Neuromuscular Unit 13-14 Flashcards
What are the 4 Key Elements of the UE to reach, grasp and manipulate?
- Locating the target
- Reaching involved transportation of the arm and hand
- Grasp, including grip formation, grasp and release
- Hand manipulation of the object
All 4 aspects must be examined when deficits in UE performance are suspected
Neuro Impairment: Effect on Reach/Grasp/Manupulation
With the Key Elements, which system is most necessary for Locating (a target)?
Vision and Cognition
Neuro Impairment: Effect on Reach/Grasp/Manupulation
With the Key Elements, which system is most necessary for Reaching?
Vision
Somatosensory
Motor Control (Most essential)
Cognition (not as essential)
Neuro Impairment: Effect on Reach/Grasp/Manupulation
With the Key Elements, which system is most necessary for Grasp/Release?
Vision (not as essential)
Somatosensory
Motor Control (Most essential)
Cognition (not as essential)
Neuro Impairment: Effect on Reach/Grasp/Manupulation
With the Key Elements, which system is most necessary for Hand Manipulation?
Vision (not as essential)
Somatosensory (Most Essentional)
Motor Control (Most essential)
Cognition (not as essential)
What is a common condition that we will see after stokes, sometimes after brain injuries/SCI and UMN lesions?
Shoulder Subluxation (A drop of the humeral head)
- Due to the severe weakness at the proximal musculature of the shoulder girdle (lack of motor control)
You measure the subluxation by how many fingertips you can fit between the acromian and humeral head
What are Intrinsic causes of Shoulder Subluxations?
- Trunk/Joint malalignment (Most common cause)
- Imbalance of muscle activation
- Weakness
- Abnormalities of tone (Specifically hyertonicity)
- Soft Tissue Extensibility
What are Extrinsic causes of Shoulder Subluxations?
- Positioning (ex. sitting in a w/c for a prolonged period of time with the arm unsupported)
- Handling (dont pull the pt. at the arm, rather support at the scapula)
- Assistive Devices
What are the effects of Subluxation of the Shoulder, acutely?
This is often not painful, however easily traumatized
- What will cause pain with when there is lack of glenohumeral rhythem when doing overhead activities with a subluxed shoulder, creating impingement syndrome.
(When the humerus elevates and the scap does not move, the humerus will impinge on the aromion causeing pain)
What are the effects of Subluxation of the Shoulder, chronically?
You will see pain because of the extensibility issue associated with the ligaments that are getting overly stretched
How can can you reduce subluxations?
- Actively align trunk
- Keep scapula in neutral position
- Have good alignement of the humerus
Effects of shoulder subluxation
How can you prevent the shoulder pain associated with this?
- By trying to prevent subluxations and trying to prevent moving the arm without moving the scapula
- The scap and the humerus are married and are not allowed to get divorced, they have to move together. When moving the patients arm for any functional task, one hand must be on the scapula and the other on the humerus and they move at the same time
What are the UE Function/Impairments Outcome Measures?
- 9 Hole Peg: This looks specifically at fine motor control, where the patient is timed to put 9 pegs into 9 different holes using different grips with their fingers
- Action Research Arm Test: This Specifically looks at functionality of the UE specific to stroke
- Fugl Meyer: This looks at motor recovery after stroke, takes into account abnormal synergy and reflexes. Also uses the Brunnstrom stages to assess motor control
A person that has had a TBI, CVA or SCI is this an example of Chronic Illness or Disability?
These are examples of Disabilites
Chronic Illness include: MS, ALS, PD, and cancer
What is the difference in onset between Chronic Illness and Disability?
Disability is sudden onset
Chronic Illness is Insidious Onset
Chronic Illness vs Disability
With Disability what are the adaptations with this?
(What is the patient respones)
- Shock
- Anxiety and Depression (Grief over loss of premorbid function)
Chronic Illness vs Disability
With Chronic Illness what are the adaptations with this?
(What is the patient respones)
- Anxiety and Depression (Relete to future; fear of death and unknown)
- Acknowledgement and adjustment phases more difficult to achieve
What is the difference between Cognition and Perception?
Cognition is the act or process of knowing, including awareness, reasoning, judgement, intuition and memory. Includes executive functions
Perception is the integration of sensory impression into information that is psychologically meaningful
Why do we need to understand cognitive and perceptual disorders?
- Cheif cause of poor rehab process
- Communication
- Safety
- Collaboration with OT
- Referral
If a patient has difficulty or the inability to perform simple task independently or safely, the patient may…?
Hesitate many times
If a patient has difficulty or the inability to initiate or complete a task, the patient may…?
Appear distracted and frustrated
If a patient has difficulty or the inability to switch from one task to another, the patient may…?
Exhibit poor planning
If a patient has difficulty or the inability to Visually locate or identify objects that are necessary for task completion, the patinet may…?
