Measuring Motor Capacity

how do we measure active movement?

ask patient to move through all plans of movement and at different speeds, mainly observational but can be quantitative if you measure

If there is a lack of movement how should you document this?

say what pattern or synergy they were limited in and what the limiting joint was, also make sure to talk about the position of the whole body and how it moves not just the arm

what does active movement tell us?

functional activity limitations, synergy movements present, movement timing, speed and accuracy problems,

what is the UE flexion synergy? scapula, shoulder, elbow, forearm, wrist, finger

scapula-retraction, elevation

shoulder-ER, abduction at 90 degrees

elbow-flexion

forearm-supination

wrist-flexion

finger-flexion

what is the UE extension synergy? scapula, shoulder, elbow, forearm, wrist, finger

scapula-protraction

shoulder-IR, adduction

elbow-full extension

forearm-pronation

wrist-extension

finger-flexion

what is the LE flexion synergy? hip, knee, ankle, toes

hip-flexion, abudction, ER

knee-flexion at 90 degrees

ankle-dorsiflexion, inversion

toes-extension

what is the LE extension synergy?

Hip-extension, adduction, IR

knee-extension

ankle-plantar flexion, inversion

toe-flexion

what is the more common synergies to see in the UE and LE?

UE: flexion

LE: extension

what are some reminders when you are doing passive range of motion?

-dont forget to move the scapula

-remebmer 2 joint muscles

-lower tank and pelvis can easily become immobile in poor alignment

-motion limited by muscle tone does not necessarily indicate joint limitation

what should you remember in stroke patients?

screen for shoulder subluxation, if they have this, ensure they are not flexing their arm past 90 degrees because this puts them at risk for impingement syndrome

what are some ways you can decrease muscle tone in these patients?

slow rhythmical rocking or rotation, deep pressure to tendon, relaxed posture, sustained weight bearing

define: spasticy and rigidity

spasticity: velocity dependent resistance to passive stretch

rigidity: resistance to passive stretch, two types: cogwheel and lead pipe,

what position do you put patients in for the modified ashworth scale?

place patient in supine position

if testing muscles that do flexion, place joint in maximally flexed position and move to one of maximal extension over one second,

if joint does opposite motion then put in opposite position

what is the scoring of modified ashworth scale?

0- no increase in muscle tone

1- slight increase in muscle tone, manifested by a catch and release or by min resistance

1+-slight increase in muscle tone, manifested by a catch, followed by minimal resistance

2-more marked increase in muscle tone

3-considerable increase in muscle tone

4-affected parts rigid in flexion or extension

what is the tardieu scale and what do the numbers mean?

mainly used for peds,

0-no resistance

1-slight resistance

2-clear catch at precise angle

3- fatiguable clonus

4- infatiguable clonus

what does R2 and R1 mean on the tardieu scale? what is the dynamic tonic component equation?

R2- angle of full ROM at slow speed

R1- the angle of muscle reaction during quick stretch

R2-R1= “dynamic tone component”

what are some components of coordinate movement?

speed, distance, direction, timing

what is something to remember for practicals with coordination?

when having patients do task, have them do their normal speed then ask them to do it as fast as they can

define: intralimb and interlimb

intralimb-single movement

inter limb- integration of 2 or more limbs

define: visual motor

integration of visual and motor activities, eye-hand coordination

define: gross motor and fine motor

gross motor- body posture, balance, extremity movements involving large muscle groups

fine motor- movements involving small muscle groups for skillful controlled manipulation of objects

what are some impariemtns that are affected when there is damage to the cerebellum?

asynergy, dysdiadochokinesia, dysmetria, ataxia, ataxic gait, rebound phenomenon,

what are some impariemtns when there is damage to the basal ganglia?

athetosis-slow, involuntary writhing, twisting movements

chores, hemiballismus, bradykinesia, hyperkinesia, hypokinesia, dystonia

when you are assessing coordination what are you observing for?

extraneous movements, awkward movements, inaccurate movements, excessively slow movements, inability to sequence motor activity

define: non-equilibrium vs. equilibrium

non-equilibrium: address components of limb movements

equilibrium: static and dynamic postural control

what are some non-equilibrium tests?

nose to therapists finger, finger to finger, drawing circle, heel on shin

what is quantification of non-equilibrium coordination tests?

0-activity impossible

1-severe impairemtn

2- moderate impairment

3- minimal impairement

4- normal performance

what are some things we look at throughout postural control?

stability, controlled mobility (weight shifting), and segmental mobility

what things within somatosensation should you always tests or screen?

light tough, localization, proprioception

what should you ask the patient with somatosensation?

“what do you feel and where”

try to not be predictable with patients, test proximal to distal

what does somatosensation not always count as if the patients eyes are open?

does not always count as sensory testing

how should you test proprioception?

start distal and move proximal, stop when you reach an intact joint

what things should you look at with vision?

acuity-eye chart

smooth saccades-look back and forth from my finger and nose

smooth pursuit- follow pen

visual fixation-watch finger as you move closer and futther away

visual field-start behind patients ear and have them look forward and tell you when. they see it

how do you test neglect?

have them copy a simple drawing

what can be done for the vestibular screen?

dynamic visual acuity, slow VOR, fast VOR, Fukuda test

how is the fukuda test done?

shoulders flexed to 90 degrees and march, if they move more than 30 degrees they have a peripheral lesion on that side

what type of lesion would failure of keeping eyes on you in slow VOR vs. Fast VOR be?

fast VOR- peripheral lesion

slow VOR-central lesion

how do you test cognition?

orient with 4 diff questions-who, what, where, why

attention, memory

*can also look at judgement and planning in these individuals

define: sustained attention and focused attention

sustained: prolonged attention to activity

focused- sustain attention within distracting environment

define: alternating and divided attention

alternating-ability to transition from one task to the next/moving between tasks

divided-attend to move than one task at the same time

how do we tests short term, long term and remote memory

short term- say 3 words and ask them to repeat them

long term-ask patient to repeat 3 words to you at a later time in session

remote- ask about something in their personal history

what are 2 standardized screens you can give patients to test standardized cognition?

Mini-Mental state examination and MoCA (Montreal cognitive assessment)

what scores on the mini best and Moca correlate with no cognitive, mild, and severe

MMSE: none-24-30

mild-28-24

severe-0-17

Moca: non 26-30

mild: 23-26

severe: 0-23

how can you screen for affect?

look for depression and anxiety signs