Upper Vs Lower motor neuron disease pg 238

atrophy

(n.) the wasting away of a body organ or tissue; any progressive decline or failure; (v.) to waste away

Resting, postural, and intention (kinetic)

3 groupings of tremors include?

athetosis

A condition that presents with involuntary movements combined with instability of posture. Peripheral movements occur without central stability

Clasp-knife response

A form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement through the range of motion

cogwheel rigidity

A form of rigidity where resistance to movement has a phasic quality to it; often seen with Parkinson's disease.

Athetosis

A movement disorder presenting with slow, twisting and writhing movements that are large in amplitude. Primarily seen in face, tongue, trunk and extremities. Common in CP secondary to basal ganglia pathology.

Fasciculation

A muscular twitch that is caused by random discharge of a lower motor neuron and its muscle fibers; suggests lower motor neuron disease, however, can be benign

Dystonia

A syndrome of sustained muscle contractions that frequently causes twisting, abnormal postures, and repetitive movements. All muscles can be affected and the involuntary movements are often accentuated during volitional movement and with progression, can produce overflow. Presentation varies as there are multiple types and etiologies surrounding.

Huntington's chorea

An inherited UMN disease which affects nerve cells in the brain

Pseudobulbar palsy

An upper motor neuron disease that effects voluntary movement of the facial muscles

PD, CP, and encephalitis

Common diagnoses that may include dystonia are?

LMN lesions

These are all examples of: poliomyelitis, ALS, GBS, Tumors involving the spinal cord, trauma, progressive muscular atrophy, infection, Bell's palsy, carpal tunnel syndrome, muscular dystrophy, and spinal muscular atrophy

white matter

UMND are caused by damaged tracts in the ? matter of the spinal cord.

Babinski's sign is indicative of an upper motor neuron lesion. This finding is often associated with damage to the corticospinal (pyramidal) tracts. The remaining options are more characteristic of a lower motor neuron lesion.

Which of the following would be a clinical presentation of an upper motor neuron syndrome? paresthesia fasciculations Babinski's sign muscle atrophy

bladder dysfunction

can be subcategorized into flaccid or reflexive categories. Flaccid or lower motor neuron bladders result from an injury of the spinal cord below the S2 spinal level. Reflexive or upper motor neuron bladders result from an injury above T12.

Clonus

characteristic of an upper motor neuron lesion; involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex

UMN disease

characterized by a lesion found in descending motor tracts within the cerebral motor cortex, internal capsule, brainstem or spinal cord. Symptoms include weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, and abnormal reflexes. Damaged tracts are in the lateral white column of the spinal cord.

hyperkinesia

excessive movement

ataxia

inability to perform coordinated movements

Apraxia

inability to perform particular purposive actions, as a result of brain damage.

poliomyelitis (polio)

inflammation of the gray matter of the spinal cord, leading to paralysis of the limbs and muscles of respiration

tremors

involuntary, rhythmic, oscillatory movements

tremor

involuntary, rhythmic, oscillatory movements secondary to a basal ganglia lesion. There are various classifications secondary to specific etiology

post-polio

is a lower motor neuron disorder that refers to new neuromuscular symptoms that occur decades after recovery from an acute paralytic episode of polio. The primary symptom is a decline in the strength of muscles that had previously been affected by polio. Other symptoms include myalgia, joint pain, muscle atrophy, excessive fatigue with activity, and diminished endurance.

LMN disease

is characterized by a lesion that affects nerves or their axons at or below the level of the brainstem. The ventral gray column of the spinal cord may also be affected. Symptoms include flaccidity or weakness of the involved muscles, decreased tone, fasciculations, muscle atrophy, and decreased or absent reflexes.

bradykinesia

movement that is very slow

chorea

movements that are sudden, random, and involuntary

Tics

sudden, brief, repetitive coordinated movements that will usually occur at irregular intervals. There are simple and complex that vary from myoclonic jerks to jumping movements that may include vocalization and repetition of other sounds

present

Describe the atrophy in LMND?

akinesia

The inability to initiate movement; commonly seen in patients with Parkinson's disease

Dystonia

closely related to athetosis; however there is larger axial muscle involvement rather than appendicular muscles

Lead pipe rigidity

form of rigidity where there is uniform and constant resistance to ROM, often associated with lesions of basal ganglia

rigidity

stiffness

kinesthesia

the ability to perceive the direction and extent of movement of a joint or body part

Dysmetria

the inability to control the range of a movement and the force of muscular activity

ataxia, athetosis, chorea, tics, tremors, dysmetria, and dystonia

Common forms of hyperkinesia include:

apraxia, rigidity, and bradykinesia

Common forms of hypokinesia include:

mild from disuse

Describe the atrophy in UMND?

present

Describe the fasciculations in LMND?

absent

Describe the fasciculations in UMND?

diminished or absent

Describe the reflexes for LMND?

hyperactive

Describe the reflexes for UMND?

hypotonic to flaccid

Describe the tone in LMND?

Hypertonic

Describe the tone in UMND?

