Higher Motor Centres

Question 1

Motor Cortex: key words

Answer 1

Complexity, intricacy, thought to motor, new learning, highly skillful

Question 2

Responsibility of which HMC?: Releases command sequences for locomotor activities/primary issuer of command ‘packages’ related to movement

Answer 2

Motor Cortex

Question 3

Responsibility of which HMC?: Key higher motor centre in learning of new motor activities through visual observation (‘see and reproduce’/mimicking), or as part of a process of thought/imagination (invention)

Answer 3

Motor Cortex

Question 4

Responsibility of which HMC?: Primary HMC (higher motor centre) for voluntary (intentional) movement (‘think, then do’)

Answer 4

Motor Cortex

Question 5

Responsibility of which HMC?: Primary HMC for dexterity, fine motor control.

Answer 5

Motor Cortex

Question 6

Responsibility of which HMC?: Key HMC for fxns that combine cognitive and fine motor fxns, such as speech

Answer 6

Motor Cortex

Question 7

Responsibility of which HMC?: Plays a larger role when movements are complex, skillful, bilateral.

Answer 7

Motor Cortex

Question 8

Responsibility of which HMC?: Because it is constantly generating output, contributes a significant amount of baseline motor system tone as a biproduct.

Answer 8

Motor Cortex

Question 9

If the motor cortex is damaged, it could look like/impair…

Answer 9

Learning new motor skills
Fine motor control activities
Speech fxns
Generalized hypotonicity (reduction in basic mm tone)
Significant impairment of more complex activities and involuntary movement initiation

Question 10

Cerebellum: key words

Answer 10

Movement memory, balance, proprioception, coordination details

Question 11

Responsibility of which HMC?: Primary HMC for overall coordination, integration of elements within movement command packages.

Answer 11

Cerebellum

Question 12

Responsibility of which HMC?: Monitors incoming sensory info from external and internal body sources (esp visual and proprioceptive data), and integrates this info into organizing effective, appropriate movements; info is coming in as movement is happening.

Answer 12

Cerebellum

Question 13

Responsibility of which HMC?: Key HMC for the body’s motor adjustments to the horizon and to gravity.

Answer 13

Cerebellum

Question 14

Responsibility of which HMC?: Primary HMC for sequencing/ordering of commands- crucial to perfect movement, esp rapid, complex actions (SSS- speed, sequencing, synchronicity)

Answer 14

Cerebellum

Question 15

Responsibility of which HMC?: Role in learning- helps mobilize motor command packages for newly learned or newly improved activities into and out of memory storage; pulling off new skill base.

Answer 15

Cerebellum

Question 16

Responsibility of which HMC?: Constant fine tuning of motor commands- monitors motor cortex output and makes adjustments, both while the commands are being issued and after (to improve continuous actions or to improve upon learned skills)

Answer 16

Cerebellum

Question 17

Responsibility of which HMC?: Suppression of tremor during purposeful body part activity- through counteracting surge-like qualities of motor cortex output.

Answer 17

Cerebellum

Question 18

Symptom of dysfunction of which HMC?: generalized poor coordination

Answer 18

Cerebellum

Question 19

Symptom of dysfunction of which HMC?: Intention tremor/body part tremors during purposeful activity

Answer 19

Cerebellum

Question 20

Symptom of dysfunction of which HMC?: Decomposition of movement. Rather than one mvmnt that’s simultaneous, it becomes several , separate, voluntary movements. Can be speech decomposition.

