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NeuroPT 1 > Problems w/ Body Structure/Function: Abnormal MM Tone and Motor Control: Exam 1 > Flashcards

Problems w/ Body Structure/Function: Abnormal MM Tone and Motor Control: Exam 1 Flashcards

1
Q

Muscle Tone

what is it?

A

Resist. offered by mm’s when passively lengthened

*like a dimmer switch that can be turned up/down

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2
Q

MM tone will be uniform _________ @ all speeds

A

resistance

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3
Q

Some ex’s of Abnormal MM tone

A
  • HypOtonia/flaccidity
    • flaccidity==comp. absence tone
  • HypERtonia
    • spasticity—-velocity dep.
    • rigidity—non-velocity dep.
  • Dystonia
  • Spasm
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4
Q

Dystonia

A

Involuntary mm contractions

force body into abnorm/painful postures

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5
Q

MM Spasm

A

sustained involuntary mm contraction

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6
Q

HypOtonia

what is going on?

A
  • LOSS of normal alpha-gamma coactivation
    • slack spindle, no proprio. input
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7
Q

HypOtonia

Pathologies:

A
  • Down’s
  • Cb damage
  • UE paralyzed after CVA
    • UE more common
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8
Q

Hypotonia

what should you examine?

A
  • Passive motion
  • Relaxed posture —- whole posture
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9
Q

Hypertonia

Spasticity

A
  • Velocity-dependent INC in resist. to PROM
    • add speed===INC resistance
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10
Q

Hypertonia

Rigidity

A
  • NON-velocity dependent INC resistance to PROM
    • stiff regardless
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11
Q

Spasticity vs. Spastic Paralysis

A

2 diff. things!!!

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12
Q

Hypertonia

what should you Examine?

A
  • passive mvmt @ varying speeds
  • consider abnorm reflexes
    • DTR’s
    • Clonus
    • Babinski
  • observe posture @ rest
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13
Q

Rigidity

Decorticate

the FLEXION one

A
  • UE Flexion
  • trunk, and LEs in EXT

***LOOK AT THE ARMS THOUGH—-THIS IS THE FLEXION ONE!!!

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14
Q

Rigidity

Decerebrate

the one w/ all the e’s…..EXTENSION ONE!!!

A
  • EXT of trunk and ALL extremities!!!
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15
Q

Rigidity

2 types

A
  • Lead pipe
    • SLOW resist. t/o ROM
  • Cog Wheel
    • catch and release t/o ROM
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16
Q

Measuring Tone

A
  • Min, Mod, Severe
    • describe specific mm groups
    • WHERE in the ROM resistance is encountered
  • Modified Ashworth

NOTE: NO SCALE FOR HYPOTONIA

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17
Q

Modified Ashworth Scale

Explain

A
  • Controlled, but rapid PROM @ ea jt thru ROM
  • Starting point:
    • limb @ rest w/ pt pos’d comfortably
  • Score:
    • 0-4/4
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18
Q

Mod. Ashworth

Grade 0

A

NO inc in mm tone

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19
Q

Mod. Ashworth Scale

Grade 1

A

SLIGHT INC. in mm tone

manifested by catch and release OR by MINIMAL RESIST. @ end range of motion when part moved

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20
Q

Modified Ashworth

Grade 1+

A

SLIGHT INC mm tone

manifested by catch, followed by MIN resist. t/o remainder (<50%) of ROM

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21
Q

Mod. Ashworth

Grade 2

A

MORE marked INC in mm tone thru MOST (>50%) of ROM

BUT affected part is easily moved

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22
Q

Mod. Ashworth

Grade 3

A

CONSIDERABLE INC’S in mm tone, passive mvmt is difficult

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23
Q

Mod. Ashworth

Grade 4

A

affected part is rigid in position

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24
Q

Hypertonia causes

Neural Mech’s

A
  • AMNs are more sensitive to input
    • ​depolarized—-closer to firing threshold
    • net INC excitatory inputs
    • net DEC inhibitory inputs
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25
Q

Hypertonia

NON-Neural Causes

A
  • altered viso-elastic props of connect. tissue from immobilization
    • ​tendons, ligs, jt cap
    • contractures
  • changes in mm fiber structure
    • ​fibrosis, atrophy
    • free Ca+ in motor fibers
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26
Q

3 other ways to measure mm tone

A
  1. functional performance
  2. self-report scale
  3. reflexes

**H-reflex—-sensitivity of AMN system

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27
Q

Flexibility is the cornerstone to…..

A

Mobility!!!!!

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28
Q

Treating abnormal tone

A
  • Consider:
    • neural and non-neural mech’s
    • systems
    • Functional relevance
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29
Q

changing tone does NOT necessarily…..

A

change function!!!

if they are functioning w/ it…..no need to “treat” it

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30
Q

In relationship to function

when would you want to test mm tone?