GBS and carpal tunnel

Identify two conditions that are characterized as LMN diseases: birth injuries brain tumors GBS carpal tunnel syndrome TBI

1. hypotonicity 2. fasciculations

Identify two symptoms of an LMN lesion: hypotonicity fasciculations rigidity hyperactive reflexes

1, hypertonicity 2. abnormal reflexes

Identify two symptoms of an UMN lesion: hypertonicity flaccidity fasciculations abnormal reflexes muscle atrophy

Ballism

Is a form of chorea that includes choreic jerks of large amplitude. Produces flailing movements of the limbs and is typically secondary to damage of the subthalamic nucleus

chorea

Is a form of hyperkinesia that presents with brief, irregular contractions that are rapid, but not to the degree of myoclonic jerks. Typically secondary to damage of the caudate nucleus. Often equated to fidgeting

LMN pathology

Muscle weakness, hypotonicity, and muscle fasciculations are all characteristics of: bulbar palsy upper motor neuron pathology lower motor neuron pathology pseudobulbar affect

UMN lesions

These are all examples of: cerebral palsy, hydrocephalus, ALS, CVA, birth injuries, MS, Huntington's chorea, TMI, Pseudobulbar palsy, and brain tumors

Intention (kinetic) tremor

Tremors are absent at rest, but observable with activity and typically increase as the target approaches. These tremors likely indicate a lesion of the cerebellum or its efferent pathways and are typically seen with MS.

resting tremor

Tremors are observable at rest and may or may not disappear with movement; may increase with mental stress. An example is the pill-rolling tremor associated with PD

Postural tremor

Tremors are observable during a voluntary contraction to maintain a posture. Examples include the rapid tremor associated with hyperthyroidism, fatigue or anxiety, and benign essential tremor

true

True or False: A LMN lesion affects nerves or their axons at or below the level of the brainstem

false (UMN and LMN)

True or False: ALS is a disease that affects only LMN.

false (LMN)

True or False: Poliomyelitis is an example of an UMND?

progressive muscular atrophy

What is a LMN disease that causes muscle wasting?

Huntington's disease

What is an example of a pathology that presents with chorea

Tourette syndrome

What pathology is an example that presents with tics involuntary, spasmodic, twitching movements; uncontrollable vocal sounds; and inappropriate words

3+

Which deep tendon reflex grade would be most anticipated in a child diagnosed with cerebral palsy? 0 1+ 2+ 3+

ALS

Which diagnosis is considered both an upper and lower motor neuron disease? multiple sclerosis Duchenne muscular dystrophy spinal muscular atrophy amyotrophic lateral sclerosis

fasciculations

Which of the following is characteristic of a lower motor neuron disease? rigidity spasticity muscle hypertrophy fasciculations

muscular dystrophy

Which of the following is not characterized as an UMN disease: muscular dystrophy CP hydrocephalus MS

hyperactive reflexes (Upper motor neuron diseases typically display hyperactive reflexes, hypertonic tone, and mild atrophy from disuse. Examples of upper motor neuron diseases include multiple sclerosis, Huntington's chorea, and cerebral palsy.)

Which of the following symptoms is commonly linked to an upper motor neuron disease? severe muscle atrophy hyperactive reflexes fasciculations hypotonic

post-polio

Which pathology is considered to be a lower motor neuron disease? bulbar palsy multiple sclerosis cerebral palsy post-polio

damage to descending motor pathways

Which potential cause would be least likely to be associated with abnormal "floppy" tone in an infant? neuromuscular disorder the infant is weak damage to descending motor pathways premature birth at 28 weeks

hypoactive reflexes and hypotonia (The ventral grey column of the spinal cord contains cell bodies of lower motor neurons. Lesions of lower motor neurons often produce characteristic symptoms including diminished or absent reflexes and low tone.)

Which symptoms would be most consistent with a lesion in the ventral grey column of the spinal cord? hyperactive reflexes and hypertonia hypoactive reflexes and hypertonia hyperactive reflexes and hypotonia hypoactive reflexes and hypotonia

flaccid

Which term is most consistent with bladder dysfunction resulting from an S4 spinal cord injury? flaccid reflexive absent asymptomatic

rigidity

a state of severe hypertonicity where a sustained muscle contraction does not allow for any movement at a specified joint

hypokinesia

abnormally decreased muscle function or activity

hemiballism

an involuntary and violent movement of a large body part

LMN disease

characterized by a lesion that affects nerves or their axons at or below the level of the brainstem, usually within the "final common pathway". The ventral gray column of the spinal cord may also be affected. Symptoms include flaccidity or weakness of the involved muscles, decreased tone, fasciculations, muscle atrophy, and decreased or absent reflexes

deep tendon reflex

elicit a muscle contraction when the muscle's tendon is stimulated. The most commonly used reflex grading system ranges from 0 = no response to 4+ = very brisk/hyperactive response. An upper motor neuron disease such as cerebral palsy would most likely result in reflex grades of 3+ or 4+.

asthenia

generalized weakness, typically secondary to cerebellar pathology

bradykinesia

slow movement

Dysdiadochokinesia (DDK)

the inability to perform rapidly alternating movements