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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
What is the average age of onset for Parkinson's?
60 years
26
What causes Parkinson's disease?
Loss of dopaminergic neurons especially in the substantia nigra
27
What percentage of dopaminergic neurons are lost before Parkinson's systems appear?
80%
28
What are the risk factors of Parkinson's disease?
Idiopathic (no known cause) Genetic factors (Age 60+, gender male) Environmental factors
29
What are the motor symptoms of Parkinson's
``` Bradykinesia Rigidity Postural instability Dysphonia/Dysarthria Dysphagia ```
30
What are non-motor causes of Parkinson's Disease?
``` Cognitive impairment Mood disorders insomnia anosmia drooling constipation ```
31
What is an example where bradykinesia is seen?
Alternative, repetitive movements such as tapping or handwriting (start normal and then diminish in size)
32
What are the 3 main signs of bradykinesia in parkinson's?
Falls, freezing and festinations
33
What is festination?
Small shuffling gate
34
What is lead pipe rigidity?
``` Smooth consistent rigidity in movement. Involuntary stiffening (rigidity) of muscles that remains the same even while being passively manipulated ```
35
What is cogwheeling?
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
What tremor is most commonly observed in parkinson's disease?
pill-rolling tremor
37
How are Parkinson's patients classified?
The Hoehn and Yahr Scale | Unified PD rating scale
38
What are the features of the Hoehn and Yahr scale?
Published in 1967 5 stages Has been extensively modified
39
What are the features of the Unified PD rating scale
Comprehensive 4 parts Intellectual function, ADLs, Motor Exam, motor complications Time consuming
40
How is Parkinson's medically managed?
Dopamine replacement therapy Dopamine Agonist Anticholinergics
41
How is Parkinson's surgically managed?
Deep brain Stimulation
42
What is Muscular System Atrophy?
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
What causes MSA?
Idiopathic | Overproduction and accumulation of alpha-synuclein in the brain
44
What Does MSA affect?
Basal ganglia Cerebellum Brain stem
45
What is the age of onset for MSA?
54-60 years
46
Which develops faster, PD or MSA?
MSA
47
What are clinical features of MSA?
``` 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
What is Progressive Supranuclear Palsy?
Causes balance, movement, vision, speech, swallowing problems A rare neurological condition that can cause problems with balance, movement, vision, speech and swallowing.
49
What causes PSP?
It is idiopathic, associated with accumulation of protein tau
50
What are the clinical features of PSP?
Atrophy of subthalamic nucleus, brainstem and superior cerebellar peduncle
51
What are symptoms of PSP?
``` Axial rigidity in extension restricted eye movements falls when walking downstairs Diplopia Light sensitivity Blepharospasm Memory/behaviour changes Dysarthria Dysphagia ```
52
What is Chorea?
Involuntary non-rhythmic, abrupt dance like movements
53
What is tremor?
Involuntary, rhythmic, alternating movements involving one or more joints
54
What are the 3 types of tremor?
Essential, resting and intentional
55
What is dystonia?
Involuntry, slow, sustained contractions of agonist +/- antagonist muscles
56
What is myoclonus?
Involuntary sudden, brief muscle contractions or inhibitions (shock like)
57
What are tics?
Involuntary, repetitive, stereotyped movement and vocalisations
58
What is athetosis?
Involuntary, slow, writhing movements
59
What are agonist muscles?
The muscle that is contracting
60
What are antagonist muscles?
The muscles that are relaxing or lengthening
61
What is huntington's disease?
An inherited progressive neurodegenerative disease.
62
True or false: Huntington's disease affects males and females equally
True
63
What characterises Huntington's disease?
Choreiform movements Psychiatric problems Dementia
64
What function does Huntington's affect?
Motor Cognitive Emotional function
65
What are choreiform movements?
Random, brief, and non-rhythmic movements
66
`What is the age of onset for Huntington's disease?
30-40 years
67
How is Huntington's Disease diagnosed?
Diagnosis is based on clinical features Positive family history Confirmed with genetic testing Axial MRI to identify caudate atrophy
68
What is the prognosis of Huntington's disease?
15-25 years
69
What are the signs of Huntington's disease?
``` Chorea Hypotonia with hyperreflexia Progressive loss of motor control Abnormal eye movements Psych symptoms Cognitive impairment and dementia ```
70
What is hyperreflexia?
Hyperreflexia is defined as overactive or overresponsive reflexes
71
How is Huntington's disease managed?
Symptomatic management and therapy
72
What symptomatic management is suitable for Huntington's disease?
Medication to supress movements Antipsychotics Antidepressants
73
What therapy can assist with Huntington's disease?
Lifestyle management Allied health management for feeding, communication, mobility Palliative care
74
What is Tourette's Syndrome?
A common neurophysiological disorder
75
How is Tourette's characterised?
By repetitive stereotyped involuntary movement and vocalisations called tics
76
What causes tics?
Dopaminergic imbalances
77
What other conditions are associated with Tourette's?
ADHD and OCD
78
What are examples of movement tics?
``` Shrugging eye blinking head jerking nose twitching swallowing coughing lip twitching ```
79
What are examples of vocal tics?
Grunting Barking Throat clearing Repetitive words
80
What is the cause of Tourette's?
Idiopathic
81
What is the average age for onset of Tourette's?
7-10 years old
82
True or false: Tourette's affects more females than males?
False, affects males 3-4 times more than females
83
How is Tourette's managed?
Medication for suppression of tics

Clinical Medicine - OT (35 decks)

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