Exam 3 ppt 1 Cerebellar Disorders Flashcards

1
Q

What are the three main parts of the cerebellum callded by their functional names?

A

vestibulocerebellum
spinocerebellum
pontocerebellum or cerebrocerebellum

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2
Q

What are the three main parts of the cerebellum called by their phylogenic names (matched with thier functional names in parentheses)?

A

archicerebellum (vestibulocerebellum)

paleocerebelum (spinocerebellum)

neocerebellum (pontocerebellum)

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3
Q

Vestibulocerebellum (Archicerebellum) is composed of which anatomical parts?

A

Flocculonodular lobe (flocculus and nodule)

Picture: cerebrocerebellum is the same as pontocerebellum

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4
Q

Spinocerebellum (Paleocerebellum) is composed of which anatomical parts?

A

Vermis and intermediate parts of the hemispheres (“paravermis”)

Picture: the cerebrocerebellum is another name for pontocerebellum

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5
Q

Pontocerebellum (neocerebellum) is composed of which anatomical parts?

A

Lateral parts of the hemispheres

Picture: Cerebrocerebellum is the same as pontocerebellum

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6
Q

what is the defining functions of the vestibulocerebellum?

A

•Maintaining equilibrium and coordinating eye, head, neck movement.

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7
Q

what is an example of a pathology that involves the vestibulocerebellum?

A

Torticolis (specifically spasmotic torticolis which is a form of dystonia - cervical dystonia)

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8
Q

what are the defining functions of the spinocerebellum?

A

•Coordinated truck and LE movements

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9
Q

what are the defining functions of the pontocerebellum?

A

quick finely controlled limb movement (mainly UE coordination)

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10
Q

what is an example of a pathology that involves the spinocerebellum?

A

Friedreich’s ataxia

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11
Q

what is an example of a pathology that involves the pontocerebellum?

A

Chorea

(as in Huntington’s Dance or Huntington’s Chorea)

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12
Q

what is friedreich’s ataxia?

A

Friedreich’s ataxia is an autosomal recessive inherited disease that causes progressive damage to the nervous system. It manifests in initial symptoms of poor coordination such as gait disturbance; it can also lead toscoliosis, heart disease and diabetes, but does not affect cognitive function. The disease progresses until a wheelchair is required for mobility. Its incidence in the general population is roughly 1 in 50,000

from wikipedia

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13
Q

does damage to the three regions of the cerebellum occur in isolation?

A

doesn’t have to

can have injuries that inovle one, two, or three of the areas

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14
Q

Is the cerebellum isolated?

A

No It has conneections the basal ganglia, etc.

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15
Q

Ataxia definition

A

shappy: reeling wide-based movements related to gate

(I dissagree that it is mainly just gait. Ataxic gait is mainly gait, but ataxia seems to just mean uncoordinated movments from my experience outside of shappy’s class. Wikipedia does seem to make special effort to point out the gait aspect though)

Wikipedia:

Ataxia (from Greek α- [a negative prefix] + -τάξις [order] = “lack of order”) is a neurological sign consisting of lack of voluntarycoordination of muscle movements that includes gait abnormality. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum. Several possible causes exist for these patterns of neurological dysfunction. Dystaxia is a mild degree of ataxia. Friedrich’s ataxia has gait abnormality as the most common presenting symptom.[1]

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16
Q

what is “decomposition of movement”?

A

-inability to correctly sequence fine coordinated movements/acts

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17
Q

define dysarthria:

A

–Inability to articulate words (motor function). “speech problems” per Dr. Shappy

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18
Q

•Dysdiadochokinesia:

A

–Inability to produce rapid alternating movement (Examples: flipping hands, moving leg up and down shin)

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19
Q

Definition of Dysmetria:

A

–Inability to control ROM (hard to pick up specific objects)

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20
Q

define hypotonia

A

flaccidity

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21
Q

define Nystagmus

A
  • –Rapid alternating eye movement (back and forth of the eyes; rapid alt of the eye movements)
  • –Involuntary
  • –Some people live in this state
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22
Q

define Scanning Speech:

A
  • –Slow enunciation and a tendency for hesitation
    • •It’s there, but it is slow and interrupted (almost a stutter)
    • •Typically more at beginning of word or sylable

(slow speech, interrupted, hesitated)

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23
Q

define tremor (brief definition of it generally)

A

rhythmic ocillatitory movement

  • –“another garbage tern”
  • –Many types of tremors
  • –Rhythmic alternating oscillatory movements of anything
    • •Facial twitches
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24
Q

What are three things that an MD considers when making a medical diagnosis for cerebellar disorders?

