Week 5: Assessment Motor Control - PPT

Question 1

“control of both movement & posture”

Answer 1

Motor control

Question 2

What is part of motor control?

Answer 2

Fluid interrelationships
Stability and mobility
Proximal & distal musculature
Agonists and antagonists
Balance
Parameters of movement – spatial, temporal…

Question 3

T/F: Function-Based Stroke Rehabilitation, p.81)…
-suggests that motor behavior emerges from persons’ multiple systems interacting with unique tasks and environmental contexts…more interactive or heterarchical and emphasizes the role of the environment.

Answer 3

True

Question 4

What are system model of motor control?

Answer 4

regulation system
environmental
commanding
musculoskeletal
comparing
sensorimotor

Question 5

What is part of person in model?

Answer 5

Client factor, skills, patterns (cognition, psychosocila, sensorimotor)

Question 6

what is part of environment?

Answer 6

context and activity demand (physical, socioeconomic, cultural)

Question 7

What happens when someone has an upper motor neuron lesion like stroke?

Answer 7

Changes in muscle strength (weakness)

Changes in muscle tone/postural control

Changes in muscle activation (central coordination)

Changes in sensation

Question 8

Most common change is weakness after stroke

Answer 8

Most common changes: muscle paralysis and or paresis (slight or partial paralysis)
Muscle weakness varies depending on the starting position of the body, length of the muscle, and specific action muscle is being asked to perform
Manual muscle tests are unreliable with neurological deficits
Loss of muscle strength is strongly influenced by secondary changes in joint alignment & mobility, muscle & tissue length, and problems with tone & muscle activation
Can be in trunk or in extremities

Question 9

T/F: manual muscle test are reliable with neurological deficits

Answer 9

False.Manual muscle tests are unreliable with neurological deficits

Question 10

TF: we see that when there is weakness in the trunk, it is often accompanied by hypertonicity in an arm or leg.

Answer 10

true

Question 11

– amount of tension in a muscle or resistance of a muscle to passive elongation or stretching

Answer 11

muscle tone

Question 12

special category, referring to overall state of tension in body musculature

Answer 12

postural tone

Question 13

greater than normal, increased resistance to passive movement; may be located in muscles which can be actively contracted (active stiffness)

Answer 13

hypertonicity

Question 14

lower than normal; no resistance to passive movement; lower than normal tension at rest/during movement; difficulty resisting the force of gravity

Answer 14

hypotonicity

Question 15

associated w/muscles that are weak or paralyzed; most common in acute state – may persist.

Answer 15

hypotonicity

Question 16

leads to atypical patterns of muscle activation; may also develop in muscles in constant positions of shortness…

Answer 16

Hypertonicity

Question 17

– special type of hypertonicity; increased muscle tension associated with unnatural body postures and limb positions caused by changes in the le

Answer 17

Spasticity – special type of hypertonicity; increased muscle tension associated with unnatural body postures and limb positions caused by changes in the le

Question 18

• hyperactive response to quick stretch
  
  • velocity-dependent
  • clasp-knife phenomenon
  • must be elicited by doing something to muscle group in the opposite direction

Answer 18

spasticity

Question 19

– usually involves tactile, proprioceptive, and kinesthetic sensation.

Answer 19

Sensory Awareness

Question 20

Dynamic Systems Theory

Answer 20

Behaviors emerge from the interaction of many systems.
Behavior is considered to be self-organizing.
Transitions in behavior, phase shifts, are changes from one preferred pattern of coordinated behavior to another.
Motor control parameters are gradable.
There is no inherent ordering of systems in terms of their influence on motor behavior….control parameters shift behavior from one pattern to another…

Question 21

This theory proposes that behaviors emerge from the interaction of many
systems -> self-organizing. There are “normal strategies” which limit the
degrees of freedom.

Answer 21

Dynamic systems theory

Question 22

phase shifts

Answer 22

Transitions in behavior are called phase shifts where 1
preferred behavior is chosen over another; ie…walking faster and faster and
then running!

