Week 13

Question 1

What are the areas of the brain responsible for motor control

Answer 1

cerebral cortex
basal ganglia
cerebellum

Question 2

Cerebral cortex

Answer 2

sensorimotor cortex

*role in complex motor activies

Question 3

Basal Ganglia

Answer 3

*role in the refinement of complex movements, automatic movements, associated movements, and regulation of postural tone
(parkinson’s)

Question 4

Cerebellum

Answer 4

*role in balance, coordination, postural control, muscle tone, and planning of movements

Question 5

Parts of Normal Posture Mechanism

Answer 5

-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

Question 6

Normal postural tones

Answer 6

tone in neck, trunk and limbs
high enough to resist gravity
low enough to allow movement
provides proximal stability to enable distal movement

Question 7

Normal postural control

Answer 7

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

Question 8

Righting reactions

Answer 8

maintain and restore normal position of head in space

Question 9

Equilibrium reactions

Answer 9

allows us to maintain and regain balance

Question 10

Protective reactions

Answer 10

protective extensions of arms and hands to protect the head and face when falling

Question 11

Primitive reflexes

Answer 11

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

Question 12

Dynamic Stability

Answer 12

when one body part provides stability to that another may be mobile

Question 13

Types of Muscle Tone

Answer 13

Flaccid
hypotonic
normal
hypertonic
Rigid

Question 14

Flaccid

Answer 14

severly decreased muscle tone
no resistance to PROM - feels heavy when the limb is moved
decreased or absent deep tendon reflexes

Question 15

Hypotonic

Answer 15

decreased in muscle tone (a degree of tone is present)
seen initially, sometimes permanently with stoke patients
**problms - edema, subluxation

Question 16

Normal Tone

Answer 16

amount of tension in resting muscles
state of preparedness
varies from person to person
both high and low interfere with selective movements

Question 17

Hypertonicity

Answer 17

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

Question 18

Rigidity

Answer 18

increase of tone in the agonist and antagonist muscles simultaneously
increased resistance to passive movement in any direction throughout ROM

Question 19

2 types of rigidity

Answer 19

cogwheel - rhythmic give that occurs in the resistance throughout ROM
leadpipe - a constant resistance throughout the joint ROM, making any movement extremely difficult

Question 20

Factors that affect tone

Answer 20

Position
temperature
pain
stress/fear
primitive reflexes
fatigue
exertion

Question 21

Spasticity / treatment/inhibition (decrease)

Answer 21

Spastic is dependent on velocity.

• Inhibit spastic muscle while facilitating antagonist.
• orthotics
• serial casting
• weightbearing
• meds
• cold
• heat
• electric stim

Question 22

Indications for splints, slings

Answer 22

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

Question 23

Weightbearing uses

Answer 23

Low & high tone, coordination

Strengthens muscles

Question 24

Shldr Subluxation

Answer 24

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!

Question 25

Coordination definition

Answer 25

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

Question 26

Coordination tests

Answer 26

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

Question 27

Errors in coordination

Answer 27

• 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

Question 28

Coordination treatment techniques

Answer 28

• 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

Question 29

Games for incoordination

Answer 29

Connect Four
Checkers
Cards
Operation game
Ball
Clothes pins