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Motor Examination Flashcards

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1
Q

Describe the difference between a sign and a symptoms.

A 
Sign = an objective measurement (BP, ROM, MMT, Reflexes)
Symptom = subjective reporting; patient report/feelings (pain, dizziness, nausea, anxiety)
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2
Q

Describe a primary impairment.

A

A direct effect of a pathology or lesion.

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3
Q

Describe a secondary impairment.

A

Developed as a result of the original problem.

Example = bed sore

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4
Q

What does a positive pathology presentation tell you?

A

That there is a presence of abnormal behavior.

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5
Q

What does a negative presentation of pathology tell you?

A

That there is an absence of normal behavior.

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6
Q

What type of signs do you see with an UMN lesion?

A
  1. Weakness
  2. Increased reflexes
  3. Increased tone
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7
Q

What type of signs do you see with a LMN lesion?

A
  1. Weakness
  2. Atrophy
  3. Fasciculations
  4. Decreased reflexes
  5. Decreased tone
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8
Q

What do the neural contributions of strength reflect?

A
  1. Number of motor units recruited
  2. Type of motor units recruited
  3. Discharge frequency
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9
Q

What do the MSK contributions to strength reflect?

A
  • Length of movement arm of the muscle
  • Length/tension relationship of the muscle
  • Cross-sectional area of muscle
  • Type of muscle fiber
  • Fiber arrangement
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10
Q

Describe weakness in the context of neuropathology.

A
  • The inability to generate force, which leads to loss of movement, loss of power.
  • The inability to correctly and/or adequately recruit or modulate motor neurons, leads to lack of muscle activity/immobility.
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11
Q

What may neurologically induced weakness result from?

A
  1. Cortical lesion
  2. Lesion in descending pathways.
  3. Peripheral nerve injury
  4. Synaptic dysfunction at neuromuscular junction
  5. Damage to muscle tissue
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12
Q

Does the extent and distribution of weakness depend on the extent and location of a lesion?

A

Yup.

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13
Q

What is paralysis or plegia?

A

Total or profound loss of muscle activity.

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14
Q

What is paresis?

A

Mild or partial loss of muscle activity.

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15
Q

Describe the different names of distribution for paralysis/plegia/paresis.

A 
Mono = one limb
Hemi = one side
Para = one half
Quad/tetra = whole body
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16
Q

What is a synergy?

A

When muscle/joint movements occur in stereotypical patterns. Can have flexor and extensor patterns.

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17
Q

Describe a flexor synergy (UE).

A

Scapula retraction and elevation, shoulder abduction and ER, elbow flexion, supination, wrist and finger flexion.

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18
Q

Describe a extensor synergy (LE).

A

Hip extension, adduction, IR, knee extension, ankle PF and inversion, toe PF.

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19
Q

What muscular actions would you perform for myotomes C5, C6, and C7?

A

C5 = shoulder abduction

C6 = elbow flexion, wrist extension

C7 = elbow extension, wrist flexion

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20
Q

What muscular actions would you perform for myotomes C8, T1, L1-L2?

A

C8 = finger flexion, thumb extension

T1 = finger adduction

L1-L2 = hip flexion

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21
Q

What muscular actions would you perform for myotomes L3, L4, L5, and S1?

A

L3 = knee extension

L4 = ankle dorsiflexion

L5 = great toe extension

S1 = plantarflexion

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22
Q

What position should you test myotomes in?

A

Seated!

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23
Q

Do you grade myotome testing?

A

Heck no! Looking for the duration that the patient can hold the position.

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24
Q

For reflex abnormalities (stretch reflex dysfunction), what structures might we see damage to?

