Red Flags for Motor Dysfunction

Question 1

What are red flags for cerebellar dysfunction?

Answer 1

• Ataxic movements impeding a patient’s ability to bring a cup or spoon to the mouth without spilling
• Over- or undershooting when reaching for items in a closet
• Wide-based staggering gait during functional activities
• Noted nystagmus with functional complaints of dizziness, diplopia, and difficulty reading and writing
• Inability or difficulty applying makeup secondary to intension tremors
• Difficulty or inability to clap hands
• Hypertonia or hypotonia
• Broken or slurred speech

Question 2

What are red flags for basal ganglia dysfunction?

Answer 2

• Pill rolling or tremor-like movement at rest
• Difficulty bringing eating utensils to the mouth or both hands to the face for grooming activities, secondary to UE rigidity
• Inability to initiate voluntary movement
• Increased time noted to perform motor components of self-care or mobility due to bradykinesia
• Jerky movement inhibiting fine and gross motor tasks

Question 3

What are red flags for brainstem dysfunction?

Answer 3

• Complaints of vertigo
• Loss of balance during seated and standing ADL tasks
• Diplopia or disconjugate gaze
• Flaccidity of an extremity
• Spasticity of an extremity
• Inability to perform bed mobility secondary to extensor tonal patterns
• Difficulty performing anterior weight shifts secondary to extensor tone dominance
• Hypertonicity with yawning and coughing
• Associated reactions

Question 4

What are red flags for the primary motor area?

Answer 4

• Inability to voluntarily move the involved extremity

- Spasticity

Question 5

What are red flags for motor tract dysfunction?

Answer 5

• Inability to initiate and carry out a desired movement
• Decreased visual scanning, binocular vision, and diplopia
• Difficulty swallowing
• Dysarthric speech
• Inability to coordinate head and neck movements during reaching, scanning, and ADL performance
• Difficulty ambulating on uneven terrain secondary to loss of balance
• Inability or difficulty transitioning from bending to retrieve low items to returning to a normal midline trunk position in sitting
• Inability to maintain head in a neutral position or hold head up against gravity

Question 6

What are red flags for frontal lobe dysfunction?

Answer 6

• Inability to correctly select or use eating utensils secondary to apraxia
• Inability to perform grooming and hygiene tasks secondary to incorrect utensil use (or apraxia)

Question 7

What is the pathway of neural messages from the cortex to muscles?

Answer 7

Primary motor cortex > Internal capsule > Thalamus > Brainstem > Spinal cord > Ventral horn of spinal cord > Ventral rootlets > Ventral root > Skeletal muscle