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Intro to Clinics > Neuromuscular Assessments > Flashcards

Neuromuscular Assessments Flashcards

1
Q

Common structures affected in the upper limb in UMN syndrome include

A

Scapula

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2
Q

Common lower limb structures affected in UMN syndrome

A

Pelvis
Hip
Foot and Ankle
Trunk

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3
Q

Affected muscles of the scapula in UMNL

A

Rhomboids

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4
Q

Affected muscles of the pelvis in UMNL

A

Quadratus Lumborum

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5
Q

Affected muscles of the Hip in UMNL

A

Adductors, Gracilis, G. Max

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6
Q

Affected muscles of the knee in UMNL

A

Quadriceps

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7
Q

Affected muscles of the foot and ankle in UMNL

A

Gastrocsoleus, Tibialis posterior, Long toe flexors, Extensor hallucis longus, Peroneus longus

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8
Q

Affected muscles of the hip and knee during prolonged sitting posture in UMNL

A

Iliopsoas
Rectus femoris
Pectineus
Hamstrings

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9
Q

Affected muscles of the trunk in UMNL

A

Rotators
Internal/External obliques

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10
Q

Location of lesion in UMNL

A

CNS cortex, brainstem, corticospinal tracts, spinal cord

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11
Q

Location of lesion in LMNL

A

Cranial nerves, Anterior horn and spinal roots of the spinal cord, Peripheral nerves

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12
Q

Diagnosis or pathology of UMNL

A

stroke, TBI, SCI

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13
Q

Diagnosis or pathology of LMNL

A

Polio, Guillain-Barre’s Syndrome, Peripheral Nerve Injury
Peripheral neuropathy, radiculopathy

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14
Q

Muscle tone in UMNL

A

Increased; hypertonia
Velocity dependent; spastic

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15
Q

Muscle tone in LMNL

A

Decreased; hypotonia, flaccid
Non-velocity dependent

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16
Q

Involuntary movements in UMNL

A

Muscle spams in flexors or extensors

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17
Q

Involuntary movements in LMNL

A

With denervation: fasciculations

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18
Q

pt Strength in UMNL

A

Ipsilateral weakness/paralysis (CVA)
Bilateral weakness/paralysis (SCI)
Contralateral if above decussation in medulla

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19
Q

Muscle bulk in UMNL

A

Disuse atrophy; widespread distribution, especially of antigravity ms

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20
Q

Muscle bulk in LMNL

A

Neurogenic atrophy; focal distribution, severe wasting

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21
Q

Voluntary movements in UMNL

A

Impaired or absent

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22
Q

Voluntary movements in LMNL

A

Weak or absent if nerve is interrupted

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23
Q

MAS grade 0

A

No increase in muscle tone

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24
Q

MAS grade 1

A

Slight increase in tone manifested by catch and release at the end ROM

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25
Q

MAS grade 1+

A

Slight increase in muscle tone, manifested by catch followed by minimal resistance throughout the remainder of the ROM

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26
Q

MAS grade 2

A

More marked increase in tone though most of the ROM but joint is easily moved

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27
Q

MAS grade 3

A

Considerable increase in muscle tone; passive testing is difficult

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28
Q

MAS grade 4

A

The affected part is rigid in flexion or extension

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29
Q

What do you ask the patient to draw in the MMSE?

A

Overlapping pentagons with one being inverted

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30
Q

Mental Status Examination must be oriented to the

A

person
place
date
situation

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31
Q

What is asked during the memory part of the mental status examination?

A

Current events

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32
Q

Give the patients four objects to remember in 5 minutes

A

Recent Memory

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33
Q

“If I say 1-2-3 you say 3-2-1”

A

Digit Span Forward

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34
Q

Serial subtraction 100 - 7 or 30 - 3

A

Arthematic

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35
Q

Compare and Contrasting two objects

A

Ability to abstract: Similarity and Differences

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36
Q

Listen to the patient as he answers questions.

A

Speech and Language

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37
Q

Have the patient draw a clock at 11:15.

