Movement Considerations in Neuro Disorders

Question 1

Signs Definition

Answer 1

Signs of neurologic dysfunction represent objective findings of pathology that can be determined by physical examination

Question 2

Symptoms Definition

Answer 2

Symptoms are subjective reports associated with pathology that are perceived by the patient, but may not necessarily be objectively documented on examination

Question 3

Definitions of Tone

Answer 3

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

Question 4

Tone Modifiers

Answer 4

UMN
Sensory input
LMN
Position
Ability to relax
State of alertness

Question 5

Spasticity

Answer 5

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’

Question 6

Rigidity

Answer 6

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’

Question 7

Spasticity and Function

Answer 7

No correlation between spasticity and degree of disability

We can strengthen individuals with UMN lesions (treating negative signs) without increasing spasticity - Guiliani, 1997

Question 8

Modified Ashworth Scale - 0

Answer 8

No increase in muscle tone

Question 9

Modified Ashworth Scale - 1

Answer 9

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

Question 10

Modified Ashworth Scale - 1+

Answer 10

Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

Question 11

Modified Ashworth Scale - 2

Answer 11

More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved

Question 12

Modified Ashworth Scale - 3

Answer 12

Considerable increase in muscle tone, passive movement difficult

Question 13

Modified Ashworth Scale - 4

Answer 13

Affected part(s) rigid in flexion or extension

Question 14

Modified Tardieu Scale

Answer 14

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.

Question 15

Abnormalities Resulting from Motor Cortex Dysfunction

Answer 15

Motor weakness (paresis)
Abnormal synergies
Co-activation
Abnormal muscle tone (usually hypertonia)

Question 16

Abnormalities Resulting from BG Dysfunction

Answer 16

Hypokinetic disorders: bradykinesia and akinesia
Rigidity
Resting tremor
Hyperkinetic disorders: choreiform and athetoid movements, dystonia

Question 17

Abnormalities Resulting from cerebellar Dysfunction

Answer 17

Hypotonia
Incoordination
Intention tremor
Impaired error correction affecting motor learning

Question 18

Abnormal Synergistic Movements

Answer 18

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)

Question 19

Typical ‘abnormal’ limb synergies

Answer 19

Flexion synergy-flexion, abduction, and ER

Extension synergy-extension, adduction, IR

Question 20

Most Typical Abnormal Synergy

Answer 20

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

Question 21

Twitchell and recovery after stroke

Answer 21

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

Question 22

Brunnstrom Assessment

Answer 22

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

Question 23

Brunnstrom Stage 1

Answer 23

Flaccidity

No movement present (reflex or voluntary)

Question 24

Brunnstrom Stage 2

Answer 24

Weak associated reactions appear
Or minimal voluntary movement responses are present in limb synergies
Spasticity begins to develop

Question 25

Brunnstrom Stage 3

Answer 25

All movements are in synergy
Synergies may not be through full ROM
Spasticity peaks

Question 26

Brunnstrom Stage 4

Answer 26

Some movement combinations out of synergy
Mastered with difficulty
Spasticity now decreasing

Question 27

Brunnstrom Stage 5

Answer 27

Synergies lose their dominance
More difficult movement combinations can be mastered
Spasticity further decreases

Question 28

Brunnstrom Stage 6

Answer 28

No synergies; full isolated joint movement are possible

Decreased coordination

Question 29

Fugl Meyer Assessment Tool

Answer 29

Standardized test that includes joint ROM, pain, sensation, motor function and balance
Designed for individuals with CVA
Based on Brunnstrom’s stages of motor recovery
Includes specific voluntary movements the person attempts to perform
Scoring: 3 point scale for each item of motor function section (50 total movements)
0=item can not be performed
1=item can be partially performed
2=item performed faultlessly

Maximum scores: 
UE motor performance =66; 
LE motor performance = 34 
ULE TOTAL = 100
Motor scores < 50: severe motor impairment
50-84: marked motor impairment
85-95: moderate motor impairment
96-99: slight motor impairment

Question 30

Hypometria

Answer 30

Underestimation of the required force or range of movement

Question 31

Dysmetria

Answer 31

Traditionally, problems in judging the distance or range of a movement

Question 32

Hypermetria

Answer 32

Overestimation of the required force or range of movement

Question 33

Dysdiadochokinesia

Answer 33

Abnormal rapid movement

Question 34

Non-equilibrium tests

Answer 34

Finger to nose, heel to shin
Quality of movement
Subjectively graded 1-5

Question 35

Dystonia

Answer 35

Sustained muscle contractions, often twisting, repetitive and abnormal

Question 36

PT tx for tone

Answer 36

Rhythmic rotation in various positions

Can modulate tone, can’t reduce it

Question 37

Treatment (intervention) of involuntary movements

Answer 37

Reduced effort/increase efficiency
Weight bearing and approximation
Distal fixation
Limb weighting is controversial

Question 38

Define Positive Signs

Answer 38

Release of abnormal behaviors

ex: positive Babinski, tremor, hypertonicity

Question 39

Define Negative Signs

Answer 39

Loss of normal behaviors

ex: paresis, aphasia

Question 40

Primary impairments of body structure/function

Answer 40

Impairments that result from the original pathology/health condition
Ex: Paresis, paralysis, spasticity

Question 41

Secondary impairments of body structure/function

Answer 41

Result from primary impairments
Ex: contracture, adaptive changes to mechanical fiber properties, loss of ROM, deconditioning, skin breakdown, loss of strength

Question 42

Hypotonia

Answer 42

Less than normal tone, stiffness, tension

Little or no tension in response to passive stretch

Question 43

Hypertonia

Answer 43

Excessive tone, stiffness, tension in response to palpation of the muscle
Excessive tension in response to passive stretch

Question 44

Define these words:
Weakness
Paralysis/plegia
Paresis

Answer 44

Weakness: inability to generate adequate force, can be a musculoskeletal or neuro problem
Paralysis/plegia: total or severe loss
Paresis: mild or partial loss

Question 45

What is motor function?

Answer 45

The ability to learn and demonstrate the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns

Strength, power, and endurance

Coordinatiom and synergistic movements of agonists, antagonists, stabilizers