UMN & LMN Lesion and Cerebellum & Basal Ganglia Disorders

Question 1

Where can a lesion occur for it to be considered UMN lesion? (4)

Answer 1

1. CNS cortex
2. Brain stem
3. Corticospinal tracts
4. Spinal cord

Question 2

Where can a lesion occur for it to be considered LMN lesion? (3)

Answer 2

1. Cranial nerve nuclei
2. Spinal cord: anterior horn cells or spinal roots
3. Peripheral nerve

Question 3

IMPORTANT
If an UMN lesion occurs, what are the common diagnoses? (3)

Answer 3

1. Stroke
2. TBI
3. SCI

Question 4

IMPORTANT
If a LMN lesion occurs, what are the common diagnoses? (4)

Answer 4

1. Polio, GBS
2. Peripheral nerve injury
3. Peripheral neuropathy
4. Radiculopathy

Question 5

Describe the tone differences between an UMN & LMN lesion (2 characteristics each)

Answer 5

UMN
-Increased; hypertonia
-Velocity dependent

LMN
-Decreased or absent; hypotonia; flaccidity
-Not velocity dependent

Question 6

What is the main thing to remember about the tone between UMN and LMN lesion?

Answer 6

UMN lesion is velocity dependent and LMN is not which is important when testing reflexes or assessing for tone

Question 7

Describe the reflexes differences between an UMN(3) & LMN (2) lesion

Answer 7

UMN
-Increased; hyperreflexia; clonus
-Exaggerated cutaneous & autonomic reflexes
-+Babinski

LMN
-Decreased or absent; hyporeflexia
-Cutaneous reflexes decreased or absent

Question 8

What do we know about involuntary movements with an UMN and LMN lesion?

Answer 8

UMN
-Muscle spasms; flexor or extensor

LMN
-with denervation causes fasciculations

Question 9

How does an UMN lesion (3) and LMN (2) lesion impact strength?

Answer 9

UMN
-weakenss or paralysis; ipsilateral (stroke) or bilateral (SCIS)
-Corticospinal: contralateral if above decussation in medulla; ipsilateral if below
-Distribution: never focal

LMN
-Ipsilateral weakness or paralysis
-Limited distribution; segmental or focal pattern; root-innervated pattern

Question 10

How does an UMN (1) lesion and LMN (1) lesion impact muscle bulk?

Answer 10

UMN
-disuse atrophy; variable widespread distribution especially of antigravity muscles

LMN
-Neurogenic atrophy; rapid, focal distribution, severe wasting

Question 11

How does an UMN (2) lesion & LMN (1) lesion impact voluntary movements?

Answer 11

UMN
-Impaired or absent
-Dyssnergic patterns; obligatory mass synergies

LMN
-Weak or absent if nerve interrupted

Question 12

What are a few things that are considered IADLs? (4)

Answer 12

-money management
-functional communication & socialization
-functional & community mobility
-health maintenance

Question 13

In technical terms, how do we define mobility?

Answer 13

both the BOS & COM are moving

Question 14

If a lesion occurs to the cerebral cortex or corticospinal tracts, what would that be called?

Answer 14

stroke

Question 15

How is sensation impacted during a stroke (2)?

Tone (3)?

Reflexes (1)?

Answer 15

Sensation
-Impaired or absent; depends on lesion location
-Contralateral sensory loss

Tone
-Hypertonia/spasticity & velocity dependent
-Clasp-knife
-Initial flaccidity; cerebral shock

Reflexes
-Hyperreflexia

Question 16

How is strength impacted during a stroke (2)?

Muscle bulk (1)?

Involuntary movements (1)?

Answer 16

Strength
-Contralateral weakness or paralysis; hemiplegia or hemiparesis
-Disuses weakness in chronic stage

Muscle bulk
-Normal during acute stage; disuse atrophy in chronic stage

Involuntary movements
-Spasms

Question 17

How are voluntary movements impacted during a stroke (1)?

Postural control (2)?

Gait (1)?

