Upper and lower motor neurons Flashcards
(155 cards)
1
Q
Anterior horn ->nerve-> muscle
A
LMN
2
Q
Brain-> Spine
A
UMN
3
Q
Spastic
A
UMN
4
Q
Hypertonic
A
UMN
5
Q
Disuse Atrophy
A
UMN
6
Q
+ Banbinski
A
UMN
7
Q
Flaccid
A
LMN
8
Q
Hypertonic
A
LMN
9
Q
Hyporeflexic
A
LMN
10
Q
Denervation Atrophy
A
LMN
11
Q
-Babinski
A
LMN
12
Q
Muscle is in spasm
A
Spastic
13
Q
Muscles is limp/relax
A
Flaccid
14
Q
We our not able to use the muscle due to injury
A
Disuse Atrophy
15
Q
Lose innervation on the muscle
A
Denervation Atrophy
16
Q
use reflex hammer stroke bottom of the foot, the toes curls down
A
- Banbinski
17
Q
use reflex hammer stroke bottom of the foot, the toes curls up
A
+ Banbinski
18
Q
clasp knife phenomenon
A
tighter in the middle range if motion then as we go towards end of range, that releases.
19
Q
no rigidity of tremor
A
Spastisity
20
Q
restruction of wrist movent ROM. tension in extending finger
A
UMN
21
Q
Velocity dependent
A
UMN
22
Q
Most affected in anti-gravity muscles
A
Biceps, Quads (hip flex), Hip
23
Q
involuntary muscle contractions. 5-7hz contraction.
dorsiflex and plantarflex nakikita
A
Clonus
24
Q
brisk reflexes
A
Hyperreflexia of deep tendon reflex
25
tapping the supratellar tendon will elicit knee jerk reflex
Hyperreflexia of deep tendon reflex
26
Superficial abdominal reflex and cremasterix reflex are decreased.
Hyporreflexia of superficial reflex
UMN
27
involuntary movements in a limb that have asscoiation to voluntary movements
Synkinesia
UMN
28
CN 7&12, WIP
Psuedo bulbar palsy
| UMN
29
lumiliit muscles due to lack of nutrients
Muscle Atrophy
| LMN
30
Weekness
LMN
31
Fasciculation
LMN
32
Damaged alpha motor neurons can produce spontaneous action potentials. These spikes cause the muscle fibers that are part of that neuron's motor unit to fire, resulting in a visible twitch (called a ___) of the affected muscle.
Fasciculation
33
Fibrillation
LMN
34
Maliit na twicth
Fibrillation
35
Because alpha motor neurons are the only way to stimulate extrafusal muscle fibers, the loss of these neurons causes a decrease in muscle tone.
May strenght but less tone
Hypotonia
36
Hyporeflexia
LMN
37
D
The myotatic (stretch) reflex is weak or absent with lower motor neuron disorders, because the alpha motor neurons that cause muscle contraction are damaged.
Hyporeflexia
38
Weakness agad makikita
LMN
39
Late mainly because of disuse wasting
UMN
40
Early and present wasting
LMN
41
is the sudden occurrence of permanent damage to an area of the brain caused by a blocked blood vessel or bleeding within the brain. Other causes of focal brain damage, such as traumatic injury to the brain, demyelinating lesions, brain tumors, brain abscesses, and others, can produce stroke like symptoms but are not included in this definition.
Cerebrovascular Accident
42
Most common weakness of stroke
Focal weakness
43
Close head injury but Skull is not actually penetrated
Traumatic Brain Injury
44
Components of GCS
Eyes
Verbal
Motor
45
Abnormal flex/ abnormal slow flec. What is it and grade
Dicorticate, 3
46
complex, multifactorial disease that requires the expertise of neurologists, physiatrists, occupational therapists, and physical therapists, as well as countless other participants in the patient's care.
Multiple Sclerosis
47
is considered to be an autoimmune diseases. Like all autoimmune disorders, it is more common in women, occurring about twice as often in women as in men. ➡
Multiple Sclerosis
48
also appears to involve genetic factors with HLA-DR2 in DR-positive families having a greater chance of developing the disease.
Multiple Sclerosis
49
The hallmark of MS pathology
| Cardinal Symptoms:
Scanning Speech. Intention Tremor, Nystagmus also known as Charcot's Triad.
50
The hallmark of MS pathology
| Cardinal Symptoms:
Scanning Speech. Intention Tremor, Nystagmus also known as Charcot's Triad.
