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Neuro exam 1 - Rivera > Lecture 3: Upper and Lower Motor Neuron Pathology > Flashcards

Lecture 3: Upper and Lower Motor Neuron Pathology Flashcards

1
Q

Golgi Tendon Organs (GTO) structure

A

-Encapsulated receptor located at the musculotendinous junction
-In series (follows in line with tendonitis fibers) with extrafusal fibers/sensory organ
-2-50 GTO per muscle
-Innervated by afferent fiber branches, 1b by which the distal and the proximal parts of the tendon-spindle are innervated

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1
Q

GTO function

A

1) Detect small change in muscle contraction (<1g force)
2) Sensitive to twitch contractions
3) Compensate for fatigue in motor units
4) May facilitate for inhibit muscle contractions
5) Reflex regulation of alpha motor neuron activity
6) Context and task dependent
7) Determines FORCE and speed and organizes it so that we do not get fatigued as easily
8) Stimulates the alpha motor neuron to regulate like a police
9) Able to shut the muscle down if needed

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2
Q

GTO Mechanoreceptors

A

-Monitoring and regulating the tension of muscle force
-Prevents muscle damage

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3
Q

what does the GTO inhibit

A

its own muscle Autogenic inhibition

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4
Q

How does autogenic Inhibition work

A
  • 1B innervation at the tendinous junction
    -Stimulated by tension of the muscle to the tendon
    -Too much force = Inhibitory interneuron inhibits muscle contraction (also called inverse stretch reflex)
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5
Q

Muscle Spindle axon

A

1a sensory

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6
Q

muscle spindle functioning

A

monitoring length and velocity of the muscle

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7
Q

Muscle spindle activation

A

tendon reflex

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8
Q

gamma motor neurons axon

A

2 (motor)

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9
Q

gamma motor neurons function

A

resetting the muscle spindle after activation

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10
Q

gamma motor neurons activation

A

brain modulats muscle spindle to stretch

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11
Q

GTO axon

A

1B (sensory)

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12
Q

GTO function

A

monitoring and regulating the tension of the muscle force. workload distributor

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13
Q

GTO activation

A

inverse stretch reflex

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14
Q

alpha motor neuron axon

A

alpha motor

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15
Q

alpha motor neuron function

A

activates the muscle

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16
Q

alpha motor neuron activation

A

force production

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17
Q

Upper motor neuron Definition of a Syndrome Involves

A

-Motor cortex and pathways
-brainstem
-cerebellum
-Spinal cord reflex and coordination

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18
Q

Upper motor neuron neurologic signs and symptoms

A

postures, postural responses, movements (passive and active) and involuntary responses that correspond with an upper motor neuron lesion

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19
Q

Lower motor neuron Syndrome

A

-injury resides in the anterior horn cell or peripheral nerve
- involves the peripheral nerve or cranial nerves

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20
Q

what is an upper motor neuron syndrome the result from

A

the disruption of central motor pathways that arise from the cerebral cortex and pathways in the spinal cord

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21
Q

Pathways (connection to motor system)

A

1) Corticospinal tracts
2) corticobulbar tracts
3) lateral and medual reticulospinal tracts
4) lateral and medial vestibulospinal tracts
5) rubrospinal tracts
6) tectospinal tracts

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22
Q

Classic Upper Motor Neuron Syndrome weakness

A

loss of CNS drive

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23
Q

Classic Upper Motor Neuron Syndrome Spasticity

A

increase in muscle tone with a velocity - based muscle stretch (changes in tone)

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24
Q

Classic Upper Motor Neuron Syndrome decreased muscle control

A

changes in selective function

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25
Q

Classic Upper Motor Neuron Syndrome Hyperreflexia or exaggerated deep tendon reflexes

A

increase muscle response to tendon tap

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26
Q

Classic Upper Motor Neuron Syndrome clonus

A

repeated rhythmic contractions of individual muscle groups

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27
Q

muscle tone definition

A

Resistance to passive stretch as a patient is attempting to maintain a relaxed state of muscle activity

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28
Q

muscle tone reflexes

A

-Muscle state (at relaxation): test at every joint flextion/extention, Ab.Ad
-Independent of strength, coordination or involuntary movement

