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OTB 510 > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Define upper motor and lower motor neuron function

A

1) Lower motor neurons (LMN) are the only neurons that carries signals to both the extrafusal/intrafusal skeletal muscle fibers., which means they carry signals to the muscles.
2) Upper motor neurons (UMN) gives off signals from the brain to the spinal cord, it also provides signal from the cerebrum to the cranial nerve lower motor neurons in the brainstem., which controls the motor activity of the body

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2
Q

What is muscle tone?

A

resistance to stretch in resting muscle” pg. 272

We assess through PROM.

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3
Q

Can we remedy muscle tone issues?

A

*Stretching does not reverse contractures.

(It is preventative to help with joint integrity.
We can’t stop tone from increasing if its neurological)

High tone=hard to do PROM.

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4
Q

Describe involuntary muscle contractions and what are the types?

A

Spontaneous involuntary muscle contractions include:

  • Muscle cramps
  • Fasciculations: quick twitches of all muscle fibers in a single motor unit.
  • Myoclonus: brief involuntary contraction of a muscle.
  • Abnormal movements generated by dysfunction basal ganglia
  • Fibrillation: random, spontaneous, brief contractions of a single muscle, fibers not visible on the surface of the skin and are always pathologic.
  • Tremors
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5
Q

Describe involuntary muscle contractions and what are the types?

A

Spontaneous involuntary muscle contractions include:

  • Muscle cramps
  • Fasciculations:
  • Myoclonus
  • Abnormal movements generated by dysfunction basal ganglia
  • Fibrillation

-Tremors

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6
Q

Define Muscle cramps

A

severe painful muscle contraction.

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7
Q

Define Fasciculations:

A

quick twitches of all muscle fibers in a single motor unit.

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8
Q

Define Myoclonus:

A

brief involuntary contraction of a muscle.

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9
Q

Define Fibrillation

A

random, spontaneous, brief contractions of a single muscle, fibers not visible on the surface of the skin and are always pathologic.

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10
Q

Define Tremors

A

involuntary rhythmic movements of a body part. Small tremors occur in everyone at rest and during action.

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11
Q

Abnormal movements generated by dysfunction….?

A

basal ganglia

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12
Q

Voluntary contractions:

A

example; flexing the bicep. Can do after a verbal command

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13
Q

Common causes of motor neuron damage:

A

-Interrupting MN signals to muscle decreases or prevents muscle contraction.

Trauma (knife wounds)
Demyelinating diseases (Guillain Barre)
Infection (polio)
Chronic Neuropathy

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14
Q

Define paresis:

A

a condition of muscular weakness caused by nerve damage or disease; partial paralysis.

  • Paresis occurs in MT lesions as a consequence of inadequate facilitation of MN’s.
  • Common after a stroke, spastic CP, TBI, and incomplete SCI. Pg 267
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15
Q

Define Paralysis

A

occurs in the muscles innervated by MN’s below the level of complete spinal cord lesion (loss of all somatosensory & voluntary muscle function below the lesion). Pg 267

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16
Q

What’s denervation atrophy

A

Denervation atrophy of skeletal muscle reflects lesions of lower motor neurons.

interruption of the nerve connection to an organ or part, reduction in muscle fiber diameter which creates a discontinuation of nerve supply always accompanied by paralysis

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17
Q

Define hypotonia (low tone)

A

Hypotonia: Abnormally low muscular resistance to passive stretch.

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18
Q

Define flaccidity

A

Flaccidity: Complete loss of muscle tone.

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19
Q

Define hypertonia (high tone)

A

is an abnormally strong resistance to passive stretch, can be caused by chronic MT lesions & basal ganglia disorders.

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20
Q

What are signs of motor neuron lesions

A
  • Decrease or loss of reflexes
  • Paresis or paralysis
  • Atrophy
  • Decrease or loss of muscle tone
  • Fibrillations
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21
Q

Understand testing for nerves: Nerve conduction

A

examine motor nerves, the skin OVER a nerve is electrically stimulated and potentials are recorded from the skin overlying an innervated muscle.

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22
Q

Understand testing for nerves: Surface EMG

A

The electrical activity of muscle is recorded FROM the skin overlying muscle.

