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Neuro exam 1 - Rivera > Lecture 3: Upper and Lower Motor Neuron Pathology > Flashcards

Lecture 3: Upper and Lower Motor Neuron Pathology Flashcards

1
Q

Golgi Tendon Organs (GTO) structure

A

-Encapsulated receptor located at the musculotendinous junction
-In series (follows in line with tendonitis fibers) with extrafusal fibers/sensory organ
-2-50 GTO per muscle
-Innervated by afferent fiber branches, 1b by which the distal and the proximal parts of the tendon-spindle are innervated

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1
Q

GTO function

A

1) Detect small change in muscle contraction (<1g force)
2) Sensitive to twitch contractions
3) Compensate for fatigue in motor units
4) May facilitate for inhibit muscle contractions
5) Reflex regulation of alpha motor neuron activity
6) Context and task dependent
7) Determines FORCE and speed and organizes it so that we do not get fatigued as easily
8) Stimulates the alpha motor neuron to regulate like a police
9) Able to shut the muscle down if needed

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2
Q

GTO Mechanoreceptors

A

-Monitoring and regulating the tension of muscle force
-Prevents muscle damage

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3
Q

what does the GTO inhibit

A

its own muscle Autogenic inhibition

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4
Q

How does autogenic Inhibition work

A
  • 1B innervation at the tendinous junction
    -Stimulated by tension of the muscle to the tendon
    -Too much force = Inhibitory interneuron inhibits muscle contraction (also called inverse stretch reflex)
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5
Q

Muscle Spindle axon

A

1a sensory

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6
Q

muscle spindle functioning

A

monitoring length and velocity of the muscle

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7
Q

Muscle spindle activation

A

tendon reflex

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8
Q

gamma motor neurons axon

A

2 (motor)

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9
Q

gamma motor neurons function

A

resetting the muscle spindle after activation

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10
Q

gamma motor neurons activation

A

brain modulats muscle spindle to stretch

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11
Q

GTO axon

A

1B (sensory)

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12
Q

GTO function

A

monitoring and regulating the tension of the muscle force. workload distributor

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13
Q

GTO activation

A

inverse stretch reflex

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14
Q

alpha motor neuron axon

A

alpha motor

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15
Q

alpha motor neuron function

A

activates the muscle

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16
Q

alpha motor neuron activation

A

force production

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17
Q

Upper motor neuron Definition of a Syndrome Involves

A

-Motor cortex and pathways
-brainstem
-cerebellum
-Spinal cord reflex and coordination

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18
Q

Upper motor neuron neurologic signs and symptoms

A

postures, postural responses, movements (passive and active) and involuntary responses that correspond with an upper motor neuron lesion

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19
Q

Lower motor neuron Syndrome

A

-injury resides in the anterior horn cell or peripheral nerve
- involves the peripheral nerve or cranial nerves

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20
Q

what is an upper motor neuron syndrome the result from

A

the disruption of central motor pathways that arise from the cerebral cortex and pathways in the spinal cord

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21
Q

Pathways (connection to motor system)

A

1) Corticospinal tracts
2) corticobulbar tracts
3) lateral and medual reticulospinal tracts
4) lateral and medial vestibulospinal tracts
5) rubrospinal tracts
6) tectospinal tracts

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22
Q

Classic Upper Motor Neuron Syndrome weakness

A

loss of CNS drive

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23
Q

Classic Upper Motor Neuron Syndrome Spasticity

A

increase in muscle tone with a velocity - based muscle stretch (changes in tone)

