Another One :) Movement System Diagnoses for Patients with NM Conditions

What is a movement pattern coordination deficit?

Difficulty with timing and sequencing of one body segment in relation to another

What conditions are commonly associated with movement pattern coordination deficit?

Stroke, Multiple Sclerosis (MS), Parkinson Disease (PD), generalized debilitation, multisensory gait and balance disturbance, post-surgery

What is a force production deficit?

Weakness (may be related to fatigue) due to MSK, neuromuscular, peripheral nerve, or CNS dysfunction

Force production deficit can affect what areas?

One joint/muscle group or an entire body segment (extremity or hemibody)

What diagnoses are commonly associated with force production deficit?

Generalized debilitation, disuse atrophy, stroke, brain injury, MS, myopathy, muscular dystrophy, SCI

What is a fractionated movement deficit?

Inability to isolate movement from one joint to another in the UE, LE, or both

Fractionated movement deficit is always associated with what?

Central neurologic deficit involving the lateral corticospinal tract (CST)

What diagnoses are commonly associated with fractionated movement deficit?

Stroke, brain injury, SCI, MS, Cerebral Palsy (CP)

What is a sensory detection deficit?

Inability to execute movement due to impaired joint position sense (JPS) or multisensory failure (vision/vestibular)

What diagnoses are commonly associated with sensory detection deficit?

Stroke, brain injury, peripheral neuropathy, multisystem failure, bilateral vestibular loss

What is a sensory selection and weighting deficit?

Inability to utilize or attend to appropriate sensory inputs to maintain postural control

What symptoms are commonly seen with sensory selection and weighting deficit?

Postural instability, dizziness, visual motion sensitivity, sensory overload

What diagnoses are commonly associated with sensory selection and weighting deficit?

Stroke, brain injury, unilateral/bilateral vestibular loss, generalized debility

What is a cognitive deficit movement diagnosis?

Deficit in movement related to lack of cognitive ability

What diagnoses are commonly associated with cognitive deficit?

Brain injury and dementia

What is a perceptual deficit?

Inaccurate perception of vertical orientation causing resistance to correction of center of mass (COM) alignment

What problems result from perceptual deficit?

Postural control deficits in anterior/posterior or medial/lateral directions

What diagnoses are commonly associated with perceptual deficit?

Stroke, brain injury, generalized debilitation, dementia

What is dysmetria?

Inability to appropriately grade force for distance and/or speed of a task

What is the most common type of dysmetria?

Hypermetria (overshooting a target)

Dysmetria is usually associated with dysfunction of what structure?

The cerebellum

What diagnoses are commonly associated with dysmetria?

Stroke, cerebellar degeneration, MS, CP

What is hypokinesia?

Slowness in initiating and executing movement; may include stoppage of ongoing movement

What diagnoses are commonly associated with hypokinesia?

PD, extrapyramidal syndromes, stroke

Which movement system diagnosis is ALWAYS associated with central neurologic dysfunction involving the lateral CST?

Fractionated movement deficit

Which movement system diagnosis is MOST associated with cerebellar dysfunction?

Dysmetria

Which movement system diagnosis involves sensory overload and inability to prioritize sensory input?

Sensory selection and weighting deficit

Which movement system diagnosis involves impaired timing and sequencing between body segments?

Movement pattern coordination deficit

Which movement system diagnosis primarily presents as weakness?

Force production deficit

Which movement system diagnosis involves impaired perception of vertical orientation?

Perceptual deficit

Which movement system diagnosis is characterized by slow initiation and execution of movement?

Hypokinesia

Can patients have more than one movement system diagnosis?

Yes — patients commonly present with multiple movement system diagnoses simultaneously

What are common LE findings in movement pattern coordination deficit?

Deficits with postural control tasks, variable foot placement, slow/cautious gait, increased sway

What are common UE findings in movement pattern coordination deficit?

Difficulty with manipulation, grasp/release, reaching, slowed or awkward reaching, difficulty adjusting grip

What gait findings are associated with movement pattern coordination deficit?

Variable foot placement, slow cautious gait, may require assistance for balance/gait

What sit-to-stand finding is associated with movement pattern coordination deficit?

Altered sequencing during sit to stand

What postural response deficit is seen in movement pattern coordination deficit?

Inappropriate amplitude of postural adjustments/responses

What strength finding defines force production deficit?

MMT less than 5/5

What happens with repetition in force production deficit?

Deterioration in ROM or speed of movement

What sit-to-stand problem is common in force production deficit?

Failure initiating sit to stand

What gait findings occur with force production deficit?

Significant gait deviations or inability to ambulate

What UE deficits occur with force production deficit?

Difficulty/failure to reach and inability to maintain grip force

What assistance may patients with force production deficit require?

