Neuro Quiz #4 Tone, Motor Performance, Strength

It is important to distinguish between limited motions at a joint due to ____ vs, ____, vs ____.

joint restriction; decreased muscle flexibility; increased muscle tone

____ is the resistance of muscle to passive elongation or stretch.

Tone

Tone is influenced by ____, ____, ____.

physical inertia; intrinsic stiffness of muscle and connective tissue; tonic stretch reflex

____ is decreased tone and ____ is absent tone.

hypotonia; flaccidity

The two types of hypertonicity are ___ and ___.

spasticity; rigidity

____ is prolonged involuntary movement/posturing.

dystonia

A (positive/negative) neurological sign is something that was there before but is now absent/diminished.

negative

Hypotonia and/or flaccidity is a (LMN/UMN) sign.

LMN

Other signs and symptoms of LMN include:

hyporeflexia, fasciculations, fibrillations, atrophy, weakness

LMN symptoms can sometimes present during _____.

cerebral and spinal shock

____ is velocity dependent, where there is increased resistance with increased speed.

spasticity

Spasticity is a (LMN/UMN) sign.

UMN

Spasticity is on (one/both) side(s) of the joint.

one

____ is resistance to passive stretch that is NOT velocity dependent.

rigidity

Leadpipe rigidity is ___, whereas cogwheel ridigity is ____.

the same resistance the entire range; jerky resistance

True or False: rigidity can be felt on both sides of the joint.

True

____ is beating motions after a quick stretch.

clonus

Sustained clonus is ____ beats, whereas unsustained is ____.

10 or more; less than 10 beats that go away

Decorticate posturing is ____ whereas decerebrate posturing is ____.

UEs in flexion and LEs in extension; extension of all limbs

(Decerebrate/decorticate) posturing has a worse prognosis.

decerebrate

Dystonia occurs when there is a lesion in the ____.

basal ganglia

The examination of tone involves ____, ____, and ____.

initial observation of resting posture

passive motion testing

action motion testing

Passive motion testing includes ___, ___, and ___.

the modified ashworth scale (MAS)

paratonia

clonus

Paratonia is ____.

when someone is purposefully resisting during testing

Grade 0 MAS

no increase in muscle tone

Grade 1 MAS

Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM

Grade 1+ MAS

Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

Grade 2 MAS

More marked increase in muscle tone through most of the ROM, but affected parts easily moved

Grade 3 MAS

Considerable increase in muscle tone, passive movement difficult

Grade 4 MAS

Affected parts rigid in flexion or extension (STUCK)

Inhibition techniques are used for _____.

hypertonicity

True or False: Medical management alone or PT alone are best for patients with hypertonicity.

FALSE; medical management coupled with PT intervention often yields the best results

Some of the medicine used for hypertonicity is _____.

baclofen, botox, diazapem, calcium channel blockers, Zanaflex, cannabis

For hypotonicity, you want to use (inhibitory/facilitating) techniques such as ____.

facilitation; taping, approximation, icing

Positive neurological signs are ____.

signs that weren't there before that are now there

Examples of positive neurological signs are ____.

hyperreflexia, spasticity

Motor performance includes:

muscle strength/force generation

power

endurance

length or muscle extensibility

____ is the loss of muscle bulk (wasting).

atrophy

The two types of atrophy are _____.

disuse and neurogenic

Neurogenic atrophy can be due to____.

peripheral nerve loss, LMN injury

ALS is injury to (UMN/LMN/both).

both

_____ is the capacity of muscle(s) to generate force.

muscle performance

Muscle strength is _____.

the force exerted by muscles to overcome a resistance

Muscle power is _____.

work produced per unit of time OR the product of strength and speed

____ is the inability to generate sufficient levels of force.

weakness

Paresis is _____ whereas plegia is ____.

partial weakness; absence of strength

Hemi is ____ and usually occurs with lesions to the _____, paraplegia often occurs with _____, and tetra is _____.

one half; cortex (stroke, TBI); SCI; all four limbs

For MMT the patient must demonstrate ____.

isolated joint motion

True or False: we would prefer MMT over functional testing of muscles.

FALSE; we prefer functional testing of muscles

A lot of times patients with neurological conditions are unable to perform actions ____, so they may need to place them in _____ positions.

against gravity; antigravity

Handheld dynamometry is validated for _____ and ____.

