ROM Assess. in Eval of Tone..
1. PROM supplements and correlates with
2. Client with acute CVA has 20 degree wrist ext. one month after onset with no orthopedic causes (arthritis, contracture)-what do you do?
3. __________ of these muscles prohibits wrist
1. tone assessment
2. Assess tone of wrist flexors and extrinsic finger flexors
3. Hypertonicity
1. Assess. of PROM can reveal signs of ________ that occur from chronic hypertonus
2. Ex. of chronic hypertonus
3. PROM can document the loc. of
1. joint changes-sublux., dislocation, contracture
2. PIPs that measure -45 to 125 instead of 0-100.
3. first tone, or resting position, before and after botox injections
Juan has only 20 degree active supination with no limited PROM. He has a soft tissue limitation due to:
paresis of the supinator and hypertonicity of the pronators. 20 degrees is not enough for palm to be up to hold coins
1. ________ can limit joint ROM
2. Heterotopic Ossif. can lead to ______ and occur in ________
3. Presence of fixed contractures can be mislabeled as...
4. Determine contracture with use of...
1. changes in bone (heterotopic ossific.)
2. joint ankylosis (stiffness of joint)/ TBI and SCI and severe spasticity
3. hypertonus
4. diagnostic short term nerve block, EMG, X-ray
Client has no passive ROM deficits, so client does not have
contractures
1. Along with tone assessment, therapist must assess..
2. Identify degree to which abnormal tone
3. Identify which direction of mvmt _________ occurs and effect on function
4. _______ is not appropriate for severe hypertonicity/rigidity
5. If hypertonia i
1. UE mvmt. and control
2. interferes with selective control
3. hypertonicity
4. MMT
5. grade strength of antagonists to measure progress
1. What influences muscle tone and motor control? (4)
2. Level and distribut. of muscle tone change when
3. Therefore, tone cannot be assessed in isolation from...
1. Position change, spinal reflexes, reticular formation, and supraspinal reflexes
2. position of head in space changes
3. postural mechanisms, motor function, synergies present, task specifity.
Sensibility tests for clients with damage to CNS: 5
static 2-pt discrim., kinesthesia, propriocept., pain, light touch using the Semmes-Weinstein monofilaments test (better pressure control than cotton ball)
1. Used to assess muscle tone:
2. EMG determines...
1.static or dynamic surface or percutaneous (needle) EMG
2. hypertonicity of muscles, abnormal, excessive electrical activity in muscles, plan and implement nerve blocks to treat hypertonia
Clients should undergo an EMG to rule out ___________ if they experience temporary numbness, tingling, and pricking sensations (Paresthesia), sensitivity to touch, or muscle weakness, Paresis (weakness of voluntary movement, or partial loss of voluntary m
peripheral neuropathy
1. Normal postural mechanism is:
2. Automatic reactions allow for..
1. auto mvmts that provide approp. level of stability and mobility
2. trunk control, mobility, head control, midline orientation, weight shifting, balance, vol. limb mvmt.
Components of normal postural mechanism:
normal postural tone and control, primitive reflexes and mass mvmt patterns, righting reactions, equilibrium and protective reactions, selective mvmt
