Clinical Implications of Movement Disorders Flashcards
What does distribution refer to?
Where in the body you see impairments
What does degree/severity refer to?
How significant the impairments are and how they impact function
What are the types/stages of movement?
Initiation, sustaining, terminating movement
What is quadriplegia/tetraplegia?
Whole body is involved in varying degrees
What is diplegia?
Whole body distribution, but LEs are more impacted than UEs
What is hemiplegia?
One side of the body is involved (1/2 of face, UE, and LE)
What is monoplegia?
One extremity is involved
What is paraplegia?
Involvement of the trunk and LEs to varying degrees
How does paresis differ from plegia?
Paresis is less severe and refers to slight weakness, but the words are often used interchangeably
How do you qualify the degree/severity of tone?
Narrative descriptors of mild, moderate, and severe
How do you quantify the degree/severity of tone?
- Modified Ashworth Scale
- Modified Tardieu Scale
- Wilson-Howle Assessment of Motor Tone
What structures are/may be involved when a patient presents with spasticity?
- Motor cortex
- White matter projections between corticosensorimotor areas of the brain
- Pyramidal system
- Corticospinal tracts
What are some hallmarks of spasticity?
- Hypertonicity
- Increased tension when lengthened
- Muscle is firm upon palpation
- Increased DTR
- Clonus
- Increase in tone with increased velocity and position change
- Atypical firm end-feel
- Increased co-contraction/decreased reciprocal inhibition
- Presence of primitive reflexes
- Disuse atrophy
- Distribution asymmetrical
What determines the severity of spasticity?
General health, excitability, strength of stimulus, and amount of neural damage
What structure is involved when a patient present with rigidity?
Basal ganglia
What are some hallmarks of rigidity?
- Continuous or intermittent hypertonicity
- Sustained muscle contraction
- Increased tension upon lengthening
- Firm upon palpation
- No change in tone with changes in velocity or position
- Atypical firm end-feel
- Symmetrical distribution
- Increased co-contraction/decreased reciprocal inhibition
- Disuse atrophy
- Lead-pipe rigidity throughout ROM
What is akinesia?
Type of rigidity that results in no movement of affected limb
What is hypokinesia?
Type of rigidity that results in less movement or smaller movements
What is bradykinesia?
Type of rigidity that results in slow movements
What is decorticate posture?
- Movement characteristic of rigidity
- Involvement of cortex
- UEs are flexed, LEs are extended
What is decerebrate posture?
- Movement characteristic of rigidity
- Involvement of cortex and midbrain
- UEs extended, LEs extended
What is opisthotonic posture?
- Movement characteristic of rigidity
- Involvement of cortex, midbrain, and brainstem
- Extreme extension positioning
What are some hallmarks of hypotonicity/atonia?
- Decreased tone of muscle groups
- Decreased tension when lengthened
- Soft upon palpation
- Decreased DTR/MSR and potential changes with rate/velocity of movement and position
- Hypermobility at elbows and knees
- Symmetrical presentation (sometimes asymmetrical)
- Decreased co-contraction and reciprocal inhibition
- Atrophy, weakness, and decreased endurance
Which structures are involved/damaged in a patient who presents with hypotonicity?
- UMN system
- Cerebellum
- Unknown sites
(Seen in conditions such as Fragile X Syndrome, Prader-Willi Syndrome, Down Syndrome, Cri Du Cath Syndrome)
