Week 3 UMN vs LMN Flashcards
Location for UMN
central nervous system cortex, brain stem, corticospinal tracts, spinal cord
UMN dx/pathology
stroke, TBI, SCI
UMN tone
increased; hypertonia
velocity dependent
UMN reflexes
increased: hyperreflexia,
clonus
exaggerated cutaneous and autonomic reflexes + babinski
UMN involuntary movements
muscle spasms: flexor or extensor
UMN strength
weakness or paralysis: ipsilateral (stroke) or bilateral (SCI)
Corticospinal: contralateral if above decussation in medulla; ipsilateral if below
Distribution: never focal
UMN muscle bulk
disuse atrophy: variable widespread distribution, especially of antigravity muscles
UMN voluntary movements
impaired or absent: dyssynergic patterns, obligatory mass synergies
LMN location of lesion and structures involved
cranial nerve neclei/nerves
spinal cord: anterior horn cell, spinal roots
peripheral nerve
LMN diagnosis/ pathology
polio, Guillain-barre
Peripheral nerve injury
peripheral neuropathy
radiculopathy
LMN tone
decreased or absent: hypotonia, flaccidity
not velocity dependent
LMN reflexes
decreased or absent: hyporeflexia
cutaneous reflexes decreased or absent
LMN involuntary movements
with denervation: fasciculations
LMN strength
ipsilateral weakness or paralysis
limited distribution: segmental or focal pattern, root-innervated pattern
LMN muscle bulk
neurogenic atrophy: rapid, focal distribution, severe wasting
LMN voluntary movements
weak or absent if nerve interrupted
Lesion of cerebral cortex/corticospinal sensation
impaired or absent: depends on lesion location; contralateral sensory loss
Lesion of cerebral cortex/corticospinal tracts diagnosis/patho
stroke
Lesion of cerebral cortex/corticospinal tone
hypertonia/spasticity velocity-dependent; clasp-knife
Initial flaccidity: cerebral shock
Lesion of cerebral cortex/corticospinal reflexes
hyperreflexia
Lesion of cerebral cortex/corticospinal strength
contralateral weakness or paralysis: hemiplegia or hemiparesis
Disuse weakness in chronic stage
Lesion of cerebral cortex/corticospinal muscle bulk
normal during acute stage; disuse atrophy in chronic stage
Lesion of cerebral cortex/corticospinal involuntary movements
spasms
Lesion of cerebral cortex/corticospinal voluntary movements
dyssynergic; abnormal timing, co-activation, fatigability
Lesion of cerebral cortex/corticospinal postural control
impaired or absent, depends on lesion location
impaired balance
Lesion of cerebral cortex/corticospinal gait
impaired: gait deficits due to abnormal weakness, synergies, spasticity, timing deficits
Basal ganglia diagnosis/pathology
Parkinson’s disease
Basal ganglia sensation
not affected
Basal ganglia tone
lead-pipe rigidity: increased, uniform resistance cogwheel rigidity: increased, ratchet like resistance
Basal ganglia reflexes
normal or may be decreased
Basal ganglia strength
disuse weakness in chronic stage
Basal ganglia muscle bulk
normal or disuse atrophy
basal ganglia involuntary movements
resting tremor
basal ganglia voluntary movements
bradykinesia: slowness of movement
akinesia: absence of movement
Basal ganglia gait
impaired: shuffling, festinating gait
Basal ganglia postural control
impaired: stooped (flexed)
impaired balance
Cerebellum dx/patho
tumor, stroke
cerebellum sensation
not affected
cerebellum tone
normal or may be decreased
cerebellum reflexes
normal or may be decreased
cerebellum strength
normal or weak: asthenia
Cerebellum muscle bulk
normal
Cerebellum involuntary movements
none
Cerebellum voluntary movements
ataxia: intention tremor dysdiadochokinesia dymetria dyssynergia nystagmus
Cerebellum postural control
impaired: truncal ataxia
impaired balance
Cerebellum gait
impaired: ataxic gait deficits, wide-based, unsteady
Spinal cord dx/patho
trauma, tumor, vascular insult: complete, incomplete SCI
Spinal cord sensation
impaired or absent below the level of lesion
Spinal cord tone
hypertonia/spasticity below the level of the lesion
initial flaccidity: spinal shock
Spinal cord reflexes
hyperreflexia
Spinal cord strength
impaired or absent below the level of the lesion: paraplegia or paraparesis; tetraplegia or tetraparesis
Spinal cord muscle bulk
disuse atrophy
Spinal cord involuntary movements
spasms
Spinal cord voluntary movements
above level of lesion: intact (normal)
below level of lesion: impaired or absent
Spinal cord postural control
impaired below level of lesion
impaired balance
Spinal cord gait
impaired or absent: depends on level of lesion