Peds Neuro- The human movement system and movement system diagnoses

human movement

a complex behavior within a specific context, and is influenced by social, environmental, and personal factors

structure, function, and potential of the human body

recognition and validation of the movement system is essential to understand the

promote optimal development, diagnose impairments, activity limitations, and participation restrictions

the physical therapist will be responsible for evaluating and managing an individual's movement system across the lifespan to...

the movement system

what is the CORE of physical therapist practice, education, and research

humanism

physical therapists must place high value on the person level and maintain a holistic view of the patient even when therapeutic efforts are directed at a lower level of the natural system

activities

movement is most closely related to

history

when looking at a history and initial observation; 75-80% of information can be obtained when completing a thorough...

primary and secondary impairments

the hypotheses, used in the HOAC II model serve as a means to identify

write better goals and have improved outcomes

by understanding the difference between primary and secondary impairments, you will be able to...

1/2

if you have a patient problem well stated, you are already what percentage of the way to reaching your desired outcome/goal

human movement system

comprises the anatomic structures and physiologic functions that interact to move the body or its component parts

environment

by using movement related interventions targeted at these levels to optimize functional capacity and performance the physical therapist maximizes an individuals ability to engage with and respond to his or her...

signs

physical manifestations identified in an examination

symptoms

things reported by the patient

signs and symptoms

a movement system diagnosis is established through a collection of

prognosis

accurate diagnoses can help guide the selection of intervention strategies, and ultimately contribute to the...

decrease the variability in management of patients with neuromuscular conditions, minimize the trial and error approach to treatment selection, improve in communication with other health care professionals, advance research by enabling creation of homogenous patient groupings

by using movement system diagnoses, a practitioner will...

physical therapy intervention

the movement system diagnosis is not meant to replace the medical diagnosis driven by a physician, but it does need to be specific enough to guide

syndrome

the movement system diagnosis should be based in the human movement system (frequently at an impairment level) and should represent signs that occur together, thus comprising a...

movement pattern coordination deficit, force production deficit, fractionated movement deficit, postural vertical deficit, sensory selection and weight deficit, sensory detection deficit, dysmetria, hypokinesia, hyperkinesia

what are the 8 movement system diagnosis

movement pattern coordination deficit

the primary movement dysfunction is the inability to coordinate an intersegmental task or postural response (anticipatory or reactive) because of a deficit in timing and sequencing of one segment in relationship to another; the movement dysfunction in the LE is primarily observed during tasks that require stability prior to and during limb and trunk movements and in the UE during in hand manipulation and grasp and release of different objects coupled with reach

reports of patients/caregivers with movement pattern coordination deficits

feels unsteady/risk for possible fall, fear of falling, clumsiness, occasional falls, delay in fine motor tasks, overly messy when eating and dressing, started walking later than other children, awkward compared to peers, poor performance in sports activities

down syndrome and developmental coordination disorder, mild stroke, MS, mild parkinsons, generalized debilitation, multi sensory gait/balance disturbance, s/p LE surgery, BPPV with postural instability, intellectual disability, prenatal drug/alcohol exposure, autism, preterm birth, developmental delay, fragile X, idiopathic toe walker, motor apraxia

what are associated conditions of movement pattern coordination deficits

practice and instruction

patients with movement pattern coordination deficits can typically improve in motor performance with

sit to stand, step up, gait, jump, run, skip, other advanced motor tasks, reach and grasp, postural control

what tasks should be examined with suspected movement pattern coordination deficits

force production deficit

the primary movement fault is weakness, the origin of the weakness may be muscle, neuromuscular junction, peripheral nerve, or central nervous system dysfunction, the presentation may be focal (one joint), segmental (generalized to an extremity or body region), or related to fatigue (of skeletal muscle rather than cardiopulmonary capacity)

reports of patients/caregivers with force production deficits

increased need for caregiver assistance, fatigue, history of preterm birth, delay in acquisition of motor milestones appropriate for age, need for assistive technology/devices

