Week 6: Motor and Sensory Function

Question 1

Somatic nervous system

Answer 1

innervates skeletal muscle (voluntary muscle);

provides sensory and motor innervation to all parts of the body

• touch, pain, temperature, position

Question 2

autonomic nervous system

Answer 2

innervate smooth muscle (involuntary muscle) in the intestines, sweat and salivary glands, myocardium, and some endocrine glands. The autonomic nervous system functions as a unit to maintain constancy in the internal environment

Question 3

nerve root

Answer 3

Nerve root: portion of the peripheral nerve that connects the nerve to the spinal cord

Question 4

dorsal

Answer 4

Dorsal: where incoming sensory nerves comes to synapse

Question 5

ventral

Answer 5

Ventral: where motor nerves exit the spinal cord

Question 6

Why are peripheral nerves called inert tissues?

Answer 6

not contractile

Question 7

What are some morphological factors that contribute to muscular strength?

Answer 7

• cross sectional area
• fibre arrangement, pennation increases strength
• tendon stiffness: stiffer tendon, increased force production

Question 8

What are some ways muscular strength can be measured?

Answer 8

• max single rep effort
• manual muscle testing
• hand held dynamometer
• modified sphygmomanometer (grip strength)

Question 9

What could cause drop foot?

Answer 9

lesion at L4. disc herniation

Question 10

Myotomes
- define
- what would happen if a lesion to a single nerve root occured?
- objective of myotome testing?

Answer 10

are defined as groups of muscles that are predominantly supplied by a single nerve root

A lesion of a single nerve root is usually associated with paresis (incomplete paralysis) of the myotome (muscles) supplied by that nerve root

objective: identify which nerve root is responsible for pathology; potential lesion

Question 11

How to test myotome? basically methodology

Answer 11

The examiner should place the test joint or joints in a neutral or resting position and then apply a resisted isometric force

The contraction should be held for at least 5 seconds and repeated 3 times to show if there is fatiguable weakness.

Positive findings indicate neurological impairment as opposed to muscle weakness

Question 12

What are the actions of the lower limb myotomes?

Answer 12

Kick!
L1-L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: toe extension

S1: plantarflexion and eversion

S2: hip extension and knee flexion

S3: knee flexion

Question 13

What are the actions of the upper limb myotomes

Answer 13

yes, listen, huh, salute, at rest, woof, piano

C1-C2: neck flexion
C3: neck side flexion
C4: shoulder elevation
C5: shoulder abduction
C6: elbow flexion and wrist extension
C7: elbow extension, and wrist flexion
C8: thumb extension and ulnar deviation
T1: hand intrinsics (abduction and adduction)

Question 14

negative features:

Answer 14

lessening or absence of normal behaviours

Question 15

positive features

Answer 15

excess or change in normal function

Question 16

Define: upper motor neuron syndrome

• negative features
• positive features

Answer 16

Includes lesions involving the corticospinal pathways; Levels of involvement include: brainstem, spinal cord, Cortex, internal capsule

• weakness, slowness of movement, impaired condition

+ spasticity, hyperactive muscles, rigidity, intensional tremors, dystonia

Question 17

spasticity

Answer 17

hyperexcitability of the muscle - constant problem (example: CP)

Question 18

dystonia

Answer 18

neurological movement disorder characterized by involuntary (unintended) muscle contractions that cause slow repetitive movements or abnormal postures that can sometimes be painful

Question 19

Define: lower motor neuron syndrome

• symptoms
  + symptoms

Answer 19

Damage to lower motor neuron cell bodies or their peripheral axons

Negative features: Paresis (weakness), Hyporeflexia (decreased or absent reflex response), Rapid atrophy, Fatigue

Positive features: Fasciculations (involuntary muscle contractions), Spasms

Question 20

paraesthesia

Answer 20

Paresthesia can be defined as an abnormal sensation of pins and needles, numbness, or prickling

Question 21

Sensibility

Answer 21

describes the neural events occurring at the periphery, nerve fibers, and nerve receptors.

Question 22

What is a pain gait

Answer 22

provides additional sensory input to override pain (pressure, touch, vibration, etc.) - TENS machine

Question 23

Anterior spinothalamic tract

Function

decussates?

Answer 23

• light touch and pressure

yes

Question 24

Dorsal Column – Medial Lemniscal tract

function

decussates?

Answer 24

proprioception

vibration

fine touch

yes

Question 25

What happens if theres a lesion somewhere in the dorsal column medial lemniscal pathway?

Answer 25

- Loss of discrimination: the patient cannot differentiate a single touch from a two-point touch. - Loss of vibration sense: the patient cannot perceive the vibration of a tuning fork placed on a bone. - Loss of sense of position and movement: the patient cannot state the position of his body in space, without visual input.

Question 26

lateral spinothalamic tract function decussates?

Answer 26

Pain Temperature yes decussates

Question 27

ALP, DPFV, LPT

Answer 27

A little parrot, dove past ferrets, veerring left past tarots Anterior spinothalamic tract Light Touch Pressure Dorsal-column medial lemniscus Proprioception Fine touch Vibration Lateral spinothalamic tract Pain Touch

Question 28

Dermatome

Answer 28

A dermatome is defined as the area of skin supplied by a single nerve root. The area innervated by a nerve root is larger than that innervated by a peripheral nerve

Question 29

How can you test dermatomes?

