Neuromuscular Assessment 2

Question 1

What is CP?

Answer 1

Permanent but changeable
Caused by non progressive defect or lesion in 1 or multiple locations
Utero/during or shortly after birth
Infectious meningitis and trauma are the most common causes of acquired CP
Produces motor and possible sensory deficits
Involves 1 or more limbs and usually the trunk
Voluntary motor function deficits
Produces multiple symptoms
Anatomic sites of involvement, degree of disability, associated dysfunction and causes are heterogeneous

Question 2

What are some common problems seen in children who have Cerebral Palsy

Answer 2

Learning disabilities in 50-70 percent
Speech disorders in 25 percetn
Auditory in 25 percent
Seizure disorders in 25 -35
Disc dengeration and cervical spine instability
Visual disturbances in 40-50%
Strabismus, esotropia, nystagmus, homonymous hemianopsia

Question 3

How is CP classified?

Answer 3

Area of the body exhibiting impairments

Movement abnormalities resulting from brain lesions

Degree of severity of CP

Question 4

Area of Body impairment Classification system

Answer 4

Monoplegia- involvement of one limb
Diplegia (paraplegia)- involvement in both lower limbs
Hemiplegia- upper and lower limbs on one side
Quadriplegia- equal involvement in all limbs

Question 5

Molnar (85), identifies several major groups of children with CP based upon clinical signs

(4) main clinical sgins

Answer 5

. 1. Spastic- motor cortex
hemiparesis, diplegia, quadriplegia
2. Dyskinetic- basal ganglia
athetosis,(slow writhing finger movements of the the lower extermity) dystonia, choreiform movements, ballismus, tremor
3. Ataxia- cerebellar lesion
4. Atonia, hypotonic

Question 6

what does spastic mean?????

Answer 6

showing upper motor neuron involvement (hyperreflexia, abnormal movement patterns, weakness, loss of dexterity) -motor cortex

Question 7

What is athetosis

Dystonia, Choreiform, Ballisums,

Answer 7

Athetosis- showing signs of extrapyramidal involvement with involuntary movements slow writhing movements of face and extremities

Dystonia -rhythmic, changing tone proximally leading to slow uncontrolled movements with a tendency towards fixed postures -basal ganglia
Choreiform movements- rapid jerky movements of face and extremities
Ballismus – coarse flinging movements of extremities with wide amplitude of motion
Tremor – fine shaking of head and extremities

Question 8

Rarer types of CP what does Hypotonic come from

Ataxic-

Can you have mixed types of lesions yes or no

Answer 8

Hypotonic- showing severe depression of motor function and weakness
Ataxic- showing signs of cerebellar involvement with ataxia (rare) -cerebellar lesion
Mixed lesions combine characteristics of spastic, athetoid and ataxic groups

Question 9

Describe some characteristics of hypotonic CP think decreased muscle tone.

Answer 9

\Flaccidity
Extreme floppiness
Inability to generate muscle force
Transient- reclassified spasticity or athetosis

Question 10

Describe some characteristics of Spascity CP

Answer 10

Dystonia
Resistance to passive stretch
Hyperactive stretch reflexes (hyperreflexia)
Changes in muscle structure & function
Abnormal muscle activity elicited by changes in head or body positions
UE flexion/ LE extension

Question 11

Athetoid CP

Answer 11

Without a fixed steady position and may involve choreiform or writhing movements
Maintain fixed dystonic posture
Involuntary movements at rest and during movements
Joints often hyper mobile and dislocations occur especially if spasms are present

Question 12

Ataxic CP (just think lack inability to vounlantary control muscles)

Answer 12

Uncommon
Hydrocephalus, head injury, encephalitis, or cerebellar tumor
Difficulty controlling rate, range, direction and force of movements

Question 13

So thinking back to neuro where might the Brain lesion be and what might result if its
Coritcal Basal Ganglia lesion- think athen lives in the BG.

Cerebral Cortex-

Cerebellar

Answer 13

Cortical Basal ganglia thalamic loop- dyskinesia or athetosis, intermittent muscular tension of extremities or trunk, involuntary movement patterns
Cerebellar lesion- ataxia, general instability of movement
Cerebral cortex & pyramidal tracts- spasticity
Hypotonic classification- diminished resting muscle tone and decreased ability to generate voluntary muscle force

Question 14

Give some examples of Single System Problems ( like think muscular system ) what are some malalignments from that

Answer 14

Expressed in muscular and skeletal systems
 damage occurred in the CNS
Insufficient force generation
Spasticity   (vel dependent)  tone
Abnormal extensibility
Exaggerated or hyperactive reflexes
Malalignments (femoral anteversion/
femoral & tibial torsion)

Question 15

Multisystem Approach think like

Answer 15

Expressed in the Neuromuscular system
Poor selective control of muscles
Poor regulation of activity in muscle groups in anticipation of postural changes
Decreased ability to learn unique movements

Question 16

Look at page 187 tecklin

Answer 16

look at page 187 tecklin

Question 17

Reflection on Some Standardized tools

Answer 17

Movement Assessment of Infants (MAI) 73.5 % in high risk populations (4 months of age)
Bayley 100% for spastic di and quadriplegia and 75% for spastic hemi at 1 year corrected age
Alberta (AIMS) 6 months
General Movement Assessment- saws few false positives
Test of Infant Motor Performance (TIMP) – early detection