Answer 17

Voluntary movements
-Dyssynergic: abnormal timing, co-activation, fatigability

Postural control
-Impaired or absent, depends on lesion location
-Impaired balance

Gait
-Impaired; gait deficits due to abnormal weakness, synergies, spasticity, timing deficits

Question 18

When a lesion occurs at the basal ganglia, what pathology do we typically suspect?

Answer 18

Parkinson’s Disease

Question 19

When someone has Parkinson’s Disease, how is the sensation affected (1)?

Tone (2)?

Reflexes (1)?

Answer 19

Sensation
-Unaffected

Tone
-Lead pipe rigidity; increased uniform resistance
-Cogwheel rigidity; increased, ratchet-like resistance

Reflexes
-Normal or may be decreased

Question 20

When someone has Parkinson’s Disease, how is their strength affected (1)?

Muscle bulk (1)?

Involuntary movements (1)?

Answer 20

Strength
-Disuse weakness in chronic stage

Muscle bulk
-Normal or disuses atrophy

Involuntary movements
-Resting tremors

Question 21

When someone has Parkinson’s Disease, how does it affect their voluntary movements (2)?

Postural control (2)?

Gait (1)?

Answer 21

Voluntary Movements
-Bradykinesia: slowness of movement
-Akinesia: absence of movement

Postural Control
-Impaired: stooped (flexed)
-Impaired balance

Gait
-Impaired: shuffling, festinating gait

Question 22

When someone has a lesion to their cerebellum, what two diagnoses would we suspect?

Answer 22

Tumor or stroke

Question 23

If we suspect a tumor or stroke in the cerebellum, how would we suspect sensation to be affected (1)?

Tone (1)?

Reflexes (1)?

Answer 23

Sensation
-Not affected

Tone
-Normal or may be decreased

Reflexes
-Normal or may be decreased

Question 24

If we suspect a tumor or stroke in the cerebellum, how would we suspect strength to be affected (1)?

Muscle bulk (1)?

Involuntary movements (1)?

Answer 24

Strength
-Normal or weak: asthenia

Muscle bulk
-Normal

Involuntary movements
-None

Question 25

If we suspect a tumor or stroke in the cerebellum, how would we suspect voluntary movements to be affected (1)? Postural control (2)? Gait (1)?

Answer 25

Voluntary movements -Ataxia: intention tremor, dysdiadochokinesia, dysmetria, dyssynergia, nystagmus Postrual Control -Impiared: truncal ataixa -Impaired balance Gait -Impaired: ataxic gait deficits, wide-based, unsteady

Question 26

If we suspect a lesion in the spinal cord, what diagnoses should we consider (4)?

Answer 26

Trauma Tumor Vascular insult Complete or incomplete SCI

Question 27

If we suspect a lesion to the spinal cord, how would we suspect sensation is affected (1)? Tone (2)? Reflexes (1)?

Answer 27

Sensation -Impaired or absent below the level of lesion Tone -Hypertonia/spasticity below the level of lesion -Initial flaccidity: spinal shock Reflexes -Hyperreflexia

Question 28

If we suspect a lesion to the spinal cord, how would we suspect strength is affected (1)? Muscle bulk (1)? Involuntary movements (1)?

Answer 28

Strength -Impaired or absent below the level of lesion: paraplegia or tetraplegia Muscle bulk -Disuse atrophy Involuntary movements -Spasms

Question 29

If we suspect a lesion to the spinal cord, how would we suspect voluntary movements to be affected(1)? Postural control(2)? Gait (1)?

Answer 29

Voluntary movements -Above level of lesion intact (normal) but below level of lesion: impaired or absent Postural Control -Impaired below level of lesion -Impaired balance Gait -Impaired or absent: depends on level of lesion

Question 30

What role does the basal ganglia play in movement and postural control? (4)

Answer 30

-initiation and regulation of gross intentional movements, planning, and execution of complex motor responses -facilitation of desired motor responses while selectively inhibiting others -accomplish automatic movements & postural adjustments -maintaining normal background muscle tone

Question 31

What is the importance of the Dorsal (Posterior) Column-Medial Lemniscal Pathway?