A
  1. •Family history
  2. •Neuroimaging/MRI
  3. •Genetic testing
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25
Q

What are the things the PT can identify and evaluate in a pt with a cerebellar disorder? (9 examples)

A

The PT assists in diagnosis, outcome measures, assessment

  1. Ataxia
  2. Decomposition of Movement
  3. Dysarthria
  4. Dysdiadochokinesia
  5. Dysmetria
  6. Hypotonia
  7. Nystagmus
  8. Scanning Speech
  9. Tremor
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26
Q

Etiology of Cerebellar Disorders: 3 categories

A
  1. Congenital Malformations
  2. Hereditary Ataxias
  3. Acquired Conditions
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27
Q

Congenital Malforations: Characteristics/Details (3)

A

•Congenital Malformations

  1. –Manifest early in life
    • –Example: maybe cerebellum maybe just didn’t form)
  2. –doesn’t progress (won’t get worse)
  3. –Variety of deficits is possible
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28
Q

Two types of Hereditary Ataxias

A
  1. Freidreich Ataxia
  2. Spinocerebellar Ataxia
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29
Q

What is Friedreich ataxia?

A

Shappy Notes: Genetic mutation; Progressive disorder

(see video: https://www.youtube.com/watch?v=ThMH3WCUU4A)

(also is the crossfit guy vidio: https://www.youtube.com/watch?v=rHlC1W9r704)

Wikipedia:

Friedreich’s ataxia is an autosomal recessive inherited disease that causes progressive damage to the nervous system. It manifests in initial symptoms of poor coordination such as gait disturbance; it can also lead to scoliosis, heart disease and diabetes, but does not affect cognitive function. The disease progresses until a wheelchair is required for mobility. Its incidence in the general population is roughly 1 in 50,000.

http://en.wikipedia.org/wiki/Friedreich%27s_ataxia

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30
Q

What are Spinocerebellar ataxias

A

Shappy’s Notes:

  • •Ataxia, parkinsonism, dystonia, facial twitching
    • –Will go into more detail with some of these later

Inherited

Wikipedia:

Spinocerebellar ataxia (SCA) or also known as Spinocerebellar atrophy or Spinocerebellar degeneration, is a progressive, degenerative,[1] genetic disease with multiple types, each of which could be considered a disease in its own right. An estimated 150,000 people in the United States are diagnosed with Spinocerebellar Ataxia. SCA’s are the largest group of this hereditary, progressive, degenerative and often fatal neurodegenerative disorder. There is no known effective treatment or cure. Spinocerebellar Ataxia can affect anyone of any age. The disease is caused by either a recessive or dominant gene. In many times people are not aware that they carry the ataxia gene until they have children who begin to show signs of having the disorder.[2]

http://en.wikipedia.org/wiki/Spinocerebellar_ataxia

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31
Q

What are some examples of aquired conditions? (9)

A
  1. –Cerebellar strokes,
  2. systemic disorders,
  3. MS,
  4. repeated TBI,
  5. toxins,
  6. idiopathic,
  7. heat stroke,
  8. alcohol abuse (the withdrawal part)
  9. brain tumor,
  10. etc.
32
Q

Tremor: Basic definition

A

•Rhythmic alternating oscillatory movements of anything

33
Q

What is the difference between physiologic and pathologic tremor?

A
  • –Physiological just means it’s there, but its not interfering or getting worse. Not sign of an underlying condition.
    • •Typically barely perceivable until stress provokes it or ability to inhibit it are down
  • –Pathologic is a sign of an underlying condition
34
Q

Tremmor Occurance: What is the

Pattern?

Severity?

acuity?

A

•Occurrence
–Pattern- could be intermittent or constant (any type of tremor)
–Severity- large or small oscillations, duration, etc. Amplitude
–Acuity- gradual onset or abrupt onset

35
Q

What is the pathophysiology of tremor? (three main)

A

•Pathophysiology-

  1. lesions of brain stem,
  2. extrapyramidal,
  3. cerebellum

–Is complex, lots of stuff.

