OCCTH 1 PART 2 (WEEK 3 - neuromotor impairments) Questions & Answers Already Passed!!

Motor Neglect - ️️- impaired initiation or execution of movement into contralateral hemispace by either limb - often difficult to distinguish between sensory or motor neglect ◦Limb akinesia: failure to move limb ◦Hypokinesia: limb moves only after long delay and much encouragement ◦hypometria: movements are of decreased amplitude ◦impersistence: inability to maintain a movement or posture ◦motor perseveration: inability to disengage from a motor activity ◦motor extinction: delay or failure to move contralateral limb when also required to move ipsilateral limb LESIONS IN CORTEX// APRAXIA - ️️inability to perform goal-directed motor activity; omissions, disturbed sequence, clumsiness, perseveration, inability to gesture or use common objects 4 types: IDEOMOTOR: Errors made with goal-directed movements; improves with use of actual movements (Awkward or clumsy use of tools to complete tasks; may not be able to complete movement pattern for brushing teeth, but able to complete task in context with real objects) IDEATIONAL(CONCEPTUAL): Error in use of common object use and sequencing of multistep tasks (may attempt to use toothbrush to brush hair) CONSTRUCTIONAL: Difficulty with copying, drawing, and constructing 2D and 3D designs (setting table, making sandwich, etc.) DRESSING: inability to dress oneself Neuromaturational Theory of motor development - ️️Changes in neural structures is directly related to changes in motor function - Changes in neural structures -- Changes in motor function - Changes are due to interaction of multiple systems & contexts - CNS damage can lead to regression to lower levels and stereotypical behaviors Assumptions of Therapeutic Approaches - ️️- CNS is hierarchically organized- Motor control is heterarchical system (smaller subsystems have effect on overall motor function) - Environment, Activity demands, and client factors all relate to performance - Behavioral changes reflect attempts to compensate and achieve task performance ◦use remaining capacities in addition to new strategies to continue functional performance (ex: learned non-use) site, extent - ️️______ and _________ of CNS damage will determine the type of motor dysfunction ** damage in specific locations will correlate to damage/deficits PATHWAY of MOTOR messages (start in neuro system and move to skeletal) - ️️Precentral Gyrus: primary motor cortex (combines with sensory info here) ---- internal capsule ---- thalamus ---- brainstem ----- spinal cord (ventral horn to ventral root to PNS) ---- skeletal muscle LESIONS IN CORTEX// PRECENTRAL GYRUS - ️️loss of voluntary muscle movement on contralateral side ◦spasticity, hyperreflexia LESION IN CORTEX// HYPOTONIA, HYPERTONIA, SPASTICITY - ️️Hypotonia: decreased muscle tone or flaccidity; less than normal resistance to passive elongation Hypertonia: increased muscle tone; more than normal resistance to passive elongation Spasticity: *velocity-dependent* increase in tonic stretch reflexes and exaggerated tendon reflexes ◦component of hypertonicity ***Change in tone can be caused by both mechanical or neurological factors of the muscle Mechanical factors: changes in the elastic part of the muscle Neurological factors: spasticity in muscle because of damage to the brain LESIONS IN CORTEX// CLONUS - ️️oscillating contraction and relaxation of a limb caused by alternating stretch reflex and inverse stretch reflex of spastic muscle - Caused by hyperreflexia of muscleLESIONS IN CORTEX// LEAD PIPE RIGIDITY - ️️hypertonus in agonist and antagonist muscles, resistance to movement not velocity-dependent, but felt throughout ROM LESIONS IN CORTEX// LOSS OF FRACTIONATION AND WEAKNESS - ️️FRACTIONATION: inability to move a single joint without producing unnecessary movements in other joints; causing stereotyped movement patterns (difficulty w/ small movements) WEAKNESS: inability to generate necessary force for effective motor action Basal Ganglia - ️️Integration and storage of stereotypic and automatic motor patterns ◦Learned motor patterns that require little conscious cortical input ◦Dressing, walking, hand to mouth, etc. Tone and posture Initiation and dis-inhibition of movement Error correction during movement