Neuro 3- Motor Function 2 & Diagnostic tests pg 141- 146 Flashcards
What are Motor responses to positional and movement testing?
- Move or position the body, observe automatic adjustments that restore normal alignment of head position- face vertical, mouth horizontal, righting reactions
- Alter the body’s COM or BOS or both; observe automatic postural adjustments that serve to maintain body posture and balance- keep COM within BOS
- Alter the body’s COM outside of the BOS; observe the automatic adjustments of the arms (protective reaching) or legs ( protective stepping) or both to extend and support the body weight in anticipation of a fall.
- Testing conditions: can use a displacing manual force against the COM (perturbation or push) or displace the BOS using a movable surface (platform, gymnastic ball etc.
4 Musculoskeletal elements and Limits To Stability (LOS)
- Determine MSK strength and ROM, LE & trunk
- Determine LOS: ability to move COM over BOS
during self-initiated movements. - Determine center of alignment: location of COM
within the center of the BOS - determine availability of postural synergies
(strategies) used to preserve balance- Ankle, Hip &
Stepping Strategy.
What is Ankle Strategy?
Ankle muscles (DF & PF) maintain balance by shifting COM forward or back using a long axis motion (LE relatively fixed)
What is Hip Strategy?
Hip and lower trunk muscles maintain balance by shifting COM using hip motions (flexion or extension)
What is Stepping Strategy?
Rapid steps are taken to realign COM within BOS
What is static balance?
The ability to maintain a position and response to perturbations
How is static balance examined? Think test positions (4)
- Sitting- holding a steady position, arm support, no arm support
- Standing- Double and single limb support
- Romberg test- pt stands with feet in normal stance
position, first with eyes open, then with eyes closed;
used to detect posterior column (sensory) ataxia - Sharpened or Tandem Romberg - Patient stand in a
tandem heel to toe position, first with eyes open
then with eyes closed; increases sensitivity to
Romburg test.
How is dynamic balance examined? (4)
- Functional movement tasks- sit to stand, walking, turning
- Navigation through obstacle course
- Dual Tasking- Walks while talking test, walk and
carry items, walk and complete cognitive tasks
(backward counting by 3s) - BOS challenges- sits on swiss ball, wobble board,
dyna disc, stand on balance/wobble board, dense
foam & foam roller
What are the Functional Balance Grades? (5)
Normal
- Pt able to maintain steady balance without HH
support (static)
-Pt accepts maximal challenge and can shift weight
easily at full range in all directions (dynamic)
Good
- Pt able to maintain balance without HH
support, limited postural sway (static)
-Pt accepts moderate challenge; able to maintain
balance while picking object off floor (dynamic)
Fair
- Pt able to maintain balance with HH support,
may require occasional min assist (static)
-Pt accepts minimal challenge, able to maintain
balance while turning head/trunk (dynamic)
Poor
- Pt requires HH support and mod to max assist to
maintain position (static)
-Pt unable to accept challenge or move without loss
of balance (dynamic)
0 Absent- Pt unable to maintain balance
List of Functional Balance and Locomotion Tests (11)
- Performance Oriented mobility Assessment ((POMA)
- Berg Balance Scale
- Timed Up & Go (TUG)
- Functional Reach (FR)
- Multidirectional Reach Test (MDRT)
- Short Physical Performance Battery (SPPB)
- Dynamic Gait Index (DGI)
- Balance Efficacy Scale (BES)
- Walkie-talkie test (Stops Walking While talking
SWWT) - Functional Gait Assessment (FGA)
- Modified Emory Functional Ambulation Profile Scale
(mEFAP)
Timed Up and Go Test (TUG)
Examines functional balance during rise from a chair, walk 3m, turn, and return to chair. Performance is timed. Norm < 10
Functional Reach Test (FR)
Examines max distance a person can reach forward beyond arm’s length while maintaining a fixed position in standing (single item test)
Multidirectional Reach Test (DRT)
Examines max distance a person can reach forwards, backwards, and lateral to right and left
Balance Efficacy Scale (BES)
Examines level of self-confidence when performing functional tasks encountered in daily life
Walkie-Talkie Test
Examines ability to talk while walking, a measure of dual task. Test is positive if the person must stop walking in order to respond to a question
What is gait?