51
Refers slowness of movement
Bradykinesia
52
Sx: Bradykinesia
Parkinson's disease
53
Cardinal features of PD
Rigidity
o Bradykinesia
o Tremor
o Postural instability
54
Shaking palsy
Parkinson's disease
55
Resistance of mm to passive elongation or stretch
Muscle tone
56
Tone is influenced
physical inertia
intrinsic mechanical-elastic stiffness of muscle and connective fissues.
spinal reflex muscle contraction (tonic strotch reflexos),
57
Hypertonic state characterized by constat resistance thoughout ROM that is independent of the Velocity movment
Rigidity
58
Mukhang sinapian
Opisthotonus
59
UMNL is the first order neurons regulated by the
| neurotransmitter___
glutamate
60
what is spaticity
Slow passive movement will not elicit the increased
resistance
A velocity dependent increase in mm resistance to
a passive stretch
61
brisk stretches of mm will cause an abrupt inc in tone followed by a dec in mm resistance c continued stretch
Clasp knife rigidity
62
Affects the antigravity mm of arms and legs (flexors
| of the arm and extensors of leg)
UMNL
63
in umnl Patients often exhibit flexor and extensor ____
spasms
- Ex. Stroke pts: UE is in flexion while LE is
in extension
64
What is clonus?
A sequence of rhythmic, involuntary mm cxn that occur at a frequency of ___
5-7 Hz
65
Occurs as a response to abruptly applied stretch
| stimuli
clonus
66
where does clonus Most easily elicited at?
the ankle c brisk dorsiflexion and
| plantar flexion movements
67
Patient can be seen to have abnormally brisk
reflexes which are d/t decreased modulation by
descending inhibitory pathways
Hyperreflexia of the DTR
68
: the tensing of abs
| by stroking the overlying skin
Superficial abdominal reflex
69
the elevation of scrotum in
| response to stroking medial thigh
Cremasteric reflex
70
what is synkinesia
Involuntary movements in limb that have
associations c the voluntary movements in other
limbs
71
flexion of arm may result in flexion of leg is an example of
synkinesia
72
____ can occur when yawning or sneezing
synkinesia
73
Volitional movements of one arm or leg may result
| in mirror movements of opposite limb
synkinesia
74
Most CN have bilateral innervation from the brain,
| with the exception of CN 7 & 12
Pseudo-Bulbar Palsy
75
Sx of pseudo-bulbar palsy
Slurred speech, dysphagia, dysarthria, brisk jaw
| jerk, spastic tongue, and speudobulbar affect
76
Damaged alpha motor neuron → produces
| spontaneous action potentials
Fasciculation, lmnl
77
These spikes cause the muscle fibers that are part
of the neuron’s motor unit to fire, resulting in visible
twitch of the affected mm.
fasciculation
78
Because ____ are the only way to
stimulate extrafusal muscle fibers, the loss of these
neurons causes a decrease in mm tone
alpha motor neurons
79
Hyporeflexia
- Myotatic (stretch reflex) is weak or absent c LMN
d/o because the ____that cause
mm contraction are damaged
alpha motor neurons
80
Where is the lesion for UMNL?
Above the anterior
horn in the SC or
above the nuclei of
the CN
81
Where is the lesion for LMNL?
Anterior horn cell,
motor nn fiber or
neuromuscular
junction
82
Where is the mm weakness in UMNL?
LE: All muscle groups (more
marked in the flexors)
```
UE: distally > proximally (Both flex & ext)
(bec. UE ay usually naka-flex,
so yung extensors di
nag-cocontract, pero
counterproductive rin
kasi lagi namang
nag-cocontract yung
flexors)
```
83
Where is the mm weakness in LMNL?
distally>proximally. (Both
| flexors and extensors affected)
84
Fasciculation in UMNL
absent
85
Fasciculation in LMNL
May be present in anterior horn cell
86
2 Major categories of stroke:
Ischemic
| Hemorrhagic
87
Caused by a vascular occlusion
Ischemic
88
Caused by bleeding within the Parenchyma
| of the brain
Hemorrhagic
89
Artery
```
pt deficit: CL weakness and sensory
loss primarily in the LE,
incontinence, aphasia,
memory and behavioral
deficits
```
Anterior cerebral Artery
90
Artery
pt deficit: CL sensory loss and
weakness in face and UE
Less involvement in LE,
homonymous hemianopia
Middle cerebral Artery
91
Artery
pt deficit: Ataxia, equilibrium,
disturbances, headaches,
dizziness
Vertebrobasilar Artery
| > balance
92
```
Artery
pt deficit: CL sensory loss, thalamic
pain syndrome,
homonymous
hemianopsia, visual
agnosia, and cortical
blindness
```
Posterior cerebral Artery
> for Vision
> Related sila ng vertebrobasilar
(without vision, nawawala visuospatial awareness)
93
TRAUMATIC BRAIN INJURY (TBI) Are classified as ___, wherein the skull is ____.
