Neurologic Impairments Flashcards
Signs
Objective findings determined by physical examination
Symptoms
Subjective reports associated with pathology perceived by patients
Positive Signs/Symptoms
Release of abnormal behavior (i.e. Hyperactive reflex)
Negative Signs/Symptoms
Loss of normal behavior (i.e. paresis)
Primary Effect of Lesion
Impairments causing problems in motor, sensory/perceptual and/or cognitive systems.
Secondary Effect of Lesion
Impairments NOT directly resulting from CNS lesion, developed as result of original problems
Lesion in descending motor
Primary: Paresis, Spasticity
Secondary: Structural & Functional changes in muscles
Motor Weakness (paresis)
Inability to generate sufficient tension in a muscle and a major impairment of motor function in UMN syndrome
Spasticity
Velocity-dependent increase in tonic stretch reflexes
Muscle tone
Muscle’s resistance to a passive stretch
Modified Ashworth
0 = No increase in muscle tone; 1 = slight increase in tone …; 1+ = slight increase in tone; 4 = affected parts rigid in flexion/extension
Coordination Problems
Capacity to generate force does not predict the ability of that muscle to perform a specific task
Abnormal synergies
Loss of ability to recruit a limited number of muscles controlling movement and to control individual joints
Inappropriate muscle activation in sequence, causing unnecessary movements
Flexor Synergy
Scapular retraction/elevation
Shoulder abduction/ER
Elbow Flexion, forearm supination
Wrist/finger flexion
Impairments in Cerebellar Pathology
Hypotonia, Ataxia, Dysmetria, Action/Intention tremor
Impairments in BG
Hypokinetic and Hyperkinetic
Hypokinetic Disorders
PD
Bradykinesia, Rigidity, Resting tremor, Postural Instability
Hyperkinetic Disorders
Huntingtons: Excessive involuntary movement and low muscle tone
Chorea & Dystonia
Somatosensory cortex deficits
Discriminative sensations (Proprioception, 2-point Stereognosis, touch localization)
Visual Deficits based on location of lesion
optic nerve: loss of vision in ipsilateral eye
optic chiasm: loss of vision in temporal visual field from both eyes (bitemporal hemianopsia or tunnel vision)
optic tract (temporal & parietal lobes): loss of vision in contralateral visual fields in both eyes (homonymous hemianopsia)
optic radiation: contralateral homonymous hemianopsia
Assessment of Visual Deficits
Visual Acuity, Depth Perception, Visual Field Confrontation test, Oculomotor Control test
Vestibular Deficits
Gaze Stabilization problem
Impairments in balance and posture
Dizziness or vertigo (BBPV most common)
Motor Learning
Study of acquisition and modification of movement
Conventionally: Learn new skills
Recovery of function: Reacquire lost due to injury
Motor learning and control emerge from interaction between?
Individual, task, environment
Learning
Performance
Practice/experience leading to permanent changes
Temporary changes in motor behavior
Plasticity
Ability to show modification
Nondeclarative learning
Nonassociative, Associative, Procedural
Nonassociative
Habituation: Decreased responsiveness after repeated exposure
Sensitization: Increased responsiveness following threatening stimulus
Associative learning
Classical conditioning: Pair two stimuli
Operant conditioning: associate a response with a consequence
Procedural learning
Learning tasks that can be performed automatically without attention
Develops gradually through repetition of act over many trials
Declarative Learning
Results in knowledge of facts/events, such as awareness, attention, and reflection
*Practice can make transition from declarative to procedural knowledge
Closed versus open loop
Closed: Feedback from movement used for guidance
Open: Movements performed in absence of feedback
Schema Theory
Emphasize open loop
Generalized motor programs: Rules for creating spatial and temporal patterns of muscle activity needed for a task
Five Components to conceptual framework
A model of practice, A model of function and disability, Hypothesis-driven clinical practice, Principles of motor control and learning, Evidence-based practice
Nagi’s Model
Pathology, Impairment, Functional limitation, disability
Impairment
Abnormalities, defects or losses in function of system
Functional limitation
Impairment at level of organ
Disability
Limitation of person in performing socially defined roles or tasks.
Evidence-based practice
Integration of clinical expertise, the best available research evidence, and patient’s value
Task-oriented approach
Integrates ICF model in EXAMINATION at a number of different levels
Framework for retraining posture, mobility, and manipulation
Task-oriented Approach
What, how, why
What: Functional
How: Strategy
Why: Impairment
Task-oriented Approach
What, how, why
Functional level
What can the patient do?
What does he/she have difficulty with?
Strategy level
What strategies are used to perform the task and what’s the ability to adapt strategy to changing task and environmental conditions?
How does he/she move?
