Transcript RHS 332-1

RHS 332: Clinical Neurology
Ahmad Alghadir, M.S. Ph.D. P.T.
Room: 2071
[email protected]
[email protected]
Ahmad Alghadir M.S. Ph.D. P.T.
Recommended texts
• S.B. O’sullivan, T.J. Schmitz, Physical
Rehabilitation: Assessment and
Treatment, F.A. Davis Company. 3rd ed.
1994.
• R.L. Braddom, Physical Medicine &
Rehabilitation, W.B. Saunders Company.
1st ed. 1996.
Ahmad Alghadir M.S. Ph.D. P.T.
Motor Control Assessment
Ahmad Alghadir M.S. Ph.D. P.T.
Introduction
•
“Motor control evolves from a complex
set of neurologic and mechanical
processes that govern posture and
movement.”
1. Reflex patterns: genetically
predetermined.
2. Motor skills: learned through interaction
and exploration of the environment and
required practice and experience.
Ahmad Alghadir M.S. Ph.D. P.T.
• Sensory feedback is required to shape
and guide the development of the motor
program.
• Motor program: “a set of commands that,
when initiated, results in the production of
a coordinated movement sequence.”
• Motor plan: “combination of several motor
programs into an action strategy.”
Ahmad Alghadir M.S. Ph.D. P.T.
• Motor subprogram: smaller subroutine of
coordinated muscle action.
• Motor memory: “involves the storage of
motor programs or subprograms and
includes information on how the
movement felt (sense of effort), movement
components, and movement outcome.”
Ahmad Alghadir M.S. Ph.D. P.T.
• “Memory allows for continued access of
this information for repeat performance or
modification of existing patterns of
movement.”
Ahmad Alghadir M.S. Ph.D. P.T.
• Levels of CNS command hierarchies:
1. Association cortex: “organize sensory
information and elaborate the overall
motor plan.”
2. Sensorimotor cortex: “shape and define
the specific motor programs and initiate
commands.”
Ahmad Alghadir M.S. Ph.D. P.T.
3. Brainstem and spinal cord: “executes the
commands, translating them into the final
muscle actions.”
• “Command levels vary depending upon
the specific task executed.”
Ahmad Alghadir M.S. Ph.D. P.T.
• Rigid top-down vs. rigid down-top
hierarchy (e.g. reflex, vision, loss of
sensory feedback, neural activity at spinal
level, different reactions to one stimulus,
loss of motor memory).
• Distributed or flexible motor control.
• Control commands proceed in both
descending and ascending manner.
Ahmad Alghadir M.S. Ph.D. P.T.
Closed-loop system
• Definition: “a control system employing
feedback, a reference of correctness,
computation of error, and subsequent
correction in order to maintain a desired
state of the environment.”
• Feedback sources to monitor movement:
visual, vestibular, proprioceptive, and
tactile inputs.
Ahmad Alghadir M.S. Ph.D. P.T.
• Primary role:
1. “Monitoring of constant states such as
posture and balance.”
2. “Control of slow movements or those
requiring a high degree of accuracy.”
3. “Learning of new motor tasks.”
• Compensation with other sensory
systems e.g. Romberg test.
Ahmad Alghadir M.S. Ph.D. P.T.
Open-loop system
•
Not all movements are controlled by
closed-loop system.
1. Stereotypical movements e.g. gait.
2. “Rapid, short duration movements, which
do not allow sufficient time for feedback
to occur.”
Ahmad Alghadir M.S. Ph.D. P.T.
• Independent of error-detection
mechanisms.
• “Control originates centrally from a motor
program, which is a memory or
preprogrammed pattern of information for
coordinated movement.”
Ahmad Alghadir M.S. Ph.D. P.T.
Validity vs. reliability
• Validity: “if the tool accurately measures
the parameter of performance being
examined, it is said to have validity.”
• Intra-rater reliability: “consistency of
results obtained by an examiner over
repeat trials.”
• Inter-rater reliability: “consistency of
results obtained by multiple examiners.”
Ahmad Alghadir M.S. Ph.D. P.T.
Qualitative vs. quantitative
• “Assessments can be qualitative, focusing
on a subjective estimation of performance,
or quantitative, using objective measures.”
Ahmad Alghadir M.S. Ph.D. P.T.
UMN and LMN syndromes
Possible
locations
Common
causes
Distribution of
abnormalities
Voluntary
movements
UMN
LMN
CNS
PNS
CVA, tumors,
trauma, MS
Groups, ipsicontra-lateral
Paralysis or
paresis
Trauma,
metabolic dis.
Segmental,
ipsilateral
Ahmad Alghadir M.S. Ph.D. P.T.
Paralysis
Muscle tone
Myotatic
reflexes
Cutaneous
reflexes
Muscle bulk
UMN
LMN
Increased
Decreased
Hyperactive or Decreased or
exaggerated
absent
Abnormalities
Decreased or
(Babinski sign)
absent
Slight atrophy
Pronounced
due to disuse atrophy 70-80%
Ahmad Alghadir M.S. Ph.D. P.T.
I. Flexibility
• ROM “is an important element of
functional movement.”
• “Limitations restrict the normal action of
muscles as well as the biomechanical
alignment of body parts.”
• “Longstanding immobilization results in
contracture, a fixed resistance resulting
from fibrosis of tissues surrounding a joint.
• Variability, side to side comparison.
Ahmad Alghadir M.S. Ph.D. P.T.
1. AROM
• Definition: “amount of joint motion
obtained with unassisted voluntary joint
motion.”
• Influenced by muscle strength and
coordination.
• Goniometer.
• Full AROM without pain  PROM is not
necessary.
Ahmad Alghadir M.S. Ph.D. P.T.
• Determine:
a)The presence of pain (when appears, how
severe).
b)“Movement of associated joints or
substitutions.”
c)The cause of limitation if present.
Ahmad Alghadir M.S. Ph.D. P.T.
2. PROM
• Definition: “amount of joint motion
available when an examiner moves the
joint through the range without
assistance from the patient.”
• Joint play: “small amount of joint motion
that occurs at the end range and is not
under voluntary control”  PROM >
AROM.
Ahmad Alghadir M.S. Ph.D. P.T.
• Goniometer.
• Determine the
cause of limitation
if present.
AROM PROM
Contractile
structures
+ve
-ve
Passive
structures
+ve
+ve
Ahmad Alghadir M.S. Ph.D. P.T.
3. End feel
• Definition: “characteristic feel each
specific joint has at the end ROM.”
• Soft, firm, or hard.
• Joint capsule, ligaments, muscle tension,
soft tissue approximation, or joint
surfaces.
4. Special tests
Ahmad Alghadir M.S. Ph.D. P.T.