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E&M > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Examination

A

History

Systems review

Tests and measures

  • From history and systems review - determine needs and generate diagnostic hypotheses
  • Use to establish diagnosis, prognosis, plan of care and select interventions
  • Selection of specific tests and measures and depth of evaluation varies according to multiple factors

Age, severity of problem, stage of recovery, phase of rehab, home/community/work, and other factors - need to consider

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2
Q

Evaluation

A

Clinical judgement

Establish diagnosis, prognosis, plan of care

Diagnosis - organize ada into defined clusters, syndromes, categories

Prognosis - level of optimal improvement and time involved

Plan of care along w/ anticipated goals and expected outcomes, specific interventions, and proposed duration and frequency of interactions (in collab w/ clients and families)

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3
Q

Re-Examination

A

To modify or redirect interventions prompted by new clinical findings or failure to respond to PT interventions (referral back to physician)

Outcomes = impact on patient

  • Disablement categories
  • Risk reduction/prevention
  • Wellness & fitness
  • Societal resources
  • Satisfaction
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4
Q

Why Examination?

A

Baseline info

Progression w/ disease or interventions

Placement decisions (rehab vs. long-term care)

Safety

Evidence of treatment effectiveness

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5
Q

Clinical Utility (Why Clinicians Choose Certain Tools)

A

Time to administer (concise vs testing everything; gross measures/screening)

Costs

Patient/client factors (diagnosis, tolerance - can they handle how long the test it?)

Sensitive to change - ability to measure change

Responsiveness -ability to measure meaningful clinical change (floor vs. ceiling effect - everyone is either at the top or bottom of test scale)

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6
Q

How to Select Examination Tools - Reliability

A

Consistency

Test-retest (stability of measure - admits once and retest them - should stay the same)

Intrarater - same therapist different times

Interrater - multiple therapists

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7
Q

How to Select Examination Tools - Validity

A

Accuracy

Face validity - does it look like what it’s going to measure (goniometry measures joint position)

Content validity - does it actually measure what it’s going to measure (VAS measures pain at rest or in motion, but does not assess factors that aggravate pain)

Construct validity - look at how’s tool built (not really concerned with this)

Concurrent ability - what’s been used in clinic compared to gold standard

Predictive validity

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8
Q

Predicative Validity

A

Predicts likelihood of return to function

Sensitivity - correct referrals/total abnormal x 100 = percentage of abnormal cases identified (how many people have condition)

Specificity - correct referrals/total normal x 100 = percentage at normal cases classified normal (how many people are normal and don’t have condition)

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9
Q

False Negative

A

Under referral

Tested negative, but have disease

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10
Q

False Positive

A

Over referral

Test positive, but don’t have disease

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11
Q

True Negative

A

Tested negative and don’t have disease

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12
Q

True Positive

A

Tested positive and have disease

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13
Q

Ability to Detect True Change

A

MDC (minimal detectable change) - statistical calculation - smallest amt of chance needed to exceed measurement variability

MCID (minimally clinical important difference)

  • Clinically/patient meaningful change
  • Usually compared to therapist or patient opinion of meaningful change or compared to gold/established standard measure
  • Can depend on initial scores
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14
Q

Types of Instruments - Performance

A

Patient asked to perform tasks

Current level or ID max level

Do not measure real patient’s environment

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15
Q

Types of Instruments - Self-Assessment

A

Can be administered by therapist

Habitual performance (have you done it before and do it all the time) or perceived capacity (think you can do it)

May have time frame (how many times did you do this in last 24 hours)

May not have accurate reporting (lying, can’t read)

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16
Q

Degrees of Measurement - Nominal

A

Opposites - able to do vs. not able

Indep. vs. not indep.

Con - doesn’t provide enough info

Ex: can you stand up or no?

