Movement system diagnoses Flashcards
What should we focus on what with rehab?
impairments that create limitations
Factors that constrain movement
- ROM/Flexibility (EX: Contracture)
- Strength/muscle activation (weakness)
- Coordination
- Endurance
- Muscle Tone (hyper/hypotonicity)
- Sensation
- Perception
- Posture and alignment
- Cognitive Status
Coordination
Temporal and Spatial (Timing and Where in Space to the right place)
Elements: accuracy, speed control, move limbs independently (fractionation/dissociation)
Endurance
- Muscular
- Cardiopulmonary
- Neural/Cognitive elements (peripheral and central fatigue, motivation)
Spasticity
- Velocity dependent, due to exaggerated stretch reflex
- Inadequate activation of agonist vs. velocity dependent resistance of antagonist impairs movement
Rigidity
Increased resistance – not velocity dependent
Sensation
Missing one of these senses changes how you move:
* Touch and Joint position sense
* Vision
* Vestibular
* Nociception
Perception
- Vertical orientation (typically post stroke)
– Ex: Screen hangs down due to gravity, tells you what is up and down. Post Stroke many people may lose this. - Threat value of movement (as in chronic pain states)
– Ex: Fear Avoidance
Posture and Alignment
COM relative to BOS
Ex: Child and Eldery is different than young to middle aged adults
Ex: Steve being hunched over, shifts the COM forward and makes them much less stable as they are not within the BOS
Movement “Diagnoses”
Standardize the movement problem and worry less about thinking about the medical Dx because it doesn’t always guide what we do. We must target impairments and limitations. Underlying pathology can play some role but limitations are more important to focus on.
Medical “Diagnoses” List
- Movement pattern coordination deficit (Timing and sequencing)
- Force production deficit (weakness)
– Ex: Atrophy, central neural injury, muscle pathology - Force gradation deficit
- Hypokinesia
- ROM Deficit
- Fractionated movement deficit
- Sensory Deficits (Proprioception, Vestibular, Vision)
- Sensory selection and weighting deficit
- Perceptual Deficit
- Cogntive Deficit (Movement deficit due to lack of cognitive ability)
- Endurance Deficit
- Activity tolerance deficit (physiologically cannot tolerate upright activity) Ex: Cardiopulmonary, Neuro
Force Gradation Deficit
- Unable to grade forces appropriately for distance or speed aspects of task
- Movements generally too large for task
- Associated with cerebellar dysfunction
– Ex: Trying to touch noise, leads to inability to stay in one place; intention tremor. Can’t code the right muscle forces to the target. Not pathology specific.
Hypokinesia
- Slowness of initiating or executing movement
- Includes stoppage of movement (freezing)
– Ex: Parkinsons
– Ex: Child with low tone
Fractionated movement deficit
- Inability to facilitate seperation of movement
- Associated with CNS deficit (cortex)
– Ex: Monkey able to get something off the wall with finger tip and after surgery can only paw at it
Cortex is used to seperate movements. Especially fingers.
Sensory selection and weighting deficit
- Inability to screen and attend to appropriate sensory inputs for postural orientation
- Complaints of dizziness or vision motion sensitivity
- Ability to quickly switch between sensory modalities
– Ex: Athletes with concussions
Perceptual Deficit
- Postural control deficits from inaccurate perception of vertical orientation
- Tend to resist correction of COM position
- Threat value of movement (Ex: Pain)
– Ex: Post Stroke