1. Normal postural mechanism is effected with client who has
2. Assess damage to postural mechanism with clients with..
1. UMNS damage (abnorm. tone and mass patterns effect balance and stability)
2. CNS trauma or disease
1.Directs head to an upright position and help to assume a position=
2. Without this, client will have trouble..
1. righting reactions
2. getting up from floor, out of bed, sitting up, kneeling
1. Helps one sustain or keep their balance and is the 1st line of defense against falling=
2. Elicited by stimulation of..
3. Without this, client will have trouble..
1. equilibrium reactions
2. labyrinths within inner ear
3. maintaining balance in all positions and activities
1. Second line of defense against falls and is the extension of arms and hands to protect head and face when falling=
2. Without this, client may..
1. protective reactions
2. fall or be afraid to weight bear on affected side
1. Evaluate righting reactions during
2. Balance depends on...
1. transfers and ADLs
2. normal equilib. and protective reactions
1.Assess static and dynamic balance before leaving unattended when client has
2. maintaing balance while moving=
3. maintain equilibr. while stationary=
3. Test that assesses phys. function during activity and static and dynamic balance=
1. CNS dysnfunction
2. dynamic
3. static
4. Physical Perform. Test
1. Brain stem level reflexes (4)
2. Spinal Level reflexes (3)
1. Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR), Symmetrical Tonic Labyrinthine Reflex (TLR), Positive Supporting Reflex
2. Crossed ext., flexor withdrawal, grasp reflex
Client has trouble maintaining head in midline while moving eyes, cannot extend arm without moving head, cannot flex arm without turning head away, cannot move both arms to midline (asymmetry) bc arm control depends on head control
ATNR
Client is unable to support body wt. on hands and maintain balance in quadruped, or crawl normally. Also has difficulty lying to sitting=
STNR
Flexion of UE with Ext. of LE or opposite is =
Ex. Head is lifting to sit up, hip ext. resists mvmt or arms and neck extended to move to chair, legs flex
STNR
Increase in extension or flexion tone / extension or flexion of extremities. Severely limited in ability to move, lift head while supine, initiate flexion to sit up, roll over, sit for long periods.
TLR
Caused by pressure on ball of foot that creates rigid ext. of LE from co-contraction of flexors/extensors of knee and hip jts. May have IR of hip, plantar flex., foot inversion
Ex. Unable to put heel down first to walk, place heel on ground to stand
Positive Supporting Reactions
1. Occur after an UMN lesion bc of lack of higher level integration=
2. Examples are:
1. Spinal level reflexes
2. hyperact. deep tendon reflex, Babinski sign, flexor withdrawal, crossed ext., grasp reflex (***Rarely seem in isolation)
1. Crossed Ext. causes
2. Client with hemiplegia has this and flexes unaffected leg for walking, what happens?
1. increased extensor tone in one leg while other leg is flexed.
2. strong ext. hypertonicity occurs in affected leg and effects walking
1.Client with Flexor withdrawal exhibits..
2. interferes with
1. flexion of ankle, knee, hip while sole of foot is touched
2. gait pattern and transfers
Client with grasp reflex cannot
release objects, even with active finger ext.
1. Collin and Wade created a test of trunk control for clients with..
2. 4 timed tests:
1. CVA
2. rolling to weak side, rolling to good side, supine to sit, sitting on side on bed for 30 secs
1. To assess trunk control, therapist must assess strength and control in these muscles:
2. Position of client for all tests
1. trunk flexors, extensors, lateral flexors, and rotators
2. sit upright on mat table with feet supported
1. Trunk flexor-observe for...
2. Functional test:
3. Client to move shoulders behind hips
4. hold end-range position
5. move forward to initial position
1. unliateral weakness, potential for falls, symmetry of wt. shift
2. supine to sit
3. eccentric control
4. isometric control
5. concentric
1. Concentric trunk extensor control is needed for
2. Client to maintain erect spine and lean forward =
3. Client to move back to upright position=
1. LE dressing and forward reach
2. eccentric trunk Ext. control
3. concentric contraction of trunk extensors
1. Lateral Flexion- Sitting upright, move body to the right..muscles on left show_____________ while muscles on right _______
2. Client returns to start position=
3. Needed for...
1. eccentric contraction / shorten
2. concentric control of left side
3. Fall prevention when reaching to side (shutting car door)
1. Prob's with coordination stem from ___ and ______ disorders..
2. noncerebellar causes:
3. Prevents testing of coordination=
1. cerebellar and extrapyriamidal
2. diseases and injuries of muscles and periph. nerves, posterior lesions on SC, lesions on frontal and post-central cortex
3. paralysis from PNS lesion
Cerebellar dysfunction...
