Gait, Cerebellar Fxn and Movement Disorders Flashcards
Essential for normal walknig
Strength –>
Coordination –>
Postural control –>
Sensation –>
+ _____ , which allows us to “put into action” the concept of walking. A type of deficit, calle gait ______, patients are immobile when asked to walk, despite having all other essentials
Strength –> UMN, LMN, NMJs, muscle
Coordination –> cerebellar systems
Postural control –> extrapyramidal system
Sensation –> particularly proprioception
+ MEMORY/ CONCEPT OF WALKING, which allows us to “put into action” the concept of walking. A type of deficit, called GAIT APRAXIA patients are immobile when asked to walk, despite having all other essentials
_______ RHOMBER SIGN =
Due to lesion in the ________
How can this patient stand steadily with feet together?
POSITIVE RHOMBER SIGN, means the patient sway and topples when EYES ARE CLOSE
Due to POSTERIOR COLUMN / SENSORY NERVE LESION (IMPAIRED PROPRIOCEPTION)
THIS PATIENT CAN STAND STEADILY WITH FEET TOGETHER DUE TO VISUAL ORIENTATION COMPENSATING FOR IMPAIRED PROPRIOCEPTIVE INPUT
What two lesions could cause abnormal stance PRIOR TO WALKING?
- Posterior Column / sensory nerve –> positive Romberg
- Cerebellar Disease
A patient that cannot stand with feet together, regardless of whether eyes are open or closed is due to ______ disease; in comparision to a positive rhomberg sign, this patient’s _______ cannot compensate
A patient that cannot stand with feet together, regardless of whether eyes are open or closed is due to CEREBELLAR DISEASE; in comparision to a positive rhomberg sign, this patient’s VISUAL CLUES cannot compensate
A broad-based ataxic gait:
Feet –>
Gait is worse when ______
caused by lesions of
_______ or
_______ (which is worse with _____) or
__________
Broad-based ataxic gait:
Feet are s_pread wide apart_ for stability
Gait is worse when walking a straight line / tandem / heel to toe
Found with lesions @:
POSTERIOR COLUMNS
SENSORY/ PROPRIOCEPTIVE NERVES (WORSE WITH EYES CLOSED)
CEREBELLUM
Hemiplegic gait:
The affected lower limb is stiffly ______ and _____/circumducted
The affected ipsilateral upper limb is _____at the elbow and wrist with ______ [inc/dec] arm swing.
This is commonly observed in _____ patients
Hemiplegic gait:
The affected lower limb is stiffly EXTENDED and SWUNG/circumducted
The affected ipsilateral upper limb is FLEXED at the elbow and wrist with DECREASED arm swing.
This is commonly observed in STROKE PATIENTS
TABETIC GAIT
it is also know as the “foot ______” gait, where patient compensates for impaired _____ by forcibly _______ the feet down to _____ the floor
Occurs due to: ____/____ or severe _________
what other sx may be associated with tabetic gait?
TABETIC GAIT
it is also know as the “FOOT SLAPPING” GAIT, where patient compensates for impaired SENSATION by forcibly PLANTING the feet down to FEEL the floor
Occurs due to: NEUROSYPHILIS/TABES DORSALIS or
severe neuropathy
with neurosyphilis, argyl robinson pupils may also be noted
Steppage Gait:
caused by ______ drop or a weak _______
to prevent tripping over the toes, the hip is _____ even higher to elevate the ______, which is lowered to the floor toe first
Caused by: Lesions to the ______ nerve or
_____ root lesions or
severe _________
Steppage Gait:
caused by FOOT DROP or a weak DORSIFLEXION
to prevent tripping over the toes, the hip is FLEXED even higher to elevate the DROOPING FOOT, which is lowered to the floor toe first
Foot drop/weak dorsiflexion caused by:
Lesions to the PERONEAL NERVE or
L5 ROOT LESIONS or
SEVERE PERIPHERAL NEUROPATHY
Waddling Gait:
when walking, weak ____ or _____ muscles cannot support the body on “_____” while the opposite foot is lifted off the ground
Patient compensates by _____ or _____ to the left when the right foot is raised and vice versa, alternately tilting the pelvis from side to side, reminiscent of a _______.