A

Visual-spatial skills

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38
Q

Generalized ms weaknes

A

Asthenia

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39
Q

Loss of ability to associate ms together for complex movements

A

Asynergia

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40
Q

Increased time required to initiate voluntary movements

A

Delayed reaction time

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41
Q

Disorder of the motor component of speech articulation

A

Dysarthria

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42
Q

Impaired ability to perform rapid alternating movements

A

Dysdiadochokinesia

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43
Q

Inability to judge the distance or range of a movement

A

Dysmetria

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44
Q

Movements are performed in a sequence of component parts rather than as a single smooth activity

A

Dyssynergia

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45
Q

Ataxic pattern; broad base of support; postural instability

A

Gait disorders

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46
Q

Ataxic gait is aka

A

Drunken gait

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47
Q

Hypotonia

A

Decreased ms tone

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48
Q

Hypermetria

A

Overestimation of distance or range needed to accomplish a movement

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49
Q

Hypometria

A

Underestimation of distance or range needed to accomplish a movement

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50
Q

Rhythmic, quick, oscillatory, back-and-forth movements of the eyes

A

Nystagmus

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51
Q

Patient is unable to stop sudden limb motion

A

Rebound phenomenon

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52
Q

Involuntary oscillatory movement resulting from alternate contractions of opposing ms groups

A

Tremor

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53
Q

Coordination tests that address components of limb movements

A

Nonequilibrium tests

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54
Q

Coordination tests that consider the ability to maintain the body in equilibrium with gravity both statically and dynamically

A

Equilibrium tests

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55
Q

Nonequilibrium tests

A

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

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56
Q

Tests for dydiadochokinesia

A

Finger-to-nose
Alternate nose-to-finger
Pronation/Supination
Knee flexion/extension
Walking, alter speed or direction

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57
Q

Tests for dsymetria

A

pointing and past pointing
drawing a circle
heel on shin
placing feet on floor markers

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58
Q

Tests for dyssynergia

A

Finger-to-nose
Finger-to-therapists finger
Alternate heel-to-knee
Toe-to-examiner’s finger

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59
Q

Tests for hypotonia

A

passive movements
DTR

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60
Q

Tests for intentional tremors

A

finger-to-finger
finger-to-therapists finger
toe-to-examiner’s finger

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61
Q

Tests for resting tremors

A

observation patient at rest; limb or jaw movements
observation during functional activities

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62
Q

Tests for postural tremors

A

observation of steadiness

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63
Q

Tests for asthenia

A

Fixation or position holding
Application of manual resistance to determine ability to hold

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64
Q

Tests for rigidity

A

passive movements
observation during functional activities and resting posture

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65
Q

Tests for Bradykinesia

A

Walking, observation of arm swing and trunk motion

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66
Q

Nonequilibrium test grade 4

A

normal

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67
Q

Nonequilibrium test grade 3

A

minimal impairment; slightly less than normal control, speed, and steadiness

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68
Q

Nonequilibrium test grade 2

A

moderate impairment; accomplishes activity; slow, awkward, and unsteady movements

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69
Q

Nonequilibrium test grade 1

A

severe impairment; can only initiate activity; movements are slow with significant unsteadiness

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70
Q

Nonequilibrium test grade 0

A

activity impossible

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71
Q

Functional balance grade 4

A

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

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72
Q

Functional balance grade 3

A

Good; pt is able to maintain balance s handhold support. pt accepts moderate challenge

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73
Q

Functional balance grade 2

A

Fair; pt able to maintain balance c handheld support; may require minimal assistance. pt accepts minimal challenge

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74
Q

Functional balance grade 1

A

Poor; pt requires handhold support and moderate to maximal assistance. pt cant accept challenge

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75
Q

Functional balance grade 0

A

pt unable to maintain balance

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76
Q

Developed by Tinetti and measures static and dynamic balance

A

Performance-Oriented Mobility Assessment (POMA)

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77
Q

Total possible score of the original Performance-Oriented Mobility Assessment (POMA)