Answer 31

responsible for the afferent transmission of discriminative sensations & coordinated movement

Question 32

What role does this pathway play in sensory modalities?

Answer 32

this system mediates the sensory modalities

Question 33

What sensations are the DCML pathway responsible for? (4)

Answer 33

-discriminative touch & kinesthesia -stereognosis & graphesthaia -tactile pressure & proprioception -barognosis & vibration

Question 34

Describe the pathway of the DCML sending ascending neurons to the brain

Answer 34

after entering the dorsal column, the fibers ascend to the medulla & synapse w/dorsal column nuclei; then they cross over to the opposite side and pass up to the thalamus then terminate in the posterolateral thalamus

Question 35

What key things is the cerebellum primarily responsible for? (4)

Answer 35

-equilibrium -posture -muscle tone -initiation & force of movement

Question 36

What are the 3 regions of the cerebellum and if they are affected due to stroke/tumor, what manifestations are present??

Answer 36

Midline (vermis) -truncal ataxia -orthostatic tremor -gait imbalance Hemispheres (neocerebellum) -limb ataxia (dysdiadochockinesia, dysmetria) -dysarthria & hypotnia Posterior (flocculonodular) -posture & gait -eye movement disorders

Question 37

Match the following definitions with its appropriate motor impairment due to cerebellar pathology -Generalized muscle weakness associated with cerebellar lesions -Disorder of the motor component of speech articulation -Movement performed in a sequence rather than as one single/smooth activity -Inability to judge the distance or range of a movement -Impaired ability to perform rapid alternating movements A. Dysmetria B. Dysarthria C. Asthenia D. Dyssnergia E. Dysdiadochokinesia

Answer 37

C. Asthenia B. Dysarthria D. Dyssnergia A. Dysmetria E. Dysdiadochokinesia

Question 38

Match the following definitions with its appropriate motor impairment due to cerebellar pathology -Loss of ability to associate muscles together for complex movements -Decrease in muscle tone -Rhythmic, quick, oscillatory, back-and-forth movement of the eyes -Loss of the check reflex -Involuntary oscillatory movement resulting from alternate contractions of opposing muscle groups -Ambulatory patterns that demonstrate a broad BOS. A. Gait ataxia B. Hypotonia C. Tremor D. Rebound phenomenon E. Nystagums F. Asynergia

Answer 38

F. Asynergia B. Hypotonia E. Nystagmus D. Rebound phenomenon C. Tremor A. Gait ataxia

Question 39

What are the 3 common motor deficits associated with basal ganglia pathology?

Answer 39

1. poverty and slowness of movement 2. involuntary extraneous movement 3. alterations in posture & muscle tone

Question 40

Match the following definitions with its appropriate motor impairment due to basal ganglia pathology -Involuntary, rhythmic, oscillaotyr movement observed at rest -Abnormally increased muscle activity or movement -Sustained involuntary contractions of agonist & antagonist muscles -Movement disorder with features of both chorea & athetosis -Iniability to initiate movement and is seen in the late stages of PD A. Akinesia B. Choreoathetosis C. Dystonia D. Hyperkinesia E. Tremor

Answer 40

E. Tremor B. Hyperkinesia C. Dystonia B. Choreoathetosis A. Akinesia

Question 41

Match the following definitions with its appropriate motor impairment due to basal ganglia pathology -Slow, involuntary, writhing, twisting, "wormlike" movements -Decreased amplitude & velocity of voluntary movements -Involuntary, rapid, irregular, and jerky movements involving multiple joints -Large amplitude sudden, violent, flailing motions of the arm & leg of one side of the body -Increase in muscle tone causing greater resistance to passive movement A. Rigidity B. Athetosis C. Bradykinesia D. Hemiballismus E. Chorea

Answer 41

B. Athetosis C. Bradykinesia E. Chorea D. Hemiballismus A. Rigidity