Be inattentive to 1 side of the body
If a patient has difficulty or the inability to Follow 1 step commands, the patient may…?
Complete task impulsively
If a patient has difficulty or the inability to Complete tasks in a timely manner, the patient may…?
Deny presence or extent of disability
What is Attention?
The ability to select and attend to a specific stimulus while simultaneously suppressing extraneous stimuli
What is Sustained Attention?
Attend to relevant information
What is Focused (Selected) Attention?
Attend to task despite visual or auditory stimuliu in enviornment
What is Alternating Attention?
Move between tasks
What is Divided Attention?
Respond simultaneouly to 2+ task
What is Memory?
Ability to restore and retrieve information for recall at a later time
With memory, what is Immediate Recall?
Retention of info stored for a few seconds
What is short-term Memory?
Retention of events or learning within a few minutes, hours, or days
What is Long-Term Memory?
Early experiences; info acquired over years
What are Executive Functions?
Those capabilites that enable a person to engage in independent, purposeful, self-serving behavior
Executive Function
What is Volition?
Capacity to determine what one needs and wants to do; creation of goals
Executive Function
What is planning?
Organization of steps to accomplish task; weighing alternatives; decision making
Executive Function
What is Purposive Action?
Productivity and self regulation to achieve goal
Executive Action
What is Effective Performance?
Quality control and self-correction of behaviors
What is the difference between Body Scheme and Body Image?
Body Image: Visual and metal image of body
Body Scheme: Sptial awareness of body parts and of the body within the environment
Body Scheme and Body Image Impairment
What is Unilateral Neglect?
The inability to register and integrate stimuli and perceptions from one side of the body (Body neglect) or environment (Spatial neglect)
This leads to poor recovery as compared to those without neglect
Body Scheme and Body Image Impairment
What is Anosognosia?
A severe form of neglect
- More common with R hemisphere injuries
- They deny body part is their own or deny the paresis/paralysis
- Confabulates stories as to what it is or why it is not working
Safety is a concern
Body Scheme and Body Image Impairment
What is Somatoagnosia?
Impairment in body scheme
- Difficulty following instructions that require distinguishing body parts
- May be unable to initiate movements
- Pts will confuse name or body parts and how body parts in relation to enviornment
- “Extend the knee” may be a comand that they find confusing
Body Scheme and Body Image Impairment
What is Right-Left Discrimination?
Inability to identify R and L sides of one’s body or that of the examiner
- Unable to follow commands that include terms left and right
- Unable to imitate movements
Body Scheme and Body Image Impairment
What is Finger Agnosia?
- Inability to identify the fingers of one’s own hands or of the hands of the examiner
- Difficulty naming fingers on command
- Difficulty identifying which finger was touched
What are Spatial Relation Disorder?
What are some examples
- These look at complex perception
- Difficulty in perceiving the relationship between the self and 2+ objects
- Frequent in R parietal lobe lesions
Examples:
- Figure Ground Discrimination: Distinguish object from background
- Form Discrimination: Differentiating between shapes/forms
- Spatial Relations: Relationship between objects
Spatial Relation Disorders
What is Position in Space Impairment?
The inability to perceive and interpret spatial concepts (i.e. up/down, under/over)
Spatial Relation Disorders
What is Topographical Disorientation?
Difficulty understanding and remembering the relationship on 1 location to another
Spatial Relation Disorders
What is Depth and Distance Perception?
Inaccurate judgement of direction, distance and depth
Spatial Relation Disorders
What is Vertical Disorientation?
Distorted perception of vertical
What is Agnosias?
The inability to recognize or make sense of incoming information despite intact sensory capacities (Visual, auditory, tactile)
What is Visual Agnosia?
Inability to recognize familiar objects despite normal function of the eys
What are 3 different Types of Visual Agnosia?
- Simultanagnosia: Inability to perceive visual stimulus as a whole (will interpret in pieces)
- Prosopagnosia: Inability to recognize familiar faces (can lead to significant frustration from family - education to family is necessary - compenstate with recognition of voice)
- Color Agnoisa: Inability to recognize, identify or name colors (not color blindness)
What is Auditory Agnosia?
Inability to recognize nonspeech or to discriminate them
- This is a Temporal Lesion
What is Tactile Agnosia (or Astereognosia)?
Inability to recognize forms by handling them
- Tactile, proprioceptive and thermal sensation may be intact
What is Apraxia?
Impairment of voluntary movement
- Not a result of motor, sensory or intellectual deficit
- Inability to perform purposeful movement
- Occurs often with aphasia as a result from a lesion in the dominate hemisphere (usually left)
What is Ideomotor Apraxia?
The patient understand what to do
- Habitual task can be done automatically but there is an inability to perform a task when commanded
What is Ideational Apraxia?
Lost in the idea of what to do
- Cannot carry out the steps of the task
- Unable to conceptualize a task and cannot perform a purposeful motor act either on command or automatically