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17
Q

Degrees of Measurement - Ordinal

A

Degree to which person can perform

Rank order scale

  • No difficulty/some difficulty/unable to do
  • Min/mod/max assist

Con - not equal separation b/w categories

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18
Q

Summary Additive Con

A

Two patients w/ same score may be very different

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19
Q

Why Assess Function (Activity and Participation)

A

Patient’s key concern (as opposed to impairment level changes)

Collect consistent data

Provide baseline data

Determine other examinations (impairments such as ROM and strength)

Evaluate efficacy of rehab interventions

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20
Q

Capability vs. Performance

A

Can you vs. do you

Capability - 20% higher than performance

Depends on external environment and internal characteristics of individual

  • Time constraints - may take them long time to do it and whip out their energy
  • Energy demands - ADs to be used to save energy for other activities
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21
Q

Range of Motion

A

Measures - goniometry, tape measure

Functional tasks - getting up from floor, picking up a coin from floor, put on a coat, STS from low chair, place object overhead

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22
Q

Strength

A

Measures - MMT, one rep max, hand-held dynamometry, isokinetic dynamometry

Functional Tasks - picking up coin from floor, getting up from floor, lift weighted object, up/down 1-4 flights of stairs, chair rises

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23
Q

Balance

A

Measures - Tinetti, Berg, functional reach, Romberg/sharpened Romberg (EO/EC)

Functional tasks - obstacle course, picking coin up from floor, standing activities, turning 360, gait (change speed and direction)

Any time hands are in guard position - balance issue

Quick turns are when people fall

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24
Q

Cardiovascular Function

A

Measures - HR, BP, perceived exertion

Functional tasks - seated step test, 6 minute walk test, up/down 1-4 flights over stars, chair rises (x5 - timed chair rises, x10 timed stand rises)

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25
Q

Interrelationship between impairment and activity/function

A

Impairments doesn’t predict functions

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26
Q

Fugl-Meyer

A

Majority is impairment based

Performance based test

Approx. 30 minutes (can pick components)

Patients post stroke

Score: summary, UE, LE - 3 levels of grading (0,1,2)

Areas of assessment - UE/LE - joint range, joint pain, sensation (light touch, proprioception), DTRs, mvts in/out of synergy, grasp, coordination (tremor, dysmetria), sitting/standing balance

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27
Q

Dysmetria

A

Body can’t figure out distance needed to touch another part

Inaccurate aim

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28
Q

Berg Balance Scale

A

Balance - looks at risk of falling

Performance based

Approx. 15-20 minutes

5 levels of measurement

Higher score = better performance

Cutoff score < 45 - predictive of recurrent or future falls

Areas of assessment - STS, pivot transfers, changing BOS (feet together, tandem, one foot, place alternate foot on stool), reaching, bending, changing head position (looking behind you), eyes closed, turn 360

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29
Q

Resting Tremor vs. Intention Tremor

A

Resting tremor - tremors appear while resting, but disappear when moving

Intention tremor - start to move, tremor moves

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30
Q

Tinetti-POMA

A

Balance - performance-based - looks at risk of falling

Areas of assessment:

  • Balance: sitting/standing balance, STS x3, turn 360, one foot stance, tandem stance, reaching, and bending
  • Gait: initiation, path, balance, turning, timed walk, obstacle clearance

<19 - high risk for falls
19-24 - moderate risk

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31
Q

Functional Reach

A

Balance - performance based test

5 mins

> 15.2 but <25.4 cm - 2x as likely to fall

<15.2 cm - 4x more likely to fall

As you age, discrepancies b/w males and females increase

Looks at risk of falls

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32
Q

Multidirectional Reach Test

A

Balance - performance based test

Adds sideways and backward reaches

Fear of falling contributes to ability to reach backwards

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33
Q

Sit and Reach

A

Balance - performance based test

Patients w/ acute stroke - able to sit

1 min, raise intact arm to 90 degrees

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34
Q

TUG (Timed Up and Go)

