Chapter 5 Of Shumway-Cook: Constraints On Motor Control

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Motor System Impairments

Back 1

Primary Neuromuscular impairments

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Primary Neuromuscular Impairments

Back 2

Motor weakness, abnormalities of muscle tone, coordination problems, involuntary movements

Front 3

Sensory Impairments

Back 3

Somatosensory Deficitis, Visual Deficitis, Vestibular System

Front 4

Cognitive and Perceptual Problems

Back 4

body image/scheme disorders, spatial relation, apraxia, attention, orientation, memory, explicit and implicit, problem solving

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Paresis

Back 5

mild or partial loss of muscle activity

Front 6

Abnormalities of Muscle Tone

Back 6

Hypertonia, Hypotonia

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Coordination Problems

Back 7

activation and sequencing, timing problems, scaling forces, involuntary movements

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Secondary Musculoskeletal Impairments

Back 8

pressure sores, deconditioning

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Hypertonia

Back 9

Spasticity, Rigidity

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Spasticity

Back 10

a motor disorder charactized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jersk, resulting from hyperexcitability of the stretch reflex, UMN syndrome

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Rigidity

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heightened resistance to passive movement of the limb, independent of the velocity of stretch

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Lead pipe rigidity

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constant resistance to movemetn throughout entire ROM

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Cogwheel rigidity

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alternating epidsodes of resistance and relaxation, catching as the extremity is passively moved through its ROM

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Flaccidity

Back 14

complete loss of muscle tone

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hypotonicity

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reduction in the stiffness of a muscle to lengthening (Down Syndrome)

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Activation and Sequencing problems

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Abnormal synergies, coactivation, impaired interjoint coordination

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Abnormal synergies

Back 17

abnormal or disordered motor control, lack of fractionation, flexion synergy of UE, Extensor synergy in LE

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Lack of fractionation

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ability to move a single joint without simultaneously generating movements in other joints

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Coactivation

Back 19

coactivation of agonist and antagonist muscles during functional movements; CP

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Impaired interjoint Coordination

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movement trajectories characterizedby decomposition (moving one joint at a time); cerebellar pathology

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Timing Problems

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Reaction time, slowed movement time, problems terminating a movement

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Problems initiating movement

Back 22

reaction time, time between the patient's decision to move and the initiation of the movement.

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Movement time

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the time taken to execute a task-specific movement once it has been initiated. Hemiparesis after stroke, Parkinson's, CP, cerebellar

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Terminating movement

Back 24

inability to stop a movement, inability to change directions. Cerebellar

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dysdiadochokinesia

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inability to perform rapidly alternating movements

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scaling forces

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dysmetria

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Dysmetria

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problems in judging the distance or range of a movement, cerebellar lesions, basal ganglia disease,

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Hypometria

Back 28

underestimation f the required force or range of movement, parkinson's

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hypermetria

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overestimation of the force or range of movement needed for a task

Front 30

Involuntary movements

Back 30

dystonia, associated movements, tremor, choreiform/athetoid movements

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dystonia

Back 31

a syndrome dominated by sustained muscle contractions, frequently causing twisting and repetitive movements of abnormal postures

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focal dystonia

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singel body region

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segmental dystonia

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two or more adjoining body regions

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hemidystonia

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arm and leg on one side of the body

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multifocal dystonia

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two or more nonadjoining parts

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idiopathic dystonia

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occurs in teh absence of other lesions within the CNS

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symptomatic/secondary dystonia

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in conjunction with other neurologic diseases or acquired brain lesions

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Associated movements

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unintentional movements of one limb during the voluntary movement of another limb. Patients with hemiplegia during forceful movements.

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tremor

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rhythmic involuntary oscillatory movement

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resting tremor

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occurs in a body part that is not voluntarily activated and is supported against gravity. Amplitude increases during mental stress or movements of another body part

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Active Tremor

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produced by voluntary contraction of muscle

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postural tremor

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voluntarily maintaining a position against gravity

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kinetic tremor

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occurs during a voluntary movement

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intention tremor

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pathology of cerebellum

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chorea

Back 45

involuntary, rapid, irregular, jerky movements that result from basal ganglia lesions

Front 46

Perceptual impairments

Back 46

body image/ scheme disorders, spatial relation disorders, apraxia

Front 47

Cognitive impairments

Back 47

attention, orientation, memory, explicit and implicit motor learning, problem solving

Front 48

Body scheme

Back 48

awareness of body parts, and their relationship to one another and the environment

Front 49

somatagnosia

Back 49

lack of awareness of the body structure and the relationship of body parts to one antoher

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unilateral spatial neglect

Back 50

AKA hemi-inattention and hemispatial neglect, the inability to perceive and integrate stimuli on one side of the body

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anosognosia

Back 51

denial of the presence or severity of one's paralysis

Front 52

spatial relation disorders

Back 52

difficulty in perceiving oneself in relation to other objects, or other objects in relation to oneself

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topographic disorientation

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inability to remember the relationship of one place to another

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figure ground perception

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inability to distinguish foreground from background

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apraxia

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inability to carry out purposeful movement

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types of apraxia

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verbal, buccofacial, limb, constructional, and dressing

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ideomotor

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movement may occur automatically but cannot be performed on command

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ideational apraxia

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purposeful movement is not possible either automatically or on command

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Attention

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ability to focus on a specific stimulus without being distracted

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focused attention

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ability to respond to specific stimuli

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sustained attention

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ability to sustain attention in the presence of distracting stimuli

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selective attention

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ability to focus attention in the presence of distracting stimuli

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alternating attention

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ability to shift focus of attention from one task to another

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divided attention

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ability to respond simultaneously to multiple tasks

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orientation

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an understanding of people, place, time, and situation

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Memory

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ability to process, store, and retrieve information

Front 67

Implicit motor learning strategies

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repetition of movement to promote learning

Front 68

explicit motor learning

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instructions on how to perform a task, impaired in patients with medial temporal lobe damage

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problem solving

Back 69

ability to manipulate and apply knowledge to new or unfamiliar situations