Gait, Cerebellar Function, and Movement Disorders

Question 1

what helps provide coordination and postural control of gait

Answer 1

cerebellar and EPS

Question 2

gait apraxia

Answer 2

have adequate strength, coordination, postural control, and sensation to walk but are immobile when asked to do so

Question 3

Romberg sign

Answer 3

-suggests a problem with impaired proprioception, either from involvement of posterior or dorsal column pathway or their afferent sensory nerves

Question 4

broad based ataxic gait

Answer 4

lesions in posterior columns or proprioceptive sensory nerves OR cerebellar dysfunction

Question 5

hemiplegic gait

Answer 5

• stroke pts
• affected lower limb stiffly extended and swung when walking
• ipsi upper limb flexed at elbow and wrist with decreased armswing

Question 6

tabetic gait

Answer 6

foot slapping

Question 7

steppage gait

Answer 7

• pts with foot drop of weak dorsiflexion of the foot
• unilat: lesion in peroneal nerve or L5 root
• bilat: severe polyneuropathy, motor neuron dz, or b/l L5 lesions
• hip is flexed and pulled up even higher to elevate drooping foot
• distal sensory loss and weakness

Question 8

duck waddle/waddling gait

Answer 8

-2/2 weakness of hip girdle, seen in myopathy (muscle dz)

Question 9

scissors gait

Answer 9

• 2/2 UMN (Corticospinal tract) lesions affecting the lower limbs, as in spastic paresis
• increased spastic tone and tightness in adductor muscles of thigh force the lower limbs together when walking

Question 10

parkinsonian gait

Answer 10

slow and shuffling, dec armswing, stooped forward/bent over

Question 11

cerebellar function

Answer 11

helps maintain the smoothness and precision of movements for the limbs, trunk, eyes, and voice

Question 12

What tests are used to identify cerebellar function?

Answer 12

• finger nose finger
• heel shin knee
• rapid alternating movements

Question 13

dysdiadochokinesia

Answer 13

uncoordinated, nonrhythmic, sloppy hand movements 2/2 cerebellar dysfunction

Question 14

rebound phenomenon/abnml check reflex

Answer 14

• imbalance between agonist and antagonist muscles

- pt accidentally strikes face

Question 15

cerebellar dysarthria

Answer 15

-slurred speech associated with involvement of left cerebellar hemisphere

Question 16

nystagmus

Answer 16

-multidirectional, can be due to: cerebellar dz (but also: lesions of vestibular system and brain stem)

Question 17

What does a lesion of a cerbellar hemisphere predominantly affect

Answer 17

IPSI limbs; causing:

• kinetic tremor
• limb dysmetria
• dysdiadochokinesia
• rebound phenomenon

Question 18

what part of the body is affected by a midline lesion of the cerebellar vermis?

Answer 18

the TRUNK=truncal unsteadiness when walking/standing, with impaired balance and gait ataxia

Question 19

alcoholic cerebellar degeneration

Answer 19

• toxic disorder
• chronically leads to atrophy of anterior-superior vermis (area of trunk and lower limbs)
• deficits include: gait ataxia, truncal unsteadiness, lower limb dysmetria

Question 20

Friedreich’s ataxia

Answer 20

• spinocerebellar degeneration
• aut recessive
• spinocerebellar tract lesions (w/ patchy loss of cerebellar Purkinje cells)=limb dysmetria, gait ataxia, dysarthria
• corticospinal tract lesions=weakness and Babinski signs
• lesions of drg and dorsal of posterior columns affects lower limbs, causing l/o vibration, position sense, and absent reflexes

Question 21

What are non neurologic features of F’s ataxia

Answer 21

• scoliosis
• pes cavus (high arched feet)
• cardiac hypertrophy
• potentially fatal cardiac arrhythmias

Question 22

How is a clinical diagnosis of F’s ataxia made

Answer 22

blood test revealing multiple trinucleotide repeats from a defect in chromosome 9

Question 23

What kind of tremor is typical of PD

Answer 23

resting tremor of the limbs or head-noticeable during rest

Question 24

postural tremor

Answer 24

more noticeable when limbs maintained in various positions-holding object or extending arm/leg
-often d/t familial essential tremor

Question 25

kinetic tremor

Answer 25

-in a limb moving towards a target or performing a task; may accompany other s/s of cerebellar dz

Question 26

choreoathetosis

Answer 26

• athetosis: slow writhing continuous mvmt of distal limbs
• chorea: purposeless random mvmt of limbs, face, neck, trunk
• 2/2 lesions in caudate nucleus or its connecting pathways
• **Huntington’s dz

Question 27

hemiballismus

Answer 27

• violent rapid flinging mvmt of proximal limbs on one side

- 2/2 lesion in contralat subthalamic nucleus

Question 28

dystonia

Answer 28

• continued painful contraction of muscles leading to spasms; unnatural fixed postures
• focal (cervical dystonia/torticollis) or generalized

Question 29

tics

Answer 29

• brief repetitive focal muscle contractions

- ??d/t decreased motor inhibition in basal ganglia??

Question 30

Tourette’s syndrome

Answer 30

-boys, assoc with ADHD–motor tics + vocal tics

Question 31

Which movement disorders accompany encephalopathy

Answer 31

myoclonus (myoclonic jerks) and asterixis

Question 32

myoclonus

Answer 32

rapid shocklike lightening movements or jerks of limbs and trunk

Question 33

asterixis

Answer 33

extended hands and feet, flapping tremor

Question 34

tx resting tremor of PD

Answer 34

anticholinergic drugs

Question 35

tx essential tremor

Answer 35

beta adrenergic blockers or barbiturates

Question 36

what are dopamine antagonist drugs used to tx

Answer 36

• choreoathetosis
• hemiballismus
• tics

Question 37

tx for dystonia

Answer 37

• anticholinergic drugs
• benzos
• botulinum toxin injections into the affected muscles

Question 38

deep brain stimulators

Answer 38

• inhibit the thalamus for essential tremor

- inhibit STN for PD

Question 39

resting Pill rolling tremor

Answer 39

-low amplitude, low freq
-starts in one hand may progress to involve other extremities, jaw, face, tongue, lips
(PD d/t loss of DA neurons in basal ganglia)