Pathology of Ataxia and Gait Disorders Flashcards
What is ataxia?
1 - being able to stand up against gravity
2 - altered motor control affecting balance and gait
3 - involuntary muscle spasms
4 - all of the above
2 - altered motor control affecting balance and gait
- uncoordinated control between agonist and antagonist muscles
What % of people experience gait abnormalities by the time they reach 60?
1 - 1.5%
2 - 15%
3 - 30%
4 - 60%
2 - 15%
What % of people experience gait abnormalities in >85 y/o?
1 - 6%
2 - 16%
3 - 35%
4 - 80%
4 - 80%
What are the 3 key phases of an individuals gait in the correct order?
1 - heel strike, mid stance, toe off
2 - heel strike, toe off, mid stance
3 - mid stance, toe off, heel strike
4 - toe off, heel strike, mid stance
1 - heel strike, mid stance, toe off
What is required for an evaluation of complete gait cycle?
1 - biomechanical equipment
2 - recording of the patient
3 - foot strike from the same foot following alternative foot strike
3 - foot strike from the same foot following alternative foot strike
When we look at the phases of gait, there are 3 measures that we can also take, what are they?
1 - cadence, step, time
2 - cadence, time, stride
3 - cadence, step, stride
4 - time, step, stride
3 - cadence, step, stride
When we look at the phases of gait, there are 3 measures that we can also take. One of these is cadence, what is the definition of cadence?
1 - steps/minute
2 - distance per stride
3 - distance per step
4 - step number
1 - steps/minute
- normal = 115/minute
When we look at the phases of gait, there are 3 measures that we can also take. One of these is stride, what is the definition of stride?
1 - steps/minute
2 - distance per stride
3 - distance per step
4 - step number
2 - distance per stride
- stride is consecutive initial contacts of the same foot with the ground
When we look at the phases of gait, there are 3 measures that we can also take. One of these is cadence, what is the definition of step?
1 - steps/minute
2 - distance per stride
3 - distance per step of alternating legs
4 - step number
3 - distance per step of alternating legs
When we talk about our gait cycle, aprox 60% can be described as the stance phase. What is the stance phase?
1 - foot is in the air
2 - foot is in contact with the floor
2 - foot is in contact with the floor
- when the foot is in contact with the floor
- when we are weight bearing
When we talk about our gait cycle, aprox 60% can be described as the stance phase, which is when the foot is in contact with the floor and we are weight bearing. The stance phase can be further subdivided into 3 stages, what are they?
1 - support, heel off and toe-off phases
2 - strike, toe-off phases and heel strike
3 - strike, support, and toe-off phases
4 - strike, support, and heel-off phases
3 - strike, support, and toe-off phases
When we talk about our gait cycle, aprox 40% can be described as the swing phase, what is the swing phase?
1 - foot is in the air
2 - foot is in contact with the floor
- when the foot leaves the ground and then the same foot touches the ground again
When we talk about out gait cycle, aprox 40% can be described as the swing phase, which is when the foot leaves the ground and then the same foot touches the ground again. This can be further sub-dived into 2 phases, what are they?
1 - heel strike and swing phase
2 - leg lift and swing phases
3 - leg lift and heel strike
4 - heel strike and mid stance
2 - leg lift and swing phases
What is the difference between the single and double support phase when we look at gait cycle?
- single = one foot in contact with the ground giving support
- double = both feet in contact with the ground giving support
During the initial contact of heel strike there are 3 key groups of muscles that are involved. Which muscle group acts on the hip to slow down the forward motion of the lower limb?
1 - psoas major
2 - gluteal maximus
3 - semitendinosus
4 - iliacus
2 -gluteal maximus
During initial contact of heel strike there are 3 key groups of muscles that are involved. What key muscle of the quadriceps keeps the leg extended at the knee and the thigh flexed at the hip?
1 - vastus lateralis
2 - vastus medialis
3 - rectus femoris
4 - biceps femoris
3 - rectus femoris
- as its origin is on the anterior inferior iliac spine
During initial contact of heel strike there are 3 key groups of muscles that are involved. What 3 muscles of the anterior compartment of the leg help maintains ankle dorsiflexion, positioning the heel for the strike:
1 - T.anterior, E.hallucis longus + E.digitorum longus
2 - T.anterior, E.pollicis longus + vastus lateralis
3 - T.anterior, E.hallucis longus + soleus
4 - plantar, E.pollicis longus + E.digitorum longus
1 - T.anterior, E.hallucis longus + E.digitorum longus
- ANKLE DORSIFLEXORS
During the stance phase where there is a loading response, where there is the initial double stance phase (2 feet in contact with the floor). What muscles in the thigh are involved in stabilising the knee with leg flexion?