A

Performance based - look at dependence

Stand up, walk 3 meters, cross a line, turn around, walk back, sit down

As quickly and as safe as possible

<20 seconds - independent in ADLs, community ambulation speed

> 30 seconds - increased dependence, need Ads, none could go out alone

Reliable for patients w/ PD

Time is dep. on pt’s ability

Use TUG to estimate Berg

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35
Q

Modifications to TUG

A

Cognitive - subtraction task (counting backwards by 3s)

Manual - holding almost full glass of water

Decrease in time to TUG alone

  • Looks at ability to do two things at once
  • Normal to have some decrements in both tasks

Huge time differences - higher risk of falls

Walk and talk test - have to stop and talk - higher risk for falls

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36
Q

BEST (Balance Evaluation Systems Test) Test

A

Full test - 27 items

Mini-BEST - 14 items (eliminated less reliable items)

Brief-BEST - 8 items (1 to 2 items in category)

Categories - biomechanical constraints, stability limits (functional reach), transitions (anticipatory postural adjustment - stand on one leg), reactive postural control (compensatory stepping), sensory orientation (modified foam and dome), dynamic gait/stability in gait = TUG

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37
Q

Short Physical Performance Battery

A

Screening test - performance based

Several components - chair rises 5x scored according to time, standing balance 3 foot positions (semi-tandem, side by side, tandem), walk 8 feet scored according to gait speed

Perfect score = 12

Low scores (4-6) - 4x more likely to have disability 4 years later

Mid-range scores (7-9) - 2x more likely

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38
Q

Physical Performance Test

A

ADLs, balance, gait speed

Task performance - performance-based

Approx. 10 minutes

9 or 7 items dependent on ability to use stairs

Time performance - scored according time to perform task except turning 360 degrees and no of flights of stairs

Quicker time = higher scores = better performance

Areas of assessment - writing, stimulated eating, putting book on shelf, putting jacket on, picking object from floor, 360 degrees turn, 50 m walk, stairs

Very reliable

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39
Q

Timed Movement Battery

A

Performance-based - screening test

Approx. 15-20 minutes

Two speeds - self-selected and as fast as possible

Quicker time = better score/performance

11 movement skills - supine to sit, STS, ambulation (6m towards, 3m backwards, walking and stepping over low (2 in) and high (6 in), obstacle, figure 8 walk, stairs, rising from floor

Can modify for pts

Rising from the floor - depicts fear of falling if they can’t get up

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40
Q

FIM (WeeFim for Children)

A

ADLs

Task performance tool - performance-based

7 levels of measurement w/ grades for device use (6) and supervision (5)

Higher scores = increased independence

Areas of assessment - feeding, dressing, bathroom skills, grooming, transfers, locomotion (ambulation/WC), stairs, communication, cognition

Heavily used in rehab

Score at admissions - predict where they wind up

Devices - different scores

WeeFim - children

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41
Q

Barthel Index

A

ADLs

Self report (5 mins) or observational tool (20 mins)

3 measurement levels (dependent = 0/assistance = 5/independent = 10)

Higher score = increased independence (100 = independent, 20-45 severe disability)

Areas of assessment - feeding, dressing, grooming, bathroom skills, transfers, ambulation, stairs

42
Q

Katz Index of ADL

A

Observation/self-report

3 levels of measurement - indep w/o supervision, assist w/ more difficult components, assist or dep

Grading by letters (B = indeed in all but one area, C = indep except for bathing and one other area)

Areas of assessment - bathing, dressing, toileting, transfers (bed, chair), continence, feeding

NO AMBULATION ITEMS (bed mobility, transfers)

43
Q

Rivermead ADL Scale

A

ADLs and IADLs

Task performance - performance based

30-60 minutes

3 levels of measurement (1 = indepen, 0v = requires verbal assistance, 0 = dep)

Higher score = increased independence

Areas of assessment

  • Self care - grooming, bathroom skills, eating, dressing, mobility, transfers
  • Household - money skills, meal prep, housecleaning, shopping, use of public transportation

