Neuro 2 Flashcards
Joints have _________
range of motion
It is not proper to say the that the patient is strong at the elbow or has good range of motion of the biceps.
Muscles have ________
strength
It is not proper to say the that the patient is strong at the elbow or has good range of motion of the biceps.
What is wrong with this statement?
the patient is strong at the elbow
Joints have range of motion
Muscles have strength
What is wrong with this statement?
the patient has good range of motion of the biceps.
Joints have range of motion
Muscles have strength
•muscular twitching involving the simultaneous contraction of contiguous groups of muscle fibers
fasciculation
residual muscle tension present in the muscle at rest
TONE
How do you test for muscle TONE?
- Assessed by feeling for resistance to passive stretch
- Move the joints through Passive Range of Motion & feel for resistance
Assessing muscle tone
INCREASED; Variable, worse at extremes of PROM
Spacticity
Assessing muscle tone
INCREASED; Continuous throughout PROM
Lead pipe rigidity
Assessing muscle tone
INCREASED; Intermittent/rachet like
Cogwheeling
Assessing muscle tone
DECREASED
- hypotonia
- flacidity
Abnormal Involuntary Movements
•most common cause is Parkinson’s Disease. This tremor is often called a “pill rolling” tremor for its characteristic movement.
Resting Tremor-
Abnormal Involuntary Movements
•a tremor of movement. Does not exist at rest. Usually is caused by brainstem or cerebellar disease.
Intention Tremor-
Abnormal Involuntary Movements
tremors and dyskinesias
Abnormal Involuntary Movements
Two types of tremors/Dyskinesia
- Tremor at rest (pill rolling)
- Intention tremor (best seen on finger-to-nose)
Abnormal Involuntary Movements
What is the best way to spot an Intention tremor?
•(best seen on finger-to-nose)
Abnormal Involuntary Movements
Identify:
- a tremor of sustained posture. Is usually normal variant.
- Postural Tremor
- May be familial, or be caused or enhanced by medications, anxiety, sleep deprivation, caffeine, or hyperthyroidism
Abnormal Involuntary Movements
Identify the causes:
- Postural Tremor
- Postural Tremor
- May be familial, or be caused or enhanced by medications, anxiety, sleep deprivation, caffeine, or hyperthyroidism
- a tremor of sustained posture. Is usually normal variant.
Abnormal Involuntary Movements
Tics worsen with ______ and disappear during _______.
- Tics
- Tics worsen with stress and disappear during sleep.
- Sudden, quick, coordinated movements that may be easily imitated.
- Occurs repeatedly and can be voluntarily suppressed for a short time.
Abnormal Involuntary Movements
Identify:
- Sudden, quick, coordinated movements that may be easily imitated.
- Occurs repeatedly and can be voluntarily suppressed for a short time.
- Tics
- Tics worsen with stress and disappear during sleep.
Abnormal Involuntary Movements
Identify:
- –Unpredictable, brief, rapid, jerky movements
- •Chorea
- –Seen in Huntington’s Disease
Abnormal Involuntary Movements
Identify the cause:
- Chorea
- •Chorea
- –Seen in Huntington’s Disease
- –Unpredictable, brief, rapid, jerky movements
Abnormal Involuntary Movements
Identify the cause:
- •Athetosis
- Athetosis
- –Seen in Cerebral Palsy
- –Slow, twisting writhing movement
Abnormal Involuntary Movements
Identify:
- –Slow, twisting writhing movement
- Athetosis
- –Seen in Cerebral Palsy
Strength examination is the act of….
Testing muscles against resistance
Strength scale
Identify:
- No movement/flicker
Zero-0
_____________________
GRADED 0 – 5 scale:
0 = No movement / flicker
1 = Visible flicker of contraction
2 = Active movement with gravity eliminated
3 = Active movement against gravity (no resistance at all)
4 = Active movement against gravity with some resistance
5 = Active movement against gravity with full
resistance
Strength scale
Identify:
- Visible flicker of contraction
One-1
_____________________
GRADED 0 – 5 scale:
0 = No movement / flicker
1 = Visible flicker of contraction
2 = Active movement with gravity eliminated
3 = Active movement against gravity (no resistance at all)
4 = Active movement against gravity with some resistance
5 = Active movement against gravity with full
resistance
Strength scale
Identify:
- Active movement with gravity eliminated
Two-2
_____________________
GRADED 0 – 5 scale:
0 = No movement / flicker
1 = Visible flicker of contraction
2 = Active movement with gravity eliminated
3 = Active movement against gravity (no resistance at all)
4 = Active movement against gravity with some resistance
5 = Active movement against gravity with full
resistance
Strength scale
Identify:
- Active movement against gravity (no resistance at all)
Three-3
_____________________
GRADED 0 – 5 scale:
0 = No movement / flicker
1 = Visible flicker of contraction
2 = Active movement with gravity eliminated
3 = Active movement against gravity (no resistance at all)
4 = Active movement against gravity with some resistance
5 = Active movement against gravity with full
resistance
Strength scale
Identify:
- Active movement against gravity with some resistance
Four-4
_____________________
GRADED 0 – 5 scale:
0 = No movement / flicker
1 = Visible flicker of contraction
2 = Active movement with gravity eliminated
3 = Active movement against gravity (no resistance at all)
4 = Active movement against gravity with some resistance
5 = Active movement against gravity with full
resistance
Strength scale
Identify:
- Active movement against gravity with full resistance
Five-5
_____________________
GRADED 0 – 5 scale:
0 = No movement / flicker
1 = Visible flicker of contraction
2 = Active movement with gravity eliminated
3 = Active movement against gravity (no resistance at all)
4 = Active movement against gravity with some resistance
5 = Active movement against gravity with full
resistance
Two rules for accurate strength testing
- Always test side to side!
- Never test both sides at the same time!
Strength Testing
Need to immobilize the _____________ of the muscles you are testing
limb proximal to the joint
Strength Testing
Do the deltoids have a joint you need to immobilize?
No; therefore may test both at same time
Strength Testing
Which muscle?
“Make chicken wings and hold them up”
Deltoids
- Nothing to immobilize
Strength Testing
Which muscle?
“Make a muscle and don’t let me move it”
Biceps or Elbow Flexion
- Immobilize shoulder
Strength Testing
Which muscle?
“Push me away”
Triceps or Elbow Extension
- Immobilize shoulder
Strength Testing
Which muscle?
“Curl your wrist down and don’t let me uncurl it”
Wrist Flexion
- Immobilize arm so patient can’t move at elbow
Strength Testing
Which muscle?
“Stick ‘em up and don’t let me move your wrist”
Wrist Extension
- Immobilize arm so patient can’t move at elbow
Strength Testing
Which muscle?
“Lift your leg straight up and don’t let me push it down ”
Hip Flexors
Strength Testing
Which muscle?
“Kick out against my hand”
Knee extension
- Support thigh just above the knee
Strength Testing
Which muscle?
“Bend your knee and don’t let me straighten it”
Knee extension
- Support thigh just above the knee
Strength Testing
Which muscle?
“Toes to the nose and don’t let me move them”
Ankle dorsiflexion
- Support heel
Strength Testing
Which muscle?
“Step on the gas!”
Ankle plantarflexion
- Support heel
Strength Testing
Which muscle?
“Big toe up like a thumbs up and hold it”
Toe extensors
Strength Testing
Which muscle?
“Curl your toes and don’t let me uncurl them”
Toe flexors