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24
Classic Upper Motor Neuron Syndrome decreased muscle control
changes in selective function
25
Classic Upper Motor Neuron Syndrome Hyperreflexia or exaggerated deep tendon reflexes
increase muscle response to tendon tap
26
Classic Upper Motor Neuron Syndrome clonus
repeated rhythmic contractions of individual muscle groups
27
muscle tone definition
Resistance to passive stretch as a patient is attempting to maintain a relaxed state of muscle activity
28
muscle tone reflexes
-Muscle state (at relaxation): test at every joint flextion/extention, Ab.Ad -Independent of strength, coordination or involuntary movement
29
Range of muscle tone hypo to hyper
- Flaccidity (LMN) - Hypotonia -normal -hypertonia (UMN) -rigidity (UMN)
30
Hypertonia definition
Increase in passive muscle tightness
31
Hypertonia spasticity
-velocity dependent -muscle spindle not reseting -need to be tested very fast -UMN
32
Hypertonia: rigidity
-tight throughout -Significant increase in resistance to multi directional external force about a joint
33
Hypertonia Dystonia
-State of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy -Tone fluctuate throughout -Goes with the basil ganglia -In huntingtons or with children growing really fast
34
Common postures in UMN syndrome: CVA, TB, Cerebral palsy
-Flexed elbow -Bent wrist -Pronated forearm -Clenched fist -Thumb in palm
35
Ataxia definition
-loss of coordination, trimmers, overshooting, loss of velocity -Associated with cerebellum
36
Bradykinesia
slow movement Associated with basal ganglia (parkinsons)
37
Dystonia
-a state of abnormal muscle tone resulting in muscular spasm and abnormal posture -Associated with basal ganglia
38
Chorea Distonia definition
continuous stream of slow flowing, writing involuntary movements
39
Ballistic Dystonia
explosive movement of the extremities
40
Contractures with UMN
1) Neuromuscular changes - Loss of selective movement - Muscle hyper-reflexia - Muscle hypertonia - Loss of ROM over time leads to contracture 2) Associated with sensory loss - Loss of proprioception - Loss of light touch - Loss of pin prick
41
Hyperactive reflexes
-Is an increase in the reflex response -Clonus -Associated movements: moving one part of the body and another limb moves involuntary
42
Brainstem involvement: advanced brain lesion
-Causes severe motor disruption (sensory and motor): posturing all limbs are fixed in a postures with limited limb movements -Associated with rigidity (severe increase in tone) -Extension or flexion posturing
43
Extension posturing
extension of both limbs
44
abnormal flexion posturing
flexion of UE and extension of LE with slight internal rotation
45
CVA UMN signs
1) Initially flaccid 2) Later develops spasticity 3) Reflexed hyperactive 4) Synergistic movements 5) Clonus (variable) 6) Loss of joint position sense 7) CN changes or loss of vision or facial 8) weakness 9) Bladder changes
46
CVS signs
Headache Mental changes Aphasia RESP problems (decreased neuromuscular control) Decrease in cough and swallow reflex agnosia Incontinence seizures Hemiparesis or hemiplegia Emotional lability Visual changes Vomiting Perceptual defects hypertension
47
Spinal cord injury UMN vertebra body fracture leads to
1) compression injury 2) flexion injury 3) extension injury
48
Clinical syndromes of incomplete spinal cord injury
1) central cord 2) brown sequard 3) anterior horn
49
Central cord
-Large lesion -cervical -Hyperextension -Slight pain and temperature loss localized -Due to spinothalamic crossing over at the specific level of the injury
50
Brown Sequard injury
-Hemisection of spinal cord -Ipsilateral UMN signs below the level of lesion -Ipsilateral loss of tactile vibration, proprioception sense 1-2 levels below the level of the lesion -Contralateral pain and temperature loss below the level of the lesion -Ipsilateral loss of all sensation at the level of the lesion -Ipsilateral LMN signs
51
anteiror cord
1) incomplete (hemicord) -Ispilateral vibration, position, and motor loss -Contralateral pain and temperature loss 2) Complete -Everything below the injury not working
52
Lower Motor Neuron Lesions
1) Loss of muscle function (weakness or flaccid) - Peripheral nerve injury/spinal nerve root injury - Range from weakness to paralysis 2) Loss of sensory function from nerve damage (proprioception , touch and pain) 3 ) Tone: hyporeflexia - No response to weak response on tendon tap
53
Additional LMN signs
1) Fibrillations 2) Fasciculations 3) Hypotonia or atonia 4) Hyporeflexia 4) Strength - limited to segmental or peripheral nerve pattern 5) Sensation (loss of discriminative touch, light touch, ain, temperature, vibration, pressure, and joint position)
54
Fibrillations Definition
muscular twitching involving individual muscle fibers acting without coordination
55
Fasciculations definitions
causes by increase receptor concentration on muscles to compensate for lack of innervation
56
Peripheral nerve injury
1) Neuropraxia 2) Axonotmesis 3) Neurotmesus
57
Neuropraxia
loss of myelin weakness
58
axonotmesis
loss of axon and myelin Weakness Atrophy Sensory loss
59
Neurotmesis
Complete transection of nerve Recovery more difficult due to neuroma formation
60
Clinal presentation to peripheral nerve injury
1) muscle atrophy 2) weakness or paralysis 3) pain along nerve distribution 4) numbness along nerve 5) sensory loss over nerve 6) loss of ROM
61
Examination of a peripheral nerve injury muscle testing
-test muscles in the uninvolved side first - test muscles in the involved side - test muscles of adjacent peripheral nerves
62
Examination of a peripheral nerve injury sensory testing
- ask about pain behavior -Test sensation uninvolved then involved -test sensation of adjacent peripheral nerves
63
Injury to the common fibular (peroneal) muscles involved
fib long and brev,TA, EHL and EDL
64
Injury to the common fibular (peroneal) signs and symptoms
- numbness and tingling - shooting pain along the nerve - pain with nerve tapping -pain at rest
65
Injury to the common fibular (peroneal) clinical presentation
1) hyporeflexia 2) muscular weakness along the fib n. distribution 3) sensory loss
66
Injury to the C5-6 nerve root signs and symptoms
1) hyporeflexia 2) decreases DTR 3) weakness 4) sensory loss 5) pain 6) numbness and tingling follows dermatome pattern
67
Injury to C6 spinal nerve muscles
myotomal pattern of C6 Bircps, brachioradialis, and wrist extensors
68
Diabetic neuropathy
glove and stocking presentation
69
polyneuropathy
distal symmetric sensation loss
70
L4 motor weakness
extension of quads
71
L4 functional test
squat and rise
72
L4 reflexes
Knee jerk diminished
73
L5 motor weakness
dorsiflexion of great toes and foot
74
L5 screening and exam
heel walking
75
S1 motor weakness
planter flexion of great toe and foot
76
S1 screening and exam
walking on toes
77
S1 reflex
ankle jerk
78
Peripheral nerve LMN injury testing
1) locate specific location 2) tinels sign 3) nerve injury follows the peripheral nerve 4) muscle and sensory loss below the level of injury 5) weakness and hyporeflexia
79
Spinal nerve root injury LMN testing
1) injury at the spinal nerve root 2) injury follows a myotome and dermatome pattern
80
LMN lesion muscle strength
weakness are paralysis
81
LMN lesion muscle tone
decreased or absent
82
LMN lesion reflex
decreased or absent
83
LMN lesion wasting
rapid muscle wasting
84
UMN lesion muscle strength
weakness or paralysis
85
UMN lesion muscle tone
increased
86
UMN lesion reflex
increased + babinski sign
87
UMN lesion wasting
muscle mass maintained

Neuro exam 1 - Rivera (8 decks)

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