Question 23

are variables that shift behaviors from 1 form to another.
They do not control the change, but act as agents/catalysts for reorganizing the behavior
to a new form,

Answer 23

Control parameters are variables that shift behaviors from 1 form to another.
They do not control the change, but act as agents/catalysts for reorganizing the behavior
to a new form,

Systems themselves are subject to change
No inherent ordering of systems in terms of their influence on motor behavior

Question 24

T/F: Client with damaged CNS attempts to compensate for the lesion to achieve functional goals.

Answer 24

true

Question 25

TF: Systems and CNS are heterarchically organized

Answer 25

true

Question 26

T/F;Providing appropriately challenging tasks and environments for those with CNS dysfunction appears critical to the maximal rehabilitation of our clients.

Answer 26

true. Experimentation with different strategies leads to optimal solution

Question 27

Changes over time are caused by multiple factors/systems such as maturation & the nervous system,
biomechanical constraints & resources, & the influences of the social environment. Behavioral changes reflect
attempts to compensate and to achieve a certain task.

Recovery is variable because personal characteristics & environmental factors are unique for each person

This theory also believes that normal development does not follow a rigid, task-oriented sequence,
as the motor milestones suggests; other factors influence the developmental stages…

Answer 27

Dynamic systems theory

Question 28

Emphasis on the role and occupational performance areas

1. Role Performance (past and future roles)
2. Occupational Performance Tasks: Areas of Occupation
3. Task: Selection & Analysis
4. Person: Performance Skills/Client Factors
5. Environment: Performance Context

Answer 28

Task Oriented Approach

Question 29

1. Assess foundations for movement - alignment and biomechanics)
2. Assess muscle tone - “placing” “high enough to resis gravity, low enough to allow movement, attempts at voluntary movement”
3. Assess voluntary muscle activity through observation (qualitatively) - movement patterns “typical” “missing”
4. Assess functional use of the upper extremity (performrmance skills)

Answer 29

Non-Standardized (Observational) Assessment of Motor Behavior: Based on the Neurodevelomental Treatment (NDT) Approach

Question 30

grounded in observation and based on a dynamic systems approach, functional approach and contemporary understanding of motor behavior

Answer 30

non standardized method

Question 31

What do you think conditions of observation could be?

Answer 31

Temperature
Weather
Setting
People around
Not feeling well/sleepy
Family present?
Roommate present?
Before or after medications given?

Question 32

Although the test was developed and described as a measure of spasticity, AS MODIFIED…the scale is a measure of muscle tone or the resistance to passive movement.

Answer 32

Modified Ashworth Scale

Measure of spasticity/tone

Most widely used

Question 33

. The MAS measures resistance during passive soft-tissue stretching.

Answer 33

The MAS is done in supine (this will garner the most accurate and the lowest score; any tension anywhere in the body will increase spasticity);
· Because spasticity is “velocity dependent” (the faster the limb is moved, the more spasticity is encountered), the MAS is done moving the limb at the “speed of gravity.” This is defined as the same speed a non-spastic limb would naturally drop. In other words, fast;
· The test is done a maximum of three times for each joint. If it is done more than three times the short-term effect of a stretch impacts the score;

Question 34

MAS Scale?

Answer 34

0 Normal muscle tone (no increase)
1 Slight increase in muscle tone, “catch and release” or minimal resistance at end of ROM when limb moved
1+ Slight increase, “catch” followed by minimal resistance through remainder (less than half) of ROM
2 Marked increase through most of ROM, but affected parts are easily moved
3 Considerable increase in tone, passive ROM difficult
4 Rigid in flexion or extension (any motion)

Question 35

Developed to evaluate motor function, balance, some aspects of sensation, and joint function/pain in persons following a stroke

Answer 35

Fugl-Meyer Assessment

Question 36

2nd most widely used assessment of motor deficits of persons with CNS impairments

Answer 36

Fugl-Meyer Assessment

Question 37

226-point multi-item Likert-type scale
Motor domain: movement, coordination, & reflex action at the shoulder, elbow, forearm, wrist, hand, hip, knee, & ankle
3-point scale: 0= cannot perform, 1= performs partially, 2=performs fully
Takes approximately 20 minutes and does not require training/certification

Answer 37

Fugl-Meyer Assessment