The manner in which a person walks, characterized by rhythm, cadence, step, stride, and speed
kinematic gait analysis analyzes gait characteristics and deviations
What is Locomotion?
The ability to move from one place to another
Two outcome measures to assess Locomotion
- Timed Walking test- pt asked to walk first at preferred speed and then at max speed over a set distance. velocity, cadence and stride length are calculated.
- 6-Minute Walk Test- Examines the ability to walk at self-selected speed for a set time interval. Total distance and overall exercise tolerance is determined.
Diagnostic procedures and result- what is Radiological procedures?
Skull x-rays
- Delineates lesions of the bone
- Tomographs (tomography)- layered a-ray exposures, either vertical or horizontal
Diagnostic procedures and result- What is ventriculography?
X-rays of the skull after injection of air into the lateral ventricles
- Delineates ventricles, helps localize tumors
- Useful with increased intracranial pressure
Diagnostic procedures and result- What is a Myelography?
X-ray of the spine after injection of air or dye into spinal subarachnoid space
- It delineates abnormalities impinging on subarachnoid space
- complications- dye may result in meningeal irritation
Diagnostic procedures and result- What is cerebral Angiography?
X-rays of skull after injection of dye into the carotid or vertebral arteries or both.
- has largely been replaced by magnetic resonance angiography
- Complications- invasive technique; may cause meningeal irritation, hemorrhage, vasospasm, or anaphylactic reaction to dye.
Diagnostic procedures and result- What is Computed Tomography (CT)
Neuroimaging technique in which narrow x-ray beams are transmitted through tissues of varying densities and precisely measured; allows cross-sections (slices) of the brain to be visualized with three-dimensional localization.
- Contrast agents can be used to increase diagnostic
sensitivity to detect brain abnormalities e.g tumors,
calcifications
Diagnostic procedures and result- What is a Positron Emission Tomography (PET) scan?
Neuroimaging technique in which radioisotopes are inhaled or injected, and emissions are measured with gamma-ray detector system
- It allows for physiological mapping; a major clinical
research tool for imaging cerebral blood flow, brain
metabolism - Lacks detailed resolution of CT or MRI
Diagnostic procedures and result- What is Electroencephalography (EEG)?
Ongoing electrical activity of brain is recorded, appearing as periodic waves.
- Provides useful information about structural disease
of the brain, especially when seizures are present or
likely - Can assist in localization of intracranial lesions in the
brain
Diagnostic procedures and result- what is evoked potentials/evoked responses?
External visual, auditory or somatosensory stimuli are used to evoke potentials in brain; visual evoked potential (VEP), brainstem auditory evoked potential (BAEP), Somatosensory evoked potential (SEP)
- Potentials are recorded from surface electrodes and
processed by computer. - Delineates conduction times along these sensory
pathways - Detects lesions if responses are delayed or absent.
Diagnostic procedures and result- What is an Echoencephalogram?
An ultrasound doppler technique. reflected ultrasonic waves are recorded and analyzed
- Useful for imaging lumen of carotid artery and
analyzing flow, detection of plaques in carotid
arteries. - Measures position and shifts of midline structures
e.g. tumors or herniations
Diagnostic procedures and result- What is Magnetic Resonance Imaging (MRI)?
Neuroimaging technique in which nuclear particles are depicted in a strong external magnetic field; no radiation used.
What is an MRI useful for?
Superior imaging of brain, providing greater resolution of tissue and blood flow within medium and larger arteries and veins; bone is poorly imaged.
