05-05c: Tone, Motor Control Flashcards Preview

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Flashcards in 05-05c: Tone, Motor Control Deck (37):

Definition of tone

- Resistance of muscle to passive elongation or stretch (PROM)
- Not a contracture
- Not voluntary resistance to movement


Reasons for Tone

- Physical inertia
- Intrinsic mechanical-elastic stiffness of muscle and connective tissue
- Reflex muscle contraction (tonic stretch reflex)


What affects tone

- Voluntary effort
- Anxiety and pain
- Position and interaction of tonic reflexes
- Ambient temperature (cold facilitates, warm inhibits)
- Medication
- State of arousal



Increased tone about normal resting levels



- Decreased tone below normal resting levels
- Low tone can include flaccidity
- Diminished resistance to passive stretch
- Stretch reflexes are dampened or absent
- Limbs "floppy", easily moved
- Associated with LMN lesions
- Can use quick stretch to activate spindle fire



- Impaired or disordered tonicity
- Involuntary movements involving large portions of the body
- Hyperkinetic movement disorder
- Associated with CNS lesions involving basal ganglia; inherited conditions; Neurodegenerative diseases (Parkinson's); Metabolic disorders; Torticollis; Writer's cramp


Types of hypertonicity (2)

Spasticity, Rigidity



- Characteristic of UMN lesions
- Velocity dependent resistance to passive stretch (larger and quicker the stretch, the stronger the spasticity)
- Clasp-knife response (sudden inhibition or letting go; sudden release)


Chronic spasticity may result in...

- Contractures
- Abnormal posturing
- Deformities
- Functional limiations
- Disability



- Cyclical, spasmodic alternation of muscular stretch of a spastic muscle
- Normal; common in plantar flexors, wrist and jaw


Clonus Scale

1 = no clonus
2 = minimal clonus (1-2 beats)
3 = moderate clonus (3-9 beats)
4 = sustained clonus (10+ beats)



- Lesions of basal ganglia
- Characteristic of uniform resistance throughout the entire ROM
- Velocity independent resistance to passive ROM
- Leadpipe: Heavy load makes high resistance
- Cogwheel: Catch-release jerkiness, commin in UE movements in pts with Parkinson's; May have tremor on top of rigidity


Chronic rigidity may result in...

- Stiffness
- Inflexibility
- Significant functional limitations


Spasticity vs. Rigidity

- Spasticity: Increase in muscle tone (velocity dependent)
- Rigidity: No effect in tone (not velocity dependent)


Decorticate Rigidity

- Results from severe brainstem involvement (BI)
- Pt is in coma
- Abnormal flexor pattern
- UE in flexion (elbow, wrist, fingers, shoulder adduction), LE in extension (Ext, IR, PF)


Decerebrate Rigidity

- Results from severe brainstem involvement (BI)
- Pt is in coma
- Abnormal extensor pattern
- UE in extension (elbow ext, wrist flex, fingers flex, forearm pronation, shoulder adduction), LE in extension (Ext, IR, PF)


Tone Scale

0 = No response (flaccidity)
1+ = Decreased response (hypotonia)
2+ = Normal
3+ = Exaggerated response (mild to moderate hypertonia)
4+ = Sustained response (severe hypertonia)


Modified Ashworth Scale

0 = No increase in muscle tone
1 = Slight increase in muscle tone, manifested by catch-release or by min resistance at end of ROM when affected part is moved in flexion/extension
1+ = Slight increase in muscle tone, manifested by a catch, followed by min resistance throughout the remainder (less than half) of ROM
2 = Marked increase in tone through most of ROM, but affected parts easily moved
3 = Considerable increase in tone, passive movement difficult
4 = Affected parts rigid in flexion or extension

- "Gold standard" for hypertonicity
- Inability to detect small changes
- Limited application (only for extremity)
- Inability to distinguish soft tissue viscoelasticity and neural changes


Documentation of tone includes...

- Location
- Type of tone
- Symmetrical/Asymmetrical (both sides? one side?)
- Resting postures (Position at rest)
- Factors that influence tone (speed of movement, anxiety, pain)
- Effects of tone on function


Development of motor/functional skills

- Mobility
- Stability
- Controlled mobility
- Skill



Ability to consistently perform coordinated movement sequences for purposes of attaining an action goal


Mobility/Transitional Mobility

- Ability to move through functional ROM (from one position to another independently and safely)
- Initiating, controlling and terminating movement


Stability/Static Postural Control

Ability to maintain a position or posture with center of mass (COM) staying over the BOS with body not in motion


Controlled mobility/Dynamic balance

Ability to move within WB position or rotate around a long axis
- Maintain postural stability and COM over BOS while parts of body are in motion


Motor control theory

- Ability to produce, regulate and alter mechanisms that produce movement and control posture
- Task-specific training to reduce impairment


Motor control interventions do...

- Resolve impairment (body, not cellular level)
- Retrain using functional tasks (reprogram brain)
- Design/implement recovery strategies
- Design/implement compensatory strategies (last option when recovery is insufficient)



Ability to modify or change at the synapse level either temporarily or permanently in order to perform a certain function
- (neuro) Capacity for brain and nerve cells to repair and change in response to experience or environment
- allows recovery of function after injury or disease


Motor learning

Ability to perform movement as a result of internal processes that interact with the environment and produce a consistent strategy to generate the correct movement
- Relatively permanent changes in ability to perform skilled behavior
- Includes practice and experience to facilitate (i.e., piano, drumming, typing)


Postural control

- Ability of the motor and sensory systems to stabilize position and control movement
- Maintain posture while performing functional tasks



- Plan used to produce a specific result or outcome that will influence structure or system
- Treatment = development of most effective strategies



- Adoption of alternative behavioral strategies to complete a task
- Different muscles, movement, adapteive equipment substitute for loss of function
- AFO, crutches, cane, splints = compensatory devices


Motor recovery

- Reacquisition of movement skills lost through injury
- Movements may be modified, but task completed without compensation
- Relies on neuroplasticity



- Ordinal scale measures recovery after CVA
- Brunnstrom's sequence of recovery
- Assesses 1) joint movement and pain, 2) balance, 3) UE motor function, 4) sensation, 5) LE motor function


Fugi-Meyer Scoring

- Each item scored 0-3
- Cumulative, max score is 100; can be interpreted as percentage of motor recovery
- Lower the score, higher the disability


Rivermead Motor Assessment

- NDT approach to neurological recovery
- Self-report
- 3 sections: 1) Gross function, 2) leg and trunk, 3) arm
- Each section has subscale of tasks that increase in difficulty


Rivermead Motor Assessment Scoring

- 1 for completion of task, 0 for inability
- Can stop test if cannot perform 3 tasks in a row


Upright motor control test

- Incorporates upright posture and WB
- Simulates stance and swing phases of gait
- Requires 2 people to administer (one to stabilize, one to cue
- 2 sub tests: Flexion Control (swing phase), Extension Control (stance phase)