Answer 29

- pain: pin prick vs blunt- ask if they can feel it - light touch: tap the person's skin with a piece of cotton or your finger tips, avoid dragging cotton or finger across skin - proprioception: hold the distal phalanx between two fingers, move the finger up and down so the person understands which direction is up an down, ask them to close eyes and move the joint up or down and ask them to say outloud which direction their joint moved. begin with large movements and then gradually reduce size of movements. begin with distal digits then move proximally

Question 30

reflex

Answer 30

involuntary, predictable, and specific response to a stimulus dependent on an intact reflex arc

Question 31

Types of Reflexes

Answer 31

Deep tendon reflexes Proprioceptive reflexes Cutaneous reflexes

Question 32

Describe what makes up a reflex arc

Answer 32

afferent sensory neuron efferent motor neuron interneurons muscle

Question 33

Hyporeflexia

Answer 33

An absent or diminished response to tapping. It usually indicates a disease that involves one or more of the components of the two-neuron reflex arc itself.

Question 34

Hyperreflexia

Answer 34

Hyperactive or repeating (clonic) reflexes These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways.

Question 35

deep tendon reflex - define

Answer 35

deep tendon reflex (DTR) results from stimulation of the stretch sensitive IA afferents of the neuromuscular spindle producing muscle contraction via a monosynaptic pathway

Question 36

if DTRs are increased or decreased, what does this indicate?

Answer 36

DTRs are increased in upper motor neuron syndrome (e.g., stroke) and decreased in lower motor neuron syndrome (e.g., peripheral neuropathy, nerve root compression), cerebellar syndrome, and muscle disease.

Question 37

deep tendon reflex testing objective and methodology

Answer 37

DTR objective: determine if there is an upper motor neuron syndrome or lower motor neuron syndrome causing patient's sympatmology DTRs are tested by tapping sharply over the muscle tendon with a standard reflex hammer or with the tips of the therapist’s fingers. They are then rated from 0-4 - 0 = absent (areflexia) 1 = diminished (hyporeflexia) 2 = average (normal) 3 = exagerrated 4 = clonus, very brisk (hyperreflexia)

Question 38

Discuss the site of stimulus and expected resonse when checking the DTR of: - biceps - triceps

Answer 38

- biceps: biceps tendon; expect bicep contraction; C5-C6 - triceps: distal triceps tendon above the olecranon process; elbow extension/ muscle contraction, C7-C8

Question 39

Describe Hoffman's reflex test Objective Methodology Findings

Answer 39

objective: verify the presence or absence of an issue arising from the corticospinal tract loosely holding the middle finger and flicking the fingernail downward, allowing the middle finger to flick upward reflexively A positive response is seen when there is flexion and adduction of the thumb on the same hand. Eg. in hypertonia, the tips of other fingers flex and the thumb flexes and adducts.

Question 40

Discuss the site of stimulus and expected resonse when checking the DTR of: - patellar - achilles - hamstring

Answer 40

patellar: patellar tendon, leg extension, L3-L4 achilles: achilles tendon, plantarflexion of foot, S1-S2

Question 41

clonus test - objective - methodolgy - findings

Answer 41

- objective: determine if upper motor neuron syndrome or lower motor neuron syndrome - methodology: extend the wrist or dorsiflex subject's ankle, then quickly apply overpressure. - the subject's movements should oscillate 1-2 beats but more than 3 beats is a positive sign and indicative of UPNS

Question 42

babinski - objective - methodolgy - positive findings

Answer 42

- objective: determine if upper motor neuron syndrome or lower motor neuron syndrome methodology: stroke lateral aspect of sole of foot positive sign: big toe extends and small toes fan out Corticospinal tract disruption (pyramidal). upper motor neuron syndrome

Question 43

if a person can't smell coffee, what nerve is affected?

Answer 43

cranial nerve 1 - olfactory

Question 44

if a person can't see fingers in their peripheral vision, what nerve is affected?

Answer 44

cranial nerve 2 - optic

Question 45

if a person's pupils don't constrict in response to shining light, and/or can't smoothly pursuit an object up or down, what nerve is affected?

Answer 45

CN3- occulomotor

Question 46

if a person can't follow an object diagonally in their field of vision smoothly - what nerve is affected?

Answer 46

CNIV (4) - trochlear

Question 47

if a person can't feel sensation on their face, or if their jaw muscles can't open and close well what nerve is affected?

Answer 47

CNV - trigeminal

Question 48

if a person can't follow an object laterally or they say they have double vision, what nerve is affected?

Answer 48

CNVI - abducens

Question 49

if a person can't raise their eyebrows, close eyes, smile, or puff cheeks normally, what nerve is affected?

Answer 49

CNVII - FACIAL

Question 50

if a person has different hearing acuity between ears, what nerve is affected?

Answer 50

CNVIII - auditory/vestibulocochlear

Question 51

if a person has a lack of gag reflex what nerve is affected?

Answer 51

CNIX - glossopharyngeal

Question 52

if a person has asymmetrical elevation of the palate when asked to say ahh, what nerve is affected?

Answer 52

CNX - vagus

Question 53

if when a person protrudes their tongue and it deviates from the midline, what nerve is affected?

Answer 53

CNXII - hypoglossal