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clps 0450 > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

Define Apraxia

A

Disorder of Skilled Movement

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2
Q

List traits that are NOT caused by Apraxia

A

1) Impaired primary motor ability
- weakness, akinesia, deafferentation
- abnormal tone or posture, primary movement disorder

2) Impaired comprehension

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3
Q

In right handers where are the focal lesions associated with?

A

The left hemisphere
Right hand is often paralyzed
- Often have hemiplegia; test it in left (nondominant) hand

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4
Q

What are the 4 types of Clinical Assessments used for apraxia patients?

A

1) Limb Gesture
2) Limb Manipulation
3) Buccofacial Gesture
4) Buccofacial Manipulation

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5
Q

Give an example of a Limb Gesture

A

Wave goodbye

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6
Q

Give an example of a Limb Manipulation

A

Open a door with a key

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7
Q

Give an example of a Buccofacial Gesture

A

Stick out toungue

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8
Q

Give an example of a Buccofacial Manipulation

A

blow a kiss

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9
Q

What is the grading of questions used in a clinical assesment for an apraxia patient?

A

pantomime -> imitation -> object use

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10
Q

Define Ideomotor/Ideational Apraxia

A

Clumsy; difficulty with the selection, sequencing, and spatial orientation of movements
- Often use body-parts as objects

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11
Q

Why do patients rarely complain of apraxic disturbances?

A
  • Often paralyzed in right arm
  • Attribute clumsiness to using nondominant hand
  • Apraxia most severe when asked to pantomime a skilled act, and mildest when actually using the object
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12
Q

What did Geschwind think caused apraxia?

A

Geschwind invoked a language mechanism: Localized to LH

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13
Q

Describe the pathway that Geschwind proposed?

A

Right Hand
- Command goes from Wernicke’s to premotor to primary motor in LH

Left Hand
- Command must also pass through Wernicke’s to pre-motor in LH, then to premotor in RH

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14
Q

Geshwind’s Patient #1

What part of his brain was damaged?
Describe his behavior

A

Damage
- The anterior fourth fifths of corpus collosum

Behaviour
- Would carry out command with right arm correctly
- When given commands to use left arm, would make no or incorrect response
- Could imitate or use actual object with left arm

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15
Q

In terms of Geschwinds pathway, what function was impaired in patient #1?

A

Patient #1
- Verbal information could not reach RH to control left hand

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16
Q

Why could patient #1 imitate?

A

He could perform those functions because they were not dependent on language

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17
Q

Patient #2 had damage in his left premotor region

Describe his impairments

A
  • Paralysis of right limbs
  • Failure to carry out commands in left limbs
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18
Q

Patient #3 had damage in the pathway between wernickes and premotor area in the left hemisphere

Describe his impairments

A
  • No paralysis in either arm
  • Apraxic in left and right arms

language can not get to the premotor area in both hemispheres

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19
Q

List reasons that disprove Geshwinds pathway

A

1) Other studies have not found a close relationship between aphasia apraxia

2) Unlike Geschwind’s patient, most apraxia patients are impaired on imitation

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20
Q

Describe why apraxic patients being impaired in imitation might disprove Geshwinds pathway?

A

If apraxia is due to disconnection of language areas, then these patients should be able to imitate - but they can not

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21
Q

what did Liepman & Mass propose?

A

1) Left hemisphere is not only dominant for language
2) Left hemisphere contains motor engrams

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22
Q

Why is left hemisphere dominant for

A
  • Superiority of right hand is not just in greater strength, but greater skill
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23
Q

Describe motor engrams?

A
  • “movement formulas”
  • “time-space-form picture” of movement
  • skill of left hand is “borrowed” from the left hemisphere
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24
Q

What is the broad reasoning behind why most apraxic patients can’t imitate

A

A Callosal region accounts causes accounts for function of language and motor engrams

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25
Q

Describe the effects of a callosal lesion?

What does this account for

A

1) Disconnects language
2) Separates left hemisphere motor engrams from the motor areas of the right hemisphere

Accounts for finding that the left hand of patients with right hemiplegia is more clumsy than that of people who broke their right hand

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26
Q

Where is the motor engram of a left-handed person located?

