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Neuromuscular Exam and Rehab Exam 1 > Motor Screen > Flashcards

Motor Screen Flashcards

(100 cards)

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1
Q

What is the purpose of a motor screen?

A

To assess strength, AROM, PROM, tone, and activation/sequencing
End feel, muscle length, power, endurance
Helps determine if motor deficits are neurological (tone, paresis) or MSK (past or present injuries)

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2
Q

What body regions are part of the peripheral nervous system?

A

Muscles, joints, and their sensory and motor innervation

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3
Q

What are the parts of the central nervous system?

A

Association area
Motor cortex and cerebellum
Brain stem and spinal cord

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4
Q

What is the association area of the CNS?

A

cortex and basal ganglia; movement strategy to best achieve the goal

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5
Q

What is the motor cortex and cerebellum of the CNS for?

A

sequence of contractions, ararnged in space and time, smoothness to achieve goal

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6
Q

What is the brain stem and spinal cord in the CNS for?

A

executions and activation of the motor neurons to generate the movement

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7
Q

Where does information come directly from?

A

motor cortex, spinal cord, and premotor areas

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8
Q

What does NOT have a DIRECT output to the spinal cord?

A

cerebellum and basal ganglion

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9
Q

What guides the motor response?

A

integration of the sensory input informs and guides the motor reasponse

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10
Q

What is the main area that involves motor function?

A

motor cortex

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11
Q

The primary motor cortex has the largest concentration of ______________ _________

A

corticospinal neurons

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12
Q

Where is the primary motor cortex?

A

anterior to the central sulcus

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13
Q

What does the primary motor cortex control?

A

CONTRALATERAL VOLUNTARY movements

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14
Q

What does the primary motor cortex require?

A

stimuli of low response to elicit a motor response

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15
Q

Where is the supplementary and premotor area (SMA and PMA)?

A

anterior to the primary motor cortex

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16
Q

What does the SMA and PMA require?

A

higher intensity stimuli for motor response

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17
Q

What is in the SMA?

A

axons that directly innervate motor units involved in the initiation of movement

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18
Q

What does the SMA control?

A
  • timing
  • sequential tasks
  • action monitoring
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19
Q

What is the PMA innervating?

A

the motor units that control trunk and proximal limb movements

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20
Q

What does the PMA control?

A

planning and preparing the body for movement

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21
Q

What does the motor cortex recieve information from?

A

the somatosensory cortex, the cerebellum and basal ganglia

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22
Q

Where is the somatosensory info relayed directly to?

A

the primary motor cortex from the thalamus

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23
Q

Where does the thalamus relay info to?

A

the cerebellum and basal ganglia which allow integration and appropriate course of action

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24
Q

What does the cerebellum regulate?

A

movement, postural control and muscle tone
- error correcting
- compares command for intended movement transmitted to the motor cortex with the actual movement of the body

