S3_L1: Movement Disorders Flashcards
Lesions in the cerebellum leads to problems with what? (1-2).
balance and coordination
_______ is the loss of coordination that may be central or peripheral
Ataxia
TURE OR FALSE: Since the cerebellum contains both motor and sensory representations of the body, lesions to the cerebellum produces either paralysis or significant muscle weakness
False
Determine which which condition is part of what kind of ataxia.
- Alcohol Abuse
- Tabes Dorsalis
- Cerebellar Atrophy
- (+) DM
A. Sensory Ataxia
B. Cerebellar Ataxia
- B
- A
- B
- A
Determine which which condition is part of what kind of ataxia.
- Decreased Proprioception
- Peripheral Vascular Disease
- Stroke
- TBI
A. Sensory Ataxia
B. Cerebellar Ataxia
- A
- A
- B
- B
Determine the condition.
- Has difficulty stopping a movement
- Associated with cognitive disorders, emotional lability, &depression
- Definite decomposition of movement
- (+) Uthoff’s phenomenon
- Progress visual feedback from narrow/small to wide (~1 ft)
A. Parkinson’s Disease
B. Multiple Sclerosis
- B
- B
- A
- B
- A
Determine the condition.
- Basal ganglia affectation
- Cerebellum affectation
- Has difficulty starting a movement
- Cognitive affectation may not be present
- Increase in amplitude of the movement, wide BoS
A. Parkinson’s Disease
B. Multiple Sclerosis
- A
- B
- A
- A
- B
TRUE OR FALSE: Pts c PD walk with decreased velocity, cadence, & stride length. The ideal feedback to give pts c Parkinson’s disease is both visual and verbal cues
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
Cadence increases in PD
TRUE OR FALSE: Lesions of the central regions of the cerebellum are accompanied by movement incoordination related to the intent of movement and reflect problems with preparation for movement.
Lesions of the lateral region result in problems reflecting the loss of ‘updating’ afferent information.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are false
NOTE: The regions must be interchanged
TRUE OR FALSE: Lesions of the vestibulo-cerebellum, with its connections to the vestibular system, are associated with disturbances of balance. It also results in nystagmus.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
TRUE OR FALSE: Cerebellum contributes to engram formation or motor memory. Cerebellum dictates how big and small movements should be.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
TRUE OR FALSE: Alcohol is a stimulant.
False
Determine whether the following impairments are primary or secondary
- Dysmetria
- Rebound Phenomenon
- Sequencing Problems
A. Primary
B. Secondary
- B
- B
- A
Determine whether the following impairments are primary or secondary
- Decomposition of Movement
- Scaling Problems
- Timing Problems
- Dysdiadochokinesia
A. Primary
B. Secondary
- B
- A
- A
- B
Identify the clinical signs of cerebellar affectation.
Decreased coordination of rapid alternating movements
Dysdiadochokinesia
Identify the clinical signs of cerebellar affectation.
Abnormal coordination affecting speed, amplitude of displacement, directional accuracy, and force of movement
Ataxia
Identify the clinical signs of cerebellar affectation.
Unable to terminate the movement soon enough
Hypermetria
Identify the clinical signs of cerebellar affectation.
Decomposition of movement
Dyssynergia
Identify the clinical signs of cerebellar affectation.
Abnormal coordination of muscles for speech production
Dysarthria
This is one of the hallmarks of a cerebellar disorder. It presents with widened base, unsteadiness, irregularity of stepping both in direction and distance, and reduced stride length with a trend to reduced cadence.
Ataxic Gait
Answer the following questions:
- How often does fatigue occur in MS?
- In what time of day do fatigue most common occur in MS patients?
- daily
- afternoon
Fill in the blanks: Role of the cerebellum in movement.