36
Q

What is an essential tremor? (2)

A

•Essential tremor-

  1. familial condition typically;
  2. rhythmic shaking of almost any body part
37
Q

What is a resting tremor?

A

–Happens at rest or when body part is in gravity supported position., but goes away with intentional movment

38
Q

what is an action tremor?

A

–Happens when body is in movement. It may or may not change when the target is reached.

there are at least three types

39
Q

What is a kinetic tremor?

what amplitude?

A

A type of Action tremor (happens when body is in movement).

  1. tend to appear in the last part of the movement toward the target.
  2. Typically small amplitude
40
Q

what is a intention tremor?

A

A type of Action tremor (happens when body is in movement).

  1. occurs during the movement towards the target.
  2. Might go away when target is reached.
41
Q

what is a postural tremor?

A

A type of Action tremor (happens when body is in movement).

  1. Postural tremor: maximal when a limb is maintained in a fixed position against gravity.
  2. large movments
42
Q

What are complex tremors?

A

A combination of any kind of tremor

43
Q

what are the classifications of tremors based on? (at least the classifications that Dr. shappy gave us)

A

based on when the tremor occurs

44
Q

What are three types of Pathologic Tremors?

A
  1. Action or postural tremor
  2. Resting tremor
  3. Intention Tremor
45
Q

Pathologic Tremor: Action or Postural Tremor details/causes (3)

A

Action or Postural Tremor:

  1. •Essential tremor (non-familial)
  2. •Alcohol or drug withdrawal- DT’s (Delerium Tremins - what happens during alcohol/drug withdrawal)
  3. •Endocrine, metabolic or toxic conditions-
    • encephalopathy,
    • renal,
    • hepatic,
    • hypoglycemia,etc.
46
Q

Pathologic Tremor: Resting Tremor, two diseases that commonly have resting tremor

A

Resting Tremor

  1. •Parkinson’s- pill rolling, chin, leg; shuffling gait, bradykinesia, cogwheel rigidity, micrographia
  2. •Progressive supranuclear palsy- coarse or jerky tremor with eye gaze issues (typically difficulty looking down)
47
Q

What are some symptoms of Parkinson’s Dz? (5)

A
  1. Resting tremor
    • pill rolling,
    • chin
    • leg
  2. shuffling gait,
  3. bradykinesia,
  4. cogwheel rigidity,
  5. micrographia
48
Q

What are some symptoms of Progressive supranuclear palsy? (2)

A

•Progressive supranuclear palsy-

  1. coarse or jerky tremor with
  2. eye gaze issues (typically difficulty looking down)
49
Q

Pathologic Tremor: Intention Tremor, two examples of causes/symptoms

A
  1. •Cerebellar lesions- low frequency, unilateral, ataxia, dysmetria, dysdiadochokinesia, dysarthria
  2. •History of drug use- tremor when stopping
50
Q

What is Motor Control?

A

Dr Bringman:

Motor control is

  • the ability to maintain and change posture and movement
  • the result of a complex set of neurological and mechanical process.

Shappy Notes: Motor control

(she said we must have some knowledge of this side beyond this slide and that we got it from Bringman. She did not talk more about it really)

51
Q

What is Motor Coordination?

A

from Wikipedia:

Motor coordination is the combination of body movements created with the kinematic (such as spatial direction) and kinetic (force) parameters that result in intended actions.

More if you feel like it:

Motor coordination is achieved when subsequent parts of the same movement, or the movements of several limbs or body parts are combined in a manner that is well timed, smooth, and efficient with respect to the intended goal. This involves the integration of proprioceptive information detailing the position and movement of the musculoskeletal system with the neural processes in the brain and spinal cord which control, plan, and relay motor commands. The cerebellum plays a critical role in this neural control of movement and damage to this part of the brain or its connecting structures and pathways results in impairment of coordination, known as ataxia.

http://en.wikipedia.org/wiki/Motor_coordination

(We did not talk of it in class I don’t think)

52
Q

What are Five types of Motor Coordination?

A

Coordination

  1. –Dexterity
  2. –Agility
  3. –Intra limb coordination
  4. –Inter limb coordination
  5. –Visual motor coordination
    • •Hand-eye coordination
53
Q

What is Dexterity?