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25
What happens if the feedback system does not compare appropriately?
the cerebellum gives a counteractive influence
26
What does the cerebellum to do modify movement?
sends signals to the cortex
27
Where are basal ganglia located?
in the cerebral cortex
28
What are the main basal ganglia?
- caudate nucleus, putamen and globus pallidus
29
Which basal ganglia are subcortical but still part of the basal ganglia?
subthalamic nucleus and substantia nigra
30
What about muscle tone do the basal ganglia regulate?
normal background muscle tone
31
What do the basal ganglia initate and regulate?
intentional movement, planning and executing motor responses, facilitation of desired responses while inhibiting others, accomplish automatic movements and postural adjustments
32
What is strength?
ability to generate sufficient tension in a muscle for posture and movement
33
What does strength result from?
musculoskeletal properties of the muscle and neural activaiton
34
What is weakness?
inability to generate normal levels of force
35
What kind of lesion is weakness common with?
UMN
36
What is paresis?
decreased voluntary motor unit recruitment
37
What does paresis cause difficult recruiting?
motor units to generate the movement
38
What is paralysis?
absence of muscle recruitment and inability to generate movement
39
What should we do with the trunk to strength test?
stabilize the trunk by testing in supine or sitting with back support
40
What do we ask the patient to do first with strength testing?
move the limb through ROM against gravity
41
What are we observing the initial movement for with strength testing?
quality of movement or any compensations (synergy)
42
If a patient cannot perform ROM against gravity, what do we do?
put them in a gravity eliminated position
43
What may we need to do during AROM?
assist them
44
What has good evidence for stroke patients to improve strength?
progressive resistance training
45
What are the muscle grades?
0- no contraction 1- visible muscle twitch but no movement of the joint 2- weak contraction and unable to overcome gravity 3- weak but able to overcome gravity but not able to take additional resistance 4- weak but able to overcome gravity and some resistance but not full 5- able to overcome gravity and full resistance
46
What is the myotome level and action of the deltoid?
C5 - shoulder abduction
47
What is the myotome level and action of the biceps?
C5, C6 - elbow. flexion
48
What is the myotome level and action of the triceps?
C7 - elbow extension
49
What is the myotome level and action of the wrist extensors?
C6, C7 - wrist extension
50
What is the myotome level and action of the wrist flexors?
C6, T1 - wrist flexion
51
What is the myotome level and action of grip?
C7, C8 - Finger flexion
52
What is the myotome level of finger extension/abduction?
C7, C8/C8, T1
53
What is the myotome level and action of the hip flexors?
L1, L2 - hip flexion
54
What is the myotome level and action of the knee extensors?
L3, L4 - extends knee
55
What is the myotome level and action of the knee flexors?
L3, L4 - flexes knee
56
What is the myotome level and action of the ankle DFs?
L4, L5 - dorsiflexes ankle
57
What is the myotome level and action of the ankle PFs?
S1 - plantarflexes ankle
58
What is muscle tone?
muscles resistance to passive stretch caused by output from alpha and gamma motor neurons
59
What is spasticity?
VELOCITY-DEPENDENT increase in the tonic stretch reflex - dysfunction of the corticospinal tract - exaggeration tendon jerks from hyperexcitability of the stretch reflex - common in UMN lesions - can be related to abnormal posturing, excessive co-activation of muscles, associated reactions, clonus, and synergies
60
What is rigidity?
Increased resistance to passive movement but is NOT VELOCITY DEPENDENT - due to disruption or disease of the basal ganglia
61
What is lead pipe rigidity?
consistent resistance to movement through the entire range
62
What is cogwheel rigidity?
alternating episodes throughout range, catching
63
What is hypotonia?
reduced stiffness of the muscle when lengthened or moved through the range
64
What is stage 1 of motor recovery?
flaccid paralysis: no movement is elicited
65
What is stage 2 of motor recovery?
Early synergy: faciliatory stimuli will elicit partial range synergies and appear in associated reactions, little voluntary movement
66
What is stage 3 of motor recovery?
voluntary control of the synergy movement and spasticity has further developed
67
What is stage 4 of motor recovery?
some isolated out-of-synergy movements emerge
68
What is stage 5 of motor recovery?
independence of synergy, but spasticity continues to decrease, and isolated joint movements are more apparent
69
What is stage 6 of motor recovery?
patterns appear near normal
70
When can motor recovery plateau?
at any stage
71
What is the modified ashworth scale?
a scale used to assess alterations in muscle tone
72
When can muscle tone be tested?
when the muscle is fully at rest
73
What can tone be treated with?
pharmacology, surgery and PT
74
What is often overlooked during a PT screen?
observing to bulk and involuntary movement
75
What are the two kinds of bulk?
hypertrophic (too much) or atrophic (muscle wasting)
76
What are fasciculations?
movements under the skin that are small and indicate denervation of the muscle, looks like fish jumping in the skin
77
What are tremors?
rhythmic movement
78
What is chorea?
quick, larger piano-playing movement
79
What is dystonia?
slower, writhing like movement
80
What is myoclonus?
quick, jerky moving a joint or limb
81
What is the type of paralysis with UMN injuries?
spastic
82
What is the type of paralysis with LMN injuries?
flaccid
83
What is the type of atrophy with UMN injuries?
no disuse atrophy
84
What is the type of atrophy with LMN injuries?
severe atrophy
85
What do DTRs do with UMN injuries?
increased
86
What do DTRs do with LMN injuries?
absent
87
What kind of injury have absent pathological reflexes?
LMN
88
What kind of injury has fasciculation and fibrillation?
LMN
89
What does coordination involve?
multiple joints and muscles that are activated at the appropriate time and with a certain force
90
What should we assess with coordination?
timing, sequence, accuracy and movement efficiency
91
When are coordination issues commonly seen? (which lesions)
motor cortex, basal ganglia, and cerebellum lesion
92
What is synergy?
abnormal patterns of movement secondary to lack of ability to move a single joint without simultaneously generating movement in other joints
93
What is synergy in the UE (flexion)?
scapular retraction and elevation, shoulder abduction and ER, elbow flexion, forearm supination and wrist/finger flexion
94
What is the most common synergy in the LE? (extension)
- hip extension, adduction and IR, knee extension, ankle PF and inversion, to PF
95
What is dysmetria?
problems judging distance or range of movement - inability to scale forces to meet the tasks
96
What is hypermetria?
overestimation of the force or range of movement needed for a specific task
97
What is hypometria?
underestimation of the required force or range to complete a task
98
What is dysdiadochokinesia?
inability to perform rapid alternating movements
99
What are some tests to assess coordination?
- finger to nose - pronation/supination - rebound test - heel to shin
100
How do we treat coordination?
repetition of functional task-specific movements and WB activities

Neuromuscular Exam and Rehab Exam 1 (11 decks)

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