Answer 20

Cerebellum

Question 21

Symptom of dysfunction of which HMC?: Dsfxn of balance and equilibrium

Answer 21

Cerebellum

Question 22

Symptom of dysfunction of which HMC?: Impaired motor fxn memory

Answer 22

Cerebellum

Question 23

Symptom of dysfunction of which HMC?: Dysmetria

Answer 23

Cerebellum

Question 24

Symptom of dysfunction of which HMC?: Nystagmus

Answer 24

Cerebellum

Question 25

Symptom of dysfunction of which HMC?: Vertigo

Answer 25

Cerebellum

Question 26

Symptom of dysfunction of which HMC?: Dysdiadochokinisia

Answer 26

Cerebellum

Question 27

Symptom of dysfunction of which HMC?: Dystaxia, ataxia

Answer 27

Cerebellum

Question 28

Dysmetria; def

Answer 28

Impaired pin-pointing (pass pointing); dsfxn in moving a body part to a point, in the most direct route.

Question 29

Nystagmus; def

Answer 29

A combo of intention tremor and dysmetria as applied to eye movement. The eyes shimmy back and forth when the person tries to focus on a visual target.

Question 30

Vertigo; def

Answer 30

Hallucination of movement; either of the person's own body or of the external environment, or both.

Question 31

Dysdiadochokinesia; def

Answer 31

The inability to perform rapidly, alternating movements.

Question 32

Dystaxia, ataxia; def; aka ____

Answer 32

AKA drunken sailor's gait. Body parts are not working well together and centre of gravity is not stable; person has trouble with foot placement; person has difficulty maintaining a straight course and managing objects in the environment; person often imagines body part and objects are moving when they are not.

Question 33

Basal Nuclei: key words

Answer 33

Initiator, watching what's happening

Question 34

Responsibility of which HMC?: First initiator- 'alerts' the other centres to the need for new command sequences to be issued

Answer 34

Basal Nuclei

Question 35

Responsibility of which HMC?: The beginning of every motor sequence

Answer 35

Basal Nuclei

Question 36

Responsibility of which HMC?: Key HMC in oversight of reflexive relationships in the motor system: agonist/antagonist/synergist relationship- Stabilizes the base or pxml jj during mvmnt; oversees this process.

Answer 36

Basal Nuclei

Question 37

Responsibility of which HMC?: Key HMC in oversight of reflexive relationships in the motor system: postural reflexes- long term: cycle through motor units throughout the day; arm swing and hip lift in gait; sway/lean/mms activate to bring trunk back to midline/oversees this process.

Answer 37

Basal Nuclei

Question 38

Responsibility of which HMC?: Key HMC in oversight of reflexive relationships in the motor system: 'background positioning' of trunk and limb girdles

Answer 38

Basal Nuclei

Question 39

Responsibility of which HMC?: Key HMC in oversight of reflexive relationships in the motor system: inherent, automatic types of movement responses.

Answer 39

Basal Nuclei

Question 40

Responsibility of which HMC?: Error correction - monitors information coming into the MS and surpresses automatic responses that are not correct for the situation; editing fxnr

Answer 40

Basal Nuclei

Question 41

Responsibility of which HMC?: Adds gracefulness and efficiency to movement.

Answer 41

Basal Nuclei

Question 42

Responsibility of which HMC?: Suppression of tremor in body parts not engaged in purposeful activity through counteracting surge-like qualities of motor cortex output.

Answer 42

Basal Nuclei

Question 43

Basal Nuclei vs Cerebellum - which 'built' and which is 'inherrited'?

