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Gross Motor Skills, Test & Measures, Neuromuscular Exam - Coggle…

- - - - can also be done in
        
        supine
    - - can also be in
        
        supine. but what to remember in supine
        
        knee flex 45 degrees
  - - - Hands down
  - - - knees bent to prevent stretch of hamstrings
    - - also include
        
        rolled towel under ankle for possible hyperextension
  - - - Knees straight, so hamstrings are only doing hip ext not knee flex as well
- - - - characteristics (5)
        
        • Postural/supportive
        
        • Often 2-joint muscles
        
        • Higher proportion of slow-twitch fibers
        
        • Low tendency for atrophy
        
        • Higher tendency toward “tightness”
    - - characteristics (5)
        
        Often 1-joint muscles
        
        • Higher proportion of fast-twitch fibers
        
        • Higher tendency to atrophy
        
        • Easily fatigable
        
        • Higher tendency toward “lengthened” (and thus weak)
  - - - Realize that lengthening one muscle ofen lengthens others
        
        example
        
        cervical lateral flexion
    - - origin, insertion, action
    - - active
      - passive
- - - - PT applies force to try to break pt position
        
        how long should the resistance be held for
        
        gradually but quickly ramp up to the max amount (about 1-2 secs), be held for 3-5 secs, the gradually but quickly ramp down (about 1-2 secs)
  - - - pt applies the force by pushing into the PTs adequate resistance
    - - “Push into my hand as hard as you can”
    - - when pt has substantial pain, fear, or very limited AROM
- - - - is one or both hands used
        
        either is fine depending on the size of the area
  - - - gentle back-and forth pressure through the pads of your fingers (often the first and second digits, and possibly the third)
  - - - Liver, gallbladder, transverse colon, kidney pancreas
    - - pancreas, kidney, transverse colon, spleen, stomach
    - - Cecum, appendix, colon (ascending), small intestines
    - - small intestines, descending colon, sigmoid colon, rectum
        
        which one of these is more centered
        
        rectum
    - - imbilicus
    - - illiac crest
- - - - ramp up over the course of 1–2 seconds, be held 3–5 seconds, and then be ramped down over the course of 1–2 seconds
- - - - strips of skin that
        correspond to a particular nerve root
    - - no
    - - the virus that causes sshingles lays dormant in the sensory ganglion of the nerve root after one has chicken pox, and if activated, painful skin lesion along that dermatome will occur
        
        what is the virus called that caused shingles
        
        varicella-zoster virus
    - - what is usually used for light touch test(3)
        
        light finger touch, cotton balls, and pieces of gauze
        
        is one or both sides examined at once
        
        usually both to compare both sides
      - what types of tests are usually done (3)
        
        sensory tests such as light touch, temperature, and pain (sharp vs dull)
      - if one n. root is suspected to be affected, what do you test
        
        the dermatome above, at, and
        below the suspected level
  - - - narrowing of the vertebral foramen, facet hypertrophy, or pressure from a herniated intervertebral disc
      - example: pt has shooting pain down the back of the leg towards pinky toe. what n, root is probably compressed
        
        S1
        
        where would you feel the dermatome
        
        lateral malleolus
        
        what DTR would you do
        
        Achilles tendon
        
        DTR (Deep Tendon Reflexes)
        
        Fundamental Concepts
        
        what can affect an individual’s DTR response (4)
        
        1 more item...
        
        what type of reflex is it
        
        1 more item...
        
        what is DTR also known as
        
        1 more item...
        
        Grading Scale (4 of them with description)
        
        2 more items...
        
        Hypotonic DTRs
        
        what injury does this frequently result from
        
        1 more item...
        
        what does the patellar tendon reflex cause the contraction of
        
        1 more item...
        
        Hypertonic DTRs
        
        what pathology is this usually from
        
        1 more item...
        
        Procedure
        
        Hammer
        
        3 more items...
        
        what does the pt have to do
        
        1 more item...
        
        Testing
        
        5 more items...
        
        what myotome test
        
        ankle eversion
    - - peripheral to the spinal cord (so in PNS)
        
        so is this considered a LMN or UMN lesion
        
        LMN lesion
  - - - CNS
        
        so is this considered a LMN or UMN lesion
        
        UMN lesion
    - - all sensation and volitional motion is absent below the level of the lesion
        
        what testing is done to identify the specific deficits
        
        dermatome and myotome testing for nerve roots above, at, and below the lesion can identify sensory and motor deficits specific to each patient
        
        when is this sometimes not the case
        
        pts that have an incomplete SCI, which can have variable deficits
        
        why are the levels below the damage also affected
        
        the brain and body's signals can't pass past the damaged area
  - - - group of mm. supplied to a single nerve root
    - - would lesion or compression at one root cause weakness of a m. or paralysis
        
        weakness
        
        why
        
        bc most muscles in the human body are
        supplied by more than one nerve root
      - would lesion or compression at a peripheral n. cause weakness of a m. or paralysis
        