Can be assisted

44
Q

Wheelchair Skills Test

A

Performance based

Mean time to administer - 29 minutes

2 areas scored for each item - skills/safety and pass/fail or not tested (if easier skill was failed)

Forms for manual and power w/c (users and caregiver versions)

Skills such as driving, turning, transfers and curbs

45
Q

SIP 68 (Sickness Impact Profile)

A

ADLs and IADLs

Measure of perceived function

Report or interview view

5-10 minutes

Add up number of checked items for each sub scale and for total scale (higher# = higher # of problems)

Areas of assessment

  • Somatic autonomy (walking, dressing, stairs, bathroom use)
  • Mobility control (stairs, inclines, distance walking, handiwork)
  • Psychic autonomy and communication (concentration, thinking, decisions, speech)
  • Social behavior
  • Emotional stability
  • Mobility range (into town, shopping, housework, business affairs)
46
Q

SF-36

A

Self assessment or interview

About 10 minutes

Yes/no or 3 levels of measurement

Complex scoring (computer)

Lower scores represent poorer health

More for healthy community dwelling patients

Areas of assessment - physical functioning, physical role, social function, emotional role, mental health, energy/fatigue, bodily pain, general health perceptions

47
Q

OASIS (Outcome and Assessment Info Set)

A

Mostly ADLs

Self assessment (takes longer, but get more info)

3 to 6 levels of measurement dependent on functional task

Higher scores for increasing dependence

Asks for prior and current level of functioning (what you could do before and what you do now)

  • Big gap - can’t get back to PFS
  • Small gap - can get back to PFS

Areas of assessment - bathroom skills, dressing, transfers, locomotion, feeding, housekeeping, transportation, telephone use

Recommended

48
Q

FSQ

A

ADLs, IADLs

Self report - about 15 mins (scored by computer - produces warning zone)

Areas of assessment - physical function (BADL and intermediate ADLs - housework, errands, driving, sports), psychological function, work performance, social activity, quality of interaction, health satisfaction

Has work skills - capability to do work

49
Q

FES (Falls Efficacy Scale)/Modified FES

A

Self report or interview

10 point scale (0 not at all confident to 10 completely confident)

Areas of assessment - 10 ADL skill in original version (cleaning, dressing, simple meals, bathing, simple shopping, in/out of chairs, walking in neighborhood, reaching into cabinets, hurrying to answer phone)

Modified version added using public transportation, crossing roads, light gardening/hanging laundry, using outside house steps

Ask men how afraid they are - won’t tell you anything
-How confident is better question to ask

50
Q

SAFE (Survey of Activities and Fear of Falling in Elderly)

A

Self report or interview

11 activities ADLs and IADLs

4 levels - not worried to very worried

Asks if it is not due to fear or falling, why do you avoid activity

Have you reduced level of activity in past years

Areas of assessment - going out when slippery, visiting friends/relatives, go into places w/ crowds, walk several blocks, bend down to get something

Men won’t admit they’re worried

51
Q

ABC (Activities-Specific Balance Confidence Scale)

A

Self report (5-10 mins)

Rated 0-100% confidence

Higher numbers increased confidence (less likely to need assistance to go out, more community activities)

Areas of assessment - reaching (eye level, over head, on tiptoes, standing on chair), picking up objects, ambulation (inside, outside, ramps, escalator, crowded mall, on ice), transfers (car)/stairs

Suitable for elderly who do activity outside home

Wider used to tool

How confident are you doing things

Ordered from easiest thing to do to hardest (confidence should go down)

52
Q

Fear of Falling Avoidance Behavior Questionnaire

A

Self report - less than 3 mins to complete

5 levels of measurement (0-5)

Higher scores = increased activity avoidance

Areas of assessment - walking on level and uneven surfaces, carrying objects, stairs, transfers, leaving home, bathing, some IADLs, work, leisure

What are you avoiding and how much you are avoiding it

53
Q

Combo of Self Report and Performance Based Measures

A

Patients w/ PD

Self report - ABC, FES

Performance - BERG, FRT, TUG, DGI

Two tests vs. three - best sensitivity/specificity w/ 3 tests w/ one being self report measure