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29
Q

Range of muscle tone hypo to hyper

A
  • Flaccidity (LMN)
  • Hypotonia
    -normal
    -hypertonia (UMN)
    -rigidity (UMN)
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30
Q

Hypertonia definition

A

Increase in passive muscle tightness

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31
Q

Hypertonia spasticity

A

-velocity dependent
-muscle spindle not reseting
-need to be tested very fast
-UMN

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32
Q

Hypertonia: rigidity

A

-tight throughout
-Significant increase in resistance to multi directional external force about a joint

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33
Q

Hypertonia Dystonia

A

-State of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy
-Tone fluctuate throughout
-Goes with the basil ganglia
-In huntingtons or with children growing really fast

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34
Q

Common postures in UMN syndrome: CVA, TB, Cerebral palsy

A

-Flexed elbow
-Bent wrist
-Pronated forearm
-Clenched fist
-Thumb in palm

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35
Q

Ataxia definition

A

-loss of coordination, trimmers, overshooting, loss of velocity
-Associated with cerebellum

36
Q

Bradykinesia

A

slow movement
Associated with basal ganglia (parkinsons)

37
Q

Dystonia

A

-a state of abnormal muscle tone resulting in muscular spasm and abnormal posture
-Associated with basal ganglia

38
Q

Chorea Distonia definition

A

continuous stream of slow flowing, writing involuntary movements

39
Q

Ballistic Dystonia

A

explosive movement of the extremities

40
Q

Contractures with UMN

A

1) Neuromuscular changes
- Loss of selective movement
- Muscle hyper-reflexia
- Muscle hypertonia
- Loss of ROM over time leads to contracture
2) Associated with sensory loss
- Loss of proprioception
- Loss of light touch
- Loss of pin prick

41
Q

Hyperactive reflexes

A

-Is an increase in the reflex response
-Clonus
-Associated movements: moving one part of the body and another limb moves involuntary

42
Q

Brainstem involvement: advanced brain lesion

A

-Causes severe motor disruption (sensory and motor): posturing all limbs are fixed in a postures with limited limb movements
-Associated with rigidity (severe increase in tone)
-Extension or flexion posturing

43
Q

Extension posturing

A

extension of both limbs

44
Q

abnormal flexion posturing

A

flexion of UE and extension of LE with slight internal rotation

45
Q

CVA UMN signs

A

1) Initially flaccid
2) Later develops spasticity
3) Reflexed hyperactive
4) Synergistic movements
5) Clonus (variable)
6) Loss of joint position sense
7) CN changes or loss of vision or facial
8) weakness
9) Bladder changes

46
Q

CVS signs

A

Headache
Mental changes
Aphasia
RESP problems (decreased neuromuscular control)
Decrease in cough and swallow reflex
agnosia
Incontinence
seizures
Hemiparesis or hemiplegia
Emotional lability
Visual changes
Vomiting
Perceptual defects
hypertension

47
Q

Spinal cord injury UMN vertebra body fracture leads to

A

1) compression injury
2) flexion injury
3) extension injury

48
Q

Clinical syndromes of incomplete spinal cord injury

A

1) central cord
2) brown sequard
3) anterior horn

49
Q

Central cord

A

-Large lesion
-cervical
-Hyperextension
-Slight pain and temperature loss localized
-Due to spinothalamic crossing over at the specific level of the injury

50
Q

Brown Sequard injury

A

-Hemisection of spinal cord
-Ipsilateral UMN signs below the level of lesion
-Ipsilateral loss of tactile vibration, proprioception sense 1-2 levels below the level of the lesion
-Contralateral pain and temperature loss below the level of the lesion
-Ipsilateral loss of all sensation at the level of the lesion
-Ipsilateral LMN signs

51
Q

anteiror cord

A

1) incomplete (hemicord)
-Ispilateral vibration, position, and motor loss
-Contralateral pain and temperature loss
2) Complete
-Everything below the injury not working