- quadriceps
- vastus medialis, intermedius lateralis and rectus femoris
- LEG FLEXORS
During the stance phase where there is a loading response, where there is the initial double stance phase (2 feet in contact with the floor). Which muscle of the anterior compartment of the leg contracts eccentrically to control plantarflexion?
1 - flexor digitorum longus
2 - extensor hallucis
3 - tibialis anterior
4 - soleus
3 - tibialis anterior
During the mid stance of the gait cycle, which is where there will be single leg support (as we can see below), what muscle in the thigh region contracts eccentrically?
1 - sartorius
2 - gluteus medius
3 - pectineus muscle
4 - gluteus maximus
2 - gluteus medius
During the mid stance of the gait cycle, which is where there will be single leg support (as we can see below), what muscle in the leg contract eccentrically?
1 - gastrocnemius and extensor digitorum longus
2 - tibialis anterior and soleus
3 - gastrocnemius and plantar
4 - gastrocnemius and soleus
4 - gastrocnemius and soleus
- CALF MUSCLES
During the terminal stance phase of the gait cycle (just prior to the pre-swing phase, as we can see below), what muscle in the leg contract during heel rise and continues until the opposite foot heel touches the floor?
1 - gastrocnemius
2 - tibialis posterior
3 - plantar
4 - soleus
2 - tibialis posterior
During the terminal stance phase of the gait cycle (just prior to the pre-swing phase, as we can see below), what muscle in the foot contract during heel rise and continues until the opposite foot heel touches the floor?
1 - flexors of the toes
2 - extensors of the toes
3 - adductors of the toes
4 - abductors of the toes
- TOE FLEXORS
- abductor hallucis, Flexor Digitorum Brevis, Lumbricals, Quadratus Plantae, Flexor Digiti Minimi Brevis,
During pre-swing phase (as we can see below), which is the second double support, what muscle group will then contract to propel the hips forward through hip flexion?
1 - hip flexors
2 - hip extensors
3 - knee flexors
4 - knee abductors
1 - hip flexors
The hip flexors are important during pre-swing phase (as we can see below), which is the second double support. The hip flexors are composed of 5 muscles, label the image below, using the labels:
psoas major iliacus pectineus rectus femoris sartorius
1 - iliacus 2 - rectus femoris 3 - psoas major 4 - pectineus 5 - sartorius
During swing phase (as we can see below), what muscle group will then contract to propel the hips forward through hip flexion?
1 - hip flexors
2 - hip extensors
3 - knee flexors
4 - knee abductors
1 - hip flexors
- contract to pull the hip forward
The mid-swing of the gait cycle is when the foot needs to clear the floor. What group of muscles is involved in achieving this?
1 - knee flexors
2 - hip flexors
3 - ankle plantarflexors
4 - ankle dorsiflexors
4 - ankle dorsiflexors
The ankle dorsiflexors are important in the mid-swing of the gait cycle to ensure the foot clears the floor. What 3 muscles of the ankle dorsiflexors are important here?
1 - tibialis anterior
2 - extensor hallucis longus
3 - extensor digitorum longus
The terminal swing phase of the gait cycle is the point from where tibia is vertical to just prior to initial contact. What group of muscles are important in controlling the movement of the limb forwards?
1 - hip extensors
2 - knee extensors
3 - ankle plantarflexors
4 - knee flexors
4 - knee flexors
- more commonly referred to as hamstrings
What 3 muscles make up the hamstrings?
1 - bicep femoris
2 - semimembranosus
3 - semitendinosus
What is the centre of gravity?
- the balance point of your body
What is the normal centre of gravity in humans?
1 - 5cm anteriorly to L2 vertebral of the spine
2 - 5cm anteriorly to T2 vertebral of the spine
3 - 5cm anteriorly to S2 vertebral of the spine
4 - 5cm anteriorly to S4 vertebral of the spine
3 - 5cm anteriorly to S2 vertebral of the spine
During the normal gait cycle what happens to the centre of gravity in men?
1 - remains the same
2 - moves horizontally 5 degrees
3 - moves backwards 5 degrees
4 - moves vertically 5 degrees
2 - moves horizontally 5 degrees
- only horizontal in men
During the normal gait cycle the centre of gravity (COG) is able to move vertically and horizontally in women. What stage of the gait cycle would the COG be highest?
