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Neuro for PT > Motor Systems Shai. > Flashcards

Motor Systems Shai. Flashcards

1
Q

what is the motor system?

A

neural activity begins with a decision made in the anterior part of the frontal lobe.. next, motor planning areas are activated and then its followed by control circuts which consist of the cerebellum and basal ganglia that regulate the activity in upper motor neuron tracts

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2
Q

what do UMN do in the motor system?

A

deliver signals to spinal interneurons and LMNs

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3
Q

what do LMNs do in the motor system?

A

signal directly to skeletal muscles eliciting the contraction of muscle fibers that move the upper/lower limbs and fingers

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4
Q

how is voluntary movement controlled. what direction?

A

top down.. brain to spinal cord to muscle

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5
Q

what is the direct motor pathway?

A

Corticospinal tracts- start in the premotor cortex to the motor cortex through the brainstem.

efferent=motor

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6
Q

what is the premotor cortex?

A

frontal lobe–planning and decision making

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7
Q

what is the precentral gyrus?

A

primary motor cortex && upper motor neurons with very long axons

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8
Q

where are the upper motor neurons?

A

in the precentral gyrus– the axons go through the CNS in an area called the INTERNAL CAPSULE

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9
Q

how does the INTERNAL CAPSULE Seperated?

A

posterior limb of internal capsule is associated with motor below neck

cranial nerves travel in the bend of the internal capsule, so motor behaviors above the neck

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10
Q

where does the direct motor pathway stufff go after the internal capsule?

A

crus cerebri at the midbrain, on the ventral side of the brainstem (just the name changes, theyre the same axons)

then the pons - motor fibers arent solid structure anymore

to medulla where they recoalesces and become pyramid but its still the same axon from the cortex.

pyramidal decussation at the bottom of the medulla where it defines the border between the brainstem and the spinal cord

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11
Q

what are the basal nuclei?

A

caudate nucleus, putamen, globus pallidus

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12
Q

what is the lateralcorticospinal tract?

A

innervates limbs lateral to ventral horn in spinal cord.. close to where target cells are in ventral horn

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13
Q

where is the medial corticospinal tract?

A

innervates the trunk, and is medial to the ventral horn in the spinal cord.. close to where the target cells are in the ventral horn.

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14
Q

what is a similarity between the lateral and medial corticospinal tracts?

A

they both synapse in the ventral horn iwth LMN (alpha motor neurons); big neurons with axons go through the ventral rootlets, roots, spinal nerve(named enrves)

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15
Q

what about the ventral/anterior corticospinal tract?

A

1/2 crossed and 1/2 not crossed

trunk moves as a whole

needs info from both sides of brain talking to both sides of body

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16
Q

what is the motor units iwth the corticospinal tract?

A

muscle fibers innervated by one lower motor neuron (alpha motor neuron) determines how fine the control is

1 neuron=100motorfibers
1 neuron to 1000

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17
Q

what is the medial corticospinal tract?

A

directo connection from cerebral cortex to the spinal cord.

descends from the cortex through the internal capsule and the anterior brainstem–same as lateral

individual medial corticospinal axons project to the ipsilateral contralateral and bilateral spinal cord

medial corticospinal neurons synapse with motor neurosn that control neck shoulder and trunk muscles.

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18
Q

where to LMNs originate? aka where is their cell body?

A

ventral horn of spinal cord

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19
Q

where do alpha motor neurons (LBNs) project to?

A

extrafusal skeletal muscle

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20
Q

where do gamma motor neurons project to?

A

intrafusal fibers in muscle spindle

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21
Q

what are motor units?

A

lower motor neurons and the muscle fibers it innervates

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22
Q

where do LMNs receive input?

A

from peripheral afferents and from UMNs

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23
Q

what do alpha motor neurons look like?

A

have large cell bodies and alrge myelinated axons

axons of alpha motor neurons project to extrafusal skeletal muscle, branching into numerous terminals as they approach the muscle

normally the release ACh to all muscle fibers it innervates causes them to contract

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24
Q

what is the neuromuscular junction

A

alpha motor neuron to the muscle. Ach

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25
Q

what are gamma motor neurons like?

A

medium sized myelinated axons

axons project to intrafusal fibers in the muscle spindle

DO NOT CONTRIBUTE TO MUSCLE FORCE

they keep muscle spindle taut and sensitive to stretch

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26
Q

what does the muscle spindle do with regards to the peripheral input to motor neurons?

A

signal muscle length and velocity of contraction

sensitivity adjusted by gamma motor neurons

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27
Q

what do golgi tendon organs do with regards to peripheral input to motor neurons?

A

convert tension on muscle to NEURAL signals

diverges to LMNs via interneurons

cutaneous and joint afferents, spinal reflexes, CPGs and UMNs

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28
Q

What is fractionation?

A

the ability to activate individual muscles independently of other muscles

essential for normal mveoment of hands.

without fractionation, fingers and thumb would act as a single unit

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29
Q

what does fractionation have to do with the lateral corticospinal tract?