        m. paralysis
        
        why
        
        bc most mm. (like the triceps) are solely innervated by one n., so if the actual n. is compressed the m. will no be able to work
        
        what mm. would be paralyzed if there was a radial n. lesion (5)
        
        triceps, brachioradialis, ECRL, ECRB, and extensor digitorum
    - - what types of tests are used
        
        break tests of gross strength
        
        how long should you hold the resistance for
        
        a minimum of 5 seconds
        
        why
        
        bc since mm. are supplied by more than one n. root, it takes longer for the m. to fatigue if only one n. root is functioning abnormally
        
        if pt cannot hold against resistance, is it usually bc of pain or weakness (and why)
        
        weakness, bc the source is neural and not contractile tissue (even tho pain can still occur)
      - if one n. root is suspected to be affected, what do you test
        
        the myotome above, at, and
        below the suspected level
- - - - functions (6)
        
        perception of light touch, temperature, pain, vibration, joint position, and discriminative sensation
      - 2 main tracts
        
        dorsal medial lemniscus tract
        
        where is it located
        
        in the posterior column in white mater
        
        what info does it sense (3)
        
        light/fine touch, vibration, and proprioception
        
        where do the nerve fibers cross
        
        in the medulla
        
        when does the next synapse occur
        
        in the thalamus, and then third-order neuron goes to somatosensory cortex
        
        spinothalamic tract
        
        what info does it sense (2)
        
        pain and temp
        
        where do the nerve fibers cross
        
        cross to the contralateral side within one or two spinal cord levels of entry
        
        when does the next synapse occur
        
        in the thalamus, and then third-order neuron goes to somatosensory cortex
      - diseases
        
        Nonselective n. damage
        
        will somatosensory loss typically be bilaterally or unilateral
        
        bilateral
        
        Reduction or block of sensory n. conduction to distal extremities
        
        what is this called
        
        “stocking and glove distribution”
        
        Common conditions (6)
        
        DM
        
        defintion
        
        1 more item...
        
        type 2 DM
        
        1 more item...
        
        MS
        
        definition
        
        1 more item...
        
        what does it affect (2)
        
        1 more item...
        
        Gullian-Barre Syndrome
        
        definition
        
        1 more item...
        
        what does it affect (2)
        
        1 more item...
        
        Hansen's disease
        
        definition
        
        1 more item...
        
        aka
        
        1 more item...
        
        what is the usual first symotom
        
        1 more item...
        
        Lyme disease
        
        definition
        
        1 more item...
        
        Alcoholic neuropathy
        
        common symptoms (2)
        
        1 more item...
        
        what occurs
        
        1 more item...
        
        what can an injury that was not sensed for a long period sometimes lead to
        
        limb amputation
    - - definition
        
        taste
    - - definition
        
        smell
    - - definition
        
        how we maintain are body in space (coordination and balance)
  - - - many c pts eyes closed, compare both sides always, compare distal and proximal areas of skin, test on actual skin, test unaffected area first so pt understands the test
    - - things to remember
        
        if both sides are affected, complete testing on limb first before switching sides
        
        begin distally
      - what to do if you suspect unilateral peripheral n. dysfunction
        
        test affected and unaffected side simultaneously so pt can compare
      - performing test steps (4)
        
        pt closes eyes
        
        ask pt to tell you when touch is felt
        
        Gently touch the patient’s skin, being careful not to
        “dent” the skin
        
        why would we not want to dent the skin
        
        bc this stimulates mechanoreceptors
        
        what to avoid
        
        stabilizing testing limb c other hand, so they don't register the stabilizing touch
        
        what to do if pt does not register touch
        
        you may test the area again, but do not increase your touch
        
        1 more item...
        
        continue procedure at random intervals until areas of normal and abnormal sensation been located
      - what spinal tract is this from
        
        posterior colomn
    - - what spinal tract is this from (2)
        
        posterior column and spinothalamic tract
      - what does it asses
        
        minimum level of light touch recognition
      - what equipment is used
        
        monofiliments
        
        which number is usually tested
        
        5.07
      - performing test steps
        
        pt closes eyes
        
        ask pt to tell you when touch is felt
        
        hold filament at 90° angle to pts skin until it bends slightly
        
        how long to hold pressure
        
        1.5 sec
        
        Perform on one foot at a time, but test both feet during
        the session
        
        what to do if they do not feel one of the 9 spots
        
        move to the next spot, and touch again once all the spots are tested
        
        1 more item...
      - test position (2)
        
        in supine or reclining with the lower extremities supported
      - what pts usually lose this sense
        