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23
Q

Understand testing for nerves: Diagnostic EMG

A

requires inserting a needle electrode directly into the muscle. Used to distinguish between denervated muscle and myopathy (abnormal/disease intrinsic to muscle tissue).

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24
Q

Understand testing for nerves: What are the 4 conditions muscle electrical activity is records for Diagnostic EMG?

A

1) Insertion of needle into muscle(insertional activity)
2) During rest
3) During minimal voluntary contraction
4) During maximal voluntary contraction

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25
Q

During rest, what two types of muscle activity may occur?

A

1) Fibrillation (always abnormal)

2) fasciculation (occurs in a normal muscular system, ex: leg twitching after vigorous exercise)

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26
Q

Where does the Medial motor tracts Innervates?

A
  • Innervates postural and girdle muscles.
  • Medial corticospinal neurons synapse with MN’s that control neck, shoulder, and trunk muscles. Medial vestibulospinal: neck
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27
Q

Where does the Lateral motor tracts Innervates?

A

-innervates muscles used for fractionated movement and innervate wrist and finger extensors. Lateral vestibulospinal facilitates motor neurons to postural muscles

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28
Q

What does the Reticulospinal: facilitates?

A

facilitates motor neurons to: bilateral postural muscles and gross limb movement muscles of the entire body.

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29
Q

Rubrospinal Tract: descends the …?

A

descends the lateral spinal cord. Makes a minor contribution to control of upper limb distal extensor muscles.

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30
Q

What’s the most important pathway controlling VOLUNTARY movement?

A

Lateral Corticospinal Tract

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31
Q

What Tract provides voluntary control of muscles in the head and many muscles in the neck?

A

Corticobrainstem Tract

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32
Q

What are abnormal reflexes?

A

abnormal cutaneous reflexes such as Babinki’s sign

33
Q

Describe phasic stretch hyperreflexia

A

(excessive muscle contraction)

34
Q

Describe Clonus

A

involuntary, repeating, rhythmic, reflexive contractions of a single muscle group.

35
Q

Describe Clasp Knife Response

A

when paretic muscle is slowly stretched resistance drops at a specific point in the range of motion.

36
Q

Describe Myoplasticity

A

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

37
Q

What’s Abnormal cocontraction

A

occurs only in developmental spasticity. Temporal overlap of agonist and antagonist muscle contraction.

38
Q

What’s Abnormal muscle synergies?

A

occur most often in a specific type of stroke and are covered in the section on MCA stroke.

abnormal motor impairments in pts after a stroke, can lose control of selected muscles groups which leads to inappropriate joint movements for a desired task

39
Q

Identify: paraplegia, tetraplegia, quadriplegia, hemiplegia:

*weakness affecting one side of the body.

A

Hemiplegia

40
Q

Identify: paraplegia, tetraplegia, quadriplegia, hemiplegia:

*affects all 4 limbs

A

Quadriplegia

41
Q

Identify: paraplegia, tetraplegia, quadriplegia, hemiplegia:

  • limbs and head
A

Tetraplegia

42
Q

Identify: paraplegia, tetraplegia, quadriplegia, hemiplegia:

*affects the body below the arms

A

Paraplegia

43
Q

What is muscle disuse atrophy?

A
  • Results from lack of muscle use.
  • MT lesions decrease neuromuscular signals
  • Paresis following MT lesions leads to muscle disuse, causing secondary changes in muscles and the nervous system.
44
Q

Motor Tract Lesions Tx: Spastic Cerebral Palsy

A
  • CIMT beneficial for hemiplegic CP
  • Botulinum toxin (BTX) injection preventing active muscle contraction.
  • Task oriented gait training improves gait more effectively than therapy that focuses on normalizing muscle tone and the use of hands-on techniques for facilitating movements.
45
Q

Motor Tract Lesions Tx: Stroke

A
  • Forceful movement is beneficial in adults following stroke and does not increase spasticity.
  • Hand & finger movements against resistance
  • Robotic therapy for the upper limb
  • CIMT
  • BTX
  • Cycling
  • Task-oriented gait training
  • Virtual reality
46
Q