Usually from _____ / muscle_____.
Waddling Gait:
when walking, weak PELVIC or HIP MUSCLES CANNOT SUPPORT THE BODY on “ONE LEG” while the opposite foot is lifted off the ground
Patient compensates by SWAYING or LEANING to the left when the right foot is raised and vice versa, alternately tilting the pelvis from side to side, reminiscent of a waddling duck.
Usually from MYOPATHY/ muscledisease.
Scissors Gait:
Although legs are _____, there is marked ____ and tighthess in the ____ muscles of the thighs, forcing the ____ stiffly together when walking –> legs tend to _____ like closing blades of a scissor
Due to:
Scissors Gait:
Although LEGS ARE WEAK, there is marked SPASMS and tighthess in the ADDUCTOR muscles of the thighs, forcing the KNEES sti_ffly together when walking_ –> legs tend to CROSS OVER like closing blades of a scissor
Due to: CST LESIONS (AFFECTING THE LEGS/ SPASTIC PARAPARESIS), AS IN CEREBRAL PALSY OR MS
CERVICAL SPINAL CORD INJURY, UMN WEAKNESS – SPASTICITY
Parkinsonian Gait:
Slow, _____ gait with a ______ posture, and a lack of a ______ arm swing
Festination =
Turning around is _____, requiring _______
Parkinsonian Gait:
SLOW, SHUFFLING GAIT with a “STOOPED FORWARD” posture, and a LACK OF NORMAL ARM SWING
Festination = leaning further and further forward to walk, the pt then runs to catch up with the center of gravity
Turning around is LABORIOUSLY SLOW, requiring multiple, small steps, foten with a tendancy to fall over
What are different ways to test cerebellar function of limb movements? (4)
Finger-nose-finger
Heel-shin-knee
Rapid alterations of hands
Rebound (antagonistic muscle) test
How would cerebellar dysfunction look like in realtion with…
speech?
eyes?
Speech –> CEREBELLAR DYSARTHRIA
due to left cerebellum dysfunction
SX: slurred, thick, scanning (erratic, jerky, explosive or hypernated quality)
Eyes –> nystagmus with erratic, jerky eye movements
What are abnormal limb control movements related with cerebellar disease? (4)
Kinetic Tremor - rhythmic oscillations during limb movment towards a target
Dysmetria - overshooting or undershooting a target
Decomposition of movement - a normally smooth movement becomes jerky “broken down”
Loss of check response (reboud) - sudden release of contracted biceps leads to striking the face; triceps does not normally “check/protect” this action due to imbalance of agonist-antagonist muscles
Cerebellar Syndromes:
Hemispheral Syndrome - predominately affects _______ limbs, leading to —-> (4)
causes: (4)
Cerebellar Syndromes:
Hemispheral Syndrome - predominately affects IPSILATERAL limbs, leading to —-> kinetic tremor, limb dysmetria, dysdiadochokinesia, rebound phenomenon
causes: ipsilateral infraction, hemorrhage, tumor, MS, (bilateral lesions in degenerative disease)
Cerebellar Syndrome:
Vermal/Vermian Syndrome –> predominately affects the _____ –> ____ unsteadiness with.. (5)
causes: (4)
Could also be caused by _____ cerebellar degeneration: atropy of the _________ vermis –> gait ___ and lower limb ____
Cerebellar Syndrome:
Vermal/Vermian Syndrome –> predominately affects the TRUNK –> TRUNCAL unsteadiness with..standing or walking, tremor, postural impairment, gait ataxia
causes: hemorrhage, tumor, MS, degenerative disorders
Could also be caused by ALCOHOLIC CEREBELLAR DEGENERATION: atropy of the ANTEIOR-SUPERIOR VERMINS –> gait ATAXIA and lower limb DYSMETRIA
Spinocerebellar degeneration / Ataxias
is a ______ degenerative disorder with _____ cause and no curative treatment
Predominately affects the _____ and the ____ of the cerebellum and spinal cord in progressive fashio
older patients can become wheelchair-dependent
