PPT Assessment of Motor Control - UE Flashcards
Motor control
- Definition: “control of both movement and posture”
- Fluid interrelationships (selective movements or fluid in nature between movements- i.e. anterior/posterior pelvic tilt) - Stability and mobility (Proximal stability→ distal mobility)
- Agonists (muscle that moves the body part) and antagonists (muscle that moves body part BACK)
- Balance (Anticipatory and reactionary control; can be static/dynamic)
- Parameters of movement – spatial, temporal (needed for functional movement, nervous system turns on muscles for sequencing, timing, etc.)
(Dynamic) Systems Model of Motor Control/Behavior
Motor behavior from different systems interacting (PxExO) - EMPHASIZING ENVIRONMENT
- Person: cognitive, psychosocial, sensorimotor
- Environment: physical, cultural, socioeconomic
- Occupational performance tasks/ role performance
- Nervous system is now one system (used to be the primary system)
- Posture/movement happens not through reflex reflex-hierarchical model (i.e. primary reflexes, old way of thinking) but movement can happen by adapting to changing circumstances in different systems
Primary Impairments Related to Movement with Upper Motor Neuron Lesions
Change in muscle strength (weakness)
- Most common: muscle paralysis/paresis
- Based on body starting position, muscle length, muscle action performed
- Manual muscle testing not reliable with neurological deficits
- Secondary changes in joint alignment/mobility, muscle/tissue length, and tone/muscle activation → decrease in muscle strength
- Can be trunk (common) or extremities, with hypertonicity in arm or leg
- Concern: Strength imbalance (stronger flexors versus extensors)
Change in muscle tone/postural control
- Muscle tone: amount of tension in a muscle or resistance to stretching (passive)
- Postural tone: overall tension state in body musculature (body’s ability to resist gravity’s downward pull)
- Hypotonicity: lower than normal tension at rest/during movement, hard to resist the force of gravity (with weak/paralyzed muscles)
- Hypertonicity – greater than normal, increased resistance to passive movement, may be located in muscles which can be actively contracted (active stiffness, can lead to shortness)
– Spasticity: increased muscle tension in unnatural body postures, limb positions from changes in length/tension relationship
Changes in Muscle Activation (central coordination)
- Changing patterns of activation
(Wrong muscles activated, changes sequence of activation, or too many muscles activated with inappropriate force for task at hand) - Changes in motor control/brain organization/sequencing movement
Changes in sensation
Deficits
- Sensory awareness: tactile, prop, kinesthetic
(Patient’s affected side: can’t perceive/identify/ignore/neglect, feels numb/asleep (dense flaccid paresis and hyptonia))
- Sensory processing and interpretation (from involved side)
- Sensation affecting planning and movement execution (sensory knowledge of normal movement-sequencing, timing, speed, force, memorizes and recognizes when needed)
Secondary Impairments Related to Movement with Upper Motor Neuron Lesions
- Orthopedic changes
(Joint alignment/mobility) - Muscle/soft tissue length
(Tendon, skin fascia, connective tissue;
Lose length/flexibility → stiff/hard/knots in muscle belly; skin/fascia become tight and adhere to muscles, tendons, bones - Pain
(SIGNIFICANT: → makes patient do protective responses that alter posture → not use/avoid movement; Joint/muscle pain; Pain from altered sensitivity: CNS misinterprets sensory info as painful) - Edema
(Hand and/or foot or around patient ID bracelet sites; Disrupts muscular contributions to venous return, related to dependent positioning initially; Manual treatment and movement most effective) - Terms for impairments in UMN lesions:
Abnormal synergy, cocontraction, hyperreflexia, muscle contracture/hyperstiffness/overactivity/tone, myoplastic hyperstiffness, paresis, spasticity
Dynamic Systems Theory
- Use to understand patient’s motor behavior
- Behaviors from interaction of a lot of different systems → self organizing
(Control parameters shift behavior from one pattern to another
Transitions in behavior (phase shifts) - change from one preferred pattern of coordinated behavior to another) - We use preferred patterns, each person’s is unique (hence a variable recovery rate)
- Motor control parameters can be graded up/down
Recovery/Rehab after CNS Dysfunction
Client tries to compensate for the lesion to achieve functional goals.
- Systems/CNS heterarchically organized
- Functional tasks organize behavior
- Occupational performance emerges from (PxE)
Just right challenge for task/environment is CRITICAL for max rehab
- Experimenting different strategies → best solution
Assessment of Motor Control from a contemporary perspective
From a contemporary perspective
- Client/Occupation centered- role and occupational performance
- Task analysis- what performance skills/ client factors limit function
- ID which preferred movement patterns are used for different tasks
- Determine variables that cause transitions to new patterns
Assessment of Motor Control – OT Task-Oriented Approach (top-Down Approach Eval)
- Based on dynamic systems model of motor control
- Emphasize role performance (past and future), occupational performance tasks, (P- performance skills/client factors x E-performance context x O-Selection/analysis of task)
- Evals done on participation/activity level > body function/structure/impairment level
Assessment of Motor Control – Non-standardized (observational) – NDT Approach
Assess foundations for movement (important to observe!)
- Soft tissue integrity
- Alignment/biomechanics
- –Trunk (Lower, upper, head/neck), Scapula, Shoulder girdle, UE joints
Assess muscle tone
- “Placing” is important!!- “High enough to resist gravity, low enough to allow for movement”
- Observation
- Attempts voluntary movement
Assess voluntary muscle activity through observation (qualitatively)
- Observe movement patterns (typical/missing components, describe selective or non-selective)
- Control in function/occupation
- “Conditions of observation”: Temperature, weather, setting, environment/who’s around, not feeling good/sleepy, after medications, etc.
Assess functional use of UE
- No movement
- Spontaneous use
- How they use it voluntarily (to assist other extremity, stabilize)
- Performance skills: positions, reaches, manipulates, transports, lifts, grasps, etc.
Assessment of Motor Control – Standardized – Modified Ashworth Scale
- MOSTLY USED
- Measures spasticity (muscle tone/resistance to passive movement)
- Done in supine, moving the limb at “speed of gravity” because spasticity is velocity dependent
- Test done max 3x per joint (if more, confounding factor of stretch on score)
- Scale (Mathiowetz & Bass-Haugen, 2008, p.194)
0 Normal muscle tone (no increase)
1 Slight increase in muscle tone, “catch and release” or minimal resistance at end of ROM when limb moved
1+ Slight increase, “catch” followed by minimal resistance through remainder (less than half) of ROM
2 Marked increase through most of ROM, but affected parts are easily moved
3 Considerable increase in tone, passive ROM difficult
4 Rigid in flexion or extension (any motion)
Fugl-Meyer Assessment
- 2nd most used for people with CNS impairments and motor deficits
- 226 items Likert scale, ~20 minutes, no certification needed
- Evaluates motor function, balance, some sensation, joint function/pain after someone has a stroke
- Motor domain: movement, coordination and reflex action at shoulder, elbow, forearm, wrist, hand, hip, knee, and ankle
- Scale
0- can’t perform
1- perform partially
2- perform fully
Other Assessments
- MAS - Motor Assessment Scale
- AMAT- Arm Motor Ability Test
- WMFT- Wolf Motor Function Test
- For hand function/Dexterity
