4

what is the continuum of muscle tone?

Answer 4

Question 5

Define hypotonia and what conditions it is commonly associated with

Answer 5

Question 6

Define hypertonia and what conditions it is often associated with

Answer 6

Question 7

What are 2 types of hypertonicity?

Answer 7

Question 8

define spasticity and what conditions is it typical for?

Answer 8

Question 9

define rigidity and what diseases it is most common for

Answer 9

Question 10

compare spasticity and rigidity in terms of: pattern of muscle involvement, nature of tone, and clinical significance

Answer 10

Spast = extensors and flexors at different times

Rigidity = more core

Question 11

define pyramidal vs extrapyramidal tract

Answer 11

Extrapyramidal: part of the motor system causing involuntary movements - modulate and regulate (indirect control) ventral horn cells

Pyramidal: tracts of the motor cortex that reach their targets by traveling through the “pyramids” of the medulla - directly innervate motor neurons of the spinal cord or brainstem

Question 12

what is a tonic response?

Answer 12

Tonic response = resistance to passive stretch

Question 13

how would you grade a low tone muscle response?

Answer 13

A muscle is said to have low tone when there is no or little resistance to passive lengthening, it may also feel soft on palpation. There is no other grading of low tone; only qualitative.

Question 14

how is muscle tone typically assessed?

Answer 14

¢Muscle tone is typically tested clinically by moving limb segments through range (passive mvmt) and judging or grading the amount of resistance to the lengthening movement.

Question 15

how would you grade a high tone/spasticity response?

Answer 15

often graded clinically using the Modified Ashworth Scale (MAS); other scales exist but MAS is clinically widespread.

Question 16

describe how to carry out a test for spascticity using the modified ashworth scale

Answer 16

note: for spasticity or high tone only!

* ie just lengthen the muscle!

Question 17

what is the rating scale for the modified ashworth scale?

Answer 17

Question 18

what are the 2 superficial reflexes? - what conditions are these assocaited with?

Answer 18

1) Babiniski or plantar reflex
2) Hoffman’s reflex

*note these are associated with upper motor neuron conditions

Question 19

Describe the Babinski reflex

Answer 19

Question 20

describe the hoffman’s reflex

Answer 20

Hoffman’s = Its the thumb and finger (either or both) that will move

Question 21

describe how to assess deep tendon reflexes (DTRs) and how to assess if thr patient is unable to relax

Answer 21

Question 22

name the 5 reflexes and their spinal nerve roots

Answer 22

Question 23

what is the scale for tendon reflex assessment?

Answer 23

Question 24

what is the pendilar reflex and what is it associated with?

Answer 24

Pendular reflex – associated with cerebellar lesions

reflexes are not brisk but actually involve poor agonist-antagonist movement control; loosely swings forwards and backwards several times, slows down (decreases in amplitude) & stops.

Question 25

what is clonus reflex?

Answer 25

Question 26

How is the clonus reflex assessed?

Answer 26

Question 27

what is sustained vs unsustained clonus?

Answer 27

unsustained – stops by itself (note # beats) sustained (constant) – does not stop \*Sustained clonus - note how weight-bearing on heel stops clonus.

Question 28

what are the impacts of having low tone and high tone?

Answer 28

Question 29

what are the 2 types of pt techniques to manage tone? what typoes of sensory imput are involved?

Answer 29

1) Facilitatory (activation) techniques to increase tone 2) Inhibitory techniques to decrease tone Types of Somatosensory input – cutaneous/proprioceptive

Question 30

name some facilitatory techniques for increasing tone

Answer 30

Question 31

name some inhibitory techniques for decreasing tone

Answer 31

Question 32

describe the management of spasticity flow chart

Answer 32

Question 33

define motor coordination - what is normal and abnormal?

Answer 33

Question 34

what is ataxia associated with?

Answer 34

often associated with cerebellar conditions

Question 35

what is the difference between ataxia and tremor?

Answer 35

ataxia = abnormal coordination tremor = dyskinesia, rythmic oscillations of any body part

Question 36

what are important movement qualities to observe & evaluate for motor coordination?

Answer 36

note to: Compare both sides Counts # performed in 10 s (usual objective outcome)

Question 37

how do you assess coordination? (2 common tests)

Answer 37

Question 38

define: diadochokinesia

Answer 38

quick succession of agonist-antagonist movements

Question 39

define: dysdiadocokinesia

Answer 39

unable to perform quick succession of agonist-antagonist movements

Question 40

define: dysmetria

Answer 40

over or undershooting during point to point movements

Question 41

define: dysynergia

Answer 41

jerky multi-joint mvmt during point to point movements

Question 42

define: Dyskinesia, how it is assessed and what disease/disability it is associated with

Answer 42

Involuntary movements (tremors, dystonia, chorea) assessed through observation Typical in lesions of cerebellum or basal ganglia

Question 44

define tremors (and types)

Answer 44

Tremors – rythmic oscillations of any body part; action (during any volunary mvmt) intention (target-related) postural (holding anti-gravity positions) resting (at rest, no mvmt)

Question 45

define: dystonia

Answer 45

Dystonia – sustained contractions, often with repetitive twisting or abnormal postures

Question 46

define: chorea

Answer 46

Chorea – irregular, purposeless movement of any part of the body; can include ballistic (maximum accelerations over short period of time) movement or fast ‘flailing’ movements