Neurological Assessment of Impairment Flashcards
Components of the Objective Assessment
vision cranial nerves sensation muscle length and joint ROM muscle strength and tone motor control and recovery co-ordination balance gait UL function perceptual/cognitive function
Motor Control/Recovery - LMNL signs
flaccidity reduced or absent reflexes inability to activate the muscle resultant disuse atrophy secondary changes due to altered sensation autonomic changes
Motor Control/Recovery - UMNL signs
general weakness
slowness to initiate and complete a movement
inability to control all of ROM available
loss of dexterity
inability to fractionate movement (control one joint at a time)
Motor Control/Recovery - UMNL Negative Signs
flaccidity
weakness
loss of dexterity
fatigability
Motor Control/Recovery - UMNL Positive Signs
spasticity exaggerated deep tendon reflexes dystonia associated reactions rigid co-contraction rigidity/tremor
Neurological Primary Impairments
Motor Sensory Speech Vision Cognitive Perceptual Coordination Vestibular
Neurological Secondary Impairments
increased stiffness/thixotropy
decreased muscle length
decreased cardiopulmonary function/fitness
sensory changes and resultant pressure lesions
learned non-use
maladaptive motor behaviour
psychosocial changes
UMNL - Abnormal Synergies Decorticate
upper limb flexion pattern
lower limb extension pattern
- learnt anti gravity extension against gravity
- learnt feeding reflex
UMNL - Abnormal Synergies Decerebrate
upper limb extension pattern
lower limb extension pattern
- all descending tracts compromised except rubrospinal
- only extension action remains
Seven Stages of Motor Recovery
- Flaccid Paralysis - no movement
- Spasticity Emerging - some resistance to passive movement, no volitional movement, synergistic movement can be elicited
- Marked Spasticity - attempted volitional movement produces synergistic movement only
- Spasticity Decreasing - synergistic movement still present, capable of movement of at least on joint out of pattern
- Relative Independence from Synergies - spasticity only elicited at end ROM with rapid movements
- Synergies only elicited with rapid/complex movements - isolated joint movement can be freely performed
- Normal movement - strength, endurance, co-ordination and timing
Muscle Tone - Flaccidity definition
complete loss of muscle tone
- no evidence of muscle contraction or DTR
Muscle Tone - hypotonia definition
reduction in muscle contractibility
- weakness
- poor muscular co-contraction
- poor trunk control
- decreased stability
Muscle Tone - spasticity
motor disorder characterised as a velocity dependent increase in the stretch reflex
- reflex hyperexcitability
- result of UMNL
- clonus = continual eliciting of the stretch reflex
Spasticity - non-neural contributors
- increased stiffness of muscles due to altered ratio of muscle to connective tissue
- altered thixotrophy
- adaptive shortening
Spasticity - neural contributors
- disordered inhibition via descending pathways to the anterior horn cell
- reflex hyperexcitabiltiy occurs as a result - no turning down of the stretch reflex
- unmasked proprioceptive phenomena - reflexes and abnormal synergies emerge
- rigid co-contraction - continual eliciting of the stretch reflex within muscle pairs resulting in continuous contraction/stretch - unable to function properly
Cortical Dysfunction - abnormal tone
- flaccidity
- hyperactive stretch reflexes (spasticity)
- stereotypical movement synergies
Basal Ganglia Dysfunction - abnormal tone
- athetosis
- chorea
- dystonia
- myoclonus
- hemiballismus
Cerebellar Dysfunction - abnormal tone
- hypotonia
Decorticate UL Flexion Pattern
shoulder adduction shoulder IR scapular retraction elbow flexion wrist flexion finger flexion forearm supination
Decorticate LL Extension pattern
hip IR hip adduction hip extension knee extension ankle PF
Decerebrate UL Extension pattern
scapular retraction shoulder IR shoulder adduction elbow extension wrist flexion finger flexion forearm supination
Decerebrate LL extension pattern
hip IR hip adduction hip extension knee extension ankle PF
