Neurorehabilitation- Sensory And Motor Function Flashcards
Spinal cord involvement
Bilateral typically
Below level of lesion with diffuse sensory involvement
Brain stem involvement
Ipsilateral facial impairments
Contra lateral trunk and limb impairments
Brain involvement
Cortical lesion- impairment is dependent on area of somatosesory cortex affect
Deeper lesions involving thalamus and adjacent structures can lead to diffuse unilateral dysfunction
Contra lateral side affected (crossing of tracts)
Feedback control
Sensory info is received during mvmt to adject motor output
Feedforward conril
Sensory info from past experience are used for anticipatory adjustments (postural control, mvmt)
Sensation testing
Vision should be occluded
Provide a normal
Test stimuli in a random and unpredictable manner
Order of testing sensory
Superficial (pain, tem, touch)
Deep (proprio)
Combine cortical sensations (stereognosis)
What do you record for sensory testing
Modality tested
Surface area affected
Degreee or severity of involvement
Subjective feelings about altered sensation
Potential impact of sensory impairment on function
Superficial sensations
Pain perception (sharp dull)
Temperature awareness (distinguish b/w hot and cold)
Touch awareness (tactile touch input)
Pressure perception (assess by pressing enough to leave an imprint)
Deep sensations testing
Proprioception awareness (up or down or mirroring) *hold sides to keep it controlled
Kinesthesia awareness (awareness of movement, going up or going down)
Vibration perception (assesses the ability to perceive vibratory stimuli with a tuning fork on a bony landmark)
Coritcal sensations
Stereognosis perception (assess tactile object recognition- objects they old know)
Tactile localizations (assess the ability to localize touch sensation- touch patient then patient point where they were touched)
Two-point discrimination (assesses the ability to perceive two separate points on the skin simultaneously and measure the minimal detectable distance between points)
Double simultaneous stimulation (assesses the ability to perceive simulaneous touch stimulus)
Graphesthesia (tracing number, letters, designs that are known)
Texture Recognition (assess the ability to differentiate among various textures)
Barognosis (assesses recognition of weight)
Allodynia
Non-noxious stimulus produces pain
Analgesia
Loss of pain sensitive
Causalgia
Burning painful sensation, often along nerve distribution
Dysesthesia
Touch sensation produces pain
Hyperalgesia
Heightened sensitivity to pain
Hyperasthesia
Heightened sensitivity to sensory stimulation
Hypoalgesia
Decreased sensitivity to pain
Paresthesia
Abnormal sensation with no apparent cause (numbness, tingling)
Interventions to impaired sensation- compensatory approach
How to accommodate with having sensory impairments
Developing alternate stratgies and environmental adaptions
Interventions to impaired sensation- sensory integration approach
Functional skills through guided practice with controllers sensory intake
Activates sensory receptors and higher brain centers
Stimuli are presented in the context of meaningful activities
Enhance sensory integrations is the goal- will have an effect on motor performance
Upper motor neurons
Originate in the brain, brainstorm,, or spinal cord
Before the anterior horn cells of the spinal cord
Lower motor neuron
Originate in the cranial nerve nuclei and motor neurons distal to the anterior horn cells of the spinal cord (receive info from the upper and carry to the muscles)
Weakness
UMN (spastic) and LMN (flaccid)
Atrophy
LMN
Fasciculations
LMN
Reflexes
UMN- hyperreflexive LMN- hyporeflexia/ areflexia
Tone
UMN- increased
LMN- decreased
UMN S&S
Hyperactive stretch reflexes
Involuntary flexor and extensor spasms
Clonus
Babinskis sign
Exaggerated cutaneous reflexes
Loss of precise autonmic control
Dyssynergic mvmt patterns
LMN S&S
Decrease or absent tone and reflexes
Paresis
Muscle fasciculations and fibrillations with enervation
Neurogenic atrophy
UMN lesions
Amyotrophic lateral sclerosis (ALS)
Brain injury
Cerebral palsy
Multiple sclerosis
Spinal cord injury
Stroke
Tumor in brain or spinal cord
LMN Lesions
Amyotrophic lateral sclerosis (ALS)
Bell’s palsy
Cauda equine syndrome
Gillian-barre syndrome
Peripheral nerve injurie s
Poliomyelitis
Post-polio syndrome
Tone
Resistance of muscle to passive elongation
Hypertonia (spacitisty, rigidity)
Hypotonia (below normal at resting level)
Dystonia (disordered tonicity)
Spasticity
Velocity dependent resistance to passive elongation
- increase speed of stretch= increase resistance
- clasp knife response- catch and let go
- associated with UMN syndrome
Rigidity
Velocity independent hypertonic state of muscle
Leadpipe- constant rigidity throughout entire ROM (Parkinson’s disease)
Cogwheel- jerky type of rigidity (Parkinson’s disease)
Decorticate rigidity
For those in a coma (unconscious, corticospinal tract lesion usually)
UE in flexion (shoulder in adduction)
LE in extension (INTERNAL ROTATED, ankle plantarflexion)
Decerebrate rigidity
Brain stem lesion
Sustained trunk and limbs in full extension
UE- elbow extended, forearmpronated
LE- no internal rotation
Hypotonia (flaccidity)
Muscles feel soft and squishy upon palpating
Poor postural control
Floppy limbs
W sitting
Dystonia
Normal birth history- starts in the legs and move up if it is generalized
Involuntary twisting and repetitive mvmts, abnormal fixed postures and disordered tone
Dry tonic posturing- cocontraction of muscles causing weird posture
How do you grade spasticity?
Modified Ashworth scale
0
1
1+
2
3
4
Interventions for abnormal tone
Stretching casting splinting orthoses sensory stimulation techniques
Interventions for hypotonia
Decrease support
Increase resistance
Joint compression (no pain)
Manual facilitation techniques
Interventions for hypertonic may include
Increase support
Modify tasks
Positioning in lengthen positions
Heat
UMN reflexes
Clonus
Babinski
Hoffman
