Stroke - Motor Impairments

Question 1

Define muscle weakness.

Answer 1

reduction in ability to produce normal levels of voluntary force in the arms and legs.

Question 2

Define decreased muscle coordination.

Answer 2

Reduced dexterity/ control, reduced ability to solve any motor task precisely, quickly, rationally. Can occur without any loss of muscle strength (cerebellar ataxia).

Question 3

Define muscle spasticity.

Answer 3

Velocity-dependent tendon jerks (also known as hypertonia). Increased resistance to fast passive stretch.

Question 4

Define reduced muscle length.

Answer 4

Contracture. Decreased passive range of motion at a joint as muscles shortened.

Question 5

Why stroke patients often experience shoulder subluxation?

Answer 5

Due to muscle weakness around the shoulder (e.g. posterior deltoids and supraspinatus), leading to the inferior displacement of the head of humerus. Can put patient’s arm in a sling to increase stability and reduce pain.

Question 6

Assessment for muscle strength?

Answer 6

Manual muscle testing (MMT) or Medical Research Council Scale (MRC). Grade 0 - 5. MMT is often tricky because patient may have cognitive or language deficits or they are often too weak to change position.

Question 7

What are the 4 strengthening principles for weak muscles?

Answer 7

• train muscles at mid-length
• train in gravity-eliminated position
• shorter lever arm
• reduce friction (using skateboard/ sliding sheet)

can also consider providing manual guidance, use mental practice, mirror therapy, use of FES.

Question 8

3 ways to address compensatory behaviour?

Answer 8

• verbal communication
• manual guidance
• environment set-up

Question 9

Assessment for spasticity?

Answer 9

• modified ashworth scale (MAS)
• modified tardieu scale (MTS) –> can differentiate between contracture and spasticity.
  commonly found in shoulder adductors, internal rotator, elbow flexor, wrist flexor, ankle plantarflexors.

Question 10

Limitations with modified ashworth scale (MAS) to assess spasticity?

Answer 10

• reliability differs from muscle to muscle.
• assessment technique must be standardised.
• measures only one aspect of spasticity (cannot differentiate between contracture and spasticity, velocity component not included)
• ambiguity of wording

Question 11

How to use modified tardieu scale (MTS)?

Answer 11

perform test at at least 2 different speeds (1 fast, 1 slow). Note for clonus (fatiguable or non-fatiguable)
Grade 0 - 4.

Question 12

Possible treatment for spasticity?

Answer 12

usually not treated unless affecting daily functions. Can do botulinum toxin A (botox) in addition to rehabilitation therapy. Can reduce spasticity but not improve motor function. Other adjuncts include electrical stimulation, casting, taping. Stretching routinely is not recommended.

Question 13

Is stretching effective in treating muscle contracture in stroke patients?

Answer 13

Stretch did not result in clinically important improvements in ROM in people with neurological conditions. Instead, muscles should be strengthened in lengthened position.
Other strategies include positioning. Stretching should come as last resort.

Question 14

Components of constraint-induced movement therapy (CIMT)?

Answer 14

• immobilisation of non-affected arm (reduce usage of intact arm)
• intensive task-oriented training in affected arm (>6h/day for 2 weeks)
• behavioural strategies to improve compliance and transfer of the practiced activities from the clinical setting to home environment.
• important to ensure that patient has good standing balance, restraining arm might perturbed their balance.