Clinical Aspects Of Motor Systems

Question 0

What do you see with issues in muscle strength and Bulk

Answer 0

Paralysis
paresis
Atrophy

Question 1

What do you affect with injury to motor systems

Answer 1

Muscle strength and bulk
muscle contraction
muscle tone
muscle stiffness reflexes

Question 2

What is paralysis

Answer 2

The inability to voluntarily produce a muscle contraction

Question 3

What is paresis

Answer 3

Weakness

can produce a muscle contraction but not as strong as it should be

Question 4

What is hemiplegia

Answer 4

Weakness or paralysis on one side or one half of the body

Question 5

What is paraplegia

Answer 5

Weakness or paralysis in the lower extremities

Question 6

What is tetraplegia or quadriplegia

Answer 6

Weakness or paralysis in all four extremities

Question 7

What is atrophy

Answer 7

Decrease in muscle size

Question 8

What are two kinds of atrophy

Answer 8

Disuse atrophy and

neurogenic atrophy

Question 9

What is the main cause of neurogenic atrophy

Answer 9

Lose the nerve to the muscle

Question 10

Examples of involuntary muscle contractions

Answer 10

Spasms
cramps
fasciculations

Question 11

What might involuntary muscle contractions indicate

Answer 11

May or may not indicate pathology

Question 12

What are fasciculations

Answer 12

One motor neuron becomes over excitable and can cause spontaneous contractions almost like a twitch

Question 13

What are involuntary movements that always indicate a pathological condition

Answer 13

Fibrillations

abnormal movements caused by dysfunction in the basal ganglia

Question 14

What are fibrillations

Answer 14

You lose the nerve that goes to the muscle, fibers become more excitable and some start spontaneously contracting
do not see the movement but can pick up through EMG recordings

Question 15

What are problems in muscle tone

Answer 15

Tension in resting muscles

hypotonia and hypertonia

Question 16

What can cause hypotonia

Answer 16

Transection of the ventral root, peripheral nerve, or dorsal root rhizotomy
injury to the cerebellum: often temporary hypotonia

Question 17

What are the causes of hypertonia

Answer 17

Chronic injury to UMN or some basil ganglia

Question 18

What do you often see in velocity dependent hypertonia

Answer 18

Accompanied by hyperreflexia of DTR
clasp knife phenomenon
clonus

Question 19

What is clasp knife phenomenon

Answer 19

Lot of tone when stretching then quick release

Question 20

What is clonus

Answer 20

Rapid dorsiflex and rapid planter and dorsiflex by patient

Question 21

What is leadpipe rigidity

Answer 21

Hi resistance with constant level of increased tone

Question 22

What is cogwheel rigidity

Answer 22

Increased resistance, gives a little, then repeats

Question 23

What two types of rigidity are seen after severe lesions to the brain

Answer 23

Decorticate rigidity

Decerebrate rigidity

Question 24

Where is the lesion in decorticate rigidity

Answer 24

Superior to the midbrain

Question 25

Where is the lesion decerebrate rigidity

Answer 25

In the midbrain level

Question 26

What do you see in decorticate rigidity

Answer 26

Upper extremity flexion lower extremity extension

Question 27

What do you see in Decerebrate rigidity

Answer 27

Extension upper extremity internal rotation plantarflexion

Question 28

What does decorticate rigidity separate

Answer 28

Separates the cerebral cortex from structures that are caudal to it

Question 29

What does decerebrate rigidity separate

Answer 29

Separates cortex and midbrain from brainstem

Question 30

What happens in spinal or cerebral shock

Answer 30

Descending motor commands are interrupted by injury to upper motor neurons lower motor neurons become temporarily inactivated

Question 31

What does spinal or cerebral shock depend on

Answer 31

The location of the injury

Question 32

What do you see in spinal or cerebral shock

Answer 32

Hypotonia and hyporeflexia that resolves the time

Question 33

What are different causes of disorders of lower motor neurons

Answer 33

Trauma infectious/degenerative/vascular diseases Tumors

Question 34

Where does the injury occur in the nervous system for a disorder of the lower motor neuron

Answer 34

Cell bodies in the spinal cord and brain stem Ventral root spinal and peripheral nerve

Question 35

In an upper motor neuron injury where does the injury occur in the nervous system

Answer 35

Anywhere from where cell bodies are down to where it lower motor neurons are Cell bodies in cerebral cortex axons in the base of the brainstem, cerebral cortex, spinal cord