A

From Wikipedia, since we didn’t explicity discuss it:

Fine motor skills (or dexterity) is the coordination of small muscle movements—usually involving the synchronization of hands and fingers—with the eyes. The complex levels of manual dexterity that humans exhibit can be attributed to and demonstrated in tasks controlled by the nervous system. Fine motor skills aid in the growth of intelligence and develop continuously throughout the stages of human development.

http://en.wikipedia.org/wiki/Fine_motor_skill

Other definitions:

skillfulness in the use of one’s hands or body.

Fine Motor Control: Ability to perform delicate manipulations with the hand requiring steadiness, muscle control, and simultaneous discrete finger movements.
Synonym(s): dexterity, fine coordination, fine motor control.

http://medical-dictionary.thefreedictionary.com/dexterity

54
Q

What is Agillity?

A
  1. the power of moving quickly and easily; nimbleness (http://dictionary.reference.com/browse/agility)

From Wikipedia, since we didn’t discuss much in class:

Agility or nimbleness is the ability to change the body’s position efficiently, and requires the integration of isolated movement skills using a combination of balance, coordination, speed, reflexes, strength, and endurance. Agility is the ability to change the direction of the body in an efficient and effective manner and to achieve this requires a combination of

balance – the ability to maintain equilibrium when stationary or moving (i.e. not to fall over) through the coordinated actions of our sensory functions (eyes, ears and the proprioceptive organs in our joints);
static balance – the ability to retain the centre of mass above the base of support in a stationary position;
dynamic balance – the ability to maintain balance with body movement; speed - the ability to move all or part of the body quickly; strength - the ability of a muscle or muscle group to overcome a resistance; and lastly,
co-ordination – the ability to control the movement of the body in co-operation with the body’s sensory functions (e.g., in catching a ball [ball, hand and eye co-ordination]).

In sports, agility is often defined in terms of an individual sport, due to it being an integration of many components each used differently (specific to all of sorts of different sports). Sheppard and Young (2006) defined agility as a “rapid whole body movement with change of velocity or direction in response to a stimulus”.[attribution needed]

Agility is also an important attribute in many role playing games, both computer games and as Dungeons and Dragons. Agility may affect the character’s ability to evade an attack or navigate uneven terrain.

http://en.wikipedia.org/wiki/Agility

55
Q

What is intra-limb coordination?

A

From Wikipedia:

Intra-limb coordination involves the planning of trajectories in the Cartesian planes.[4] This reduces computational load and the degrees of freedom for a given movement, and it constrains the limbs to act as one unit instead of sets of muscles and joints. This concept is similar to “muscle synergies” and “coordinative structures.” An example of such concept is the Hogan and Flash minimum-jerk model,[15] which predicts that the parameter that the nervous system controls is the spatial path of the hand, i.e. the end-effector (which implies that the movement is planned in the Cartesian coordinates). Other early studies showed that the end-effector follows a regularized kinematic pattern[16] relating movement’s curvature to speed and that the central nervous system is devoted to its coding.[17] In contrast to this model, the joint-space model postulates that the motor system plans movements in joint coordinates. For this model, the controlled parameter is the position of each joint contributing to the movement. Control strategies for goal directed movement differ according to the task that the subject is assigned. This was proven by testing two different conditions: (1) subjects moved cursor in the hand to the target and (2) subjects move their free hand to the target. Each condition showed different trajectories: (1) straight path and (2) curved path.[18]

http://en.wikipedia.org/wiki/Motor_coordination#Intra-limb

56
Q

What is Inter-limb coordination?

