Examination of Motor Function in Neurologic PT Flashcards by Emily Renner

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

brown sequard syndrome

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s/s of UMN lesion

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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s/s of LMN lesion

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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the resistance of a muscle to a passive elongation or stretch

tone

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what is tone influenced by

physical inertia, intrinsic muscle stiffness, spinal reflexes

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occurs following CNS (UMN) injury or disorder

hypertonicity

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what are the different types of hypertonicity

spasticity, rigidity, decorticate/decerebrate rigidity

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

clasp-knife response

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velocity-dependent resistance to PROM/stretch

spasticity

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what is spasticity associated with

contractures, abnormal posturing, functional limitations, disability

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spasticity occurs due to CNS injuries of

pyramidal and brainstem tracts

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rhythmic spasmodic contractions in response to a sustained stretch

clonus

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where is clonus most common

PFs, jaw, wrist

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hypertonic state that is not velocity-dependent

rigidity

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what are the two types of rigidity and describe them

cogwheel: ratchet like resistance, jerkiness
leadpipe: stiffness, inflexibility throughout ROM

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ridigity often occurs with damage to what CNS structures

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

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UE and LE extension

decerebrate

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

superior colliculus and vestibular nucleus

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UE flexion and LE extension

decorticate

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decordicate associated with corticospinal tract lesion above what structure

superior colliculus

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spasticity occurs due to CNS injuries to what tracts

pyramidal and brainstem tracts

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prolonged involuntary twisting/writhing with increased muscle tone

dystonia

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sustained abnormal postures due to co-contraction of muscles

dystonic posturing

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dystonia is associated with lesions where

basal ganglia

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decreased or absent muscle tone (flaccidity)

hypotonia

hypotonia usually seen in LMN disease affecting what

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

are cerebellar lesions associated with hyper or hypotonia

hypotonia

factors influencing tone

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

the modified ashworth scale is only used to assess what

spasticity ONLY

measuring tone scoring

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

MAS scoring

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

CN associated with nasal cavity and anterior cerebellum

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

2, 3, 4

CN associated with Lesions to pons

5, 6

CN associated with Lesion to junction between pons and medulla

7, 8

CN associated with lesions to medulla

9, 10, 11, 12

CN associated with lesions to C1-5

patterns of muscle innervation that corresponds to specific spinal segments

myotomes

loss of muscle bulk (wasting)

atrophy

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

disuse atrophy

what muscles does disuse atrophy typically occur

antigravity muscles

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

neurogenic atrophy

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

strength

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

power

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

weakness

partial weakness, both UMN and LMN lesions

paresis

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

plegia

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

- polio (LMN) - not validated for UMN because may have pathologic synergies, spasticity, contractures

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

poor

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

fair

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

good

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

normal

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

muscle endurance

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

fatigue

limit of endurance beyond which no further performance is possible

endurance

ways to examine fatigue

- self-reported instruments - performance-based activities (timed tests) - sub-max isokinetic testing

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

synergies

what type of synergy is most common in UE

flexor

what type of synergy is most common in LE

extensor

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

task analysis

spasticity occurs due to CNS injuries of

pyramidal and brainstem tracts

what are the 3 functions of the vestibular system

- 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

what structure gets deflected due to endolymph movement

cupula

what do the superior and inferior vestibular N individually innervate

- Sup: ant and horizontal SCC and utricle - Inf: post SCC and saccule

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

L nystagmus (L excited and R inhibited)

what direction is the nystagmus named by

named based on the fast phase (excitatory)

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

clear C/s

what does the head impulse/head thrust test assess

VOR

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

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

what does the head shake test assess

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

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

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

what does the dix-hallpike assess and which canals

BPPV anterior and posterior SCC

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

nystagmus in the direction indicative of anterior or posterior SCC BPPV testing the side/ear that is down

what type of issue is BPPV

mechanical

what does the roll test assess and which canals

horizontal BPPV horizontal SCC

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

nystagmus and vertigo (lateral beating nystagmus) Geotropic: fast phase toward floor Ageotropic: fast phase toward ceiling