Motor Tract Lesions Tx: SCI

A
  • Activity based therapy consists of rehab that activates the neuromuscular system below the level of the lesion.
  • Treadmill training with body weight support, robotic walking therapy, FES
  • Somatosensory input to the SC during treadmill training
  • Use of drugs to control spasticity
  • Neural stem cell implants
47
Q

Understand the role of the cerebellum

A
  • Coordinates movements and postural control
  • Receives information regarding the activity in spinal interneurons
  • Actual movement is provided by information from the spindles, Golgi tendon organs, and cutaneous mechanoreceptors
  • Integrates information from these sources ^ and adjusts the activity of UMN
  • Involved in learning the timing and rhythm of movements and the synchronization of movements and in learning to correct motor errors
48
Q

Functions of the cerebellum

A

-Coordination of voluntary movements via influence on corticospinal, corticobrainstem, and rubrospinal tracts

-Planning of movements
Timing

-Cognitive functions: language comprehension, goal-directed behavior, visuospatial function

49
Q

Identify why cerebellar damage is ipsilateral

A

A lesion in one cerebellar hemisphere will cause motor deficits on the ipsilateral side of the body. This is due to the “double cross” (i.e., input fibers cross to reach the cerebellum, and cerebellar output fibers cross to reach their destination).

50
Q

Explain how to tell between impairments due to cerebellar lesion and lesions involving somatosensory system

A

-To differentiate between the two possibilities use the Romberg test and test proprioception, vibration sense and ankle reflexes

**Spinocerebellar tract lesions or lesions involving peripheral sensory axons cause movements to be clumsier with eyes closed than with eyes open → this is because the intact cerebellum can compensate for the loss of somatosensation by using vision to improve coordination

**Cerebellar lesions cause ataxia regardless of the use of vision: the damaged cerebellum cannot compensate by using visual cues to improve coordination

51
Q

If a person has impaired proprioception causing sensory ataxia, balance will be better with eyes closes/open or both?

A

eyes open

Sensory ataxia is confirmed by finding impaired passive proprioception, vibration sense, and Achilles deep tendon reflexes

52
Q

If a person has cerebellar ataxia, they will find it to maintain balance with eyes closes/open or both?

A

**equally difficult to maintain balance whether or not the eyes are open or closed **

Passive proprioception, vibration, and Achilles deep tendon reflexes are normal in cerebellar ataxia

53
Q

What are signs of cerebellar dysfunction/disorders ?

A

Signs of cerebellar motor dysfunction involve abnormal motor execution that does not change with or without the use of vision

54
Q

What functional region is described below?

Signs:
Signs of cerebellar motor dysfunction involve abnormal motor execution that does not change with or without the use of vision

Description: Difficulty maintaining sitting and standing balance & abnormal eye movements

A

Vestibulocerebellum

55
Q

What functional region is described below?

Signs: Intention tremor
Ataxic gait
Dysarthria 
Dysdiadochokinesia
Dysmetria
Movement decomposition
Description: 
Dysdiadochokinesia (inability to rapidly alternate movements)
Dysmetria (inability to accurately move an intended distance)
Action tremor (shaking of a limb during voluntary movements) → action tremor may arise because of onset and offset of muscle activity are delayed
A

Spinocerebellum

56
Q

What functional region is described below?

Signs: Finger ataxia
Dysarthria

Description: Inability to move fingers in a coordinated manner; slurred, poorly articulated speech

A

Cerebrocerebellum

57
Q

What cerebellum disorder is described below?
Chronic alcoholism/Acquired disorders/Inherited degenerative disorders

** the anterior lobe section of the spinocerebellum is often damaged because of malnutrition, resulting in the characteristic ataxic gait

A

Chronic alcoholism

58
Q

What cerebellum disorder is described below?
Chronic alcoholism/Acquired disorders/Inherited degenerative disorders

** that are most commonly affect the cerebellum:
Multiple sclerosis
Stroke
Tumor
Alcoholic degeneration
Compression of the inferior brainstem and cerebellum in the foramen magnum

A

Acquired disorders

59
Q

What cerebellum disorder is described below?
Chronic alcoholism/Acquired disorders/Inherited degenerative disorders:

** Spinocerebellar ataxia (SCA) → causes atrophy of the spinocerebellar tracts and the cerebellum; depending on the specific type of SCA, a variety of additional structures are affected
Multiple system atrophy (MSA)

A

Inherited degenerative disorders

60
Q

What are Signs of cerebellar dysfunction?

