Resisted Isometric Movements Flashcards
What are Dermatomes?
Dermatomes are developed within the first 3-5 weeks of fetal life
They connect each spinal level to a specific section of skin that is mapped out similarly in each individual
If a patient has neurological symptoms such as flaccidity, (motor loss), paresis (weakness), anesthesia (sensory loss), paresthesia (sensory impairment) or dysesthesia (pain), we as therapists can map on the body what part of the skin it is and its corresponding spinal level
As a therapist, we use this information to check the spinal level further for the reflex and then the myotome to establish a level of dysfunction
The sensory distribution of each nerve root is called the dermatome
Defined by the area of skin supplied by a single nerve root
The descriptions of dermatomes should be considered as examples only because there are slight variances between each person and a lot of overlap
Levels of Principal Dermatomes
C5 Level of clavicles
C5, C6 Lateral sides of upper limbs
C8, T1 Medial sides of upper limbs
C6 Digit I (thumb)
C6, 7, 8 Hand
C8 Digits IV, V (ring & little finger)
T4 Level of nipples
T10 Level of umbilicus
L1 Inguinal region
L1-L4 Anterior and medial surfaces of lower limbs
L4-L5, S1 Foot
L4 Medial side of digit I (great toe)
L5, S1-S2 Lateral and posterior surfaces of lower limbs
S1 Lateral margin of foot and digit V (little toe)
S2-S4 Perineum
What are Myotomes?
Defined as a group of muscles supplied by a single nerve root
A lesion of a single nerve root is usually associated with paresis (incomplete paralysis) of the myotome (muscles) supplied by that nerve root
Because it takes time for any weakness to become evident on resisted isometric or myotome testing, the testing is held for at least 5 seconds
Testing Myotomes
Tests for muscle power for possible neurological weakness
Myotomes are assessed individually
The test joint or joints should be in a neutral or resting position and then isometric resistance is applied for at least 5 seconds
If possible, both sides should be tested simultaneously to compare
Myotomes of the Upper and Lower Limbs
C1-C2 Neck flexion
C3 Neck side flexion
C4 Shoulder elevation
C5 Shoulder abduction
C6 Elbow flexion & wrist extension
C7 Elbow extension & wrist flexion
C8 Thumb extension & ulnar deviation
T1 Hand intrinsics (fingures abduction)
L2 Hip flexion
L3 Knee extension
L4 Ankle dorsiflexion
L5 Great toe extension
S1 Ankle plantar flexion, eversion &
hip extension
S2 Knee flexion
Reflexes
To obtain information on the state of the nerve or nerve roots supplying the reflex
If neurological involvement is suspected, both reflexes and sensation should be tested to clarify the problem and where the problem actually is
If the neurological system is thought to be normal, there is no need to test the reflexes or cutaneous distribution
Deep Tendon Reflexes (know what we are looking for)
Are performed to test the integrity of the spinal reflex, which has a sensory (afferent) and motor (efferent) component
Are most often tested using a reflex hammer
Can be elicited from almost any tendon with practice
Abnormal deep tendon reflexes are not clinically relevant unless they are found with sensory or motor abnormalities
Common Deep Tendon Reflexes (pay more atten than superficial.know where the tendon)
Testing Deep Tendon Reflexes
The patient must be relaxed and the therapist must ensure that the muscle of the tendon to be tested is relaxed
The tendon to be tested is put on a slight stretch
An adequate stimulus is applied by dropping the reflex hammer onto the tendon
The tendon should be tapped 5-6 times to uncover any fading reflex response, indicative of developing nerve root signs
If the reflexes are difficult to elicit, they can often be enhanced by having the patient clench the teeth or squeeze the hands together when testing the lower limb or squeeze the legs together when testing the upper limb
Deep Tendon Reflex Grading ignor
0 - Absent (areflexia)
1 - Diminished (hyporeflexia)
2 - Average (normal)
3 - Exaggerated (brisk)
4 - Clonus, very brisk (hyperreflexia)
Superficial Reflexes
Superficial reflexes are provoked by superficial stroking, usually with a moderately sharp object that does not break the skin
A great deal of practice is needed to become proficient in testing the superficial reflexes
Pathological Reflexes
Pathological reflexes are not normally present, except in the young (5-7 months-cerebrum is not developed enough to suppress this reflex,BUT THEY CRAW TOES DOWN) because they are suppressed by the cerebrum at the brainstem or spinal cord level
If it’s present in adults and children, it often signifies a pathological condition and may indicate upper motor neuron lesions if present on both sides or lower motor neuron lesions if present on one side
Improper stimulation (too much pressure) may lead to voluntary withdrawal in normal subjects (they may move the limb out)
Two of the most commonly tested pathological reflexes are the Babinski reflex and the Hoffman reflex
Reflex Findings
To be of clinical significance, findings must show asymmetry between bilateral reflexes unless there is a central lesion
1 strong 1 weak
Do not be overly concerned if the reflexes are absent, diminished or excessive on both sides, especially in young people, unless a central lesion is suspected
Tendon reflexes can be accentuated by exercise or patient anxiety
(We can’t assum they have problem from 1 test)
Hyporeflexia or areflexia-indicates a lesion of a peripheral nerve or spinal nerve root as a result of impingement, entrapment, or injury. Can also be seen in the absence of muscle weakness or atrophy
Ex. nerve root compression, cauda equina syndrome, peripheral neuropathy
Hyperactive or exaggerated reflexes (hyperreflexia) indicate upper motor neuron lesions as seen in neurological disease and cerebral or brainstem impairment
