Please enable JavaScript.

Coggle requires JavaScript to display documents.

Coordination, Cranial N. Testing - Coggle Diagram

- - - - 3 components
        
        somatosensory
        
        vestibular
        
        visual
    - - where does this occur (3 areas)
        
        basal ganglia
        
        cerebellum
        
        supplementary motor area
  - - - activation of ankle muscles for stability during small perturbations (disruptions)
        
        which mm. activate if the bodys COM is shifted anterior to the BOS (2)
        
        hamstrings and gastrocnemius
        
        which mm. activate if the bodys COM is shifted posterior to the BOS (2)
        
        quads and tibialis anterior
    - - body’s reaction to larger perturbations (disruptions) or smaller support surface
        
        what occurs
        
        hips rapidly flex and/or extend in an attempt to move the body’s COG back w/in the BOS
    - - body’s COG moves too quickly or too far outside BOS to
        use either of above strategies
      - what do you do
        
        step forward/backward/side creating a
        larger BOS
    - - Automatic responses to postural disturbances
  - - - seated balance
        
        it is essential for what type of injury
        
        SCI in wheelchair
        
        things to monitor (4)
        
        posture, compensation on one side than the other, seat height (so foot can touch the ground), if they can reach
        
        two ways to perform
        
        side-to-side or front-to-back weight
        shifts, to reach in various directions
        
        how can increase difficult
        
        pt closes eyes
      - standing balance
        
        3 types
        
        Romberg (eyes open or closed)
        
        rules of the test (4)
        
        NO shoes
        
        • Firm surface
        
        • Feet together
        
        • Arms at side or across chest
        
        how long is the test
        
        30 sec (can have variations)
        
        Abnormal or failed test: (4 things)
        
        sway, LOB, use of
        UEs to stabilize, stepping out of BOS
        
        what is a positive Romberg test classified as
        
        ability to stand in this position with eyes
        open but not with eyes closed
        
        how can you make it harder (2)
        
        arms crossed on chest or shoes on
        
        Sharpened Romberg (eyes open or closed)
        
        rules of the test (2)
        
        Firm Surface
        
        Heel in line with toe, test with each foot in
        front
        
        which leg is working more
        
        1 more item...
        
        how long is the test
        
        30 sec
        
        Abnormal or failed test: (2 things)
        
        sway outside BOS,
        or LOB
        
        Single leg stance
        
        rules of the test (3)
        
        Eyes open (EO) or eyes closed (EC)
        • Firm surface, no shoes, arms at sides
        • Standing on one foot with other raised
        
        how long
        
        30 sec
        
        Abnormal or failed test: (3 things)
        
        COG sway outside BOS, LOB, foot down
        
        how can you make it harder (3)
        
        arms crossed on chest, shoes on, or stand on less stable surfaces
    - - standing balance
        
        reactive test
        
        definition
        
        Response to external forces on body
        
        what is the test called
        
        Nudge/push test
        
        what occurs
        
        giving pt a nudge at random intervals from the front, sides, and back; Start light to increase force as pt able to tolerate
        
        3 more items...
        
        what are common sites to nudge (3)
        
        Shoulder, sternum, pelvis
        
        how is pt positioned (3 things)
        
        Ask the patient to stand quietly with eyes open, feet a
        comfortable distance apart, and arms comfortably at
        
        1 more item...
        
        anticipatory
        
        2 types
        
        functional reach test
        
        what occurs
        
        pt reaches as far as they can by a wall without moving their feet; measuring the reach
        
        3 more items...
        
        catching
        
        where does PT stand
        
        directly in front of the patient
        (5–10 feet away)
        
        how can you make it difficult (5)
        
        aim for pt left or right side
        
        Aim high or low.
        
