Problems and pathophysiology Flashcards
Dysarthria/ Dysphagia
Motor deficits to the mouth muscles, which are sued to speak and swallow
PD = Tremor present in the tongue, Flexed posture and protruded neck, excessive saliva and difficulty swallowing. Increased inhibition of muscles, leads to difficulty producing and articulating sound
MS = decreased stimulation to motor muscles of the mouth, lesions within the frontal lobe, brainstem and corticospinal tract.
Stroke = Bleed/ neuronal death within frontal lobe, brainstem (cranial nerves responsible for facial and swallowing muscles)
Expressive aphasia
Damage to Broca’s area within the frontal lobe responsible for expressive speech.
Pt understand what is being said and know what they want to say but struggle to find the words and express themselves, small words often left out
Receptive aphasia
Damage to Wernickes area in temporal lobe which stores memory, lays down new memories and hearing, visual recognition and language
Pt struggle to understand what is being said to them and can speak fluently but it can be jumbled or unrecognisable
Cognitive Deficits
PD = Side effects of medications, decreased levels of neurotransmitter dopamine effects mood, memory and cognition,
Alpha- synuclein protein misfolds causing Lewy boidies which is associated with Lewy body dementia
Stroke = damage to frontal lobe where higher cortical functions are initiated
MS = Lesions within white and grey matter in the cerebrum (cortical lesions), and slower processing speeds due to reduced communication between axons (no myelin)
Rigidity
A type of high tone from an UMN lesion or damage to the extraprymidal tracts which regulate tone causing resitance to the muscle on a passive stretch.
It is non directional or velocity dependant
Cogwhell = jerky, giving way movements (rigidity and tremor)
Leadpipe = resistance through entire ROM
Spasticity
Type of high tone due to UMN lesion which causes disrupted excitatory and inhibitory signals causing hyper-excitation of the LMNs eg: tonic stretch reflex causing flexor pattern
Spasticity is velocity dependant and directional dependant and should be moved slowly, limb is often weak
Ataxia
Reduction of smooth voluntary muscle movements (co-ordination) due to problems within the basal ganglia, cerebellum or frontal lobe (motor planning and stimulation)
- they know what they want to achieve but cannot perform it smoothly
PD = tremor and decreased grading/ initiation of movement
Ms = plaque and dymelination within the cerebellum, basal ganglia, frontal lobe and the descending tracts = poor communication, initiation and weakness = ataxia
intention tremor
Poor Posture
PD = Due to forward COG, flexed posture due to hypertonicity (rigidity/ high tone) , Reduced extensor muscle excitation
Automatic and well-learned movements are affected within parkinsons so reminder to sit/stand up straight is reduced
MS = decreased stimulus to trunk muscles,
Hypotonicity
Due to LMN lesion meaning that signals do not reach the muscle, decreased muscle activation means that weakness, lack of control and atrophy (floppy)
Apraxia
The inability to perform well learned movement when asked as requires more planning.
They have normal strength but poor motor planning (premotor cortex, frontal lobe)
Fine Motor control
Occurs due to lesion in the corticospinal tract which sends voluntary motor signals to peripheral muscles form the motor cortex (frontal lobe)
In patients early on if their finger and thumb function remains it is a sign that the corticospinal tract is intact and there is more likelihood to regain hand function.
Poor initiation
Can be due to lack of muscle stimulation causing weakness and instability
PD = bradykinesia and increased inhibition making it harder to initiate movement
MS = dymyelination, slower nerve impulses and communication, decreased stimulation (intention tremor)
Stroke = Hemiparesis/ weakness, no strength to imitate movement
Reduced balance/ trunk control
The inability to keep ones posture/ COG up against gravity, due to muscle weakness or deficits to sensory feedback
PD = due to flexed posture, forward COG, poor initiation due to over inhibition of muscles
Automatic and well-learned movements are affected within parkinsons so reminder to sit/stand up straight is reduced
MS = decreased stimulation to trunk muscles due to dymelination or lesions within the corticospinal tract or sensory signals
Also due to foot drop and tripping
Stroke = hemiparesis, neglect and weakness to one side (leaning) or cerebellum responsible for balance/ posture
Gait disorders
PD = forward COG
- reduced dorsiflexion, hip flexion, knee extension makes it harder to step
- bradykinesia and inhibition of muscles means that arm swing is reduced = reduced trunk rotation, small shuffling steps, pt walk fast (festinating gait) to remain balances, chasing their COG
MS = foot drop, reduced stimulation to trunk muscles and LL muscles causing instability, visual/ sensory disorders - reduced balance
Decreased proprioception
- Deficit in the somatosensory system which tells the brain where a joint is in space.
- Peripheral systems send afferent signal to brain to process Posture, limb position and weight
Hemiparesis
Due to contralateral deficits in motor cortex within the frontal lobe (responsible for motor planning, movement and weakness when damaged)
Can be related to low tone in stoke patients due to LMN lesion below anterior horn (brain stem stroke)
muscles do not receive efficient stimuli to move and become weak/ atrophy
What for hemiplegic shoulder
Facial changes
Stroke and MS = Lesion or loss of blood flow to brainstem so loss of facial muscle control
= the face is supplied by the 12 cranial responsible for a lot of facial function including: eye movement and vision, swallow/speaking, smell, autonomic function (HR, breathing, digestion), facial muscles/ expression.
PD = reduced control of voluntary movements and increased muscle inhibition means they are slower or unable to react/ make facial expressions = Mask like facial expression
Constipation/ incontinence
MS = plaques within brain stem which is responsible for digestive and bladder control. May become over active or not function effectively
PD = Smooth muscle movements are effected with the reduction in dopamine. The guts contract and relax mechanism is effected and it struggles to push matter through the system (an early “non-motor” sign
Tremor
PD = pill rolling tremor, resting.
Oscillating/ disrupted output from basal ganglia, due to decreased inhibition of indirect pathway. Causes rhythmic co-contraction of antagonist and agonist muscles. Often first motor symptom in PD
MS = intention tremor, does not occur at rest but increases when moving or reaching/ grasping. Caused by demyelination/ lesion within the cerebellum responsible for smooth control/ coordination of movement, premotor cortex responsible for planning, basal ganglia = execution or corticospinal tract
Dystonia
Type of hyperkinetic movement/ high tone
Where involuntary sustained contractions occur causing twisting or uncomfortable postures
UMN lesion, lack of dopamine causing disrupted output from the basal ganglia , or by longterm use of lavodopa/ PD medication used to improve bradykinesia
