Motor Tone and Coordination (Lecture) Flashcards
What does a motor assessment include?
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)
define tone
what is tone important for (incl 3 main areas) and what is it necessary for?
what is the continuum of muscle tone?
Define hypotonia and what conditions it is commonly associated with
Define hypertonia and what conditions it is often associated with
What are 2 types of hypertonicity?
define spasticity and what conditions is it typical for?
define rigidity and what diseases it is most common for
compare spasticity and rigidity in terms of: pattern of muscle involvement, nature of tone, and clinical significance
Spast = extensors and flexors at different times
Rigidity = more core
define pyramidal vs extrapyramidal tract
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
what is a tonic response?
Tonic response = resistance to passive stretch
how would you grade a low tone muscle response?
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.
how is muscle tone typically assessed?
¢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.
how would you grade a high tone/spasticity response?
often graded clinically using the Modified Ashworth Scale (MAS); other scales exist but MAS is clinically widespread.
describe how to carry out a test for spascticity using the modified ashworth scale
note: for spasticity or high tone only!
* ie just lengthen the muscle!
what is the rating scale for the modified ashworth scale?
what are the 2 superficial reflexes? - what conditions are these assocaited with?
1) Babiniski or plantar reflex
2) Hoffman’s reflex
*note these are associated with upper motor neuron conditions
Describe the Babinski reflex
describe the hoffman’s reflex
Hoffman’s = Its the thumb and finger (either or both) that will move
describe how to assess deep tendon reflexes (DTRs) and how to assess if thr patient is unable to relax
name the 5 reflexes and their spinal nerve roots
what is the scale for tendon reflex assessment?
what is the pendilar reflex and what is it associated with?
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.
what is clonus reflex?
How is the clonus reflex assessed?
what is sustained vs unsustained clonus?
unsustained – stops by itself (note # beats)
sustained (constant) – does not stop *Sustained clonus - note how weight-bearing on heel stops clonus.
what are the impacts of having low tone and high tone?
what are the 2 types of pt techniques to manage tone? what typoes of sensory imput are involved?
1) Facilitatory (activation) techniques to increase tone
2) Inhibitory techniques to decrease tone
Types of Somatosensory input – cutaneous/proprioceptive
name some facilitatory techniques for increasing tone
name some inhibitory techniques for decreasing tone
describe the management of spasticity flow chart
define motor coordination - what is normal and abnormal?
what is ataxia associated with?
often associated with cerebellar conditions
what is the difference between ataxia and tremor?
ataxia = abnormal coordination
tremor = dyskinesia, rythmic oscillations of any body part
what are important movement qualities to observe & evaluate for motor coordination?
note to:
Compare both sides
Counts # performed in 10 s (usual objective outcome)
how do you assess coordination? (2 common tests)
define: diadochokinesia
quick succession of agonist-antagonist movements
define: dysdiadocokinesia
unable to perform quick succession of agonist-antagonist movements
define: dysmetria
over or undershooting during point to point movements
define: dysynergia
jerky multi-joint mvmt during point to point movements
define: Dyskinesia, how it is assessed and what disease/disability it is associated with
Involuntary movements (tremors, dystonia, chorea)
assessed through observation
Typical in lesions of cerebellum or basal ganglia
define tremors (and types)
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)
define: dystonia
Dystonia – sustained contractions, often with repetitive twisting or abnormal postures
define: chorea
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
