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Clinical Medicine - OT > Week 3 - Movement Disorders > Flashcards

Week 3 - Movement Disorders Flashcards

1
Q

What is the role of the basal ganglia in movement?

A 
Decision to move
Direction of movement
Amplitude of movement
Speed of movement
Records pre-learned motor sequences
Generates feedback loop to guide future movement patterns
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2
Q

What is the basal ganglia?

A

An area in the brain that controls movement.

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3
Q

What are the 4 parts of the basal ganglia?

A

Corpus striatum
Globus Pallidus
Substantia nigra
Subthalamic nucleus

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4
Q

What makes up the Corpus Striatum?

A

The caudate nucleus and putamen

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5
Q

What makes up the Globus Pallidus?

A

Internus and externus

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6
Q

What is the thalamus?

A

The gatekeeper to the cortex
Under tonic inhibition regulated by the basal ganglia
Once this inhibition is removed, signals can be sent by the basal ganglia, which is how the basal ganglia controls movement

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7
Q

Which is the input nuclei of the basal ganglia?

A

The Corpus Striatum

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8
Q

Which is the output nuclei of the basal ganglia?

A

The Globus Pallidus

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9
Q

What is the role of the substantia nigra?

A

Processes information received by the corpus striatum.

Further inhibits the Globus Pallidus

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10
Q

What is the role of the subthalamic nucleus?

A

Processing information received by the corpus striatum

Excites the globus pallidus

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11
Q

What causes movement disorder?

A

Errors in basal ganglia mechanism

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12
Q

What pathways does the basal ganglia modulate movement?

A

Direct and indirect pathways

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13
Q

What is a direct pathway?

A

The direct pathway, sometimes known as the direct pathway of movement, is a neural pathway within the central nervous system through the basal ganglia which facilitates the initiation and execution of voluntary movement.

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14
Q

What is an indirect pathway?

A

The indirect pathway, sometimes known as the indirect pathway of movement, is a neuronal circuit through the basal ganglia and several associated nuclei within the central nervous system which helps to prevent unwanted muscle contractions from competing with voluntary movements.

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15
Q

What are the 2 types of classification of movement disorder?

A

Hyperkinetic and Hypokinetic

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16
Q

What are the 2 types of Hypokinetic disorders?

A

Bradykinesia and rigidity

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17
Q

What are the 5 types of Hyperkinetic disorders?

A 
Tremor
Chorea
Dystonia
Myoclonus
Tics
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18
Q

What is bradykinesia?

A

Bradykinesia means slowness of movement, a reduction in movement in both amplitude and speed

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19
Q

What conditions are hypotonic movement disorders seen in?

A 
Parkinsons
Multiple System Atrophy
Progressive Supranuclear Palsy
Lewy body dementia
Stroke
Medications
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20
Q

What is Ataxia?

A

Voluntary muscular incoordination that present as jerky, intermittent movement

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21
Q

What are the 3 types of ataxia?

A

Cerebellar
Sensory
Vestibular

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22
Q

What is Parkinson’s Disease?

A

A chronic neurodegenerative disorder characterised by resting tremor, bradykinesia, rigidity and postural instability

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23
Q

What is Parkinsonism?

A

Parkinsonism is a general term that refers to
a group of neurological disorders that cause
movement problems similar to those seen
in Parkinson’s disease such as tremors, slow
movement and stiffness

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24
Q

What is the most common cause of parkinsonism?

A

Parkinson’s disease

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25
Q

What is the average age of onset for Parkinson’s?

A

60 years

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26
Q

What causes Parkinson’s disease?

A

Loss of dopaminergic neurons especially in the substantia nigra

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27
Q

What percentage of dopaminergic neurons are lost before Parkinson’s systems appear?

A

80%

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28
Q

What are the risk factors of Parkinson’s disease?

A

Idiopathic (no known cause)
Genetic factors (Age 60+, gender male)
Environmental factors

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29
Q

What are the motor symptoms of Parkinson’s

A 
Bradykinesia
Rigidity
Postural instability
Dysphonia/Dysarthria
Dysphagia
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30
Q

What are non-motor causes of Parkinson’s Disease?

A 
Cognitive impairment
Mood disorders
insomnia
anosmia
drooling
constipation
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31
Q

What is an example where bradykinesia is seen?

A

Alternative, repetitive movements such as tapping or handwriting (start normal and then diminish in size)

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32
Q

What are the 3 main signs of bradykinesia in parkinson’s?

A

Falls, freezing and festinations

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33
Q

What is festination?

A

Small shuffling gate

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34
Q

What is lead pipe rigidity?

A 
Smooth consistent rigidity in movement.
 Involuntary stiffening (rigidity) of muscles that remains the same even while being passively manipulated
35
Q

What is cogwheeling?

A

A jerky, ratchet like quality of movement caused by rigidity superimposed on a tremor.
Muscular stiffness is throughout the range of passive movement in both extension and flexion.

36
Q

What tremor is most commonly observed in parkinson’s disease?

A

pill-rolling tremor

37
Q

How are Parkinson’s patients classified?

A

The Hoehn and Yahr Scale

Unified PD rating scale

38
Q

What are the features of the Hoehn and Yahr scale?

