Module 3 UMN and LMN

Question 1

What is the locations and structures involved in UMN lesion?

Answer 1

central nervous system cortex, brain stem, corticospinal tracts, spinal cord

Question 2

UMN diagnosis/pathology

Answer 2

stroke, traumatic brain injury, spinal cord injury

Question 3

UMN tone

Answer 3

increased: hypertonia velocity dependent

Question 4

UMN reflexes

Answer 4

increased: hyperreflexia, clonus
Exaggerated cutaneous and autonomic reflexes, +Babinski

Question 5

UMN involuntary movements

Answer 5

muscles spasms: flexor or extensor

Question 6

UMN strength

Answer 6

Weakness or paralysis ipsilateral stroke) or bilateral (SCI)
Corticospinal: contralateral if above decussation in medulla; ipsilateral if below distribution: nerve focal

Question 7

UMN muscle bulk

Answer 7

Disuse atrophy: variable widespread distribution. especially of antigravity muscles

Question 8

UMN voluntary movements

Answer 8

impaired or absent: dyssynergic patterns, obligatory mass synergies

Question 9

LMN location and involved structures

Answer 9

cranial nerve nuclei/nerves
Spinal cord: anterior horn cell, spinal roots
peripheral nerve

Question 10

LMN diagnosis/pathology

Answer 10

Polio, Guillain-Barre
Peripheral nerve injury
Peripheral neuropath
Radiculopathy

Question 11

LMN tone

Answer 11

decreased or absent: hypotonia, flaccidity
not velocity dependent

Question 12

LMN Reflexes

Answer 12

decreased or absent: hyporeflexia
cutaneous reflexes decreased or absent

Question 13

LMN involuntary movement

Answer 13

with denervation: fasciculations

Question 14

LMN strength

Answer 14

Ipsilateral weakness or paralysis
Limited distribution: segmental or focal pattern, root-innervated pattern

Question 15

LMN muscle bulk

Answer 15

neurogenic atrophy: rapid, focal distribution, severe wasting

Question 16

LMN Voluntary Movements

Answer 16

Weak or absent if nerve interrupted

Question 17

Cerebral Cortex Corticospinal tracts diagnosis/pathology

Answer 17

stroke

Question 18

Cerebral cortex corticospinal tract sensation

Answer 18

impaired or absent: depends on lesion location; contralateral sensory loss

Question 19

cerebral cortex corticospinal tracts tone

Answer 19

hypertonia/spasticity velocity-dependent; clasp-knife
initial flaccidity: cerebral shock

Question 20

Cerebral cortex corticospinal tracts reflexes

Answer 20

hyperreflexia

Question 21

Cerebral cortex corticospinal tracts strength

Answer 21

Contralateral weakness or paralysis: hemiplegia or hemiparesis
Disuse weakness in chronic state

Question 22

Cerebral cortex corticospinal tracts muscle bulk

Answer 22

normal during acute stage; disuse atrophy in chronic stage

Question 23

Cerebral cortex corticospinal tract involuntary movement

Answer 23

Spasms

Question 24

Cerebral cortex corticospinal tracts voluntary movement

Answer 24

Dyssynergic: abnormal timing, co-activation, fatigability

Question 25

Cerebral cortex corticospinal tract postural control

Answer 25

impaired or absent, depends on lesion location impaired balance

Question 26

Cerebral cortex Corticospinal tracts Gait

Answer 26

impaired: gait deficits due to abnormal weakness, synergies, spasticity, timing deficits

Question 27

Basal ganglia diagnosis/pathology

Answer 27

Parkinson's disease

Question 28

Basal ganglia sensation

Answer 28

not affected

Question 29

Basal ganglia tone

Answer 29

lead-pike rigidity: increased uniform resistance Cogwheel rigidity: increased, ratchet-like resistance

Question 30

Basal ganglia reflexes

Answer 30

normal or may be decreased

Question 31

Basal ganglia strength

Answer 31

Disuse weakness in chronic stage

Question 32

Basal ganglia muscle bulk

Answer 32

normal or disuse atrophy

Question 33

Basal ganglia involuntary movements

Answer 33

resting tremor

Question 34

Basal ganglia voluntary movements

Answer 34

bradykinesia: slowness of movement Akinesia: absence of movement

Question 35

Basal ganglia postural control

Answer 35

Impaired: stooped (flexed) Impaired balance

Question 36

Basal ganglia gait

Answer 36

Impaired: shuffling, festinating gait

Question 37

Cerebellum diagnosis/pathology

Answer 37

tumor, stroke

Question 38

Cerebellum sensation

Answer 38

not affected

Question 39

Cerebellum tone

Answer 39

Normal or may be decreased

Question 40

Cerebellum reflexes

Answer 40

Normal or weak: asthenia

Question 41

Cerebellum muscle bulk

Answer 41

Normal

Question 42

Cerebellum involuntary movements

Answer 42

none

Question 43

Cerebellum voluntary movements

Answer 43

Ataxia: intention tremor dysdiadokinesia dysmetria dyssynergia nystagmus

Question 44

Cerebellum postural control

Answer 44

Impaired: truncal axtaxia impaired balance

Question 45

Cerebellum gait

Answer 45

Impaired: ataxic gait deficits, wide-based, unsteady

Question 46

SC diagnosis/pathology

Answer 46

trauma, tumor, vascular insult: complete, incomplete SCI

Question 47

SC sensation

Answer 47

Impaired or absent below the level of lesion

Question 48

SC tone

Answer 48

hypertonia/spasticity below the level of the lesion Initial flaccidity: spinal shock

Question 49

SC reflexes

Answer 49

Hyperreflexia

Question 50

SC strength

Answer 50

Impaired or absent below the of the lesion: paraplegia or paraparesis; tetraplegia or tetraparesis

Question 51

SC muscle bulk

Answer 51

disuse atrophy

Question 52

SC involuntary movements

Answer 52

spasms

Question 53

SC voluntary movements

Answer 53

Above level lesion: intact Below level of lesion: impaired or absent

Question 54

SC postural control

Answer 54

impaired below level of lesion impaired balance

Question 55

SC gait

Answer 55

impaired or absent: depends on level of lesion