INTRODUCTION TO NEUROLOGICAL CONDITIONS. F

SPASTICITY

arises from injury to descending motor pathways from the cortex (pyramidal tracts) or brainstem (medial and lateral vestibulospinal tracts, dorsal reticulospinal tract)

UMN syndrome

SPASTICITY a part of what motor neuron syndrome?

SPASTICITY

produces disinhibition of spinal reflexes with hyperactive tonic stretch reflexes or a failure of reciprocal inhibition.

Babinski sign

dorsiflexion of the great toe with fanning of the other toes on stimulation of the lateral sole of the foot.

RIGIDITY

a hypertonic state characterized by constant resistance throughout ROM that is independent of the velocity of movement

RIGIDITY

increase in static stretch reflexes and activation of alpha motor neurons in both agonist and antagonist muscle groups & occurs all throughout ROM

COGWHEEL RIGIDITY

jerky, ratchet-like response to passive movement as muscles alternately contract and relax.

LEADPIPE RIGIDITY

smooth uniform resistance with no fluctuations to passive movement

• COGWHEEL RIGIDITY

• LEADPIPE RIGIDITY

TWO TYPES OF RIGIDITY

COGWHEEL RIGIDITY

this is theorized to be a result of autogenic reflex inhibition from GTOs, or it may result from superimposed tremor or rigidity

• DECORTICATE RIGIDITY

• DECEREBRATE RIGIDITY

Severe brain injury results in coma and may result in posturing

DECORTICATE RIGIDITY

refers to sustained contraction and posturing of the upper limbs in flexion and the lower limbs in extension.

DECEREBRATE RIGIDITY

an abnormal extensor response refers to sustained contraction and posturing of the trunk and limbs in a position of full extension.

Opisthotonus

characterized by strong and sustained contraction of the extensor muscles of the neck and trunk, resulting in a rigid, hyperextended posture.

DECORTICATE RIGIDITY

The elbows, wrists, and fingers are held in flexion with shoulders adducted tightly to the sides while the legs are held in extension, internal rotation, and plantarflexion

DECORTICATE RIGIDITY

indicative of a corticospinal tract lesion at the level of diencephalon (above the superior colliculus)

DECEREBRATE RIGIDITY

elbows are extended with shoulders adducted, forearms pronated, and wrist and fingers flexed. The legs are held in stiff extension with plantarflexions

DECEREBRATE RIGIDITY

indicates a corticospinal lesion in the brainstem between the superior colliculus and vestibular nucleus

corticospinal tract

• DECEREBRATE RIGIDITY

• DECORTICATE RIGIDITY

what tract lesion?

diencephalon

DECORTICATE RIGIDITY what site of lesion?

RIGIDITY

Physiology: Over-discharge of motor neuron - Alpha Motor Neuron

SPASTICITY

Physiology: Over-discharge of motor neuron - Gamma Motor Neuron

RIGIDITY

Physiology: Influence from higher centers - Extrapyramidal system

SPASTICITY

Physiology: Influence from higher centers - Pyramidal system

RIGIDITY

Physiology: Temperature changes - Less sensitive

SPASTICITY

Physiology: Temperature changes - More sensitive

RIGIDITY

Physiology: Range of hypertonicity - Whole ROM

SPASTICITY

Physiology: Range of hypertonicity - initial movement

RIGIDITY

Physiology: DTR/MSR - Decreased

SPASTICITY

Physiology: DTR/MSR - Increased

Hypotonia

decreased tone below normal resting levels

Hypotonia

used to define decreased or absent muscular tone

Hypotonia

resistance to passive movement is diminished, stretch reflexes are dampened or absent, and limbs are easily moved (floppy).

Hypotonia

Hyperextensibility of joints is common

Dystonia

a prolonged involuntary movement disorder char. by twisting or writhing repetitive movements and increased muscular tone

Neurological Conditions

any conditions that affects the nervous system.

Neurological Conditions

are diseases of the brain, spine and the nerves that connect them that impair their functions.

ALERT

quick to perceive and to react to stimulus

CONFUSION

Memory is impaired Is confused and disoriented

DROWSY

ready to fall asleep

CONFUSION

implies that the patient is disoriented in terms of time, place, or person.

ALERT

Is readily aroused, oriented, & fully aware of surroundings

LETHARGY

a lesser impairment of consciousness characterized by dullness, decreased mental alertness and excessive drowsiness

LETHARGY

Is drowsy and inattentive

LETHARGY

Responds to name; Has slow and fuzzy thinking

OBTUNDITY

Responds to loud voice or shaking

OBTUNDITY

Responds to painful stimulus (withdrawal)

OBTUNDITY

Is confused when aroused

OBTUNDITY

Talks in monosyllables; Mumbles and is incoherent; Needs constant stimulation to cooperate

• STUPOROUS

• SEMICOMA

a marked impairment of consciousness but still arousal is possible by physical means.