CVA; CP

For patients in synergy, you describe ____ AROM.

percentage

Flexion synergy of UE includes scapula ____, shoulder ____, elbow ____, forearm _____, wrist ____, and fingers/thumb _____.

retraction and elevation; abduction and ER; flexion; supination; flexion; flexion and adduction; abduction

Extension synergy of UE includes scapula ____, shoulder ____, elbow ____, forearm _____, wrist ____, and fingers/thumb _____.

protraction and depression; adduction and IR; extension; pronation; flexion or extension; flexion and adduction

Flexion synergy of LE includes pelvis ____, hip ____, knee _____, ankle ____, and toe ____.

elevation and retraction; flexion, abduction, ER; flexion; DF and inversion; dorsiflexion;

Extension synergy of LE includes pelvis ____, hip ____, knee _____, ankle ____, and toe ____.

elevation and retraction; extension, adduction, IR; extension; PF and inversion; plantarflexion

For UE, ____ synergy is most often observed, and for LE, ____ synergy is most often observed.

flexion; extension

Muscle ____ is a decline in muscle performance resulting from prolonged or sustained use or target muscle group, whereas muscle ____ is the muscle's ability to sustain forces or generate forces repeatedly over time.

fatigue; endurance

____ is important to determine functional capacity.

Muscle endurance

Fatigue is ____, and is a very big barrier in patients with ____.

overwhelming sense of exhaustion and decreased capacity for physical work at the usual level; MS

____ is a standardized assessment tool to test motor recovery.

Fugl-Meyer Post-Stroke Assessment of Physical Performance

The Fugl-Meyer Assessment measures _____ on a scale from 0 which is _____ to 2 which is _____.

impairment of volitional movement; cannot perform; performs fully

The subsets of the Fugl-Meyer include ______.

UE function, LE function, balance, sensation, ROM, pain

When the patient struggles with mobility, you want to use techniques to _____.

facilitate motion

Once there is some mobility, you want to position a patient in ____ position and develop _____.

closed chain; static control, postural control, and holding

Once there is stability, you want to work on _____.

weight shifting in all 3 directions

Once there is controlled mobility, you want to work on _____.

distal end free

Facilitation techniques include:

quick stretch

resistance

tapping

vibration

traction

approximation

quick ice

stroking

fast vestibular stimulation

Inhibitory techniques include:

prolonged stretch or deep pressure

warm temps (air cast)

prolonged cold

maintained pressure (air cast, AFO)

slow stroking down back

slow vestibular stimulation

The neurodevelopmental treatment is strengthening in _____.

developmental positions (supine, seated, quadruped, half kneeling, tall kneeling)

The neurodevelopmental treatment strengthens out of ____ and trains ____, ____, and ____.

synergy; isometric, concentric, eccentric

Brunnstrum is for ____ patients.

CVA

Brunnstrum incorporates the use of _____, and observes and defines ____.

developmental reflexes; abnormal synergistic patterns and stages of motor recovery after CVA

True or False: The Brunnstrum Stages are linear.

FALSE

Stage 2 of Brunnstrum Stages is when ______ begins to develop.

spasticity

In Stage ____, spasticity will peak.

3

Stage 7 of Brunnstrum is _____.

normal movement

True or False: PNF patterns are still widely supported when treating neurological patients.

FALSE; not super supported

____ is the primary impairment in neuro disorders.

weakness

The importance of strength training is to ____, ____, and ____.

remediate weakness deficits; prevent secondary impairments; promote optimal health and wellness

The three influential factors for muscle strength, performance, and endurance are ____, ____, and ____.

neural; structural; mechanical

Neural factors include _____, structural factors include ____, and mechanical factors include ____.

motor unit type and recruitment, recruitment ordering and firing rate; muscle size and fiber type, orientation, and arrangement; length-tension and velocity-tension relationship

Benefits to strength training are ____.

promoting neuroplasticity; reversing the effects of prolonged inactivity, reduce fall risk, prevent disuse atrophy

Training for very weak muscles include:

facilitation, NMES, EMG biofeedback

Training functional muscle synergies includes:

task-oriented training, PNF, aquatic therapy

Training isolated muscles includes:

progressive resistance exercises

isokinetic equipment

exercise machines

The exercise design principles are _____.

overload, specificity of training, cross training, reversibility

Exercise prescription includes ____.

intensity, frequency, duration

PT interventions incorporating ______ can improve the function and overall health of patients with neuro diagnoses.

moderate to high cardiovascular intensity

You want to shoot for ____% max HR for patients with stroke, BI, and SCI according to the CPG.

70-85%

____ and ____ are examples of task-specific training that are commonly used for functional skill training.

reaching; bodyweight support treadmill

Using the bodyweight support treadmill training can lead to changes in ____.

strength, endurance, gross motor function, gait speed

FES has a positive effect on patients with _____.

UMN, muscle activation pattern dysfunction, and SCI

True or False: immobilization is better than FES for limb health.

FALSE

The biggest factor for how to prescribe strength training is the patient's ____.

GOALS