duchenne's muscular dystrophy, spinal muscular atrophy, generalized debilitation

what are associated conditions of force production deficits

strength, task analysis, gait, reach and grasp, postural control

what tasks should be evaluated with suspected force production deficit

fractionated movement deficit

the primary movement system problem is the inability to fractioate movement associated with moderate or greater muscle hyperexcitability; may describe the upper or lower extremity or both; always associated with central neurological deficit

reports of patients/caregivers with fractionated movement deficit

stiffness of the limbs and/or pain, difficulty with mobility/falls/slow walking, poor use of UW, and/or complicated perinatal history

cerebral palsy and stroke

associated conditions of fractionated movement deficits

movement, muscle tone, reflex testing, task analysis

what are components that should be evaluated with suspected fractionated movement deficits

postural vertical deficit

the primary movement system problem is inaccurate perception of vertical orientation resulting in postural control deficits and the tendency to resist correction of center of mass alignment; the condition may be in the medial/lateral or anterior/posterior direction

reports of patients/caregivers with postural vertical deficits

backward falls, fear of falling, visual or visual perceptual deficits

rett's syndrome and stroke with unilateral neglect

what are associated conditions of postural vertical deficit

postural control, perception

what components should be evaluated with suspected postural vertical deficits

sensory selection and weighting deficit

the primary movement system problem is the inability to maintain postural orientation or motor performance as a result of decreased ability to screen for and attend to appropriate sensory inputs; patients may demonstrate sensory seeking or sensory avoidance behaviors

reports of patients/caregivers with sensory selection and weighting deficits

symptoms when riding in a car, when walking along patterned walkways, or in visually simulating environments, repetitive non-purposeful movements, impaired social behaviors, aversion to a variety of sensory stimuli, delayed acquisition of motor milestones appropriate for age, decreased tolerance to highly stimulating environments

sensory processing disorders and autism

what are associated conditions of sensory selection and weighting deficits

sensory detection deficit

the primary movement dysfunction is the inability to execute intersegmental movement due to lack of joint position sense or multi-sensory failure affecting joint position sense, vision, and/or the vestibular system; may involve UE, LE, or both

reports of patients/caregivers with sensory detection deficits

unable to stand still, exposure to vincristine for childhood cancer, child trips while walking or running, can hear child walking due to foot slap, lack of hand function without visual or tactile guidance

spinal cord injuries

associated conditions of sensory detection deficit

sensation, task analysis, sit to stand, gait, reach and grasp, postural control

what components should be evaluated with suspected sensory detection deficit

dysmetria

the primary movement dysfunction is related to the inability to grade forces appropriate for the distance and speed aspects of a task; rapid movements are generally too large, and slow movements are generally too small for their intended purpose; performance deteriorates with faster speeds, may involve UE, LE, or both

cerebellar dysfunction

dysmetria is generally associated with

reports of patients/caregivers with dysmetria

falls, messy when eating, clumsiness, has frequent injuries, may require use of assistive device in community

ataxic cerebral palsy and multiple sclerosis

what are associated conditions of dysmetria

non-equilibrium coordination, movement, task analysis, sit to stand, reach and grasp

what components should be evaluated with suspected dysmetria

hypokinesia

the primary movement system problem is related to slowness in initiating and executing movement; may be associated with stopping of ongoing movement

reports of patients/caregivers with hypokinesia

tremor, or rhythmic unintentional movement, rigidity or stiffness, bradykinesia (or a sense of slowinf down in general), hypophonia (or softening of the voice), micrographia (or small handwriting), flexed posture, masked facial expression

parkinson's or other disorders with underlying basal ganglia dysfunction

what are associated condictions of hypokinesia

movement, postural control, task analysis, sit to stand or floor to stand, gait, muscle tone, reflexes

what components should be evaluated with suspected hypokinesia

to serve as common language to help facilitate communication between providers, to inform the prescribed treatment plan, to convey progress in functional abilities, to help justify reimbursement (along with results from standardized tests and other metrics)

the overall purpose of systemic clinical decision making and use of standardized terminology is...