• STUPOROUS

• SEMICOMA

Responds to painful stimuli (withdrawal) or shaking; Groans, mumbles; Exhibits reflex activity

COMA

unarousable unresponsiveness to stimulus; Does not respond to painful or any other stimuli

SPEECH

is the motor activity by which the respiratory, laryngeal and oral structures produce the sound patterns(phonemes) to communicate

LANGUAGE

is a complex and dynamic systems of conventional symbols that is used in various modes for thought & communication

PHONATION

sound generated by rapid vocal fold movement excited by exhaled airstream.

airstream

refers to respiration, the power source for voice and speech

• Voicing

• Whispering

2 types of phonation during speech

VOICE

is the audible sound produced by phonation

VOICE

one of the component of the total speech act

FLUENCY

is the smoothness with which sounds, syllables, words and phrases are joined together during oral language with lack of hesitations or repetitions.

125

Average number of words per minute or the speaking rate

PROSODY

encompasses the rate, rhythm.

PROSODY

Loudness and pitch contours that signal stress and therefore carry additional meaning beyond individual speech sounds, words, or sequence of words (vocal stress)

APHASIA

defect or loss of the power of expression by speech, writing or signs of comprehending spoken nor written language due to injury or disease of the brain center.

• FLUENCY

• COMPREHENSION

• REPETITION

3 Particular discriminating binary language behaviors in classifying aphasia by syndrome

BROCA’S APHASIA

a primary deficit in language output or speech production

BROCA’S APHASIA

in the most advanced form, patients will have lost all the power of speaking aloud

BROCA’S APHASIA

in the milder forms, words are uttered slowly and laboriously

WERNICKE’S APHASIA

an impairment in the comprehension of speech which reflects involvement of the auditory association areas or their separation from the angular gyrus and primary auditory complex.

WERNICKE’S APHASIA

Fluently articulated but paraphasic speech which reveals the major role of the auditory region in the regulation of speech. It is manifested further by a varying inability to repeat spoken words

WERNICKE’S APHASIA

Listening comprehension difficulty is a cardinal sign and has poor repetition

BROCA’S APHASIA

Nonfluent, with telegraphic speech and reduced verbal content, typically have functional comprehension but have trouble following complex grammatical statements

NONFLUENT/EXPRESSIVE APHASIA

BROCA’S APHASIA

SENSORY/FLUENT

WERNICKE’S APHASIA

TOTAL APHASIA

all aspects of speech and language are affected.

GLOBAL or TOTAL APHASIA

Severely impaired in all language modalities which results in almost total inability to communicate orally.

GLOBAL or TOTAL APHASIA

Fluency, comprehension, and repetition are all seriously compromised.

ANOMIC APHASIA

most striking in her loss of words both orally and in writing; tends to circumlocute (talk around a word) and generally has functional reading and listening skills.

CIRCUMLOCUTE

talk around a word

ANOMIC APHASIA

fluency and repetition skills are unremarkable

CONDUCTION APHASIA

have difficulty in repeating a word or phrase; spontaneous speech is relatively fluent with functional comprehension.

TRANSCORTICAL MOTOR APHASIA

has fluency and comprehension resembling that of a person with Broca’s aphasia, but repetition skills are spared.

TRANSCORTICAL MOTOR APHASIA

The hallmark of this syndrome is ADYNAMIA

ADYNAMIA

TRANSCORTICAL MOTOR APHASIA: hallmark of this syndrome

ADYNAMIA

difficulty in initiating speech

TRANSCORTICAL SENSORY APHASIA

relatively a rare condition similar to Wernicke’s aphasia but has the ability to repeat.

ISOLATION SYNDROME

a rare syndrome that is severely impaired in all language-processing abilities except for the oasis of being able to repeat

APRAXIA

A disturbance in the execution of learned movements other than those disturbances caused by any coexisting weakness

APRAXIA

A disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked.

DYSPRAXIA

an incomplete form of apraxia

IDEATIONAL/CONCEPTUAL APRAXIA

movements of affected body parts appear to suffer a lack of a basic plan, although an individual familiar movements are carried out easily.

IDEATIONAL/CONCEPTUAL APRAXIA

Inability to conceptualize a task and impaired ability to compete for multistep actions and a loss of ability to voluntarily perform a learned task when given the necessary objects or tools.

IDEOMOTOR APRAXIA

motor behavior is intact when executed spontaneously but faulty attempted in response to verbal command

IDEOMOTOR APRAXIA

most frequently encountered form of CLASSIFICATION OF APRAXIA

IDEOMOTOR APRAXIA

have a deficit in the ability to plan or complete motor action that relies on semantic memory; able to explain action but unable to imagine or act out the movement on demand

INNERVATORY APRAXIA

attempted movement is disorganized; the patient appears clumsy or unfamiliar with the movements called for in tasks such as writing or using utensils

BUCCOFACIAL APRAXIA

resulting in difficulty carrying out movements of the face

CONSTRUCTIONAL APRAXIA

inability to draw or construct simple configurations, such as intersecting shapes

GAIT APRAXIA

loss of ability to have normal function of the lower limbs such as walking.

OCULOMOTOR APRAXIA

difficulty moving the eye, especially in saccadic movements that direct the gaze to targets