A

28

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78
Q

POMA scores < 19

A

high risk for falls

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79
Q

POMA scores bet 19-24

A

moderate risk for falls

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80
Q

Total possible score of Performance-Oriented Mobility Assessment (POMA) II

A

54

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81
Q

Developed by Duncan to provide a quick screen of balance problems in older adults

A

Functional Reach Test

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82
Q

Normal functional reach for men aged 20-40

A

16.7 (+-1.9)

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83
Q

Normal functional reach for men aged 41-69

A

14.9(+-2.2)

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84
Q

Normal functional reach for men aged 70-87

A

13.2(+-1.6)

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85
Q

Normal functional reach for women aged 20-40

A

14.6(+-2.2)

86
Q

Normal functional reach for women aged 41-69

A

13.8(+-2.2)

87
Q

Normal functional reach for women aged 70-87

A

10.5(+-3.5)

88
Q

Developed by newton that determines the amount of reach that is influenced by several factors (size and height of an individual)

A

The Multidirectional Reach Test (MDFR)

89
Q

Normal reach forward

90
Q

Normal reach backward

91
Q

Normal reach right lateral

92
Q

Normal left lateral

93
Q

A quick measure of dynamic balance and mobility developed by Mathias

A

The Get Up and Go (GUG)

94
Q

Distance for GUG

95
Q

How long does a healthy adult take to complete the GUG?

96
Q

How long does frail elderly or individuals c disability take to complete the GUG?

A

11-20 seconds

97
Q

The patient is asked to walk at his or her preferred speed
over a set distance clearly marked on the floor

A

Timed Walking Tests

98
Q

can be used to determine the effects of attentional demands by
introducing a secondary task, talking, while walking.

A

Stops While Walking Test (SWWT)

99
Q

Another name for SWWT

A

Walkie-Talkie test

100
Q

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

A

Function In Sitting Test (FIST)

101
Q

How many items does FIST have?

102
Q

A self-report measure that examines how confident an individual
feels while performing 10 items of ADL and functional mobility. Developed by Tinetti

A

Balance Efficacy Scale (BES)

103
Q

How is the CN I assessed?

A

By using aromatic, non-irritable materials such as lemon, tobacco, coffee, and garlic

104
Q

What is CN II

105
Q

How is CN II assessed?

A

Through the use of Snellen chart

106
Q

How is CN III assessed?

A

Shining pen light on the eyes

107
Q

How can a lesion of the CN II be detected?

A

No pupillary response on the side where light is shone as well as the contralateral eye.

108
Q

How can a lesion of the CN III be detected?

A

Absent pupillary response on the contralateral eye where the light was shone
Presence of Ptosis

109
Q

Vertical diplopia

110
Q

Horizontal diplopia

111
Q

eye muscle responsible for looking down and in

A

Superior oblique

112
Q

eye muscle responsible for looking up and in

A

Inferior oblique

113
Q

How can CN V be assessed?

