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נארו > quiz 1: motor > Flashcards

quiz 1: motor Flashcards

1
Q

PT Diagnosis Vs. Medical Diagnosis

A

PT Diagnosis: effect of pathology on movement (L sided w R hemiplegia w gait balance)

medical diagnosis: look at pathology (L. sided ischemic stroke)

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2
Q

Why do a neuro eval?

A
  1. identify if disease process or impairment is impacting the nervous system
  2. localize the lesions: recognize patterns and deduce pathology
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3
Q

NAGI model of Disablement

A

Pathology –> Impairment –> Functional Limitations –> Disability

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4
Q 
NAGI Model: Pathology
-what is it
-give 4 examples:
Stroke
TBI
Parkinsons
MS
A

underlying disease/defect occurs at the cellular level
1. Stroke: impaired blood supply to CNS bc thromboembolsim or bleeding – bld supply lost

  1. TBI: acute trauma to the brain - damage can be diffuse
  2. Parkinsons: specific damaged substantia nigra -tremor, rigidity
  3. MS: autoimmune CNS demyelination (lesions can be anywhere in nervous system)
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5
Q

NAGI Model: Impairment

  • what is it
  • give 5 examples:
A

Disruption of motor, sensory, or cognitive process

spasticity, sensory loss, bradykinesia, fatigue, thermosensitivity

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6
Q

NAGI Model: Functional Limitation

A

Limitation of performance at the level of the whole organism or person
inability to walk, balance, reach, stand, etc.

gait, balance, transfer, bed mobility, ADL, IADL

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7
Q

NAGI Model: Disability

A

decreased ability/inability to perform social roles
-unable to participate in society as did before
QOL

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8
Q

PT Exam for Impairment

A

sensory, motor, spasticity, ROM, etc

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9
Q

PT Exam for Functional Limitation

A

balance, transfers

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10
Q

PT Exam for Disability

A

QOL measures, self report measures

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11
Q

Lesion localization

  • focal
  • diffuse
  • multifocal
  • multifocal and diffuse
A

based on characteristics of lesion can assume location

  • focal: in one spot (specific sx) [parkinsons]
  • diffuse: many regions [MS]
  • multifocal: many foci [alzheimers in various lobes]
  • multifocal and diffuse: TBI (force through frontal lobe and forced to other side of the brain and diffuse in btwm)
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12
Q

coup countrecoup

A

coup injury is under site of impact

contrecoup is on side opposite impacted area

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13
Q

What makes up CNS

-what if lesion here?

A

brain, brainstem, spinal cord

lesion here is UMN lesion

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14
Q

What makes up PNS

-what if lesion here?

A

once nerve exits from the spinal cord

lesion here is LMN lesion

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15
Q

UMN Lesion

A

motor damage involved in CNS

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16
Q

LMN Lesion

A

motor damage involved in PNS

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17
Q

if clear that there is UMN damage, what do we know about the sensory system?

A

nothing, it is motor and not sensory

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18
Q

Dermatomal/Myotomal

A

if lesion in C1, everything that C1 mediates, motor and sensory, will be involved

myotomal–motor
dermatomal–sensory

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19
Q

C1 Myotomal LMN involvement

A

anything motorically innervated by C1 is involved

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20
Q

C1 Dermatomal LMN involvement

A

anything sensorically innervated by C1 will have sensory involvement

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21
Q

Peripheral Myotomal/dermatomal (c1)

A

only in the myatome or dermatome of that C1

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22
Q

CNS myotomal/dermatomal (c1)

A

it is not only that myotome or dermatome but everything below that level if it is in the cord itself

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23
Q

Non-myotomal/non-dermatomal

A

above the cord stroke: it is not a myatome or dermatome pattern but instead it is a diffuse weakness because it is above the cord.

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24
Q

lesion localization:

  • CNS
  • PNS
A

CNS: cortical, subcortical, cerebellar, basal ganglia, spinal cord

PNS: anterior horn cell, nerve root, plexus, in peripheral nerve itself

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25
Q

Validity vs Reliability

A

validity: does test measure what it claims to measure
reliability: repeatable: inter-rater reliability, intra-rater reliability

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26
Q

berg balance scale

A

test of falls (not of balance) 56= low risk of falls

<42 high risk of falls

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27
Q

Specificity vs Sensitivity

A

specificity: able to pick up various signs and sx of pathology

Sensitivity - able to rule out other pathologies

28
Q

motor exam to test?

A

muscle strength (force output), motor function (tasks), motor control (nervous system with muscle relationship) - motor force and timing

locate the lesion

examine for symmetry, hypertrophy Psuedohypertrophy in duchennes), atrophy

29
Q

what is muscle tone

A

normal resting state of muscle, normal tension of muscle, created by ongoing activities of Motor Unit recruitment

30
Q

Types of Decreased/Increased Tone

A

Decreased: hypotonia, flaccidity

Increased: hypertonia, spasticity, rigidity

31
Q

Spasticity

A

velocity dependent reaction to stretch

  • increased “gain” of the stretch reflex
  • hallmark of the UMN syndrome
  • hyperactive reflex to stretch
  • must be CNS (motoric involvement) [not PNS]
32
Q 
MAS
0
1
1+
2
3
4
A

Modified Ashworth Scale
0: no increase in tone
1: slightly increased tone/ catch and release/ min resistance at end of ROM
1+: slightly increased tone/ a catch/ minimal resistance throughout the remainder of ROM (less than 1/2)
2: More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
3: Considerable increase in muscle tone, passive movement difficult
4: Affected part(s) rigid in flexion or extension