- Initiates and control _______
- ______ of movement/muscle action
- Compares ______ with _______
- _______ and adaptive adjustments
- Compensating for lesions of the ______
- voluntary movement
- Timing
- intended movement (IM) ; motor performance (MP)
- Motor learning (ML)
- cerebral cortex
TRUE OR FALSE: The cerebellum regulates movement and posture directly by adjusting the output of major descending motor systems
False
It is indirect.
The cerebellum acts as a (1)_____ to detect the difference between an intended movement and the actual movement, and, through its projections to the upper motor neurons, to reduce the ______.
- comparator
- error
Enumerate the 2 mechanisms in which the cerebellum acts.
- Moment to moment error correction
- Feed-forward mode of control
TRUE OR FALSE: When the cerebellum has a lesion, the moment to moment error correction becomes disrupted. Movement is not corrected while the individual is doing it; thus presenting with hypo- or hypermetria.
True
Anticipatory response of the body to prevent an error or pain
A. Moment to moment error correction
B. Feed-forward mode of control
B. Feed-forward mode of control
TRUE OR FALSE: Motor learning requires a transition from non-specific responses to highly selective associations
True
People with diabetes mellitus can have ataxia because of the loss of what? and on where?
proprioception on the LE
Tabes Dorsalis affects what spinal cord tract?
DCML
Tabes Dorsalis results in what?
Wide BOS
TRUE OR FALSE: The capacity to generate force in an isolated muscle predicts the ability of that muscle to work in concert with others in a task-specific way
False
TRUE OR FALSE: If muscle is strong, it means that a person has good coordination. If muscle is weak, it means that a person has poor coordination.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
Problems with coordination involve problems in what? Enumerate all 4.
- Activation
- Sequencing of movement
- Timing
- Scaling
Determine which condition or action falls under what category.
- Coactivation of the muscle
- Slowed Execution
- Difficulty terminating or changing a movement
- Problems judging distance or range
- Loss of fractionation
A. Activation
B. Sequencing of movement
C. Timing
D. Scaling
- B
- C
- C
- D
- A
Determine which condition or action falls under what category.
- Decomposition of movement
- Cannot dictate how big the joint ROM body needs to do
- Inability to break down a task
- Compensation by doing smaller movements
- Slowed Initiation
A. Activation
B. Sequencing of movement
C. Timing
D. Scaling
- B
- D
- A
- B
- C
Identify the clinical signs of cerebellar affectation.
Disorder of movement termination
Dysmetria
Identify the clinical signs of cerebellar affectation.
alternating contractions of agonists and antagonists
Tremor
Identify the clinical signs of cerebellar affectation.
Oscillatory eye movements
Nystagmus
Identify the clinical signs of cerebellar affectation.
delay in the antagonistic response that is demonstrated by asking the individual to flex the elbow isometrically against the examiner’s resistance.
Rebound Phenomenon
The following are adaptive motor behavior seen in pts with cerebellar affectations, EXCEPT:
A. Increased variability in performance
B. Wide base of support
C. Excessive preshaping of the hand
D. Lack of yield at the knee in midswing
E. None
D. Lack of yield at the knee in midswing
it happens in midstance
The following are adaptive motor behavior seen in pts with cerebellar affectations, EXCEPT:
A. Excessive use of arms
B. Excessive stepping
C. Supporting arms while doing hand activities
D. Fast walking with large, uncontrolled steps
E. None
E. None
Multiple Sclerosis affects what structures?
white matter tracts and cerebellum
Arrange the progression of MS in sequence.
A. Depletion of oligodendrocytes; Axons denuded are seen within the lesion
B. Active destruction of oligodendrocytes and their myelin sheath due to contact with macrophages and microglia
C. Scar formation from astrocytic
reactivity; hardened patches/plaques
D. Accumulation of inflammatory cells, lymphocytes and monocytes around CNS venules
DBAC
The following are the most commonly affected areas in MS, EXCEPT:
A. Brainstem
B. Cerebellar white matter
C. Thoracic Spinal Cord
D. Periventricular regions
E. Optic Nerves
C. Thoracic Spinal Cord
Determine what pattern of MS is being described.
