motor impairments

what is a sign

objective

bp, rom, mmt

what is a symptom

subjective

pain, dizziness, nausea

what is a primary impairment

direct effect of pathology or a lesion

what is a secondary impairment

develop as a result of original problem

what is a positive behavior

presence of abnormal behavior

what is a negative behavior

absence of normal behavior

what are the two primary motor impairments

upper and lower motor neuron lesion

where can upper motor neuron lesions be

motor cortex

descending motor tracts

brainstem

spinal cord proximal to alpha motor neuron

where can lower motor neuron lesions be

alpha motor neuron

ventral root

motor nerve plexus

peripheral motor nerve

neuromuscular junction

which lesions deal with weakness

upper and lower

which lesions deal with atrophy

lower only

which lesions deal with fasciculations

lower only

how are reflexes with upper motor neuron lesions

increased

how are reflexes with lower motor neuron lesions

decreased

how is tone with upper motor neuron lesions

increased

how is tone with lower motor neuron lesions

decreased

what is a fasciculation

muscle twitch/ smaller irregular muscle contractions on the surface of a muscle

what does strength tell us about the musculoskeletal contributions

length of movement arm of muscle

length/tension relationship of muscle

cross sectional area of muscle

type of muscle fiber

fiber arrangement

what does strength tell us about neural contributions

number of motor units recruited

type of motor units recruited

discharge frequency

how do we describe weakness in context of neuropathology

inability to generate force

inability to correctly and/or adequately recruit or modulate motor neurons

what does muscle weakness lead to

loss of movement and power

lack of muscle activity/immobility

how do we test muscle weakness

mmt

myotomes

what can weakness result from

cortical lesion

lesion in descending pathway

peripheral nerve injury (axon, myelin)

synaptic dysfunction at neuromuscular junction

damage to muscle tissue

what does the extent and distribution of weakness depend on

extent and location of lesion

what does paralysis do to muscle activity

total or profound loss of muscle activity

what does paresis do to muscle activity

mild or partial loss of muscle activity

what is muscle weakness named by

by distribution

mono, hemi, para, quad/tetra

what is a synergy

muscle/joint movements that occur in stereotypical patterns

mono is...

one limb

hemi is ...

one side of the body (left right)

para is...

upper or lower half of body

also called diplegia

quad/tetra is...

whole body

what are the parts of motor recruitment

agonist activation

inhibition of antagonist

what does impaired motor control impact

proper motor recruitment

when does impaired recruitment get worse

with stress, fatigue, and distractions

if someone is trying to flex their knee but they have impaired motor control, what could their quad do

still activate instead of inhibitting

what is an active impairment

an impairment that only happens during movement

is synergy an active impairment

yes

impaired motor control can do what to isolated movements

limit/ lose them

synergies instead

what can happen in a synergy

multiple flexions or multiple extensions happen at the same time

two major synergies

flexor synergy

extensor synergy

stretch reflex dysfunction is caused by damage to

supraspinal structures:

lateral corticospinal tract

cerebellum

spinal cord:

interneurons

motor neurons

sensory feedback systems

what kind of injury do we see a lack of reflex

lower motor neuron injury

lack of reflex aka

hyporeflexia

areflexia

what neuroanatomy is involved during hyporeflexia

alpha motor neuron

sensory neuron

what kind of injury do we see hyperreflexia

upper motor neuron injury

what neuroanatomy is involved in hyperreflexia

supraspinal structures like spinal cord and up

what is tone

muscle's resistance to passive stretch

tone is a state of...

slight residual contraction

or

readiness

flaccid is...

total flop

hypotonia is

reduced muscle tone

hypertonia is

increased muscle tone/resistance

rigid is

immovable extreme muscle tone

what is normal tone influenced by

physical inertia

intrinsic mechanical elastic stiffness

spinal reflex muscle contraction

spinal reflex muscle contraction aka

tonic stretch reflex

what is the tonic stretch reflex mainly modulated by

corticospinal tract

hypotonicity is

reduction in passive resistance to lengthening

floppy is

collapse into gravity, harder to excite

flaccidity is

complete loss of muscle tone

what are the two types of hypertonicity

spasticity

rigidity

when does spasticity show up

when you move the muscle quick

when does rigidity show up

always regardless of velocity

what is spasticity dependent on

velocity

what does spasticity occur as a result of

damage to descending pyramidal tracts

spasticity comes from a loss of

inhibitory effect on tonic stretch reflex

spasticity can be associated with

clonus

what extremities have more clonus

distal more than proximal

what is rigidity

resistance to passive movement regardless of velocity

when is rigidity commonly seen

with basal ganglia dysfunction

where is rigidity predominantly seen

flexors

what is lead pipe rigidity

constant resistance throughout the ROM

what is cogwheel rigidity

alternating episodes of resistance and relaxation

what is clasp knife rigidity

initial rigidity with sudden absence throughout remainder of range

spasticity happens in a damage to

descending pyramidal tracts

what are the pyramidal tracts

Corticospinal tracts

Corticobulbar tracts

what does increased tone do to posture

make it abnormal

what does increased tone do to alignment of joints

misalign in ways they shouldn't

what can increased tone do at rest

increase chances of injury especially skin issues like pressure ulcers by constantly being in a position

how does tone influence recruitment

see more common synergistic movement and less solo recruitment

what can decreased tone do to balance

fall into gravity

what does decreased tone do to injury risk

increases injury risk during dynamic tasks

dystonia is primarily seen with

damage to basal ganglia

dystonia is a syndrome dominated by

sustained muscle contractions

dystonia can cause

twisting

repetitive movements

abnormal postures

dystonia causes what kind of activation

coactivation of agonist and antagonist

what is a tremor

rhythmic, involuntary oscillatory movement of a body part

tremors can be...

intermittent or constant

what is a resting tremor

occuring in a body part that is not voluntarily activated or is relaxed

what is an action tremor

any tremor produced by voluntary contraction

what are the two types of action tremor

postural

intention

what is a postural tremor

when a person maintains a part of a body against gravity

what is an intential tremor

a tremor produced with purposeful movement

what is choreiform

involuntary, rapid, irregular, and jerky movements

choreiform is a sign of

huntington's disease

what is athetosis

slow, writhing, twisting movements

what does athetosis show up more in

UE more than LE

when is athetosis common

in cerebral palsy

coordination is...

the ability to use different parts of the body together smoothly and efficiently

components of coordination

sequencing

timing

grading

what is incoordination

movements that are awkward, uneven, and innaccurate