Motor disorders Flashcards
List some Basal Ganglia Disorders
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
What causes parkinson’s disease? What damage does it cause?
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)
What are some of the symptoms associated with Parkinson’s disease?
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
hypokinesia
difficulty initiating movements.
bradykinesia
a slowness in control of movements
bradyphrenia
slowness of thought
Parkinsonian mask
frozen facial features.
resting tremors
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
pill-rolling tremor
refers to a stereotypical movement made at rest that resembles rolling a pill between your fingertips and thumb.
cogwheel rigidity
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).
postural disturbances
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
gait disturbances
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
What are some treatments of PD?
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
pallidotomies
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.
internal stimulators
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
Huntington’s Disease
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
Hyperkinesias
chorea (Greek for dance).
athetosis – writhing contractions.
contorted postures – head, arms and legs in constant motion.
bradykinesia
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.
Who is Nancy Wexler?
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.
Tourette’s syndrome
named after French neurologist Georges Gilles de la Tourette.
begins in childhood (≈ 11 years old).
echolalia
the repetition of what has just been heard.
coprolalia
obscene utterances.
What are some symptomes of tourette’s?
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.
What causes Tourette’s syndrome?
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.
What are some treatments for Tourette’s
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.
Cortical movement disorders
hemiplegia
apraxia
optic ataxia
alien hand syndrome
hemiplegia
paralysis arising from motor strip lesions.
- one regular step then dragging of leg
- damage to contralateral strip
apraxia
– 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.
optic ataxia
– poor control of movements in the periphery arising from bilateral superior parietal injury.
- impairment of visually guided movements
alien hand syndrome
anarchic control of contralateral hand.
- feel hand has been taken out of control
- is purposeful
Alien (anarchic) Hand
“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!
What does apraxia result in?
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.
How is apraxia diagnosed?
like many neuropsychological disorders apraxia is diagnosed by exclusion.
What does apraxia co occur with?
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
Ideomotor apraxia
inability to carry out a simple motor activity in response to a verbal command (can’t mime the use either).
- folding example
Ideational apraxia
inability to carry out a sequence of actions that are components of a behavioural script.
anatomy is very complex (most strokes cause some degree of apraxia.
may involve disconnection of motor cortical areas from the rest of cortex.
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
1 ) A primary symptom of Huntington's disease is A) akinesia. B) dystonias. C) tremor at rest. D) difficulty initiating movement. E) uncontrollable movements.
E) uncontrollable movements.
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
A) the inability to perform properly a learned, skilled movement
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.
D) damage to dopamine neurons that normally facilitate motor movements
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
D) internal division of the globus pallidus; remove inhibition of the motor cortex
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.
C) apraxia.
