Neuromuscular Assessments Flashcards
1
Q
Common structures affected in the upper limb in UMN syndrome include
A
Scapula
2
Q
Common lower limb structures affected in UMN syndrome
A
Pelvis
Hip
Foot and Ankle
Trunk
3
Q
Affected muscles of the scapula in UMNL
A
Rhomboids
4
Q
Affected muscles of the pelvis in UMNL
A
Quadratus Lumborum
5
Q
Affected muscles of the Hip in UMNL
A
Adductors, Gracilis, G. Max
6
Q
Affected muscles of the knee in UMNL
A
Quadriceps
7
Q
Affected muscles of the foot and ankle in UMNL
A
Gastrocsoleus, Tibialis posterior, Long toe flexors, Extensor hallucis longus, Peroneus longus
8
Q
Affected muscles of the hip and knee during prolonged sitting posture in UMNL
A
Iliopsoas
Rectus femoris
Pectineus
Hamstrings
9
Q
Affected muscles of the trunk in UMNL
A
Rotators
Internal/External obliques
10
Q
Location of lesion in UMNL
A
CNS cortex, brainstem, corticospinal tracts, spinal cord
11
Q
Location of lesion in LMNL
A
Cranial nerves, Anterior horn and spinal roots of the spinal cord, Peripheral nerves
12
Q
Diagnosis or pathology of UMNL
A
stroke, TBI, SCI
13
Q
Diagnosis or pathology of LMNL
A
Polio, Guillain-Barre’s Syndrome, Peripheral Nerve Injury
Peripheral neuropathy, radiculopathy
14
Q
Muscle tone in UMNL
A
Increased; hypertonia
Velocity dependent; spastic
15
Q
Muscle tone in LMNL
A
Decreased; hypotonia, flaccid
Non-velocity dependent
16
Q
Involuntary movements in UMNL
A
Muscle spams in flexors or extensors
17
Q
Involuntary movements in LMNL
A
With denervation: fasciculations
18
Q
pt Strength in UMNL
A
Ipsilateral weakness/paralysis (CVA)
Bilateral weakness/paralysis (SCI)
Contralateral if above decussation in medulla
19
Q
Muscle bulk in UMNL
A
Disuse atrophy; widespread distribution, especially of antigravity ms
20
Q
Muscle bulk in LMNL
A
Neurogenic atrophy; focal distribution, severe wasting
21
Q
Voluntary movements in UMNL
A
Impaired or absent
22
Q
Voluntary movements in LMNL
A
Weak or absent if nerve is interrupted
23
Q
MAS grade 0
A
No increase in muscle tone
24
Q
MAS grade 1
A
Slight increase in tone manifested by catch and release at the end ROM
25
MAS grade 1+
Slight increase in muscle tone, manifested by catch followed by minimal resistance throughout the remainder of the ROM
26
MAS grade 2
More marked increase in tone though most of the ROM but joint is easily moved
27
MAS grade 3
Considerable increase in muscle tone; passive testing is difficult
28
MAS grade 4
The affected part is rigid in flexion or extension
29
What do you ask the patient to draw in the MMSE?
Overlapping pentagons with one being inverted
30
Mental Status Examination must be oriented to the
person
place
date
situation
31
What is asked during the memory part of the mental status examination?
Current events
32
Give the patients four objects to remember in 5 minutes
Recent Memory
33
"If I say 1-2-3 you say 3-2-1"
Digit Span Forward
34
Serial subtraction 100 - 7 or 30 - 3
Arthematic
35
Compare and Contrasting two objects
Ability to abstract: Similarity and Differences
36
Listen to the patient as he answers questions.
Speech and Language
37
Have the patient draw a clock at 11:15.