1 - mid swing phase
2 - swing phase phase
3 - heel strike phase
4 - mid stance phase
4 - mid stance phase
During the normal gait cycle the centre of gravity (COG) is able to move vertically and horizontally. What stage of the gait cycle would the COG be lowest?
1 - mid swing phase
2 - swing phase phase
3 - double limb support
4 - mid stance phase
3 - double limb support
- we generally drop slightly forward when walking in this stage
What can happen to our centre of gravity when we walk on different terrains?
- will adjust to the terrain (up or down hill for examples)
Why can some musculoskeletal conditions affect our gait?
- alters normal gait to relieve pain or other symptoms
- i.e. arthritis, Tendinopathy, Ligament injury, Muscle problems, Skeletal abnormalities
Why can some neurological conditions affect our gait?
- affects muscle co-ordination
At what age is normal gait acquired?
1 - 1-4 y/o
2 - 4-8 y/o
3 - 10 y/o
4 - 12 y/o
- 2 - 4-8 y/o
If a patient has significant knee osteoarthritis, what other joints could be affected?
- ankle
- hip
- back
During the normal gait cycle what happens to the centre of gravity in women?
1 - remains the same
2 - moves horizontally and vertically 5 degrees
3 - moves backwards 5 degrees
4 - moves vertically 5 degrees
2 - moves horizontally and vertically 5 degrees
Which of the following is NOT involved in balance and coordinated movement?
1 - basal ganglia
2 - thalamus
3 - cerebellum
4 - corpus callosum
5 - vestibular system
6 - motor cortex
4 - corpus callosum
What is the name of the main tract involved in coordinated gait, movement and balance involved in the limbs and trunk?
1 - corticospinal tract
2 - spinocerebellar tract
3 - spinothalamic tract
4 - all of the above
1 - corticospinal tract
- message travels from the cortex (cortico) into the spine (spinal)
Are neurons that travel in the corticospinal tract referred to as upper or lower motor neurons?
- upper motor neurons
- lower motor neurons are those that begin in the spinal cord and end at target tissue
From the cortex the corticospinal tract moves through the corona radiata, internal capsule, pons, midbrain, before teaching the caudal medulla. What is the name of where these fibres meet?
1 - cerebral peduncle
2 - thalamus
3 - pyramids
4 - inferior olives
3 - pyramids
The corticospinal tract moves from the cortex to the caudal medulla where it forms the pyramids. What % of fibres then decussate here?
1 - 8%
2 - 20%
3 - 50%
4 - 80%
4 - 80%
- the other 20% travel down the ventral corticospinal tract on the same side
When we look at the corticospinal tract, not all fibres originate from the motor cortex. Of the following, where do the majority of fibres originate from?
1 - primary motor cortex,
2 - premotor and supplementary
motor cortex
3 - parietal lobe and primary
somatosensory area
3 - parietal lobe and primary
somatosensory area
- 40% of fibres originate here
- 31% are from the primary motor cortex,
- 29% are from the premotor and supplementary motor cortex
Which system do emotional movements originate from?
1 - nigrostriatal
2 - mesocortical
3 - mesolimbic
4 - tuberoinfundibular
3 - mesolimbic
- involved in emotions
- could involve fight or flight responses
Which lobe is sensory information processed in that helps us coordinate and plan our voluntary gaits?
1 - frontal lobe
2 - parietal lobe
3 - temporal lobe
4 - occipital lobe
2 - parietal lobe
- specifically the posterior parietal lobe
- involved in visual, tactile, and proprioceptive information
- the sensory information is then sent to the motor cortex
Sensory information from the posterior parietal lobe is received and delivered to the motor cortex. The motor cortex can be divided into 3 parts, which of the following is NOT one of these parts?
1 - Primary Motor Cortex (Brodmann’s area 4)
2 - Premotor cortex
3 - Supplementary motor area
4 - motor end cortex
4 - motor end cortex
- Primary Motor Cortex = located on precentral gyrus and referred to as M1
There are 3 parts of the motor cortex. 2 of these parts are important for planning and coordinating high levels movements. Which of these 3 parts of the motor cortex are involved in simple movements?
1 - Primary Motor Cortex (Brodmann’s area 4)
2 - Premotor cortex
3 - Supplementary motor area
1 - Primary Motor Cortex (Brodmann’s area 4)
- involved in simple movements
If we damage any of the 3 motor complex areas of the brain:
- Primary Motor Cortex (Brodmann’s area 4)
- Premotor cortex
- Supplementary motor area
Does the patient experience weakness and impaired executive function on the ipsilateral (same side) or contralateral (opposite side)?
