unilateral upper motor neuron

Question 1

UUMN may be one of the most common occurring dys?

Answer 1

yes

Question 2

UUMN commonly occurs with aphasia and apraxia when lesion occurs in the L hemisphere

Answer 2

Yes

Question 3

when the lesion is in the Right hem. it may co-occur with cognitive and other speech deficits (not related to dys)

Answer 3

YES

Question 4

UUMN tends to be mild and of short duration

Answer 4

(and it can be masked by the other concomitant problems are why not much attention has been given it)

Question 5

What is the most common cause of UUMN?

Answer 5

stroke

Question 6

what does uumn primarily affect?

Answer 6

articulation (spch probs are mainly due to weakness of the face and tongue) also there may be some spasticity and incoordination

Question 7

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.

Answer 7

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

Question 8

where do the corticospinal fibers decussate?

Answer 8

in the pyramids of the medulla

Question 9

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

Answer 9

True

Question 10

why is the indirect pathway called indirect?

Answer 10

bc it synapses with several structures such as basal ganglia, cerebellum, reticular formation and other brainstem nuclei

Question 11

what is the indirect activation pathway important for?

Answer 11

regulating reflexes and controlling posture and tone upon which skilled movements must be superimposed.

Question 12

what is central facial weakness?

Answer 12

refers to weakness caused by central nervous system damage not PNS damage (it involves the lower part of the face)

Question 13

What are the clinical characteristics of UUMN?

Answer 13

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)

Question 14

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.

Answer 14

True

Question 15

What does decerebrate posturing mean?

Answer 15

assuming a stiff, rigid posture–it occurs primarily when the cerebrum is removed

Question 16

What are the etiologies of UUMN

Answer 16

anything that damages the UMN system unilaterally
some trauma and tumors can cause UUMN
strokes are the most common

Question 17

degenerative, inflammatory and toxic metabolic dz usually cause more than unilateral damage.

Answer 17

not the cause of uumn

Question 18

what are the types of strokes that cause UUMN.

Answer 18

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)

Question 19

Lacunar infarcts cause:

Answer 19

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

Question 20

site of lesion fro pts with uumn damage: percentages:

Answer 20

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

Question 21

Severity: of uumn damage:

Answer 21

most UUMN dys is reported to be mild or mild-mod

there are some cases reported for mod- severe

Question 22

UUMN is usually transient or chronic?

Answer 22

transient (doesn’t last long can clear up)

but it can persist in some cases

Question 23

what does the ptnt complain of?

Answer 23

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

Question 24

what are some nonspeech clinical findings of UUMN damage?

Answer 24

often have hemiplegia/hemiparesis

may have sensory deficits

Question 25

oral mech findings of uumn are?

Answer 25

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

Question 26

what are the speech findings of UUMN>

Answer 26

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

Question 27

distinctive characteristics of UUMN damage?

Answer 27

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