CVA Impairments 1: motor based

Question 1

Mild ipsilateral weakness can be seen post-CVA and is most notably observed in ________________

Answer 1

proximal muscles

Question 2

Common patterns of weakness between muscle pairs:

Answer 2

Ext > flex (EXCEPT: DF > PF)
ER > IR
ABD > ADD
Evertors > Inverters

Question 3

Motor control

Answer 3

the underlying substrates of neural, physical, and behavioral aspects of movement

Question 4

Reactive (feedback) and proactive (feedforward) movement is associated with

Answer 4

motor control

Question 5

Motor Plan

Answer 5

an idea or plan for purposeful movement that is made up of component motor programs.

Question 6

Motor program

Answer 6

An abstract representation that when initiated results in the production of a coordinated movement sequence.

Question 7

Motor learning

Answer 7

A set of internal processes associated with feedback or practice leading to relatively permanent changes in the capability for motor skills.

Question 8

Motor Recovery

Answer 8

the reappearance of motor patterns present prior to CNS injury performed in the same manner as prior to injury

Question 10

Motor compensation

Answer 10

The appearance of new motor patterns resulting from changes in CNS

Question 11

Adaptation and substitution are associated with

Answer 11

motor compensation

Question 12

Common impairments of motor control

Answer 12

Abnormal synergies and apraxia

Question 13

UE flexion synergy

Answer 13

• Scapular retraction/elevation or hyperextension
• Shoulder ABD, ER
• Elbow FLEX*
• Forearm supination
• Wrist finger flexion

Question 14

LE Flexion synergy

Answer 14

• Hip flexion*, abd, ER
• Knee flex
• Ankle DF, Inversion
• Toe DF

Question 15

UE Extension Synergy

Answer 15

• Scapular protraction
• Shoulder ADD*, IR
• Elbow EXT
• Forearm pronation
• Wrist and finger FLEX

Question 16

LE Extension Synergy

Answer 16

• Hip EXT, ADD*, IR
• Knee EXT
• Ankle PF*, Inversion
• Toe PF

Question 17

Apraxia

Answer 17

Inability to plan and execute purposeful movements that cannot be accounted for by any other reason.

Question 18

Ideomotor Apraxia

Answer 18

Inability to produce movement on command but able to move automatically, conceptualization of task remains intact.

Question 19

Ideational apraxia

Answer 19

inability to produce movement on command or automatically, complete breakdown of conceptualization of task

Question 20

Stage 1 of Motor Recovery

Answer 20

period of flaccidity immediately following acute episode.

Question 21

Stage 2 of Motor Recovery

Answer 21

• limb synergies/components may appear
• minimal voluntary movement
• spasticity begins

Question 22

Stage 3 of Motor Recovery

Answer 22

• Voluntary control of movement synergies
• Increase spasticity (may become severe)

Question 23

Stage 4 of Motor Recovery

Answer 23

• Movement combos that do not allow the paths of synergy are mastered (difficult > ease)
• Spasticity begins to decline

Question 24

Stage 5 of Motor Recovery

Answer 24

• More difficult movement combos are learned
• Synergies start to lose their dominance over motor acts.

Question 25

Stage 6 of Motor Recovery

Answer 25

- Disappearance of spasticity - Individual joint movements become possible and coordination approaches normal

Question 26

What four factors have a significant influence in a patient's progression through the stages of motor recovery

Answer 26

1. Initial weakness 2. Presence of spasticity 3. Cognitive deficits 4. Access to rehab

Question 27

Why is MMT not the best option to evaluate with a post-CVA patient?

Answer 27

MMT requires selective capacity (ability to isolate a single joint movement)

Question 28

The MDC for UE and LE of the Fugl-Meyer Assessment is

Answer 28

UE 5.4 points LE 5 points

Question 29

The MCID for the Fugl-Meyer Assessment for UE/LE is:

Answer 29

10 points for both

Question 30

The MCID of the Rivermead Motor Assessment is

Answer 30

3 points

Question 31

If unable to complete graded exercise testing what is the recommended exercise intensity and modifications to compensate for intensity.

Answer 31

Light to moderate exercise is recommended w/increased frequency and duration

Question 32

Dysynergia

Answer 32

fragmented movement patterns (movements occur in sequence of component parts rather than a single and coordinated smooth output)

Question 33

Asynergia

Answer 33

loss of ability to associate muscles together for complex movements

Question 34

Ataxia

Answer 34

uncoordinated movements that manifest when voluntary movements are attempted

Question 35

Classification of ataxia:

Answer 35

Cause or Location (limb, truncal, gait)

Question 36

What is tone

Answer 36

muscle's resistance to passive stretch

Question 37

Describe the progression of tone abnormalities with an UMN injury

Answer 37

temporary hypotonia (Acute) > development of spasticity (subacute/chronic)

Question 38

Common UE areas of spasticity

Answer 38

Scapula retractors, downward rotators Shoulder IR, adductors Elbow flexors Forearm pronators Wrist/hand flexors, finger adductors

Question 39

Common LE areas of spasticity

Answer 39

Hip adductors, IR, extensors Knee flexors Ankle/foot PF, inverters, toe flexors

Question 40

Primitive and tonic reflexes can return in patients with

Answer 40

extensive brain damage