Examination of Motor Function in Neurologic PT Flashcards

1
Q

what is the name of the dx in which there is damage only to 1/2 of the spinal cord

A

brown sequard syndrome

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2
Q

s/s of UMN lesion

A

Hypertonia, rigidity, spasticity
Hyperreflexia, (+) babinski, clonus, primitive reflexes present
Paresis/plegia
Muscle spasms
Disuse atrophy, variable, widespread
Especially in antigravity muscles
Impaired voluntary movements, pathological synergies

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3
Q

s/s of LMN lesion

A

Hypotonia, flaccidity (floppy)
Hyporeflexia - diminished or absent
Ipsilateral weakness, may be isolated to a nerve root or focal pattern
May see visible fasciculations (muscle twitching); fibrillations seen on needle EMG → we cannot see them with naked eye
Neurogenic atrophy, severe wasting (due to damage of a peripheral nerve)
Movement patterns may appear abnormal due to weakness

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4
Q

the resistance of a muscle to a passive elongation or stretch

A

tone

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5
Q

what is tone influenced by

A

physical inertia, intrinsic muscle stiffness, spinal reflexes

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6
Q

occurs following CNS (UMN) injury or disorder

A

hypertonicity

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7
Q

what are the different types of hypertonicity

A

spasticity, rigidity, decorticate/decerebrate rigidity

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8
Q

what is the name for the catch-release sensation associated with spasticity

A

clasp-knife response

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9
Q

velocity-dependent resistance to PROM/stretch

A

spasticity

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10
Q

what is spasticity associated with

A

contractures, abnormal posturing, functional limitations, disability

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11
Q

spasticity occurs due to CNS injuries of

A

pyramidal and brainstem tracts

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12
Q

rhythmic spasmodic contractions in response to a sustained stretch

A

clonus

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13
Q

where is clonus most common

A

PFs, jaw, wrist

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14
Q

hypertonic state that is not velocity-dependent

A

rigidity

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15
Q

what are the two types of rigidity and describe them

A
  • cogwheel: ratchet like resistance, jerkiness
  • leadpipe: stiffness, inflexibility throughout ROM
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16
Q

ridigity often occurs with damage to what CNS structures

A

basal ganglia and extrapyramidal tracts
(Ex: parkinson’s and huntington’s)

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17
Q

UE and LE extension

A

decerebrate

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18
Q

decerebrate is associated with corticospial tract lesion in the brain stem between what structures

A

superior colliculus and vestibular nucleus

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19
Q

UE flexion and LE extension

A

decorticate

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20
Q

decordicate associated with corticospinal tract lesion above what structure

A

superior colliculus

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21
Q

spasticity occurs due to CNS injuries to what tracts

A

pyramidal and brainstem tracts

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22
Q

prolonged involuntary twisting/writhing with increased muscle tone

A

dystonia

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23
Q

sustained abnormal postures due to co-contraction of muscles

A

dystonic posturing

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24
Q

dystonia is associated with lesions where

A

basal ganglia

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25
Q

decreased or absent muscle tone (flaccidity)

A

hypotonia

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26
Q

hypotonia usually seen in LMN disease affecting what

A

anterior horn cells or peripheral nerves
can also be seen with cerebellar lesions

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27
Q

are cerebellar lesions associated with hyper or hypotonia

A

hypotonia

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28
Q

factors influencing tone

A

time of day, volitional effort required, body posture, anxiety, pain, medications, ambient temperature and state of CNS arousal or alertness, and bladder fullness, electrolyte balance, fever/infection will affect tone

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29
Q

the modified ashworth scale is only used to assess what

A

spasticity ONLY

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30
Q

measuring tone scoring

A

0 - no response (flaccidity)
1 - decreased response (hypotonia)
2 - normal response
3 - exaggerated response (mild-mod hypertonia)
4 - sustained response (severe hypertonia)

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31
Q

MAS scoring

A

0: no response
1: slight increase in muscle tone, manifested by a catch and release or minimal resistance at end-range
1+: slight increase in muscle tone, manifested by a catch followed by minimal resistance t/o the remainder (less than ½) ROM
2+: more marked increase in muscle tone through most of ROM, but affected parts easily moved
3+: considerable increase in muscle tone, passive movement difficult
4+: affected parts rigid in flexion or extension

32
Q

CN associated with nasal cavity and anterior cerebellum

A

C1

33
Q

CN associated with Lesions to optic chiasm, optic radiations, midbrain, and visual cortex

