1
Q
Rigidity
A
- increased resistance to passive range of motion
- “lead pipe” phenomenon
- Overactive agonista nd antagonist muscles
- most often seen with basal ganglia dysfunction
- “cog wheeling” may relate to superimposed tremor
2
Q
Spasticity
A
- UMN syndrome
- exaggeration of flexion/extension skeletal muscle reflexes
- resulting from corticospinal tract dysfunction
- “clasp knife” phenomenon/clonus
- Always pathologic –> measure on passive range of motion
3
Q
Spasticity clinical manifestations
A
- abnormal posturing
- flexor/extensor spasms
- abnormal synergistic movements
- babinksi sign/exaggerated cutaneous reflexes
- decreased postural/trunk stability
- Decreased range of motion
- contractures/join stiffness
4
Q
Cerebral palsy
A
- Non-progressive disorder of posture/motor control
- Co-Morbidities = visual impairment, hearing loss, speech/language delay, epilepsy, depression, behavioral problems
- management:
- evaluate for treatable disease (MRI, lab tests)
- pysical/occupational therapy (bracing)
- surgical release of tendons/grafting
- botox
- Tx objectives = mobility, physical fitness, education
5
Q
tremor
A
- rhythmic oscillations about a joint
- amplitude/velocity similar in both driections
- three types
- resting
- postural
- intention
- three types
6
Q
resting tremor
A
- associated with basal ganglia pathology
- most prominent at rest
- Pill rolliwng character
- little functiona impairment
7
Q
Postural tremor
A
- often seen without identifiable pathology
- distal in limbs
- head/neck/lips/gonue involvment
- worse with stress/fatigue/stimulants
- better with rest
- gone during sleep
- may be disabling
8
Q
Intention tremor
A
- Kinetic tremor = brought out with movement
- scanning at end point of movement
- assocaited with disease of cerebellum and its connections
- associated with ataxia
9
Q
Tic
A
- involuntary/stereotyped/quick movements
- irregular intervals
- simple/complex
- buildup of psychic tension
- vocal/guttural tics
10
Q
Gilles de la tourette sydrome
A
- multiple motor tics
- at least 1 vocal/sonic tic
- onset < 18 years
- duration > 1 year
- affect daily function/cause distress
- 1/2 with obsessive/compulsive symtpoms
11
Q
Dystonia
A
- abnormal posturing
- may be
- focal/mutli-focal
- generalized
- segmental
- task specific - writer’s cramp, yips
- trial of L-dopa
- botox tx
12
Q
Athetosis
A
- Writhing/snake-like involuntary movements
- movement between two dystonic postures
13
Q
Chorea
A
- Involuntary random movements sufficient to move a body part
- patients may finish with voluntary movement
14
Q
Hemi-ballismus
A
- Large amplitude/violent form of chorea
- Limb/limbs fling out into space
- typically one sided
- associated with lesions in the contralteral subthalamic nucleus
15
Q
tardive dyskinesia
A
- abnormal movemetns brought on by medications/neuroleptics
- Oral/facial/lingual most common
- also limb/trunk involvement
16
Q
Ataxia
A
- decomposition of voluntary movement
- decreased movement speed
- decreased coordination
- halting/imprecise movement
- affects limbs, speech, eyes, trunk
- resulting from disease in cerebellum and its connections
17
Q
Asterixis
A
- Intermittent loss of postural tone
- affects limbs/trunk
- seen with metabolic/toxic encephalopathies
- Negative myoclonus
18
Q
Myoclonus
A
- involuntary jerks/shock like movements of muscle groups
- focal/multifocal/generalized
- Cortical
- epilepsy/degenerative disorders
- metabolic encepahlopathies (anoxia)
- Subcortical/spinal/peripheral (hemifacial spasm)
- physiologic = hypnic jerks
19
Q
Restless legs
A
- uncomfortable urge to move legs/body parts
- worse at rest
- associated sleep disorder
- assocaited iron deficiecny
- treated with
- reassurance, DOPA agonists, sedatives, opiates
20
Q
Psychogenic
A
- difficult diagnostic problem
- inconsistent findings/incongruent with known pathologic entities
- impovement when distracted
- may see other false neuro signs/symptoms
- 2-5% movements disorders clinic patients
- psychaitric patients often have abnormal movements
Neuro/Behav
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