UMN/LMN DDx

Question 1

What are the symptoms of an UMN disease?

Answer 1

Tone: hypertonic/spasticity
Reflexes: hyperreflexia
Strength: weakness
Involuntary movements: spasm, intention tremors etc

Question 2

What are the symptoms of a LMN disease?

Answer 2

Tone: flaccidity
Reflexes: hypo reflex is
Strength: weakness
Involuntary movements: fasciculations

Question 3

What are the UMN diseases?

Answer 3

Stroke, SCI, MS, TBI

Question 4

What are the LMN diseases?

Answer 4

GBS

Question 5

Stroke

Answer 5

UMN
Sensory: Sensory+motor impaired or absent (depends on lesion)
Tone: hypertonic/spasticity; initial flaccidity during cerebral shock
Reflexes: hyperreflexia
Strength: contralateral weakness or paralysis
Muscle: normal during acute & disuse atrophy in chronic
Involuntary movements: spasm
Impaired balance
BRUNNSTROMS STAGES OF RECOVERY

Question 6

SCI

Answer 6

UMN
Sensation/motor: sensory+motor impaired or absent below the level of lesion
Tone: spasticity below the level of lesion. Initial flaccidity during spinal shock
Reflexes: hyperreflexia
Strength: paraplegia/paresis; tetraplegia/paresis
Muscle: disuse atrophy
Involuntary movements: spasms

Question 7

Parkinson’s Disease

Answer 7

LMN?? UMN???
Sensation not affected
Tone: rigidity/leadpipe uniform resistance, cogwheel ratchet like
Reflexes: normal or decreased
Strength: disuse weakness in the chronic stage
Muscle: disuse atrophy or normal
Involuntary movements: resting tremor
Stooped posture
Festinating gait, on-off phenomenon of drugs, pill rolling tremors, rigidity

Question 8

GBS

Answer 8

LMN (autoimmune disease affecting the PNS)
Sensation/motor: motor+sensory distal extremities more affected than proximal/symmetrical
Tone: flaccidity
Reflexes: hyporeflexia
Strength: B/L distal to proximal muscle weakness
Muscle: muscle atrophy, weakness
NO INVOLUNTARY MOVEMENTS
Rapid onset of weakness with bilateral symptoms peaking at 2-3 weeks progressing no greater than 4 weeks

Question 9

ALS

Answer 9

UMN+LMN (motor neuron disease)
Motor/sensation: pure MOTOR condition/asymmetrical
Tone: spasticity/hypotonicity
Reflexes: Hyper/hyporeflexia
Strength: weakness/atrophy
Involuntary movements: fasciculations
Posture is normal initially until deterioration and they are WC bound
Pt has pseudobulbar and bulbar palsy

Question 10

MS

Answer 10

UMN (demyelination of axons and white matter)
Motor and sensory affected
Tone: spasticity
Reflexes: hyperreflexia
Strength: weakness can vary from mild to total paralysis
Muscle: atrophy 2’ inactivity/disuse
Involuntary movements: intention and postural tremors can occur, spasms
Uthoff’s phenomenon, Lhermitte’s sign, pseudobulbar effect, Marcus Gunn pupil, optic neuritis

Question 11

MG

Answer 11

Disorder of NMJ autoimmune condition
Pure motor, proximal muscles more affected than distal
Strength: weakness worsens with activity
Fatigable and rapidly fluctuating asymmetric proxies is a hallmark of the problem.
Symptoms show a fluctuation in intensity and are more severe late in the day or after prolonged activity

Question 12

What is the scale for Parkinson’s disease?

Answer 12

Hoen and Yahr

Question 13

What is stage one Hoehn and Yahr?

Answer 13

Minimal or absent disability, UNILATERAL

Question 14

What is stage 2 Hoehn and Yahr?

Answer 14

Minimal bilateral or midline involvement, no balance involvement
(2 for both sides beginning to be affected)_

Question 15

Hoehn and Yahr stage 3?

Answer 15

Impaired balance, some restrictions in activity

Question 16

Hoehn and Yahr stave IV?

Answer 16

All symptoms present and severe, stands and walks only WITH ASSISTANCE

Question 17

Hoehn and Yahr stage V?

Answer 17

Confinement to WC or bed

Question 18

Stage I of ALS?

