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Neuro E&I

NM Exam: Implication of Neuro Disease or Injury

Which is not a req. of skilled motor perf.? 1. All involved muscle generate peak force 2. Force production is all or nothing 3. Acquire ability to sustain force 4. Peak force quickly at appropriate time 5. Ability to perform gross motor mvmnt normall 2. "Force production is all or nothing" FALSE -Force must be graded and timed 5. "Ability to perform gross motor mvmnt normally -Ability to perform fractionated movements (fine motor)
Which neurons have cell bodies in the anterior horn of spinal gray? Lower Motor Neurons
Lesions to UMN can be caused by what type of injuries? Stroke, MS, SCI, TBI
DIscuss why blurry vision is a cardinal sign with stroke, assuming the occipital lobe is not damaged? Optic nerve pathway is close to damage sites in frontal lobe.
What are you assessing with Slow PROM and Fast PROM? Slow PROM: assess available motion Fast PROM: assess spasticity Also: arthrokinematic motion, end feel
Absence of muscle tone and reflexes below neurological level of pt. w/ ACUTE spinal cord injury Spinal Shock
If SCI are UMN associated, why does one see hyporeflexia or hypotonia immediately following a stroke? How long does it typically last? Inactivity of LMN's can be seen with spinal shock, resulting in opposite signs. -Typically does not last more than 6 weeks. The longer the SS, the poorer the prognosis.
Discuss clinical presentations for Spinal Shock and considerations. 1. Flaccid muscle tone (avoid overactive stretching with PROM) 2. Absent DTR 3. Flaccid Bladders/Sphincter (Retraining occurs after spinal shock) 4. Absent Erection in Males
What precautions should be taken during NM assessment of someone with SCI pre-surgically? 1. Cervical Injury. Caution with shoulder motion. Stay <90º with flex. and abd. 2. No straight leg raise >90º with injury T6 or below 3. No long finger extension 4. Monitor VS and Spinal Shock
What precautions should be taken during NM assessment of someone with SCI post-surgically? 1. Monitor for AD 2. Preserve tenodesis 3. Selective ROM, keep certain areas tight 4. No prone activities with halo
Discuss the implications for selective tightening of the lower back? (L2-L3) Pt. cannot ant. pelvic tilt. Tighten back to provide more stability and increased momentum energy for transfers
Discuss the implications for selective stretching of the hamstrings? What must you be careful not to stretch while stretching HS? Extra flexibility needed to allow for long sitting. 110º. Avoid stretching lower back concurrently.
What motions are selectively tightened and stretched in the UE? Selectively Tightened: Long Finger Flexors (maintain tenodesis) Selectively Stretched: -ER and Extension of shoulder (Transfers) -Ext, Sup, Pro of elbow/forearm
Discuss selective flexibility for the ankle in terms of non-ambulatory and ambulatory goals Non-ambulatory: 0º. Enough to have foot flat for transfers and footplate Ambulatory: 10-15-20º, enough to walk.
Why should a PT take into account trunk control and posture during the motor control assessment? Poor core strength/stability will alter distal limb movement. The arm may not be weak.
When is Torque Testing indicated and how is it different from MMT? Testing of major functional muscles, where force for MMT is innapropriate. -Provide constant resistance throughout the range of motion vs. MMT performed in one position.
What should one consider when watching an active movement pattern where the pt. is unable to move through there available ROM? Consider whether or not it's a ROM limitation or a motor control problem (ex. flexor synergy)
A pt. flexes their right hip AROM: 45º (PROM 90º) in the supine position, however they exhibit knee flexion and ankle eversion with the movement DOCUMENT AROM R Hip Flexion 50% ROM AG w/ flexion synergy of the knee and ankle When would you correct for deviations? During Ther. Ex. Not when assessing AROM.
True or False: Most functional tasks are open chain (ex. swing phase of gait) -What exercises could you prescribe? FALSE! Most functional tasks are close chain EXCEPT for the swing phase of gait. -Prescribe STS or Step-Ups
Place assessment steps in order of first to last. Spasticity Check AROM PROM PROM-Spasticity Check-AROM
How could you train a pt. to utilize their peak force at the appropriate time? Utilizine TIMING as a training variable.
These cells are the only cell to deliver commands to muscles. They are aslo a conduit for reflex arcs. Be specific. Anterior Horn Cells of LMN
Disuse atrophy is more seen with ___MN injury while Short Term atrophy is more seen with ___MN Injury Disuse Atrophy: UMN -intact motor unit gets neglected Short Term Atrophy: LMN -related to hypotonia
True or False: A singular relationship does NOT exist between a lesion site and an impairment or between an impairment and a disability True. A singular relationship does NOT exist between a lesion site and an impairment or between an impairment and a disability Both impairments: Lack of Sh. Flexion and Hip Extension. Bigger disability with Hip due to inability to stand straight.
When considering impairments for patients with neurological pathology, what other factors could limit mobility? o Cognitive state o Premorbid conditions o Environment o Presence or lack of support
Why would a patient present with cognitive deficits due to a stroke? Close proximity of Frontal Lobe->cognitiion
Why is MMT not indicated for the neurological population? MMT is designed for normal CNS. Not designed for this population who are limited not only by weakness but by force generation, sustaining force, timing
Muscle weakness can result from what 4 conditions o Cortical lesions: brain problem o Disruption of the alpha motor neuron impulses o Neuromuscular synaptic dysfunction: problem where nerve meets tissue o Damaged muscle tissue
Created by: Phillypino