Question 18

Assessment of postural control

Answer 18

Postural activity is noted when the child has muscle activation against the supporting surfaces
Postural preparations are strategies used before a functional movement,
increase stability by changing the base of support or increasing muscle activation around a joint
Changes are in anticipation of a specific task that has been learned previously
Uses fb from completing the task prior in a feedforward manner

Question 19

Assessment of postural tone

Answer 19

Describes the impairments of spasticity and abnormal extensibility
Abnormally high tone maybe caused by spasticity – velocity dependent over activity that is proportional to the imposed velocity of the limb movement
Stiffness- describes the resistance to movement felt when joints are moved in space
Assess during transitions and as the limb moves
Assess compensatory stiffness

Question 20

Musculoskeletal assessment what are some things you look for obviously measure for ROM but, what specific ranges are you looking for???

Answer 20

Goniometric measurements
Evaluate mobility of the spine
Flexion in supine
Extension, lat flexion, & rotation in sitting
Thoracic movements
Breathing cycle/ motion of thorax- note lack of downward slant of ribs, poor rib cage fixation leading to sternal depression, lack of thoracic expansion = shallow respiratory efforts
Focus on facilitating antigravity control of axial extensors and flexor muscles (oblique abdominals for forceful expiration needed for coughing and sneezing

Question 21

What are some things that you notice in the Shoulder region with CP patients. think like rounded shoulders.

Answer 21

Shoulder girdle / UE
Poor trunk extension
Results in rounding of the thoracic spine/ tight pectoralis major & rectus abdominus muscles
Dynamic scapula stability fails to develop
Fixed scapulae in a downward rotation with forward tipping resulting in restricted sterno and acromioclavicular joint movements
Limited passive flexion,abd, ext rot of shoulder with the utilization of shoulder elevation
Limited extension of ue distal joint movements

Question 22

Examination of the hip

Answer 22

Tight hip flexors, add, internal rot with resultant limitations in hip extension, abd, and ext rot
Thomas test – identify flexion contractures of hip
Ortolani click for congenital hip dislocation or shorter femoral length

Question 23

Femoral anteversion how much is the shaft twisted on the neckfor an adult what about an child with CP

Answer 23

Torsion or internal rotation of the femoral shaft on the femoral neck
Birth 40 degree of anteversion (transcondylar axis of the femur and the femoral axis of the neck)
Adult 15 degrees of femoral anteversion
CP increased anteversion

Question 24

Examination of the Knee

Answer 24

May have limited knee flexion or extension
Tibial torsion
Birth 4 degrees of ext rot
Adults 14 degrees of ext rot

Question 25

Where the measurement for LE length

Answer 25

from ASIS to medial malleous and 1 -2 cm is normal range I believe is what she was going for.

Question 26

Evaluation of gait the forever ? “when will my child walk?”

Answer 26

Watt et al. 89, predications at 2 yrs of age increased accuracy for early prognosis of walking status
Age of sitting, type of CP, presence of tonic labyrinthine, ATNR, symmetrical tonic neck and Moro reflexes, foot placement and parachute postural reactions significantly correlated with ambulation at 8yrs of age.
High stepping, slow lurching gait, small steps, uneven steps, simultaneous flexion of hip/knee/ankle, limited hip extension/ankle DF, knee hypertension in stance, internal rot & add

Question 27

Classic gait patterns of CP gait

Answer 27

Limited asymmetric pelvic tilt or rotation
Use excessive head, neck, upper trunk & UE mobility
Flexed hips during stance
Excessive adduction & internal rotation of hip (Medial aspect of knees may approximate)
Knees either flexed or hyper extended during stance
Feet in valgus
Plantarflexed
Speed of walking is half that of aged matched

Limbs on involved side are retracted or rotated posterior
No arm swing & involved UE held in hyperextension at shoulder with elbow flexion

Question 28

What the components of a goal

the ABCDES of goals basically

Answer 28

Remember objectives (short term goals) do not need to be components of long term goals but they need to be logically connected and have…
Subject
An observable action verb
An observable functional performance with a beginning and an end point
Conditions under which the performance will be met (circumstances & environment)
Criteria or how well the client performs this function

Question 29

Therapeutic intervention

Answer 29

Window of opportunity” to reduce primary impairments and prevent secondary impairments
Force production
Spasticity
Hypoextensibility
Casting and orthoses

Question 30

Therapeutic Exercise How to progress resistance in infants and how to progress to endurance activities always remember dual tasking is great for these patients

Answer 30

Strength progressions
Gravity eliminated movements-against gravity
Alter amount of assistance
Endurance progressions
Increase number of reps
Increase length of time of exercise
Coordination progressions
Dual tasks

Question 31

Therapeutic Exercise How to progress resistance in infants and how to progress to endurance activities always remember dual tasking is great for these patients

Answer 31

Strength progressions
Gravity eliminated movements-against gravity
Alter amount of assistance
Endurance progressions
Increase number of reps
Increase length of time of exercise
Coordination progressions
Dual tasks