M1-L10: Ax Neurological - Movement Disorders

Question 1

What are the ICF body functions and structures in the neurological assessment item?

Answer 1

Question 2

What is a deep tendon reflex (DTR)?

Answer 2

1. Monosynaptic stretch reflex
2. Same mechanism in children as adults

Question 3

How can Deep Tendon Reflex be tested in older children?

Answer 3

Test using tendon hammer in older children.

Question 4

How can Deep Tendon Reflex be tested in infants?

Answer 4

Can use finger tips for small infant muscles.

• Just use 3 fingers but still be firm

Question 5

In a baseline assessment, what are 4 Deep Tendon Reflexes (DTR) that should typically be tested?

Answer 5

1. Quads
2. Gastrocs
3. Biceps Brachii
4. Brachioradialis

Question 6

What does a brisk reflex in the Deep Tendon Reflex (DTR) mean?

Answer 6

hyper-reflexia

• Often seen with high tone

Question 7

What does a reduced reflex in the Deep Tendon Reflex (DTR) mean?

Answer 7

hypo-reflexia

• Seen with low tone or flaccid paralysis

Question 8

What happens when there is no response in the Deep Tendon Reflex (TDR)?

Answer 8

No response = try again (relaxed position), get hands pulling apart/clench teeth/ stress balls to raise tone (Gentracic maneouvre)

Question 9

What is spasticity?

Answer 9

A motor disorder characterised by velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex, as one component of the UMN syndrome

Question 10

What are 3 features that spasticity is sinificantly influenced by?

Answer 10

1. the testing posture,
2. the initial length from which the muscle is stretched
3. as well as any sensory [or emotional] stimulation
   4.

Question 11

What are 2 pathological mechanism of spasticity?

Answer 11

1. Brain or Spinal Cord Injury
   
   • Loss of central inhibition of the spinal reflex arcs, resulting in hyper-excitability of primary motor neurons that are activated by inputs which otherwise would not provoke a response and so result in inappropriate co-activation of muscles
2. Segmental hyper-excitability
   
   • Increased reflex sensitivity at the segmental level of the spinal cord -modulated by a complex interaction of varying supraspinal inputs

Question 12

What is the pathological mechanism of CNS/spinal cord for spasticity?

Answer 12

Question 13

How is spasticity tested in assessment?

Answer 13

• Move limb passively through ROM at range of velocities
• Slow velocity may not evoke an abnormal reflex
• Abnormal response appears as velocity increases

Question 14

What are 7 features of increasing spasticity in the assessment (what does it feel like)?

Answer 14

Question 15

What is the implication of kids with spasticity over a long period of time?

Answer 15

Kids with spasticity over long periods of time will have CONTRACTURE (MSK vs Neurological)

Question 16

WHat is the criterion validity in spasticity assessment?

Answer 16

Test compliance with concept of spasticity

Question 17

What are the 3 standarisation in the validity of spasticity assessment?

Answer 17

1. Movement velocities
2. Testing posture
3. Quantification of spasticity

Question 18

What are 2 features of clarityin scoring systems in the validity of spasticity assessment?

Answer 18

1. Scaling
2. Terminology

Question 19

What is the clinical applicability in the validity of spasticity assessment?

Answer 19

Time required to complete testing

Question 20

Is the orginal scale in Ashworth Scale valid? Why?

Answer 20

Original scale is not valid

Grades the resistance encountered in a specific muscle group by means of passively moving the limb through its ROM

• Not appropriate unless 2 speeds used

Question 21

When is the Ashworth Scale valid? Why?

Answer 21

Modified Ashworth Scales

• Most have non-specified velocity
  
  • Modified Ashworth – Peacock
  • Modified Ashworth – Bohannon

May be valid if 2 speeds used

• NYU Tone Scale -includes slow & fast speeds
• Some others retrospectively modified to add slow and fast speeds
• Still not the preferred scale

Question 22

What is the Ashworth Scale?

Answer 22

Question 23

What is the Tardieu (or Held) Scale? What are the 3 things it assesses?

Answer 23

1. Passively move the joint at 3 velocities (V1-°©3)
   
   1. As slow as possible
   2. At speed of limb fall under gravity
   3. As fast as possible
2. Rate the intensity and duration of the muscle reaction to stretch (X0-4)
   
   • 0 No reflex
   • 1 Only visible contraction
   • 2 Contraction with a short catch
   • 3 Contract few sec / fatigable clonus (< few sec)
   • 4 Contract >few sec / infatigable clonus (>few sec)
3. Record the joint angle (Y) where muscle reaction is first felt

Question 24

What is the Modified Tardieu (or Held) Scale? What are the 3 things it assesses?

Answer 24

1. Passively move the joint at 2 velocities (V1 + V3)
   
   1. As slow as possible
   2. As fast as possible
   • Sometimes miss speed 2 (if not enough time also this speed is harder to be reliable)
2. Rate the intensity and duration of the muscle reaction to stretch (X0-°©4)
   
   • 0 No reflex
   • 1 Only visible contraction
   • 2 Contraction with a short catch
   • 3 Contract few sec / fatigable clonus (< few sec)
   • 4 Contract >few sec / infatigable clonus (>few sec)
3. Record the joint angle (Y) where muscle reaction is first felt

Question 25

What are the normal popliteal angle for children aged 1-5+ years old?

