Motor Impairments Flashcards
(43 cards)
1
Q
Apraxia
A
- Motor planning deficits
- Often associated with aphasia and is at the same level of severity
- Inability to perform purposeful movements, loss of coordination, impaired sensation, attention difficulties, abnormal tone or loss of cognition
- Pt unable to accomplish task
2
Q
Ideomotor Apraxia
A
- Pt is unable to perform a task upon commanded but may carry out habitual tasks
ie: Pt cannot blow out match upon command, but will blow it out spontaneoulsy - Pt often perseverates with actions
- increase success with task performance
(one step at a time, then combine steps)
3
Q
Ideational Apraxia
A
- Is a failure in the conceptualization of the task
- Pt may not perform either automatically or upon command
- The pt no longer understands the overall concept of the act (pt may not know what to do with a razor, comb..)
4
Q
Paresis
A
- Weakness due to CNS (UMNL)
- Most significant on the contraleteral side
- Ipsilateral mm may also be weak
5
Q
Tonal Abnormalities
A
- Flaccidity
- Spasticity
6
Q
Flaccidity
A
- Absence of mm tone, resulting in a lack of voluntary movement
- Usually short lived, lasting hours, days, or weeks
- Persists in small number of pt’s
7
Q
Spasticity
A
- Develops in 90% of cases and in predictable patterns (Synergy Pattersn)
8
Q
UE Flexion Synergy
A
- Spasticity
- Scapular Retraction
- Shoulder: Abd, external rotation
- Elbow/Forearm: Flexion / Supination
- Wrist / Finger: Flexion
9
Q
UE Extension Synergy
A
- Spasticity
- Scapular Protraction
- Shoulder: ADD, Internal Rot
- Elbow / Forearm: Extension / Pronation
- Wrist / Finger: Flexion
10
Q
LE Flexion Synergy
A
- Spasticity
- Hip: Flexion, ABD, Exteral Rot
- Knee: Flexion
- Ankle: Dorsiflexion, Inversion
- Toes: Extension
11
Q
LE Extension Synergy
A
- Spasticity
- Hip: Extension, ADD, Internal Rot
- Knee: Extension
- Ankle: Plantarflexion, Inversion
- Toes: Flexion
12
Q
Neck and Trunk Patters of Spasticity
A
- Paracervical mm’s spasticity resulting in:
- Flexion to the hemiplegic side and contralateral rotation
- Forward head
- Trunk appears laterally flexed on hemiplegic side
13
Q
Clonus
A
- may be present, especially in plantarflexors and wrist flexors
- Alternating rhythmic contraction and relaxation following stretch
14
Q
The most common pattern of spasticity is?
A
- UE Flexion and LE Extension
15
Q
Dominance of reflexes
A
- Primitive and tonal
16
Q
Flexor withdrawl
A
- Relexes
- Stimulation on sole of the foot produces ankle dorsiflexion and hip/knee flexion
17
Q
STNR
A
- Symmetric tonic neck reflex
- Neck flexion results in UE flexion and LE extension
- Nexk extension results in UE Extension and LE Flexion
18
Q
ATNR
A
- Asymmetric tonic neck reflex
- Head rotation results in jaw side extension and skull side flexion of all extremities
19
Q
TLR
A
Tonic Labyrinthine Reflex
- Prone causes increase in flexor tone
- Supine causes increase in extensor tone
20
Q
Grasp
A
- Pressure in palm produces finger flexion
21
Q
Tonic Lumbar Reflexes “Rotation of upper Trunk to the involved side” results in
A
- Flexion in involved UE
- Extension of involved LE
22
Q
Tonic Lumbar Relexes “Rotation to the uninvolved side results in
A
- Extension in involved UE
- Flexion in involved LE
23
Q
Positive Supporting Reaction
A
- Pressure on the bottom of the hemiplegic foot may produce a strong co-contraction response and increase extensor tone in LE resulting in a rigidly extended and fixed limb with foot in PF and knee possibly in genu recurvatum (knee hyperextension)
24
Q
Associated Reactions
A
- Abnormal, automatic responses of the involved limbs, resulting from action occurring in some other part of the body by voluntary or reflex stimulatoin
ie: Voluntary mm contraction
Coughing
Yawning
Sneezing - These reactions are easier to elicit in the presence of spasticity and frequently interact with tonic reflexes
25
Souques Phenomenon
- Elevation of involved UE above 150 deg with elbow extended produces finger extension and abduction
26
Raimste Phenomenon
- resisted hip abduction or adduction on the uninvolved produces a similar response on the involved side
27
Decreased function of higher level postural reactions
- Writing
- Equilibrium
- Protective Extension
- Can result in poor posturing, poor balance and / or inability to self correct or make postural adjustments
28
Brunnstrom States of Motor Recovery
Stages 1-6
29
Stage 1
- Flaccidity
| - No voluntary movement and patient is confind to a bed
30
Stage 2
- Spasticity begins to develop (in synergy patters) in extremities as well as trunk, shoulder and pelvic girdles (still no voluntary movement)
31
Stage 3
- Spasticity increases and reaches its peak
| - Pt gains voluntary control of synergies but not necessarily full ROM with movements
32
Stage 4
- Spasticity begins to decline
- Pt begins movement out of synergy
- Can place hand behind body, alternate pronation / supination with the elbow at 90 deg flexion and elevation of arm to forward horizontal position
33
Stage 5
- Spasiticity continues to decrease
| - Increased muscular control out of synergy (arms raised to a side horizontal position, can bring hand over head)
34
Stage 6
- Spasiticity disappears, coordination approaches normal
| - All isolated joint movements available
35
Synergy movements can be useful to initiate______, but they interfere with _________.
- Movements
- Rehabilitation
(after stage 1)
36
Muscles typically not involved in synergy patters
- Latissimus Dorsi
- Teres Major
- Serratus Anterior
- Finger Extensors
- Ankle Evertors
(much more difficult to activate)
37
Tredelenburg limp
- Weak Abductors
| opposite side
38
Scissoring
- Spastic Adductors
39
Abducted Gait
- PF and / or knee extension spasticity
40
Circumduction
- Weak hip flexors
| - Foot Drop
41
Steppage Gait
- Marching
- Good hip flexors
- Foot drop and or tight gastroc
- Strong flexion synergy
42
Equinovarus
- Plantarflexion with inversion or varus
- Due to:
Tight gastroc or tibialis posterior
Spastic anterior tibialis, posterior tibialis, toe flexors and gastroc/soleus
Weak Peroneals and toe extensors
43
Genu recurvatum
- Tight or spastic gastroc and tibialis posterior
