UE function Flashcards

1
Q

What is the enablement model?

A
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
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2
Q

What are factors at play during sensory motor processing?

A

Constraints of individual
type of task
Specific environmental constraints

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3
Q

What are UE functional roles?

A
Balance/arm swing
Pointing/gesturing
Weight bearing
Reaching
Grasping
Manipulation
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4
Q

What are subsystems for reaching, grasping, manipulating?

A

Musculoskeletal

Neural: internal representations, higher level processes, sensory processes, motor processes

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5
Q

What part of nervous system controls reach and grasp?

A

Primary motor cortex
Premotor cortex
Posterior parietal lobe
Cerebellum

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6
Q

What is amplitude of head movement when coordinating eye, head, trunk when looking at something?

A

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

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7
Q

What sensory systems are involved in normal UE function?

A

Somatosensory input

Visual feedback

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8
Q

What would you expect from a patient who has a ventral stream lesion?

A

Inaccurate in estimating size of object but they can still reach for it.
Intact action, altered perception

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9
Q

What are the motor systems involved in normal UE function?

A

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

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10
Q

What does the bell shaped velocity profile look like for point vs. grasp?

A

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)

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11
Q

What are aspects of coordinating grasp?

A

Close on object by moving fingers (thumb stabilizes)
Sensory info on characteristics of object: weight, firmness, shape, slickness
Grasp patterns

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12
Q

What is manipulation?

A

Interaction with environment: writing, typing, dressing, opening/closing an object, eating, throwing, counting money, turning page

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13
Q

What are theories of neural control of reach and grasp?

A

Fitt’s law: the more difficult the task, longer it takes to move
Speed-accuracy trade off: contrains of visual system

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14
Q

What are UE dysfunctions (impairments, abnormalities)?

A

Impairments in: vision, perception, sensation, proprioception
Abnormalities in: tone, voluntary movement (strength, coordination)

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15
Q

What are causes of reach dysfunction?

A

Timing problems
Impaired inter limb coordination: elbow, shoulder (degrees of freedom)
Proximal weakness

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16
Q

What are different grasp dysfunctions?

A
Anticipatory hand shape
Grip force
Precision grip
Premature finger closure
Slow release
17
Q

What are characteristics of neuro recovery?

A

Proximal vs. distal motor control
Unilateral vs. bilateral function
Driven by active movement, task goals
Learned non use post CVA

18
Q

What are 3 parts of assessment for UE?

A

Impairments (hand grip force, pinch force), observation, functional performance scale

19
Q

What are some different functional performance scales?

A
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
20
Q

What is an effect of stroke on the shoulder?

A

Pain in 70-84% of patients
Local, end range pain develops into diffuse, pervasive pain
Effect on posture, learned non use

21
Q

T/F: shoulder subluxation can occur post CVA?

22
Q

What are some causes of shoulder pain post CVA?

A
RTC muscles: paralysis, incoordination or weakness
Adhesive capsulitis
Scapular position
Scapulo-humeral rhythm
Repeated trauma
23
Q

What are complex regional pain syndrome symptoms post CVA?

A

Chronic pain affecting paretic arm or leg
10-25% post CVA
Hand tenderness, hypersensitivity, swelling, warm, red, glossy skin
Monitor for early signs

24
Q

What are treatment ideas for shoulder impairments post CVA?

A
Depends on cause
Prevent subluxation
Soft tissue restrictions
Air splint
Weight bearing
25
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
26
What are considerations for treating hand impairments?
Edema: multiple causes Impaired grasp and release function Alien hand syndrome
27
What is treatment for hand impairments?
Prevent/treat edema Facilitate or inhibit flexor/extensor muscles Hand positioning splints
28
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
29
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
30
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
31
What are issues with CIMT?
Patient compliance with protocol, safety, criteria for minimal motor function, reimbursement