Test 1: Stroke Rehab pt 2 Flashcards
what is tone
resistance of muscles to passive stretch or elongation
amount of tension at rest
can be normal or abnormal
what is elasticicty
tone in all muscle groups must be balanced for smooth movement
what CNS involvement can cause disturbances in muscle tone
impairement of the brain, spinal cord, and other receptors/ability to work together
what is spasticity
abnormal tone
increased involuntary, velocity dependent muscle tone (faster passive movement, stronger the resistance)
UMN motor disorder
what is flaccidity
hypotonicity; often present immediately after stroke
due to effects of cerebral shock
lasts a few days/weeks
how does spasticity present following a stroke
early in stroke following falccidity (90% of cases)
pts lack ability to adjust/stabilize proximal limbs and trunk
spasticity patterns influence resting posture and limit active movements outside of synergistic patterns
what is posturing
the tightness/stiffness that is a result of spasticity in muscles (i.e. elbow remaining flexed)
can lead to spasms, degenerative changes, and fixed contracturesw
what are synergistic patterns
autonomic adjustments of postural muscles that occurs normally in prep for and during movement task
synergy definition
working together
characteristics of normal synergies
create orderly, purposeful, precise, efficient movements
movements not limited outside of biomechanical ability
characteristics of abnormal synergies
movement bound together
“massed patterns of movement”
primitive/reflexive/automatic
limited movement combos; cant be adapted to environment
attempt to activate one muscle results in activation of abnormally coupled models
where are flexor synergies more commonly seen
UE
possibly due to primitive reflex of brining hand to mouth to feed
where are extensor synergies more commonly seen
LE
possibly due to primitive reflex to stand legs extended
flexion synergy of shoulder girdle
elevation and retraction
flexion synergy of shoulder
abduction to 90 deg
ER
hyperext
flexion synergy of elbow
flexion
flexion synergy of forearm
supination
flexion synergy of wrist and fingers
flexion
extension synergy of hip
extension
abduction
internal rotation
extension synergy of knee
extension
extension synergy of foot/ankle
plantar flexion
inversion
which neurofacilitation model uses relflexive synergies to define the stages of motor learning and recovery following a neuro injury
Brunnstrom
how to test for spasticity in PROM
repeat specific movements passively at different speeds to check for spasticity
quicker = higher spasticity
can use Modified Ashworth Scale
describe clonus testing
quick stretch of muscle that causes sustained beating of muscle
common in plantar flexors but can occur in jaw or wrist
+ when spasmodic contraction of antagonist muscle occurs
what is the modified ashworth scale (MAS)
used to measure/grade spasticity
observe position of affected limbs at rest and during voluntary movement
describe the grades of the MAS
0 = no increase in tone
1 = slight increase; catch and release at end ROM
1+= slight increase; catch/release through rest ROM (1/2)
2 = more marked increase through ROM but affected part moved easily
3 = considerable increase in tone; PROM difficult
4 = affected part in rigid flexion or extension
middle stages of brunnstrom synergies focus on what
moving out of synergies and into functional movements
Words that mean that the pt is exhibiting isolated control of a movement following a synergy
selective capacity
individualization
fractionation
recovery following synergies occurs in what direction
proximal to distal
description and goal of Brunnstrom’s stage 1/falccid paralysis
marked flaccidity; no reflex/voluntary movement
Goals:
-PNF to regain motor function (reciprocal initiation)
-encourage facilitation and support against gravity
description and goal of brunstrom’s stage 2/development of minimal movement in synergies
minimal voluntary movement
movement in partial or whole synergy patterns
spasticity begins to develop
Goals:
-continue to progress PNF to gain motor function
description and goal of Brunnstrom’s stage 3/voluntary movement synergy dependent
voluntary control of movement synergies (stuck in synergy)
movement may not be through full ROM
spasticity peaks
Goals:
-break pt out of imporper synergies to develop active, isolated movements
-recovery vs compensation: is pt using spasticity to allow for functional movility
Brunnstrom’s stage 4/some movements out of synergy description/goal
development of some isolated voluntary control of movement out of synergy (can break synergy)
selective capacity; can isolate movement against gravity
spasticity declining but still present
goal:
-cont to break pt of imporper synergies to further develop active/isolated movement (i.e. knee ext with hip flexion or shoulder flexion with elbow ext)
Description and goals of Brunnstrom’s stage 5/movements almost independent of synergy
can perform more difficult movements out of synergy
increased selective capacity
spasticity declining but still slightly present
goal:
-continue to break improper synergies
-develop active isolated movement and incorporated functions
-i.e. knee ext exercises with hips in flexed position while advancing limb during swing phase
Description and goals of Brunnstrom’s stage 6/normal movement
ability to perform selective capacity movement
individual active/isolated joint movements out of synergy patterns
no spasticity
goals:
-continue rehab to incorporate function and return to full recovery
-avoid any learned compensatory movements (bad habits)
Brunnstrom’s stage 7 vs 6
stage 7 is normal motor function restored (back to pre-stroke levels)
reasons UE use is compromised post stroke
hemiplegia
spasticity
contractures
non-use
MCA involved
common strength findings in UE limb screen
strength losses typically greater in distal aspect of extremity compared to proximal
is UE or LE more commonly affected post stroke
UE more frequent
high incidence of MCA involvement
residual deficits often seen in UE following stroke
20% of individuals with MCA strokes fail to regain functional use of affected UE
concern of flaccidity in UE following stroke
can result in shoulder sublux
need to monitor position of arm/gap in glenohumeral joint
disuse/atrophy can cause further problems
as contractures develop, what other factros can further restrict mobility
edema
spasticity
pain
what is coordination
ability to execute smooth, accurate, controlled movement
characterized by appropriate:
-speed
-amplitude
-direction
-timing
-muscular tension
-fluidity of movement
coordination deficits due to neuro injury
dyssynergia
dysmetria
dysdiadochokinesia
gait ataxia
speech dysarthria
clinical considerations for coordination testing
- screening often not performed if other deficits are present prior
-perform 1UE and 1LE bilaterally
-test EO and EC to determine if vision is compensating
what to observe with coordination test
-movement direct/precise/easily reverse?
-reasonable time frame?
-affected by speed?
-can adjustments be made?
-does vision affect?
-greater proximally or distally?
-one side more involved?
-consistent over time?
describe finger to nose coordination test
abd arm to 90
have pt bring tip of finger to nose with EO and EC
+ = jerky/wandering movement, discrepency between sides, between EO/EC, or consistently missed target
describe finger to finger test
touch therapist finger then touch your nose
longer path = greater challenge for dysmetria
therapist can move finger while pt is going toward their nose
+ = jerky, missed target
describe the rapid alternating movements test
tests for dysdiadochokinesia
ask pt to rapidly pronate/supinate with arms extended or on thighs
+ = uneven/jerky/slow movement/need to change amplitude
describe finger opposition test
touch every fingertip with thumb
+ = uneven/jerky/sliding finger for stability
speed differences expected between dominant and non dominant hand
describe heel to shin test
stroke heel of foot up and down other shin
+ = uneven/k=jerky
describe rapid alternating movemnent test
rapid DF and PF feet or bend and straighten knees
ask to do unilaterally and bilaterally and compare
