Hypertonic States

Question 1

Rigidity

Answer 1

Increased resistance to passive ROM
Lead pipe phenomenon
Overactive agonist/antagonist muscles
Seen with basal ganglia dysfunction
Cog wheel - superimposed tremor

Question 2

Spasticity

Answer 2

UMN syndrome
Exaggerated flexion/extension of reflexes
Result of cortico-spinal tract dysfunction (inhibitory)
Clasp knife phenomenon
Always pathologic

Question 3

Spasticity clinical manifestation

Answer 3

Abnormal posturing
Flexor/extensor spasms
Abnormal synergistic movements
Babinski sign/exaggerated cutaneous reflex
Decreased postural/trunk stability
Decreased ROM

Question 4

Cerebral Palsy

Answer 4

Non-progressive disorder of posture/motor control - present at birth

Question 5

CP Co-morbidities

Answer 5

Visual impairment
Hearing loss
Speech delay
Epilepsy
Mental retardation
Depression

Question 6

CP Management

Answer 6

Eval for treatable disease
PT/OT - bracing
Surgical release of tendons/grafting
Botox

Question 7

CP TX objectives

Answer 7

Mobility
Physical fitness
Education

Question 8

Syringomyelia

Answer 8

Cyst in spinal cord

Question 9

Meds for Spasticity

Answer 9

Baclofen
Dantrolene (hepatotoxic)
Tizanidine
Benzo

Question 10

Surgery for Spasticity

Answer 10

Rhizotomy - dorsal/ventral root section
Tendon release/transfer
Spinal stimulator
Baclofen pump

Question 11

Tremor

Answer 11

Rhytmic oscillations about at joint

Amplitude/velocity similar in both directions

Question 12

Resting Tremor

Answer 12

Basal ganglia pathology
Pill-rolling
Little functional impairment

Question 13

Postural Tremor

Answer 13

Seen without pathology
Distal (limbs), head, neck, lips, tongue
Worse with stress, fatigue, stimulants

Question 14

Intention Tremor

Answer 14

Kinetic tremor (w/movement)
Associated with cerebellar disease and ataxia

Question 15

Tic

Answer 15

Involuntary stereotyped quick movements at irregular intervals

Question 16

Simple tics

Answer 16

Motor - eye blinking/rolling, grimacing, fist clench, toe curl
Sonic - throat clear, grunt, sniff, snort, bark, click

Question 17

Complex tics

Answer 17

Motor - jump, touch, smell, rub, copropraxia, echopraxia

Vocal - coprolalia, echolalia, singing, whistling, humming

Question 18

Tourette Syndrome

Answer 18

Multiple motor tics and at least one vocal/sonic tic
Onset <18
Also see - ADD, behavior disorders, dyslexia

Question 19

Dystonia

Answer 19

Abnormal posturing
May be focal/multi-focal, generalized, segmental, task specific
TX: L-Dopa or Botox

Question 20

Athetosis

Answer 20

Writhing/snake-like involuntary movements

Question 21

Chorea

Answer 21

Involuntary random movements sufficient to move body part
Huntington, Sydenham, RF
Drug induced - dopa, amphetamines, neuroleptic

Question 22

Huntington

Answer 22

Personality disorder
Dementia
Movement disorder
Onset - 3rd/4th decade
AD
No Caudate Nucleus

Question 23

Hemi-Ballismus

Answer 23

Large amplitude/violent chorea
Limbs fling out, typically one-sided
Associated with lesions of contralateral subthalamic nucleus

Question 24

Tardive dyskinesia

Answer 24

Abnormal movements brought on by meds/neuroleptics

Oral/facial/lingual most common

Question 25

Ataxia

Answer 25

Decomposition of voluntary movement Decreased speed, coordination, imprecise movement Affects limbs, eyes, trunk, speech Disease in cerebllum

Question 26

Asterixis

Answer 26

Intermittent loss of postural tone Affects limbs/trunk Seen with metabolic/toxic encephalopathies Negative myoclonus

Question 27

Myoclonus

Answer 27

Involuntary jerks - shock like Cortical - epilepsy, degenerative disorders, encephalopathies Subcortical/spinal - hemifacial spasm Physiologic - hypnic jerks

Question 28

Restless leg

Answer 28

Associated sleep disorder and iron deficiency