Motor disorders

Question 1

List some Basal Ganglia Disorders

Answer 1

Parkinson’s Disease- difficult time walking, slouched over

Huntington’s Disease- opposite of parkinson’s to much movement

Tourette’s Syndrome- swearing out loud, repetition, ticks, OCD

Question 2

What causes parkinson’s disease? What damage does it cause?

Answer 2

typically idiopathic (of unknown cause) but can result from encephalitis(brain swelling), toxins, trauma (e.g., boxer’s encephalopathy- from being punched in the head to much), designer drugs (MPTP).- drugs wiped out all the dopamine producing cells

damage to cells in the substantia nigra pars compacta (80% of dopamine producing cells are damaged – therefore, dopamine deficiency results)

Question 3

What are some of the symptoms associated with Parkinson’s disease?

Answer 3

hypokinesia (akinesia, bradykinesia)
lack of movement or limited movement
-> walking; hunching over, no movement of arms when walking they do small shuffling steps and when turning its a series of small shuffling steps to go back the other way

resting tremors (pill rolling)

• > happen during rest diff then intention tremor
• > happen anywhere in the body
• > begins with low amp which increases with inactivity, at a fixed position it will temporarily stop but then start again

cogwheel rigidity

• intermittent in nature
• > click clack effect bc muscles aren’t doing what they are supposed to do

posture and gait disturbances
-> tremor when doing something as well like eating

Question 4

hypokinesia

Answer 4

difficulty initiating movements.

Question 5

bradykinesia

Answer 5

a slowness in control of movements

Question 6

bradyphrenia

Answer 6

slowness of thought

Question 7

Parkinsonian mask

Answer 7

frozen facial features.

Question 8

resting tremors

Answer 8

can be used to determine the laterality of PD – PD is most often unilateral but can be bilateral.
-.> only right hand or one is way worse than other hand

Question 9

pill-rolling tremor

Answer 9

refers to a stereotypical movement made at rest that resembles rolling a pill between your fingertips and thumb.

Question 10

cogwheel rigidity

Answer 10

increased muscle tone in extensor and flexor muscles leads to resistance to movement.
-> intenser and flexer muscles restricting each other

refers small rigid steps in a passive movement (i.e., when the examiner tries to move the patient’s arm she encounters resistance leading to brief rigid steps rather than smooth movement).

Question 11

postural disturbances

Answer 11

bent posture, sometimes to point of falling.
- end up in a wheelchair

head droops.

postural adjustments can be impaired – may fall when bumped.
- if an uneven terrain you fall down bc you aren’t able to stabilize your legs

Question 12

gait disturbances

Answer 12

shuffling gait – very different from Ozzy’s wide based gait!

gradually diminishing distance between steps.
- smaller and smaller in shuffling

eventual freezing.

virtual lines as treatment.
- goal directed movement step over line each time which can help with stepping

Question 13

What are some treatments of PD?

Answer 13

L-dopa
dopamine does not cross the blood-brain barrier.
L-dopa is a precursor for dopamine.

anti-cholinergic drugs reduce the uptake of acetylcholine (used with muscles voluntary movements) restoring the balance between dopamine and acetylcholine (a balance disrupted by the depletion of dopamine).

new combination medicines like Stalevo.
-> combines L- Dopa with other drugs

Question 14

pallidotomies

Answer 14

Michael J Fox has two!

• done in younger patients that show extreme tremors
• treatment for PD

the internal globus pallidus is lesioned during stereotaxic surgery.
stimulated first to determine region responsible for excessive inhibition.

Question 15

internal stimulators

Answer 15

like a brain pacemaker. An electrode implanted in the thalamus stimulates the motor pathways (bypassing the connections from the basal ganglia).
- sever the normal connection between globus pallidus and thalamus

Question 16

Huntington’s Disease

Answer 16

inherited, autosomal dominant, degenerative disease affecting the caudate nucleus

excessive amount of activity
- movements of mouth and flailing

St. Vitus’ dance – 16th century Germany. Dance in front of statue for good health – mistaken for chorea.

Huntington’s chorea
- individual brief non repetitive movements

begins between 30 and 45 years of age.

death occurs 10 to 15 years after onset.
- kids of parents are also affected- suicide rates went up

Question 17

Hyperkinesias

Answer 17

chorea (Greek for dance).
athetosis – writhing contractions.
contorted postures – head, arms and legs in constant motion.

Question 18

bradykinesia

Answer 18

shown in huntingtons
a slowness in control of movement.
more closely associated with degeneration of the caudate.
disease was brought to North America by Europeans fleeing persecution (burned as witches).
European origin to HD in Asian cultures too.

Question 19

Who is Nancy Wexler?

Answer 19

is a scientist whose mother died of HD.and she has it

she and her colleagues isolated the gene responsible for HD in a small community in Venezuela with the highest incidence of HD in the world.
- lots of intermarrying no new blood

made a genetic test for the gene possible – can determine whether you will develop HD.

Question 20

Tourette’s syndrome

Answer 20

named after French neurologist Georges Gilles de la Tourette.

begins in childhood (≈ 11 years old).

