Neuro Flashcards
LE Flexor Synergy
• Hip Abduction • Hip External Rotation • Knee Flexion • Ankle Dorsiflexion • Ankle Inversion • Toe Extension
LE Extensor Synergy
- Hip Extension
- Hip adduction*
- Hip Internal Rotation
- Knee Extension *
- Ankle Plantarflexion *
- Ankle Inversion
- Toe Flexion
*Do the exercises that pull them out the MOST of the pattern
UE Flexor Synergy
- Scapular Retraction & Elevation
- Shoulder Abduction
- Shoulder External Rotation
- Elbow Flexion*
- Forearm Supination
- Wrist and Finger Flexion
UE Extensor Synergy
Scapular Protraction
- Shoulder adduction*
- Shoulder Internal Rotation
- Elbow Extension
- Forearm Pronation*
- Wrist and Finger Flexion
Dominant Pattern of Synergy
- Hip Flexion
- Knee Extension
- Ankle Plantarflexion
- Toe Flexion
ASIA Scale
ASIA SCALE
• A = Complete no sensory or motor function
preserved in the sacral segments S4-S5
• B = Incomplete, sensory but no motor function
is preserved below the level of the lesion
• C – Incomplete, more than half of the key
muscles below the NLI have an MMT grade of
less than 3/5
• D = Incomplete, at least half of the key muscles
below the NLI have an MMT of 3/5 or more
• E = Normal Sensory and Motor function
Brunnstrom Stage 1
Flaccidity
Brunnstrom Stage 2
Onset of primitive reflexes/synergies WHICH ARE LIKE BABINSKI, ATNR, MORO. USE THESE REFLEXES TO GET THEM MOVING
Brunnstrom Stage 3
Max spasticity
Brunnstrom Stage 4
Spasticity declines and some movements are performed out of synergy
Brunnstrom Stage 5
Selective control of movement
Brunnstrom Stage 6
Near normal with coordinated
motions out of synergy
Brunnstrom Stage 7
Normal
Functional Independence Measure Scoring
Looking at a patient’s functional status during the recovery process following TBI. It addresses feeding, grooming, bathing, UE dressing, LE dressing, and toileting
FIM Scores
Functional Independence Measure
7 - Complete independence with no helper
6 - Modified independence with no helper
5 - Supervision or setup with helper (Subject = 100%)
4 - Minimal assistance with helper (Subject = 75% or more)
3 - Moderate assistance with helper (Subject = 50% or more)
2 - Maximal assistance with helper (Subject = 25% or more)
1 - Total assistance with helper (Subject = <25%)
**Total will be between 18 and 126
ASIA Scale A
A = Complete no sensory or motor function
preserved in the sacral segments S4-S5
ASIA Scale B
B = Incomplete, sensory but no motor function
is preserved below the level of the lesion
ASIA Scale C
C – Incomplete, more than half of the key
muscles below the NLI have an MMT grade of
less than 3/5
ASIA Scale D
D = Incomplete, at least half of the key muscles
below the NLI have an MMT of 3/5 or more
ASIA Scale E
E = Normal Sensory and Motor function
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C1-C4
C1-C4 SCI
- Key Muscles are for Nodding and Facial (SCM, Facial Muscles, Capital Muscles, Diaphragm, Trapezius)
- PT Implications
- Power Wheelchair with mouth stick or chin control.
- Tilt in space/recline for pressure-relief!!
- Limitations
- Dependent on ventilator (partial
diaphragm only)!! Abdominals are most important to clear secretions and this person does not have this.
• Dependent with all ADL’s, transfers and
bed mobility
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C5
- C5 Level SCI
- Key Muscles (Think “I dunno”)
- Deltoid, Biceps, Rhomboids, External Rotators
- PT Implications
- Mobility
- Power wheelchair with hand controls (preferred)
- Manual wheelchair with rim projections (energy-costly)
- Max Assist with transfers (sliding board)
- Independent forward raise for pressure relief* THIS IS HIGHEST LEVEL YOU CAN DO WITH PRESSURE RELIEF
*ANTERIOR DELTOID CAN LOCK ELBOW INTO EXTENSION
• Limitations
These patient are prone to elbow flexion contractures
AND are dependent with bathing and dressing
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C6
- Key Muscles
- Extensor Carpi Radialis, Pectoralis Major, Teres
*CAN USE TENODESIS GRIP
Major
- PT Implications
- Mobility
- Manual wheelchair with rim projections
- Independent to MinA with sliding board
- Independent pressure relief w/ weight shift
- Independent rolling / feeding
- Limitations
No Elbow extension and are also prone to elbow flexion contractures!
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C7
Key Muscles (Think “The Phelps”)
- Triceps, Lats, Pronator Teres
- PT Implications
- Mobility
- All of the above
- Mod I transfers, wheelchair propulsion,
pressure relief, upper and lower extremity
dressing
• Will eventually achieve independent pop over
transfers without sliding board
- Limitations
- Transfers to floor require mod to maxA because he doesn’t have great grip strength or core strength.
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C8
- Key Muscles (Think “Hand Intrinsics”)
- ECU, FCU, Hand intrinsics
- PT Implications:
- Mobility is increased because of the tenodesis grip!
- Same potential as C7
- Wheelies in WC
- Negotiation of 2-4 inch curbs!!
Pressure relief with push up
- Limitations:
- Transfers from WC to floor require minA
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES T12-L2
- T12-L2 Level SCI
- Key Muscles
- Quadratus Lumborum, iliopsoas
- PT Implications
- Mobility
- Household ambulation
- Independent coming to stand and ambulation
with HKAFO OR KAFO’S (KAFO’s are for L2!)
- WC used for all community ambulation***
- Limitations
- No quad control
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES L3
Key Muscles
- Quadriceps, hip adductors
- PT Implications
- Mobility
- Community ambulation with orthoses** (GRAFO)
- WC for independence, efficiency
- If SCI is complete (ASIA A) will need more
restrictive AFO to prevent ankle instability.
- Limitations
- No gluteus maximus function
- Foot clearance
*THESE PEOPLE HANG ON THEIR Y LIGAMENTS
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES L4-5
- Key Muscles
- Tibialis Anterior, Extensor Digitorum, Extensor
Hallicus
- PT Implications
- Mobility
- Community ambulation with AFO and canes
- Limitations
- No gluteus maximus function
Motor Level
Careful- A MOTOR LEVEL IS THE LEVEL IN WHICH THEY CAN OPERATE
LMN vs UMN
L1 and below are LMN signs! L1 and above are UMN signs
What’s the lowest level a patient will still need assistance with secretion clearance?
T7, the abdominals start here.
What is Lhermitte’s Sign?
Long sitting position and passively flexing the head and one hip while keeping the knee in position. It identifies dysfunction in the spinal cord and/or upper motor neuron lesions. A positive test is pain down the spine and into the upper or lower extremities.
What is Lasegue Test?
Also known as the straight leg raise test, is performed with the patient in supine position. The therapist passively flexes the hip until the patient reports of pain or tightness in the back or leg. The leg is then lowered slowly until symptoms subside. The foot is dorsiflexed, which places tension on the sciatic nerve. If this causes a return of symptoms, the test is considered positive for pathological neurologic symptoms.
Which is MOST indicative of a good prognosis for functional recovery of the upper extremity following stroke?
the presence of either finger extension or shoulder abduction within 72 hours of stroke onset is predictive of functional recovery in 6 months.