Answer 18

Early disease, mild focal weakness, asymmetrical distribution; symptoms of hand cramping and fasciculations

Question 19

Stage II of ALS?

Answer 19

Moderate weakness in groups of muscles, some wasting of muscles, modified independence with assistive devices

Question 20

Stage III of ALS?

Answer 20

Severe weakness of specific muscles, increasing fatigue; mild to moderate functional limitations, still ambulatory

Question 21

Stage IV of ALS?

Answer 21

Severe weakness and wasting of LE’s, mild weakness of UE’s, moderate assistance and assistive devices required, WC users **

Question 22

Stage V of ALS?

Answer 22

Progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk, spasticity, hyperreflexia; loss of head control *** , maximal assist

Question 23

Stage VI of ALS?

Answer 23

Bedridden, dependent ADLs, FMS; progressive respiratory distress

Question 24

What is Complex regional pain syndrome Type I?

Answer 24

Also referred to as reflex sympathetic dystrophy, presents with intense pain throughout the limb (UE or LE) but does not involve specific damage to the peripheral nervous system

Question 25

What is Complex Regional Pain syndrome Type 2?

Answer 25

Also called causalgia, involves specific damage to the peripheral nervous system (radiculopathy, plexopathy, or mononeuropathies) typically resulting in both overt motor and sensory neuropathic signs and symptoms

Question 26

Describe Relapsing-remitting MS?

Answer 26

Characterized by discrete attacks of neurological deficits (relapses) with FULL OR PARTIAL recovery (remission) in subsequent weeks or months; periods between relapses are characterized by lack of disease progression. Affects 85% of cases.

Question 27

Describe Primary Progressive MS?

Answer 27

Characterized by disease progression and a deterioration in function from onset; patients may experience modest fluctuations in neurological disability but discrete attacks DO NOT OCCUR.

Question 28

Describe Secondary Progressive MS?

Answer 28

Characterized by an initial relapsing-remitting course with a steady decline in function, with or without acute attacks.

Question 29

Describe Progressive-relapsing MS?

Answer 29

Characterized by a steady deterioration in disease from onset (similar to PPMS) but with occasional acute attacks; intervals between attacks are characterized by continuing disease progression.

Question 30

What does the Brunnstrom scale measure?

Answer 30

Synergy - It measures motor recovery

Question 31

What is stage 1 of the brunnstrom scale?

Answer 31

Flaccid

Question 32

What is stage 2 of the Brunnstrom scale?

Answer 32

It takes 2 to move- some spastic tone through ROM, no voluntary motion

Question 33

What is stage 3 of the Brunnstrom scale?

Answer 33

Marked spasticity throughout all ROM, voluntary movement in synergy

Question 34

What is stage 4 of the Brunnstrom scale?

Answer 34

Decreased spasticity, initial voluntary movement in synergy, can break parts

Question 35

What is stage 5 of the Brunnstrom scale?

Answer 35

Minimal spasticity, slight increase in tone, can initiate out of synergy “High 5”

Question 36

What is stage 6 of the Brunnstrom scale?

Answer 36

Close to normal, difficulty with quick tasks, no spasticity

Question 37

What is stage 7 of the Brunnstrom scale?

Answer 37

Normal

Question 38

What is a “0” on the Modified Ashworth Scale?

Answer 38

No increase in muscle tone

Question 39

What is a 1 on the Modified Ashworth Scale?

Answer 39

Slight increase in tone w/ CATCH AND RELEASE, minimal resistance AT END OF ROM

Question 40

What is a 1+ on the Modified Ashworth Scale?

Answer 40

Slight increase in tone with CATCH AND SLOW RELEASE Through LESS THAN HALF of ROM

Question 41

What is a 2 on the Modified Ashworth Scale?

Answer 41

Increased tone through >1/2 of ROM, affected part is easily moved

Question 42

What is a 3 on the Modified Ashworth Scale?

Answer 42

PROM difficult

Question 43

What is a 4 on the Modified Ashworth Scale?

Answer 43

Rigid, stuck

Question 44

Decerebrate posture?

Answer 44

More E’s Rigid extension of all 4 limbs and trunk and neck. Seen in comatose/brain stem lesion patients

Question 45

Decorticate posture?

Answer 45

Upper limbs in flexion and lower limbs in extension