Gait, Cerebellar Function, and Movement Disorders Flashcards
what helps provide coordination and postural control of gait
cerebellar and EPS
gait apraxia
have adequate strength, coordination, postural control, and sensation to walk but are immobile when asked to do so
Romberg sign
-suggests a problem with impaired proprioception, either from involvement of posterior or dorsal column pathway or their afferent sensory nerves
broad based ataxic gait
lesions in posterior columns or proprioceptive sensory nerves OR cerebellar dysfunction
hemiplegic gait
- stroke pts
- affected lower limb stiffly extended and swung when walking
- ipsi upper limb flexed at elbow and wrist with decreased armswing
tabetic gait
foot slapping
steppage gait
- 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
duck waddle/waddling gait
-2/2 weakness of hip girdle, seen in myopathy (muscle dz)
scissors gait
- 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
parkinsonian gait
slow and shuffling, dec armswing, stooped forward/bent over
cerebellar function
helps maintain the smoothness and precision of movements for the limbs, trunk, eyes, and voice
What tests are used to identify cerebellar function?
- finger nose finger
- heel shin knee
- rapid alternating movements
dysdiadochokinesia
uncoordinated, nonrhythmic, sloppy hand movements 2/2 cerebellar dysfunction
rebound phenomenon/abnml check reflex
- imbalance between agonist and antagonist muscles
- pt accidentally strikes face
cerebellar dysarthria
-slurred speech associated with involvement of left cerebellar hemisphere
nystagmus
-multidirectional, can be due to: cerebellar dz (but also: lesions of vestibular system and brain stem)
What does a lesion of a cerbellar hemisphere predominantly affect
IPSI limbs; causing:
- kinetic tremor
- limb dysmetria
- dysdiadochokinesia
- rebound phenomenon
what part of the body is affected by a midline lesion of the cerebellar vermis?
the TRUNK=truncal unsteadiness when walking/standing, with impaired balance and gait ataxia
alcoholic cerebellar degeneration
- 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
Friedreich’s ataxia
- 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
What are non neurologic features of F’s ataxia
- scoliosis
- pes cavus (high arched feet)
- cardiac hypertrophy
- potentially fatal cardiac arrhythmias
How is a clinical diagnosis of F’s ataxia made
blood test revealing multiple trinucleotide repeats from a defect in chromosome 9
What kind of tremor is typical of PD
resting tremor of the limbs or head-noticeable during rest
postural tremor
more noticeable when limbs maintained in various positions-holding object or extending arm/leg
-often d/t familial essential tremor
kinetic tremor
-in a limb moving towards a target or performing a task; may accompany other s/s of cerebellar dz
choreoathetosis
- 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
hemiballismus
- violent rapid flinging mvmt of proximal limbs on one side
- 2/2 lesion in contralat subthalamic nucleus
dystonia
- continued painful contraction of muscles leading to spasms; unnatural fixed postures
- focal (cervical dystonia/torticollis) or generalized
tics
- brief repetitive focal muscle contractions
- ??d/t decreased motor inhibition in basal ganglia??
Tourette’s syndrome
-boys, assoc with ADHD–motor tics + vocal tics
Which movement disorders accompany encephalopathy
myoclonus (myoclonic jerks) and asterixis
myoclonus
rapid shocklike lightening movements or jerks of limbs and trunk
asterixis
extended hands and feet, flapping tremor
tx resting tremor of PD
anticholinergic drugs
tx essential tremor
beta adrenergic blockers or barbiturates
what are dopamine antagonist drugs used to tx
- choreoathetosis
- hemiballismus
- tics
tx for dystonia
- anticholinergic drugs
- benzos
- botulinum toxin injections into the affected muscles
deep brain stimulators
- inhibit the thalamus for essential tremor
- inhibit STN for PD
resting Pill rolling tremor
-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)
