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Week 5: Motor Impairments Flashcards

1
Q

Define sign vs. symptom:

A

sign is objective and symptom is subjective

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2
Q

a positive sign is an indication that:

A

there is a presence of an abnormal behavior

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3
Q

a negative sign indicates a:

A

absence of normal behavior

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4
Q

A primary impairment is:

A

a direct effect of the pathology or lesion

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5
Q

a secondary impairment develops as:

A

a result of the original problem

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6
Q

Upper motor neuron lesions effect the:

A

motor cortex
descending motor tracts
brainstem
spinal cord proximal to alpha motor neurons

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7
Q

lower motor neurons effect:

A 
alpha motor neurons
ventral root
motor nerve plexus
peripheral motor nerve
neuromuscular junctions
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8
Q

What sign do we see with upper motor neurons?

A

weakness, increased reflexes and increased tone

no effects on atrophy or fasciculations

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9
Q

what signs do we see with lower motor neurons?

A

weakness, atrophy, fasciculations, decreased reflexes and decreased tone

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10
Q

With a stroke, what signs will we see?

A

weakness, hypertonicity and hyperreflexia

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11
Q

with a brachial plexus injury, what signs do we see?

A

weakness, atrophy, fasciculations, decreased tone and decreased reflex

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12
Q

Neural contributions to strength reflect:

A 
# of motor units recruited
type of motor units recruited 
discharge frequency
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13
Q

musculoskeletal contributions to strength reflect:

A 
length/tension relationship
length of movement arm of the muscle
cross sectional area available
type of muscle fiber 
muscle fiber arrangement
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14
Q

What is weakness in the context of neuropathy?

A

inability to generate force or inability to correctly recruit or modulate motor neurons

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15
Q

muscle weakness leads to:

A

loss of movement and loss of power

lack of muscle activity and immobility

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16
Q

neurologically induced weakness may result from:

A 
cortical lesion
descending pathway injury
peripheral nerve injury
synaptic dysfunction at neuromuscular jxn
muscle tissue damage
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17
Q

extent and distribution of weakness depend on:

A

extent and location of lesion

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18
Q

paralysis or plegia is:

A

total or profound loss of muscle activity

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19
Q

paresis is:

A

mild or partial loss of muscle activity

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20
Q

what are the 4 categories of distribution?

A

tetraplegia
monoplegia
hemiplegia
paraplegia/ diplegia

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21
Q

Impaired motor control is often worse with:

A

stress, distraction, fatigue

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22
Q

Motor recruitment is:

A

agonist activation + reflexive inhibition of antagonist

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23
Q

What are synergies?

A

Muscle and joint movements that occur in stereotypical patterns

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24
Q

synergies are the loss of:

A

single joint, isolated movement patterns

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25
What is the upper extremity flexor synergy?
``` scapula retraction and elevation shoulder abduction and ER elbow flexion supination wrist finger flexion ```
26
What is the extension synergy in the lower extremity?
Hip extension, adduction and internal rotation knee extension ankle plantar flexion and inversion toe plantar flexion
27
What are the myotomes we are responsible for knowing (C5 - T1) and (L1 - S1)
``` C5 - shoulder ABD C6: elbow flexion and wrist extension C7: elbow extension and wrist flexion C8: finger flexion and thumb extension T1: finger adduction L1 - L2: hip flexion L3: knee extension L4: ankle dorsiflexion L5: great toe extension S1: plantar flexion S2: Knee flexion ```
28
When we look at myotomes, our patient should be _________ and __________ movements should be observed
seated; isolated
29
stretch reflex dysfunction is damage to:
supraspinal structures involved in reflex modulation such as --------the cerebellum and the corticospinal tract, reticulospinal tract, rubrospinal tract, ---- --------vestibulospinal tracts spinal cord (interneurons and motor neurons) sensory feedback systems
30
hyporeflexia (or areflexia) is a __________ motor neuron injury
lower
31
hyperreflexia is a ___________ motor neuron injury
upper
32
What neuroanatomical structures are involved with hyporeflexia?
alpha motor neuron and sensory neuron
33
what neuroanatomical structures are involved in hyperreflexia?
supraspinal structures and spinal cord structures
34
What deep tendon reflexes are we responsible for knowing? | (C5 - C7), L4 and S1
``` C5 - biceps C6 - brachioradialis C7 - triceps L4 - patella (quadriceps) S1 - Achilles (gastrocsoleus complex) ```
35
What are the deep tendon reflex grades?
``` 0: absent 1+ hyporeflexia 2: normal 3+ hyperreflexia 4+ hyperreflexia with nonsustained clonus 5+ hyperreflexia with sustained clonus ```
36
A positive babinski's test is characterized by:
fanning or extension of the toes to a stimulus
37
Tone is characterized by:
a muscle's resistance to passive stretch
38
tone represents a state of:
slight residual contraction in normally innervated resting muscle (steady-state contraction)
39
What are contributions to normal tone influenced by?
physical inertia intrinsic mechanical elastic reflex spinal reflex muscle contraction or tonic stretch reflex
40
the spinal reflex muscle contraction consists of:
a net balance of descending input on motor neurons from corticospinal, rubrospinal, reticulospinal, and vestibulospinal tracts cerebellar input
41
hypotonicity is characterized by:
reduction in passive resistance to lengthening floppy - collapse into gravity, harder to excite flaccidity - complete loss of muscle tone
42
hypotonicity is caused by - afferent input from: - lack of _____________ efference influence - decreased input to:
stretch reflex cerebellar gamma motor neurons
43
what are the common pathologies that can cause hypotonicity?
- cerebellar lesions, down syndrome, late-stage ALS, muscular dystrophies, and post-polio - acute CNS injuries that can progress to hypertonicity/spasticity once subacute or chronic - can see with PNS injuries and connective tissue disorders
44
What is speed dependent?
spasticity
45
what is resistant to movement and independent of movement velocity?
rigidity
46
Spasticity occurs as a result of damage to:
descending pyramidal tracts | causes a loss of inhibitory effect on tonic stretch reflex and results in alterations to the threshold of reflex
47
spasticity CAN be associated with ___________, a condition that is more common in distal extremities than proximal
clonus
48
clonus and spasticity are characterized as a ___________ and oscillating stretch reflex.
rhythmic
49
What is commonly seen with basal ganglia dysfunction?
rigidity
50
rigidity is more commonly seen in our __________
flexors
51
Define the phrases that are associated with rigidity: Lead pipe cogwheel clasp - knife
lead pipe = constant resistance to movement throughout the entire ROM cogwheel = alternating episodes of resistance and relaxation clasp knife = initial rigidity with sudden absence throughout the remainder of range
52
What kind of posturing will we see when there is a brainstem lesion above the red nucleus? Describe what that posturing looks like.
decorticate; UE flexion, LE extension/ IR/ and PF
53
What kind of posturing will we see when there is a brainstem lesion below the red nucleus? Describe what that posturing looks like.
decerebrate: UE and LE extension
54
What are functional implications associated with someone who has high tone?
abnormal posturing misalignment high risk of injury during prolonged sitting (skin breakdown) bias with recruitment and increased likelihood of synergistic movement destabilization with changes in position
55
What are the functional implications associated with someone who has a lower tone?
fall into gravity | high risk of injury associated during dynamic tasks
56
Tone assessment in UE consists of what motions at the shoulder, elbow, wrist, and hand?
shoulder - flex/ext. and IR/ER elbow - Pronation/supination and flexion/extension wrist - flex/extension fingers - flex/extension
57
Tone assessment in LE consists of what motions at the hip, knee, ankle, and foot?
hip - abd/add. and flex/exten. and IR/ER knee - flexion and ext. ankle - DF and PF foot - toe flex. and extension
58
What test measures spasticity and spasticity alone?
modified ashworth scale
59
Describe what happens at V1, V2, and V3 on the Tardieu scale.
V1 - slow as possible - PROM assessment V2 - speed of limb falling under gravity - Spasticity assessment V3 - fast as possible - spasticity assesment
60
Dystonia is seen when there is damage to:
the basal ganglia
61
A syndrome dominated by sustained muscle contractions that causes twisting, repetitive movements, and abnormal postures is called:
dystonia
62
What are the 5 characteristics of dystonia?
- damage to the basal ganglia - syndrome dominated by sustained muscle contractions - causes twisting, repetitive movements, and abnormal postures - coactivation of agonist and antagonist - focal, segmental, hemibody or generalized/ whole
63
rhythmic, involuntary oscillatory movements of a body part are called:
tremors
64
What are resting tremors?
occurs in the body part that is not voluntarily activated, relaxed
65
what are action tremors?
tremors produced by voluntary contraction of a muscle
66
Name and describe the 2 types of action tremors?
postural tremors - person maintains a part of body against gravity intention tremors - produced with purposeful movement
67
Slow, writhing and twisting movements typically found in the UE more than in the LE are characterized by a disorder called:
athetosis
68
involuntary, rapid, irregular, and jerky movements seen with Huntington's disease are characterized by a condition called?
choreiform

Neuroscience (10 decks)

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