Neuro Conditions Flashcards
Apraxia
-a neurological disorder that affects the ability to perform movements and gestures
-a motor disorder that affects the ability to perform learned movements or tasks
May I assign two diagnoses?
- The need to do so does not happen often
- No, if it comes from uncertainty or an incomplete examination
- Yes, if you are “well-behaved”
- If the patient has an impairment, but the level of impairment does not meet
the threshold for a given diagnosis, consider adding it as a descriptor to the
primary diagnosis.
Multiple, equally impactful impairments= 2 diagnosis
Can a diagnosis change?
The Diagnosis is Unlikely To Change If the Exam was complete/Interpreted Correctly
Movement System Diagnosis
- Can be applied to adults and children across the continuum of care
- Not focused on medical diagnosis
- Derived from a complete examination of body/structure/function + task
analysis - May have addenda related to other impairments not associated with primary
impairments - Will be used to guide treatment and education
Weakness movement diagnosis
- FPD: good (restorative)
-FPD: poor (compensatory)
Coordination movement diagnosis
- Movement pattern coordination deficit (restorative)
- Dysmetria (compensatory)
- Hypokinesia (compensatory)
Fractionation movement diagnosis
Fractionated movement deficit (compensatory)
Sensation and perception movement diagnosis
-sensory selection and weighting (restorative)
-sensory detection (compensatory)
-postural vertical deficit (could go either way depending on severity)
Force production deficit key impairments and chief complaints
-Key Impairment: Weakness; Range of Severity is Extensive Affecting
Prognosis
-complaints: tripping, fatigue, weak, buckling
-medical dx: can be CNS or PNS
FPD key tests and signs
Strength:
* Less than 3+/5 to 4/5 muscle strength throughout a limb or limbs or entire body
* Difficulty moving through full range against gravity or
* Focal weakness at one primary joint or limb
* Deterioration in range of motion/speed of movement with repetition
Patients with significant weakness will need varied levels of assistance (independent to dependent) across a variety of functional tasks
FPD associated signs
- Have fractionated movement
- Normal to mildly altered muscle tone
- Normal to mildly impaired sensation
- Coordination: In more severe forms may be unable to test due to weakness; In
milder forms, likely to be slow but accurate - Possible need for supportive structures
- Postural control: In early stages of recovery, unable to sit or perhaps stand
unsupported; would fall without support
Movement Pattern Coordination Deficit (MPCD) key impairments and chief complaints
-Key Impairment: Mild Coordination Deficit, improves with cues and practice
Deficits in STS, walking, reaching/grasping
-Complaints: messy, falls, clumsy, unsteady, awkward
-Medical Dx Varied, Tend to be Higher Level Function (includes children with developmental delay)
-Ex: early PD, stroke, MS, down syndrome, autism
MPCD key tests and signs
- Postural Responses are Slow/Inappropriate Amplitude;
- STS:
- altered sequence or direction of movement components during execution, e.g. knee
extension before hip extension - posterior rather than anterior translation of tibia over foot
- ankle sway during termination
- Gait: variable foot placement/line of progression; slow, guarded steps
- Reach/Grasp: awkward/slow; difficulty adjusting grip during transport (not age appropriate)
- Difficulty with transitions as develop in age
MPCD associated signs and outcome
- Little/no muscle weakness
- Generally fractionated movement
- No >mild spasticity; No > 2 on Modified Ashworth Scale
- No > mild sensory loss
- No >mild non-equilibrium coordination deficits
- latency/sway; inappropriate amplitude of movement affecting balance
Outcome: favorable
MPCD treatment
Focus is Restoration/Remediation: need to push these pt’s
* limb use and refining movement strategy
* improving movement speed and amplitude
* improving coordination of anticipatory and reactive postural responses relative to balance demands
* generating consistency, flexibility, and efficiency of motor behavior during changing environmental demands
Dysmetria key impairments and chief complaints
Key Impairment: Inability to Grade Forces Appropriately for Distance and Speed of a Task
-Complaints: overshooting, clumsy, dyscoordination, cerebellum, wide BOS
-Medical Dx-Most Commonly Those Affecting the Cerebellum
Dysmetria key tests and signs
- Non-equilibrium coordination: Notable under or overshooting;
Abnormal rhythm and incoordination that does not improve with practice; This is a key impairment test that makes the diagnosis, as they tend to have moderate to severe deficits with this - Able to move against gravity
- During function: Needs wide base of support; Under or overshoots; Excessive postural sway (and postural responses);
- Difficulty grasping small or light objects
- Because they overshoot, have most difficulty with termination phase of movement
Dysmetria associated signs and outcome
- Often needs UE support to sit safely (more severely impaired)
- Wide base of support/high guard
- Variable foot placement
- Generally requires assistance
Outcome: variable with compensation (less favorable)
Dysmetria treatment focus
- Compensatory
- AFO: suggested so pt will only have to control 2 segments instead of 3
- slowing down
- decompose mvmt: move one segment at a time
- assisted device
hypokinesia key impairments and chief complaints
- Key Impairment: Slowness in Initiating and Executing Movement; May be Associated with Stopping of Ongoing Movement.