54
Q

Components of a Neurological Exam

A

Neurological history

Cognition

Communication

Cranial nerves

Muscle tone

Reflexes

Mental status (orientation/know where they are at)

Sensation

Perception

Strength

Mvt patterns

Balance

Coordination

Gait/locomotion

Functional abilities

Include concussions

55
Q

Neurological History

A

Disturbance of consciousness

Nausea, vomiting (projectile - immediate ER - brain pressure)

Paresthesias - disturbances in sensation

Seizures (daydream all day and no sign when waving hand in front of them)

Headaches

Altered Vision (double vision - impending stroke)

Tinnitus (ringing in ears)

Vertigo, dizziness

Weakness, stiffness

Disturbances in B&B

Speech disorders

Incoordination

56
Q

Cognition

A

Memory, judgement, attention span

57
Q

Communication

A

Articulation deficits

Receptive language disorders - can’t understand

Expressive language disorders - can’t express what’s wrong/hurts

58
Q

Mental Status

A

Orientation (to familiar or current environment)

Attention and state of consciousness

MiniMental State Exam (MMSE)

  • <24 - cognitive impairment
  • <20 - dementia/affective disorder

Mini-Cog (repeast 3 items, clock drawing, recall 3 items)

59
Q

MoCA - Montreal Cognitive Assessment

A

10 minutes - screening test for mild cognitive impairment (MCI)

Max score - 30 - add 1 point for individual who has < 12 yrs of formal ed

26 and above considered normal

7 components - attention/concentration, executive function, language visuo-constructional skills, conceptual thinking, calculations, orientation

60
Q

Sensory Testing

A

Provide baseline

Determine need to instruct patient in compensatory techniques

Assures pt safety and prevention of secondary complications - loss of sensation in pts w/ diabetes

Directed by recommended interventions - some modalities contraindicated w/ sensory loss

61
Q

Assessment of Sensation - Protective

A

Pain via sharp/dull

Light touch

Deep pressure

Temp

Monofilaments

Loss of this group - injure body

62
Q

Assessment of Sensation - Deep (Discriminative Sensation)

A

Vibration

Kinesthesia (jt is moving)

Proprioception (jt is static)

First sensations that are lost

63
Q

Assessment of Sensation - Cortical (Discriminative Sensation)

A

Tactile Localization

Stereognosis

2 pt discrimination

Double simultaneous touch

Barognosis

Graphesthesia

Texture - perceive how it looks and then determine how hard/soft to drip something

64
Q

Assessment of Sensation - Tinel’s Sign

A

Test for regrowth of peripheral nerve

New nerve - unmyelinated - painful

65
Q

Assessment of Sensation - Functional Test

A

Modified Moberg’s Pick Up Test

Pick something up and move

Sensation loss - time increases for person

May need to pinch harder

66
Q

Types of Neurological Lesions - Peripheral Nerve

A

Usually unilateral

Loss of all type of sensation in distribution of affected nerve

Sensory goes first, then motor

67
Q

Types of Neurological Lesions - Nerve Root

A

Loss of all types of sensation in dermatome of affected nerve root (anything in pathway)

Usually unilateral

68
Q

Types of Neurological Lesions - Spinal Cord

A

Loss of sensation is dependent on extent and area of spinal cord damage

Everything below damaged disc is gone

69
Q

Types of Neurological Lesions - Diabetic Peripheral Neuropathy

A

Bilateral loss

Early in process, loss of vibration/temp

Prolonged disease, loss of protective sensation

70
Q

Types of Neurological Lesions - Anterior Cord Syndrome

A

Anterior aspect is affected

Motor paralysis

Loss of pain/temp

71
Q

Types of Neurological Lesions - Posterior Cord Syndrome

A

Loss of proprioception and light touch

Motor still in tact

72
Q

Types of Neurological Lesions - Brain Stem

A

Sensory loss in contralateral side of body, except cranial nerve deficits, which occur on ipsilateral side

