Neuro Flashcards
where does motivation for movement come from
limbic system
where does ideation for movement come from
frontal, partietal, temporal and occipital lobes
where does programming for movment come from
premotor areas, basal ganglia, cerebellum
where does execution of movemtn come from
motor cortex, cerebellum, spinal cord
what are the four traditional intervention approaches to motor control dysfunction
- Rood
- Brunnstrom Movement Therapy
- Proprioceptive Neuromuscular Facilitation (PNF)
- Neurodevelopmental Treatment (NDT)
Assumptions of Rood approach
- normal muscle tone is required for movememnt
- movement occurs in developmental sequence
- repetition is necessary for re-education of muscular responses
- sensory stimulation can be inhibitory or facilitory
facilitory techniques within Rood treatment
- quick or maintained stretch
- vibration
- light touch
- brushing
- manual contact
inhibitory techniques for Rood treatment
- prolonged, firm stretch
- firm pressure on tendon
- icing or neutral warmth
- slow stroking
What is Brunstrum techniques used for
used to understand stroke recovery
assumptions of Brunnstrom
- regerssion of older pattern of movements
- stages of motor recovery categorize arm funciton
- normal movement requires muscles to work synergistically
Describe Brunnstrom stage 1
- flaccid tone
- no voluntary movement
- reflexive responses
describe brunstrom stage 2
- synergies are eliceted reflexively
- spasticity developing
describe brunnstrom stage 3
- begin voluntary movment but only in synergy
- significant spasticity
describe brunnstrom stage 4
- spasticity begines to decrease
- movement starting to deviate from synergy patterns
describe brunnstrom stage 5
- further decreases in tone
- increased abilty to perform complex movements
describe brunnstrom stage 6
- tone nearly normal
- able to do complex movements
describe brunnstrom stage 7
normal speed and coordination of movements
treatment goals of brunnstrom stage 1-2
- facilitate increased muscle tone
- promote development of synergies
treatment goals of brunstrom stage 4-5
- break away from limb synergies and decrease tone
- moving in isolated and complex movement patterns
treatment goals of brunnstrom stages 2-3
- assist in achieving full voluntary control of limb synergies for funcitonal use
- tone peaking at end of stage 3
treatment goals of brunnstrom stage 5-6
develop more complex isolated movements and increase speed
treatment goals of brunnstrom stage 7
demonstrate normal isolated complex movements
describe PNF treatments
- use awareness of body position, verbal commands and visual cues by therapist
- Diagonal movements crossing midline
- create balance between agonists and antagonists
Describe Diagonal 1 in PNF patterns
- start by opposite ear, pull down to same side hip
- like putting on seat belt driver side
Describe diagonal 2 PNF pattern
- start straight up same side and pull down to opposite side
- putting on seat belt passenger side
goals of NDT
improve postural control and movement
Techniques of NDT
- handling techniques
- weight bearing
- guide normal movement and discourage compensation
what is dystonia
abnormal tone
describe flaccidity
- no tone
- no voluntary muscle activation
describe hypotonicity
muscle feels soft and offers little movement
describe hypertonicity
increased muscle tone
what causes hypertonicity
damage to UMN increases stimulation of LMN
what is the job of UMN
inhibits LMN
what is the job of LMN
increases motor activity
describe spasticity
increased tone with rapid movements
what is clonus
involuntary contraction and relaxation of spastic muscles
describe rigidity
increase of muscle tone of agonist and antagonist simultaneously
lead pipe rigidity
constant resistance
cogwheel rigidity
rhythmic give in resistance
Modified Ashworth Scale gradings
- 0 no increase in muscle tone
- 1 slight increase in tone, catch and release
- 1+ slight increase in tone, catch nad minimal resistance through remainder of ROM
- 2 increased tone through ROM but easily moved
- 3 considerable increase in tone making passive movement difficult
- 4 rigid
dysmetria
inabiltiy to judge distances leading to over or under shooting targets
dysdiadochokinesia
impaired abilty to complete rapid alternating movements
intention tremor
tremor that occurs during voluntary movement
apraxia vs ataxia
-both affect coordination
- ataxia is motor control impairment
- apraxia is perceptual impairment
dressing apraxia
inability to plan movements for dressing
ideomotor apraxia
inability to create plan and carry out
ideational apraxia
inability to use real objects appropriately, may use objects for something unintended for
agnosia
inabilty to interpret senses
anosognosia