A

fractionates by activating inhibitory neurons to prevent unwanted muscles from contracting

THIS IS THE MOST IMPORTANT PATHWAY CONTROLLING VOLUNTARY MOVEMENTS

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30
Q

what is the rubrospinal tract?

A

this starts in the medulla, and terminates in the cervical spine. its smaller but involves in fine motor control and larger muscle groups

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31
Q

what are the medial upper motor neuron tracts? how many are there?

A 
4.
reticulospinal tract
medial vestibulospinal tracts
lateral vestibulospinal tract
medial corticospinal tract
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32
Q

what is the reticulospinal tract? (MU-MNT)

A

facilitates bilateral LMN innervating postural and gross limb movements of muscles throughout body

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33
Q

what is the medial vistibulospinal tract (MU-MNT)

A

recieves info about head movement and position from the vestibular apparatus

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34
Q

what is the lateral vestibulospinal tract?(MU-MNT)

A

responds to gravity informaiton from the vestibular apparatus

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35
Q

what is the medial corticospinal ttract? (MU-MNT)

A

has a direct connection from cerebral cortex to the spinal cord

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36
Q

what does the rediculospinal tract look like?

A

1) begins at the reticular formation in the brainstem
2) it facilitates bilateral MNs inervating gross limb and postural movement

also involved in anticipatorypostural adjustemnets and reaching

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37
Q

what does the medial vestibularspinal tract do/

A

head movement and position

start: medial vestibular nucleus
end: cervical and T spinal cord
crosses? bilaterally
fxn: neck and upper back muscles

38
Q

lateral vestibulospinal tract?

A

gravity info.
ipsilateral
travels entire spinal cord
doesnt cross midline

39
Q

what does the medial motor system do?

A

controls proximal and axial muscles

uses sensory info about balance body position and visual environment to maintain balance posture and locomotion

includes:
- vestibulospinal
-reticulospinal
annnnd anterior corticospinal and tectospinal

40
Q

what is the anterior corticospinal tract?

A

start: cortex
end: spinal cord cervical?
fxn: trunk and prox musculature
crosses? yes it crosses. at the cervical spinal cord

41
Q

what the tectospinal tract look like?

A

start: midbrain at supeior colliculus
end: cervical spine?
function: coordiation of eye and head movement
crosses? yes in midbrain

42
Q

what is the corticobulbar tracts? (aka corticonuclear tracts)

A

they go from the cerebral cortex to the cranial nerve nucleui in the brainstem.

innervate contralatera muscle of face head neck

geberally bilateral except VII and XII

43
Q

tracts that are very fractionated are good for?

A

functional and volitional movement

44
Q

tracts that account for subconsicous automatic control are….. more or less fractionated? and what does this mean

A

less fractionated, and less precicse.

45
Q

can less precise movements be useful?

A

yes. in addressing baseline and backgroundt runk position and to figure out what they then can do

46
Q

what are some examples of disorders in lower motor neurons?

A

trauma, infection (poliomyelitis infection that destroys LMNs denervating muscle fibers), degenerative or vascular disorders, tumors,

examples: myasthenia gravis, diabetic neuropathy

47
Q

what are examples of upper motor neuron disorders?

A

stroke, spinal cord injury (complete or incomplete)
cerebral palsy
MS
huntington’s

48
Q

what is a complete spinla cord injury?

A

all descending neuronal control is lost below the level of the lesion

49
Q

what is an incomplete sci?

A

function of some ascending and or descending fibers is preserved.

50
Q

What are some signs of a motor neuron lesion

A

paresis (partial loss of voluntary contraction)

paralysis (complete loss of voluntary contraction)

muscle atrophy (disuse, nerogenic, denervation is the most severe)

involuntary muscle contractions (cramps, fasciculations which are visible small tiny contractions)

abnormal muscle tone (hypertonia - rigitity or spasticity) (hypotonia - flaccidity, LNM and initial UMN, cerebral disorders)

abnormal synergies

abnormal reflexes

distrubances of movement efficiency and speed

impaired postural control

51
Q

What is babinksi sign

A

extension of great toe and fanning of other toes. its positive in infants but shoundnt be in adults

usually sign of UMN (lateral corticospinal)

52
Q

what are the three most common abnormal reflexes in those with chronic SCIs

A

muscle stretch hyperreflexia
clonus
clasp knife response

53
Q

in people with sci why might a muscle spasm occur?

A

in response ot cutaneous stimuli (these begin after recovery from spinal shock)

54
Q

what is muscle stretch hyperreflexia?

A

loss of inhibitory corticospinal imput (stretch receptor is hypersensitive)

results in excessive LMN response to afferent input from stretch receptors

55
Q

what is clonus?

A

involuntary repeating and rhythmic muscle contractions

unstrained clonus fades after a few beats, even with maintained stretch

sustained clonus is always pathologic in origin and is produced when there is a lack of UMN control which allows the activation of oscillating neural networks in the spinal cord

56
Q

what is the clasp knife response?