The most common type is ______
Spinocerebellar degeneration / Ataxias
is a HEREDITARY DEGENERATIVE DISORDER WITH NO KNOW CAUSE cause and no curative treatment
Predominately affects the NUCLEI and the TRACTS of the cerebellum and spinal cord in progressive fashion
older patients can become wheelchair-dependent
The most common type is: FRIEDREICH’S ATAXIA
TREMOR is ______, ______ movement of hands, limbs, head or voice
In parkinsonisms –>
Familia essential tremor –>
Cerebellar disease –>
TREMOR is rhythmic, oscillatory movement of hands, limbs, head or voice
In parkinsonisms –> resting tremor
Familial essential tremor –> predominately seen when maintaining a position = postural tremor
Cerebellar disease –> predominately when performing a movement = kinetic tremor
Choreathetosis = athetosis and chorea
Athetosis =
Chorea =
From a lesion in the _______ (dz) or its connecting pathways
OR
High levels of ______ medications may produce chreo-athetosis or dystonia, which can be seen in pts with (dz)
Choreathetosis = athetosis and chorea
Athetosis = slow, writhing, continual limb movements,
plus brief
Chorea = irregular, flowing “dancelike” movements
affecting limbs, trunk and face
From a lesion in the CAUDATE NUCLEUS / HUNTINGTON’S DISEASE or its connecting pathways
OR
High levels of DOPAMINERGIC MEDS may produce chreo-athetosis or dystonia, which can be seen in pts with PARKINSON’S
HEMIBALLISMUS = ….
due to a lesion …….
Hemiballismus = rapid, violent “ballistic” flinging movements of proximal upper and lower limbs on one side
Due to a lesion, usually infarction, of the contralateral subthalamic nucleus
Dystonia = …..
Could be focal (ie ___) or generalized (ie _____)
What lesion or pathology is underlying dystonia?
Dystonia = continual or sustained painful contractions of muscles, causing turning and spasms of the limbs or neck, with fixed, unnatural postures
Focal – torticollis or generalized – dystonia musculorum deformans
NO specific lesion or pathology has been correlated with this disorder
Tic = ….
associated with ____ syndrome –> (4)
What lesion or underlying pathology has been correlated with this disorder?
Tic = brief, semipurposeful, stereotyped, repetitive contractions of groups of muscles ( ie- eye blink, facial twich, sniff)
Associated with Tourette’s Syndrome:
Motor and vocal tics
Inherited, with var penetrance, BOYS>females
ADD and behavioral problems
NO specific lesion or pathology has been correlated with this disorder (decreased motor inhibition in the basal ganglia may cause tics?)
Myoclonus=….
due to diffuse ______ from neurological (ie ________disease_ or medical diseases (ie ….)
Myoclonus = rapid, shocklie movements of the limbs or body, usually bilateral and often asynchronus
Due to diffuse ENCEPHALOGPATHIES from neurological (ie CREUTZFELDT-JAKOB DISEASE) OR medical diseases (renal or hepatic failure, anoxia)
Asterixis is a _____ tremor, of the extended _____ or ____ due to _______
Seen _____ [uni/bilateral] in _________ from medical disease such as ______
seen [uni/bilateral] in __________
Asterixis is a FLAPPING TREMOR, of the extended hand or foot due to LOSS OF POSTURAL TONE
Seen BILATERAL in DIFFUSE ENCEPHALOPATHIES from medical disease such as renal or hepatic failure
seen UNILATERAL in STRUCTURAL BRAIN LESIONS
RX:
Parkinsonian resting tremor –> (3)
Essential tremor –> (2)
Choreathetosis, hemiballismus, tics –> (1)
Dystonia –> (3)
Parkinsonian resting tremor –> L-dopa, anticholinergics, dopamine agonist
Essential tremor –> beta-adrenergic blockers, barbiturates
Choreathetosis, hemiballismus, tics –> dopamine antagonist
Dystonia –> anticholinergics, benzos, botxo
