UE function Flashcards
What is the enablement model?
Define patient's roles (participation) What skills (activities) are needed What resources does the patient have? What is lacking? Set goals related to functional recovery: control of arm movements changes depending on the goal of the task
What are factors at play during sensory motor processing?
Constraints of individual
type of task
Specific environmental constraints
What are UE functional roles?
Balance/arm swing Pointing/gesturing Weight bearing Reaching Grasping Manipulation
What are subsystems for reaching, grasping, manipulating?
Musculoskeletal
Neural: internal representations, higher level processes, sensory processes, motor processes
What part of nervous system controls reach and grasp?
Primary motor cortex
Premotor cortex
Posterior parietal lobe
Cerebellum
What is amplitude of head movement when coordinating eye, head, trunk when looking at something?
When head movement is necessary to look at an object the amplitude of head movement is usually about 60-75% of the distance to the target
What sensory systems are involved in normal UE function?
Somatosensory input
Visual feedback
What would you expect from a patient who has a ventral stream lesion?
Inaccurate in estimating size of object but they can still reach for it.
Intact action, altered perception
What are the motor systems involved in normal UE function?
Multiple degrees of freedom
Reach/grasp: under distinct neural control
ROM, strength, tone, coordination
Posture: scapula position, grasp patterns
Eye movement: saccade
Head, trunk movement
Transport hand: role of thumb, shape of hand opening
Postural support
What does the bell shaped velocity profile look like for point vs. grasp?
Movement duration of reaching is longer than pointing
Preparing to grasp object: acceleration of reaching is shorter than duration
Pointing: acceleration is longer than the deceleration (high velocity when finishing)
What are aspects of coordinating grasp?
Close on object by moving fingers (thumb stabilizes)
Sensory info on characteristics of object: weight, firmness, shape, slickness
Grasp patterns
What is manipulation?
Interaction with environment: writing, typing, dressing, opening/closing an object, eating, throwing, counting money, turning page
What are theories of neural control of reach and grasp?
Fitt’s law: the more difficult the task, longer it takes to move
Speed-accuracy trade off: contrains of visual system
What are UE dysfunctions (impairments, abnormalities)?
Impairments in: vision, perception, sensation, proprioception
Abnormalities in: tone, voluntary movement (strength, coordination)
What are causes of reach dysfunction?
Timing problems
Impaired inter limb coordination: elbow, shoulder (degrees of freedom)
Proximal weakness
What are different grasp dysfunctions?
Anticipatory hand shape Grip force Precision grip Premature finger closure Slow release
What are characteristics of neuro recovery?
Proximal vs. distal motor control
Unilateral vs. bilateral function
Driven by active movement, task goals
Learned non use post CVA
What are 3 parts of assessment for UE?
Impairments (hand grip force, pinch force), observation, functional performance scale
What are some different functional performance scales?
Motor activity log Wolf motor function test Chedoke-McMaster stroke/hand and arm inventory Box and block test Arm reaction arm test Nine hole peg test
What is an effect of stroke on the shoulder?
Pain in 70-84% of patients
Local, end range pain develops into diffuse, pervasive pain
Effect on posture, learned non use
T/F: shoulder subluxation can occur post CVA?
True
What are some causes of shoulder pain post CVA?
RTC muscles: paralysis, incoordination or weakness Adhesive capsulitis Scapular position Scapulo-humeral rhythm Repeated trauma
What are complex regional pain syndrome symptoms post CVA?
Chronic pain affecting paretic arm or leg
10-25% post CVA
Hand tenderness, hypersensitivity, swelling, warm, red, glossy skin
Monitor for early signs
What are treatment ideas for shoulder impairments post CVA?
Depends on cause Prevent subluxation Soft tissue restrictions Air splint Weight bearing
What is treatment for reduced scapular mobility?
Soft tissue scapular mobilizations
Side lying
Add active movements/PNF diagonals
Soft tissue/capsular tightness may also be present in elbow, wrist, finger joints
What are considerations for treating hand impairments?
Edema: multiple causes
Impaired grasp and release function
Alien hand syndrome
What is treatment for hand impairments?
Prevent/treat edema
Facilitate or inhibit flexor/extensor muscles
Hand positioning splints
What is task oriented training for UE treatment?
Treat impairments
Retrain strategy: eye head coordination, reach, grasp/release, manipulation
Restore function
Connect to patient goals, familiar activities
unilateral vs bilateral tasks
What are deficits of uninvolved UE and why do we see these?
Deficits: coordination, timing/speed, grip strength
Why: bilateral cortical control, component of corticospinal tract that does not decussate, cognitive deficits, visual perceptual deficits
What is constraint induced movement therapy (CIMT)?
overcome learned non use in stroke
Shows changes in brain mapping
Restrict less affected limb during waking hours of 14 days
Improved motor and function : maintained 2 years post study
What are issues with CIMT?
Patient compliance with protocol, safety, criteria for minimal motor function, reimbursement