A

Abnormal motor execution that does not change with or without the use of vision. This affects:
Posture
Automatic movements
Eye movements (nystagmus)
Voluntary movements
Ataxia (impaired coordination, normal strength, jerky & inaccurate)
Dysarthria (slurred speech)
Dysdiadochokinesia (inability to rapidly alternating movements)
Dysmetria (inability to accurately move an intended distance)
Action tremor (shaking of the limb during voluntary movement)

61
Q

Understand role of basal ganglia

A
  • Predict the effects of various actions, then make and execute action plans.
  • Involved in the psychological functions of goal-directed behaviors, social behavior, emotions, and motor control. -
  • This includes decision making, judgement, prioritizing information, emotional processing and responses, learning, eye movements, spatial attention, and motor output.
62
Q

Basal ganglia disorders:

A
  • range from hypokinetic disorders (too little movement) to hyperkinetic disorders (excessive movement).
  • Differences in abnormal movements are due to dysfunction in specific parts of the basal ganglia
  • Basal ganglia inhibit the motor thalamus, the PPM, and the MLR
  • excessive inhibition results in hypokinetic disorders
  • inadequate inhibition results in hyperkinetic disorders
63
Q

What’s Hypokinetic disorders?

A

(decrease in the amount/speed in voluntary/automatic movement) such as parkinson’s disease; parkinson’s-plus disease; parkinsonism;

64
Q

What’s hyperkinetic disorders?

A

(movement that is excessive and abnormal) such as huntington’s disease; dystonia; tourette’s disorder; and dyskinetic cerebral palsy.

65
Q

What are the three fundamental types of movement?

A

postural control, ambulation, reaching and grasping)

66
Q

Which of the three fundamental types of movement is described below? (postural control, ambulation, reaching and grasping)

**Provides orientation and balance (equilibrium) -> achieved by central commands to lower motor neurons
Orientation= adjustment of the body and head to vertical, and balance is the ability to maintain the center of mass relative to the base of support

A

Postural

67
Q

Which of the three fundamental types of movement is described below? (postural control, ambulation, reaching and grasping)

**All regions of the NS is required for normal human ambulation

A

Ambulatory

68
Q

Which of the three fundamental types of movement is described below? (postural control, ambulation, reaching and grasping)

**Visions and somatosensation are essential for normal reaching/grasping

A

Reaching/grasping

69
Q

What’s Henneman’s size principle

A

The order of recruitment from smaller to larger alpha MNs

70
Q

Slow twitch fibers

A
  • smaller-diameter, slower-conducting alpha MN innervate slow twitch muscles
  • Slow twitch fibers constitute the majority of the muscle fibers in postural and slowly contracting muscles

**Example: the soleus muscle (part of the calf, which runs from just below the knee to the heel) has primarily slow twitch muscles that are active when standing and walking)

71
Q

Fast twitch fibers

A

larger-diameter, faster-conducting alpha MNs innervate fast twitch muscle fibers

**Example: the gastrocnemius muscle (superficial to the soleus muscle) has more fast twitch muscle fibers than the soleus– contraction of the gastrocnemius produces fast, powerful movements (e.g. sprinting)

72
Q

Whenever an alpha MN is activated, the _________________ is released at all of the neuromuscular junctions & all the muscles innervated by that neuron contract

A

neurotransmitter ACh

73
Q

What descends the lateral spinal cord. Makes a minor contribution to control of upper limb distal extensor muscles.

A

rubrospinal tract

74
Q

What’s the most important pathway controlling VOLUNTARY movement.

A

lateral corticospinal tract

75
Q

Information in the spinal cord destinuted for the cerebellum travels in the..?

A

spinocerebellar tract

76
Q

What’s dysdiadochokinesia

A

inability to rapidly alternate movements

77
Q

Define dysmetria

A

inability to accurately move an intended distance

78
Q

What’s the role of the basal ganglia?

A

Predict the effects of various actions, then make and execute action plans.

OTB 510 (4 decks)

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