        If the patient is performing well, aim slightly outside his or her BOS to encourage a step
        
        vary speed
        
        standing on unstable surface
        
        Walking
        
        can incorporate alot of elements like setting up an obstacle course
        
        examples of elements
        
        Side stepping
        Marching in place
        Reaching for object on shelf
        Walking with changes in speed
        Walking while carrying object
        
        what is the most widely used clinical tools for assessing balance
        and functional mobility
        
        Berg Balance Scale (BBS)
        
        description
        
        assess a pt ability to maintain certain positions or to perform particular motions of increasing difficulty
        
        1 more item...
        
        what is one clinical drawback
        
        takes 15–20
        minutes to administer
        
        1 more item...
      - seated balance
        
        what can be performed
        
        side-to-side or front-to-back weight
        shifts, to reach in various directions with one UE or both UEs moving
        
        how can difficulty be increased
        
        pt closing eyes
  - - - what is important to know about falls
        
        they are the leading cause of injury-related deaths among older adults
      - what are the 2 standardized questionnaires that have proven
        clinically useful to know if a pt is confident w balance
        
        -16-item Activities-specific Balance Confidence (ABC) scale
        -10-item Falls Efficacy Scale
- - - - definition
        
        poorly coordinated movement, lacking fine motor control
    - - 2 types
        
        intentional tremor
        
        decription
        
        tremor that begins as limb reaches a target during volitional movement
        
        postural tremor
        
        description
        
        type of tremor occurs when you try to hold a body part still against gravity, such as holding your arms out in front of you
    - - definition
        
        decrease in normal resting muscle tone
      - how are the mm.
        
        loose and not ready to engage
    - - definition
        
        poor word formation from inability to coordinate muscles of speech
    - - 4 types
        
        nystagmus
        
        what does the eyes sometimes do
        
        continues to beat after looking to the side
        
        poor smooth pursuit
        
        saccades
        
        delayed initiation of eye movements
    - - If suspected cerebellar dysfunction,
        the minimum to perform is ( 3 tests)
        
        • One LE test
        
        LE coordination tests
        
        Heel to shin
        
        what does pt do
        
        1 more item...
        
        toe to clinician finger
        
        what occurs
        
        1 more item...
        
        pt position
        
        1 more item...
        
        toe tapping
        
        what does pt do
        
        2 more items...
        
        Romberg or Sharpened Romberg
        
        gait
        
        • One test of unsupported stance or gait
        
        what are the 2 unsupported stance tests
        
        romberg
        
        sharpened Romberg (tandem)
        
        One UE test
        
        UE coordination tests (4)
        
        Rapid Alternating Movements (RAM)
        
        what test is commonly used
        
        2 more items...
        
        what is the term that means inability to perform RAM
        
        1 more item...
        
        what can you add to make the test harder (2)
        
        1 more item...
        
        Finger opposition
        
        what does the pt do
        
        1 more item...
        
        how to make test harder (2)
        
        1 more item...
        
        how many trials are sufficient
        
        1 more item...
        
        Finger to nose (or chin)
        
        How is the pt positioned
        
        1 more item...
        
        what does the pt do
        
        1 more item...
        
        how many trials is sufficient
        
        1 more item...
        
        what can you add to make the test harder (2)
        
        1 more item...
        
        Finger to clinician finger
        
        what occurs (3)
        
        1 more item...
        
        what is dysmetria
        
        2 more items...
      - what do you note during the tests (3 things)
        
        patient’s rhythm, smoothness of movement, speed, accuracy
      - what is important to do
        
        Both sides should be completed
        when possible
      - why test for coordination (3)
        