- contralateral
- corticospinal tract decussates at the pyramids in the medulla
What is the prefrontals function in gait and voluntary, coordinated movements?
1 - plan movements
2 - organise thoughts about movements
3 - make decisions about movements
4 - all of the above
4 - all of the above
Prior to the execution of movement, is the pre-motor cortex or the primary motor cortex more active?
- pre-motor cortex
- the primary motor cortex is only involved in initiaing the movement
Which of the following does NOT provide sensory information in relation for voluntary movement and gait?
1 - visual
2 - cerebellum
3 - proprioception
4 - vestibular
2 - cerebellum
Information is gathered before we walk. Which of the following is NOT involved in bringing all this information together and integrating it prior to voluntary movement and gait?
1 - cerebellum
2 - cerebral cortex
3 - occipital lobe
4 - brain stem
3 - occipital lobe
Damage to the cerebral cortex can cause what?
1 - unilateral weakness
2 - vertigo
3 - difficulty changing direction
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
1 - unilateral weakness
Damage to the basal ganglia can cause what?
1 - unilateral weakness
2 - vertigo
3 - difficulty changing direction
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
3 - difficulty changing direction
Damage to the thalamus can cause what?
1 - loss of proprioception
2 - vertigo
3 - difficulty changing direction
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
1 - loss of proprioception
Damage to the cerebellum can cause what?
1 - loss of proprioception
2 - vertigo
3 - ataxia
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
3 - ataxia
- impairment of the smooth performance
of goal-directed movement
Ataxia is an impairment of the smooth performance of goal-directed movement and can be caused by damage to cerebellum. Which of the following is NOT a type of ataxia?
1 - Cerebellar Ataxia
2 - Central Sensory ataxia
3 - Corticospinal Ataxia
4 - Posterior Column Ataxia
3 - Corticospinal Ataxia
- Cerebellar Ataxia = irregular movement due to a lesion in a cerebellar hemisphere & it’s connections
- Central Sensory ataxia = impaired proprioception due to lesion in somatosensory cortex, thalamus, or the thalamocortical pathways to the parietal lobe
- Posterior Column Ataxia = lesions in afferent somatosensory pathways in the dorsal portion of the spinal cord
(fasciculus gracilis and fasciculus cuneatus)
Damage to the brain stem can cause what?
1 - loss of proprioception
2 - vertigo
3 - ataxia
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
Damage to the vestibular system can cause what?
1 - loss of proprioception
2 - vertigo
3 - sensory loss and weakness
4 - slurred speech, diplopia (double vision), facial weakness, vertigo
2 - vertigo
Damage to the peripheral nerves can cause what?
1 - loss of proprioception
2 - vertigo
3 - sensory loss and weakness
4 - weakness
4 - weakness
Damage to the muscles can cause what?
1 - loss of proprioception
2 - vertigo
3 - sensory loss and weakness
4 - peripheral weakness
4 - peripheral weakness
Dysarthria can be caused by cerebellum dysfunction/damage. What is dysarthria?
1 - inability to control range of movement
2 - inability to perform rapid movements
3 - inability to articulate words correctly
4 - decreased muscle tone
3 - inability to articulate words correctly
- may also slur and use inappropriate phrasing
Dysdiadochokinesia can be caused by cerebellum dysfunction/damage.
What is dysdiadochokinesia?
1 - inability to control range of movement
2 - inability to perform rapid movements
3 - inability to articulate words correctly
4 - decreased muscle tone
2 - inability to perform rapid movements
Dysmetria can be caused by cerebellum dysfunction/damage. What is dysmetria?
1 - inability to control range of movement
2 - inability to perform rapid movements
3 - inability to articulate words correctly
4 - decreased muscle tone
1 - inability to control range of movement
Damage to the cerebellum can result in a tremor, which is rhythmic, oscillating and alternating movement of limbs and muscles. There are intentional, resting and postural tremors. Match the type with the description below:
- muscle movement when a patient is trying to walk or balance
- when a patients limb is approaching its target
- when a patient is sat still doing nothing
- intentional = when a patients limb is approaching its target
- postural = muscle movement when a patient is trying to walk or balance
- resting = when a patient is sat still doing nothing
What is the most common cause of autosomal ataxia?
