unilateral upper motor neuron Flashcards
UUMN may be one of the most common occurring dys?
yes
UUMN commonly occurs with aphasia and apraxia when lesion occurs in the L hemisphere
Yes
when the lesion is in the Right hem. it may co-occur with cognitive and other speech deficits (not related to dys)
YES
UUMN tends to be mild and of short duration
(and it can be masked by the other concomitant problems are why not much attention has been given it)
What is the most common cause of UUMN?
stroke
what does uumn primarily affect?
articulation (spch probs are mainly due to weakness of the face and tongue) also there may be some spasticity and incoordination
fibers from the UMN pathway start at the cortex and then descend via the corona radiata then go into the internal capsule near the level of the basal ganaglia and thalamus-the tracts then descend to the brainstem here the corticobulbar fibers cross to the oppo side just before they get to the level of the cranial nerves they are going to innervate.
corticospinal fibers cross over (decussate) in the pyramids of the medulla the nerve impulses from these 2 tracts provide innervation for finely coordinated, skilled movements
where do the corticospinal fibers decussate?
in the pyramids of the medulla
The indirect activation pathway has the same origin and the same contralateral dimensions and it crosses over in the same general area as the direct activation pthway just not through the pyramids
True
why is the indirect pathway called indirect?
bc it synapses with several structures such as basal ganglia, cerebellum, reticular formation and other brainstem nuclei
what is the indirect activation pathway important for?
regulating reflexes and controlling posture and tone upon which skilled movements must be superimposed.
what is central facial weakness?
refers to weakness caused by central nervous system damage not PNS damage (it involves the lower part of the face)
What are the clinical characteristics of UUMN?
central facial weakness
combo of direct and indirect pthwy lesions–typically weakness and spasticity are seen in the limbs that are affected (Babinski reflex on side of body affected)
T or F. the symptoms change over time in UUMN it is initially weakness, hyporeflexia and hypertonia are seen in limbs–this changes to spasticity, hyperactive reflexes as time goes by.
True
What does decerebrate posturing mean?
assuming a stiff, rigid posture–it occurs primarily when the cerebrum is removed
What are the etiologies of UUMN
anything that damages the UMN system unilaterally
some trauma and tumors can cause UUMN
strokes are the most common
degenerative, inflammatory and toxic metabolic dz usually cause more than unilateral damage.
not the cause of uumn
what are the types of strokes that cause UUMN.
left carotid or left middle cerebral artery blockages that lead to aphasia/apraxia as well as uumn damage
-right carotid/middle cerebral artery blockages–lead to neglect and cognitive problems
-unilateral strokes in posterior cerebral basilar and anterior vertebral arteries may also cause UUMN
Lacunar infarcts (most common cause of UUMN when the dysarthria is the only sign of stroke)
Lacunar infarcts cause:
uumn damage in structures like the basal ganglia
don’t typically cause aphasia
motor or sensorimotor deficits are the most common probs in addition to dys
site of lesion fro pts with uumn damage: percentages:
95% supratentorial
61% left hem.
34% r hem
(could be more l than r hem were referred to duffy bc of aphasia and speech problems
Severity: of uumn damage:
most UUMN dys is reported to be mild or mild-mod
there are some cases reported for mod- severe
UUMN is usually transient or chronic?
transient (doesn’t last long can clear up)
but it can persist in some cases
what does the ptnt complain of?
ptnt usually aware of problem
thick tongue or thick slurred speech
speech deteriorates with fatigue but not as sharp as in MG
words don’t come out right-diff with pronunciation
drooling or mild dysphagia
occasionally some have inppropriate crying and laughing
what are some nonspeech clinical findings of UUMN damage?
often have hemiplegia/hemiparesis
may have sensory deficits
oral mech findings of uumn are?
unilateral lower facial weakness (central weakness bc damage to CNS not PNS)
unilateral tongue weakens
jaw usually demonstrates normal strength but some contralateral jaw weakness may occasionally be seen
unilateral palatal weekness
dysphagia may occur
what are the speech findings of UUMN>
imprecise consonants is the most common slow rate irregular AMR's Slow AMR's hoarseness/harshness hypernasality is rare but occurs sometimes may sound similar to spastic dys reduced loudness intelligibility usually only mildly affected therapy is often not needed
distinctive characteristics of UUMN damage?
unilateral central face and tongue weakness primarily results from strokes mild-mod articulation problems mild irregular articulatory breakdowns slow rate slow and irregular amr's strained hoarse voice quality reduced loudness