Question 36

What are abnormal cutaneous reflexes

Answer 36

Babinski sign | muscle spasms in response to normally innoculous stimuli

Question 37

When is the Babinski sign normal

Answer 37

Until six months of age occurring | after injury to the corticospinal tract

Question 38

What causes the Babinski sign

Answer 38

Damage to the lateral corticospinal spinals

Question 39

What happens in paresis

Answer 39

Weakness inability to activate lower motor neurons loss of ability to fractionate movements

Question 40

What is the loss of ability to fractionate movements occur in

Answer 40

Lateral corticospinal tract

Question 41

Myoplastic hyperstiffness post stroke is due to

Answer 41

Loss of sarcomeres increased weak binding of actin and myosin atrophy of muscle fibers

Question 42

What is hyper stiffness

Answer 42

Excessive resistance to muscle stretch

Question 43

What are some changes in muscle fibers after injury

Answer 43

Muscle fiber diameter is decreased | selective atrophy of type two fibers

Question 44

After stroke most patients do not have what

Answer 44

Hyperactive stretch reflexesw

Question 45

Hyperreflexia is seen only in people with

Answer 45

Hemiplegia severe contractures spinal cord injury

Question 46

Evidence suggests that hyperreflexia may result from

Answer 46

Contractures

Question 47

What changes do you see after incomplete spinal cord injury

Answer 47

Contractures hypertonicity predominance of type IIb muscle fibers and a decrease in type one muscle fibers

Question 48

What reflexes do you see after spinal cord injury

Answer 48

Hypertonia Decrease in tonic stretch reflex Clasp knife response clonus

Question 49

Types of upper motor neuron lesions

Answer 49

Spinal cord injury stroke congenital lesions

Question 50

What happens in a complete spinal cord injury

Answer 50

All descending motor control is last below the level of the lesion spinal shock

Question 51

When spinal shock is present at and below the level of lesion what happens

Answer 51

Muscle tone is decreased reflexes are lost voluntary control of movement is lost

Question 52

What happens in spinal shock resolves

Answer 52

Tone is increased monosynaptic reflexes are increased polysynaptic reflexes are decreased voluntary muscle control paresis

Question 53

What happens in a stroke

Answer 53

Occlusion or hemorrhage of a blood vessel in the CNS

Question 54

What does occlusion produce

Answer 54

Lack of blood flow | ischemic stroke

Question 55

What is the most common site for a stroke

Answer 55

Middle Cerebral artery

Question 56

What does an MCA stroke do

Answer 56

Disrupt connections between the cerebral cortex and the brainstem spinal cord and cerebellum damages adult upper motor neuron's

Question 57

What do you see when adult upper motor neuron's are damaged

Answer 57

Paresis | loss of fractionation of movement

Question 58

What also might be damaged in an MCA stroke

Answer 58

Communication systems and sensory systems

Question 59

What does an MCA stroke affect on motor systems

Answer 59

``` Abnormal muscle in activation Corticospinal is decreased lateral reticulospinal is decreased medial reticulospinal is active the vestibulospinal is active ```

Question 60

Standing posture of MCA stroke in the hemiparetic upper extremity

Answer 60

Contracture Weak actin-myosin bonds atrophy of type two muscle fibers

Question 61

MCA stroke standing posture in the lower extremity

Answer 61

Excessive extension in standing and walking

Question 62

What is a congenital disorder of upper motor neuron

Answer 62

Spastic cerebral palsy

Question 63

What do you see in spastic cerebral palsy

Answer 63

Abnormal tonic stretch flexes at rest and while moving Reflex irradiation abnormal cocontraction of antagonist muscles lack of postural preparation prior to movement

Question 64

Signs more common with spinal cord injury

Answer 64

Hyperreflexia of phasic stretch reflexes clonus clasp knife phenomenon

Question 65

Signs common with congenital disorders

Answer 65

Abnormal Co-contraction of antagonistic muscles | Reflex irradiation

Question 66

Upper Motor neuron injury signs and symptoms

Answer 66

``` Paresis fasciculations spasticity hyperreflexia Babinski sign clonus Muscle hyper stiffness Abnormal cutaneous reflexes abnormal timing of muscle activation ```

Question 67

Lower motor neuron signs and symptoms of injury

Answer 67

``` Fibrillations atrophy that is rapid and severe paralysis Loss of reflexes Flaccid paralysis ```