CNS Class 6 - Rigidity & HMC Coordination Flashcards
One possible manifestation of _____ _______ dysfunction is rigidity.
Basal Ganglia
Hypertonia where the resistance to externally imposed joint movement is present at very low speeds of movement.
Rigidity
T/F - Rigidity depends on imposed speed of movement, as it exhibits a speed or angle threshold.
False - Rigidity DOES NOT depend on imposed speed of movement, as it DOES NOT exhibit a speed or angle threshold.
Hypertonia where simultaneous co-contraction of agonists and antagonist may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint.
Rigidity
T/F - A limb with rigidity does not tend to return toward a particular fixed posture or extreme joint angle.
True
T/F - Voluntary activity in distant muscle groups leads to involuntary movements about rigid joints, and rigidity may worsen.
False - Voluntary activity in distant muscle groups DOES NOT lead to involuntary movements about rigid joints, ALTHOUGH rigidity may worsen.
Areas where ________ can be present include limbs (e.g. lead pipe, cogwheel), facial, respiratory and GI tract.
Rigidity
Overall __________ and lowering of sympathetic activation will help reduce some amount of tone in rigid muscles.
Relaxation
T/F - The more relaxed a person is means they are less likely to recruit early protective reflexes in response to aspects of a massage treatment.
True
It makes sense to focus on achieving a relaxation response _____ in the treatment in order to set the stage for your more specific approaches to rigid muscles.
Early
T/F - Even if the person is relaxed, the rigid muscles won’t be more responsive to your work and available range of motion will not change.
False - WHEN the person is relaxed, the rigid muscles WILL be more responsive to your work and THERE MAY BE MORE available range of motion.
_________ difficulties may require position adaptation so that the patient can feel at ease. If the patient has _________, lying completely flat in supine may promote choking.
Breathing
Dysphagia
Rigid muscles are prone to ________ for obvious reasons, so in addition to their basic neurological disorder, they tend to become irritable because of poor nutrition and _____ clearance.
Ischemia
Waste
T/F - Improving circulation helps reduce tone in muscles generally, and even more so in hypertoned muscles.
True
____ or ____-based contrast are the best hydrotherapy modes to optimize perfusion for rigid muscles.
Heat/Heat-Based
To the extent that it is possible given the rigidity, _______ ROM within resistance-free range will also aid circulation.
Passive
T/F - Joint mobilization techniques cannot help increase joint-related circulation.
False - Joint mobilization techniques CAN help increase joint-related circulation.
Commonly referred to as adaptive shortening. The result of fascial elements passively conforming to holding patterns, which can greatly increase range of motion loss.
Contracture
Over and above the rigidity itself, ____________ can decrease mobility and function. They can also cause premature activation of _______ ______ responses to increase tone in rigid muscles.
Contractures
Stretch Reflex
T/F - Contractures can add to muscle ischemia and joint degeneration.
True
Some reasonable approaches to working with ____________ include:
- Heat application
- Kneading, stripping and friction techniques
- Joint play
- Passive ROM
- Exercise prescription
Contractures
Having the person use _________ contraction, against resistance provided by you during treatment, may be very helpful in _________ the target muscles and reducing tone.
Isometric
Fatiguing
The most effective reflex technique for rigidity is ______ release, which can be used extensively to get temporary reductions in tone, in order to facilitate direct work on muscles and joints.
GTO
T/F - Light vibrations and stroking may prevent relaxation responses in rigidity.
False - Light vibrations and stroking may INDUCE relaxation responses in rigidity.
The least effective reflex techniques for rigidity is __________ inhibition and antagonist contraction techniques. Muscle _____________ will also have limited usefulness because of the decrease in available ROM.
Reciprocal
Approximation
“_______ ________” can help renormalize reflex sensitivity, so combinations of temperature, touch/pressure and movement may create some release of the rigidity.
“Sensory Overload”
T/F - There is no harm in trying a range of reflex techniques, as success in using these mechanisms varies depending on the degree of rigidity.
True
Rigidity has an obvious resistance to ________, but it is important to stay focused on objective of minimizing ____________ and maximizing joint health.
Movement
Contractures
Joint play can be very good for rigidity, both to stimulate reflex muscle relaxation and to provide joint __________.
Succussion
Passive ______ movements can be effective if done properly. This involves:
- Move joint to point of resistance
- Hold with gentle overpressure
- Joint will usually “give” a bit
- Take to next resistance point
- Repeat one or more times
Forced
T/F - GTO release cannot be combined with stretch for patients with rigidity and mobilization is best done after other tone-reducing work.
False - GTO release CAN be combined with stretch for patients with rigidity and mobilization is best done after other tone-reducing work.
T/F - It is not best to treat when the patient’s rigidity-influencing medication is in full force.
False - IT IS best to treat when the patient’s rigidity-influencing medication is in full force.
They receive inputs from multiple areas within each hemisphere of the brain and integrate incoming sensory information, while also forming connections between sensory and motor areas.
Association Areas
Because they are involved in organizing information that comes from various other areas of the brain, ___________ _____ are often linked to complex functions.
Association Areas
___________ _____ work together on the same function such as:
- Sensory info
- Safety/fight or flight
- Creation/invention/artistic expression
- Moving from place to place/work use of skills
- Improving & refining motor activities
Association Areas
________ association areas stimulate HMCs to act, which then plan the response together and the motor cortex releases the plan to the corticospinal tract in the direct/_________ pathway to the anterior/ventral horn of the spinal cord to alpha neurons, which will activate muscles.
