Motor Tone: Exam & Tx [Guest Lecture]

Question 1

Describe the scale for hypotonia assessment

Answer 1

TRICK QUESTION: There is no scale to assess hypotonia

Question 2

List 3 ways to assess hypertonia

Answer 2

• Passive ROM at varying speeds
• Modified Ashworth
• Tardieu

Question 3

List 3 ways you can describe tone

Answer 3

• clasp knife
• cog wheel
• lead pip

Question 4

Describe the scoring of the Modified Ashworth Scale

Answer 4

0 = normal

1 = slight tone

2 = mid range tone

3 = approaching rigidity

4 = rigidity

Question 5

Describe the aspects of the Tardieu Scale

Answer 5

Has two axes

X axis = spasticity angle or threshold (speed at which tone is felt)

Y = spasticity grade or gain (amount of tone 0-4 scale)

Question 6

Term: Indicates sensitivity of alpha motor neuron system

Answer 6

H Reflex

Gold standard to assess the neural component of tone

Question 7

Describe the tx for hypertonicity

Answer 7

Medications: Baclofen, Valium, BoTox

• need a balance between decreasing tone and effect on function

Surgical: nerve ablation or block

Question 8

Term: move precisely and quickly

Answer 8

Task goal

Question 9

Term: multiple joints and mm activated at appropriate time to work together

Answer 9

multi-muscle activation

Question 10

List the 2 sequencing problems that can present with attempts at multi-muscle activation

Answer 10

• coactivation across joint
• interjoint/trunk coordination

Question 11

Term: Inability to move a single joint without simultaneous movement in other joints

Answer 11

Synergy

Question 12

Describe the typical synergy presenation following a stroke

Answer 12

UE tends to be flexor synergy dominant

LE tends to be extensor synergy dominant

Question 13

Describe the Brunnstrom Stages of Synergy

Answer 13

Stage 1 = no movement

Stage 2 = involuntary movement only (ex. twitch w/coughing)

Stage 3 = abnormal synergy only

Stage 4 = isolate one joint

Stage 5 = isolate two joints

Stage 6 = isolate all joints (but lack coordination/speeD)

Stage 7 = normal movement

Question 14

Term: When the pt. moves due to effort of separate limb movement

Answer 14

Associated reaction

ex. while focusing on flexing the left elbow the left wrist may also flex

Question 15

Describe the Fugl Meyer Test

Answer 15

Is a test of motor control

Very lengthy and loosely based on Brunnstrom staging but fails to address function

Question 16

Describe the STREAM Test

Answer 16

The STREAM is based on the Fugl Meyer but as a component to address function

STREAM = stroke rehabiliation assessment of movement

Question 17

Describe the S-STREAM test

Answer 17

It is a simplified version of STREAM that only takes 10 minutes to administer

Question 18

Describe how the STREAM is scored

Answer 18

3 point scale for MOVEMENT

4 point scale for MOBILITY

Total raw score is out of 70 (20 for UE, 20 for LE, 30 for mobility) and can be converted to a percentage