A

From Wikipedia:

Inter-limb coordination concerns how movements are coordinated across limbs. J. A. Scott Kelso and colleagues have proposed that coordination can be modeled as coupled oscillators, a process that can be understood in the HKB (Haken, Kelso, and Bunz) model.[13] The coordination of complex inter-limb tasks is highly reliant on the temporal coordination. An example of such temporal coordination can be observed in the free pointing movement of the eyes, hands, and arms to direct at the same motor target. These coordination signals are sent simultaneously to their effectors. In bimanual tasks (tasks involving two hands), it was found that the functional segments of the two hands are tightly synchronized. One of the postulated theories for this functionality is the existence of a higher, “coordinating schema” that calculates the time it needs to perform each individual task and coordinates it using a feedback mechanism. There are several areas of the brain that are found to contribute to temporal coordination of the limbs needed for bimanual tasks, and these areas include the premotor cortex(PMC), the parietal cortex, the mesial motor cortices, more specifically the supplementary motor area (SMA), the cingulate motor cortex (CMC), the primary motor cortex (M1), and the cerebellum.[14]

http://en.wikipedia.org/wiki/Motor_coordination#Intra-limb

57
Q

What is visula motor coordination (hand-eye coordination)?

A

the ability to coordinate vision with the movements of the body or parts of the body. (http://medical-dictionary.thefreedictionary.com/visual-motor+coordination)

From Wikipedia:

Eye–hand coordination (also known as hand–eye coordination) is the coordinated control of eye movement with hand movement, and the processing of visual input to guide reaching and grasping along with the use of proprioception of the hands to guide the eyes. Eye–hand coordination has been studied in activities as diverse as the movement of solid objects such as wooden blocks, sporting performance, music reading, computer gaming, copy-typing, and even tea-making. It is part of the mechanisms of performing everyday tasks; in its absence most people would be unable to carry out even the simplest of actions such as picking up a book from a table or playing a video game. While it is recognized by the term hand–eye coordination, without exception medical sources, and most psychological sources, refer to eye–hand coordination.[citation needed]

http://en.wikipedia.org/wiki/Eye%E2%80%93hand_coordination

58
Q

What are Four big categories of movement disorders?

A
  1. Hypokinetic
  2. Hyperkinetic
  3. Rhythmic
  4. Nonrhythimc
59
Q

Movement Disorders: What is a hypokinetic movement disorder characterizd by?

what are some goals for treatment?

A

–Hypokinetic- decreased or slow
•Treat: speed them up or prevent them from getting slower

60
Q

Movement Disorders: What is a hyperkinetic movement disorder characterizd by?

A

increased movement

61
Q

Movement Disorders: What are rhythmic movement disorder characterizd by?

A

–Rhythmic- regular alternating or oscillatory

62
Q

Movement Disorders: What are non-rhythmic movement disorder characterizd by?

A

can be slow, sustained, or rapid

Many types!

63
Q

Movement Disorders: what are seven types of non-rhythmic movement disorders?

A
  1. •Athetosis:
    • movements that are non-rhighmic slow and rihging. Primarily distal muscles (Dr. Lake: common in CP pts). Tend to produce a flowing stream of movement.
  2. •Chorea:
    • non-rhythmic jerky and rapid. Distal muscles or the face.
  3. •Dystonias:
    • sustained muscle contractions. Typically alter posture or body position.
  4. •Hemiballismus:
    • non rhythmic rapid movements. Violent, flinging, non-suppressible.
  5. •Myoclonus:
    • rapid jerky. Shock like twitches. Restless leg falls under this category.
  6. •Tics:
    • Tourets is the example. Rapid repetitive non-rhythmic. Pts usually have some urge to do it and get some sort of relief after they do it. There is some thought that urge can be suppressed.
  7. •Tremor:
    • go back to other definitions she gave

(these will have a seperate flashcard for each also)

64
Q

Movement Disorders, non-rhythmic: what is athetosis?

A

movements that are non-rhythmic slow and wringing. Primarily distal muscles (Dr. Lake: common in CP pts). Tend to produce a flowing stream of movement.

Dr. lake gave us a youtube video of an adult man with CP with his fingers moving in his affected (and dysfunctioning) hand. I think he looked like he was from India or some similar country. His hand looked spastic or rigid with difficult continued movement of fingers.

65
Q

Movement Disorders, non-rhythmic: what is chorea?

A

•Chorea: non-rhythmic jerky and rapid. Distal muscles or the face are most common.

[My note: This is typical in Huntington’s Disease (aka Huntington’s Dance)]

66
Q

Movement Disorders, non-rhythmic: what is dystonia?

A

•Dystonias: sustained muscle contractions. Typically alter posture or body position.

Youtube gave an example where spasmotic torticolis is a type of dystonia. Other examples mentioned a dystonic storm that looks similar to a grand mal seizure. Some videos make it look like contortions or random contrations of the body. I reccomend looking up videos to get the idea.

