Primary Impairments - Lecture 11 Flashcards
motor recovery is initially
flaccid
motor recovery: there is a development of
spasticity
hyperreflexia
mass patterns of movement
as recovery continues –> motor recovery
spasticity and synergies decline
advanced motor patterns are possible
Brunnstrom Stages of recovery
6 stages
stage 1
flaccidity
no mvt
stage 2
minimal voluntary mvt
associated rxns
spasticity begins to develop
stage 3
voluntary control of mvt synergies
spasticity peaks in severity
stage 4
mastery of some mvt synergies
spasticity peaks in severity
stage 5
difficult mvt combos are learned
synergies lose their dominance
stage 6
spasticity disappears
isolated joint movement and coordination achieved
flexion synergy components UE strongest component
elbow flexion
strongest component of flexion synergy components LE
hip flexion
strongest component of extension synergy components
shoulder ADD
forearm pronation
strongest component of extension synergy component
hip ADD
knee extension
why do we experience paresis
decrease # of fxning agonist motor units
recruitment order may be altered
decreased firing rates
denervation changes in corticospinal tract
why do we experience paresis (2)
atrophy of mm fibers
contraction time increases with increased fatigability
inappropriate co-contract of mm
mechanical changes in soft tissue
incoordination is the result of
cerebellar or BG involvement
proprioceptive losses
motor weakness
ataxia (esp w/ cerebellar disorders)
impaired stretch reflex response)
impaired stretch reflex response
normally allows automatic adaptation of mm to postural movement changes
aphasia
brocas
wernikes
global
conduction
dysarthria
impairment of speech production secondary to damage to the CNS or PNS
what does dysarthria cause
oral motor weakness, paralysis or incoordination of the motor speech system
what does dysarthria affect
respiration
phonation
articulation
resonance
dysarthria has deficits in
swallowing
dysarthria has lesions affecting
CN 9 & 10
CN lesions cause
delayed triggering of swallow reflex
decreased pharyngeal peristalsis
decreased lingual control
cognitive/behavioral deficits
in orientation
attention
processing speed
conceptual abilities
executive fxn
memory
cognitive/behavioral deficits cause
emotional liability
(R) CVA
(L) CVA
generalizations
emotional liability
unstable or changeable emotional state
emotional liability is characterized by
pathological rapid change from laughing to weeping w/ only slight provocation
(R) cva
difficulty grasping the whole idea or the overall organization of a pattern or activity
what is R cva described as
indifferent, quick, impulsive, euphoric
pt overestimates their ability while minimizing the problem
R CVA major issue
safety
L cva
difficulty with processing ingo in sequential/linear manner
L cva described as
slower, negative, cautious, uncertain, depressed, anxious
generalizations
does not apply to everyone
Visual perception disorders
body scheme/body image disorders
spatial relation syndrome
agnosias
apraxia
body scheme/body image disorders
somatagnosia
unilateral neglect
right-left discrimination
finger agnosia
anosognosia
somatagnosia
lack of awareness of the body structure and the relationship of body parts in oneself or others
somatagnosia –> difficulties
performing transfers
following direction
somatognosia lesion
dominant parietal lobe or posterior temporal lobe
unilateral neglect
spatial neglect
inability to register and to integrate stimuli and perceptions from one side of the body and the environment
unilateral neglect types
personal
peri personal
extrapersonal
where does unilateral neglect typically affect
left side of the body
sensory loss compounds the problem
unilateral neglect lesion
non-dominant parieto-occipital area
right left discrimmination
inability to identify R or L side of one’s own body or the examiner
RL discrimmination lesion
parietal lobe or either hemisphere
finger agnosia
inability to identify the fibers of one’s own hand
correlates highly with poor dexterity
finger agnosia lesion
parietal lobe of either hemisphere
anosognosia
severe condition including denial, neglect and lack of awareness of the presence or severity of one’s paralysis
anosognosia lesion
non-dominant parietal lobe
spatial relation deficits
figure - ground discrimination
form consistency
spatial relations
position in space
spatial memory
topographical disorientation
depth and distance perception
vertical disorientation
figure ground discrimmination
inability to visually distinguish a figure from the background
lesion: non-dominant parietal lobe
form consistency
inability to perceive or to attend to subtle differences in form and shape
lesion: non-dominant parieto-temporo-occipital region
spatial relations
inability to perceive the relationship of one object in space to another object or to oneself
difficulty crossing midline
spatial relations lesion
non-dominant parietal lobe
position in space
inability to perceive and to interpret spatial concepts
such as up, down, under, over, in, out, etc
position in space lesion
non-dominant parietal lobe
spatial memory deficit
impaired memory of location of objects/places
spatial memory lesion
non-dominant parietal lobe
topographical disorientation
difficulty in understanding and remembering the relationship of one location to another
unable to trace path/route
topographical disorientation lesion
non-dominant occipitoparietal lobe
depth and distance perception
inaccurate judgement of direction, distance and depth
lesion: non dominant occipital lobe
vertical disorientation
distorted perception of what is vertical
causes imbalance and distorted midline orientation
vertical disorientation lesion
non-dominant parietal lobe
agnosia
inability to recognize familiar objects using one or more sensory modalities
while often retaining the ability to recognize the same object using other sensory modalities
types of agnosia
visual
auditory
tactile
visial
visual object agnosia
simultanagnosia
propagnosia
color agnosia
visual object agnosia
inability to recognize and name common objects
simultanagnosia
inability to perceive the whole or the “big picture”
only sees 1 element of an object at a time
decreases visual span –> tubular vision
prosopagnosia
facial agnosia
inability to recognize familiar faces
color agnosia
difficulty recognizing names of colors
motor praxis
ability to plan and execute coordinated movements
apraxia
disorder of voluntary learned movement
inability to perform purposeful movements
where is apraxia seen
L hemisphere lesions more than R
often accompanied by aphasia
lesion –> apraxia
premotor frontal cortex of either hemisphere
left inferior parietal lobe
corpus callosum
types of apraxia
ideomotor
ideational
ideomotor
breakdown b/w concept and performance
movement is not possible upon command by occurs automatically
oral apraxia
subtype of ideomotor apraxia
buccofacial ms cannot produce purposeful movement
ideational
failure in conceptualization of the task
purposeful movement is not possible
either automatic or on command
apraxia like syndromes
not true apraxias
more associated with R hemisphere lesions
like syndromes
constructional apraxia
dressing apraxia
constructional apraxia
difficulty in recognizing parts to a whole
secondary faulty spatial analysis and conceptualization of the task
dressing apraxia
inability to dress oneself properly owing to a disorder in body scheme or spatial relations
