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