A

Jaw Jerk Reflex
Corneal Reflex

114
Q

An increased jaw jerk reflex indicates

A

Bilateral UMNL

115
Q

Afferent route in corneal reflex

A

Ophthalmic division of the trigeminal nerve

116
Q

Efferent route in corneal reflex

117
Q

Sensory functions of CN V

A

tongue and face sensation

118
Q

Facial muscle for raising the eyebrow

A

Occipitofrontalis

119
Q

Facial muscle for scrunching the forehead

A

Corrugator supercilli

120
Q

Facial muscle for scrunching the nose

121
Q

Facial muscle for moving the nostrils

A

Levator Labi Superioris Alaeque Nasi

122
Q

Facial muscle for moving and scrunching the nose

123
Q

Facial muscle for fixed smile c teeth

A

Zygomaticus Major

124
Q

Facial muscle for fixed smile s teeth

A

Zygomaticus Minor

125
Q

Facial muscle for elevating the lips

A

Levator Labii Superioris

126
Q

Facial muscle for puffing of the cheeks

A

Buccinator

127
Q

Buccinator is aka

A

Kissing muscle

128
Q

Facial muscle for angling the mouth

129
Q

Facial muscle for wrinkling of the neck

130
Q

Platysma is aka

A

Muscle of disgust/EGAD

131
Q

Facial muscle for contracting the chin

132
Q

Facial muscle for mouth closing

A

Orbicularis Oris

133
Q

Facial muscle for angling the mouth downward

A

Depressor Anguli Oris

134
Q

Facial muscle for depressing the mouth

A

Depressor Labii Inferioris

135
Q

Tests for CN VIII

A

Weber’s and Rinne’s test

136
Q

What frequency of tuning fork is used for Weber’s test

A

256 or 512 Hz

137
Q

What is a positive sign of conductive deafness in Weber’s test?

A

Sound is louder in affected ear

138
Q

What is a positive sign of nerve deafness in Weber’s test?

A

Sound is louder in the normal ear

139
Q

What is a positive sign of conductive deafness in Rinne’s test?

A

Bone conduction is better than air conduction

140
Q

A negative sign for Rinne’s test

A

Air conduction is better than bone conduction

141
Q

What is a positive test for nerve deafness in Rinne’s test?

A

Bone and Air conduction is impaired

142
Q

Conductive deafness refers to

A

middle ear deafness

143
Q

How is CN IX tested?

A

Gag reflex

144
Q

FAST method in detecting CVA

A

Facial Palsy
Arm weakness
Speech slurring
Time to call for help

145
Q

How many items does Stroke Impact Scale (SIS) contain?

146
Q

Domains of Stroke Impact Scale

A

Strength
Hand Function
ADL/IADL
Mobility
Communication
Emotion
Memory and thinking
Participation

147
Q

Common Gait Deviations of MS

A

Hip hiking/Steppage
Circumduction
Foot drop/slap
Shuffling
Vaulting
Shortened Step length
Knee Recurvatum
Knee buckling

148
Q

Assessments for MS

A

10m walk
25ft walk
2 min walk
6 min walk
TUG

149
Q

Balance assessments for MS

A

MS walking scale
Berg Balance
Dynamic Gait Index

150
Q

How many items does Modified Fatigue Impact Scale have?

151
Q

Requirements of Amyotrophic Lateral Sclerosis

A

Evidence of LMN degen
Evidence of UMN degen
Progressive spread of symptoms

152
Q

Schwab and England ADL Scale 100%

A

Independent, no slowness in ADLs

153
Q

Schwab and England ADL Scale 90%

A

Independent; some slowness and difficulty in ADLs; may take twice as long as usual

154
Q

Schwab and England ADL Scale 80%

A

Independent; conscious difficulty and slowness; takes twice as long as usual

155
Q

Schwab and England ADL Scale 70%

A

Assisted; more difficulty and slowness; takes thrice or four times longer than usual

156
Q

Schwab and England ADL Scale 60%

A

Some dependency; exceedingly slow and difficult with considerable errors

157
Q

Schwab and England ADL Scale 50%

A

More dependent; needs help c half the chores; difficulty in ADLs

158
Q

Schwab and England ADL Scale 40%

A

Very dependent; can assist c chores but only few can be done alone

159
Q

Schwab and England ADL Scale 30%

A

Much help needed; only does chores c effort

160
Q

Schwab and England ADL Scale 20%

A

Does nothing alone; severe invalid

161
Q

Schwab and England ADL Scale 10%

A

Totally dependent and helpless; complete invalid

162
Q

Schwab and England ADL Scale 0%

A

Vegetative functions; bedridden

163
Q

How many items does ALS Functional Rating Scale have?

164
Q

Hoehn-Yahr Disability Stage I

A

Minimal or absent; unilateral if present

165
Q

Hoehn-Yahr Disability Stage II

A

Minimal bilateral or midline involvement; No balance impairment

166
Q

Hoehn-Yahr Disability Stage III

A

Impaired righting reflex; Instability upon rising from chair; Some activities are restricted

167
Q

Hoehn-Yahr Disability Stage IV

A

All S/Sx present and severe; can only stand and walk c assistance

168
Q

Hoehn-Yahr Disability Stage V

A

Confined to bed or w/c

169
Q

MDS-UPDRS Part I

A

Non-motor experiences of daily living

170
Q

MDS-UPDRS Part II

A

Motor experiences of daily living

171
Q

MDS-UPDRS Part III

A

Motor examination

172
Q

MDS-UPDRS Part IV

A

Motor complications

173
Q

How many items does UPDRS have?