A

On their right hemisphere

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27
Q

Where are motor engrams stored?

A

In the parietal lobe of dominant hemisphere

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28
Q

What causes ideomotor apraxia?

A

1) Damage to SMG/AG
2) Disconnection of SMG/AG from premotor areas

29
Q

What impairments arise when A) SMG/AG is damaged

B) Disconnection of AMG/AG from premotor areas

A

A) Impaired at performing to command and imitation

B) Impaired at discriminating poorly-performed from well-performed acts AND Impaired at performing to command and imitation

30
Q

What experiment did Heilman conduct to distinguish between

A) impairments caused by damage to the motor engrams

VS

B) damage to the pathway between motor engrams and the premotor cortex

A

Gesture comprehension test
- watched film of person performing pantomimed acts
a) well-executed
b) clumsily performed

31
Q

What is skill?

A

In learning a skill, a performer must combine appropriate movements into bth the correct and serial order and correct temporal pattern within that order

32
Q

what does skilled performance involve?

A

The ** refinement through** practice of the sequencing and timing of the movements underlying a task

33
Q

What is skilled performacne relfected in?

A

1) More coordinated and rapid performance
2) Economy of effort and muscle groups used to perform the task

34
Q

Whta are the 3 stages of Skill Acqusition?

Which phases are controlled and attentional? Which aare automatic?

A

1) Cognitive Phase
2) Associative Phase
3) Autonomous Phase

Cognitive and Associative Phases = Controlled and Attentional

Autonomus phase = Automatic

35
Q

Describe the Cognitive Phase (2)

A
  • Identify strategy to accomplish task
  • Verbalize each part of task
36
Q

Describe the Associative Phase (3)

A
  • Component parts of skill tried out
  • Set of action components assembled
  • Knowledge of results/feedback
37
Q

Describe the Autonomous Phase (3)

A
  • Autonomization of component processes
  • Reduction in attentional demands
  • Loss of ability to verbalize describe task
38
Q

What is the key to automatization?

A

Predictability

39
Q

The development of skill iccurs between the transition of what phases?

A

Between Associative and Autonomous phases

40
Q

Which of the stages of skill acquisition are associated with closed-loop control?

open loop?

A

Closed Loop
- Cognitive Phase
- Associative Phase

Open Loop
- Autonomous Phase

41
Q

Describe the closed loop mode of control

A
  • Reliant on feedback
  • Lag time > Reaction Time

Ex. A tracking task, with an unpredictable visual stimulus (engaging in this move-feedback-move mode)

42
Q

Describe the open loop mode of control

A
  • Internal Predictive control
  • Lag Time < Reaction Time

Ex. A tracking task, with a predicitable visual stimulus. The movement of the stimulus is in the shape of a triangle

43
Q

What is the key to internal open-loop control

A

Motor Programs

44
Q

Describe Motor Programs

A

1) Organize sequence in advance of execution
2) Not dependent on feedback from prior movement

  • Sequence of actions that allow us to participate and engage without relying on feedback
45
Q

What is an example of a simple motor program?

A
  • triphasic EMG pattern in ballistic movements (ex. a throwing movement)
46
Q

What are examples of complex motor programs?

A
  • Golf swing
  • Shifting car gear
  • Written signature

Independent of muscle groups (writing name on paper vs. a whiteboard)

47
Q

What are pieces of evidence for motor programs

A

1) Independence from sensory feedback
2) Preprogramming of responses

Skill learning involves the qcquisition of increasingly more accurate motor programs
- Allows you to engage in predictive, open-loop, and automatic behaviour

48
Q

When is feedback most critical and why?

A
  • Feedback is critical at teh begninng stages of skill acquisition
  • Initial stage involves development of template of how skill is performed
  • Feedback from movement is compared to template
49
Q

What are movement templates and motor programs?

