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define Motor Control:
neural, physical, behavioral process which result in posture and movement
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Describe Motor Skills:
- Developed through motor learning
- acquired and modified by the CNS
- gained through interaction & exploration of the environment
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Describe Feedback:
response-produced infer received during or after the movement and is used to monitor output for corrective actions
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Describe Feedforward:
sending of signals in advance of movement to ready the sensory-motor systems give you anticipatory adjustments in postural activity
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Describe coordination:
the ability to execute smooth, accurate, and controlled motor responses
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What is a motor program?
an abstract representation that results in the production of coordinated movement sequence
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What is a motor plan?
an idea or plan for purposeful movements made up of several motor programs
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What is motor memory?
the recall of motor programs
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What does motor memory typically include?
- initial movement conditions
- how the movement felt, looked, sounded
- specific parameters
- outcome
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what is motor learning?
A change in the capability of a person to perform a skill which occurs as the result of skilled practice or experience
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What does motor learning require?
- spatial organization
- temporal organization
- hierarchical organization in the CNS
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what is recovery of function?
reacquisition of movement skills lost through injury.
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What is compensation?
adoptions of alternative behavioral strategies to complete a task
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Define neuroplasticity:
the capacity of the brain to adapt to injury through mechanisms of repair and change.
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What should be included in the baseline assessment?
- CNS responses
- how the patient reacts to sensory stimulation
- are they using compensatory mechanisms in response to physiological stress?
- how are changes impacting the patient's functional level?
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What are factors that may constrain motor function examination?
- consciousness and arousal
- terminology
- Inverted U-principle
- ANS
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How does the ascending reticular system act?
- in the brainstem, it acts on the cortex to: maintain a conscious state
- control different degrees of wakefulness
- control sleep cycles
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How does the descending reticule activating system act?
it monitors baseline body functions and homeostasis through maintenance of the autonomic and somatic motor systems
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What does the pontine or medial tract of the descending reticular activating system do?
it enhances spinal cord antigravity reflexes and extensor tone of the LE
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What does the medullary or lateral tract of the descending reticular activating system do?
it reduces antigravity control
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time frame of a true coma:
<2 wks
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Describe a vegetative state:
- irregular sleep/wake cycles
- normalized respiration
- normalized digestion
- normalized blood pressure and temp regulation
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Describe a Persistent Vegetative State:
- caused by a severe head injury
- anoxia
- lasts longer than 1 year
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What is the Glascow Coma Scale?
- the gold standard for coma assessment
- scores from 3 to 15
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What does the Glascow Coma Scale evaluate in it's assessment of a coma?
- Eyes opening
- best motor response
- best verbal response
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Describe the Inverted U principle:
- related to motor performance and level of arousal
- low or high levels of arousal may cause deterioration of of motor performance
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What are elements of motor function examination?
- Tone
- hypertonia
- muscle performance
- voluntary movement patterns
- activity based task analysis
- taxonomy of tasks
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Describe tone:
- resistance of muscle to passive elongation or stretch
- steady state of muscle contraction or slight residual contraction
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what is hypertonia?
increased above normal resting levels of tone
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Types of hypertonia include:
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describe spasticity:
a muscle tone disorder that is characterized by a velocity dependent increase of muscle tone with increased resistance to stretch
- part of an upper motor neuron syndrome
- loss of inhibitory control
- over excitability of alpha motor neurons
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What is clonus?
- a form of spasticity in which is:
- cyclical
- spasmodic alternation of muscle contract & relaxin response to sustained stretch of spastic muscle
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types of rigidity:
- lead-pipe
- cogwheel
- decorticate
- decerebrate
- dystonia
- hypotonia
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What is Lead-pipe?
a form of rigidity in which there is constant resistance throughout the ROM that is independent of the velocity of movement
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How does Lead-Pipe present?
- stiffness
- inflexibility
- significant functional limitation
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What is Cogwheel?
- rigidity
- ratchet-like jerkiness
- most commonly in UEs
- may have tremor
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describe Decorticate rigidity:
- sustained contraction and posturing of:
- UE in flexion
- UE-ext rotated
- LE in extension
seen with significant brain injury and coma
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Describe decerebrate rigidity:
- sustained contraction and posturing of:
- UEs in extension
- UE-int rotated
- LEs in extension
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Describe dystonia:
- prolonged involuntary movement
- twisting or writhing repetitive movements
- increased muscular tone
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Describe hypotonia:
- decrease or absent muscle tone
- diminished resistance to passive movements
- decrease stretch reflexes
- most common in LMN or cerebellar lesions
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explain the Modified Ashworth Scale:
- measures rigidity of hypertonia
- scale of 0-4
- (0 is no increase in tone)
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What is included in examination of tone?
- observation
- palpation
- passive motion testing
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What do you not do when examining tone?
- Repeat quick stretches
- reflex testing that produces hypertonicity
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What is muscle performance?
- the capacity of a muscle or group of muscles to generate forces
- therefore produce a specific functional task
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Patients with UMN lesions typically are unable to do what?
How do you react to this?
- they are unable to recruit motor units or single joint movements in a normal fashion
- estimations of strength or description of function is usually more beneficial than MMT
- CAREFUL documentation
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What should you be aware of when testing muscle performance?
- substitution patterns
- stereotypical movement patterns
- abnormal co-activation
- spasticity
- abnormal posturing
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In relation to voluntary movement patterns, what is synergy?
- functionally linked muscles by the CNS to produce an intended motor activation
- simplify control & initiate coordinated movement patterns
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In relation to voluntary movement patterns, discuss obligatory synergies?
they are primitive highly stereotyped due to CNS damage
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What is the purpose of activity based task analysis and what may be involved?
- determine factors that may keep the patient from being successful in motor planning
- factors such as: environment, activity, psychosocial
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list the taxonomy of tasks:
- transitional mobility
- stability
- dynamic postural control
- skill
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