Movement Disorders CPC

Question 1

Basal ganglia disorders

Answer 1

• tremor (usually resting)
• Hypokinetic
  
  • rigidity
  • bradykinesia
• hyperkinetic
  
  • chorea
  • athetosis = slow, involuntary writhing movements of hands/feet (sometimes arms, legs)
  • akathisia = feelings of restlessness
  • dystonia = simultaneous agonist/antagonist contraction

Question 2

Cerebellar disorders

Answer 2

• synergy problems (ataxia)
  
  • dysmetria = lack of coordination
  • dysdidochokinesia = breakdown of quick, repetitive movements
  • decomposition of movement
• equilibrium problems
• hypotonioa
• tremor (usually w/action)
• nystagmus

Question 3

mnemonic for cerebellar lesions

Answer 3

• HANDS Tremor:
  
  • Hypotonia
  • Ataxia/Asynergia
  • Nystagmus
  • Dysarthria
  • Stance and Gait
  • Tremor

Question 4

Indications of positive romberg test

Answer 4

• romberg test = stand with feet together and close eyes
  
  • positive = wavering/loss of balance

1. ==> impaired proprioception @ dorsal column/spinal cord
2. ==> impaired vestibular fxn
   
   1. pt. will fall towards the lesion
3. ==> impaired cerebellar fxn
   
   1. usually @ vermis or vestibulocerebellar region

Question 5

Testing of CN coordination via rapid speech

Answer 5

• Lalalalalala - CN 12
• Papapapapa- CN 7
• Cacacacaca - CN 10

Question 6

Characteristics of pull test

Answer 6

• test for postural instability
• patient stands comfortably, examiner pulls backward and asks patient to try and maintain posture balance
• abnormal = pts w/extrapyramidal disorders have difficulty maintaining posture and take several steps back

Question 7

Tandem gait examination

Answer 7

• pt. walks in a straight line, touching toes of back foot to heel of front foot
• examination to dx ataxia

Question 8

Forced gait tests

Answer 8

• ask pt. to walk in different ways:
• on outsides of feet
• on heels
• on toes
• hop on left and right feet

Question 9

Types of abnormal gaits

Answer 9

• neuropathic gait
  
  • = high gait to avoid foot drag
  • = peripheral nerve disease
• myopathic gait
• hemiparetic gait
  
  • = swinging gate (circumduction) on affected side
  • • arm tuck + spastic muscle
  • = UMN lesion
• diplegic/paraparetic gait
  
  • = swinging gate on both sides
  • • adducted knees
  • = LMN problem
• bradykinetic gait
• choreiform gait = foot drop and steppage
• ataxic gait