Closed Head Injuries, not actually penetrated
94
nature of the injury sustained in vehicular accidents and falls (e.g., blunt impact, acceleration-deceleration) often results in multifocal lesions and diffuse brain damage with a variety of physical, cognitive, and neurobehavioral impairments that are unique to each person and pose formidable obstacles to community integration
TBI
95
● Clinical assessment of coma was made more precise
| and objective _____
Glasgow Coma Scale (GCS)
96
GCS for Eye opening
Spontaneous
Opens eyes on own
4
97
GCS for Best motor response
Pain
Pulls examiner’s hands away when pinched
5
98
GCS for Eye opening
Speech
Opens eyes when asked in a loud voice
3
99
GCS for Eye opening
Pain
Opens eyes when pinched
2
100
GCS for Eye opening
Pain
Does not open eyes
1
101
GCS for Best motor response
Pain
Pulls a part of the body away when pinched
4
102
GCS for Best motor response
Pain
Flexes body inappropriately when pinched (decorticate posturing)
3
103
GCS for Best motor response
Pain
Body becomes rigid in an extended position when pinched (decerebrate posturing)
2
104
GCS for Best motor response
Pain
Has no motor response to pinch
1
105
GCS for Verbal response (talking)
| Speech Carries on conversation correctly and tells examiner where he or she is, month and year
5
106
GCS for Verbal response (talking)
Speech Seems confused or disoriented
4
107
GCS for Verbal response (talking)
| Speech Talks so examiner can understand victim but makes no sense
3
108
GCS for Verbal response (talking)
| Speech Makes sounds that examiner cannot understand
2
109
GCS for Verbal response (talking)
| Speech Makes no noise
1
110
Best and lowest score for GCS
BEST score to achieve: 15
| ○ Lowest is 3
111
VERBAL
○ What is your name? Where are you? What
month is it?
■ If they answer all >
“ORIENTATED”
112
○ What is your name? Where are you? What
month is it?
■ If pt speaks in incomplete sentences
> “CONFUSED”
113
○ What is your name? Where are you? What
month is it?
■ If talking gibberish/ swearing at
you >
“WORDS”
114
○ What is your name? Where are you? What
month is it?
■ moaning/groaning and can’t
make out what they are saying >
“SOUNDS”
115
○ What is your name? Where are you? What
month is it?
■ If there’s no response
> “NONE”
116
○ What is your name? Where are you? What
month is it?
■ If there is a tube on pt’s mouth >
“NOT TESTABLE (NT)”
117
○ Grasping and releasing fingers or opening
| the mouth and sticking out the tongue >
“OBEYS COMMANDS”
118
○ Trapezius pinch (central stimulus), and
assess what their response is
■ If trapezius gives no response >
go to Supraorbital notch and test
| that area
119
○ Trapezius pinch (central stimulus), and
assess what their response is
■ If they move their arm/hand up
above clavicle towards stimulus >
“LOCALISING” to pain
120
○ Trapezius pinch (central stimulus), and
assess what their response is
■ If arm bends and moves rapidly
away from body and stimulus >
“NORMAL FLEXION”
121
○ Trapezius pinch (central stimulus), and
assess what their response is
■ Elbow bends slowly and arm
comes across body >
“ABNORMAL FLEXION
| “(Decorticate )
122
*Counterpart of Decorticate is
“ABNORMAL EXTENSION”
| Decerebrate
123
○ Trapezius pinch (central stimulus), and
assess what their response is
■ No response
> “NONE”
124
○ Trapezius pinch (central stimulus), and
assess what their response is
■ If paralyzed
> “indicate NT” (not
| testable)
125
Pathophysiology of TBI
● Primary TBI
■ Ex. nauntog sa dashboard, yung rebound
effect non
○ Damage that occurs directly and immediately as a
result of trauma to the brain. Cortical contusion
and DAI are the 2 subtypes of primary injury.
○ Cerebral contusion is the other main type of
primary injury. These cortical bruises commonly
occur at the crests of the gyri and extend to
variable depths, depending on severity.
○ Contusions often occur on the undersurface of
the frontal lobes, as well as the frontal and
temporal tips, regardless of the site of impact, due
to the internal architecture of the skull.
○ Coup-contrecoup injuries are more likely seen
when the moving head hits a stationary object,
such as with a fall. In this situation, one may see a
contusion at the site of impact as well as another,
often larger, contusion on the opposite cortex
126
```
distinguishing feature of TBI.
Acceleration-deceleration and rotational
forces that commonly result from motor
vehicle accidents produce diffuse axonal
disruption.
```
Diffuse Axonal Injury (DAI)
127
primarily responsible for the initial loss of consciousness
Diffuse Axonal Injury (DAI)
128
```
○ Any damage to brain tissue that takes place after
the initial (primary) injury
```
Secondary TBI
■ Nanggaling sa primary TBI/ remnant ng
primary TB
129
____ are examples of intracellular processes that lead to secondary injury, but can be driven by factors taking place at the tissue or systemic level.