        Assessed with patients that have
        known or suspected lesions in CNS
        
        Completed with shakiness with
        activities like buttoning, writing, eating
        
        Can be used as a screening
        
        when it is not needed
        
        if there is no known or
        suspected involvement of CNS
      - can be challenging with what type of deficits (3)
        
        strength, ROM, tone deficits
    - - cerebellar dysfunction as a result of malnutrition that
        accompanies chronic alcoholism
        
        what areas does it primarily affect (2)
        
        primarily affects the
        trunk and lower extremities
        
        what do pt present w
        
        truncal ataxia (how is it demonstrated (4 things))
        
        wide-based, staggering gait with variable starts and stops, lateral deviations, and unequal step length
        
        individual are not able to stand in what 2 ways
        
        with feet together or in a heel-to-toe (tandem)
        stance
    - - variable combination of changes in both
        upper and lower quarter muscle tone
      - reflexes (diminished)
      - uncoordinated voluntary movement of the limbs
        
        on opposite or same side as lesion
        
        same side
      - what 3 other things can be present
        
        Dysarthria, disequilibrium,
        and abnormal eye movements
- - - - what conditions usually have this (3)
        
        Down’s syndrome, cerebral palsy, PNS disorders
      - how would it feel
        
        when limb is passively moved, there is a "floppy" feeling to the movement and little to no resistance
        
        how would a hypotonia m. feel when palpating it
        
        more “give” than a muscle with normal tone
    - - what conditions usually have this (3)
        
        CVA, SCI, MS
        
        What would be affected if lesion in right side of the brain
        
        left sided mm. would be hypertonic
        
        What would be affected if lesion is in the spinal cord (SCI)
        
        areas below the level of the lesion will be affected
      - how would it feel
        
        when passively moved increased resistance is felt, especially when the muscle is placed in a stretch position
        
        how would a hypertonia m. feel when palpating it
        
        have a firmer-than-normal feel
    - - description
        
        manifestation of hypertonicity in which
        the resistance to passive motion is rate or velocity dependent
      - it is generally more marked in what m. groups in the arms
        
        flexor m. groups
      - it is generally more marked in what m. groups in the legs
        
        extensor muscle groups
    - - Provide support when testing, complete multiple cycles of PROM, increase velocity
        
        do you have to move to full ROM
        
        no, but a relatively large portion of available range
        
        can you assess several joints at once
        
        yes
        
        what does PT hold during lower extremity testing
        
        Grasp the plantar aspect of the patient’s foot with one
        hand and place your other hand just distal to the popliteal space
    - - what will you feel with increased tone
        
        resistance
      - PT passively moves the pt in a planar motion to check if you feel resistance (a pull; hypertonia) or no resistance at all (hypotonia)
      - where can you test
        
        ankle, knee, hip, wrist, elbow
        
        when going fast in hip flexion, what m. tone are you testing
        
        hip extensors, so its always the opposite
    - - UMNs in the brain directly influence and regulate the level of muscle tone by controlling the activity of lower motor neurons in the spinal cord
        
        what specifically does this
        
        (primarily the corticospinal tract modulates the response
  - - - rapid, involuntary back and forth beating, continues multiple cycles
    - - slightly different form of DTR test
    - - pt relaxed/supported, knee slight flexed, slow ankle PROM, then quickly to end range dorsiflexion
      - what is a negative result
        
        no beating/oscillations
      - what is a positive result
        
        feel/observe oscillations
        
        what to do when you feel or see beats
        
        count the beats
  - - - Flex shoulder to ~90˚ , forearm supinated
        with eyes closed
      - in what positions (2)
        
        Pt. standing/sitting
      - results
        
        normal
        
        20-30 sec and no movement
        
        abnormal
        
        arm drifts into pronation and can drift downwards
        
        what can this indicate
        
        presence of mild UMN disorder
        
        what cann occur that can indicate a more severe lesion
        
        1 more item...
  - - - position
        
        Pt supported supine, on skin of foot use capped pen or reflex hammer end
      - Swipe up lateral foot distally then medially across metatarsals
        and complete bilaterally
    - - normal
        
        adults
        
        Toe flexion or no reaction
        
        pediatrics
        
        Babinski positive/present/normal in children up to 2yrs old
      - abnormal
        
        great toe extension and other toes splay apart (“Positive Babinski“), flexor withdrawl reflex
  - - - Hold pt’s 3rd distal phalanx between finger and thumb
        Quickly slide thumb off pt’s nail (into DIP flex)
    - - monosynaptic