Steady increase in disability without attacks
A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive
D. Chronic Progressive
Determine what pattern of MS is being described.
Never new disability between attacks
A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive
B. Relapsing-remitting
Determine what pattern of MS is being described.
No disability, returns to normal in between attacks
A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive
A. Benign
Determine what pattern of MS is being described.
No new disability between attacks followed by steady increase of disability
A. Benign
B. Relapsing-remitting
C. Relapsing-
progressive
D. Chronic Progressive
C. Relapsing-
progressive
TRUE OR FALSE: Depression is unrelated to severity of MS
True
What may be used in patients with nystagmus, diplopia, and double vision?
Eye patches on one eye
This is a MS sx that increases with use and is progressive if the spinal cord is involved
Weakness
TRUE OR FALSE: MS patients cannot be given an HMP as it will produce Uthoff’s Symptoms. MS patients may receive aquatic therapy as long as the water is not too warm.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
What treatment time must be avoided in treating MS patients?
10am-2pm
NOTE: More prone to fatigue when the environment is warm. Advised to do exercises in the early morning or late afternoon only.
TRUE OR FALSE: UE and LE Ergometer can be done simultaneously to maximize treatment time for MS patients.
False
Rhythmic, mechanical oscillation of a body part that is suppressed by willed (voluntary) activity, sleep, and complete relaxation.
In what movement disorder is this seen?
Parkinson’s
NOTE: The sx was resting tremor
Sinemet takes how many minutes before it peaks?
50-60 mins
Determine the Hoehn-Yahr Stage based on the descriptions below.
Confined to bed or wheelchair
5
Determine the Hoehn-Yahr Stage based on the descriptions below.
Imparied righting reflexes. Unsteadiness when turning or rising from chair.
3
Determine the Hoehn-Yahr Stage based on the descriptions below.
Minimal or absent; unilateral if present
1
Determine the Hoehn-Yahr Stage based on the descriptions below.
Some activities are restricted, but patient can live independently and continue some forms of employment.
3
Determine the Hoehn-Yahr Stage based on the descriptions below.
All symptoms present and severe.
4
Determine the Hoehn-Yahr Stage based on the descriptions below.
Balance not impaired.
2
Determine the Hoehn-Yahr Stage based on the descriptions below.
Minimal bilateral or midline involvement.
2
Determine the Hoehn-Yahr Stage based on the descriptions below.
Standing and walking possible only with assistance.
4
TRUE OR FALSE: In treating PD pts, instructions must be detailed and thorough. It is best to elaborate every instruction so patient can understands it better.
False
Emphasis on “getting the idea of the movement” is needed, but SIMPLIFIED instructions are preferred.
TRUE OR FALSE: Exercise capacity of persons with mild to moderate Parkinson’s (Hoehn and Yahr Stage I-III) is similar to their age-matched peers even without medications
False
In PD, the aim of walking practice is to increase speed by increasing what?
stride length
Answer the following questions:
- When teaching a PD patient to turn while walking, in what manner should the PT teach the pt to turn?
- What strategy will be used for small spaces?
- Turning in a large arc using big steps
- Clock turning strategy
In PD pts, to which direction do their CoG deviates?
anteriorly
NOTE: This is due to a relatively flexed posture
TRUE OR FALSE: In PD, it is important to increase in cadence & decrease stride length.
False
The following are gait manifestations of PD pts:
A. Decrease in stride length
B. Increase cadence
C. Decrease in velocity
D. All
E. None
D. All
TRUE OR FALSE: The cerebellum regulates vestibular, spinal and cortical mechanisms by means of reciprocal neuronal connections
True
Differentiate intended movement (IM) with motor performance (MP)
IM: movement that you have in mind before the actual movement
MP: actual motor output
This is the inability to reach for a certain object d/t cerebellar affectation
Hypometria
This manifests with overreach for a certain target
Hypermetria
Avoid a mistake or error first
A. Moment-to-moment error correction
B. Feed-forward mode of control
B. Feed-forward mode of control
TRUE OR FALSE: The cerebrum plays a major role in motor coordination to adapt to the requirements of the task as conditions change.