73
Q

Types of Neurological Lesions - Cerebral Cortex

A

Sensory loss in contralateral side of body

Including ability to localize stimulation site (atopognosia)

Parietal lobe: loss of discriminative sensation (stereo, graph, sensory attention)

Loss of higher level sensation

Sensory attention - don’t really have sense for other side of body

74
Q

Denervation

A

Loss of sensibility

Overlapping areas w/ decreased sensation

Recovery

  • 1-2 mm per day
  • Pain w/ pinch
  • Tenderness to pressure and pinprick
  • Light touch and discrimination
  • Poorly localized (know someone is touching body part, but don’t know where)&raquo_space; accurate localization (as receptors grow in, becomes accurate localization)
  • Hypersensitivity - uncomfortable, but normal (need to tell pt it’s okay)
75
Q

Compression

A

Sensory fibers are more susceptible than motor

Diminished vibratory perception precedes intermittent numbness and paresthesia

In more advances cases, symptoms are more constant and include sensibility test findings

In chronic cases, motor abnormalities occur

Small areas go first

Continous compression - starts to affect motor

76
Q

Recovery from Compression

A

Dependent on severity

Mild - spontaneous recovery if compression is removed

Moderate-severe - surgical intervention

  • Immediate, full recovery
  • Gradual, full recovery
  • Partial recovery
77
Q

General Principles of Testing

A

Pt positioned comfortably w/ all areas to be tested exposed and accessible (if pt will have problems w/ balance when eyes closed, place pt is fully supported position - i.e. supine)

Procedure should be explained to pt BEFORE beginning exam

Establish area of normal sensation to use for comparison

Vision obscured during testing

Exam proceeds distal to proximal along sensory distribution

78
Q

Variables in Sensory Testing

A

Testing environment - conditions around

Pt anxiety, distractibility, cognition, fatigue, etc

Callused vs. non-callused skin

Instrumented related variables (temp of tubes, filaments)

Method related variables (different equip b/w sessions)

79
Q

Documentation

A

Status of sensation - intact, impaired, absent

Type of sensation

Location of testing

Sensory mapping

Not okay to say only “sensation is impaired”

80
Q

Evaluation

A

Exam results are analyzed for pattern

Pattern should be interpreted to determine one or more possibilities for location of lesion

Other symptoms of NS pathology must be considered

Clarification of location of lesion should occur (medical tests)

81
Q

Clinical Test for Sensory Interaction for Balance (CTSIB) or Foam and Dome

A

Visual, somatosensory (proprioception and kinesthesia), vestibular system

Tests for redundancy - which part of balance system is off

6 conditions under different sensory inputs:

  • 1: eyes open, stable surface (normal)
  • 2: eyes closed, stable surface (vision is absent)
  • 3: visual conflict w/ moving surround/dome, stable surface (eyes are inaccurate)
  • 4: eyes open, moving surface/foam (vestibular in tact)
  • 5: eyes closed, moving surface/foam (vestibular in tact)
  • 6: visual conflict w/ moving surround/dome, moving surface/foam (inaccurate vision and somatosensory, only rely on vestibular system)

First 3 on the floor, so somatosensory is available

Last 3 on foam, so somatosensory info is inaccurate

How are they using sensations to balance body

82
Q

Perception

A

Gather sensory info and make decisions

Body scheme/image - how they feel about the body

Spatial relations - where am I in relation to other people and objects

Agnosias

Apraxias - ideomotor and ideational

83
Q

Agnosias

A

Inability to recognize objects

84
Q

Apraxias

A

Without mvt

No capability to induce mvt, even though you want to

Can see contraction of muscles, pt can’t get it to happen - DTRs in tact

85
Q

Ideomotor

A

Can’t connect idea to motor output

Ex: tell patient to lick lips - can’t listen to command; however, once something is on lips, they’ll lick it

