impairments of motor control-action system

signs

objective findings of pathology that can be determined by physical exam

symptoms

subjective reports associated w/ pathology that are perceived by pt but may not necessarily be objectively documented on exam

positive s/s

release of abnormal behaviors

negative s/s

lack of release of normal behaviors

primary effects

impairments that directly results of reginald problem

secondary effects

impairments that indirectly result from the original problem

motor cortex deficits

motor weakness (paresis)

abnormal muscle tone/spasticity

loss of selective muscle activation/abnormal synergies

co-activation

paresis

inability of difficulty in recruiting and/or modulating skeletal motor units to generate torque or movement

referred to by distributions (hemi, para/di, tetra)

paralysis/plegia

more severe than paresis

clinical management of paresis

hallmark of lesions in descending motor system

exam:

• observation of resting posture, fxl tasks

• AROM

• strength: MMT, fxl

clincial mgmt of paresis

recruiting paretic muscles via biofeedback, FES, NMES, bimanual activities, visual mirror feedback

improve strength via progressive resistive, isokinetic excs

spasticity

used to describe many abnormal behaviors often seen in pts with CNS pathology

• hyperactive stretch reflexes

• abnormal posturing of the limbs

• excessive coactivation of antagonist muscles

• associated movements

• clonus

• stereotyped movement synergies

key sign of spasticity

velocity-dependent incr in resistance of a muscle or muscle group to passive stretch

more severe=ess velocity needed, less resistance to movement

spasticity examination

clinical scales and instrumented measures evaluate muscle tone

modified ash worth

pendulum/drop test

spasticity treatment

meds, surgery

splinting, orthotics

sensory modalities to inhibit or excite

joint approximation

stretching

poisitioning

strengthening

effect of strength training on spasticity

improving strength with descending motor system pathology not associated with/ incr spasticity

spasticity caution

reducing spasticity does not always improve function, could be counterproductive

careful considerations of indiv pt fx and utilization of spasticity is warranted

loss of selective muscle activation and abnormal synergies

individuation (fractionation of movement)

impaired individuation

co-activation

individuation

ability to selectively activate a muscle allowing isolated joint motion

impaired individuation

abnormal coupling btwn related muscles

extensor synergy

UE: shoulder adduction w/ elbow ext, pron, variabl ehand postures

LE: hip ext, add, IR, knee ext, ankle PF and inv, toe PF

flexor synergy

UE: ER and abd of shoulder, elbow flex, forearm sup or pron

LE: hip flex and ER, knee flex, ankle DF

clinical mgmt of abnormal synergies: exam

stroke specific—fugl meyer assessment

motor impairments associated with subcortical pathology

hypotonia

coordination problems

intention tremor

impaired error correction

hypokinetic disorders

hyperkinetic disorders

dystonia

impairments associated with/ cerebellar pathology

hypotonia

coordination problems or ataxia

intention tremor

impaired error correction

basal ganglia pathology

hypokinetic disorders (TRAP)

hyperkinetic disorders

dystonia

coordination impairment exams

equilibrium and non quilibrium tests→completed eyes open then eyes closed, graded subjectively 1-5 from cannot perform to normal performance