Visual-spatial skills
38
Generalized ms weaknes
Asthenia
39
Loss of ability to associate ms together for complex movements
Asynergia
40
Increased time required to initiate voluntary movements
Delayed reaction time
41
Disorder of the motor component of speech articulation
Dysarthria
42
Impaired ability to perform rapid alternating movements
Dysdiadochokinesia
43
Inability to judge the distance or range of a movement
Dysmetria
44
Movements are performed in a sequence of component parts rather than as a single smooth activity
Dyssynergia
45
Ataxic pattern; broad base of support; postural instability
Gait disorders
46
Ataxic gait is aka
Drunken gait
47
Hypotonia
Decreased ms tone
48
Hypermetria
Overestimation of distance or range needed to accomplish a movement
49
Hypometria
Underestimation of distance or range needed to accomplish a movement
50
Rhythmic, quick, oscillatory, back-and-forth movements of the eyes
Nystagmus
51
Patient is unable to stop sudden limb motion
Rebound phenomenon
52
Involuntary oscillatory movement resulting from alternate contractions of opposing ms groups
Tremor
53
Coordination tests that address components of limb movements
Nonequilibrium tests
54
Coordination tests that consider the ability to maintain the body in equilibrium with gravity both statically and dynamically
Equilibrium tests
55
Nonequilibrium tests
Finger-to-nose
Finger-to-therapists nose
Finger-to-finger
Alternate nose-to-finger
Finger opposition
Mass grasp
Pronation/supination
Tapping (foot/hand)
Rebound test
Pointing and pointing past
Alternate heel-to-knee; heel-to-toe
Toe to examiner's finger
Heel on shin
Drawing a circle
Fixation or position holding
56
Tests for dydiadochokinesia
Finger-to-nose
Alternate nose-to-finger
Pronation/Supination
Knee flexion/extension
Walking, alter speed or direction
57
Tests for dsymetria
pointing and past pointing
drawing a circle
heel on shin
placing feet on floor markers
58
Tests for dyssynergia
Finger-to-nose
Finger-to-therapists finger
Alternate heel-to-knee
Toe-to-examiner's finger
59
Tests for hypotonia
passive movements
DTR
60
Tests for intentional tremors
finger-to-finger
finger-to-therapists finger
toe-to-examiner's finger
61
Tests for resting tremors
observation patient at rest; limb or jaw movements
observation during functional activities
62
Tests for postural tremors
observation of steadiness
63
Tests for asthenia
Fixation or position holding
Application of manual resistance to determine ability to hold
64
Tests for rigidity
passive movements
observation during functional activities and resting posture
65
Tests for Bradykinesia
Walking, observation of arm swing and trunk motion
66
Nonequilibrium test grade 4
normal
67
Nonequilibrium test grade 3
minimal impairment; slightly less than normal control, speed, and steadiness
68
Nonequilibrium test grade 2
moderate impairment; accomplishes activity; slow, awkward, and unsteady movements
69
Nonequilibrium test grade 1
severe impairment; can only initiate activity; movements are slow with significant unsteadiness
70
Nonequilibrium test grade 0
activity impossible
71
Functional balance grade 4
Normal; pt able to maintain steady balance s handhold support. pt accepts maximal challenge and can shift weight easily within full ROM in all directions
72
Functional balance grade 3
Good; pt is able to maintain balance s handhold support. pt accepts moderate challenge
73
Functional balance grade 2
Fair; pt able to maintain balance c handheld support; may require minimal assistance. pt accepts minimal challenge
74
Functional balance grade 1
Poor; pt requires handhold support and moderate to maximal assistance. pt cant accept challenge
75
Functional balance grade 0
pt unable to maintain balance
76
Developed by Tinetti and measures static and dynamic balance
Performance-Oriented Mobility Assessment (POMA)
77
Total possible score of the original Performance-Oriented Mobility Assessment (POMA)
28
78
POMA scores < 19
high risk for falls
79
POMA scores bet 19-24
moderate risk for falls
80
Total possible score of Performance-Oriented Mobility Assessment (POMA) II
54
81
Developed by Duncan to provide a quick screen of balance problems in older adults
Functional Reach Test
82
Normal functional reach for men aged 20-40
16.7 (+-1.9)
83
Normal functional reach for men aged 41-69
14.9(+-2.2)
84
Normal functional reach for men aged 70-87
13.2(+-1.6)
85
Normal functional reach for women aged 20-40
14.6(+-2.2)
86
Normal functional reach for women aged 41-69
13.8(+-2.2)
87
Normal functional reach for women aged 70-87
10.5(+-3.5)
88
Developed by newton that determines the amount of reach that is influenced by several factors (size and height of an individual)
The Multidirectional Reach Test (MDFR)
89
Normal reach forward
8.9
90
Normal reach backward
4.6
91
Normal reach right lateral
6.2
92
Normal left lateral
6.6
93
A quick measure of dynamic balance and mobility developed by Mathias
The Get Up and Go (GUG)
94
Distance for GUG
3 meters
95
How long does a healthy adult take to complete the GUG?
< 10 secs
96
How long does frail elderly or individuals c disability take to complete the GUG?
11-20 seconds
97
The patient is asked to walk at his or her preferred speed
over a set distance clearly marked on the floor
Timed Walking Tests
98
can be used to determine the effects of attentional demands by
introducing a secondary task, talking, while walking.
Stops While Walking Test (SWWT)
99
Another name for SWWT
Walkie-Talkie test
100
Examines a person’s ability to maintain sitting
balance during static sitting (hands in lap) with eyes open and eyes
closed, as well as during dynamic challenges to balance. Developed by Gorman
Function In Sitting Test (FIST)
101
How many items does FIST have?
