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Patient Assessment Methods I > Upper Motor Neurons > Flashcards

Upper Motor Neurons Flashcards

1
Q

Upper motor neurons include which tracts?

A
  • Pyramidal/Corticospinal
  • Corticobulbar
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2
Q

What characterizes an upper motor neuron lesion?

A
  • Increased muscle tone with weakness (spastic paresis)
  • Hyperreflexia
  • Presence of pathological reflexes
  • No change in sensation
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3
Q

Where might a corticospinal lesion be found?

A

The cortex, brain stem, or spinal cord

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4
Q

In the context of corticospinal tracts, what is DASIP?

A

Dorsal
Afferent
Sensory
In-going
Posterior

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5
Q

In the context of corticospinal tracts, what is VEMOA?

A

Ventral
Efferent
Motor
Out-going
Anterior

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6
Q

Pressure in the anterior portion of the corticospinal tract may cause hyperreflexia or other UMNL signs in the ___ extremity

A

lower extremity

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7
Q

How is cervical cord compression assessed?
What will likely occur if there is increased pressure on the anterior portion of the cervical cord?

A

Test bicep and patellar reflexes with cervical spine in neutral position, then with full flexion
Hyperreflexia will likely occur in the patellar reflex with the full flexion

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8
Q

What are some causes of upper motor neuron lesions?

A
  • Cerebral vascular accident
  • Intramedullary SOL interrupting tract fibers
  • Extramedullary SOL (disc) compressing on brain or cord
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9
Q

When diagnosing an upper motor neuron lesion, history questions should rule out…

A

stroke, trauma, motor deficits, headaches, etc

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10
Q

What are three categories of tests for neurologic evaluation of upper motor neurons?

A
  • Muscular hypertonia
  • Pathologic reflexes (present or absent)
  • Superficial reflexes
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11
Q

How do you assess for clonus in the upper extremity?
What is a positive finding and what would it indicate?

A

Rapid, sustained extension of the wrist
Positive finding if a “beat” is noted against the examiner’s pressure, indicating an upper motor neuron lesion

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12
Q

How do you assess for clonus in the lower extremity?
What is a positive finding and what would it indicate?

A

Rapid, sustained dorsiflexion of the ankle
Positive finding if a “beat” is noted against the examiner’s pressure, indicating an upper motor neuron lesion
Note: in the lower extremity, one or two “beats”, particularly in a taller individual, is normal

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13
Q

What are the tests for muscular hypertonia related to upper motor neurons?

A
  • Clonus
  • Deep tendon reflexes
  • Tone across the elbow
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14
Q

What are the pathologic reflexes of the upper extremity related to upper motor neurons?

A
  • Gordon’s
  • Chaddock’s
  • Rossolimo’s
  • Tromner’s
  • Hoffman’s
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15
Q

What are the pathologic reflexes of the lower extremity related to upper motor neurons?

A
  • Gordon’s
  • Chaddock’s
  • Oppenheim’s
  • Schaefer’s
  • Rossolimo’s
  • Upgoing toe sign with plantar reflex (Babinski)
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16
Q

What are the pathologic reflexes of the face related to upper motor neurons?

A
  • Snout
  • Glabella
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17
Q

What are the superficial reflexes related to upper motor neurons?

A
  • Corneal
  • Gag
  • Abdominal
  • Plantar
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18
Q

Clonus in deep tendon reflexes results from an ___ motor neuron excitation (___ action potential threshold)

A

increased motor neuron excitation (decreased action potential threshold)

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19
Q

How are deep tendon reflexes performed for upper motor neurons?

A

Biceps and patellar reflex assessment

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20
Q

What are the findings possible for deep tendon reflexes related to upper motor neurons?

A

+3/5 (hyperreflexia)
+4/5 (transient clonus)
+5/5 (sustained clonus)

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21
Q

A ___ deep tendon reflex may be normal on some patients, and rhythmic beats may be noted with long tracks, but ___ is not normal

A

+3/5 deep tendon reflex may be normal… CLONUS, +5/5, is not normal

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22
Q

How is tone across the elbow performed?
What is a positive finding and what would it indicate?