33
Q

exertional spasticity

A

increased spasticity with exertion

34
Q

provocative testing

A

to see if spasticity under any conditions - spasticity is never normal (if a pt with CNS involvement does not show spasticity then rev them up to see what fatigue will do)

35
Q

Rigidity

  • cogwheel
  • led pipe
A

rigidity: non velocity dependent rxn to stretch
- cogwheel: successive catches and releases (parkinsons)

-lead pipe: stiff and not flexible that remains uniform throughout the range of passive movement (alzheimers)

36
Q

T or F: Spasticity indicates CNS involvement

A

T

37
Q

T or F: CNS involvement indicates spasticity

A

F

38
Q

flaccidity

A

minimal or absent muscle tone
minimal or absent muscle contractions to command or reflex
absent or diminished stretch reflex
—-if do a quick stretch no resistance will be felt

39
Q

What are the causes of flaccidity?

A
  1. Normal
  2. LMN lesion
  3. muscle damage
  4. component of spinal or cortical shock
40
Q

Can flaccidity be due to CNS involvement?

A

flaccidity can be do to CNS involvement = cortical spinal shock (stroke, SCI)

nervous system shuts down and get flaccidity below the level of the lesion for hours to months

rehab: work on rom dont let a contracture on involved side

41
Q

Diaschisis

A

shock

  • can be cortical or spinal (following cortical spinal injury)
  • period of flaccidity immediately following lesion, can last hours to months
  • unable to prognose until shock is resolved
42
Q

Upper Motor Neuron Syndrome-dx

A

TRIAD of symptoms following CNS lesions comprised of

  1. spasticity
  2. hyperreflexia
  3. pathological reflexes (clonus, babinksi)

Upper motor neuron syndrome (UMNS) is the motor control changes that can occur in skeletal muscle after an upper motor neuron lesion.

43
Q

Lower Motor Neuron Syndrome

A
  1. flaccidity
  2. hyporeflexia/arreflexia
  3. occasional fasiculations (muscle twitch)
44
Q

AROM Test

A

(see notes)

45
Q

Spasticity Eval

A

prom slowly to assess range limits then do quickly

may need to provacative testing by repeating

46
Q

Deep Tendon Reflex

A
  • –monosynaptic stretch reflex
  • –stimulus quick stretch of tendon with reflex hammer
  • -response: muscle contraction: visible motion with palpable or observational contraction
47
Q

DTR Technique

A
  1. locate and expose tendon
  2. tendon should be on relative stretch
  3. strike sharply with hammer at a 90 degree angle to the tendon
  4. use Jendrassik manouvre to reinforce (interlock fingers)
  5. alternate: strike muscle belly
48
Q

C5

A

biceps (musculocutaneous)

49
Q

C6

A

brachiradialis (radial)

50
Q

C7

A

triceps (radial)

51
Q

L3, L4

A

Quadriceps (femoral)

52
Q

S1,S2

A

achilles tendon (tibial)

53
Q 
DTR Grades
0
1+
2+
3+
4+
5+

which have clonus?

A

0-ABSENT-no visible contraction

1+ hyporeflexia: slight contraction, need reinfocement

2+ normal slight muscle contraction w/ jt movement

3+ hyperreflexia: brisk contraction with mod jt movement

4+ abnormal hyperreflexia: strong contraction w/ 1-3 beats of clonus

5+ abnormal hyperreflexia: sustained clonus

54
Q

UMN

A 
CVA
TBI
SCI
MS 
CP
Brain Tumor
ALS

but not in parkinsons, no spasticity in parkinsons, have rigidity

55
Q

Babinski

what indicates UMN?
what indicates LMN?

A

plantar response
blunt probe down across sole of foot from heel to toe

  • negative: toe flexion an adduction, angle plantarflexion
  • positive sign: toes fan an extend, ankle dorsiflexion - indicates UMN
  • equivocal response: toes go up and down
  • no response: LMN lesion
  • triple flexion response: ankle dorsiflexion, knee flexion, hip flexion (so flexion x 3)
56
Q

Clonus

what indicates UMN?
what indicates LMN?

A

rhythmic beating of jt in response to sustained stretch-bring ankle from plantarflexion to full dorsiflexion and hold at end range.

normal: 1-1.5 beats
abnormal: 2-5 beats or sustained more than 5 beats (UMN)

absent: LMN or normal and just toned

57
Q

MAS 0

A

0: no increase in tone

58
Q

MAS 1

A

1: slightly increased tone/ catch and release/ min resistance at end of ROM

59
Q

MAS 1+

A

1+: slightly increased tone/ a catch/ minimal resistance throughout the remainder of ROM (less than 1/2)

60
Q

MAS 2

A

2: More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved

61
Q

MAS 3

A

3: Considerable increase in muscle tone, passive movement difficult

62
Q

MAS 4

A

4: Affected part(s) rigid in flexion or extension

63
Q

DTR 0

A

0-ABSENT-no visible contraction

64
Q

DTR 1+

A

1+ hyporeflexia: slight contraction, need reinfocement

65
Q

DTR 2+

A

2+ normal slight muscle contraction w/ jt movement

66
Q

DTR 3+

A

3+ hyperreflexia: brisk contraction with mod jt movement

67
Q

DTR 4+

A

4+ abnormal hyperreflexia: strong contraction w/ 1-3 beats of clonus

נארו (11 decks)

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