Answer 43

``` BN = inherrited Cerebellum = built ```

Question 44

Symptom of dysfunction of which HMC?: general inefficiency of movement: person is often fatigued by minor amounts of motor activities.

Answer 44

Basal Nuclei

Question 45

Symptom of dysfunction of which HMC?: Resting Tremor: body part(s) tremors when not involved in purposeful activity.

Answer 45

Basal Nuclei

Question 46

Symptom of dysfunction of which HMC?: Bradykinesia/akinesia

Answer 46

Basal Nuclei

Question 47

Bradykinesia/akinesia/def

Answer 47

slow movement initiation/inability to initiate movement. Also the inability to stop mvmnt (initiating a 'stop'command), change mvmnt- can lead to 'freezing' during an attempt.

Question 48

How can you get the cerebellum involved in there is a basal nuclei dsxn?

Answer 48

Engage reflexes (someone pushing you fwd) Involving coordinants- putting a ruler in front of a person; black and white tiles.

Question 49

Symptom of dysfunction of which HMC?: Disorders of postural control: postural tremor, disorders of background positioning, impaired/absent post. reflex components, impaired/absent global postural reflexes

Answer 49

Basal Nuclei

Question 50

Postural tremor: def/ indicates a problem with which CNS structure?

Answer 50

Body part(s) starts to tremor after holding a body part for an abnormally short period of time. Dsfxn of Basal Nuclei

Question 51

Hypokinesia: Def & name HMC that's dsfxning

Answer 51

Slow movement (eg astronaut in space); BG dsfxn

Question 52

Festination/festinating gait: Def & name HMC that's dsfxning

Answer 52

Person has difficulty starting to walk and usually throws the upper body forward to create momentum. Any decision to change directions or other aspect of the mvmnt will cause the person to slow down or even freeze for a while. Person gen has problems stopping the gait. Also, walking is absent the knee lift and the toe off reflexes. Described as shuffling; the cerebellum is holding it together here BG dxfxn

Question 53

Tic: Def & name HMC that's dsfxning

Answer 53

An involuntary movement; brief, small contraction, often of smaller mm groups- can be larger mm groups, even f/body. Tics occur one at a time or in series BG dsfxn

Question 54

Athetosis: Def & name HMC that's dsfxning

Answer 54

An involuntary movement; writhing, intertwining action, often in the wrists, can be the ankles or legs; 'snake-like'. BG dsfxn

Question 55

Chorea: Def & name HMC that's dsfxning

Answer 55

Involuntary movement; often called a 'dance'; a series of jerky/graceful mvmnts that follows a pattern; can involve ind. body parts or be more extensive, even f/body; won't stop until entire 'cycle' has died out. BG dxfxn

Question 56

Ballism: Def & name HMC that's dsfxning

Answer 56

Involuntary mvmnt; large-scale, explosive body part mvmns, often a limb, but can be more extensive, even f/body. BG dxfxn

Question 57

Dyskenesia: Def & name HMC that's dsfxning

Answer 57

Involuntary mvmnt; body part(s) and often f/body; moves through a 'swaying' , repetitive cycle of mvmnt, gen w/ a circular, looping quality. Differs from Korea in that it has a more jerky and more of a rigid sequence. BG dsfxn

Question 58

Dystonia: Def & name HMC that's dsfxning

Answer 58

Involuntary mvnmt; body part migrates into an abnormal position and freezes there for a period of time. BG dsfxn

Question 59

Rigidity: Def & name HMC that's dsfxning

Answer 59

Dsfxn in mngmnt of the reflexive programming btwn the agonist and antagonist mm groups; results in both groups at a jj responding to mvmnt directives by trying to shorten. Results in: - Resistence to mvmnt/very limited mvmnt available - A jj jolding position set by which group is strongest.

Question 60

Impacts of rigidity on the libms (2)

Answer 60

1. Lead pipe: continuous mvmnt resistance | 2. Cogwheel: intermittent or 'stop-start' mvmnt resistance

Question 61

Impacts of rigidity on the face

Answer 61

"the mask of parkinsonism' B/c strength relationships are gen equal in facial expression, the face becomes expression-less. They can make voluntary expressions, but most facial expressions are involuntary so they remain expresion-less.

Question 62

Impacts of rigidity on respiration, RMT caution?

Answer 62