A

Rapidly extend the elbow passively while stabilizing the elbow
Positive finding is clasp-knife spasticity (resistance that stops with continue pulling on the arm) indicating an upper motor neuron lesion

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23
Q

Describe clasp knife spasticity as found when testing tone across the elbow

A
  • Muscle weakness
  • Velocity dependent
  • One direction (such as extension) is more pronounced than the other
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24
Q

Pathologic reflexes are present in ___ corticospinal tract injuries from the cortex, or ___ corticospinal tract injuries below the medulla

A

contralateral from the cortex
ipsilateral below the medulla

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25
Q

All pathologic reflexes are recorded as…

A

present or absent (with the exception of pathologic finding elicited with the plantar reflex, which when present is a normal superficial reflex)

26
Q

Which grades can be normal on the Wexler reflex grading scale?

A

+0 J (areflexic)
+1 (hyporeflexic)
+2 (normal)
+3 (hyperreflexic)

27
Q

What is the Jendrassik Maneuver?

A
  • Used when a deep tendon reflex is absent (+0)
  • Excites anterior horn cell pool bringing the motor nuclei closer to threshold
  • Must be recorded as J after reflex grade
  • No +0 without J
28
Q

A reflex recorded with a Jendrassik maneuver means that…

A

the maneuver was used; no other clinical information is derived

29
Q

Deep tendon pendular reflexes are a form of ___ associated with ___ dysfunction

A

a form of hypotonia associated with cerebellar dysfunction

30
Q

Pathological reflexes have ___ reliability

A

very high

31
Q

How is Gordon’s (finger) performed?
What is a present reflex and what would it indicate?

A

Briskly compress the pisiform
Present reflex is finger extension indicating an upper motor neuron lesion

32
Q

How is Chaddock’s performed on the upper extremity?
What is a present reflex and what would it indicate?

A

Briskly compress the wrist
Present reflex is finger extension indicating an upper motor neuron lesion

33
Q

How is Rossolimo’s hand performed?
What is a present reflex and what would it indicate?

A

Briskly and repeatedly tap the distal 3rd metacarpal (palmer side)
Present reflex is finger flexion indicating an upper motor neuron lesion

34
Q

How is Tromner’s performed?
What is a present reflex and what would it indicate?

A

Stabilize 3rd and 4th digits and briskly strike the distal digits into extension
Present reflex is finger flexion indicating an upper motor neuron lesion

35
Q

How is Hoffman’s performed?
What is a present reflex and what would it indicate?

A

While stabilizing the hand and fingers, flex the 3rd digit and allow it to “spring” into extension
Present reflex is approximation of the finger and thumb: an “OK” sign indicating upper motor neuron lesion

36
Q

How is Gordon’s (calf) performed?
What is a present reflex and what would it indicate?

A

Briskly squeeze the calf
Present reflex is upgoing toe sign indicating upper motor neuron lesion

37
Q

How is Chaddock’s performed on the lower extremity?
What is a present reflex and what would it indicate?

A

Briskly stroke a C shape around the lateral malleolus (opening of the C facing anterior)
Present reflex is upgoing toe sign indicating upper motor neuron lesion

38
Q

How is Schaeffer’s performed?
What is a present reflex and what would it indicate?

A

Briskly squeeze the Achille’s tendon
Present reflex is upgoing toe sign indicating upper motor neuron lesion

39
Q

How is Rossolimo’s foot performed?
What is a present reflex and what would it indicate?

A

Briskly and repeatedly tap the distal 3rd metatarsal (plantar surface)
Present reflex is toe flexion (curling) indicating upper motor neuron lesion

40
Q

How is the plantar reflex performed?
What are the three possible findings?

A

Briskly stroke the plantar surface of the foot along the lateral side and across the metatarsal heads
1. Curling of the toes or withdrawal of the foot is recorded as PRESENT
2. No reaction is recorded as ABSENT and is normal if bilateral
3. Upgoing toe sign is pathologic, Babinksi

41
Q

How is the snout reflex performed?
What is a present reflex and what would it indicate?