A

Distinct memory representationS

50
Q

Describe Motor Program

A
  • Memory representation that generates skilled movements
  • Can only be aquired by doing
  • Inaccessible to consiousness, non-verbalizable
51
Q

Describe Motor Engram

A
  • Memory representation that is used in early stages of skill acquisition and that is used to evaluate sensory feedback
  • Can be aquired by doing and watching and listening
  • Consciously accessible, verbalizable
52
Q

Describe the Contention Scheduling Mechanism
(Horizontal Pathway on the SAS Model)

A

1) Potential schema compete with each other to determine activation levels
2) Selection takes place on basis of activation level alone

53
Q

Describe the Supervisory Attentional System
(Vertical on the SAS Model)

A
  • Attention has only biasing role in motor program selection
  • Action will be initiated if trigger conditions are well met, despite one’s desire to select another action

Example: Saying the color of a text even if the text is a word for a color
- When you are on “auto-pilot”, take the road home even though you are going to another place

54
Q

What is a notabl part of the brain and motor circuit?

A

The striatum

55
Q

What is the function of the striatum?

A

Striatum involved in motor programing
- Contention scheduling
- Cells respond to direction, amplitude, force of movement

56
Q

Given the striatum’s role in the motor circuit, what would damage to this area result in?

A
  • Instensive impairment in the ability to display motor programing and develop motor skills
57
Q

What is Huntington’s Disease?

A

1) Inherited neurodegenerative disorder
- Autosomal dominant
- Onset 35-55 years

2) Profound loss of cells in neostriatum (80-90%)

3) Choreiform movements (writhing, dance like movements)

4) Progressive dementia

Disrupted Motor Programming

58
Q

Describe a Huntingtons patient’s performance in tracking a predictable stimulus

What does this tell us?

A
  • Improved over first few blocks by using early attentional (error-correction) strategy
  • Impaired at developing more effective predictive mode of performance

Hungtinton’s is associated with impaired motor programming

59
Q

Describe the Parkinson’s in terms of the motor circuuit pathway

A
  • Damage in pathway that provides dopamenergic input to the basal ganglia
  • Impaired modulatory input to the striatum
60
Q

What is Parkinson’s Disease?

A

1) Neurodegenerative disorder
2) Loss of pigmented cells in substantia nigra
3) Classic motor triad
4) Impaired activation of motor programs

61
Q

Define the Classic Motor Triad

A

1) Resting tremor
2) Rigidity
3) Bradykinesia (slowless of movement)

62
Q

Describe Parkinson’s patient in terms of the motor programming

A

1) Intact motor programming per se
2) Impaired activation of intact motor programs

63
Q

Describe how Parkinson’s patients have intact motor programming per se

A
  • Normal tracking performance
  • Normal pre-programming of movement sequence
  • Kinesia paradoxia can perform complex movements easilty with extremeley salient stimulus
64
Q

Describe how Parkinson’s patients have impaired activation of intact motor programs (modulatory input)

A
  • Bradykinesia
  • Increased attention or “will” to activate shemas

More conflicts not resolved
- interference between programs
- increased difficulty doing two tasks at once

65
Q

What stage are motor engrams involved in?

A
  • Accessibile to consciousness
  • Recall explicit traces of how that act is performed (e.g., visual template)
  • Motor programs are not accessible to consciousness (triggered automatically)
66
Q

Describe Apraxia Disorder of “Quasi-Skilled Movement”

A

1) Disruption of motor engrams associated with controlled system used during the early stages
2) Sparing of motor programs associated with automatic system underlying skilled behaviour

67
Q

How is apraxia assessed?
what does this indicate?

A

Apraxia is assessed very artificially

Some improve with imitation; almost all improve with the actual object

Often perform the skill normally in proper context!!!

when asked “show me how you bow” causes patient to consiously think of the engram

68
Q

Describe how context informs motor programs

A

As context more closley matches trigger conditions, it is more likley that motor program can beactivated via the automatic (open-loop) system

69
Q

Describe Early Stage Skill Learning in Apraxia

A

Impaired performance on early stage of skill learning in tracking task.

Apraxic patients can’t get past early phase to aquire new skills

Huntington patients were able to learn through the first blocks, then began to show impairments

clps 0450 (9 decks)

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