Neuro 2- Motor function etc Pages 135- 139 Flashcards
Two ways to examine for muscle bulk, firmness
- Determine whether there is atrophy
a. Is atrophy due to denervation, disuse, or primary
atrophy?
b. Is persistent fasiculations present? suggests
neurogenic injury.
c. Examine by inspection, palpation and girth
measurement - Check muscle firmness, tenderness and reactivity
Ways to examine for muscle tone
A. Use PROM to assess muscle stretch reflexes and
responsiveness to passive elongation
B. Check for flaccidity (absent, tone), Hypotonia
(decreased tone)
C. Assess Spasticity (spastic hypertonia)
D. Assess Rigidity
E. Check for Decerebrate Rigidity/ posturing
F. Check for Decorticate Rigidity/ posturing
G. Check for Opisthotonos
H. Use AROM, active movement control to assess tone
in automatic postural adjustments
I. Evaluate and document
What is the difference between Flaccidity and Hypotonia?
Absent tone vs decreased tone
When would PTs observe Flaccidity and Hypotonia?
- In segmental/ LMN lesions; nerve roots and
peripheral N injury - Initially after suprasegmental/ UMN lesions (i.e brief period of spinal shock in spinal cord injuries, cerebral shock in stroke). There is decreased or no resistance to PROM.
Details about Spasticity Aka Spastic hypertonia
- Seen in suprasegmental/ UMN lesions.
2. There is inc. resistance to PROM; determine whether inc in speed inc resistance (spasticity is velocity dependent)
5 signs of spastic hypertonia
- Clasp-knife response
- Clonus
- Hyperactive cutaneous reflexes, positive babinski sign
- Hypereflexia
- Some degree of weakness is usually present
What is Clasp-knife response?
Marked resistance to PROM suddenly gives way
What is Clonus?
Maintained stretch stimulus produces a cyclical, spasmodic contraction; commonly in plantar flexors, also seen in wrist flexors and jaw
What is Hyperactive cutaneous reflexes, positive Babinski sign
DF of great toe with fanning of other toes in response to stroking up the lateral side of the sole of the foot; indicative of corticospinal (pyramidal) tract disruption
What is Hyperreflexia?
Increased deep tendon reflexes
What is the Modified Ashworth Scale used for?
How many grades does it involve?
Identify the stages
- Scale used for grading spasticity.
- Six grades
0- No increase in muscle tone
1- Slight inc in muscle tone, minimal resistance at end
of ROM
1+- Slight inc in muscle tone, minimal resistance
through less than half of ROM
2- More marked inc in muscle tone, through most of
ROM, affected part easily moved
3- Considerable inc in muscle tone, passive movement
difficult
4- Affected part rigid in flexion and Extension
What is Rigidity?
Increase in resistance to PROM that is independent of velocity of movement.
Details about Rigidity
What type of brain disorder is it evident in?
What type of disease is it associated with?
- Seen in Basal ganglia / Nigrostriatal disorders
- Can be Leadpipe or Cogwheel
- Associated with Parkinson’s disease
What is Rigidity associated with Basal ganglia / Nigrostriatal disorders?
Increased resistance to passive movement in agonist and antagonist muscle
What is Leadpipe Rigidity?
Uniformed rigidity throughout the range
What is Cogwheel Rigidity?
Rigidity interrupted by a series of jerks
What is rigidity associated with Parkinson’s disease?
Resting tremor, bradykinesia; strength and reflexes are not affected.
What is Decerebrate Rigidity/ Posturing?
A. Seen in comatose patients with brainstem lesions between the superior colliculus and the vestibular nucleus.
B. Results in increased tone and sustained posturing of all limbs; trunk/neck in rigid extensions
What is Decorticate Rigidity/ Posturing?
A. Seen in comatose patients with lesions above the superior colliculus
B. Results in increased tone and sustained posturing of upper limbs in flexion and lower limbs in extension
What is Opisthotonos?
- Prolonged, severe spasm of muscles, causing the head, back, and heels to arch backwards; arms and hands are held rigidly flexed
- Seen in severe meningitis, tetanus, epilepsy, and strychnine poisoning.
What are the characteristics of UMN Lesions?
- Location of lesion- CNS
- Structures involved- Cortex, Brainstem, Corticospinal
tracts, Spinal Cord - Disorders- Stroke, TBI SCI
- Tone- Inc hypertonia, Velocity dependent.
- Reflexes
- Inc: hyperreflexia, clonus
- Exaggerated cutaneous & autonomic reflexes: +
Babinski response
- Involuntary movements- Muscle spasms: flexor or
extensor. - Strength
- Stroke: weakness or paralysis on one side of the
body - Corticospinal lesions: contralateral if above
decussation in medulla, ipsilateral if below - Spinal cord lesions: BLE loss below level of lesion
- Stroke: weakness or paralysis on one side of the
- Muscle bulk- Variable, disuse atrophy
- Voluntary movements- Impaired or absent:
dyssynergic patterns, obligatory synergies
What are the characteristics of LMN Lesions?
- Location of lesion- PNS
- Structures involved
-SC: Ant horn cell, spinal roots, peripheral nerves
-CN: cranial nerves - Disorders- Polio, GBS, PNI, Peripheral neuropathy,
radiculopathy - Tone- Decreased or absent; hypotonia, flaccidity, Not
velocity dependent - Reflexes- Dec or absent: hyporeflexia, cutaneous
reflexes decreased or absent - Involuntary Movements- With denervation: fasiculitis
- Strength- Limited distribution: segmental or focal
pattern, Root innervated pattern - Muscle bulk- Neurogenic atrophy: rapid, focal,
severe wasting - Voluntary movements- weak or absent if nerve is
interrupted.
Typical patterns of spasticity in UMN syndrome- Upper Limbs: Action and Muscles affected
- Scapula
- Shoulder
- Elbow
- Forearm
- Wrist
- Hand
- Scapula
- Action: Retraction & downward rotation
- Muscles Affected: Rhomboids - Shoulder
- Action: Adduction & IR, depression
- Muscles affected: Pec major, lats, teres major,
subscapularis - Elbow
- Action: Flexion
- Muscles affected: Biceps, Brachalis, Brachioradialis - Forearm
- Action: Pronation
- Muscles affected: pronator teres, Pronator quadratus - Wrist
- Action: Flexion, Adduction
- Muscles affected: Flexor carpi Radialis - Hand
- Action: Finger flexion, Clenched fist thumb adducted
in hand
- Muscles affected: Dig. profundus/sublimis, Add
policis brevis, Flexor pollicis brevis
Typical patterns of spasticity in UMN syndrome- Lower Limbs: Action and muscles affected (1-4 of 7)
- Pelvis
- Hip
- Knee
- Foot & Ankle
- Pelvis
- Action: Retraction (hip hiking)
- Muscles affected: Quadratus Lumborum - hip
- Action & Muscles Affected: Adduction/scissoring
(Add. Longus/ brevis), IR (Add. Magnus, Gracilis),
Extension (Gluteus max) - Knee
-Action: Extension
- Muscles Affected: Quadraceps - Foot & Ankle
- Action & Muscles Affected: PF (gastrocsoleus),
Inversion (Tibialis posterior), Equinovarus, Toes claw,
MP ext. PIP flex, DIP ext (long toe flexors), Toes curl
(Ext. hallacus longus), PIP, DIP Flexion (peroneus
longus)