A

2, 3, 4

34
Q

CN associated with Lesions to pons

A

5, 6

35
Q

CN associated with Lesion to junction between pons and medulla

A

7, 8

36
Q

CN associated with lesions to medulla

A

9, 10, 11, 12

37
Q

CN associated with lesions to C1-5

A

11

38
Q

patterns of muscle innervation that corresponds to specific spinal segments

A

myotomes

39
Q

loss of muscle bulk (wasting)

A

atrophy

40
Q

loss of functional mobility, develops slowly over time (weeks to months)

A

disuse atrophy

41
Q

what muscles does disuse atrophy typically occur

A

antigravity muscles

42
Q

associated with LMN, usually occurs rapidly within 2-3 weeks

A

neurogenic atrophy

43
Q

muscle force exerted by a muscle or group of muscles to overcome resistance under specific circumstances

A

strength

44
Q

work produced by a muscle per unit of time (strength x speed)

A

power

45
Q

inability to generate sufficient levels of force - occurs in both UMN and LMN pathologies

A

weakness

46
Q

partial weakness, both UMN and LMN lesions

A

paresis

47
Q

absence of muscle strength (no voluntary movement), mostly UMN pathology

A

plegia

48
Q

what population was MMT originally developed for and what population is it not valid for

A
  • polio (LMN)
  • not validated for UMN because may have pathologic synergies, spasticity, contractures
49
Q

MMT estimated grade for muscles with visible contraction but cannot overcome gravity or move through ROM

A

poor

50
Q

MMT estimated grade for muscles can move against gravity but cannot manage any resistance

A

fair

51
Q

MMT estimated grade for muscles can move against gravity and can take moderate resistance

A

good

52
Q

MMT estimated grade for muscles can move against gravity and can take strong resistance

A

normal

53
Q

ability to sustain forces repeatedly or generate force over time; determines functional capacity

A

muscle endurance

54
Q

overwhelming sustained sense of exhaustion and decreased capacity for physical and/or mental work at the usual level

A

fatigue

55
Q

limit of endurance beyond which no further performance is possible

A

endurance

56
Q

ways to examine fatigue

A
  • self-reported instruments
  • performance-based activities (timed tests)
  • sub-max isokinetic testing
57
Q

functionally linked muscles/muscle groups that work together cooperatively to produce an intended action

A

synergies

58
Q

what type of synergy is most common in UE

A

flexor

59
Q

what type of synergy is most common in LE

A

extensor

60
Q

Breaking down the parts of an activity to examine where deficits are occurring

A

task analysis

61
Q

spasticity occurs due to CNS injuries of

A

pyramidal and brainstem tracts

62
Q

what are the 3 functions of the vestibular system

A
  • stabilize visual images on fovea of the retina during head movement to allow clear vision
  • Maintaining postural stability especially during movements of the head
  • Provides CNS with exact information used for spatial orientation of the head in 3 dimensions
63
Q

what structure gets deflected due to endolymph movement

A

cupula

64
Q

what do the superior and inferior vestibular N individually innervate

A
  • Sup: ant and horizontal SCC and utricle
  • Inf: post SCC and saccule
65
Q

which way would the nystagmus be in you spin R and then stop

A

L nystagmus (L excited and R inhibited)

66
Q

what direction is the nystagmus named by

A

named based on the fast phase (excitatory)

67
Q

what is the first thing you have to do before performing vestibular tests

A

clear C/s

68
Q

what does the head impulse/head thrust test assess

A

VOR

69
Q

describe a positive head impulse/thrust test and what can a positive test indicate

A

inability to keep fixation on nose and they need saccadic eye movements to refocus on your nose → MUST occur every time
- the side that is affected is the side your are turning their head to
Ex: L side - L VOR intact = eyes look R when turn head L; L VOR not intact = eyes look L and follow movement of the head

(+) could be indicative of UVL, BVL, or central

70
Q

what does the head shake test assess

A

imbalance between sides; assesses if firing rate of both sides is equal

71
Q

describe a positive head shake test and what would a positive test indicate

A

nystagmus for at least 3 beats and dizziness
- Nystagmus toward the intact/active side
- Ex: L damage = R nystagmus

norm: no nystagmus

Positive indicated UVL
Will not be positive with BVL

72
Q

what does the dix-hallpike assess and which canals

A

BPPV
anterior and posterior SCC

73
Q

describe a postive dix-hallpike and which side are you testing

A

nystagmus in the direction indicative of anterior or posterior SCC BPPV

testing the side/ear that is down

74
Q

what type of issue is BPPV

A

mechanical

75
Q

what does the roll test assess and which canals

A

horizontal BPPV
horizontal SCC

76
Q

describe positive roll test and the different type of ways to describe the nystagmus

A

nystagmus and vertigo (lateral beating nystagmus)

Geotropic: fast phase toward floor
Ageotropic: fast phase toward ceiling