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Term 3 > Neuromuscular Unit 6 Examination of Motor Function > Flashcards

Neuromuscular Unit 6 Examination of Motor Function Flashcards

1
Q

You may you hear in the subjective report that may lead you to think the patient has a Coordination impairment?

A
  • I dont have the same control as before
  • I feel clumsy/drunk
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2
Q

You may you hear in the subjective report that may lead you to think the patient has Hypertonicity?

A

My limb is very tight/rigid/spastic

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3
Q

You may you hear in the subjective report that may lead you to think the patient has weakness?

A
  • I dont feel as strong as before
  • I cannot move my limb like before
  • One side of my body is very weak
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4
Q

During the task analysis, what may lead you to think the patient has weakness?

A
  • They have asymmetrical execution (lack of use)
  • Failure to execution
  • Compensatory movement
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5
Q

During the task analysis, what may lead you to think the patient has a Coordination Impairment?

A
  • Movement is slowed/ not smooth/ not timed well
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6
Q

During the task analysis, what may lead you to think the patient has Hypotonicity?

A

Limb is relatively still with minimal use

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7
Q

During the task analysis, what may lead you to think the patient has Hypertonicity?

A

Limb is kept in one position

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8
Q

With Motor Deficits, what is the result of Primary Muscle Weakness?

A
  • Reduced motor unit recruitment
  • Impaired motor unit firing rates and rating code
  • Slower contraction and relaxation times
  • Abnormal co-contraction of agonist and antagonist
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9
Q

Over time a patient may experience Secondary Muscle Weakness, what does this look like?

A
  • Disuse atrophy
  • Changes in viscoelastic properties
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10
Q

How do you examine muscle strength?

A
  • 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
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11
Q

What is the Flexion Synergy for the UE?

A

Scapular - Retraction/Elevation
Shoulder- ABD, ER
Elbow - Flexion
Forearm - Supination
Wrist - Flexion
Finger - Flexion

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12
Q

What is the Extension Synergy for the UE?

A

Scapular - Protraction
Shoulder- ADD, IR
Elbow - Extension
Forearm - Pronation
Wrist - Extension
Finger - Flexion

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13
Q

What is the Flexion Synergy for the LE?

A

Hip - Flexion, ABD, ER
Knee - Flexion
Ankle - DF, Inversion
Toe - DF

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14
Q

What is the Extension Synergy for the LE?

A

Hip - Extension, ADD, IR
Knee - Extension
Ankle - PF, Inversion
Toe - PF

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15
Q

What is Tone?

A

The resistance of muscle to passive elongation or stretch

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16
Q

What is Hypertonicity and its components?

A
  • 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
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17
Q

What is Hypotonia and its components?

What are the 3 criteria’s that must be met for a limb to be termed as flaccid?

A

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

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18
Q

What is the Etiology of Hypotonicity?

A
  • 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
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19
Q

What is the Pathophysiology of Spasticity?

What happens if you have a loss of descending input?

A
  • 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

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20
Q

What is a 0 in the Modified Ashworth Scale?

A

There is no increase in tone (Normal)

21
Q

What is a 1 in the Modified Ashworth Scale?

A

Slight increase in tone, end of range (May catch and release)

22
Q

What is a 1+ in the Modified Ashworth Scale?

A

Slight increase in tone through less than 1/2 range

23
Q

What is a 2 in the Modified Ashworth Scale?

A

Marked increase tone through most of the range
(Still moves easily)

24
Q

What is a 3 in the Modified Ashworth Scale?

A

Passive movement difficult

25
Q

What is a 4 in the Modified Ashworth Scale?

A

Rigid (No movement)

26
Q

What is the 1st Stage of the Brunnstrom’s Stage of Recovery?

A

There is Flaccidity and no movement

27
Q

What is the 2nd Stage of the Brunnstrom’s Stage of Recovery?

A

Spasticity begins and no Voluntary movements

28
Q

What is the 3rd Stage of the Brunnstrom’s Stage of Recovery?

A

Spasticity worsens, Voluntary movement occurs in only synergy

29
Q

What is the 4th Stage of the Brunnstrom’s Stage of Recovery?

A

Spasticity declines, some voluntary movement out of synergy may occur

30
Q

What is the 5th Stage of the Brunnstrom’s Stage of Recovery?

A

Spasticity continues to decline, relative independence from synergistic movement

31
Q

What is the 6th Stage of the Brunnstrom’s Stage of Recovery?

A

Spasticity disappears; Full isolated/coordinated movement

32
Q

What is the difference between Decorticate and Decerebrate Rigidity?

A

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

33
Q

What is Coordination?

A
  • The ability to execute smooth, accurate, controlled movement
  • The ability to initiate, control and terminate a movement
34
Q

What are the categories of Coordination?

A
  • Equilibrium Coordination
    –Ability posture/balance in upright posture
  • Nonequilibrium coordination
    –Ability to complete smooth/accurate inter and intralimb movement
35
Q

If there is damage to the Cerebellum, how would this affect Nonequilibrium coordination?

A
  • Dysmetria
  • Dysdiadochokinesia (Rapid alternating movements)
  • Tremor
  • Movement Decomposition
  • Rebound Phenomenon
36
Q

If there is damage to the Basal Ganglia, how would this affect Nonequilibrium coordination?

A

Think PD

  • Akinesia
  • Bradykinesia
  • Rigidity
  • Tremor
  • Involuntary Movements
37
Q

If there is damage to the Dorsal Columns, how would this affect Nonequilibrium coordination?

A
  • Dysmetria
  • Slowness of movement
38
Q

What is the purpose of Nonequilibrium Coordination Tests?

A

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)

39
Q

What are typical Coordination Test?

A
40
Q

When resisting Flexion of uninvolved UE, what would be the response of the involved limb?

A

Flexion of involved UE

41
Q

When resisting Extension of uninvolved UE, what would be the response of the involved limb?

A

Extension of involved UE

42
Q

When resisting Flexion of uninvolved LE, what would be the response of the involved limb?

A

Extension of involved LE

43
Q

When resisting Extension of uninvolved LE, what would be the response of the involved limb?

A

Flexion of involved LE

44
Q

When resisting Flexion of involved UE, what would be the response of the involved limb?

A

Flexion of involved LE

45
Q

When resisting Extension of involved UE, what would be the response of the involved limb?

A

Extension of involved LE

46
Q

When resisting Flexion of involved LE, what would be the response of the involved limb?

A

Flexion of involved UE

47
Q

When resisting Extension of involved LE, what would be the response of the involved limb?

A

Extension of involved UE

48
Q

When resisting Adduction of uninvolved LE, what would be the response of the involved limb?

A

Adduction (or Abd) of involved LE

Term 3 (51 decks)

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