52
Q

Lower Motor Neuron Lesions

A

1) Loss of muscle function (weakness or flaccid)
- Peripheral nerve injury/spinal nerve root injury
- Range from weakness to paralysis
2) Loss of sensory function from nerve damage (proprioception , touch and pain)
3 ) Tone: hyporeflexia
- No response to weak response on tendon tap

53
Q

Additional LMN signs

A

1) Fibrillations
2) Fasciculations
3) Hypotonia or atonia
4) Hyporeflexia
4) Strength - limited to segmental or peripheral nerve pattern
5) Sensation (loss of discriminative touch, light touch, ain, temperature, vibration, pressure, and joint position)

54
Q

Fibrillations Definition

A

muscular twitching involving individual muscle fibers acting without coordination

55
Q

Fasciculations definitions

A

causes by increase receptor concentration on muscles to compensate for lack of innervation

56
Q

Peripheral nerve injury

A

1) Neuropraxia
2) Axonotmesis
3) Neurotmesus

57
Q

Neuropraxia

A

loss of myelin
weakness

58
Q

axonotmesis

A

loss of axon and myelin
Weakness
Atrophy
Sensory loss

59
Q

Neurotmesis

A

Complete transection of nerve
Recovery more difficult due to neuroma formation

60
Q

Clinal presentation to peripheral nerve injury

A

1) muscle atrophy
2) weakness or paralysis
3) pain along nerve distribution
4) numbness along nerve
5) sensory loss over nerve
6) loss of ROM

61
Q

Examination of a peripheral nerve injury muscle testing

A

-test muscles in the uninvolved side first
- test muscles in the involved side
- test muscles of adjacent peripheral nerves

62
Q

Examination of a peripheral nerve injury sensory testing

A
  • ask about pain behavior
    -Test sensation uninvolved then involved
    -test sensation of adjacent peripheral nerves
63
Q

Injury to the common fibular (peroneal) muscles involved

A

fib long and brev,TA, EHL and EDL

64
Q

Injury to the common fibular (peroneal)
signs and symptoms

A
  • numbness and tingling
  • shooting pain along the nerve
  • pain with nerve tapping
    -pain at rest
65
Q

Injury to the common fibular (peroneal)
clinical presentation

A

1) hyporeflexia
2) muscular weakness along the fib n. distribution
3) sensory loss

66
Q

Injury to the C5-6 nerve root signs and symptoms

A

1) hyporeflexia
2) decreases DTR
3) weakness
4) sensory loss
5) pain
6) numbness and tingling
follows dermatome pattern

67
Q

Injury to C6 spinal nerve muscles

A

myotomal pattern of C6
Bircps, brachioradialis, and wrist extensors

68
Q

Diabetic neuropathy

A

glove and stocking presentation

69
Q

polyneuropathy

A

distal symmetric sensation loss

70
Q

L4 motor weakness

A

extension of quads

71
Q

L4 functional test

A

squat and rise

72
Q

L4 reflexes

A

Knee jerk diminished

73
Q

L5 motor weakness

A

dorsiflexion of great toes and foot

74
Q

L5 screening and exam

A

heel walking

75
Q

S1 motor weakness

A

planter flexion of great toe and foot

76
Q

S1 screening and exam

A

walking on toes

77
Q

S1 reflex

A

ankle jerk

78
Q

Peripheral nerve LMN injury testing

A

1) locate specific location
2) tinels sign
3) nerve injury follows the peripheral nerve
4) muscle and sensory loss below the level of injury
5) weakness and hyporeflexia

79
Q

Spinal nerve root injury LMN testing

A

1) injury at the spinal nerve root
2) injury follows a myotome and dermatome pattern

80
Q

LMN lesion muscle strength

A

weakness are paralysis

81
Q

LMN lesion muscle tone

A

decreased or absent

82
Q

LMN lesion reflex

A

decreased or absent

83
Q

LMN lesion wasting

A

rapid muscle wasting

84
Q

UMN lesion muscle strength

A

weakness or paralysis

85
Q

UMN lesion muscle tone

A

increased

86
Q

UMN lesion reflex

A

increased + babinski sign

87
Q

UMN lesion wasting

A

muscle mass maintained

Neuro exam 1 - Rivera (8 decks)

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