Question 21

echolalia

Answer 21

the repetition of what has just been heard.

Question 22

coprolalia

Answer 22

obscene utterances.

Question 23

What are some symptomes of tourette’s?

Answer 23

primary symptoms are vocal and motor “tics”.

involuntary, repetitive often compulsive movements.

face and head are typically affected, although in more severe forms the limbs and whole body can be involved.

complex movements (e.g., touching) can also be evident.

Question 24

What causes Tourette’s syndrome?

Answer 24

associated with a gene on chromosome 18 – possible sex-linked trait expressed higher in males.

also associated with OCD (25% manifest full symptoms of OCD) – tics often have a compulsive element to them.

Question 25

What are some treatments for Tourette’s

Answer 25

treatment involves dopamine antagonists (anti-dopamine).

not generally associated with major cognitive impairment.

tics may subside somewhat with age with severity of childhood tics not predictive of recovery.

Question 26

Cortical movement disorders

Answer 26

hemiplegia
apraxia
optic ataxia
alien hand syndrome

Question 27

hemiplegia

Answer 27

paralysis arising from motor strip lesions.

• one regular step then dragging of leg
• damage to contralateral strip

Question 28

apraxia

Answer 28

– impaired sequential and gestural movement control arising from left inferior parietal lesions.
- parietal damage

a = without praxis = action

term apraxia introduced by Hugo Karl Liepmann (1863 – 1925).

typically arises from left inferior parietal lesions.
bilateral – both hands are apraxic.

Question 29

optic ataxia

Answer 29

– poor control of movements in the periphery arising from bilateral superior parietal injury.
- impairment of visually guided movements

Question 30

alien hand syndrome

Answer 30

anarchic control of contralateral hand.

• feel hand has been taken out of control
• is purposeful

Question 31

Alien (anarchic) Hand

Answer 31

“la main étrangère”.

patient feels their hand behaves in a foreign or uncooperative manner.

unco-operative movements are nevertheless purposeful.

related to intermanual conflict in which hands behave at cross purposes to one another.
- one hand is doing something and the other is doing something else

arises from medial frontal cortex (SMA) and anterior corpus callosotomies.

Anarchic hand is almost always unilateral
usually left hand in right handers and can
occur for feet as well!

Question 32

What does apraxia result in?

Answer 32

impairment of learned actions (e.g., gestures, tool use, skilled, purposeful movements) and sequencing of movements that can not be explained by a loss of muscle tone, weakness, somatosensation, comprehension.

Question 33

How is apraxia diagnosed?

Answer 33

like many neuropsychological disorders apraxia is diagnosed by exclusion.

Question 34

What does apraxia co occur with?

Answer 34

often co-occurs with aphasia (comprehending language)– so comprehension must be distinguished from poor execution of motor commands.

• can u fold a piece of paper and put it on table
• > blank stare could mean they don’t understand what your saying

Question 35

Ideomotor apraxia

Answer 35

inability to carry out a simple motor activity in response to a verbal command (can’t mime the use either).
- folding example

Question 36

Ideational apraxia

Answer 36

inability to carry out a sequence of actions that are components of a behavioural script.

Answer 37

anatomy is very complex (most strokes cause some degree of apraxia.

may involve disconnection of motor cortical areas from the rest of cortex.

Answer 38

poke button with finger
pull handle
tap on ledge
- do all this in order; ppl with apraxia can’t do it in order but can do it individually

Question 39

1 ) A primary symptom of Huntington's disease is
A) akinesia.
B) dystonias.
C) tremor at rest.
D) difficulty initiating movement.
E) uncontrollable movements.

Answer 39

E) uncontrollable movements.

Question 40

2 ) Apraxia is characterized by
A) the inability to perform properly a learned, skilled movement
B) an impairment in learning a skilled movement
C) muscle weakness
D) motor paralysis
E) an impairment in motor coordination

Answer 40

A) the inability to perform properly a learned, skilled movement

Question 41

3) The slowness of movement noted in Parkinson’s disease reflects
A) damage to frontal cortex neurons that plan motor movements
B) damage to the primary motor cortex
C) loss of inhibition to the motor cortex
D) damage to dopamine neurons that normally facilitate motor movements
E) loss of inhibition of the ventromedial system from the GPi.

Answer 41

D) damage to dopamine neurons that normally facilitate motor movements

Question 42

4 ) The aim of pallidotomy is to damage the ________ in order to ________ .
A) external division of the globus pallidus; remove inhibition of the motor cortex
B) nigrostriatal bundle; balance the inputs to the globus pallidus
C) internal division of the globus pallidus; increase the inhibition of the motor cortex
D) internal division of the globus pallidus; remove inhibition of the motor cortex
E) external division of the globus pallidus; increase excitation of the motor cortex

Answer 42

D) internal division of the globus pallidus; remove inhibition of the motor cortex

Question 43

5 ) An impairment of the ability to execute a learned movement is termed 
A) paralysis.
B) Parkinsonism.
C) apraxia.
D) coordination deficit.
E) a learning deficit.

Answer 43

C) apraxia.