A

passively vs. their motor behavior DURING functional activity

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31
Q

Treating Hypertonia

pharmacologically

A
  • Baclofen—-antispasmatic
  • valium
  • botox
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32
Q

Treating Hypertonia

Sx

A

nerve cut or block

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33
Q

Treating hypertonicity

prolonged stretch

A
  • serial casting
  • air splints

*restores ROM and minimizes reflex

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34
Q

2 other ways to treat hypertonicity

A

rhythmical rotation (exactly what it sounds like)

Wt. Bearing

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35
Q

Rational for tx hypertonia

Activating the GTOs

A

Autogenic inhibition

DIRECT PRESS. to tendon of hypertonic mm

effects are temporary

allows for functional task practice

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36
Q

Spastic paralysis is related to…

A

abnormal synergy patterns

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37
Q

Abnormal synergy is the inability to what?

A

inability to isolate mm’s or mvmts

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38
Q

Abnormal synergy

A

group of mm’s working together when they shouldn’t

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39
Q

typical patterns for UE/LE synergy patterns combines what

A

Flex/Ext

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40
Q

UE Flexor Synergy

A

see pics

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41
Q

UE Flex synergy

Scapula

A

retraction

downward rotation

elevation

42
Q

UE Flexor synergy

Shoulder

A

ABD

rel. ER

EXT

43
Q

UE Flex synergy

Elbow

A

FLEX w/

pro/sup

44
Q

UE Flex synergy

Wrist

A

FLEX w/

radial/ulnar deviation

45
Q

UE Flex synergy

Fingers

A

Flexion

46
Q

UE Extensor Synergy

A

see pics

47
Q

UE EXT synergy

Scapula

A

LESS retraction

Downward rot.

Depression

48
Q

UE EXT synergy

Shoulder

A

ADD

IR

min. Flex

49
Q

UE EXT synergy

Elbow

A

EXT

Pro

50
Q

UE EXT synergy

Wrist

A

FLEX

min. Ulnar dev

51
Q

UE EXT synergy

Fingers

A

Flexion

52
Q

LE Flex synergy

A

see pics

53
Q

LE FLEX synergy

Pelvis

A

elevated

retracted

POST tilt

54
Q

LE FLEX synergy

Hip

A

flex

ABD

ER

55
Q

LE FLEX synergy

Knee

A

Flexion

56
Q

LE FLEX synergy

Ankle

A

DF

inversion

57
Q

LE EXT synergy

A

see pics

***EXT synergy more common in LE

58
Q

LE EXT synergy

Pelvis

A

elevated

retracted

ANT. tilt

59
Q

LE EXT synergy

Hip

A

rel. EXT

ADD

IR

60
Q

LE EXT synergy

Knee

A

EXT

61
Q

LE EXT synergy

Ankle

A

PF

Inversion

62
Q

Typical Arm Posture w/ Abnorm Synergy

A
  • Shouder ADD.
    • EXT pattern
  • Elbow FLEX
    • FLEX pattern
  • Forearm PRO
    • EXT pattern
  • Wrist FLEX
    • ​FLEX pattern
63
Q

Typical Leg posture abnorm synergy

A
  • Hip FLEX and ADD.
  • Knee EXT
  • Ankle PF
64
Q

Stages of Recovery from Spastic Paralysis

Brunnstrom and Bobath

A
  • Brunnstrom—more detailed
    • 7 stages from flaccid thru full recovery
  • Bobath
    • 3 stages
65
Q

Brunnstroms Stages 1 and 2 correlate to…

A

Bobath stage 1:

Initial Flaccid Stage

66
Q

Brunnstrom’s Stages 3 and 4 correlate to…

A

Bobath’s stage 2

Stage of Spasticity

67
Q

Brunnstrom’s stages 5 and 6 correlate to….

A

Bobath’s stage 3

Stage of Relative Recovery

68
Q

Stages of Recovery

Brunnstrom and Bobath correlations

A

see pics

69
Q

Brunnstrom’s Stage I

A

Flaccidity of involved limbs

NO reflex or voluntary mvmt

70
Q

Brunnstrom’s Stage II

A
  • MIN voluntary mvmt or associated rxns
    • ​contraction somewhere else causes contraction where we’re looking
    • ex. yawn and it kicks off contraction
  • mvmts in partial or whole synergy patterns
  • Spasticity BEGINS to develop
71
Q

Brunnstrom’s Stage III

A
  • Voluntary control of mvmt synergies
  • mvmt may NOT be thru full ROM
  • spasticity reaches peak
    • ​Hypertonia @ this point
    • ​may be severe

NOTE: not everyone starts in stage I

72
Q

Brunnstrom’s Stage IV

A
  • SOME mvmts out of synergy
  • spasticity declining, but observable
    • Ind. can now
      • place hand behind body
      • flex arm to horiz. pos.
      • pro/sup wrist w/ elbow @ 90deg
73
Q

Brunnstrom’s Stage V

A
  • DECLINING spasticity
  • able to perform more diff. mvmts OUT of spasticity
    • ​indiv. can now:
      • ​arm raise to side (ABD)
      • arm raise forward (flex) overhead
      • PRO/SUP w/ elbow extended
74
Q