- It allows for three-dimensional localization with high spatial resolution.
What types of diagnosis is MRI sensitive to?
Acute stroke; allows for detection of cerebral edema within 30 minutes after vascular occlusion and infarction within 2-6 hours.
- It is the primary method of examination of tumors, demyelination, and vascular abnormalities.
What is Magnetic Resonance Angiography (MRA)?
Uses special software to create an image of the arteries in the brain; identifies vascular abnormalities similar to angiography (x-ray of brain) with increased sensitivity and lowered risks
What are some contraindications of MRI?
- Metal Implants
2. Pacemakers
Diagnostic procedures and result- What is Computed Tomography (CT) useful for?
Showing presence of abnormal changes in tissue density: areas of acute bleeding (hemorrhage in
developing stroke), Cerebral Edema (Within 3 days
post stroke) and cerebral infarction (within 3-5 days post stroke)
What type of diagnosis is Computed Tomography (CT) useful for?
Acute stroke: allows administration of Tpa (clot busting drug) in absence of evidence of hemorrhage within 3 hours of thromboembolic stroke
What is a lumbar puncture?
Insertion of spinal needle below level of L1-L2
Reasons why Lumbar puncture is performed? (4)
- Withdraw CSF for chemical analysis and cytological examination; measurement of protein, glucose, immunoglobulin content, cell count.
- Measure intracranial pressures and spinal fluids dynamics
- Injection of contrast medium for radiological examination
- Injection of therapeutic agents e.g. treatment of cancer, meningitis
Complications of Lumbar Puncture (4)
- Severe headache caused by CSF leakage (relieved by lying down)
- More severe complications include:
- Infection
- Epidural hematoma
- Uncal herniation
Characteristics of normal Cerebrospinal Fluid (CSF) (4)
- Appearance crystal clear and colorless
- Pressure: 90-180mm H2O Adult, 10-100 mm H20 child
- Volume: 90-150 ml adult, 60-100 ml child
- normal protein; 15-45 ml/dl adult, 15-100 mg/dl neonates
What are some patalogical CSF findings? (4)
- Increased pressure occurs with intracranial tumors, abscesses, meningitis, inflammatory processes, subarachnoid hemorrhage, cerebral edema, and thrombosis of venus sinuses.
- Decreased pressure occurs with leaking of CSF; arachnoid block circulatory collapse, severe dehydration
- Changes in color or appearance occur with inflammatory diseases, hemorrhage, tumors. RBCs indicate hemorrhage or traumatic tap; elevated WBCs indicate significant inflammation and infection.
- Elevated proteins may indicate tumors or inflammation
name the 2 Neuromuscular Diagnostic Procedures?
- Electromyography (EMG)
2. nerve Conduction Velocity
What is EMG?
Diagnostic procedure used to detect electrical activity arising from muscles, both resting state and active contraction
What pathology is EMG useful for diagnosing?
- LMN diseases or primary muscle disease
2. Defects in transmission at neuromuscular junction
What is Nerve Conduction Velocity?
Conduction activities are obtained by stimulating peripheral nerves through the skin and recording muscle and sensory nerve action potentials.
What happens if Nerve Conduction Velocity is decreased or slowed?
Decreased conduction is seen in peripheral neuropathies characterized by demyelination e.g. GBS, Chronic Demyelinating Polyneuropathy, Charcot-Marie-Tooth disease.
Slowed conduction velocities are seen with focal compression of peripheral N.
What are the 2 spontaneous, ongoing EMG activities?
- Fibrillation- spontaneous independent contractions of individual muscle fibers. This is evident with denervation for 1-3 weeks after losing nerve
- Fasciculations- spontaneous contractions of all or most of the fibers in a motor unit; muscle twitches that can be observed or palpated. This is present with LMN disorders and denervation.
Complete LMN lesions show only fibrillation potentials; partial LMN lesions show fibrillation and fasciculation potentials.