Impairment level – What prevents him/her from doing what he/she wants to do? Limited ROM, weakness
Three Stage Model
Reduce DoF to simple movement; More cocontraction; made at cost of efficiency and flexibility;
Advance
Expert: all DoF released; take advantage of passive force and movt expenditure to increase efficiency reduce fatigue
Closed skills versus Open skills
Closed: Distinguish features of environment (Bowling, gymnastics)
Open: Adapt to ever changing environment and the demands
(Playing soccer, riding a bike)
Blocked Practice
Same task, several repetitions
Massed vs. distributed
Massed: more time in trial than rest
Distributed: time is equal or less than rest
Part verse whole practice
part: Tasks naturally divided into units (single joint motion)
whole: Multi joint coordination
guidance versus discovery
discovery is trial and error
constant practice
same task, multiple times
Factors affecting recovery of function
Age/gender, genetic make-up, lesion size/site, pre injury/experience, post injury factors
Postural control - Purpose
The ability to control our body’s position in space is fundamental to everything we do.
Alignment
relationship of body segments to one another, as well as to the position of the body with reference to gravity and the base of support.
Posture
the biomechanical alignment of the body and the orientation of the body in the environment.
Postural Control
control of the body’s position in space for orientation and stability
Postural Tone
activity increases in antigravity muscle, which keeps the body from collapsing in response to the pull of gravity during quiet stance.
Postural Orientation
ability to maintain an appropriate relationship between body segments, and between the body and the environment for a specific task
Postural stability or balance
ability to control the center of mass in relationship to the base of support
Center of Pressure
center of distribution of total force applied to supporting surface
Center of Gravity
vertical projection of the center of mass
Center of Mass
point at center of the total body mass
Clinical Definition of falls
an event that results in a person coming to rest inadvertently on the ground (unplanned or unexpected contact with a supporting surface)
Research Definition of falls
Research definition: movement of the CoM outside of the base of support (including stepping to recover stability)
Movement strategy to maintain balance
- Control body sway
- Feedback control
- Feedforward control
- Anteriorposterior stability
- Lateral stability
- Multidirectional stability
Anterioposterior stability
ankle strategy
hip strategy
stepping strategy
Feedback Control
postural control that occurs in response to sensory feedback (somatosensory, visual or vestibular) from an unexpected perturbation
Feedforward Control
postural responses that are made in anticipation of a voluntary movement potentially destabilizing in order to maintain stability during movement
Ankle Strategy: Forward Sway
Use posterior muscles to restore CoM
Ankle Strategy: Backward Sway
Use anterior muscles to restore CoM
Ankle Strategy: Timing of activation
From distal to proximal muscles
Hip Strategy: Forward Sway
Large anterior muscles used to prevent falls
Hip Strategy: Backward Sway
Large posterior muscles used to prevent falls
Hip Strategy: Timing
From proximal to distal muscles
Stepping Strategy
When the ankle and hip strategies are not enough to maintain the balance, a step will restore the CoM.
Sensory Inputs Contributing to Postural Control
Visual inputs - body/objects in environment
Somatosensory inputs - surface of support
Vestibular inputs - gravity
Sensory Weighted Hypothesis
When one sensory system is less reliable, the input to the CNS from that system is weighted less heavily, and inputs from other systems will be weighted more heavily
Major Factors Contributing to Aging
Primary or Genetic factors
contribute to the loss of neuronal function within a system over which we have LITTLE control
Secondary or experimental factors contributing to aging
environment, nutrition, and lifestyle, affect our nervous system function over which we have MORE control.
Physically Frail
JORDAN: Light house keeping, food preparation, can pass some IADL and all BADLs
Muscles and aging
Number of motor units declines with aging
Some loss of Type II fibers or atrophy of type II fibers
Age-Related change in somatosensory system
vibratory sensation threshold increases with age; tactile sensitivity decreases (or increased threshold to touch stimuli) with age;
Age-Related change in vision
visual threshold increases with age, as well as decrease in visual acuity
Age-Related change in vestibular system
aging causes a reduction in vestibular function, with a loss of 40% of vestibular hair by 70 years
Geriatric Society Recommendations for Prevention of Falls
All older individuals should be asked whether there was a fall for the last 12 months.
An older person reporting a fall should be asked about the frequency and circumstance of the fall.
Older adults should be asked if they experience difficulties with walking or balance.
Older persons presenting with a single fall should be evaluated for gait and balance, and many more.
As you age you vibration threshold will?
Increase
Walking/Talking what area/strategy is used?
attentional strategy
As you age visual threshold ____, and visual acuity ______.
Increases, decreases
Majority of falls in neurological pathologies associated with?
Mobility (gait)
Transfers
Stair Climbing