Cortical
Pyramidal
Fibres that connect the corresponding regions across the two cerebral hemispheres.
Commissural/Transverse Fibres
The ______ ________ is the primary commissural region of the brain.
Corpus Callosum
Fibres that connect the cortex and lower parts of the brain and spinal cord.
Projection Fibres
What are the 2 major descending systems of projection fibres for motor signals?
1) Pyramidal
2) Extrapyramidal
The pathway for voluntary movement involving direct connection from the brain to motor nerves. Responsible for skilled movements and controls primarily distal muscles used for fine motor control on the opposite side of the body.
Pyramidal (aka. Direct, Voluntary) Pathway
For pyramidal pathways, most fibres originate in the _____ ______ and cross to the contralateral side at the _______.
Motor Cortex
Medulla
T/F - The pyramidal system is newer than the extrapyramidal system.
True
What are the 2 tracts of the pyramidal system?
1) Corticospinal
2) Corticobulbar
The _____________ tract synapses directly in the anterior horn of the spinal cord with interneurons and the lower motor neurons innervating the muscles in the limbs and trunk.
Corticospinal
T/F - When it comes to the corticospinal tract, 80% of the fibres are part of the anterior tract and 20% of the fibres are part of the lateral tract.
False - When it comes to the corticospinal tract, 80% of the fibres are part of the LATERAL tract and 20% of the fibres are part of the ANTERIOR tract.
The _____________ tract synapses directly with the cranial neurons to control muscular movements of the face, head and neck.
Corticobulbar
T/F - A lesion on the pyramidal pathway will cause loss of distal motor function on the opposite side of the body.
True
The pathway for involuntary control where there is no direct control of the motor cortex or basal ganglia on the spinal cord, but indirectly via nuclei in the midbrain and brainstem. Responsible for coordination of movement, as well as control of posture, muscle tone and axial movement.
Extrapyramidal (aka. Indirect, Involuntary, Postural) Pathway
T/F - Extrapyramidal fibres have influence of the HMCs, which can stimulate or inhibit nuclei in the midbrain and brainstem.
True
______________ pathways include:
- Basal ganglia
- Parts of thalamus
- Brainstem nuclei (e.g. red nuclei, vestibular nuclei, superior colliculus & reticular formation)
Extrapyramidal
Cerebellar projections fall under the extrapyramidal system because they influence both the brainstem motor pathways, and the motor cortex itself via the _______________ projection.
Dentatothalamic
Some of the main purposes of the ______________ pathway includes:
- Dampen erratic motions
- Maintain muscle tone & truncal stability
- Prepare muscles to make smooth/economical movements
- Provide motor manifestations of emotions
- Affects gamma system
- Maintain rhythmic/phasic behaviour (e.g. walking)
Extrapyramidal
The _____ system mechanism sets the baseline level of activity in alpha motor neurons and helps to regulate muscle length/tone
Gamma
When putting on mascara, there is an increase in _____ activity to use reflex parameters versus involving the motor cortex, as it uses ____ energy and effort.
Gamma
Less
What are the 4 tracts of the extrapyramidal system?
1) Rubrospinal
2) Tectospinal
3) Vestibulospinal
4) Reticulospinal
The ___________ tract is responsible for modulation of flexor muscle tone and reflex activity, as well as inhibition of anti-gravity muscles.
Rubrospinal
The ___________ tract is primarily responsible for mediating reflex responses to visual stimuli, including involuntary adjustment of head position in response to visual information.
Tectospinal
The _______________ tract is responsible for increasing anti-gravity muscle tone in response to the head being tilted to one side.
Vestibulospinal
____-_______ muscles are extensor muscles in the limbs unconsciously adjusting posture to maintain balance.
Anti-Gravity
The ______________ tract is responsible for locomotion and postural control.
Reticulospinal
T/F - Both the vestibulospinal and reticulospinal are subdivided into medial and lateral tracts.
True
T/F - Both the rubrospinal and tectospinal do not decussate, therefore providing ipsilateral innervation.
False - Both the rubrospinal and tectospinal DECUSSATE , therefore providing CONTRALATERAL innervation.
The _______________ and ______________ tracts do not decussate, therefore they provide ipsilateral innervation.
Vestibulospinal
Reticulospinal
T/F - We spend a lot of time between both direct and indirect pathways when learning a motor skill.
True
The brain regions that have direct control over the spinal cord include the _________ and ________ cortex.
Brainstem
Cerebral
_________ pathways that project to the spinal cord include the extrapyramidal reticulospinal, vestibulospinal, rubrospinal and tectospinal tracts.
Brainstem
The ________ cortex gives rise to both pyramidal corticospinal and corticobulbar fibres.
Cerebral
The _____ ganglia and __________ play important roles in the regulation of motor functions.
Basal
Cerebellum
The _____ ganglia participate in the control of movement by receiving significant inputs from the ________ cortex and feeding back signals to different regions of the frontal cortex involved in the initiation of movement.
Basal
Cerebral
T/F - The basal ganglia serve to modulate activity of neurons of the motor regions of the cotex.
True
The __________ recieves inputs from most parts of the CNS that contribute to motor functions. In turn, it sends back messages to each of these regions. The presence of these ________ circuits enables it to serve as a principal integrator of motor function by synchronizing the output messages distributed to each of these regions at any given point in time.
Cerebellum
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