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UMN Lesion Lesion in DESCENDING motor systems, neural basis for abnormal…

- - - - MUSCLE OVERACTIVITY
        
        STATIC
        
        spasticity
        
        Abnormal efferent drive from higher centers = efferent
        
        spastic dystonia = tonic, chronic involuntary mm contraction in absence of any stretch or voluntary command
        
        NOT spasticity
        
        stays in that position and needs to physically be moved out bc not a voluntary contraction
        
        usually 1x motion
        
        UE
        
        ADD/IR shoulder
        
        FLX wrist
        
        PRON forearm
        
        clinched fist
        
        FLX Elbow
        
        thumb-in-palm deformity
        
        LE
        
        equinovarus
        
        stratial toe
        
        stiff knee
        
        FLX knee
        
        ADD thighs
        
        indicative of loss of inhibition control
        
        DYNAMIC = mm Overactivity
        
        abnormal processing of spinal reflexes = hyperactive stretch reflex - afferent
        
        clonus: self-sustained oscillation stretch reflex initiated by brisk stretch of hyperreflexic mms (5-8 Hz)
        
        spasticity: Velocity dependent increase in tonic stretch reflexes (increase in muscle tone)
        
        additional signs
        
        contraction of mms with different actions than mm being tested
        
        examples
        
        thigh ADDs contract with patellar reflex
        
        Finger flexors contract with brachioradialis refelx
        
        documentation
        
        3+: reflex noticeably more brisk
        
        4+: reflex hyperactive with clonus
        
        cutaneous
        
        (+) Babinski Test = toe EXT after rub bottom of toes
        
        Tests For = Cortical Spinal Tract Integrity
        
        2 more items...
        
        support reactions
        
        why hyperreflexia occurs --> no interneuron (loss of inhibition)
        
        Abnormal efferent drive from higher centers = efferent
        
        associated reaction = failure to inhibit spread of motor activity
        
        AKA: Unrelated movement contractions
        
        example: FLX of elbow with FLX of hip during gait = it gets stuck
        
        Abnormal processing of spinal input
        
        Spasm
        
        in response to active or passive movement, or spontaneous
        
        FLXor Spasms = Hip, knee, ankle DF
        
        EXTsor Spasms = Hip, knee, ankle PF
        
        Co-contraction
        
        Spastic co-contraction of agonist and antagonist during movement
        
        difficult for movement, but can be retrained over long period of time and practice
        
        flexor withdrawal
  - - - WEAKNESS (PARESIS)
        
        immobilization at short mm length
        
        biomechanical changes :arrow_forward: reduced compliance contracture
        
        HYPERTONIA (REDUCED ROM)
        
        abnormal posture
        
        impaired function
      - loss of dexterity:
        
        inability to recruit in a timely manner
        
        not able to synchronize activation (timing and appropriate force)
  - - - joint stiffness
        
        joint contracture
        
        fibrosis
        
        muscle atrophy
        
        fiber type changes
        
        osteopenia --> osteoporosis
- - - - intrasegmental: within a body segment
        
        synchronization of agonists/antagonists
      - Intersegmental: between body segments
        
        synchronization of arm and leg movements
- - - - (+) EXTsors
        
        (-) FLXors
    - - (+) FLXors
        
        (-) EXTsors
- - - - hyper-reflexive
- - - - corticospinal (movement tract)
        
        lateral
        
        control of contralateral appendicular mms (+)
        
        anterior
        
        control primarily contralateral axial mms
      - corticobulbar
        
        Brainstem: primarily reflexes associated with cranial nerves (+)
  - - - reflexive movement of the head, neck ,eyes in response to visual/auditory stimuli
    - - balance of activity in 2x tracts = maintains posture and balance with movement against gravity
    - - modulates posture, movement and balance based on vestibular input
        
        (-) FLX of neck, back, limbs
        
        (+) EXT of neck, back, limbs
  - - - Compensate for ERRORS
        
        postural
        
        proprioceptive
        
        cutaneomuscular reflexes
        
        ocular reflexes
      - influence Alpha motor neurons via cortical/brainstem nuclei
    - - volitional control of movement
      - automatic control of muscle tone and locomotion
      - muscle tone --> rigidity
- - - - urinary dysfunciton:
        
        UMN = voluntary control of voiding
        
        LMN = reflexive control of voiding