Movement selectivity (week 5)

what are the three components to motor function

movement selectivity, muscle strength, coordination

what is fractionated movement

the ability to move one segment independent of another

a loss of fractionated movement results in

a loss of selectivity or loss of isolated limb movement

movement selectivity impairments are often seen with

UMN conditions that involve the corticospinal tract

are isolated muscle actions used in function

nope

how many synergies are one muscle in

multiple

synergies involve

functionally related patterns of muscle contraction

what are synergies

patters of co-activation of muscles recruited by single neural command

are synergies normal

yes! can be things such as walking, reaching, and balance control

what are the four things synergies have

they are temporally organized, spatially organized, efficient, and adaptable

why does the brain utilize synergies

to be efficient as it is too much brain control for all individual muscles and it decreases degrees of freedom for the CNS. A high dimensional system becomes a low dimensional system.

what are organizations within a synergy

sequence / timing, duration, force production

does the ratio of muscle activity change with speed of movement

nope

does the force production of muscles in a synergy change with force

nope the ratio remains the same

can synergies be used together

yep

synergies can adapt to

internal and external constraints

synergy efficiency depends on

type of pattern used, time to complete, metabolic cost

can we override synergies

yep

abnormal synergies are

commonly due to CNS lesion or injury and result in the inability / decreased ability to adapt to new situations and or use a different movement pattern to accomplish a specific task

objective and quantifiable assessment of motor function is necessary to

identify motor problems, measure recovery of function, and measure effectiveness of treatment

what is brunnstrom staging

a qualitative assessment of motor recovery following a stroke

what does brunnstrom staging take into consideration

lack of selective motor control and loss of postural control

what does brunnstrom staging lack

numeric scoring reflecting actual severity of movement dysfunction

what does the brunnstrom abnormal synergy of UE flexion look like

scap retration and elevation, shoulder abduction and external rotation, elbow flexion, supination, and flexion of wrist and fingers

what are the strong components of UE flexion in the abnormal synergy

elbow flexion

what are the weak components of UE flexion in the abnormal synergy

shoulder abduction and external rotation

what are UE extension components with abnormal synergy

scapular pronation and depression, adduction and internal rotation at the shoulder, elbow extension, pronation, extension at wrist and flexion or extension of fingers

what are the strong components of UE extension synergy

adduction and IR at the shoulder, pronation

what are the weak components of UE extension synergy

elbow extension

what are the components of the LE flexion synergy

hip flexion, abduction, external rotation, knee flexion, and dorsiflexion

what are the strong components of LE flexion synergy

hip flexion

what are the weak components of LE flexion synergy

external rotation

what are the components of LE extension synergy

hip extension to 0, adduction and internal rotation, knee extension, plantar flexion and inversion

what are the strong components of LE extension synergy

hip adduction, knee extension, and plantar flexion

what are the weal components of LE extension synergy

hip extension

how many brunnstrom stages are there

7

what is the first brunnstron stage 1

no movement. flacidity. No movement in the affected muscled. No reflexes. No voluntary movements on the affected side can be initiated.

what is brunnstrom stage 2

assocaited reactions. Spasticity appears. Passive movement appears. No voluntary movement. Synergies are elicited through facilitations. For assessment, resist strong components on uninvolved side and observe overflow.

brunnstrom stage 3

abnormal synergies. Spasticity is marked. Active movement appears. Synergistic movements may be elicited voluntary. For assessment as patient to demonstrate flexion/extension synergy patterns.

Brunnstrom stage 4

movement combining synergy. Spasticity decreases. Synergistic movements predominate. Some movement patterns out of synergy. Significant motor control emerges. For assessment have them move into positions where some joints are in synergy patterns and some joints are out of synergy patterns.

Brunnstrom stage 5

movement out of synergy. Spasticity wanes. Can move out of synergies although synergies are still present. More complex movements combinations are learned as basic synergies lose their dominance of over motor acts. For assessment, as patient to move outside of synergy pattern.

Brunnstrom stage 6

near normal movement where there is a disappearance of spasticity. Coordination reappears. Individual joint movements become possible. Coordination and movement patterns are near normal. They may have trouble with more rapid complex movements.

Brunnstrom stage 7

normal function

what do you assess first in brunnstrom staging

level 3

if the patient is able to perform abnormal synergies (brunnstrom stage 3) what should you do next

go to level 4-7 if possible

if the patient is unable to perform abnormal synergies (brunnstrom stage 3) what should you do next

have the patient go to level 2

level 2 UE assessment

resist elbow flexion and check strong grasp on non-involved side for associated reactions (SAME)

level 2 LE assessment

resist LE extension or PF on non-invovled side and watch for extension synergy overflow on involved side or any flexion synergy (Opposite)

what is the ramiste phenomenon

seen in LEs when resisting abduction or adductions, it elicits the same response on the opposite side LE

when should you watch for associated reactions with brunnstrom stage 2

functional movements and spontaneous involuntary activities like yawning or sneezing

what are level 4 - combining strategies UE activities

arm behind back, flex shoulder to 90 with elbow extended, pronate and supinate with elbow flexed to 30-90

what are level 4 - combining strategies LE activities

in sitting slide the foot back underneath the seat, DF in sitting

what are level 5 - out of synergy UE activities

abduct to 90 degrees with elbow extension, flex past 90 with elbow extension, pronate and supinate with elbow extension

what are level 5 - out of synergy LE activities

in standing and hip in neutral, flx knee. In standing and hip in neutral DF ankle

brunnstrom assigns quantative values to

qualitative movements

what do we assign a stage to with brunnstrom

the whole limb

is the wrist stagged in brunnstrom

nope, you describe movements.

how do you examine the wrist in brunnstrom

with elbow flexed and extended, in stabilization holding in flexion and extension, and circumduction

what is the purpose of fugl meyer assessment

to provide a quick quantitative assessment of motor function in patients post-stroke with hemiplegia. It is a body function measure based on brunnstrom stages of recovery.

what is the ordinal scale used to score the fugl meyer assessment

0 = cannot perform, 1 = partially perform, 2 = performs fully

what are the 5 domains of the fugl meyer assessment

motor function, sensory function, balance, joint ROM, and joint pain.

what is the maximum score of the fugl meyer assessment

226 points

fugl meyer assessment starts at

brunnstrom stage 3. it does not assess stage 1 and 2.

should you move to higher stages of the fugl meyer even if the patient has several zeros

yep