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Ataxic, hyper, hypo, mixed - Coggle Diagram
Ataxic, hyper, hypo, mixed
Clinical signs of cerebellar damage
Ataxia: incoordinated, clumsy, high fall risk
Dysmetria: X stop mvm, mvt under or overshoot
Dyssnergia: decomposition of mvm (errors in timing, speed)
Hypotonia
Asthenia: muscle easily tired
Tremor: intention tremor only seen during mvm, OK at rest
Disturbance of posture, gait (incoordination, loss of balance=falls)
Rebound phenomenon (neurologists ask pts to put hands out, tap on arm): exaggerated reflex of mvm, positive rebound means that they have cerebellum damage, possibly have ataxic dysarthria
Nystagmnus-involuntary eye mvms, eye will dart around
Ataxic dysarthria
Causes of cerebellar damage
Trauma
Vascular disease
Infections
Tumours
Toxic, metabolic, endocrine disorders
Demyelinating, hereditary
Extra-pyramidal system disorders
Extra-pyramidal system-multi-synaptic pathways
indirectly
connecting motor areas of cerebral cortex with LMN
Major components: basal ganglia, substantia nigra, red nuclei, subthalamic nuclei
Controls muscle tone for maintenance of posture, for supporting mvms
Clinical signs
Hypokinesia
slowness, poverty spontaneous mvm
Types: akinesia- X mvm at all, most disabling symptom
Characteristics: slowness in intiation, execution of vol mvms, slow shuffling gait-dev festinating gait
Loss of postural reflex, stooped look-rounding of shoulders, loss of muscular contraction to support body-core strength impacted.
Tremor at rest: most evident at rest (limbs, head), pill rolling- thumb-fingers rubbing tgt
Rigidity: increased muscle tone, slowness of mvt, feeling of stiffness, cogwheel rigidity
Hyperkinesia
abnormal excessive involuntary mvm
2 Types
Quick
Myoclonic jerks:
abrupt, sudden, unsustained, irregular, muscles of limbs, face, oral cavity, soft palate, larynx, diaphragm-affects speech
Tics:
Brief, unsustained, recurrent, compulsive moments of small part of body eg. Tourette syndrome with multiple tics, uncontrolled vocalisations (grunting, coughing, barking), coprolalia (involuntary swearing)
Chorea:
single, unsustained, muscle action --> short, rapid, uncoordinated jerks of trunk, limb, face, tongue or diaphragm, irregular, unpredictable patterns. 2 major diseases: Huntington's chorea, Syndenham's chorea
Ballismus (hemiballismus):
wild flailing mvms on one side of body, marked in arm, facial muscle
Huntington's chorea
What is it:
chronic degenerative neurological disorder, progressive chorea, intellectual deterioration, decreased cognitive functioning.
Inherited condition: begins in adult life, fatal 10-20y post onset.
Lesions:
loss of neurons w/i caudate nucleus, putamen, cerebral cortex, white matter
Features:
facial grimacing, head jerks, weaving mvm of arms and shoulders, twists, jerks of body, increased muscle tone, problems w coordination
Slow
Athetosis
Continuous, arrythmic, slow writhing-type mvms
Irregular respiratory cycling: unable to regularly inhale, exhale. Decreased vital capacity, difficulty controlling prolonged exhalation, laryngeal spasm, incoodination of phonation, articulation, monopitch, artic errors
Dyskinesia
Lingual, facial, buccal, peri-oral areas
Repetitive, slow, writhing, flexing, extending voluntary mvm with tremor
Tardive dyskinesia, levodopa-induced kinesia (effect of dopamine medications to replenish dopamine BUT this medication then causes excessive involuntary mvm)
Dystonia
Slow, sustained for prolonged periods
Speech muscles-facial spasms, prolonged lip pursing, invl twisting, protrusion of tongue
Essential tremors
Tremors-involuntary mvms resulting from contraction of opposing muscle groups
Absent at rest-appears when muscles act to move or support body part
Slowly progressive-hands, heads commonly affected
May affect laryngeal muscles-organic voice tremor-excess low pitch, monopitch, strained, strangled quality, pitch breaks, harsh
Bradykinesia
Affects speed that muscles are activated
Slow mvm, delayed or false starts-reattempt a mvm multiple times
Slowness once mvt begun, may be difficult to stop
Intermittent freezing/immobility
Aetiology
Parkinson's disease as most freq cause. Hypokinetic dysarthria occurs in approx 70-90% of all cases. Increase in prevalence, severity as disease progresses. Degeneration nerve cells, also possible if someone has vascular lesion in extra pyramidal systemtracts in corpus striatum, substantia nigra-deficiency of neurotransmitter dopamine
Any process that damages extrapyramidal system-stroke, cerebral hypoxia, TBI, toxic-metabolic conditions (neuroleptic, anti-emetic drugs)
Pyramidal
Straight from motor cortex to LMN
Mixed dysarthria
What is it?
1 level of nervous system damaged
Aetiology:
CVA, TBI (most common), inflammatory disease, degenerative conditions
3 neurological conditions
ALS
What is it:
form of MND, selective, progressive degeneration of corticospinal, corticobulbar pathways, severe weakness of bulbar musculature, both UMN, LMN lesions , dev b/w 60-70 y/o, die usually 1-5 years from onset
Aetiology:
variety of hereditary, traumatic, toxic, viral, but mostly unknown
Problems:
swallowing, aspiration, saliva control, speech
Types of dysarthrias:
Flaccid-spastic dysarthria. BUT overall: more spastic > flaccid. Flaccid-phon and reson, spastic-prosodic excess, insufficiency, artic, reson incompetence, phon stenosis (at lvl of VF)
Multiple sclerosis
What is it:
most common demyelinating disease, is a major cause of neurological disability in young adults (peak onset 20-40y/o females slightly more affected than males),
Caseload:
2/3 cases periods where symptom get worse, remission (period of hiatus where things return to near normal), 1/3 cases progressive without remission. Majority: significant disability wrt motor, cognitive function
Aetiology:
unknown-metabolic, immunological, inflammatory, viral. Most common in temperate climates. Lesions- white matter CNS-demyelination causes scarring (sclerosis) of brain tissue- seen as plaques in white matter, may affect a number of diff parts in CNS
Symptoms:
optic neuritis, motor difficulties, incontinence, dysarthria, dysphagia, seizures, mood affected, cognitive and memory problems
TBI
Dysarthria-Approx 1/3 problems with commn in TBI Population. Wide range of severity-can be from mild artic imprecision to total unintelligibility. Long term outcome-persistent disorder
Aetiology: falls, MVAs
Prognosis: poor BUT functional speech has been recovered long after acceptable period of neurological recovery