86
Q

Ideational

A

Do something wacky w/ object

Idea w/ what to do w/ that object is wrong

87
Q

Tonal Examination - Observation

A

At rest and during mvt

Flexor or extensor synergies

88
Q

Flexor or Extensor Synergies

A

For LE, flex synergy is hip flex/abd/ER, knee flex, ankle DF (frog legs)

Extension is opposite

All muscles are bound (ex: hip flex to 90 degrees in sagittal plan is unable to occur - need to abduct out)

Flexion synergy - can’t walk

89
Q

Tonal Examination - Appearance

A

Atrophy - lower muscle bulk, feels squished

Pseudohypertrophy - false hypertrophy; look big, but may not be able to do mvt b/c strength isn’t there

Fasciculations - fluttering of muscle fibers (portion of muscle fibers, not whole muscle)

90
Q

Tonal Examination

A

Observation, appearance, palpation (consistency)

91
Q

Muscle Tone - Tests

A

Passive mvt - changing speed and performing reversals

Pendulum test - used to assess spasticity (quads - extend knee and drop to see how quads would react)

Drop arm test - best to test integrity of automatic proprioceptive rxns (hold arms and then let go)

DTRs

92
Q

DTR Nerves

A

Jaw - trigeminal

Biceps - C5

Brachioradialis - C6

Triceps - C7/8

Patellar - L2-4

Ankle - S1/2

93
Q

Muscle Tone - Definition

A

Resistance of muscle to passive stretch

May be due to - physical inertia, intrinsic mechanical-elastic stiffness of muscle and CT, reflex muscle contraction

Categorized as - hypertonia, hypotonia, dystonia

Too many cross-bridges - high/low tone

94
Q

Hypertonia

A

Too much tone

Spasticity - increases at increased speed

Clasp-knife reflex - keep pulling; at certain pt, it just drops b/c low tone

Clonus - keeps reflexing

95
Q

Rigidity

A

Similar amount at all speeds

Cogwheel - slowly notching out (same whether you go fast or slow)

Leadpipe - lots of resistance when bending, but then it gets easier closer to midline

Decerebrate - ext of all extremities (taking off cerebrum and left w/ lower brain centers)

Decorticate - UE flexed, LE extended (remove cortex)

96
Q

Hypotonia

A

Decreased muscle tone

Decreased DTRs, may appear weak

Flaccidity - no tone (denervated muscle)

Peripheral nerve injury - those muscles have no tone and don’t work)

97
Q

Dystonia

A

Dystonic posturing - sustained muscle contractions that result in twisted mvts and abnormal posture

Segmental/focal - one specific part

Hemidystonia - half body

Generalized - whole body

Action induced - need to do action

Posture induced - induced by posture (ex: laying down vs. standing up)

98
Q

Tonal Grading

A

General clinical scale

0 = no response (flaccid)

1 = decreased response (hypotonia)

2 = normal response

3 = exaggerated response (mild to moderate hypertonia)

4 = sustained response (severe hypertonia)

99
Q

Scale for Spasticity - Modified Ashworth Scale for Spasticity

A

0 = no increase in tone

1 = slight increase (catch and release)

1+ = slight increase (initial catch followed by min resistance thru partial range)

2 = increased in tone thru/out most of range

3 = increased tone, passive mvt difficult

4 = rigid in ext and flexion

100
Q

Scoring for DTRs

A

0 = no response

1+ = decreased response

2+ = normal response (slight muscle contraction w/ slight mvt)

3+ = exaggerated response (brisk muscle contraction w/ moderate jt mvt)

4+ = clonus (1-3 beats)

5+ = sustained clonus

101
Q

Factors that Influence Tone

A

Position and interaction w/ tonic reflexes

Stress and anxiety

Volitional effort and mvt

Meds

State of CNS arousal

Environmental temp (shivering - higher level of tone; warm - mushy tone)

General health - fever, infection, metabolic/electrolyte imbalance

E&M (4 decks)

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