False
It is the cerebellum
This is the breaking down of a certain task into smaller steps
Fractionation
What secondary impairment is shown by a pt who has Sequencing Problems? You may choose a maximum of 4 letters.
A. Decomposition of Movement
B. Rebound Phenomenon
C. Dysdiadochokinesia
D. Dysmetria
A. Decomposition of Movement
What secondary impairment is shown by a pt who has Scaling Problems?
A. Decomposition of Movement
B. Rebound Phenomenon
C. Dysdiadochokinesia
D. Dysmetria
D. Dysmetria
What secondary impairment is shown by a pt who has Timing Problems? You may choose a maximum of 4 letters.
A. Decomposition of Movement
B. Rebound Phenomenon
C. Dysdiadochokinesia
D. Dysmetria
B & C
TRUE OR FALSE: Primary impairments are the direct impairments. Secondary impairment are the manifestations of the abstract impairments.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
This is referred to as the early termination of movement
Hypometria
TRUE OR FALSE: In cerebellar lesions, antagonist contraction is delayed.
True
This is the reason why rebound phenomenon occurs
This manifests as decreased coordination of timing of onset and offset of agonists and antagonists and loss of smoothness of the movement
Dyssynergia
Cerebellar tremor is most marked at the ______ of the movement, for which reason it is frequently called a _____ tremor.
- end
- terminal
This occurs due to abnormal coordination of speech and respiration
Dysarthria
TRUE OR FALSE: Pts c cerebellar lesions restrict the amplitude or degrees of freedom of motion, but they often overestimate this.
True
TRUE OR FALSE: Ataxia and balance problems may be more clearly observed when the person is asked to walk fast
False
This is similar to a circuit training for the UE, where a bombardment of movement & activities occurs.
Hammering
Hammering is used to train what?
smooth movements at various amplitudes and speed
TRUE OR FALSE: In cerebellar stroke, tremors can be minimized by using cuff weights. In PD, weights cannot be used to stop tremors.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
To increase task complexity, the following may be done, EXCEPT:
A. Reduce external constraints (EC)
B. Reduce possibilities for Upper Limb support
C. Encourage increase amplitude of movement
D. Encourage increase in cadence
E. Increase cognitive challenge
D. Encourage increase in cadence
To increase task complexity, the following may be done:
- Standing on trampoline
- Talking to the patient while stacking cones
- Giving a cane
- Giving 2 tasks at once
- Encouraging small movements
A. I & IV
B. III & V
C. II, III, IV
D. I, II, IV
E. I, II, III, IV, & V
D. I, II, IV
TRUE OR FALSE: Frenkel exercise may be used as a tx strategy for ataxic patients.
True
These are stabilization exercises and platform exercises that improve balance
TRUE OR FALSE: Inflammation in MS is sufficient to cause a functional block in conduction through myelinated axons.
True
TRUE OR FALSE: The inflammation response in MS has both destructive and beneficial effects.
True
When do eye patches in MS become a restorative treatment, rather than an adaptive treatment?
if nystagmus was addressed by extra ocular muscle strengthening
YES OR NO: Can eye patches be applied to blurring vision?
NO
Described as a feeling of heaviness or clumsiness
Weakness
TRUE OR FALSE: In MS, fatigue worsens with heat, humidity, stress, strenuous exercises, sleep deprivation
True
What are the 2 positive features of PD?
Resting Tremor & Rigidity
Difficulty initiating movement
Akinesia
Reduced movement speed
Bradykinesia
Reduced excursion of movement more pronounced in sequential and simultaneous movements
Hypokinesia
Difficulty starting or continuing rhythmic repetitive movements
Freezing Phenomenon
Increased resistance throughout the range of passive movement at a joint that is of the same intensity in both extensor and flexor muscles
Rigidity