        DM
    - - what spinal tract is this from
        
        spinothalamic
      - what does it asses
        
        if the pain can differentiate between a sharp and dull stimulus
      - do you start distally or proximally
        
        begin distally and work proximally until the pt is able to distinguish sharp from dull
      - performing test steps
        
        pt closes eyes
        
        ask pt to tell you when they feel the stimulus by saying "sharp" or "dull"
        
        touch the skin c either the sharp or dull stimulus by making a slight indent in the skin
        
        what if the pt say dull when its sharp
        
        record that answer was incorrect
        
        what is the pt does not register the stimulus
        
        you can test again but do not increase pressure
        
        continue procedure at random intervals and random pattern
    - - what spinal tract is this from
        
        posterior column
      - what equipment is used
        
        a 128-Hz tuning fork (initiate vibration by tapping it on the heel of your hand)
      - test distal areas or proximal areas first
        
        distal
        
        what if they feel it distally
        
        no need to check proximal areas
      - performing test steps (4)
        
        pt closes eyes
        
        ask pt to tell you when the vibration is felt and when it stops
        
        place tip of tuning fork on most distal bony prominence, and hold the structure being tested so you can also feel the vibration
        
        If vibration is absent in the most distal area, move more proximal
        
        which areas do you test for the UEs distal to proximally (7)
        
        1 more item...
        
        which areas do you test for the LEs distal to proximally (5)
        
        1 more item...
    - - what spinal tract is this from
        
        spinothalamic
        
        when is this test omitted
        
        when pain sensation is intact
      - what equipment can be used (2 options)
        
        Two test tubes filled with hot and cold water
        
        Two tuning forks (one cooled by cold water and one
        warmed by hot water)
      - what to do if both limbs may be affected (2)
        
        test one limb at a time
        
        begin distally and move proximal
      - performing test steps
        
        pt closes eyes
        
        ask pt to tell you if the stimulus is cold or hot
        
        Place the tube gently against the pts skin for at least 2 secs
        
        complete test at random intervals and random pattern
        
        what is an abnormal response (2)
        
        inability to discriminate between cold and hot or inability to sense the presence of the stimulus at all
    - - what spinal tract is this from
        
        posterior column
      - what is this known as
        
        proprioception
      - 3 different tests
        
        joint position test
        
        performing test steps
        
        pt closes eyes
        
        tell the pt to tell you if the joint is up or down
        
        hold distal phalanx by the lateral sides w palm down, and do one of the two positions (what are they)
        
        1 more item...
        
        what to do first so pt understands the test
        
        test on unaffected joint first and tell them which position is up and which is down
        
        test distal or proximal areas first
        
        distal
        
        what is distal is fine'
        
        no need to test proximal
        
        where to start in the UE and LE
        
        UE: distal phalanx; LE: IP of great toe
        
        what are the next proximal joints for the UEs and LEs
        
        UEs: MCP, wrist, elbow ; LEs: MTP, ankle, knee
        
        what no to do when testing (2)
        
        dont touch digit on dorsal or ventral side, and dont touch other digits
        
        joint space (mirroring) test
        
        performing the test steps
        
        pt closes eyes
        
        move the finger or toe of the pts uninvolved extremity to a particular position
        
        tell pt to mirror the position with the involved extremeity
        
        1 more item...
        
        how to instruct the test to the pt
        
        demonstrate on assistant or colleague
        
        finger to nose test
        
        how to instruct the test to the pt
        
        demonstrate on assistant or colleague
        
        performing test steps
        
        pt closes eyes
        
        lightly touch one of the pts fingers, and ask pt to touch their nose with the finger that was touched
    - - what spinal tract is this from
        
        posterior column
        
        also portions from what area
        
        cerebral cortex
      - 4 test
        
        Stereognosis
        
        defined as
        
        object identification solely by touch
        
        what equipment is used
        
        objects familiar to most people
        
        examples (5)
        
        paper clip, coin, cotton ball, key, rubber band
        
        performing test steps
        
        pt closes eyes
        
        place object in pts palm and tell them to identify
        
        Perform several trials on both hands using different
        objects
        
        do you begin with unaffected side or affected side
        
        unaffected side
        
        1 more item...
        
        what is it called when you cannot identify common objects
        
        astereognosis
        
        how can you test fine discrimination
        
        using a coin and identifying heads or tails
        
        graphesthesia
        
        defined as
        
        the ability to identify writing on the skin solely by touch
        
        equipment needed
        
        blunt end of a pen or similar object
        
        performing the test steps
        
        1, perform demonstration c their eyes open so they can know what the top and bottom of the "paper" is
        
        pt closes eyes and extends unaffected side first
        
        draw a large number on their hand
        
        1 more item...
        
        what is it called when you cannot identify numbers being drawn on skin
        
        agraphesthesia
        
        Two-point discrimination
        
        equipment that can be used (2)
        
        2 unbent paperclips to use pointed ends, or special two-point discriminator tool
        
        performing the test steps
        
        pt closes eyes and extends unaffected hand out first
        
        On the pad of one finger, touch the patient with two
        points simultaneously and ask the patient if one or two point are felt
        
        Alternate touching with one and two points in a random fashion in several places on the fingers and hand.
        
        1 more item...
        
        Point Localization
        
        performing test steps
        
        pt closes eyes
        
        Lightly touch an area on the patient’s skin
        
        Ask the patient to open his or her eyes and then point
        to the place that you touched.
        
        1 more item...
        
        people with what 2 thigs can perform this test accurately
        
        intact light touch sensation and an intact
        somatosensory cortex