Hum Occ II ch 6

Reflexes

innate motor responses elicited by specific sensory stimuli; primitive reflexes are involuntary.

Protective extension reactions

- are used to protect the head when a person is off balance or falling.

- Clients may fear moving or hesitate to bear weight on the affected side during bilateral or two-handed activities.

Righting reactions

- allows one to maintain or restore the normal position of the head in space and its normal relationship with the trunk and limbs.

- Clients may have difficulty moving from one position to another.

Equilibrium reactions

- maintain and restore a person's balance in all activities.

- Clients may have difficulty maintaining and recovering balance in all positions and activities and may be unable to sit unsupported. OTA should be close to client.

Facilitation 

- Weight bearing, tactile input, proprioceptive input; proper positioning required to prevent trauma to joint structures

- Be careful not to add to much resistance and create trauma at joint structures.

Dysmetria

- inability to estimate necessary ROM to reach target of movement- cant reach into a bag of chips.

Postural Tone

 refers to tonus (muscle tension) in the neck, trunk, and limbs. Must be high enough to resist gravity and allow upright posture, yet low enough to allow movement.

 Normal Muscle Tone

continuous state of mild contraction or state of readiness of a specific muscle.

 Muscle tone

is the resting state of muscle in response to gravity and emotion.

Normal muscle tone is characterized by:

- Effective coactivation (stabilization) at axial (neck and trunk) and proximal shoulder and pelvic girdle joints

- Ability of limb to move against gravity and resistance

- Ability to maintain limb's position if placed passively, then released

- Equal amount of resistance to passively stretch between agonist (muscle that contracts to create movement at a joint) and antagonist (muscle that relaxes, or elongates, to allow movement at a joint)

- Ability to easily shift from stability ↔ mobility

- Ability to use mm in groups or selectively

- Slight resistance to passive movement

 Motor Control

The ability to regulate or direct movement to function independently during daily tasks

- Involves perception (making sense of the input), motor planning (praxis - processing input), motor execution (carrying out the movement), feedback (internal and external), and biomechanics (muscles and joints working together).

- Functional recovery depends on the extent of CNS damage and the expected neurologic recovery for a dx.

Dynamic Systems Theory

- Movement is a function of interactions among neuromuscular system, environment, cognition, and the task itself. These systems interact with each other to influence movement. 

- Changing the parameters that we work on (e.g. environment) can make a big change, altering the motor demands. 

 Neuromusculoskeletal system

- Includes the nervous, muscular, and skeletal systems, which interact to influence movement patterns and produce movement.

- Disruptions may result in motor control dysfunction.

Hypotonicity (flaccidity)

decrease in muscle tone and is usually the result of a peripheral nerve injury, cerebellar disease, or frontal lobe damage.

Hypertonicity (spasticity)

increased muscle tone-increased resistance to passive stretch, caused by an increased or hyperactive stretch reflex- any neurologic condition that alters upper motor neuron pathways (MS, CVA, TBI, brain tumors or infections, and SCI or disease).

Rigidity

- increase in muscle tone in the agonist and antagonist muscles simultaneously resulting in increased resistance to passive movement in any direction and throughout the joint ROM.

- Deep tendon reflexes are normal or only moderately increased.

- Results from lesions of extrapyramidal system such as in Parkinson's disease, certain degenerative degenerative diseases, encephalitis, tumors, and TBI.

Ataxia

impaired gross coordination and gait; may have tremor-like movements

Adaiadochokinesia

inability to perform rapidly alternating movements.

Dyssynergia

decomposition of movement in which voluntary movements are broken into component part and appear jerky.

Tremor

involuntary shaking or trembling

Intention tremor

occurs during voluntary movement, intensifies at termination of movement.

Resting tremor

present in absence of voluntary movement

Pill-rolling tremor

resting tremor seen in patients with Parkinson's disease

Rebound phenomenon of Holmes

inability to stop a motion quickly to avoid striking something

Nystagmus

involuntary movement of eyeballs in up-and-down, back-and-forth, or rotating direction.

Dysarthria

explosive or slurred speech caused by incoordination of speech mechanism.

Choreiform movements

uncontrolled, irregular, purposeless, quick, jerky, dysrhythmic movements.

Asthetoid movements

slow, wormlike, arrhythmical movements that primarily affect distal portions of extremities

Spasms

sudden, involuntary, contractions of a muscle or large groups of muscles.

Dystonia

faulty muscle tension or tone

Ballismus

projectile movement causing limb to fly out suddenly; occurs on one side of body.

suck/swallow reflex

- light touch to lips or gums

- suckling

- Ex: difficulty performing oral hygiene activities, excessive tongue protrusion during eating and drinking, difficulty creating negative pressure to suck from a straw

Asymmetric tonic neck reflex (ATNR)

- Head turned to one side with chin over shoulder

- Extension of arm and leg on face side; flexion on arm and leg on skull side.

- Ex: difficulty performing self-maintenance activities if head turned to one side

Symmetric tonic neck reflex (STNR)

- flexion of neck, flexion of trunk and extremities ot increased flexor postural tone.

- flexion of arms and extensions of legs, Extension and flexion of legs.

- Ex: difficulty bridging, difficulty crawly reciprocally, difficulty using arms to reach over head.

Tonic labyrinthine reflex (TLR)

- Supine position, prone position

- Extension of trunk and extremities or increased flexor postural tone. Flexion of trunk and extremities or increased flexor postural tone.

- Ex: difficulty performing all transitional movements that require dissociation between upper and lower body (flexion of upper body with extension of legs- e.g moving from supine to long sitting in bed)

Positive supporting reflex (PSR)

- Pressure to ball of foot.

- Extension in leg stimulated (hip and knee extension with plantar flexion of ankle- i.e toes pointing downward)

- Ex: difficulty bridging, difficulty donning shoes or keeping them on, difficulty with swing-through phase of walking as it precedes toe-off phase, difficulty climbing stairs.

Crossed extension reflex (CER)

- Flexion of one leg

- extension of opposite leg

- Ex: difficulty bridging with both legs flexed simultaneously, difficulty walking with a reciprioal arm/leg gait pattern.

Palmar grasp reflex

- pressure in palm of hand

- flexion of digits into palmar grasp

- difficulty releasing objects from a palmar grasp (e.g drinking glass, hairbrush, mop)

Plantar grasp reflex

- Pressure to ball of foot

- flexion of toes

- Ex: curling of toes in shoes, difficulty walking with foot flat, absence of equilibrium responses in foot.