Primary Sensorimotor Impairments after Stroke (Week 2)

Question 1

What are the positive primary impairments following a stroke?

Answer 1

• spasticity
• increased tone
• dystonias

Question 2

What are the negative primary impairments following a stroke?

Answer 2

• loss of strength - inability to produce force
• loss of coordination - loss of coordination of muscle activity to meet environmental demands
• loss of sensation - loss of tactile sensation, loss of proprioception

Question 3

What does positive primary impairment mean?

Answer 3

additional features

Question 4

What does negative primary impairment mean?

Answer 4

loss of pre-existing function

Question 5

Which impairments have the greatest impact on activity after stroke?

Answer 5

• negative impairments make the greatest contribution to activity limitations
• of the negative impairments, loss of strength has the largest and most consistent relationships with activity limitations

Question 6

Order the impairments in order of greatest impact: spasticity, loss of sensation, loss of coordination, loss of strength

Answer 6

1. loss of strength
2. loss of coordination
3. loss of sensation
4. spasticity

Question 7

What are the characteristics of spasticity?

Answer 7

• velocity dependent increase in the stretch reflex (hyperexcitability of the stretch reflex)
• where present - tends to be mild
• can include clonus
• appears to be adaptive i.e. probably worse when less active rehab

Question 8

What is the difference between tone and spasticity?

Answer 8

• tone is the resistance to passive movement
• tone and spasticity are often used interchangeably but tone can be due to spasticity, contracture, or excessive muscle activity/co-contraction
• tone is not a useful word clinically as it does not define the impairment

Question 9

What is the difference between the Ashworth scale vs Tardieu scale?

Answer 9

Ashworth scale:

• measures “tone” - resistance to passive movement
• grades 0-4 represent “no increase in tone” to “limb rigid in flexion or extension”

Tardieu scale:

• measures velocity dependent resistance to passive movement
• limb moved at 3 speeds: V1, V2, V3
• quality of muscle reaction is graded
• grades 0-4 represent - “no resistance” to “unfatiguable clonus”