DPTD 862 - neuro movement dx

core set of tasks

• gait

• stairs

• upright posture

• STS

• bed mobility

• reach/grasp

patients can have the same medical diagnosis but have…

significantly different impairments that affect their movement/function

movement diagnosis is based on…

patient’s primary movement system signs & symptoms, results of standardized tests & measure, & movement analysis

medical diagnosis does not specifically consider…

the patient’s movement problems

medical diagnosis is based on…

patient’s s/sx and results of standardized tests & measures

using both medical & movement diagnoses can is useful for…

future research, promoting continuity of care between healthcare providers, & patient centered care

movement pattern coordination deficit primary impairment

poor timing & sequencing of either intersegmental movements or of postural responses relative to balance demands

movement pattern coordination deficit key finding

performance typically improves w/ practice & instruction

movement pattern coordination: restorative or compensatory

restorative

force production deficit primary movement fault/impairment

weakness - can be focal or segmental

force production deficit key findings

unable to generate sufficient force to overcome effect of gravity or fatigue with repetition

force production deficit is divided into…

• good prognosis for recovery of strength

• poor prognosis for recovery of strength

sensory detection deficit primary movement fault/impairment

inability to execute intersegmental movement due to moderate-severe loss of joint position sense or protective sensation, vision, and/or vestibular system

sensory detection deficit key findings

• worse with eyes closed as they can no longer compensate

  • limited improvement with practice

sensory detection deficit restorative or compensatory

compensatory

sensory detection deficit vs sensory selection and weighting deficit

sensory detection: there is NO input (no dizziness) vs sensory selection and weighting deficit: issue in processing of sensory input (dizziness as sx)

sensory selection and weighting deficit primary movement fault/impairment

decreased ability to screen for & attend to appropriate sensory cues for postural orientation and postural stability

sensory selection and weighting deficit key findings

• difficulty making transitions from one sensory environment to another

• dizziness

sensory selection and weighting deficit restorative or compensatory

restorative

postural vertical deficit primary movement fault/impairment

inaccurate perception of vertical orientation with resistance of correction to proper COM alignment

postural vertical deficit key findings

• resists correction of COM alignment

• fearful/agitated when COM alignment is corrected

• may have disregard or neglect of involved extremity

postural vertical deficit restorative or compensatory

usually restorative

fractionated movement deficit primary movement fault/impairment

inability to fractionate movement

if pt main impairment is increased muscle tone, most likely dx is…

fractionated movement deficit

fractionated movement deficit key findings

• non-fractionated movement

• moderate to severe hyperexcitability/hypertonicity

• unable to generate quick movements

fractionated movement deficit restorative or compensatory

compensatory

dysmetria primary movement fault/impairment

inability to grade forces appropriately for distance & speed of a task/movement

examination tests for dysmetria

• finger - nose

• foot slide up shin

• rapid alt. hands

dysmetria is most common with…

cerebellum involvement

dysmetria key findings

• notable under or overshooting of targets

• abnormal rhythm & incoordination that does not improve with practice

• excessive postural sway

dysmetria restorative or compensatory

compensatory

hypokinesia primary movement fault/impairment

slowness in movement initiation & execution, often associated with small amplitude movement

hypokinesia key findings

• difficulty initiating movement

• delayed timing of postural adjustments

• lack of preparatory movements

hypokinesia restorative or compensatory

compensatory

cognitive deficit primary movement fault/impairment

impaired motor control related to lack of arousal, attention, or ability to apply meaning to situation, as appropriate for age

cognitive deficit key findings

• difficulty initiating movement

• delayed timing of postural adjustments

• lack of preparatory movements

cognitive deficit restorative or compensatory

often compensatory

in compensatory treatment, neuroplasticity is used to…

form new connections

in restorative treatment, neuroplasticity is used to…

relearn & restore damaged functions

compensatory therapeutic interventions focus on…

Discovering new ways of accomplishing a task