A

Tap philtrum above the lips (or on either side of nares)
Present reflex is pursing the lips indicating upper motor neuron lesion

42
Q

Which plantar reflex response is pathologic? What would it indicate?

A

Upgoing toe sign or Babisnki; indicates upper motor neuron lesion

43
Q

The snout reflex is an example of a ___ sign, which is a variation of the primitive tactile rooting reflex recorded as present or absent like a pathologic reflex

A

frontal release sign

44
Q

How is the glabellar reflex (AKA Myerson’s sign or glabellar tap sign) performed?
What is a pathologic/present finding and what would it indicate?

A

Briskly tap on the glabella, between the brows
Normally, a person will stop blinking after several taps. With a pathologic sign being present, the blinking continues.

45
Q

Glabellar reflex is an example of a ___ sign

A

frontal release; variation of primitive reflex

46
Q

What is the only superficial reflex with a potentially pathological reflex?

A

Plantar reflex

47
Q

How is Oppenheim’s performed?
What is a present reflex and what would it indicate?

A

Using the examiner’s knuckles, briskly and firmly trace along the tibial ridge (up or down)
Present reflex is upgoing toe sign indicating upper motor neuron lesion

48
Q

Pathological reflexes of the face are related to the ___ tract

A

corticobulbar tract

49
Q

How is the palmomental reflex performed?
What is a present reflex and what would it indicate?

A

Briskly scrape along the thenar eminence
Present reflex is curling of or pursing of the upper lip indicating upper motor neuron lesion

50
Q

Absent superficial reflexes can suggest:

A
  • ACUTE upper motor neuron lesion (generally returns when the CNS shock resolves; mediated at the cord)
  • Sensory (receptor) deficit
  • Motor (effector) deficit (lower motor neuron lesion)
51
Q

Superficial reflexes are normal when ___

A

present

52
Q

When is a loss of superficial reflexes (absent reflex) significant?

A

Only when they are either missing after an incident or are asymmetric

53
Q

How is the gag reflex performed?
What is an absent reflex and what would it indicate?

A

Using a tongue blade, contact the posterior pharynx. Must contact each side to confirm the sensory and motor arcs bilaterally. Observe elevation of the soft pallet
Absent reflex is asymmetry or failure of soft pallet elevation indicating upper motor neuron lesion

54
Q

The gag reflex arc is carried by CN ___ (sensory) and CN ___ (motor)

A

CN IX (sensory) and CN X (motor)

55
Q

How is the corneal reflex performed?
What is an absent reflex and what would it indicate?

A

Using a clean pointed cotton ball, touch the sclera of the eye near the iris
Absent reflex is lack of blinking or unilateral blink indicating upper motor neuron lesion

56
Q

The corneal reflex arc is carried by CN ___ (sensory) and CN ___ (motor)

A

CN V (sensory) and CN VII (motor)

57
Q

How is the abdominal reflex performed?
What is a present reflex?
What does an absent reflex indicate?

A

Briskly stoke a pattern towards or tangential to the umbilicus
Present reflex is small twitch or migration towards the stimulus
Absence may indicate upper motor neuron lesion

58
Q

Superficial reflexes are not dependable and are most significant if…

A

asymmetric or recently changes

59
Q

What is the cremasteric reflex?

A

Superficial reflex where inner part of a male’s thigh is stroked causing the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal

60
Q

What is the Geigel reflex?

A

Superficial reflex where muscle fibers at the upper edge of the Poupart ligament (inguinal ligament) contract on gently stoking the inner side of the thigh

61
Q

What is the anal reflex?
Which nerves supply this reflex?

A

Superficial reflex where external sphincter contracts after scratching the perianal skin
Supplied by the S4 and S5 roots

62
Q

What is the gluteal reflex?

A

Superficial reflex where contraction of the gluteal muscles occurs from stimulation of the overlying skin

Patient Assessment Methods I (22 decks)

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