Extrapyramidal System Flashcards
Pyramidal
primary pathway for voluntary movement
direct activation pathway
Extrapyramidal
responsible for the regulation of reflexes and maintenance of tone and posture
Extrapyramidal System Comprised of:
(subcortex structures)
- basal ganglia (nuclei of the EPS)
- corpus striatum (globus pallidus, putamen, caudate nucleus)
- subthalamic nucleus
- substantia nigra
- red nucleus
- brainstem
- reticular formation
- associated complex interconnecting pathways
Basal Ganglia
- nuclei (main part)
- behind the eyes
- contributes to control of the body’s posture, overall muscle tone, and facilitation/coordination of muscle movements (works w/cerebellum)
Corpus Striatum
(basal ganglia and internal capsule)
initiates and regulates gross, intentional movements of the body
-stimulation of parts of the corupus striatum produce stereotyped movements such as flexion of an entire limb
ESP also controls….
- automaticity of walking and/or running
- cooperation of independent movements of the extremities
- freedom of movements
- suppress unwanted involuntary movements including tremors
Movement Disorders
disprders involving the EPS
examples: Parkinson's disease Sydenham's chorea Huntington's chorea Athrtosis WIlson's disease Tourette's syndrome
Lesions in the basal ganglia my produce:
- various abnormal postures
- confliction between flexion and extension
- facial tics, lip-smacking
- abnormal deglutition
- flailing of the arms
Diffuse lesion in Globus Pallidus and and Corpus Striatum
may result in Athetosis
Degenerative changes in Subthalmic Nucleus
may result in Ballism
Lesions involving Caudate Nucleus
may result in Chorea
Diffuse Basal Ganglia pathology
may result in Dyskinesia
Degenerative changes in Substantia Nigra
may result in tremor
Athetosis
slow twisting and writing movements in muscles of the UE (includes speech muscles; tongue)
Ballism (Hemiballisum) (quick form)
wild flinging movements that usually involve one side of the body (violent)
Quick Form of Dysarthria
- forceful, swinging, jerky, and sudden movements of arms/legs
- one side ofthe body (hemiballism) and is associated with subthalamic nucleus contralateral to the side w/the dyskinesia
Chorea (quick form)
- rhythmis,quick involuntary movements of the muscles in distal extremities (head, neck, face, limbs, and trunk)
- rapid and appear coordinated but are purposeless
- muscles tone can var from hypo to hyper and include extremities and speech musculature
- fatigue can bring on chorea movemnets so rest can help
- movement can increase with increased fatigue and emotional distress
- appears gracefull (dance like)
Dyskinesia
accessory movements associated with a desired motor act
Tremor
rhythmic movements associated with either resting or intention types
resting=substantia nigra
intention=cerebellar
EPS Biochemisrty
- neurons in substantia nigra produce neurotransmitter dopamine
- dopamine=inhibitory
- depletion of domamine results in parkinsonsim
- levadopa or L-dopa may help replenish dopamine and reduce s/s of parkinsonism
- other neurotransmitters may be affectsed by disorders of ESP
Hypokinetic Dysarthria
Perceptual Characteristics- monopitch, reduced stress, monoloudness, inappropriate silences (freezes), short rushes (parkinsons disease)
Localization- ESP
Etiologies- PD, drug induced
Neuromuscular Conditions- slow movements limited ROM, paucity of movements, rigidity, loss of automaticity, resting tremors, pill rolling, immobility
Primary Parkinsonism
idiopathic, degenerative disease of middle age (40-60y)
the term primary refers to the structure or organ
Symptomatic Parkinsonism
occurs secondary to encephalitis, arteriosclerosis, and/or various toxicities such as carbon monoxide and manganese drugs
sympotmatic= “as a result of”
Wilson’s Disease
- inherited disorder, results from excessive amounts of copper collecting in the brain, liver, cornea
- progressive disease of early life
- ataxic-spastic-hypokinetic dysarthria