14
102
A self-report measure that examines how confident an individual
feels while performing 10 items of ADL and functional mobility. Developed by Tinetti
Balance Efficacy Scale (BES)
103
How is the CN I assessed?
By using aromatic, non-irritable materials such as lemon, tobacco, coffee, and garlic
104
What is CN II
Optic nn
105
How is CN II assessed?
Through the use of Snellen chart
106
How is CN III assessed?
Shining pen light on the eyes
107
How can a lesion of the CN II be detected?
No pupillary response on the side where light is shone as well as the contralateral eye.
108
How can a lesion of the CN III be detected?
Absent pupillary response on the contralateral eye where the light was shone
Presence of Ptosis
109
Vertical diplopia
CN IV
110
Horizontal diplopia
CN VI
111
eye muscle responsible for looking down and in
Superior oblique
112
eye muscle responsible for looking up and in
Inferior oblique
113
How can CN V be assessed?
Jaw Jerk Reflex
Corneal Reflex
114
An increased jaw jerk reflex indicates
Bilateral UMNL
115
Afferent route in corneal reflex
Ophthalmic division of the trigeminal nerve
116
Efferent route in corneal reflex
CN VII
117
Sensory functions of CN V
tongue and face sensation
118
Facial muscle for raising the eyebrow
Occipitofrontalis
119
Facial muscle for scrunching the forehead
Corrugator supercilli
120
Facial muscle for scrunching the nose
Procerus
121
Facial muscle for moving the nostrils
Levator Labi Superioris Alaeque Nasi
122
Facial muscle for moving and scrunching the nose
Nasalis
123
Facial muscle for fixed smile c teeth
Zygomaticus Major
124
Facial muscle for fixed smile s teeth
Zygomaticus Minor
125
Facial muscle for elevating the lips
Levator Labii Superioris
126
Facial muscle for puffing of the cheeks
Buccinator
127
Buccinator is aka
Kissing muscle
128
Facial muscle for angling the mouth
Risorius
129
Facial muscle for wrinkling of the neck
Platysma
130
Platysma is aka
Muscle of disgust/EGAD
131
Facial muscle for contracting the chin
mentalis
132
Facial muscle for mouth closing
Orbicularis Oris
133
Facial muscle for angling the mouth downward
Depressor Anguli Oris
134
Facial muscle for depressing the mouth
Depressor Labii Inferioris
135
Tests for CN VIII
Weber's and Rinne's test
136
What frequency of tuning fork is used for Weber's test
256 or 512 Hz
137
What is a positive sign of conductive deafness in Weber's test?
Sound is louder in affected ear
138
What is a positive sign of nerve deafness in Weber's test?
Sound is louder in the normal ear
139
What is a positive sign of conductive deafness in Rinne's test?
Bone conduction is better than air conduction
140
A negative sign for Rinne's test
Air conduction is better than bone conduction
141
What is a positive test for nerve deafness in Rinne's test?
Bone and Air conduction is impaired
142
Conductive deafness refers to
middle ear deafness
143
How is CN IX tested?
Gag reflex
144
FAST method in detecting CVA
Facial Palsy
Arm weakness
Speech slurring
Time to call for help
145
How many items does Stroke Impact Scale (SIS) contain?
59
146
Domains of Stroke Impact Scale
Strength
Hand Function
ADL/IADL
Mobility
Communication
Emotion
Memory and thinking
Participation
147
Common Gait Deviations of MS
Hip hiking/Steppage
Circumduction
Foot drop/slap
Shuffling
Vaulting
Shortened Step length
Knee Recurvatum
Knee buckling
148
Assessments for MS
10m walk
25ft walk
2 min walk
6 min walk
TUG
149
Balance assessments for MS
MS walking scale
Berg Balance
Dynamic Gait Index
150
How many items does Modified Fatigue Impact Scale have?
21
151
Requirements of Amyotrophic Lateral Sclerosis
Evidence of LMN degen
Evidence of UMN degen
Progressive spread of symptoms
152
Schwab and England ADL Scale 100%
Independent, no slowness in ADLs
153
Schwab and England ADL Scale 90%
Independent; some slowness and difficulty in ADLs; may take twice as long as usual
154
Schwab and England ADL Scale 80%
Independent; conscious difficulty and slowness; takes twice as long as usual
155
Schwab and England ADL Scale 70%
Assisted; more difficulty and slowness; takes thrice or four times longer than usual
156
Schwab and England ADL Scale 60%
Some dependency; exceedingly slow and difficult with considerable errors
157
Schwab and England ADL Scale 50%
More dependent; needs help c half the chores; difficulty in ADLs
158
Schwab and England ADL Scale 40%
Very dependent; can assist c chores but only few can be done alone
159
Schwab and England ADL Scale 30%
Much help needed; only does chores c effort
160
Schwab and England ADL Scale 20%
Does nothing alone; severe invalid
161
Schwab and England ADL Scale 10%
Totally dependent and helpless; complete invalid
162
Schwab and England ADL Scale 0%
Vegetative functions; bedridden
163
How many items does ALS Functional Rating Scale have?