A

Published in 1967
5 stages
Has been extensively modified

39
Q

What are the features of the Unified PD rating scale

A

Comprehensive
4 parts
Intellectual function, ADLs, Motor Exam, motor complications
Time consuming

40
Q

How is Parkinson’s medically managed?

A

Dopamine replacement therapy
Dopamine Agonist
Anticholinergics

41
Q

How is Parkinson’s surgically managed?

A

Deep brain Stimulation

42
Q

What is Muscular System Atrophy?

A

Affects autonomic functions

A rare, degenerative neurological disorder affecting your body’s involuntary (autonomic) functions, including blood pressure, breathing, bladder function and motor control.

43
Q

What causes MSA?

A

Idiopathic

Overproduction and accumulation of alpha-synuclein in the brain

44
Q

What Does MSA affect?

A

Basal ganglia
Cerebellum
Brain stem

45
Q

What is the age of onset for MSA?

A

54-60 years

46
Q

Which develops faster, PD or MSA?

A

MSA

47
Q

What are clinical features of MSA?

A 
Akinetic rigid parkinsonism
Autonomic failure
Cerebellar ataxia
Urogenital dysfunction
Action tremor
PISA syndrome
Lateral flexion of the spine
Severe anterior flexion of the spine
Jerky myoclonic posture
48
Q

What is Progressive Supranuclear Palsy?

A

Causes balance, movement, vision, speech, swallowing problems

A rare neurological condition that can cause problems with balance, movement, vision, speech and swallowing.

49
Q

What causes PSP?

A

It is idiopathic, associated with accumulation of protein tau

50
Q

What are the clinical features of PSP?

A

Atrophy of subthalamic nucleus, brainstem and superior cerebellar peduncle

51
Q

What are symptoms of PSP?

A 
Axial rigidity in extension
restricted eye movements
falls when walking downstairs
Diplopia
Light sensitivity
Blepharospasm
Memory/behaviour changes
Dysarthria
Dysphagia
52
Q

What is Chorea?

A

Involuntary non-rhythmic, abrupt dance like movements

53
Q

What is tremor?

A

Involuntary, rhythmic, alternating movements involving one or more joints

54
Q

What are the 3 types of tremor?

A

Essential, resting and intentional

55
Q

What is dystonia?

A

Involuntry, slow, sustained contractions of agonist +/- antagonist muscles

56
Q

What is myoclonus?

A

Involuntary sudden, brief muscle contractions or inhibitions (shock like)

57
Q

What are tics?

A

Involuntary, repetitive, stereotyped movement and vocalisations

58
Q

What is athetosis?

A

Involuntary, slow, writhing movements

59
Q

What are agonist muscles?

A

The muscle that is contracting

60
Q

What are antagonist muscles?

A

The muscles that are relaxing or lengthening

61
Q

What is huntington’s disease?

A

An inherited progressive neurodegenerative disease.

62
Q

True or false: Huntington’s disease affects males and females equally

A

True

63
Q

What characterises Huntington’s disease?

A

Choreiform movements
Psychiatric problems
Dementia

64
Q

What function does Huntington’s affect?

A

Motor
Cognitive
Emotional function

65
Q

What are choreiform movements?

A

Random, brief, and non-rhythmic movements

66
Q

`What is the age of onset for Huntington’s disease?

A

30-40 years

67
Q

How is Huntington’s Disease diagnosed?

A

Diagnosis is based on clinical features
Positive family history
Confirmed with genetic testing
Axial MRI to identify caudate atrophy

68
Q

What is the prognosis of Huntington’s disease?

A

15-25 years

69
Q

What are the signs of Huntington’s disease?

A 
Chorea
Hypotonia with hyperreflexia
Progressive loss of motor control
Abnormal eye movements
Psych symptoms
Cognitive impairment and dementia
70
Q

What is hyperreflexia?

A

Hyperreflexia is defined as overactive or overresponsive reflexes

71
Q

How is Huntington’s disease managed?

A

Symptomatic management and therapy

72
Q

What symptomatic management is suitable for Huntington’s disease?

A

Medication to supress movements
Antipsychotics
Antidepressants

73
Q

What therapy can assist with Huntington’s disease?

A

Lifestyle management
Allied health management for feeding, communication, mobility
Palliative care

74
Q

What is Tourette’s Syndrome?

A

A common neurophysiological disorder

75
Q

How is Tourette’s characterised?

A

By repetitive stereotyped involuntary movement and vocalisations called tics

76
Q

What causes tics?

A

Dopaminergic imbalances

77
Q

What other conditions are associated with Tourette’s?

A

ADHD and OCD

78
Q

What are examples of movement tics?

A 
Shrugging
eye blinking
head jerking
nose twitching
swallowing
coughing
lip twitching
79
Q

What are examples of vocal tics?

A

Grunting
Barking
Throat clearing
Repetitive words

80
Q

What is the cause of Tourette’s?

A

Idiopathic

81
Q

What is the average age for onset of Tourette’s?

A

7-10 years old

82
Q

True or false: Tourette’s affects more females than males?

A

False, affects males 3-4 times more than females

83
Q

How is Tourette’s managed?

A

Medication for suppression of tics

Clinical Medicine - OT (35 decks)

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