1 - Friedreich ataxia
2 - Louis-Bar syndrome
3 - Ataxia-Telangiectasia
4 - Hypokinesia
1 - Friedreich ataxia
- autosomal mitochondrial disease
- affects chromosome 9
In Friedreich ataxia children normally present with ataxia between the ages of 5-15. Which of the following symptoms are also present in Friedreich ataxia?
1 - dysarthria (difficulty speaking)
2 - paresis (muscle weakness) especially the lower extremities
3 - cognitive impairments
4 - reflexes and position senses are lost
5 - all of the above
5 - all of the above
The cerebellum can be divided into 3 functional sections related to their functions. These parts are:
- Midline vermis (paleocerebellum)
- Lateral hemispheres (neocerebellum)
- Archicerebellum (Vestibulo-cerebellum)
Which of these 3 parts is important in coordinating eye, head, and neck movements?
- Archicerebellum (Vestibulo-cerebellum)
The cerebellum can be divided into 3 functional sections related to their functions. These parts are:
- Midline vermis (paleocerebellum)
- Lateral hemispheres (neocerebellum)
- Archicerebellum (Vestibulo-cerebellum)
Which of these 3 parts is important in coordinating the trunk and leg movements?
- Midline vermis (paleocerebellum)
- a lesion here could result in
abnormalities of stance and gait
The cerebellum can be divided into 3 functional sections related to their functions. These parts are:
- Midline vermis (paleocerebellum)
- Lateral hemispheres (neocerebellum)
- Archicerebellum (Vestibulo-cerebellum)
Which of these 3 parts is important in controlingl quick and finely coordinated limb movements, predominantly
of the arms and hands?
- Lateral hemispheres (neocerebellum)
- typically only present in advanced species like humans
What is the most common cause of cerebellar disorders?
1 - vascular (stroke or haemorrhage)
2 - iatrogenic
3 - alcohol
4 - infective
3 - alcohol
- called Alcoholic Cerebellar Degeneration
- cerebellum atrophies
- patients lose ability to walk over months to years
Which of the following is FALSE about Dandy-Walker syndrome?
1 - congenital
2 - cystic malformation in cerebellum stopping CSF from leaving the brain
3 - causes a reduced pressure in the brain
4 - increased pressure in brain
5 - impaired motor skill function such as ataxia
6 - all of the above
6 - all of the above
- symptoms are sporadic, occur at a young age and are not progressive
What is the function of the spinocerebellar tract?
1 - incorporate proprioceptive information to coordinate movement and balance
2 - receive pain sensations from peripheral stimulus
3 - process cognitive functions
4 - all of the above
1 - incorporate proprioceptive information to coordinate movement and balance
Spinocerebellar ataxias are those where these is an abnormality in the Spinocerebellar tract. Is this autosomal dominant or recessive?
- autosomal dominant
Which of the following are signs of genetic abnormalities causing Spinocerebellar ataxias?
1 - neuropathy
2 - pyramidal signs
3 - restless leg syndrome
4 - all of the above
4 - all of the above
Which of the following is NOT an acquired cause of ataxia?
1 - vascular (stroke or haemorrhage)
2 - iatrogenic
3 - alcohol
4 - infective
5 - spinocerebellar ataxias
5 - spinocerebellar ataxias
- this is an autosomal dominant genetic condition
Can tumours or cancers cause ataxia?
- yes
General signs of an alcohol-related neurological disease can include all of the following, EXCEPT:
1 - memory loss
2 - frequent blackouts
3 - loss of coordination
4 - impaired RAAS
5 - dehydration, seizures,
6 - nystagmus & death
4 - impaired RAAS
Neuroinflammation can occur in patients who consume excessive alcohol. What affect can chronic alcohol use have on myelin?
1 - increased myelin production
2 - fibrosis of myelin
3 - reduced myelin expression and damage to myelin sheath
4 - all of the above
3 - reduced myelin expression and damage to myelin sheath
Neuroinflammation can occur in patients who consume excessive alcohol which can damage the myelin sheath and impair neurological communication causing:
- alcohol dementia
- pre-frontal cortex dysfunction
- wernicke syndrome and Korsakoff syndrome
Deficiencies in which of the following has been linked with neurological damage in excessive alcohol consumption?
1 - thiamine (vitamin B1)
2 - folate (vitamin B9)
3 - vitamins C6 and B12
4 - all of the above
4 - all of the above
- alcohol can have enough calories so patients typically do not eat well
If a patient stops drinking, they can develop delirium tremens, which is a severe form of alcohol withdrawal. Is this dangerous?
- yes
- can be a medical emergency
- 1st line treatments are typically 1 - chlordiazepoxide and thiamines
