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Phys Assess

_____ is the ability to execute smooth accurate controlled motor responses coordination
what type of input is coordination dependent on visual, somatosensory, vestibular input (think of the three things that the balance/biodex tested). you also need a fully intact neuromuscular system.
what two terms are often associated with coordination? AGILITY (gross motor, rapid + smoothly control movement while maintaining postural control) + DEXTERITY (fine motor tasks)
whats INTRALIMB coordination vs INTERLIMB? intra- single limb use (brushing teeth), interlimb- double limb use- (walking/transfers)
whats the PT term for "hand-eye coordination?" visual motor coordination -integrate vision and motor abilities with the enviro (type notes from slide, riding bicycle), eat, use utensils, reach for something of shelf
what does a coordination prob typical signify? some type of CNS pathology
the motor system can be grossly divided into peripheral and central elements. briefly describe what each do peripheral- includes motor +sensory innervation of mm and joints. central is further divided into 3 HIERARCHICAL levels (1. neocortex + basal ganglia, 2. motor cortex + cerebellum, 3. brain stem + spinal cord
what is the NEOCORTEX + BASAL GANGLIA concerned with in the motor system? STRATEGY
what is the MOTOR CORTEX + CEREBELLUM concerned with in the motor system? TACTICS (sequencing + timing)
what is the BRAIN STEM + SPINAL CORD concerned with in the motor system? EXECUTION
how do you rule out sensory impairments as a contributing factor to coordination impairments? by testing sensory BEFORE the coordination exam
what is the principle area involved in motor function in the MOTOR CORTEX? bordmann's (aka cortical) areas 4 + 6 (in the forntal lobe, just anterior to the central sulcus).
what is the difference btwn area 4 + 6? 4=designated as PRIMARY MOTOR CORTEX , controls contrallateral voluntary movemnts,has the largest concent. of corticospinal neurons. 6 is ant. to 4 + is subdivded into SUPPLMENTARY MOTOR AREA (intiating mvmnt/bilat grasp) + PREMOTOR AREA (trunk +limb)
area ___ typically results in uncomplcated movements of a SINGLE joint while stimulation to area ___ evokes a more intricate coordinated movement involving MULTIPLE joints. 4- single joint, uncomplicated 6- multiple, intricate movment
who does the motor cortex recieve info from? (3 primary areas) somatosensory cortex, cerebellum, and basal ganglia. (the THALAMUS is the major relay center for all 3!)
corticospinal pathway: what/where? aka pyramidal. from motor cortex (4+ 6) to spinal cord= SKILLED FINE MOTOR OF DISTAL LIBMS. longest and largest CNS tract! MOST fibers cross @ medulla to descend contralaterally. others eventually cross at cervical or upper thoracic regions.
corticobulbar pathway: what/where? pathway from motor cortex directly to CN 5, 7, 12 nuclei
tectospinal pathway: what/where? (aka colliculospinal tract)fibers from midbrain to contralateral muscles in CERVICAL region. GUIDES HEAD MOVMENT
reticulospinal pathway: what/where? brainstem to ant horn of spinal cord. impt in REFLEX ACTIVITY @ SPINAL CORD LVL via MUSCLE SPINDLE ACTIVITY!
vestibulospinal pathway: what/where? descend to all levels of spinal cord, postural control and coordinate head and eye movments.
where are the three places that coordination impairments come from? cerebellum basal ganglia and the ASCENDING dorsal column medial leminscal pathway
what does the cerebellum do? REGULATION of movmt, postural control, mm tone. The “compartor” compares plans of intended movement from motor cortex with actual performance of segment. CORRECTIVE INFLUENCE. Feed forward control.
give examples of the cerebellar closed loop vs open loop? o Closed loop: utilizes all levels of input, modifies o Open loop: no time for feedback, preprogramed memory. Like gait
what are some typical impairments a result of cerebellar pathlogy? o Decreased motor fx, uncoordinated movments, mm tone off
o Ataxia general term for motor impairment of cerebellum. Uncoordinated. Loss of motor coordination. Ataixic gait: uncoordinated gait
o Asthenia generalized mm weakness (in latin, asthenēs means weak)
o Dysarthria: motor speech dysfunction (articulation), scanning speech)('dys' meaning 'difficult or painful'; 'arthr' meaning 'articulating' 'ia' means condition of)
o Dysdiadochokinesia impaired ability to perform rapid alternating movment. from Greek dys "bad", diadocho "receive", kinesia "movement"),
o Dysmetria inability to judge distance or range of movement  Overreaching! Esp after final destination has changed.
Dyssynergia Failure of parts of the anatomy to work together correctly.movement performed in a sequence of component parts rather than as a single smooth activity. decomposition.
o Asynergia loss of ability to associate mm together for complex movments
o Gait ataxia wide BOS, arms out, upright posture, staggering
o Rebound phenomenon loss of check reflex, pt unable to stop sudden limb motion and will hit themself
o Tremor: involuntary oscillatory movement due to alternate contractions of opposing mm groups
intention/kinetic tremor vs postural/static tremor  Intention (tremor when u try to do something) vs postural (static-resting/all the time)
what is the Basal Ganglia's role in coordination • Initiation of movement and regulating gross movments. Facilitates desired responses, inhibited unwanted moment.
what are the characteristics of basal ganglia pathology? oInvoluntary, EXTRANEOUS movment, slow, atlerations in posture or mm tone.
o Akinesia inability to initate movments, associated with fixed postures
Athetosis slow involuntary writhing, twisting WORMLIKE movments. from Gk. athetos "not fixed, without position or place"
o Bradykinesia decreased amplitude and velocity of voluntary movement (shuffling gait ex) parkinsons pts will have this
o Chorea rapid, abnormal gait/involuntary movments, brief, purposeless, sudden, jerk rhythmic, series, complex movements. “huntingtons chorea” ("dance", from Greek khoreia)
o Choreoathetosis movemt disorder with features of both chorea + athetosis
o Hemiballisumus large amp sudden, violent, flailing motions
o Rigidity: ↑ mm tone. Leadpipe, cogwheel. Very stiff, ↓ step length.
o Tremor involuntary, rhymic, oscillatory, mainly at REST.
what are some characteristics of Dorsal Column pathology? o Less characteristic than those produced by cerebellear or basal gang o Coordination and equilibrium Impairments o Lack of joint position, awareness onf momentum localization touch sensation o Gait distrubances o Dysmetira
what is a "romberg sign?" inability to maintain standing balance with the feet together when the eyes are closed
Created by: tpostrel