Brunnstrom’s Stage VI

A
  • Individual, isolated mvmts
    • ​indiv can: isolating elbow===huge progress
      • hand from lap to chin
      • hand from lap to opp knee
  • NEARLY norm.
  • NO SPASTICITY
75
Q

Brunnstrom’s Stage VII

A

Normal motor function

76
Q

Brunnstrom’s Method

A

Neurophys. tx based on the use of reflexes to elicit mvmt; stereotyped whole-limb mvmt patterns are facilitated

***encouraged abnorm mvmts bc “mvmt is mvmt”

77
Q

Brunnstrom’s Method

Theory

A
  • synergies due to absence of control from above
  • Hemiplegia is a reversion back to earlier phylogenic pd
  • return of abnorm reflexes====Normal
  • seq. of recovery similar to development
  • abnorm synergies can be used early in recovery to facilitate mvmt
78
Q

Associated Rxns

A

eliciting of involuntary mvmt w/ resisted voluntary mvmt of some other part of body

79
Q

How can we use Associated Rxns?

A
  • Facilitate tone in hypotonic mm
  • Inhibit tone in hypertonic mm
80
Q

Using Assoc’d Rxns to facilitate/inhibit tone

Sag. plane UE

SAME RELATIONSHIP

A
  • Resist Flex uninvolved —-> get Flex involved
  • Resist EXT uninvolved—-> get EXT involved
81
Q

Using Assoc’d Rxns to facilitate/inhibit tone

Sag Plane LE

Relationship is RECIPROCAL

A
  • Resist FLEX uninvolved—–> get EXT involved
  • Resist EXT uninvolved—-> get FLEX involved
82
Q

Assoc’d Rxns to facilitate/inhibit tone

Frontal Plane UE

Relationship is SAME

Ramiste’s-like phenomenon

A
  • Resist shoulder ABD uninvolved—> get shoulder ABD involved
  • Resist ADD uninvolved—-> get ADD involved
83
Q

Assoc’d Rxns to facilitate/inhibit tone

Frontal Plane LE

Relationship is SAME

Ramiste’s Phenomenon

A
  • Resist hip ABD uninvoled—-> get ABD involved
  • resisted ABD—-> opp. side ABD
84
Q

2 Abnormal reflexes that will Facilitate/Inhibit Tone

A
  1. Asymmetrical Tonic Neck Reflex (the bow and arrow baby)
  2. Symmetrical Tonic Neck Reflex (when baby crawls on all 4 holds neck in EXT)
85
Q

ATNR

Rotation of the Neck facilitates…..

A
  • EXT of “Chin Side” limbs
  • FLEX of “Back of Skull Side” limbs

**Eventually disappears

86
Q

STNR

EXT. of neck facilitates….

A
  • UE EXT & LE FLEX
87
Q

STNR

FLEX of the neck facilitates….

A
  • UE FLEX and LE EXT
88
Q

NDT Theory or…

A

Neurodevelopment Theory

89
Q

NDT Theory in a nutshell….

A

Normalize posture/tone

THEN integrate mvmt

90
Q

W/ NDT

Abnormal mvmt is the result of what?

A

failure to integrate primitive reflexes

91
Q

According to NDT theory….

Normal mvmt CANNOT be superimposed on __________

what must you do?

A

abnormal posture/tone

*Inhibit abnorm mvmt, THEN facilitate normal mvmt

92
Q

According to NDT Theory

How is Movement improved? Through what?

A

Thru inhibition or modification of impairments of spasticity and abnorm reflex patterns

93
Q

According to NDT….

what is motor output controlled by??

A

SENSORY INPUT!!!

94
Q

3 Pos’s of developmental principles:

A
  1. cepahlo-caudal
  2. proximal-distal
  3. symmetrical-asymmetrical
95
Q

Developmental principles

Wt. Shift

A
  1. Sagittal
  2. Frontal
  3. Horizontal
96
Q

Tx Principles of NDT

Handling

A
  • “key points of control”
  • Reflex Inhibiting Patterns (RIPs)
    • inhibit abnorm tone/mvmt
  • Facilitation
    • ​encourages norm. mvmt
97
Q

Tx Principles of NDT

If hypertonia is DEC…. then what can happen?

A

“Weak” mm’s can contract

98
Q

NDT Tx Principles

Abnorm postural rxns vs. normal postural rxns

A
  • Abnorm postural rxns should be CHANGED
  • Normal postural rxns should be FACILITATED
99
Q

4 Steps to NDT Tx

A
    1. Prep pt to move—- have to get them out of tone
      * RIPs
      * sensory stimulation to normalize tone
    1. MOVE pt—you move them passively
    1. Pt ACTIVELY MOVES w/ PT’s control
    1. Pt moves W/OUT ASSIST or control
100
Q

What are the 2 MAIN problems in NDT?

A
    1. Abnormal control of movement
    1. Abnormal tone of postural mm’s
101
Q

NDT Summary:

Aim of Tx

A
  • DEC spasticity
  • Facilitate normal mvmt

*NOTE: This is only a temporary reduction

NOTE: Permanent DEC in spasticity only achieved when pt able to perform selective mvmts.

102
Q
A

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