Test 1 Flashcards
1
Q
Ataxia (cerebellar)
A
- delayed initiation of movement responses
- errors in range of movement
- errors in rate and regularity of movement
- Poor coordination is noted between the antagonist and agonist muscle groups–> results in jerky, poorly, controlled movements
2
Q
Adiadochokinesis (cerebellar)
A
- inability to perform rapid alternating movements
- ex: pronations and supination, or elbow flexion and extension
3
Q
Dysmetria (cerebellar)
A
- inability to estimate the ROM necessary to reach the target of movement
- hypermetria: limb overshooting the target
- hypometria: limb undershooting the target
4
Q
Dyssynergia (cerebellar)
A
Decompensation of movement
- voluntary movements broken up into their component parts
- appear jerky
- can cause problems with articulation and phonation
5
Q
Rebound Phenomenom of Holmes (cerebellar)
A
Lack of a check reflex (inability to stop a motion quicky to avoid striking something)
6
Q
Nystagmus (cerebellar)
A
involuntary movement of the eyeballs
- up and down
- back and fourth
- rotating
- interferes with head control and fine adjustments required for balance
- can occur as a result of vestibular system, brainstem, or cerebellar lesions
7
Q
Dysarthria (cerebellar)
A
Explosive or slurred speech caused by incoordination of the speech mechanism
- client’s speech may also vary in pitch, may seem nasal and tremulous, or both
8
Q
Chorea (extrapyramidal)
A
Irregular, purposeless, involuntary, course, quick, jerky, and dysrhythmic movements of variable distribution
- movements may occur during sleep
- 2 diagnosis often presenting with chorea:
- tardive dyskinesia
- Huntington’s disease
9
Q
Athetoid Movements (extrapyramidal)
A
Continuous, slow, wormlike, arrythmic movements that primarily affect the distal portions of extremities.
- occurs after cerebral anoxia and Wilson’s disease
- Athetosis that occurs with chorea–> Choreoathetosis
- Movement patterns:
- extension and flextion of arm
- supinaion and pronation of the forearm
- flexion and extension of the fingers
10
Q
Dystonia (extrapyramidal)
A
Persistent posturing of the extremities
- ex: in hypertension or hyperflexion of the wrist and fingers, often with concurrent torsion of the spine and associated twisting of the trunk
- Dystonic movements are often continuous and are often seen in conjunction with spasticity
11
Q
Ballism (extrapryamidal)
A
a rare symptom that is produced by a continuous, abrupt contractions of the axial and proximal musculature of the extremity
- causes the limb to fly out suddenly
- occurs on one side of the body (hemiballism)
- caused by lesions of the opposite subthalamic nucleus
12
Q
Intention Tremor
A
- associated with cerebellar disease
- occurs during voluntary movement
- intensified at the termination of the movement
- often seen in MS
- Client with intetion tremor may have trouble performing tasks that require accuracy and precision of limb placement
13
Q
Resting Tremor
A
- occurs as a result of disease of the basal ganglia
- seen in Parkinsons
- occurs at rest when voluntary movement is attempted
14
Q
Essential familial
A
Inherited as an autosomal dominant trait
- most visible when the client is carrying out a fine precision task
15
Q
Motor control
A
ability to make dynamic postrual adjustments and direct body and limb movement in purposeful activity
16
Q
Componenets necessary for motor control:
A
- Normal muscle tone
- normal postural tone and postural mechanisms
- selective movement
- coordination
17
Q
Neuroplasticity
A
anatomical and electrophysical changes in the CNS
18
Q
Unmasking
A
Motor learning through the use of existing neural pathways
- seldom used pathways become more active after the primary pathway has been injured.
- adjacent nerves take over the functions of damaged nerves
19
Q
sprouting
A
Development of new neural connections
- dendrites from one nerve from a new attachment or synapse with another
- new axonal processes develop in sprouting
20
Q
Upper Motor Neurons
A
Nerve cell body or nerve fiber in the spinal cord and all superior structures.
