Motor Function Testing

Question 1

What is the definition of muscle tone?

Answer 1

the muscles resistance to passive movement during the resting state

state of readiness in a muscle at rest which provides background level of tone for a person to function efficiently.

Question 2

Is someone’s tone lower when they are led down or when they are stood up?

Answer 2

when they are led down

Question 3

What are the non neural factors effecting muscle tone?

Answer 3

compliance or stiffness of soft tissue

viscosity of muscle

muscle length

Question 4

What are the neural factors effecting muscle tone?

Answer 4

activation of contractile properties of muscle

controlled by nervous system

specifically, alpha motor neurone in spinal cord

Question 5

Why is low tone bad?

Answer 5

damage to upper or lower motor neurones

muscles are flaccid, which can cause subluxation

Question 6

Why is high tone bad?

Answer 6

spasticity- associated with damage to upper motor neurones, muscles tense, increased resistance is seen with as increase in speed of passive movement.

rigidity- associated with parkinsons, muscles are tense, no change in resistance with increased speed of passive movement

Question 7

What are upper motor neurons?

Answer 7

carry motor information down from brain and synapse with anterior horn, after this is the lower motor neurons

Question 8

What are the 4 tracts of the upper motor neuron?

Answer 8

corticospinal tract

medial reticulospinal tract

latera reticulospinal tract

vestibulospinal tract

Question 9

What has the biggest influence on the activity of the alpha motor neuron?

Answer 9

corticospinal tract/upper motor neurone

Question 10

What are the two causes of low tone?

Answer 10

upper motor neurone

so alpha motor neurone turned down which leads to low tone

damage to lower motor neurone, (compression on nerve root, severing of peripheral nerve)

Question 11

What causes spasticity?

Answer 11

damage to upper motor neurone which causes low tone, but then over time the alpha motor neurone gets tuned up and more sensitive to stretch.

Question 12

What causes rigidity?

Answer 12

BG influences movement

BG has influence on brainstem which has reticular formation, which has a role in regulating tone

because alpha motor neurone hasnt been sensitised, the tone wont change if limd is moved passively or slowly

Question 13

What types of tones should passive movement be tested fast and slow on?

Answer 13

slow-all of them (flaccid will be heavy) (spasticity gets intermittent spasms but not in rigidity)

fast- spasticity and rigidity (not low because risk injury)

Question 14

how/procedure to test tone?

Answer 14

just give muscles a bit of a squeeze, and feel the muscle, is it floppy? or tense?

then do passive movements, then first move slowly and then fast if not flaccid, through full ROM unless flaccid.

can test these in different movements depending on the muscles.

Question 15

Precautions and contraindications?

Answer 15

recent surgery

joint instability

severe pain

Question 16

What structures and processes are being assessed?

Answer 16

upper motor neurones

muscles

basal ganglia

alpha motor neurone

Question 17

How to tell whether the measurement is normal?

Answer 17

feel the muscles for stiffness or they feel really loose and flaccid, then compare this to the other side or how the muscles should feel

Question 18

How to assess muscle tone in the trunk?

Answer 18

observe and palpate

get them to touch points on your hand and move around, get 2nd therapist for support-instead of passive movements as quite hard for trunk

can also get them to o active assisted. -slouching down and then up in good posture.

Question 19

What are we measuring and why? (myotome testing)

Answer 19

if the pt is presenting with muscle weakness, use myotome testing to see whether the weakness is caused by a neurological deficit

Question 20

What principles are used in carrying out the technique? (myotome testing)

Answer 20

see if significant weakness caused by damage to main nerve root

ask pt to push against therapist resistance

Question 21

How to tell whether the measurement is normal? (myotome testing)

Answer 21

feel for the amount of power that they have-significant weakness that’s not due to pain inhibition

comparing to the other side (C3 down, but remember dominant side may be slightly stronger)

on oxford scale 1-5

Question 22

Precautions and contraindications? (myotome testing)

Answer 22

acute muscle injury

recent surgery

severe pain (this can cause the muscle weakness instead)

Question 23

What structures/processes are being assessed? (myotome testing)

Answer 23

muscles (weakness)

spinal cord nerve root (lesion)

intervertebral disc (herniation pressing on spinal roots)

Question 24

Upper limb myotome procedure? (myotome testing)

Answer 24

apart from C1 and C2 everything is tested on both sides.

C1-cervical flexion (palm against forehead)

C2-cervical extension (palm against back of head)

C3-lateral cervical flexion (palm on temple)

C4-shoulder girdle elevation (hand on top of shoulder girdle)

C5-shoulder abduction (hand on distal humerus)

C6-elbow flexion (one hand under olecranon, another on top of forearm)

C7-elbow extension (one hand on olecranon and the other underneath forearm)

C8-thumb extension (pt elbow at 90 degrees and thumb on top of pt, make sure elbow flexion isnt present aswell)

T1-finger ab/duction (same position as C8, link fingers with pt and ask them to squeeze your fingers as you pull upwards, for abduction index finger and thumb outside of fingers and ask pt to splay them out)

Question 25

Lower limb myotome procedure? (myotome testing)

Answer 25

L2-hip flexion (ask pt to push up against hand with pt sat on plinth)

L3-knee extension (pt sat up)

L4-ankle dorsiflexion (one hand above knee joint to stop the activation of hip flexion, pt sat on edge of plinth)

L5-big toe extension (one hand on posterior calcaneus to stop dorsiflexion)

S1-plantar flexion of ankle (one hand on posterior calcaneus and one below foot)

S2-knee flexion (hand on back of calf with the pt sat on edge of plinth)