- Apical breathing through only the apex of the lungs - Dyspnea, esp. on exertion or under stress, also in certain positions (esp flat supine, flat prone) - Ribcage can get stuck in partial excursion. - Problem with the management of the synergystic relationships - In inspiration and expiration, incl recruitment of 2nd mm, as needed RMT caution: person is very susceptible to resp infections like bronchitis, pnemonia etc, thus extra care with hygenic precautions, esp. if RMT is sick.

Question 63

Impacts of rigidity on digestion, RMT caution?

Answer 63

- Constpation due to impairment o peristalsis and swallowing reflex - Swallowing impairments: dysphagia- Difficulty swallowing, Aphagia- inability to swallow RMT caution: Choking and aspiration (inhaling rather than swallowing) esp when the patient is supine.

Question 64

What is rigidity ultimately doing to the tissue? Thus, our tx goals will be _____ (3)

Answer 64

Causing it to deteriorate. 1. Optimize tissue health 2. Increase fxnl capabilities 3. Decrease pain

Question 65

Contracture: def

Answer 65

Passive adaptation of CT/fascia in a body part/s being held in a continuous holding position. Passive = energy efficient b/c the CT is holding, mostly so less/no contraction energy is required.

Question 66

Contracture: Pro's

Answer 66

Less energy expenditure in maintaining holding position

Question 67

Contracture: Con's (5)

Answer 67

- Promotes ishcemia and toxic conditions in tissue, thus reduces tissue health, poor healing, irritation of motor tone, ischemic pain - Re-inforces and increases ROM limitations, re-nforces fxnal impairments - Promotes compensation problems -Promotes degnrtve changes in tissue/jjs (b/c OA happens due to less or no ROM/cx at jj/reduced jj health) - Forces altered mechanics, thus less efficient mvmnt and resulting tissue stress - Premature activation of protective stretch reflex responsese

Question 68

General guidelines to working with rigidity: List the progressive order (8)

Answer 68

1. Gen relaxation 2. Optimize perfusion and drainage 3. Reduce/minimize contracture 4. Try mm fatigue tchqs 5. Available reflex techniques 6. Stretch and mobilization 7. Medications

Question 69

Tx rigidity: Explain why relaxation is important and how you would go about achieving that.

Answer 69

Lowering SyNS activation will help reduce some amount of tone in rigid mms. This will reduce likelihood of recruiting prtective reflexes. This will set you up for more specific approaches to treating the rigidity mores specifically. MMs will be more responsive and you have potential to gain more ROM. In order to relax, they must be comfortable- consider positioning: - Breathing difficulties? - Dysphagia? Lying flat may promote choking

Question 70

-Tx rigidity: why is optimizing perfusion and drainage important? How would you do that in a tx?

Answer 70

MMs become irritable bc of poor nutrition and waste clearance (due to ischemia). Improving circ helpsreduce tone in mms. Interventions: Heat or heat-based contrast, manual circ tchqs, PROM within resistance free-range; jj mobs if jj-related.

Question 71

Why is treating contracture an important part of treating rigidity? Interventions?

Answer 71

Over and above the rigidity itself, contracture greatly decrease mobility and fxn. They can also cause premature activation of stretch reflex responses = increase tone in rigid mms. Contracture also adds to ischemia and jj degeneration. Heat, kneading/stripping/friction tchqs, jj play, PROM and exercise prescription for tx contracture.

Question 72

MM fatiguing techniqes for tx-ing rigidity- which ones, how do they help?

Answer 72

Contract-relax; sustained isometric cx (temporary tissue softening). may be very helpful in fatiguing the target mms and reducing tone.

Question 73

Reflex techniques- which ones will be effective in tx rigidity and which ones will not?

Answer 73

Yes = GTO. Maybe vibrations and stroking (facilitate relaxation) No - Agonist/antagonist tchqs like reciprocal inhibition, antagonist cx tchqs. MM aproximation is also limited.

Question 74

Key tx aims/progression for treating rigidity?

Answer 74

We must soften tussue first, to provide ourselves with a short tx window to treat their muscles. Minimizing contracture and maximizing jj health. JJ play can be very good- relaxation and jj health. Passive forced movements can be effective if done properly- carful not to tear tissue, so gently bring them to end of ROM/resistance and test it

Question 75

Tx rigidity: medication: C/I or not?

Answer 75

It's best to treat patientwhen their medication is in full force, as the treatment will be more affective.