- structures include:
1. descending nerve tracts and brain cells of both gray and white matter that contribute to motor function
21
Q
Lower Motor Neurons
A
anterior horn cells of the spinal cord, spinal nerves, nuclei and axons of cranial nerves III through X, and the peripheral nerves.
- Lower motor dysfunction results in diminished or absent DTR and muscle flaccidity
22
Q
Normal muscle tone
A
A continuous state of mild contraction or a state of preparedness in the muscle
23
Q
Tone
A
resistance felt by the examiner as he/she passively moves a client’s limb.
- Tension b/w origin and insertion will be felt by examiner if normal
24
Q
Stretch reflex
A
mediated by the muscle spindle
25
Normal muscle tone is characterized by the following 7 things:
1. Effective coactivation (stabilization) at axial and proximal joints
2. Ability to move against gravity and resistance
3. Ability to maintain the position of the limb it if placed passively by the examiner and then released
4. Balanced tone between agonistic and antagonistic muscles
5. Ease of stability to shift to mobility and to reverse as needed
6. Abilty to use muscles in groups or selectively with normal timing and coordination
7. Resilience or slight resistance in response to passive movement
26
Hypertonicity
Increased tone. Interferes with:
* performace of normal selective movement
* affects the timing and smoothness of agonist and antagonist muscle groups
27
Flaccidity
Absence of tone.
* Client with have DTR and active movement
* Muscles will feel soft and offer no resistance to passive movement
* If the flaccid limb is moved passively, it will feel heavy.
* If moved to a given position and released, the limb will drop because the muscles are unable to resist the pull of gravity
28
Hypotonus
decreases in normal muscle tone
* deept tendon reflex are diminished or absent
29
Hypertonus
Increased muscle tone
* can occur when a lesion is present in the premotor cortex, the basal ganglia, or descending pathways.
* often occurs in a synergestic neuromuscular pattern, particularly seen after CVA or TBI
30
Synergies
patterned movement characterized by co-contraction of flexors and extensors
may increase as a result of a painful or noxious stimuli
Other factors:
* fear
* anxiety
* environmental temp extremes
* heterotopic ossification
* sensory overload
31
spasticity
motor disorder characterized by a velocity-dependent increase in tonic strength reflexes (muscle tone) with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one compenent of the UMN syndrome
32
What are the 3 compenets of spascitiy?
1. Hyperactivity of the muscle spindle's phasic stretch reflex with hyperactive firing of the Ia afferent nerve
2. Velocity dependence, meaning that the stretch reflex is elicited only by the examiner's rapid passive stretch
3. The "clasp-knife" phenomenom: when the examiner takes the extremity through a quick passive stretch, a sudden catch or resistance is felt, followed by a release of the resistance. What actually happens is that the initial high resistance of spasticity is suddenly inhibited
33
What is one of the main systems affected when spasticity is present?
the pyramidal system
34
The 2 tracts of the pyramidal system are as follows:
1. corticospinal
2. corticobulbar
35
36
What does the corticospinal tract do?
Controls goal-directed, voluntary movements by influencing the LMN
37
What does the corticobulbar tract do?
Influences voluntary action of the cranial nerves
38
In what 2 ways are hypertonia and spasticity different?
1. Hypertonicity is not typically velocity dependent
* rapid movement does not evoke it, slow movements do
* hypertonus persists as long as the muscle stretch is maintained because of the firing of group II muscle spindle afferents (tonic stretch reflex)
2. During passive movement, no catch is felt with hypertonia, as is felt with the clasp-knife phenomenon of spasticity. (objectively measurable with EMG)
39
What is clonus?
Clonus is a specific type of spasticity.
* characterized by repetitive contractions in the antagonistic muscles in response to rapid stretch
* present in clients with moderate to severe spasticity
* most commonly seen in the finger flexors and ankle plantar flexors
* therapists should educate clients and their familites about how to bear weight actively because this will stop clonus!
