Karpatkin spring 2013 1

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shmvii
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197198
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Karpatkin spring 2013 1
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2013-05-13 21:16:00
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Karpatkin spring 2013
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Karpatkin spring 2013
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  1. 5 purposes of the senorimotor exam
    • uncover impairments
    • recognized functional limitations
    • find relationships between impairments and functional limitations
    • deduce pathology
    • make intervention decisions

    the exam should be repeated at every visit because the findings will change each time, so the treatment must be adjusted to the pt's current presentation
  2. in a sensorimotor exam you can deduce pathology - advantages and indifferences about this?
    if you know the lesion you'll have info about what to expect in behavior

    but you really need to pay more attention to the pt's specific impairments and functional limitations than the lesion
  3. examples of impairment leading to functional limitation
    • has only 60degrees hip flexion --> can't sit down
    • diploplia --> unsteady gait
  4. examples of functional limitation --> impairment
    • bed-bound --> skin breakdown, stiffness, atrophy
    • dependance on a cane -->wrist problems due to unilat wt bearing
  5. 7 realms of impairments
    • range
    • strength
    • motor control
    • coordination
    • sensation
    • attention
    • vestibular
  6. flexible vs fixed ROM impairment, and treatment for each
    • flexible: with overpressure you can get the limb into normal ROM
    • fixed: no matter how much you press, it's stuck

    • flexible: stretch to increase comfortable ROM
    • fixed: do positioning to relieve compression and prevent it from worsening, and teach compensatory techniques
  7. spasticity def
    velocity dependant reactyion to stretch
  8. apraxia
    brain can't tell body what to do (like Broca's aphasia, but for motor control)
  9. some possible caused of ROM restriction
    • flexible vs fixed
    • pain vs weakness
    • soft tissue restriction vs weakness
    • muscle vs joint
    • spasticity / apraxia
  10. 5 possible causes for weakness
    • lack of force output: inability to produce sufficient force output for a particular task
    • lack of endurance: strenght is sufficient to do a task once, but not for several repetitions
    • lack of motor control: the MMT may be normal, but pt can't coordinate the force to perform specific functional tasks
    • range limitation: can't perform task due to contracture
    • cognition: maybe can do it in a calm env but not a distracting one
  11. when a pt says "I am weak," you say...?
    "too weak to do what?" - this gets directly to the task
  12. what's motor control?
    • rel btwn CNS (esp brain) and movement
    • it's all the unconscious subtle motions that support you when you move
    • controlled by communication to/from cerebellum (intersegmental dynamics)
  13. when should you suspect motor control is the problem?
    if movement skill is diminshed, but ROM, MMT, and sensation are in tact
  14. what's coordination?
    • ability to rapidly change directions and control movement
    • it's an element of motor control
    • it's run by the cerebellum, but you can also have non-cerebellar coordination deficits
    • (ataxia)
  15. disdiadochokinesia and dysmetria -- at first you suspect the cerebellum, but what else may cause these?
    weakness, spasticity, decreased ROM

    (repeat tests fast and slow to be provacative)
  16. what's the way-station between sensory input and motor output?
    cerebellum
  17. nystagmus, how it looks if its cause is peripheral vs CNS
    • peripheral: doesn't change direction, rotary with linear components, vertigo, stops with fixation, always has some immediate trigger
    • central: changes direction, rotary or linear, w/wo vertigo, won't stop with fixation, can be sponatneous
  18. vertigo def
    hallucination of movement
  19. Stroop test
    • adding an attention component to a physical task (count backwards, say the color this other color is written in...)
    • this challenges the pt and makes the PT clinic more demanding, as the real world is
  20. a bunch of pathologies/etiologies of sensorimotor troubles
    • trauma
    • vascular (hemorrhage, stroke...)
    • toxic (meds, alcohol...)
    • congential (CP, fetal alcohol syndrom...)
    • degenerative (MS, Huntington's...)
    • malignant
    • metabolic (adrenoleukodystrophy...)
    • developmental
    • infections disorders (CNS infection...)

    each will have unique features and unique ways of affecting your pt
  21. 3 types of localization
    • focal - lesion ins in one discrete area, like in a stroke
    • multifocal - multiple discrete lesions - MS, TBI...
    • diffuse - multible areas of brain w degeneration, like in alzheimer's
  22. a list of areas in the brain that can have lesions
    • cortical, subcortical, pyramidal, extrapyramidal, basal ganglia, brainstem, cord,
    • CNS vs PNS

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