From Wikipedia (Because I still didn’t understand; Probably more than you need to know):

Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.[1] The movements may resemble a tremor. Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles.[2]

The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.[1] Treatment must be highly customized to the needs of the individual and may include oral medications, botulinum neurotoxin injections, physical therapy and/or other supportive therapies, and/or surgical procedures such as deep brain stimulation.

http://en.wikipedia.org/wiki/Dystonia

67
Q

Movement Disorders, non-rhythmic: what is hemiballismus?

A

•Hemiballismus: non rhythmic rapid movements. Violent, flinging, non-suppressible.

dr Lake taught us that it would be contralateral to the legion, and it is usually the upper extremity. Hemi means one sided, so it would just be one arm. Ballisums also exists, which would be bilateral (make sure you read carefully when taking the exam!)

68
Q

Movement Disorders, non-rhythmic: what is myoclonus?

A

Myoclonus: rapid jerky. Shock like twitches.

This is related to restless leg syndrome (RLS)

(I think it is a symptom that can be present but is not always present with RLS)

69
Q

Movement Disorders, non-rhythmic: what are Tics?

A

Tourette’s is the example. Rapid repetitive non-rhythmic. Pts usually have some urge to do it and get some sort of relief after they do it. There is some thought that urge can be suppressed.

70
Q

Movement Disorders, non-rhythmic: what are Tremor?

(general)

A
•Definition: Rhythmic alternating oscillatory movements of anything
many types (go back to other slides/flashcards for full story)
71
Q

what are some good questions to ask yourself when trying to treat movement disorders?

A

How can I control these movement disorders?

What does society say about what is appropriate or acceptable? (when deciding what to do to help pts with problems)

72
Q

What are three things you can test when evaluating movement disorders?

A
  1. •Sitting balance
  2. •Standing balance
  3. •Gait
73
Q

List 8 functional balance tests

A
  1. –Romberg test: (I noted that I should look it up)
    • •Often done when pulled over for DUI
    • •Stand on one leg, put head back, close eyes (or not) and touch nose alternating with fingers from outstretched arms.
  2. –Functional Reach and Multidirectional Reach Tests
  3. –Berg Balance Scale
  4. –Performance-Oriented Mobility Assessment (POMA)
  5. –Timed get up and go test (TUG)
  6. Tinetti Assessment Tool
  7. 4-Stage Balance Test
  8. 30-Second Chair Stand Test

(see hand-outs)

74
Q

Describe (or just read) more details about Romberg Test

A

From Wikipedia:

Romberg’s test or the Romberg maneuver is a test used in an exam of neurological function, and also as a test for drunken driving. The exam is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to know one’s body in space); vestibular function (the ability to know one’s head position in space); and vision (which can be used to monitor [and adjust for] changes in body position).

A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is asked to close his or her eyes. A loss of balance is interpreted as a positive Romberg’s test.

The Romberg test is a test of the body’s sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord.[1]

The Romberg test is used to investigate the cause of loss of motor coordination (ataxia). A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a patient is ataxic and Romberg’s test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.

It is used as an indicator for possible alcohol or drug impaired driving and neurological decompression sickness.[2][3] When used to test impaired driving, the test is performed with the subject estimating 30 seconds in his head. This is used to gauge the subject’s internal clock and can be an indicator of stimulant or depressant use.

http://en.wikipedia.org/wiki/Romberg%27s_test

75
Q

What does POMA stand for?

A

–Performance-Oriented Mobility Assessment (POMA)

76
Q

What does TUG stand for?

A

–Timed get up and go test (TUG)

77
Q

Dr. Shappy spent a lot of time talking about an example of Dystonia, Spasmodic Torticollis. We should probalby watch the videos she posted.

A
  • http://www.youtube.com/watch?v=pfDYLYyoUyw
  • http://www.youtube.com/watch?v=28kMNZdNHaw
  • http://www.youtube.com/watch?v=P6XhHb90ciQ
  • http://www.youtube.com/watch?v=ElSYsIQMJZQ
  • httphttp://www.youtube.com/watch?v=u_-UO2upGW8
  • http://www.youtube.com/watch?v=I1bD5Dun7Ss