Neurological

Question 1

What is apgar score?

Answer 1

-screening test used worldwide to Ax infant 1 + 5min post birth

1 min score= how well newborn tolerated birthing process

5 min score= how well newborn adapting to environment

Question 2

What are neural contributors to muscle tone?

Answer 2

Sensory= impose on body to raise arousal/attention
–Vestibular, tactile, prop, visual–> = can increase or decrease tone
Motor= reflex contraction caused by muscle stretch, maintenance of body position
–modulate tone according to motor task + position
Cognitive= level of arousal, cognition, higher level integrative processes that map perception
–sleepy, asleep, sedated/paralysed = decreased tone
–Frightened, cranky/angry, upset, joy = increased tone

Question 3

What are non-neural contributors of muscle tone?

Answer 3

• Muscle properties
• Soft tissue properties
• Biomechanics

Question 4

Describe low tone

Answer 4

• usually genetic condition
• cerebellar syndrome
• upper/lower MN syndrome eg Flaccid spinal paralysis
• autoimmune, infections

Head= to side
Sh= relaxed, flopping back into floor
Arms= ER, abd, contact with support surface
Trunk= flat back> sinking into support
Legs= ER, taking up support
Feet= on ground, abd/PF toes

Question 5

Describe high tone

Answer 5

• usually pyramidal conditions impacting due to damage to motor cortex/corticospinal tract
• spastic type tone
• eg cerebral palsy, TBI, stroke, tumour, spinal cord

Question 6

Testing resting tone

Answer 6

• Resistance to passive movement LL
• Resistance to passive movement UL
• ROM (scarf sign, popliteal angle)
• recoil

Question 7

Testing active tone

Answer 7

• Head and neck (pull to stand)

- Body prone suspension (landau)

Question 8

What is spasticity?

Answer 8

velocity dependent increase in tonic stretch reflex influenced by test posture, initial length, sensory, or emotional stimulation

Question 9

Spasticity pathological mechanisma

Answer 9

1. Brain or spinal cord injury= loss of central inhibition, hyper-excitability of primary MNs
   - brain damaged= won’t generate inhibition signal
   - Spinal cord= won’t send inhibition sign down
2. Segmental hyper-excitability= increase reflex sensitivity at segmental level of spinal cord

Question 10

Testing spasticity

Answer 10

-tardieu scale

Question 11

What is dyskinesia

Answer 11

Motor disorder characterised by changes in muscle tone and posture w/ varying element of voluntary movement–> caused primarily by damage of basal ganglia

Question 12

What is dystonia

Answer 12

Involuntary sustained or intermittent muscle contraction cause twisting/repetitive mvmts, abnormal postures

• Strong ext positions + get stuck in those positions
• Can be triggered by voluntary mvmts and may overflow into other muscles

Cause: damage to basal ganglia, thalamus, brain stem and/or cerebellum during prenatal, perinatal or infant period

Question 13

What is athetosis?

Answer 13

Slow, continuous, involuntary, writhing movement–> prevent stable posture
-seen in fingers, hands, toes, feet, some cases see arms, legs, neck, tongue

Cause: lesions to basal ganglia, specifically corpus striatum- controls mvmt in relation to motivation
- most commonly due to intranatal asphyxia

Question 14

What is chorea?

Answer 14

Quick involuntary movements of feet and hands
-ongoing random appearing sequence of 1+ discrete involuntary movements, constant fidgeting

Cause: excess dopamine–> prevents basal ganglia from functioning normally

Question 15

How to differentiate between dystonia and spasticity?

Answer 15

-Hypertonia Ax tool

Question 16

Clinical observation of spasticity

Answer 16

Distribution

• more evident proximally
• reduced movements in affected areas
• no involuntary movements in severely affected parts

Secondary effects

• contracture towards mid position
• balance reaction affected
• Functional problems
• Faster child wants to move, more resistance they get