A

occurs when a paretic muscle is slowly and passively stretch and resistance drops at a specifc point of the ROM.

like the change of resistance with a pocket watch giving way at a certain point

TYPE II EFFERENT ELICIT THIS

57
Q

what is myoplasticity?

A

adaptive changes within a muscle in response to changes in neuromuscular activity level and to prolonged positioning

58
Q

what is spasticity

A

neuromuscular overactivity secondary to an UMN lesion

59
Q

what is hypertonia

A

increased resistance to passive movement

spasticity (i.e. velocity dependent hypertonia)
myoplasticity (I.e. intrinsic muscle stiffness)
disinhibition of brainstem and spinal circuitry

60
Q

what is velocity dependent hypertonia (spasticity?)

A

is due to the loss of descending inhibition

61
Q

what is developmental spasticity?

A

normal development: weaker synapses are eliminated and by 4yo a corticospinal axon that is previously symapsed with LMN to antagonists and synergists will only synapse with LMN to the agonist.

62
Q

what does damage to the corticospinal tracts during development cause?

A

eliminated competition for synaptic sites during a critical period, causing persistance of inappropriate connections and abnoral development of spinal motor centers.

63
Q

what is cerebral spasticity with reticulospinal overactivity?

A

brainstem UMN overactivity is the primary cause of stroke spasticity

similar patters of cerebral spasticity occur with corticospinal brainstem lesions in multiple sclerosis

64
Q

what happens with a loss of fractionated movement?

A

isolated voluntary movement is imparied.

lower motor systems (brainstem and spinal cord) become dominant sources of motor activity)

65
Q

what is flexion synergy (UE)

A

shoulder abduction and internal rotation elbow flexion and forearm pronation

66
Q

what is synergistic extention for lower extremity?

A

hip internal rotation, adduction and extension, knee extension, ankle plantarflexion adn inversion

67
Q

what does recurrent use of abnormal synergy cause?

A

weakness of underutilized muscles

weakness of underutilized nerual substrates

and strengthens the synergy

and worsens chance of recovering other movement capabilities

68
Q

what is motor learning?

A

set of processes associated with practice or leading to relatively peranent changes in the capability for responding

69
Q

what is implicity learning

A

NONDECLARATIVE

procedural or habituation/sensitization

neocortex, striatum, amygdala, cerebellum

70
Q

what is explicit learnign

A

facts, events

DECLARATIVE

medial temporal
diencephalic system

71
Q

what is motor learning

A

requires practice feedback and knowlege of results

leads to skill as someone progresses from simple to complex taxes within controlled and open environments

72
Q

what is motor learning influenced by?

A

age, motivation, learning style, cognition

73
Q

what is learning?

A

can you do it again under different circumstances (retention) not observable

74
Q

what is performance?

A

can your patient do the task, with high quality and precision? Observable

75
Q

what are the three stages of motor learning?

A

cognitive stage
associative stage
autonomous stage

76
Q

what is the cognitive stage of motor learning?

A

rely on working memory, breaking down into steps

declarative knowledge or integrate into movement

step by step

large amount of variance and error in performance

77
Q

what is the associative stage of motor learning

A

procedural process separate from working memory

decreased reliance on working memory

movement becomes more fluent

reaching this stage is dependant on skill and may require varying amount of deliberate practice

practice that is effortful and working towards improving performance

78
Q

what is the autonomous stage of motor learning?

A

minimal cognitive effort req

overlearned skills

improved anticipation and decision making (because they arent having to think about tasks)

greater ability to detect error in skill/movement

less errors and minimal variance

79
Q

what can affect the levels and success of motor learning?

A

skill level
task complexity
amount of pressure

80
Q

what is most important with motor learning?

A

amount, type, frequency of practice, and intensity

81
Q

what types of practice are there?

A

part, whole, physical, mental, blocked, random, random blocked

82
Q

what is the difference between massed and distributed practice?

A

massed is the amount of practice time exceeds amount of rest time

distributed means the amout of rest time exceeds the amount of practice time

structured vs cramming studying

83
Q

what is blocked practice?

A

all the trials of one task are blocked together (early stage of learning)

84
Q

when is random practice good?

A

later stage of learning

85
Q

whole part whole method

A

go through full, then break it down then go back to full

86
Q

what is external focus?

A

focused on the effects that movement has on the environment

87
Q

what is internal focus?

A

focus on your own motions

88
Q

external cues are better for helping with patients.. true or false?

A

true

89
Q

does mental practice help?

A

yes it may produce large positive effects for performance and learning

generally not as good as physical practice

90
Q

what is intrisnisc vs extrinsic feedback?

A

intrinsic is inherent through sensory systems

extrinsic is augmented feedback and supplements the intrinsic feedback

91
Q

what is the difference between knowledge of results and knowledge of performance?

A

results- terminal feedback about the outcome of the movement relative to the goal

performance- movement pattern used to achieve the goal

92
Q

characterastics of effective feedback?

A

emphasis on knowledge of performance and no overloading

be specific

good timing

frequency

Neuro for PT (4 decks)

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