12
164
Hoehn-Yahr Disability Stage I
Minimal or absent; unilateral if present
165
Hoehn-Yahr Disability Stage II
Minimal bilateral or midline involvement; No balance impairment
166
Hoehn-Yahr Disability Stage III
Impaired righting reflex; Instability upon rising from chair; Some activities are restricted
167
Hoehn-Yahr Disability Stage IV
All S/Sx present and severe; can only stand and walk c assistance
168
Hoehn-Yahr Disability Stage V
Confined to bed or w/c
169
MDS-UPDRS Part I
Non-motor experiences of daily living
170
MDS-UPDRS Part II
Motor experiences of daily living
171
MDS-UPDRS Part III
Motor examination
172
MDS-UPDRS Part IV
Motor complications
173
How many items does UPDRS have?
42
174
GCS Eye Opening Rating
4 - Sponty
3 - Speech
2 - Pain
1 - No response
175
GCS Motor Rating
6 - obeys
5 - localizes
4 - withdraws
3 - decorticate
2 - decerebrate
1 - no response
176
GCS Verbal Rating
5 - oriented
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - no response
177
Mild TBI LOC
0-30 mins
178
Moderate TBI LOC
> 30 min and < 24 hrs
179
Severe TBI
> 24 hrs
180
Mild TBI GCS
13-15
181
Moderate TBI GCS
9-12
182
Severe TBI
< 9
183
RLA Level I
No resposne
184
RLA Level III
Localized response; pt reacts specifically and inconsistently to stimuli
184
RLA Level II
Generalized response; pt reacts to external stimuli
185
RLA Level IV
Confused, agitated respose; pt exhibits bizarre and inappropriate behaviors
185
RLA Level VI
Confused, appropriate response; pt gives appropriate context
186
RLA Level V
Confused, inappropriate response; pt provides random/fragmented response to stimuli
187
RLA Level VII
Automatic, appropriate response; pt behaves appropriately in familiar settings
188
RLA Level VIII
Purposeful, appropriate response; pt is oriented
189
Mild Head Injury
< 60 mins
190
Moderate Head Injury
1-24 hrs
191
Serious Head Injury
> 1 week
192
ASIA Scale A
Complete; no motor/sensory function is preserved in s4-s5
193
ASIA Scale B
Incomplete; Sensory but not motor function is preserved in s4-s5
193
ASIA Scale C
Incomplete; Motor function is preserved below neurological level, more than half of the key ms have MMT < grade 3
194
ASIA Scale E
Normal; motor and sensory function is normal
194
ASIA Scale D
Incomplete; Motor function is preserved below neurological level, at least half of the key ms have MMT 3 or more
195
was developed to provide a subjective score of an individual’s sensitivity to motion
The Motion Sensitivity Quotient (MSQ)
196
Indication of a score of 0 in MSQ
No symptoms
197
Indication of a score of 100 in MSQ
Severe dizziness in all positions
198
In what conditions is Romburg's test positive?
Acute UVH & BVH
199
This is a timed test that systematically
measures the influence of visual,
vestibular and somatosensory input
on standing balance
Clinical Test of Sensory Interaction and Balance (CTSIB)
200
CTSIB relies on what sensory systems?
Vision
Vestibular
Somatosensory
201
Conditions in the CTSIB that indicates visual dependence
2 - Firm, EC
3 - Firm, VC
5 - Foam, EC
6 - Foam, VC
202
Conditions in CTSIB that indicate somatosensory dependence
4 - Foam, EO
5 - Foam, EC
6 - Foam, VC
202
Conditions in CTSIB that indicate vestibular dependence
5 - Foam, EC
6 - Foam, VC
202
Superficial sensations
Pain
Temperature
Light touch
Vibration
202
Tools used for two-point discrimination
Caliper
Aesthesiometer
203
Deep sensations
Kinesthesia awareness
Proprioceptive awareness
Vibration perception
204
Combined cortical sensations
Barognosis
Graphesthesia
Tactile localization
Two-point discrimination
Stereognosis
205
CN that supplies the MR
CN III
