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Neuroscience > Week 5: Motor Impairments > Flashcards

Week 5: Motor Impairments Flashcards

1
Q

Define sign vs. symptom:

A

sign is objective and symptom is subjective

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2
Q

a positive sign is an indication that:

A

there is a presence of an abnormal behavior

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3
Q

a negative sign indicates a:

A

absence of normal behavior

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4
Q

A primary impairment is:

A

a direct effect of the pathology or lesion

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5
Q

a secondary impairment develops as:

A

a result of the original problem

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6
Q

Upper motor neuron lesions effect the:

A

motor cortex
descending motor tracts
brainstem
spinal cord proximal to alpha motor neurons

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7
Q

lower motor neurons effect:

A 
alpha motor neurons
ventral root
motor nerve plexus
peripheral motor nerve
neuromuscular junctions
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8
Q

What sign do we see with upper motor neurons?

A

weakness, increased reflexes and increased tone

no effects on atrophy or fasciculations

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9
Q

what signs do we see with lower motor neurons?

A

weakness, atrophy, fasciculations, decreased reflexes and decreased tone

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10
Q

With a stroke, what signs will we see?

A

weakness, hypertonicity and hyperreflexia

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11
Q

with a brachial plexus injury, what signs do we see?

A

weakness, atrophy, fasciculations, decreased tone and decreased reflex

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12
Q

Neural contributions to strength reflect:

A 
# of motor units recruited
type of motor units recruited 
discharge frequency
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13
Q

musculoskeletal contributions to strength reflect:

A 
length/tension relationship
length of movement arm of the muscle
cross sectional area available
type of muscle fiber 
muscle fiber arrangement
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14
Q

What is weakness in the context of neuropathy?

A

inability to generate force or inability to correctly recruit or modulate motor neurons

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15
Q

muscle weakness leads to:

A

loss of movement and loss of power

lack of muscle activity and immobility

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16
Q

neurologically induced weakness may result from:

A 
cortical lesion
descending pathway injury
peripheral nerve injury
synaptic dysfunction at neuromuscular jxn
muscle tissue damage
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17
Q

extent and distribution of weakness depend on:

A

extent and location of lesion

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18
Q

paralysis or plegia is:

A

total or profound loss of muscle activity

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19
Q

paresis is:

A

mild or partial loss of muscle activity

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20
Q

what are the 4 categories of distribution?

A

tetraplegia
monoplegia
hemiplegia
paraplegia/ diplegia

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21
Q

Impaired motor control is often worse with:

A

stress, distraction, fatigue

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22
Q

Motor recruitment is:

A

agonist activation + reflexive inhibition of antagonist

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23
Q

What are synergies?

A

Muscle and joint movements that occur in stereotypical patterns

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24
Q

synergies are the loss of:

A

single joint, isolated movement patterns

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25
Q

What is the upper extremity flexor synergy?

A 
scapula retraction and elevation
shoulder abduction and ER
elbow flexion
supination wrist 
finger flexion
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26
Q

What is the extension synergy in the lower extremity?

A

Hip extension, adduction and internal rotation
knee extension
ankle plantar flexion and inversion
toe plantar flexion

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27
Q

What are the myotomes we are responsible for knowing (C5 - T1) and (L1 - S1)

A 
C5 - shoulder ABD
C6: elbow flexion and wrist extension
C7: elbow extension and wrist flexion
C8: finger flexion and thumb extension
T1: finger adduction
L1 - L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: great toe extension
S1: plantar flexion
S2: Knee flexion
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28
Q

When we look at myotomes, our patient should be _________ and __________ movements should be observed

A

seated; isolated

29
Q

stretch reflex dysfunction is damage to:

A

supraspinal structures involved in reflex modulation such as
——–the cerebellum and the corticospinal tract, reticulospinal tract, rubrospinal tract, —- ——–vestibulospinal tracts
spinal cord (interneurons and motor neurons)
sensory feedback systems

30
Q

hyporeflexia (or areflexia) is a __________ motor neuron injury

A

lower

31
Q

hyperreflexia is a ___________ motor neuron injury

A

upper

32
Q

What neuroanatomical structures are involved with hyporeflexia?

A

alpha motor neuron and sensory neuron

33
Q

what neuroanatomical structures are involved in hyperreflexia?

A

supraspinal structures and spinal cord structures

34
Q

What deep tendon reflexes are we responsible for knowing?

(C5 - C7), L4 and S1

A 
C5 - biceps
C6 - brachioradialis
C7 - triceps
L4 - patella (quadriceps)
S1 - Achilles (gastrocsoleus complex)
35
Q

What are the deep tendon reflex grades?

A 
0: absent
1+ hyporeflexia
2: normal
3+ hyperreflexia
4+ hyperreflexia with nonsustained clonus
5+ hyperreflexia with sustained clonus
36
Q

A positive babinski’s test is characterized by:

A

fanning or extension of the toes to a stimulus

37
Q

Tone is characterized by:

A

a muscle’s resistance to passive stretch

38
Q

tone represents a state of:

A

slight residual contraction in normally innervated resting muscle (steady-state contraction)

39
Q

What are contributions to normal tone influenced by?