Apoptosis and excitotoxicity
○ Systemic factors such as anemia, hypotension,
pulmonary injury, and cardiac or respiratory arrest
also may contribute to secondary injury by
diminishing the delivery of oxygen to the injured
brain
130
Cerebral Hypoperfusion is assessed by
| evaluating the _____
Cerebral Perfusion Pressure (CPP),
-the difference between mean arterial pressure (MAP) and intracranial pressure (ICP)
○ Factors that increase ICP or decrease MAP can
decrease CPP, leading to increased ischemic
injury.
■ ICP: di nag fflow maayos yung dugo, and
nag p-pile up lang siya sa isang area
131
Cerebral Perfusion Pressure
| (CPP), which is defined as the
difference between
mean arterial pressure (MAP) and intracranial
pressure (ICP)
132
Glasgow Outcome Scale-Extended
| 1
Dead
133
Glasgow Outcome Scale-Extended
| Dead
1
134
Glasgow Outcome Scale-Extended
| 2
Vegetative state (VS)
No cerebral cortical function that can be judged by
behavior (not able to follow simple commands or
communicate)
135
Glasgow Outcome Scale-Extended
| 3
Lower severe disability (lower SD)
136
Glasgow Outcome Scale-Extended
| 4
Upper severe disability (upper SD)
| Need supervision/assistance in ADL, but can be alone for >8h/d
137
Glasgow Outcome Scale-Extended
| 5
Lower moderate disability (lower MD)
Independent in adl and can shop and travel indep on
public transportation, but has not returned to previous
position or lifestyle
138
Glasgow Outcome Scale-Extended
| 6
Upper moderate disability (upper MD)
Able to resume previous position or lifestyle with
alternative/modified duties or part-time d/t injury
139
Glasgow Outcome Scale-Extended
| 7
Lower good recovery (lower GR)
Able to resume previous position or lifestyle (may be
modified), but reporting some problems
140
Glasgow Outcome Scale-Extended
| 8
Upper good recovery (upper GR)
Complete return to previous lifestyle with no reported
problems
141
Glasgow Outcome Scale-Extended
Vegetative state (VS)
No cerebral cortical function that can be judged by
behavior (not able to follow simple commands or
communicate)
2
142
Lower severe disability (lower SD)
3
143
Upper severe disability (upper SD)
| Need supervision/assistance in ADL, but can be alone for >8h/d
4
144
Lower moderate disability (lower MD)
Independent in adl and can shop and travel indep on
public transportation, but has not returned to previous
position or lifestyle
5
145
Upper moderate disability (upper MD)
Able to resume previous position or lifestyle with
alternative/modified duties or part-time d/t injury
6
146
Lower good recovery (lower GR)
Able to resume previous position or lifestyle (may be
modified), but reporting some problems
7
147
Upper good recovery (upper GR)
Complete return to previous lifestyle with no reported
problems
8
148
A complex, multifactorial dse that requires the expertise
of neurologists, physiatrists, OTs, and PTs, as well as
other participants in patient care
MULTIPLE SCLEROSIS
149
MS is a Autoimmune disease that is occurs twice as often in ___than ___
● Also appears to involve genetic factors c HLA-DR2 in
DR-positive families- having a greater chance of
developing the dse
women > men
150
Hallmark of MS Pathology:
Presence of:
1. multifocal plaques (lesions) of demyelination in the cerebral hemispheres,
2. optic nn
3. brain stem, and
4. spinal cord
151
Cardinal Symptoms (Charcot’s Triad):
SIN
○ Scanning speech
○ Intention tremor
○ Nystagmus
152
○ Characterized by discrete attacks of neurological
deficits (relapse) with either full or partial recovery
(remission) in subsequent weeks to months
■ To be considered a relapse, symptoms
must occur for more than 24 hours
■ Attacks for <24 hrs: pseudo- ng MS
○ The periods between relapses are characterized
by lack of disease progression
○ The stable patient may have local inflammatory
activity that is clinically silent
○ Affects approximately 85% of patients with MS at
diagnosis
● Relapsing-Remitting MS (RRMS)
153
○ Characterized by an initial relapsing-remitting
course, followed by a change in clinical course
with progression to steady and irreversible
decline with or without continued acute
attacks
○ May be the result of progressive axonal loss
rather than new lesions
○ Before newer treatments, the majority of patients
with RRMS progressed to SPMS
● Secondary-Progressive MS (SPMS)
154
○ Characterized by disease progression and steady
functional decline from onset; patients may
experience modest fluctuations in neurological
disability but discrete attacks do not occur
○ PPMS is associated with later onset (mean age
40 years) and more equal gender distribution
○ Affects approximately 10% of patients with MS
● Primary-Progressive MS (PPMS)
155
○ 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
○ Affects approximately 5% of patients with MS
○ Poor prognosis
● Progressing-Relapsing MS (PRMS)
