Motor Impairments

Question 1

Apraxia

Answer 1

• Motor planning deficits
• Often associated with aphasia and is at the same level of severity
• Inability to perform purposeful movements, loss of coordination, impaired sensation, attention difficulties, abnormal tone or loss of cognition
• Pt unable to accomplish task

Question 2

Ideomotor Apraxia

Answer 2

• Pt is unable to perform a task upon commanded but may carry out habitual tasks
  ie: Pt cannot blow out match upon command, but will blow it out spontaneoulsy
• Pt often perseverates with actions
• increase success with task performance
  (one step at a time, then combine steps)

Question 3

Ideational Apraxia

Answer 3

• Is a failure in the conceptualization of the task
• Pt may not perform either automatically or upon command
• The pt no longer understands the overall concept of the act (pt may not know what to do with a razor, comb..)

Question 4

Paresis

Answer 4

• Weakness due to CNS (UMNL)
• Most significant on the contraleteral side
• Ipsilateral mm may also be weak

Question 5

Tonal Abnormalities

Answer 5

• Flaccidity

- Spasticity

Question 6

Flaccidity

Answer 6

• Absence of mm tone, resulting in a lack of voluntary movement
• Usually short lived, lasting hours, days, or weeks
• Persists in small number of pt’s

Question 7

Spasticity

Answer 7

• Develops in 90% of cases and in predictable patterns (Synergy Pattersn)

Question 8

UE Flexion Synergy

Answer 8

• Spasticity
• Scapular Retraction
• Shoulder: Abd, external rotation
• Elbow/Forearm: Flexion / Supination
• Wrist / Finger: Flexion

Question 9

UE Extension Synergy

Answer 9

• Spasticity
• Scapular Protraction
• Shoulder: ADD, Internal Rot
• Elbow / Forearm: Extension / Pronation
• Wrist / Finger: Flexion

Question 10

LE Flexion Synergy

Answer 10

• Spasticity
• Hip: Flexion, ABD, Exteral Rot
• Knee: Flexion
• Ankle: Dorsiflexion, Inversion
• Toes: Extension

Question 11

LE Extension Synergy

Answer 11

• Spasticity
• Hip: Extension, ADD, Internal Rot
• Knee: Extension
• Ankle: Plantarflexion, Inversion
• Toes: Flexion

Question 12

Neck and Trunk Patters of Spasticity

Answer 12

• Paracervical mm’s spasticity resulting in:
• Flexion to the hemiplegic side and contralateral rotation
• Forward head
• Trunk appears laterally flexed on hemiplegic side

Question 13

Clonus

Answer 13

• may be present, especially in plantarflexors and wrist flexors
• Alternating rhythmic contraction and relaxation following stretch

Question 14

The most common pattern of spasticity is?

Answer 14

• UE Flexion and LE Extension

Question 15

Dominance of reflexes

Answer 15

• Primitive and tonal

Question 16

Flexor withdrawl

Answer 16

• Relexes

- Stimulation on sole of the foot produces ankle dorsiflexion and hip/knee flexion

Question 17

STNR

Answer 17

• Symmetric tonic neck reflex
• Neck flexion results in UE flexion and LE extension
• Nexk extension results in UE Extension and LE Flexion

Question 18

ATNR

Answer 18

• Asymmetric tonic neck reflex

- Head rotation results in jaw side extension and skull side flexion of all extremities

Question 19

TLR

Answer 19

Tonic Labyrinthine Reflex

• Prone causes increase in flexor tone
• Supine causes increase in extensor tone

Question 20

Grasp

Answer 20

• Pressure in palm produces finger flexion

Question 21

Tonic Lumbar Reflexes “Rotation of upper Trunk to the involved side” results in

Answer 21

• Flexion in involved UE

- Extension of involved LE

Question 22

Tonic Lumbar Relexes “Rotation to the uninvolved side results in

Answer 22

• Extension in involved UE

- Flexion in involved LE

Question 23

Positive Supporting Reaction

Answer 23

• Pressure on the bottom of the hemiplegic foot may produce a strong co-contraction response and increase extensor tone in LE resulting in a rigidly extended and fixed limb with foot in PF and knee possibly in genu recurvatum (knee hyperextension)

Question 24

Associated Reactions

Answer 24

• Abnormal, automatic responses of the involved limbs, resulting from action occurring in some other part of the body by voluntary or reflex stimulatoin
  ie: Voluntary mm contraction
  Coughing
  Yawning
  Sneezing
• These reactions are easier to elicit in the presence of spasticity and frequently interact with tonic reflexes

Question 25

Souques Phenomenon

Answer 25

- Elevation of involved UE above 150 deg with elbow extended produces finger extension and abduction

Question 26

Raimste Phenomenon

Answer 26

- resisted hip abduction or adduction on the uninvolved produces a similar response on the involved side

Question 27

Decreased function of higher level postural reactions

Answer 27

- Writing - Equilibrium - Protective Extension - Can result in poor posturing, poor balance and / or inability to self correct or make postural adjustments

Question 28

Brunnstrom States of Motor Recovery

Answer 28

Stages 1-6

Question 29

Stage 1

Answer 29

- Flaccidity | - No voluntary movement and patient is confind to a bed

Question 30

Stage 2

Answer 30

- Spasticity begins to develop (in synergy patters) in extremities as well as trunk, shoulder and pelvic girdles (still no voluntary movement)

Question 31

Stage 3

Answer 31

- Spasticity increases and reaches its peak | - Pt gains voluntary control of synergies but not necessarily full ROM with movements

Question 32

Stage 4

Answer 32

- Spasticity begins to decline - Pt begins movement out of synergy - Can place hand behind body, alternate pronation / supination with the elbow at 90 deg flexion and elevation of arm to forward horizontal position

Question 33

Stage 5

Answer 33

- Spasiticity continues to decrease | - Increased muscular control out of synergy (arms raised to a side horizontal position, can bring hand over head)

Question 34

Stage 6

Answer 34

- Spasiticity disappears, coordination approaches normal | - All isolated joint movements available

Question 35

Synergy movements can be useful to initiate______, but they interfere with _________.

Answer 35

- Movements - Rehabilitation (after stage 1)

Question 36

Muscles typically not involved in synergy patters

Answer 36

- Latissimus Dorsi - Teres Major - Serratus Anterior - Finger Extensors - Ankle Evertors (much more difficult to activate)

Question 37

Tredelenburg limp

Answer 37

- Weak Abductors | opposite side

Question 38

Scissoring

Answer 38

- Spastic Adductors

Question 39

Abducted Gait

Answer 39

- PF and / or knee extension spasticity

Question 40

Circumduction

Answer 40

- Weak hip flexors | - Foot Drop

Question 41

Steppage Gait

Answer 41

- Marching - Good hip flexors - Foot drop and or tight gastroc - Strong flexion synergy

Question 42

Equinovarus

Answer 42

- Plantarflexion with inversion or varus - Due to: Tight gastroc or tibialis posterior Spastic anterior tibialis, posterior tibialis, toe flexors and gastroc/soleus Weak Peroneals and toe extensors

Question 43

Genu recurvatum

Answer 43

- Tight or spastic gastroc and tibialis posterior