174
Q

GCS Eye Opening Rating

A

4 - Sponty
3 - Speech
2 - Pain
1 - No response

175
Q

GCS Motor Rating

A

6 - obeys
5 - localizes
4 - withdraws
3 - decorticate
2 - decerebrate
1 - no response

176
Q

GCS Verbal Rating

A

5 - oriented
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - no response

177
Q

Mild TBI LOC

178
Q

Moderate TBI LOC

A

> 30 min and < 24 hrs

179
Q

Severe TBI

180
Q

Mild TBI GCS

181
Q

Moderate TBI GCS

182
Q

Severe TBI

183
Q

RLA Level I

A

No resposne

184
Q

RLA Level III

A

Localized response; pt reacts specifically and inconsistently to stimuli

184
Q

RLA Level II

A

Generalized response; pt reacts to external stimuli

185
Q

RLA Level IV

A

Confused, agitated respose; pt exhibits bizarre and inappropriate behaviors

185
Q

RLA Level VI

A

Confused, appropriate response; pt gives appropriate context

186
Q

RLA Level V

A

Confused, inappropriate response; pt provides random/fragmented response to stimuli

187
Q

RLA Level VII

A

Automatic, appropriate response; pt behaves appropriately in familiar settings

188
Q

RLA Level VIII

A

Purposeful, appropriate response; pt is oriented

189
Q

Mild Head Injury

190
Q

Moderate Head Injury

191
Q

Serious Head Injury

192
Q

ASIA Scale A

A

Complete; no motor/sensory function is preserved in s4-s5

193
Q

ASIA Scale B

A

Incomplete; Sensory but not motor function is preserved in s4-s5

193
Q

ASIA Scale C

A

Incomplete; Motor function is preserved below neurological level, more than half of the key ms have MMT < grade 3

194
Q

ASIA Scale E

A

Normal; motor and sensory function is normal

194
Q

ASIA Scale D

A

Incomplete; Motor function is preserved below neurological level, at least half of the key ms have MMT 3 or more

195
Q

was developed to provide a subjective score of an individual’s sensitivity to motion

A

The Motion Sensitivity Quotient (MSQ)

196
Q

Indication of a score of 0 in MSQ

A

No symptoms

197
Q

Indication of a score of 100 in MSQ

A

Severe dizziness in all positions

198
Q

In what conditions is Romburg’s test positive?

A

Acute UVH & BVH

199
Q

This is a timed test that systematically
measures the influence of visual,
vestibular and somatosensory input
on standing balance

A

Clinical Test of Sensory Interaction and Balance (CTSIB)

200
Q

CTSIB relies on what sensory systems?

A

Vision
Vestibular
Somatosensory

201
Q

Conditions in the CTSIB that indicates visual dependence

A

2 - Firm, EC
3 - Firm, VC
5 - Foam, EC
6 - Foam, VC

202
Q

Conditions in CTSIB that indicate somatosensory dependence

A

4 - Foam, EO
5 - Foam, EC
6 - Foam, VC

202
Q

Conditions in CTSIB that indicate vestibular dependence

A

5 - Foam, EC
6 - Foam, VC

202
Q

Superficial sensations

A

Pain
Temperature
Light touch
Vibration

202
Q

Tools used for two-point discrimination

A

Caliper
Aesthesiometer

203
Q

Deep sensations

A

Kinesthesia awareness
Proprioceptive awareness
Vibration perception

204
Q

Combined cortical sensations

A

Barognosis
Graphesthesia
Tactile localization
Two-point discrimination
Stereognosis

205
Q

CN that supplies the MR

Intro to Clinics (9 decks)

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