Neurological PT Evaulation

Measuring Individual Motor Capacity

What can you gain from voluntary movement against gravity (mobility)

functional activity limitation (skill)

what can you infer if synergy movement pattern is present?

assess m. tone

• MMT not valid - if used, need to doc pt position when tested

what can you infer from watching problems with active movement timing, speed, accuracy

potential problem with coordination (further assessment needed)

other observation need during active movment

trunk movement

UE and LE synergy movement patterns

Scapula flexion synergy

retraction

elevation

shoulder flexion synergy pattern

ER

Abduction - 90

elbow flexion synergy pattern

flexion

forearm flexion synergy pattern

supination

wrist flexion synergy pattern

flexion

finger flexion synergy pattern

flexion

scapula extension synergy pattern

protraction

shoulder extension synergy pattern

IR

ADduction

Elbow extension syngery pattern

full extension

forearm extension synergy pattern

pronatinw

wrist extension synergy pattern

extension

finger extension synergy pattern

flexion

With UE synergy pattern which is seen more often

UE flexion syngery pattern

why are synergies not pathological

they help the patient perform a movement more efficiently

hip flexion synergy pattern

flexion

ABDuction

ER

knee flexion synergy pattern

flexion - 90

ankle flexion synergy pattern

DF

Inversion

toes flexion synergy pattern

extension

hip extension synergy pattern

extension

adduction

IR

knee extension synergy pattern

extension

ankle extension synergy pattern

plantarflexion

inversion

toe extension synergy pattern

flexion

PROM - decrease m. tone

slow rhythmic rocking/rotation

deep pressure to tendon

relaxed posture

sustained WB

velocity dependent resistance to passive stretch

spasticity

resistance to passive stretch that is NOT velocity dependent

rigidity (cogwheel, leadpipe)

Gold standard to quantify m. tone (adult)

Modified Ashworth

no increase in m tone

MAS 0

slight increase in m. tone

catch & release - minimal resistance at the end ROM when part moved in flexion/extension

MAS 1

slight increase in m tone

catch - followed by min reistance throughout less than half of ROM

MAS 1+

more marked increase in m tone through most ROM

affected part easily moved

MAS 2

considerable increase in m tone

passive movement difficult

MAS 3

Affected part rigid in flexion/extension

MAS 4

no resistance throughout course of passive movement

TARDIEU 0

slight resistance throughout course of passive movement

no clear catch angle

TARDIEU 1

clear catch at precise angle

interrupting the passive movement — followed by relase

TARDIEU 2

fatigubable clonus <10 sec

TARDIEU 3

infatiguable clonus >10 sec

TARDIEU 4

TARDIEU

angle of full ROM when slow

R2

TARDIEU

angle of muscle reaction at quick speed stretch

R1

TARDIEU

the closer R1 and R2 are indicates ????

less severe m tone

component of coordination

speed

distance

direction

timing

Loss of ability to associate muscles together for complex movements; Mvmt performed with component parts

Asynergy/Dyssynergia/Mvmt decomposotion

• cerebellum

Impaired ability to perform rapid alternating movements

Dysdiadochokinesia

• cerebellum

Inability to judge distance or range of movement

Dysmetria (hyper/hypometria)

• cerebellum

Inability to regulate force, direction, speed , & accuracy of movements

ataxia

• cerebellum

Ataxia during gait with wide BOS, postural instability, & high guard

Shaky and uncoordinated

ataxic gait

• cerebellum

Inability to halt forceful mvmt after resistive stimulus removed

Rebound phenonmenon

• cerebellum

Slow, involuntary, writhing, twisting, worm like movements à smooth twisting

Athetosis

• BG

Involuntary, rapid, irregular, jerky movements involving multiple joints

chorea

• BG

Large-amplitude sudden, violent, flailing motions

HEmiballismus

• BG

Decreased velocity and amplitude of movements

bradykinesia

• BG

Abnormally increased muscle activity to movement

hyperkinesia

• BG

Decreased motor response especially to a stimulus

Hypokinesia

• BG

Sustained involuntary contractions of agonists and antagonists

SE OF MOOD MANAGEMENT MEDS

Dystonia

• BG

non-equilibrium coordination tests test what??

components of limb movement

equilibrium coordination tests test ???

static & dynamic postural control

non- equilibrium coordination test

finger - nose

Dysdiadochokinesia

dysmetria

dyssynergy

non- equilibrium coordination test

finger/toe - PT finger

Dysmetria, dyssynergy

non- equilibrium coordination test

finger - finger

Dysmetria, dyssynergy

non- equilibrium coordination test

nose to PT finger

Dysmetria, dyssynergy

non- equilibrium coordination test

finger opposition

Dyssnergy

non- equilibrium coordination test

pronation/supination

Dysdiadochokinesia

non- equilibrium coordination test

tapping hand/foot

dysmetria

non- equilibrium coordination test

drawing circles

dysmetria

non- equilibrium coordination test

pointing to past pointing

dysmetria

non- equilibrium coordination test

alternate heel - toe/ toe - knee

dyssnergy

non- equilibrium coordination test

fixtation/position holding

ataxia, tremor

non-equilibrium coordination test

heel to shin

dysmetria

non-equilibrium coordination test

normal preformance

4

non-equilibrium coordination test

min impairment

able to accomplish activity, slight less than normal control, speed, steadiness

3

non-equilibrium coordination test

moderate impairment

able to accomplish activity

movement is slow, awkward, unsteady

2

non-equilibrium coordination test

severe impairment

able to only initiate activity without completeion

movement is slow, significent unsteady, oscillations, extreneous movement

1

non-equilibrium coordination test

activity impossible

0

Equilibrium Coordination

postural control

stability

controlled mobility

segmental mobility (active movement)

Always test ??? for somatosensation

light touch (proximal/distal elbow, knee, face, trunk)

localization

proprioception

follow finger - no head movement

tracking & smooth pursuit

look back and forth between fingers

smooth saccades

watch finger while maintain focus as move object near and far from pt

visual fixitation

start behind patinet ear and bring ginger foward

ask pt when they begin to see finger

visual field

head moving while reading snell chart

*more than 3 line indicates vestibular pathology

central or peripheral vest patho

slow VOR

central vestibular patho

fast vor

peripheral vestibular patho (on side keeping contact with nose)

shoulder flexion, eyes closed, march for 1 min

*deviate more than 30 degree indicates patho

Fukuda test

side turn indicates the side with vestibular issues

cognition screen in PT includes

orientation (person, place, time, event)

attention

memory

judgement

prolong attention to activity

sustained attention

sustain attention within distracting environment

focused attention

ability to transition from one task to next or moving between task

attending attention

attend to more than 1 tak at same time

diveded attention

ask about patient personal history

remote memory

Cognitive assessments

mini mental state exam (MMSE)

montral cognitive assessment (MoCA)

affect screen

depression & anxiety