40
What is **rigidity?**
Rigiity is a simultaneous increase in **muscle tone** of **agonist and antagonist muscles.**
* leads to increased resistance in passive ROM
* rigidity siganls involvement in extrapyramidal pathways--\> basal ganglia, diencephalon, brainstem
* NOT velocity dependent
* rigidity: evaluated during muscle tone evaluation
41
Name 4 types of rigidity commonly seen
1. **Lead pipe rigity: ** constant resistance is felt throughout the ROM when the part is moved slowly and pasively in any direction (can occur in Parkinsons)
**2. cogwheel rigity**: a rhythmic give in resistance occurs throughout the ROM (can occur in Parkinsons)
**3. Decerebrate rigidity:** results from lesions in the bilateral hemispheres of the diencephalon and midbrain. It appears as rigid extension posturing of all limbs and the neck
**4. Decorticate rigidity:** results from bilateral cortical lesions. Appears ad flexion hypertonus in the upper extremities and as extension tone in the lower extremities.
42
Normal Postural Mechanism
Composed of automatic movements that provide an appropriate level of stability and mobility
* includes normal postural tone and control, integration of primitive reflexes and mass movement patterns, righting reactions, equilibrium and protective reactions, and selective movement
* in clients who have sufferred UMN damage, the normal postural mechanism is disrupted
43
What is postural control?
the ability to control or regulate specific postural outputs
44
righting reactions
direct the head to an upright position; helps one assume a position (standing, getting out of bed, kneeling, etc.)
45
Equilibrium Reaction
help one sustain or keep a position; first line of defense against falling; used to maintain and regain balance in all activities
46
Protective Reactions
second line of defense against falling if the equilibrium reactions cannot correct a balance pertubation
Consists of:
* protective extension of the arms and hands
* stepping
* hopping
Without protective reactions:
* client may fall
* relunctant to bare weight on affected side
47
Asymmetric Tonic Neck Reflex (ATNR)
**Stimulus:**
Actively or passively turn the client's head 90 degrees to one side
**Response:**
An increase in extensor tone of the limb on the face side and an increase in flexor tone on the skull side of the limb
48
Symmetric Tonic Neck Reflex (STNR)
-Tested with client sitting or quadruped
**Stimulus 1:**
Flex the client's head and bring his/her chin toward the chest
**Response:**
Flexions of the UE's and extension of the LEs
**Stimulus 2:**
Extend the client's head
**Response:**
Extension of the UEs and flexion of the LE's
49
Tonic Labyrinthe Reflex (TNR)
Tested with the client supine with his/her head in midposition
**Stimulus:**
Testing position
**Response:**
Increase in extension tone or extension of the extremities
50
Crossed extension reflex
causes increased extensor tone in one leg when the other leg is flexed
51
flexor withdrawal
client will exhibit flexion of the ankle, knee, and hip when the sole of the foot is touched
-reflex interferes with gait pattern and transfers
52
Grasp reflex
client will not be able to release objects placed in the hand, even if active finger extension is present
53
Trunk Control Assessment
To accurately assess trunk control, the therapist must evaluate strenght and control in the following muscle groups:
* trunk flexors
* trunk extensors
* lateral flexors
* rotators
54
coordination
abilit to produce accurate, controlled movement. Characteristics include:
* smoothness
* rhythm
* appropriate speed
* refinement to the minimum number of muscle groups needed
* apporpriate muscle tension
* postural tone
* equilibrium
* under control of the cerebellum and is influenced by the extrapyramidal system
55
Weight Bearing
Conservative treatment approach for hypertonicity and spasticity; used for hypertonicity reduction and paresis remediation in the UE.
* increase in the surface area was noted after weight bearing, along with an increase in the the maturity of movement components needed for prehension
* if the affected arm is used when weight bearing, postrual responses occur throughout the weight-bearing extremity, as wel as during other pertubations of posture
56
