Neuromuscular Unit 6 Examination of Motor Function Flashcards
You may you hear in the subjective report that may lead you to think the patient has a Coordination impairment?
- I dont have the same control as before
- I feel clumsy/drunk
You may you hear in the subjective report that may lead you to think the patient has Hypertonicity?
My limb is very tight/rigid/spastic
You may you hear in the subjective report that may lead you to think the patient has weakness?
- I dont feel as strong as before
- I cannot move my limb like before
- One side of my body is very weak
During the task analysis, what may lead you to think the patient has weakness?
- They have asymmetrical execution (lack of use)
- Failure to execution
- Compensatory movement
During the task analysis, what may lead you to think the patient has a Coordination Impairment?
- Movement is slowed/ not smooth/ not timed well
During the task analysis, what may lead you to think the patient has Hypotonicity?
Limb is relatively still with minimal use
During the task analysis, what may lead you to think the patient has Hypertonicity?
Limb is kept in one position
With Motor Deficits, what is the result of Primary Muscle Weakness?
- Reduced motor unit recruitment
- Impaired motor unit firing rates and rating code
- Slower contraction and relaxation times
- Abnormal co-contraction of agonist and antagonist
Over time a patient may experience Secondary Muscle Weakness, what does this look like?
- Disuse atrophy
- Changes in viscoelastic properties
How do you examine muscle strength?
-
MMT
–This is appropriate when the muscle can be isolated
–This is NOT appropriate when synergies are present because you cannot tell which muscle is completing the movement - Functional Testing
–This is the completion of a particular functional task - Examination of Movement Strategies
What is the Flexion Synergy for the UE?
Scapular - Retraction/Elevation
Shoulder- ABD, ER
Elbow - Flexion
Forearm - Supination
Wrist - Flexion
Finger - Flexion
What is the Extension Synergy for the UE?
Scapular - Protraction
Shoulder- ADD, IR
Elbow - Extension
Forearm - Pronation
Wrist - Extension
Finger - Flexion
What is the Flexion Synergy for the LE?
Hip - Flexion, ABD, ER
Knee - Flexion
Ankle - DF, Inversion
Toe - DF
What is the Extension Synergy for the LE?
Hip - Extension, ADD, IR
Knee - Extension
Ankle - PF, Inversion
Toe - PF
What is Tone?
The resistance of muscle to passive elongation or stretch
What is Hypertonicity and its components?
- Increased Tone
- Spasticity: Velocity Dependent
- Rigidity: Velocity Independent (Uniform resistance through slow passive movement)
–Lead-Pipe: refers to a constant increase in muscle tone and stiffness of affected muscles
–Cogwheel: Producing stiffness and a ratchet like jerkiness when a body part is manipulate
What is Hypotonia and its components?
What are the 3 criteria’s that must be met for a limb to be termed as flaccid?
Decreased Tone
- Flaccidity (An extreme form of hypotonia whereby the limb feels heavy and limp; typically LMN lesions)
There are 3 criteria that must be met for a limb to be termed flaccid:
1. No resistance to passive elongation
2. No volunary movement possible
3. No reflex activity, i.e. no associated reactions
What is the Etiology of Hypotonicity?
- Cerebellar Disorders (Due to decreased descending facilitation of interneurons and motor neurons)
- LMN Lesion (Lack of muscle contraction despite UMN activity)
- Common in acute UMN lesion as a protective reaction
What is the Pathophysiology of Spasticity?
What happens if you have a loss of descending input?
- Stretch reflex mediated by the Ia Sensory afferents of the muscle spindle
- Quick stretch -> excitatory connection with the alpha motor neuron of muscle -> contraction
Loss of descending input = Loss of inhibition of the stretch reflex
What is a 0 in the Modified Ashworth Scale?
There is no increase in tone (Normal)
What is a 1 in the Modified Ashworth Scale?
Slight increase in tone, end of range (May catch and release)
What is a 1+ in the Modified Ashworth Scale?
Slight increase in tone through less than 1/2 range
What is a 2 in the Modified Ashworth Scale?
Marked increase tone through most of the range
(Still moves easily)
What is a 3 in the Modified Ashworth Scale?
Passive movement difficult
What is a 4 in the Modified Ashworth Scale?
Rigid (No movement)
What is the 1st Stage of the Brunnstrom’s Stage of Recovery?
There is Flaccidity and no movement
What is the 2nd Stage of the Brunnstrom’s Stage of Recovery?
Spasticity begins and no Voluntary movements
What is the 3rd Stage of the Brunnstrom’s Stage of Recovery?
Spasticity worsens, Voluntary movement occurs in only synergy
What is the 4th Stage of the Brunnstrom’s Stage of Recovery?
Spasticity declines, some voluntary movement out of synergy may occur
What is the 5th Stage of the Brunnstrom’s Stage of Recovery?
Spasticity continues to decline, relative independence from synergistic movement
What is the 6th Stage of the Brunnstrom’s Stage of Recovery?
Spasticity disappears; Full isolated/coordinated movement
What is the difference between Decorticate and Decerebrate Rigidity?
Decorticate: refers to sustained contraction and posturing of the upper limbs in flexion and the lower limbs in extension.
Decerebrate: refers to sustained contraction and posturing of the trunk and limbs in a position of full extension
Typically associated with damage to the descending UMN pathway, typical with coma and damage to brainstem
What is Coordination?
- The ability to execute smooth, accurate, controlled movement
- The ability to initiate, control and terminate a movement
What are the categories of Coordination?
- Equilibrium Coordination
–Ability posture/balance in upright posture - Nonequilibrium coordination
–Ability to complete smooth/accurate inter and intralimb movement
If there is damage to the Cerebellum, how would this affect Nonequilibrium coordination?
- Dysmetria
- Dysdiadochokinesia (Rapid alternating movements)
- Tremor
- Movement Decomposition
- Rebound Phenomenon
If there is damage to the Basal Ganglia, how would this affect Nonequilibrium coordination?
Think PD
- Akinesia
- Bradykinesia
- Rigidity
- Tremor
- Involuntary Movements
If there is damage to the Dorsal Columns, how would this affect Nonequilibrium coordination?
- Dysmetria
- Slowness of movement
What is the purpose of Nonequilibrium Coordination Tests?
They test the aspects of movement
- Alternate or reciprocal motion
- Movement accuracy
- Speed of movement
- Movement composition
- Intra and Interlimb coordination
Alternate or reciprocal motion-is the ability to reverse movement from agonist to antagonist. (pronation/supination, foot tapping; when impaired it is known as dysdiadokokinesia)
What are typical Coordination Test?
When resisting Flexion of uninvolved UE, what would be the response of the involved limb?
Flexion of involved UE
When resisting Extension of uninvolved UE, what would be the response of the involved limb?
Extension of involved UE
When resisting Flexion of uninvolved LE, what would be the response of the involved limb?
Extension of involved LE
When resisting Extension of uninvolved LE, what would be the response of the involved limb?
Flexion of involved LE
When resisting Flexion of involved UE, what would be the response of the involved limb?
Flexion of involved LE
When resisting Extension of involved UE, what would be the response of the involved limb?
Extension of involved LE
When resisting Flexion of involved LE, what would be the response of the involved limb?
Flexion of involved UE
When resisting Extension of involved LE, what would be the response of the involved limb?
Extension of involved UE
When resisting Adduction of uninvolved LE, what would be the response of the involved limb?
Adduction (or Abd) of involved LE