A

physical inertia
intrinsic mechanical elastic reflex
spinal reflex muscle contraction or tonic stretch reflex

40
Q

the spinal reflex muscle contraction consists of:

A

a net balance of descending input on motor neurons from corticospinal, rubrospinal, reticulospinal, and vestibulospinal tracts

cerebellar input

41
Q

hypotonicity is characterized by:

A

reduction in passive resistance to lengthening

floppy - collapse into gravity, harder to excite

flaccidity - complete loss of muscle tone

42
Q

hypotonicity is caused by

  • afferent input from:
  • lack of _____________ efference influence
  • decreased input to:
A

stretch reflex
cerebellar
gamma motor neurons

43
Q

what are the common pathologies that can cause hypotonicity?

A
  • cerebellar lesions, down syndrome, late-stage ALS, muscular dystrophies, and post-polio
  • acute CNS injuries that can progress to hypertonicity/spasticity once subacute or chronic
  • can see with PNS injuries and connective tissue disorders
44
Q

What is speed dependent?

A

spasticity

45
Q

what is resistant to movement and independent of movement velocity?

A

rigidity

46
Q

Spasticity occurs as a result of damage to:

A

descending pyramidal tracts

causes a loss of inhibitory effect on tonic stretch reflex and results in alterations to the threshold of reflex

47
Q

spasticity CAN be associated with ___________, a condition that is more common in distal extremities than proximal

A

clonus

48
Q

clonus and spasticity are characterized as a ___________ and oscillating stretch reflex.

A

rhythmic

49
Q

What is commonly seen with basal ganglia dysfunction?

A

rigidity

50
Q

rigidity is more commonly seen in our __________

A

flexors

51
Q

Define the phrases that are associated with rigidity:
Lead pipe
cogwheel
clasp - knife

A

lead pipe = constant resistance to movement throughout the entire ROM
cogwheel = alternating episodes of resistance and relaxation
clasp knife = initial rigidity with sudden absence throughout the remainder of range

52
Q

What kind of posturing will we see when there is a brainstem lesion above the red nucleus? Describe what that posturing looks like.

A

decorticate; UE flexion, LE extension/ IR/ and PF

53
Q

What kind of posturing will we see when there is a brainstem lesion below the red nucleus? Describe what that posturing looks like.

A

decerebrate: UE and LE extension

54
Q

What are functional implications associated with someone who has high tone?

A

abnormal posturing
misalignment
high risk of injury during prolonged sitting (skin breakdown)
bias with recruitment and increased likelihood of synergistic movement
destabilization with changes in position

55
Q

What are the functional implications associated with someone who has a lower tone?

A

fall into gravity

high risk of injury associated during dynamic tasks

56
Q

Tone assessment in UE consists of what motions at the shoulder, elbow, wrist, and hand?

A

shoulder - flex/ext. and IR/ER
elbow - Pronation/supination and flexion/extension
wrist - flex/extension
fingers - flex/extension

57
Q

Tone assessment in LE consists of what motions at the hip, knee, ankle, and foot?

A

hip - abd/add. and flex/exten. and IR/ER
knee - flexion and ext.
ankle - DF and PF
foot - toe flex. and extension

58
Q

What test measures spasticity and spasticity alone?

A

modified ashworth scale

59
Q

Describe what happens at V1, V2, and V3 on the Tardieu scale.

A

V1 - slow as possible - PROM assessment
V2 - speed of limb falling under gravity - Spasticity assessment
V3 - fast as possible - spasticity assesment

60
Q

Dystonia is seen when there is damage to:

A

the basal ganglia

61
Q

A syndrome dominated by sustained muscle contractions that causes twisting, repetitive movements, and abnormal postures is called:

A

dystonia

62
Q

What are the 5 characteristics of dystonia?

A
  • damage to the basal ganglia
  • syndrome dominated by sustained muscle contractions
  • causes twisting, repetitive movements, and abnormal postures
  • coactivation of agonist and antagonist
  • focal, segmental, hemibody or generalized/ whole
63
Q

rhythmic, involuntary oscillatory movements of a body part are called:

A

tremors

64
Q

What are resting tremors?

A

occurs in the body part that is not voluntarily activated, relaxed

65
Q

what are action tremors?

A

tremors produced by voluntary contraction of a muscle

66
Q

Name and describe the 2 types of action tremors?

A

postural tremors - person maintains a part of body against gravity
intention tremors - produced with purposeful movement

67
Q

Slow, writhing and twisting movements typically found in the UE more than in the LE are characterized by a disorder called:

A

athetosis

68
Q

involuntary, rapid, irregular, and jerky movements seen with Huntington’s disease are characterized by a condition called?

A

choreiform

Neuroscience (10 decks)

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