Week 3 UMN vs LMN

Question 1

Location for UMN

Answer 1

central nervous system cortex, brain stem, corticospinal tracts, spinal cord

Question 2

UMN dx/pathology

Answer 2

stroke, TBI, SCI

Question 3

UMN tone

Answer 3

increased; hypertonia
velocity dependent

Question 4

UMN reflexes

Answer 4

increased: hyperreflexia,
clonus
exaggerated cutaneous and autonomic reflexes + babinski

Question 5

UMN involuntary movements

Answer 5

muscle spasms: flexor or extensor

Question 6

UMN strength

Answer 6

weakness or paralysis: ipsilateral (stroke) or bilateral (SCI)
Corticospinal: contralateral if above decussation in medulla; ipsilateral if below
Distribution: never focal

Question 7

UMN muscle bulk

Answer 7

disuse atrophy: variable widespread distribution, especially of antigravity muscles

Question 8

UMN voluntary movements

Answer 8

impaired or absent: dyssynergic patterns, obligatory mass synergies

Question 9

LMN location of lesion and structures involved

Answer 9

cranial nerve neclei/nerves
spinal cord: anterior horn cell, spinal roots
peripheral nerve

Question 10

LMN diagnosis/ pathology

Answer 10

polio, Guillain-barre
Peripheral nerve injury
peripheral neuropathy
radiculopathy

Question 11

LMN tone

Answer 11

decreased or absent: hypotonia, flaccidity
not velocity dependent

Question 12

LMN reflexes

Answer 12

decreased or absent: hyporeflexia
cutaneous reflexes decreased or absent

Question 13

LMN involuntary movements

Answer 13

with denervation: fasciculations

Question 14

LMN strength

Answer 14

ipsilateral weakness or paralysis
limited distribution: segmental or focal pattern, root-innervated pattern

Question 15

LMN muscle bulk

Answer 15

neurogenic atrophy: rapid, focal distribution, severe wasting

Question 16

LMN voluntary movements

Answer 16

weak or absent if nerve interrupted

Question 17

Lesion of cerebral cortex/corticospinal sensation

Answer 17

impaired or absent: depends on lesion location; contralateral sensory loss

Question 18

Lesion of cerebral cortex/corticospinal tracts diagnosis/patho

Answer 18

stroke

Question 19

Lesion of cerebral cortex/corticospinal tone

Answer 19

hypertonia/spasticity velocity-dependent; clasp-knife
Initial flaccidity: cerebral shock

Question 20

Lesion of cerebral cortex/corticospinal reflexes

Answer 20

hyperreflexia

Question 21

Lesion of cerebral cortex/corticospinal strength

Answer 21

contralateral weakness or paralysis: hemiplegia or hemiparesis
Disuse weakness in chronic stage

Question 22

Lesion of cerebral cortex/corticospinal muscle bulk

Answer 22

normal during acute stage; disuse atrophy in chronic stage

Question 23

Lesion of cerebral cortex/corticospinal involuntary movements

Answer 23

spasms

Question 24

Lesion of cerebral cortex/corticospinal voluntary movements

Answer 24

dyssynergic; abnormal timing, co-activation, fatigability

Question 25

Lesion of cerebral cortex/corticospinal postural control

Answer 25

impaired or absent, depends on lesion location impaired balance

Question 26

Lesion of cerebral cortex/corticospinal gait

Answer 26

impaired: gait deficits due to abnormal weakness, synergies, spasticity, timing deficits

Question 27

Basal ganglia diagnosis/pathology

Answer 27

Parkinson's disease

Question 28

Basal ganglia sensation

Answer 28

not affected

Question 29

Basal ganglia tone

Answer 29

lead-pipe rigidity: increased, uniform resistance cogwheel rigidity: increased, ratchet like resistance

Question 30

Basal ganglia reflexes

Answer 30

normal or may be decreased

Question 31

Basal ganglia strength

Answer 31

disuse weakness in chronic stage

Question 32

Basal ganglia muscle bulk

Answer 32

normal or disuse atrophy

Question 33

basal ganglia involuntary movements

Answer 33

resting tremor

Question 34

basal ganglia voluntary movements

Answer 34

bradykinesia: slowness of movement akinesia: absence of movement

Question 35

Basal ganglia gait

Answer 35

impaired: shuffling, festinating gait

Question 36

Basal ganglia postural control

Answer 36

impaired: stooped (flexed) impaired balance

Question 37

Cerebellum dx/patho

Answer 37

tumor, stroke

Question 38

cerebellum sensation

Answer 38

not affected

Question 39

cerebellum tone

Answer 39

normal or may be decreased

Question 40

cerebellum reflexes

Answer 40

normal or may be decreased

Question 41

cerebellum strength

Answer 41

normal or weak: asthenia

Question 42

Cerebellum muscle bulk

Answer 42

normal

Question 43

Cerebellum involuntary movements

Answer 43

none

Question 44

Cerebellum voluntary movements

Answer 44

ataxia: intention tremor dysdiadochokinesia dymetria dyssynergia nystagmus

Question 45

Cerebellum postural control

Answer 45

impaired: truncal ataxia impaired balance

Question 46

Cerebellum gait

Answer 46

impaired: ataxic gait deficits, wide-based, unsteady

Question 47

Spinal cord dx/patho

Answer 47

trauma, tumor, vascular insult: complete, incomplete SCI

Question 48

Spinal cord sensation

Answer 48

impaired or absent below the level of lesion

Question 49

Spinal cord tone

Answer 49

hypertonia/spasticity below the level of the lesion initial flaccidity: spinal shock

Question 50

Spinal cord reflexes

Answer 50

hyperreflexia

Question 51

Spinal cord strength

Answer 51

impaired or absent below the level of the lesion: paraplegia or paraparesis; tetraplegia or tetraparesis

Question 52

Spinal cord muscle bulk

Answer 52

disuse atrophy

Question 53

Spinal cord involuntary movements

Answer 53

spasms

Question 54

Spinal cord voluntary movements

Answer 54

above level of lesion: intact (normal) below level of lesion: impaired or absent

Question 55

Spinal cord postural control

Answer 55

impaired below level of lesion impaired balance

Question 56

Spinal cord gait

Answer 56

impaired or absent: depends on level of lesion