Movement Considerations in Neuro Disorders Flashcards
Signs Definition
Signs of neurologic dysfunction represent objective findings of pathology that can be determined by physical examination
Symptoms Definition
Symptoms are subjective reports associated with pathology that are perceived by the patient, but may not necessarily be objectively documented on examination
Definitions of Tone
Continuous state of mild contraction, thought to be due to low levels of spontaneous spike activity by alpha LMNs
Readiness of a muscle to work
Resistance by a muscle to passive stretch
Resting tension in a muscle
Tone Modifiers
UMN Sensory input LMN Position Ability to relax State of alertness
Spasticity
Velocity dependent
implying response to external sensory stimulus
Tends to occur on one side of the joint (e.g., elbow flexors, not extensors)
Cannot be reduced just by cortical strategies
Typically occurs with cortical damage
‘Clasp knife’
Rigidity
Not velocity dependent
implying not a response to external sensory stimuli
Tends to occur on both sides of the joint (e.g., both flexors and extensors)
Can sometimes be reduced by cortical strategies
Typically occurs with BG damage
‘Cogwheel’
Spasticity and Function
No correlation between spasticity and degree of disability
We can strengthen individuals with UMN lesions (treating negative signs) without increasing spasticity - Guiliani, 1997
Modified Ashworth Scale - 0
No increase in muscle tone
Modified Ashworth Scale - 1
Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM when the affected part(s) is moved in flexion or extension
Modified Ashworth Scale - 1+
Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
Modified Ashworth Scale - 2
More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
Modified Ashworth Scale - 3
Considerable increase in muscle tone, passive movement difficult
Modified Ashworth Scale - 4
Affected part(s) rigid in flexion or extension
Modified Tardieu Scale
Measures the point of resistance or “catch” to a rapid velocity stretch (R1 value)
Measures the point of mechanical resistance with slow stretch (R2 value)
A large difference between the initial catch and the point of mechanical resistance indicates a large reflexive component to motion limitation, and a small difference suggests a more fixed muscle contracture.
Abnormalities Resulting from Motor Cortex Dysfunction
Motor weakness (paresis)
Abnormal synergies
Co-activation
Abnormal muscle tone (usually hypertonia)
Abnormalities Resulting from BG Dysfunction
Hypokinetic disorders: bradykinesia and akinesia
Rigidity
Resting tremor
Hyperkinetic disorders: choreiform and athetoid movements, dystonia
Abnormalities Resulting from cerebellar Dysfunction
Hypotonia
Incoordination
Intention tremor
Impaired error correction affecting motor learning
Abnormal Synergistic Movements
After injury to the motor cortex – some suggestion that since there is a reduction in corticospinal control of movement, that abnormal synergies result from the recruitment of brainstem centers (rubrospinal)
Typical ‘abnormal’ limb synergies
Flexion synergy-flexion, abduction, and ER
Extension synergy-extension, adduction, IR
Most Typical Abnormal Synergy
Flexion Synergy UE Scapula: retraction & elevation Shoulder: abduction & ER Elbow: flexion Forearm: supination Wrist and finger: flexion
Extension Synergy LE Hip: extension, adduction, IR Knee: extension Ankle: plantar flexion, inversion Toe: extension
Twitchell and recovery after stroke
Abnormal synergistic movement patterns in a stepwise sequence following stroke
Initial flaccidity and areflexia
Hyperreflexia, spasticity, stereotyped flexor and extensor voluntary movements
Voluntary movements out of abnormal synergies until normal movement is achieved.
Recovery is proximal to distal
Initial Flexor movements in UE and Extensor movements in LE
Brunnstrom Assessment
Further defined 6 stages of recovery of motor function after stroke by asking individual to perform voluntary movements and observe the responses
Sitting - LE Lift up hip and knee Straighten knee Tap your toes on the floor Sitting - UE Reach for my hand Standing Lift hip and knee Extend hip and flex knee Tap toes
Brunnstrom Stage 1
Flaccidity
No movement present (reflex or voluntary)
Brunnstrom Stage 2
Weak associated reactions appear
Or minimal voluntary movement responses are present in limb synergies
Spasticity begins to develop