-complaints: slow, rigidity, unsteady, tremor, festination, retropulsion (fall back when standing), shuffling, freezing
-Medical Dx-Most Common is Parkinson’s Disease (BUT not all ppl with PD have hypokinesia)
Hypokinesia key tests and signs
- Able to move against gravity
- Difficulty initiating movement
- Delayed timing of postural adjustments
- Lack of preparatory movements; may use repeated movements/momentum
strategy - Assistance required especially with transitional movements
- Loss of balance posteriorly and with termination (retropulsion)
- Can have poor (delayed or absent) postural responses
- Parkinson’s-later in disease, some can develop freezing of gait (FOG) and/or gait
festination
Hypokinesia: Associated Signs and outcome
- Rigidity (increased muscle tone)
- Non-equilibrium coordination- undershoots target; slow reciprocal movement
- Peds: Delayed “integration” of early/primitive reflexes
Outcome: variable with compensation (poor)
Hypokinesia treatment
Treatment Focus Is Primarily Compensatory but Can Have Restorative/Remediation Components
- slow turns, big steps, assisted devices
Fractionated Movement Deficit (FMD) Key Impairment and chief complaints
- Key Impairment: Inability to Fractionate Movement
-complaints: stiff, contracture, rigid, slow, synergy - Medical Dx: always related to CNS (hypertonicity)
FMD key tests and signs
- Non-fractionated movement* (No dissociation of movement from one joint to the other)
- Unable to generate quick movements
- Moderate to severe hyperexcitability
- Grade 3-4 on the Modified Ashworth Scale
- SCALE scores of <5 for either LE would indicated FMD
- May exhibit abnormal reflexes e.g. ATNR, STNR
FMD associated signs and outcome
- Associated reactions with effort
- Lacks dissociation of muscle groups during activities; stereotypical patterns
- Compensatory gait signs
- Stiffness of gait
- Scissoring
- Assistive devices and AFO commonly needed
- Reach limited, minimal hand movement in grasp
- Asymmetrical postural control is frequent
Outcome: Dependent on the Amount of Anti-Gravity Strength (Tends to Be Poor); They DO NOT have the capacity to “move normally”; So, don’t expect improvement with cues to incorporate essential components
FMD treatment
Focus is compensation
Sensory Selection and Weighting Deficit Key impairments and chief complaints
- Key Impairment: Decreased Ability to Screen & attend to Appropriate Sensory Inputs
-complaints: dizziness, visual sensitivity, spinning, vertigo, weaving, sensory avoidance, unsteadiness - Medical Dx:
- Stroke
- Brain Injury
- Unilateral or bilateral vestibular hypofunction
- BPPV with postural instability
- Sensory Integration Disorder
- Autism Spectrum Disorder
- Pervasive developmental disorder
- Rhett’s Syndrome
- Sensory Processing Disorder
Sensory selection and weighting deficit key tests and signs
- Sitting/Standing: Increased sway; greater instability with head movement or changes in sensory conditions (eyes closed; compliant surface)
- Standing: Hip strategy used at inappropriate times
- Gait: Variable line of progression with walking; Excessive lateral sway with turns; Deviation with head turning; loss of balance; Dizzy; Worse with increased speed
- Difficulty making transitions from one sensory environment to another
- Postural responses may be delayed or exaggerated
- May improve with modification of sensory needs and practice
- Symptoms with smooth pursuit or saccadic eye movements
Sensory selection and weighting deficit associated signs and outcome
- Movement is fractionated and non-equilibrium coordination is intact
- May have positive vestibular tests (will cover in Module 6)
- Sensation/Sensory Behavior:
- May show signs of gaze aversion
- May show signs of self stimulation behaviors such as rocking, spinning and
banging
-outcome: good, independent ambulation with no or mild deficits
Sensory selection and weighting deficit treatment
restorative
Sensory detection deficit key impairments and chief complaints
- Key Impairment: Lack of Joint Position
Sense or Multi-Sensory Failure
-complaints: dull, need vison, numb, unsteady - Medical Dx Involve Those That Affect JPS, Vision or Bilateral Vestibular Loss
Sensory detection deficit key tests and signs
- Sensation: mod/severe loss of JPS; mild or greater loss of JPS and touch sensation
- STS and Step-up: hyperextension of knees before hip extension during execution
- Gait: increased BOS; variable foot placement; increased sway; increased knee hyperextension; some improvement with visual guidance
- Grasp/in-hand manipulation: clumsy; some improvement with visual guidance
- Needs postural support or has increased sway; worse with eyes closed (or in low light environments) because they can no longer compensate with vision;
- Limited improvement with practice
Sensory detection deficit associated signs and outcome
- Poor timing and coordination of movement
- Slow and clumsy
- Some improvement with visual guidance
-outcome: variable with compensation (poor)
Sensory detection deficit treatment
compensatory
Postural vertical deficit key impairments and chief complaints
- Key Impairment: Inaccurate Perception of Vertical Orientation with Resistance of Correction of Center of Mass Alignment
-complaints: falling, resisting, leaning “off”, pusher - Medical Dx: Most Common is Stroke
Postural vertical deficit key tests and signs
- Resists correction of center of mass alignment*; fearful/agitated when center of mass alignment is corrected
- Sensation of “falling” when shifted toward correct vertical alignment
- May fix extremities and push away
- Shift COM beyond limits of stability without weight bearing
- In Medial/ lateral form is associated with disregard, motor planning deficits
- May have disregard or neglect of involved extremity
Postural vertical deficit associated signs and outcomes
- Movement is variable
- May have motor planning difficulty
- Sensation may be lacking (light touch and JPS)
- Behavior may be impulsive or fear avoidant
- Judgment may be poor or they demonstrate fear avoidance behavior
-outcome: depends on severity cog/behavioral deficits and motor function
Postural vertical deficit treatment
restorative (compensatory in severe cases)