- impaired muscle tone is usually followed by tremor or athetoid movemnets
- tremors will often precede rigidity or impaired muscle tone
- voluntary movements and deglutition are impaired early and to severe degrees
- can have masked facies, lose emotional control and mild dementia
- psychiatric illness may be present
Kayser-Fleischer Ring
are dark rings that appear to encircle the iris of the eye
Hyperkinetic Dysarthria
occurs secondary to lesions at various sites within the ESP (often involves the corpus striatum)
three forms
- Quick forms
- Slow forms
- Tremor forms
Hyperkinetic “Quick” Dysarthria
(chorea movements)
Perceptual Characteristics- CI, prolonged intravals, variable pitch, monopitch, harsh voice quality
Localization - EPS
Etiologies- Huntingtons Chorea, Ballism, Terets syndrom, infection
Neuromuscular Conditions- quick, involuntary, jerking, tics, variable muscle tone
Hyperkinetic “Dystonia” Dysarthia (slow)
Perceptual Characteristics- CI, Distorted vowels, Harsh voice, Monopitch and monoloud, Strained-strangled quality
Sydenham’s Chorea (QIick Form)
- movement disorder that occurs in childhood secondary to inflammation or infection
- a lot of time after rheumatic fever(strep throat)
- recovery usually in a few months but may persist
- jerky movements in peripheral parts of limbs (hands and fingers) w/grimacing, fidgeting and clumsiness
- often in prepubescent femals but can occur in males
- tx:antibiotics for rheumatic fever
Huntington’s Chorea (Disease) (Quick Form)
- disease passed down throught families where nerve cells in brain (cerebral cortex and corpus striatum) degenerate
- genetic defect on chromosome #4
- adut onset (30-50y) or early onset
- abnormal/unusual movemnets; behavior change in some
- dementia may co-occur and get progressively worse
- quick, sudden, jerky movements in arms, legs , face and other body parts; unsteady gait
- no tx; treat symptoms w/compensation and maintenance
Tourette’s Sundrome (Quick Form)
- disorder of nervous system causing a person to produce involuntar sounds anf movements (tics)
- symptoms usually appear b/w ages 7-10y
- facial tic is most common tic
- intensity levels are situational and may change
- dx:a person must have had may motor tics and at least one vocal tic over the course of a year (occuring most every day)
- antispychotis, antiepileptics, clonidine, tetrabenazine
- DBS (Deep Brain Stimulation)
- strong evidance that is it passed down in families
Dystonia (Slow Form)
- movement disorder
- may affect single body area or be generalized troughout multiple muscle groups
- often leads to abnormal posturing and/or sustained muscle contractions (spasms)
- dystonias that last for minutes or hours are known as dyskinesias
- torsion is applied to the term when there is a twisting, contraction of the muscle or muscle group
Torsion Dystonia (Dystonia Types)
- spasmodic plantar flexion of he feet
- rotation of the UE and trunk
- lordosis (sway back) and scoliosis
Torticollis (Dystonia Types)
-dystonia that affects the head and neck
Tardive Dyskinesia (Dystonia Type)
- irregular, quick-jerky to slow undulating movemnts
- uncontrolled movements ofthe tongue
- intermittent strangled phonation
- transient breathiness
Essential Voice Tremor (EVT)
- disease of invountary movements
- can result from a lesion affecting the ESP
- occurs with or without tremors of hands and other body parts
- -regularity and relative smoothness of movements (distinguished from PD and ataxia)
- type of dystonia
- tremors can involve: larynx, pharynx, velum, base of tongue (can impact the entire speech mechanism)
- tremors are regular
- ST not usually effective; some meds help; botox is often used
Spasmodic Dysphonia
- voice arrests that are irregular and representative of laryngeal spasms
- irregular voice arrests on vowel prolongation
- choking, strained-pitch, effortful phonation
- 2 primary types of SD
1. Adduction- VT closing
2. Abduction- open irregularly (breathy)
- arresting of voice and irregular - diane rehm(NPR) has it