Study These Flashcards
A
  1. Supraspinal structures involved in reflex modulation = **corticospinal tract, reticulospinal tract, rubrospinal tract, and vestibulospinal tracts; also cerebellum.
  2. Spinal cord = interneurons and motor neurons
  3. Sensory feedback systems.
25
What type of injury typically presents hyporeflexia (areflexia)? What neuroanatomy is damaged?
Lower motor neuron injury. Damaged = alpha motor neurons and/or sensory neurons.
26
What type of injury typically presents hyperreflexia? What neuroanatomy is damaged?
Upper motor neuron injury. Damaged = supraspinal structures and/or spinal cord structures.
27
What are the grades for deep tendon reflexes?
``` 0 = absent 1+ = hyporeflexia 2+ = normal 3+ = hyperreflexia 4+ = hyperreflexia + non-sustained clonus 5+ = hyperreflexia + sustained clonus ```
28
With the babinski's reflex, what type of reaction would be expected for a positive and negative test?
Positive = fanning (extension) of toes Negative = curling (flexion) of toes
29
Describe tone.
Characterized by a muscle's resistance to passive stretch. It represents a state of slight residual contraction in normally innervated, resting muscle.
30
What is hypotonicity?
The reduction in passive resistance to lengthening. Collapse into gravity and are harder to excite.
31
What are common pathologies that cause hypotonicity?
``` Cerebellar lesions Down syndrome Muscular dystrophies Late stage ALS Post polio Acute CNS injuries ```
32
What are the 2 types of hypertonicity?
Spasticity and rigidity
33
What is spasticity?
Velocity-dependent increase in resistance to passive movement.
34
What causes spasticity?
A result of damage to descending pyramidal tracts. A loss of inhibitory effect on tonic stretch reflex. - can be associated with clonus.
35
Is clonus typical in distal or proximal extremeties?
Distal extremities more so than proximal.
36
What is rigidity?
Heightened resistance to passive movement of the limb, independent of the velocity of the stretch.
37
What causes rigidity?
Commonly seen with basal ganglia dysfunctions
38
Where is rigidity predominantly seen?
In flexors!
39
Describe the 3 different categories of rigidity?
Lead pipe = constant resistance to movement throughout the entire ROM. Cogwheel = alternating episodes of resistance and relaxation Clasp-knife = initial rigidity with sudden absence throughout remainder of range.
40
What is posturing?
Rigidity at rest.
41
Describe decorticate rigidity.
Presents as UE flexion, LE extension/IR/PF. Caused by a brainstem lesion above red nucleus.
42
Describe decerebate rigidity.
Presents as UE and LE extension. Caused by a brainstem lesion below red nucleus.
43
What do we use to measure spasticity?
Modified Ashworth Scale
44
What is dystonia?
Syndrome dominated by sustained muscle contractions. Causes twisting, repetitive movements, abnormal postures. - Coactivation of agonist/antagonist - Primarily seen with damage to basal ganglia - Can happen focally, segmentally, hemibody, or generalized/whole
45
What are tremors?
Rhythmic, involuntary oscillatory movement of a body part. Can be intermittent or constant, sporadic or as a sequelae to disease of injury.
46
Describe a resting tremor
Occurs in body part that is not voluntarily activated, relaxed
47
Describe an action tremor
Any tremor that is produced by voluntary contraction of a muscle. Postural tremor = person maintains a part of body against gravity. Intention tremor = produced with purposeful movement.
48
What is choreiform?
Involuntary, rapid, irregular and jerky movements. | Seen with huntington's disease; side effect of PD medications.
49
What is athetosis?
Slow, writhing and twisting movements. typically seen in UE more than LE. Common in cerebral palsy.
50
What are the critical components of coordination?
Sequencing, timing, and grading
51
What is incoordination?
Movements that are awkward, uneven, inaccurate. A disruption of sequencing, timing, and grading. - Loss of coupling between synergistic joints and muscles
52
What type of injuries present with incoordination?
Lesions with motor cotrex, basal ganglia, cerebellar lesions, and proprioceptive lesion.
53
What are the grading/scaling dysfunctions of incoordination?
Dysmetria = issues with the path of getting to destination. Hypermetria = overshooting past target Hypometria = undershooting the target
54
List the functional implications of incoordination in regards to timing difficulties.
1. Increased reaction times 2. Slowed movement times 3. Difficulties terminating movement 4. Rebound phenomenon = doesn't happen in normal timing 5. Dysdiadokokinesia = inability to do rapid alternating movements
55
List the activation and sequencing problems of incoordination.
1. Abnormal synergies 2. Coactivation 3. Impaired inter-joint coordination
56
Coordination test focus on movement capabilities. What areas of movement do they focus on?
1. Reciprocal motion = the ability to reverse movement between opposing muscle groups. 2. Movement composition = movement control achieved by synergistic muvle groups acting together 3. Movement accuracy = the ability to gauge or judge distance and speed of voluntary movement 4. Fixation of limb holding = the ability to hold the position of an individual limb or limb segment.
57
When testing coordination, what are the 3 components that you are looking for?
Speed, fluidity, and accuracy
58
What are the 5 coordination assessments performed for upper extremity?
1. Finger-to-nose 2. rapid alternating movements 3. Rebound test 4. Thumb opposition 5. Fixation
59
What are the 4 coordination assessments performed for lower extremity?
1. Heel-to-shin 2. Rapid alternating movements 3. Ankle circles 4. Fixation

Neuroanatomy (18 decks)

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