Answer 25

Question 26

What is the static and dynamic (spastic) contracture? **PRAC EXAM QUESTION**

Answer 26

Question 27

What are the LL test positions in the MTS?

Answer 27

Question 28

What is the dirstibution in the ACPR form?

Answer 28

Question 29

What are the 3 distributions in clinical observation of spasticity?

Answer 29

1. Often more evident proximally 2. Reduced movement in affected parts 3. No involuntary movements in severely affected parts

Question 30

What are the 3 secondary effects in clinical observation of spasticity?

Answer 30

1. Contractures towards mid position 2. Balance reactions affected 3. Functional problems e.g.: drinking 4. Emotion – frightened by movement

Question 31

What are 5 factors proposed to increase spasticity?

Answer 31

1. Use of spasticity to move 2. Associated reactions 3. Lack of movement 4. Stimulation (internal and external) 5. Repetition of movements within the pattern of spasticity

Question 32

What are 3 types of dyskinesias?

Answer 32

1. Dystonia 2. Athetosis 3. Chorea

Question 33

What is dyskinesia?

Answer 33

A motor disorder characterized by changes in muscle tone and posture, with a varying element of involuntary movement

Question 34

What is dyskinesia caused by?

Answer 34

Caused primarily by damage to the basal ganglia

Question 35

What is dystonia?

Answer 35

Movement disorder - in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both * More excited/arousal --\> more contractions

Question 36

What is dystonia caused by?

Answer 36

Caused by damage (usually hypoxic–ischemic injury) to the basal ganglia, thalamus, brainstem and/or cerebellum during the prenatal, perinatal, or infantile period * Cause not well known, but some element of genetic pre-disposition and environmental factors)

Question 37

Dystonia may be triggered by ______ movement and may overflow into other muscles and can be _____ .

Answer 37

voluntary; painful

Question 38

Why are people with dystonia quite lean?

Answer 38

High metabolism due to high energy consumption = weight (quite lean)

Question 39

What is athetosis?

Answer 39

Slow, continuous, involuntary, writhing movements that prevents a stable posture from being maintained

Question 40

Where is athetosis often seen?

Answer 40

Often seen in the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue

Question 41

What is athetosis caused by?

Answer 41

Caused by lesions to the basal ganglia (corpus striatum - which controls movement in relation to motivation – i.e. decision to make, or to suppress a movement) or thalamus

Question 42

What are the 2 most common causes of athetosis in children?

Answer 42

1. intranatal asphyxia 2. neonatal jaundice(hyperbilirubinemia)

Question 43

What is chorea?

Answer 43

(=Greek ‘dancing’) -°© quick, involuntary movements of the feet or hands an ongoing random appearing sequence of one or more discrete involuntary movements or movement fragments

Question 44

What is chorea caused by?

Answer 44

In most forms of chorea, an excess of dopamine, the main neurotransmitter used in the basal ganglia, prevents the basal ganglia from functioning normally.

Question 45

In children, _____ and _____ occur together most often. This is called\_\_\_\_\_\_.

Answer 45

chorea; athetosis; Choreoathetosis

Question 46

What are the 2 characteristics of the Hypertonia Assessment Tool?

Answer 46

1. Use to identify dystonia v spasticity 2. Most important items 1 & 2

Question 47

What are 6 tools identified in the Dyskinesia Rating Scales?

Answer 47

1. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) 2. **Barry Albright Dystonia Scale (BAD) – most common, best for clinic** 3. Unified Dystonia Rating Scale (UDRS) 4. Movement Disorder Childhood Rating Scale (MD-CRS) 5. Movement Disorder Childhood Rating Scale for 0 – 3 years (MD-CRS 0-3) 6. **Dyskinesia Impairment Scale (DIS) – most thorough, best for CP register**

Question 48

What are 2 main tools identified in the Dyskinesia Rating Scales?

Answer 48

1. Barry Albright Dystonia Scale (BAD) – most common, best for clinic * Very short and only covers dystonia 2. Dyskinesia Impairment Scale (DIS) – most thorough, best for CP register * Covers all types of movement disorders

Question 49

What are the 5 types of ratings in the Dyskinesia Rating Scales?

Answer 49

1. Movement severity * 0 = none;; 1 = slight;; 2 = mild;; 3 = moderate;; 4 = severe 2. Movement trigger * 0 = none;; 1 = on particular action;; 2 = on many actions;; 3 = on action of distant body part/intermittently at rest;; 4 = present at rest 3. Movement duration * 0 = none;; 0.5 or 1 = Occasional (\<25% of time);; 1.5 or 2 = Intermittent (25-50%); 2.5 or 3 = Frequent (50-ˇ75%); 3.5 or 4 = Constant (\>75%) 4. Movement range / extent * 0 = none;; 1 = mild (\<25% ROM);; 2 = moderate (25-50% ROM);; 3 = severe (50-ˇ75% ROM);; 4 = extreme (\>75% ROM) 5. Disability impact * 0 = normal;; 1 = slight but independent;; 2 = some ability/needs some help;; 3 = marked difficulty/requires help;; 4 = completely dependent

Question 50

What is the Barry Albright Dystonia Scale?

Answer 50

1. Most simple scale 2. Best for use in a busy clinic where repeated measures are needed