Manual assistance or assistive devices to maintain upright posture

What sensory impairments are seen in sensory detection deficit?

Impaired joint position sense, impaired protective sensation, visual field deficits

What happens to balance when vision is removed in sensory detection deficit?

Increased sway or loss of balance with eyes closed

What improves movement in sensory detection deficit?

Visual guidance

What gait findings occur in sensory detection deficit?

Variable foot placement and need for assistance

What UE movement findings occur in sensory detection deficit?

Slow and uncoordinated reaching/grasping

What is oscillopsia?

Perception that the visual environment is moving/bouncing when it is actually stationary

What vestibular deficit is associated with oscillopsia?

VOR dysfunction

What is the primary problem in sensory selection and weighting deficit?

Inability to prioritize appropriate sensory input

What dizziness triggers are common in sensory selection and weighting deficit?

Head turns, eye movements, visually stimulating environments

What gait findings occur with sensory selection and weighting deficit?

Deviation outside gait path and difficulty with turns

What balance finding is common in sensory selection and weighting deficit?

Increased sway, especially with eyes closed

What environmental challenge is difficult for patients with sensory selection and weighting deficit?

Transitioning between environments

What vestibular tests may be abnormal in sensory selection and weighting deficit?

HIT and DVA due to VOR dysfunction

What sensation occurs when patients with perceptual deficit are moved toward vertical?

Sense of falling

What is commonly neglected in perceptual deficit?

Contralateral extremities relative to direction of lean

How do patients respond to correction of COM alignment in perceptual deficit?

They resist correction

In what positions can perceptual deficits appear?

Sitting, standing, and walking

What additional deficits commonly coexist with perceptual deficits?

Loss of fractionated movement, sensory loss, motor planning difficulty

What behavioral findings may occur with perceptual deficit?

Poor judgment, impulsivity, fearfulness

What is the hallmark of fractionated movement deficit?

Inability to isolate movement between joints

What commonly "kicks in" during movement in fractionated movement deficit?

Synergies

What tone abnormality is common in fractionated movement deficit?

Increased tone

What gait compensations occur in fractionated movement deficit?

Hip hiking, vaulting, circumduction

What UE hand finding is common in fractionated movement deficit?

Hand closure with minimal opening

What postural control finding occurs in fractionated movement deficit?

Asymmetrical postural control

What equipment may patients with fractionated movement deficit require?

Assistive devices and/or orthotics

What are the two forms of dysmetria?

Overshooting (hypermetria) and undershooting (hypometria)

What is ataxia?

Unsteadiness and incoordination of voluntary movement with impaired regulation of force, direction, range, and timing

What gait pattern is common with cerebellar ataxia?

Wide BOS with irregular stepping

Why must patients with gait ataxia be closely guarded?

Movements are highly unpredictable

What arm position is common in gait ataxia?

High guard position

What is dysdiadochokinesia?

Impaired rapid alternating movements

What tremor is associated with cerebellar dysfunction?

Intention (action) tremor

What are choreiform movements like?

Rapid, involuntary, irregular, dance-like movements

Where is chorea usually most noticeable?

Distal UE

Can chorea be voluntarily suppressed?

No

What disease is classically associated with chorea?

Huntington Disease

What pathway degenerates in Huntington disease?

Indirect ("no-go") basal ganglia pathway

What is hyperkinesis?

Excessive movement production by the motor system

What movements characterize hemiballismus?

Large-amplitude, sudden, involuntary flailing movements on one side

What muscles are mainly involved in hemiballismus?

Axial and proximal limb muscles

What lesion causes hemiballismus?

Contralateral subthalamic nucleus lesion

What is rigidity?

Velocity-independent resistance to movement

How is rigidity different from spasticity?

Rigidity affects agonists and antagonists equally and spinal reflexes are normal

What causes rigidity?

Excess supraspinal drive acting on alpha motor neurons

What is lead-pipe rigidity?

Constant resistance throughout passive ROM

What is cogwheel rigidity?

Ratchet-like jerking during passive movement

What is bradykinesia?

Decreased amplitude and velocity of voluntary movement

Is bradykinesia the same as hypokinesia?

No

What system dysfunction causes bradykinesia?

Extrapyramidal motor system dysfunction

What disease is bradykinesia strongly associated with?

Parkinson Disease

What command-following issue occurs with cognitive deficit?

Difficulty following commands

What memory issue occurs with cognitive deficit?

Difficulty remembering instructions or movement patterns

What attention problem occurs with cognitive deficit?

Difficulty staying on task, especially in complex or dual-task environments

What safety issue is common with cognitive deficit?

Lack of safety awareness and poor insight into deficits