1. Slouching and leaning
2. spinal curvature
1. bilateral lesions
2. unilateral lesions
1. Delayed initiation of mvmt, errors in ROM, regularity of mvmt, poor proximal stability=
2. Jerky mvmts from
3. Client w/ cereb. dysfunction on one hemisphere will..
1. Ataxia
2. poor coord. btw agonist and antagonists
3. fall on the side of the lesion from ipsilateral influence of cerebellum and LMN
1. Unable to perform rapid alternating mvmts such as pron. and sup. or elbow flex/ext.=
2. Test by counting cycles of pron. and sup. rotation
1. Adiadochokinesis (diadochos= successive + kinesis= movement)
2. in a 10-sec time frame
Unable to estimate ROM needed for target mvmt=
Limb overshooting is ________ and limb undershooting is _____
Dysmetria (dys + metron=measure)
hypermetria, hypometria
Decomposition of mvmt, vol. mvmt appears jerky, can cause probs in articulation and phonation, muscular incoordination as in cases of ataxia=
Dyssynergia (dys + syn=together, ergein=work)
Lack of check reflex, can't stop motion to avoid striking something =
Rebound phenomenon of Holmes
Involuntary rapid movement of eyeballs that interferes with head control and balance as a result of vestibular system, brainstem, cerebellar lesions=
Nystagmus
A speech disorder caused by disturbances of muscular control because of damage to the central or peripheral nervous system. Explosive or slurred speech from incoord. of speech mechanism =
Dysarthia (dys + arthroun, to articulate)
Cerebellar Disorders that impair coordination include: 7
Dysarthia, Nystagmus, Rebound phenomenon of Holmes, Dyssynergia Ataxia, Adiadochokinesis, Dysmetria
Extrapyramidal disorders include:
1. abnormal involuntary movement disorder with dance-like movements=
2. Can vary from mild to severe motor dysfunction; it is generally characterized by unbalanced, involuntary movements of muscle tone and a difficulty ma
1. Chorea
2. Athetoid Mvmts
3. Dystonia
4. Ballism
5. Tremor
1. Extrapyramidal disorders are character'd by
2. Parkinson's is character'd by
1. hypokinesia / hyperkinesia
2. hypokinesia (bradykinesia), cogwheel and lead pipe rigidity, loss of posture, resting pin-rolling tremor
1. Irregular, involunt., dysrhythmic mvmts of variable distribution. May occur in sleep =
2. Drug-induced from neuroleptic drugs=
3. Inherited, autosomal dominant disease=
4. Ataxic gait w/ choreo-athetoid mvmts, rigidity dev.'s over time=
1. Chorea
2. Tardive dyskinesia (psychiatric settings)
3. Huntington's
4. Huntington's
_______ mvmts are faster than athetoid mvmts
Choreiform
1. Continuous, slow, wormlike, arryhthmic mvmts that effect distal portions. Not present during sleep=
2. Occurs after..
1. Athetoid Mvmt
2. cerebral anoxia and Wilson's disease
1. Persistent posturing of extremities (hypertension of wrist) w/ torsion of spine and twist trunk and spasticity=
2. Secondary dystonia from:
3. Focal Dystonia affecting one limb seen in:
1. Dystonia
2. CNS disorders (hypoxic brain injury, tumor)
3. writer's cramp, musician cramp, spasmodic torticollis
Rare symptom from continuous contractions of axial and prox. musculature. Limb will fly out suddenly. Occurs on 1 side of body and caused by lesions of opp. subthalamic nucleus
Ballism
1. Assoc. w/ cerebellar disease, occurs during vol. mvmt, often in MS, no accuracy of limbs (insert key in lock)=
2. At rest and subsides when vol. mvmt is attempted, from damage to basal ganglia. Seen in Parkinsons=
3. Inherited by autosomal dominant tra
1. Intention tremor
2. Resting tremor
3. Essential familial tremor
4. EMG
Simulated tasks to assess coordination=
writing, opening containers, tossing and catching a ball, playing a board game
Evaluating Incoordination
Pg. 480