What are examples of UMN lesions?
- cerebral palsy
- hydrocephalus
- ALS (both upper and lower)
- CVA
- birth injuries
- multiple sclerosis
- huntington’s chorea
- traumatic brain injury
- pseudobulbar palsy
- brain tumors
What are examples of LMN lesions?
- poliomyelitis
- ALS (both upper and lower)
- Guillain-Barre syndrome
- tumors involving the spinal cord
- trauma
- progressive muscular atrophy
- infection
- Bell’s palsy
- carpal tunnel syndrome
- muscular atrophy
- spinal muscular atrophy
What are the characteristics of UMN disease?
weakness: yes
atrophy: mild from disuse/no
fasiculations: absent/no
reflexes: hyperactive/increased
tone: hypertonic/increased
What are the characteristics of LMN disease?
weakness: yes
atrophy: present
fasiculations: present
reflexes: diminished or absent
tone: hypotonic to flaccid
Describe characteristics of CVA of L hemisphere
- weakness, paralysis of R side
- increased frustration
- decreased processing
- possible aphasia (expressive, receptive, global)
- possible dysphagia (difficulty swallowing)
- possible motor apraxia (ideomotor and ideational)
- Decreased discrimination between L and R
- R hemianopsia
Describe characterisitics of CVA of R hemisphere
- weakness, paralysis of L side
- Decreased attention span
- L hemianopsia
- Decreased awareness and judgement
- Memory deficits
- L inattention
- Decreased abstract reasoning
- Emotional lability
- Impulsive behaviors
- Decreased spatial orientation
Describe characteristics of CVA of Brainstem
- unstable vital signs
- decreased conciousness
- decreased ability to swollow
- weakness on both sides of body
- paralysis on both sides of the body
Describe characteristics of CVA of Cerebellum
- Decreased balance
- Ataxia
- Decreased coordination
- Nausea
- Decreased ability for postural adjustment
- Nystagmus
What are upper limb flexor synergy patterns
Scaupla: elevation and retraction Shoulder: Abduction and lateral rot Elbow: flexion Forearm: supination Wrist: flexion Fingers: Flexion and adduction Thumb: Flexion and adduction
What are upper limb extensor synergy patterns
Scaupla: Depression and protraction Shoulder: Medial rotation and adduction Elbow: extension Forearm: pronation Wrist: extension Fingers: Flexion and adduction Thumb: Flexion and adduction
What are the Lower limb flexor synergy patterns
Hip: Abduction and lateral rotation
knee: flexion
ankle: DF and supination
Toes: Extension
What are the Lower limb extensor synergy patterns
Hip: Extension, medial rotation, and adduction
Knee: extension
Ankle: PF and inversion
Toes: Flexion and ADDcution
What are the seven stages of Stroke Recovery according to Bobath?
Stage 1: Not volitional movement initiated
Stage 2: The appearance of basic limb synergies. The beginning of spasticity
Stage 3: The synergies are performed voluntarily; spasticity increases (spasticity peaks)
Stage 4: Spasticity begins to decrease. Movement patterns are not dictated solely by limb synergy patterns
Stage 5: A further decrease in spasticity is noted with independence from limb synergy patterns
Stage 6: Isolated joint movements are performed with coordiation
Stage 7: Normal motor function is restored
What are the clinical manifestations of Middle Cerebral Artery Syndrome?
- Contralateral hemiparesis involving mainly UE and face (LE more spared)
- Contralateral hemisensory loss involving mainly the UE and face (LE more spared)
- Motor speech impairment Broca’s/nonfluent aphasia with limited vocab and slow hesitant speech
- Receptive speech impairment, Wernicke’s/fluent aphasia with impaired auditory comprehension and fluent speech with normal rate and melody
- Global aphasia: nonfluent speech with poor comprehension
- Preceptual deficits: unilateral neglect, depth perception, spatial relations, agnosia
- limb-kinetic apraxia
- Contralateral homonymous hemianopsia
- loss of conjugate gaze to the opposite side
- ataxia of contralateral limbs (sensory ataxia)
- Pure motor hemiplegia (lacunar stroke)
