Week 13 Flashcards
What are the areas of the brain responsible for motor control
cerebral cortex
basal ganglia
cerebellum
Cerebral cortex
sensorimotor cortex
*role in complex motor activies
Basal Ganglia
*role in the refinement of complex movements, automatic movements, associated movements, and regulation of postural tone
(parkinson’s)
Cerebellum
*role in balance, coordination, postural control, muscle tone, and planning of movements
Parts of Normal Posture Mechanism
-Normal postural tone-high enough to resist gravity, low enough to allow movement, proximal stability so movement can happen distally.
-Normal postural control
Righting reactions
Equilibrium reactions
Protective reactions
Primitive reflexes
Dynamic stability
Normal postural tones
tone in neck, trunk and limbs
high enough to resist gravity
low enough to allow movement
provides proximal stability to enable distal movement
Normal postural control
allows selective movements
ability to control postural output, allows for: head control , trunk control, mobility, midline orientation, WB, weight shifting, balance, coordination. Provides stability & mobility during activity
Righting reactions
maintain and restore normal position of head in space
Equilibrium reactions
allows us to maintain and regain balance
Protective reactions
protective extensions of arms and hands to protect the head and face when falling
Primitive reflexes
must be integrated
- grasp reflex - touch palm pt will grasp onto finger or hand but ask for them to release to see if it is a grasp reflex
- positive support reflex - when the ball of the foot makes contact with a surface
Dynamic Stability
when one body part provides stability to that another may be mobile
Types of Muscle Tone
Flaccid hypotonic normal hypertonic Rigid
Flaccid
severly decreased muscle tone
no resistance to PROM - feels heavy when the limb is moved
decreased or absent deep tendon reflexes
Hypotonic
decreased in muscle tone (a degree of tone is present)
seen initially, sometimes permanently with stoke patients
**problms - edema, subluxation
Normal Tone
amount of tension in resting muscles
state of preparedness
varies from person to person
both high and low interfere with selective movements
Hypertonicity
increased muscle tone, velocity dependent, increased stretch reflex, increased resistance to passive movements
a person who has spasticity is hypertonic, but not all hypertonic pts have spasticity*
Flexion - UE / Extension - LE
Seen with TBI, MS, SCI, CVA
Rigidity
increase of tone in the agonist and antagonist muscles simultaneously
increased resistance to passive movement in any direction throughout ROM
2 types of rigidity
cogwheel - rhythmic give that occurs in the resistance throughout ROM
leadpipe - a constant resistance throughout the joint ROM, making any movement extremely difficult
Factors that affect tone
Position temperature pain stress/fear primitive reflexes fatigue exertion
Spasticity / treatment/inhibition (decrease)
Spastic is dependent on velocity.
- Inhibit spastic muscle while facilitating antagonist.
- orthotics
- serial casting
- weightbearing
- meds
- cold
- heat
- electric stim
Indications for splints, slings
High or low tone Prevent or correct Contractures Enable to perform daily tasks Permit healing Maintain integrity of arches Correct or prevent deformities -Substitute for weak or absent muscle function Maintain ROM -To assist or strengthen active movement -For positioning & performance with abnormal tone
Weightbearing uses
Low & high tone, coordination
Strengthens muscles
Shldr Subluxation
Glenohumeral jt separation
Leads to pain
Never let arm hang
Approximate (push jt back together) before ROM exercise or mobilization.
No shldr ROM greater than 90degrees if scap does not move well; this could lead to impingement
Can use sling or brace
Thumb up in flexion!
Coordination definition
Ability to produce accurate, controlled movement. Characterized by smoothness, rhythm, and appropriate speed. Uses right muscles at right time with correct intensity. Controlled by cerebellum
Coordination tests
Standardized: 9 hole peg test & grooved peg test
Other tests:
- finger to nose (FTN)
- finger to nose to therapists finger
- digit opposition
- heel to shin - have pt take heel of one leg and rub it up/down shin of other leg
Errors in coordination
- ataxia: jerky movement
- dysmetria: overshooting/under shooting target
- tremors
- dysarthria: in coordination of speech & facial muscles
- dysdiadokokinesia: diff w/ rapid alternating movements
- nystagmus: eyeballs involuntarily move up/down, side to side or rotating, common in tbi & spinal injuries
- spasms- involuntary movements of muscles
Coordination treatment techniques
- Work gross /fine motor movement
- slow then increase speed
- begin with small ranges & gradually increase
- use sensory cues (visual, tactile feedback )
- cuff weights for tremors
- WB
- adapt ADLs
- pegs, cones, contrived activities
- handwriting
- repetitive movements
- provide prox stability such as pt leaning on table or chair during task
- do not allow pt to get fatigued or incoordination will increase
Games for incoordination
Connect Four Checkers Cards Operation game Ball Clothes pins