limited awareness or insight to self
ischemic stroke
clot blocks blood flow to area of the brain
hemorrhagic stroke
bleeding occurs inside or around brain tissue
ischemic embolic stroke
blood clot travels arteries and then lodges in vessel
ischemic thrombotic stroke
plaque builds up inside wall
NIH Stroke Scale grading
0- no stroke; 21-42 severe stroke
what is a SAFE Score
- MMT grades of Shoulder Abduction and Finger Extension
- if score is 8 or greater within 72 hrs predicts excellent UE function in 3 months
Interventions for Brunstrom stage 1-2
- preserve soft-tissues with positioning, orthotics, ROM
- facilitate msucle activity with e-stim, stimulation, weight bearing
- incorporate into activity with mental practice, mirror therapy, task oriented approach
interventions for brunnstrom stage 3
- task oriented strategies to facilitate functional use
- orthotics to increase hand use
- manage tone with orthotics and neuroinhibition
Interventions for Brunnstrom stage 4-5
CIMT, Mirror therapy, action observation, mental imagery, e-stim
ASIA Grade A
Complete, no motor or sensory function
ASIA Grade B
incomplete, sensory but no motor function
ASIA grade C
incomplete, motor function but majority of key muscles are less than 3 MMT
ASIA grade D
incomplete, motor function with muscle grades above 3
ASIA Grade E
Normal
describe central cord syndrome
- more damage to central grey matter of cord
- paralasys and sensory loss greater in UE
Describe cauda equina syndrome
-Central disc herniation or disc burst fracture below L2 level
- LMN paralysis and partial or complete loss of sensation
describe Anterior cord syndrome
- vascular injury or burst injury to anterior spinal artery
- loss of motor, pain and temperature
brown-sequard syndrome
- hemisection of cord
- same side deficits in motor control, proprioception and vibration sensation
- opposite side deficits in pain and temperature sensations
when does autonomic dysreflexia occur
with injury at T6 or higher
what causes autonomic dysreflexia
irritation below level of injury
symptoms of autonomic dysreflexia
- high BP
- pounding headache, flushed face
- sweating above level of injury
- slow pulse
- goose bumps above injury
how to resolve autonomic dysreflexia
- Raise patient head
- locate irritant
- loosen clothing
- check catheter
- check skin
splinting goals for C1-C4 SCI
positioning for joint protection
splinting goals for C5 SCI
positioning and enable participation
Splinting goals for C6 SCI
preserve tenodesis and enable particiapation
C7-8 SCI splinting goals
prevent deformity
describe tenodesis
fingers come together with wrist extension
how to facilitate tenodesis
- never stretch hand into full wrist and finger extension
- tenodesis training splint
what are the 2 different weight shifting schedules
- 1-2 minutes q30 minutes
- 15 seconds q15 minutes
Glasgow Cona scale grading
- 15 best response
- 8-4 comatose client
- 3 totally unresponsive
what does the glasgow coma scale measure
- eye opening response
- verbal response
- motor response
Intervention for Rancho level 1-3
- sensory stimulation
-prevention of skin break down and loss in ROM - support and educate family
- restore alertness and facilitate goal directed behaviors
Intervention for Rancho level 4
- manage agitation
- short directions and no questions
- short treatment sessions
intervention for Rancho level 5
- address performance skills
- participate in activities with direction
describe Rancho level 1
-no response to stimuli
- total assistance
describe Rancho level 2
- generalized response (may be the same regardless of type or location of stimulation)
- Total Assistance
- will follow one-step commands with 50% accuracy
describe rancho level 3
- Localized response
- reponse changes to stimuli and may respond to some people and not others
- Total Assistance
- will remain alert for 15 minute treatment sessions and attend to grooming tasks for 1 minute
describe rancho level 4
- confused, agitated
- Maximal assistance
- begin to use too appropriately
describe rancho level 5
- confused, inappropriate
- non agitated
- maximal Assistance
- beginning to follow 2 step commands
describe rancho level 6
- Appropriate
- moderate assistance
- inconsistent orientation but able to attend to highly familar tasks
- will refer to memory book and follow daily schedule with cueing
describe rancho level 7
- automatic- appropriate
- Min assist for routine ADLs
- consistently oriented
describe rancho level 8
- purposeful and appropriate
- SBA for ADLs
Describe rancho level 9
- Purposeful and appropriate
- SBA on request for ADLs
- can begin medicaiton management with pillbox
describe Rancho level 10
- Purposeful and appropriate
- independent
- can multitask
