Neuromuscular Assessment

What are the layers of protection for the CNS?

skull, meninges, CSF

what are the two pathways the brain uses to reach the spinal cord and brainstem?

direct, indirect pathways

the direct pathway is responsible for what type of movement?

fine motor movements

the indirect pathway is responsible for what type of movement?

gross, crude reflexive movements

basal ganglia fxn:

on/off switch for movement

if the direct pathway is always upregulated what occurs?

all motor plans will be ON, excess constant movement

Huntingtons disease would be a result of an upregulated _____ pathway

direct

if the indirect pathway is always on what occurs?

no movement!

someone with an upregulated indirect pathway might present with what disease?

parkinsons

injury to the spinal cord results in loss of ability to send the output to the peripheral system resulting in _______.

paralysis

the feet and LE are present on what portion of the motor homonculus?

medial

the arm and face are present on what side of the motor homunculus?

lateral side

a stroke of the MCA would affect what portion of the homunculus?

Lateral, ex arms, face,

a stroke of the anterior cerebral artery affects what part of the body?

lower extremities (medial homunculus)

the cortical pathway overarching is responsible for ____ movement/

fine

the corticospinal tract fxn

voluntary motor function to hand, legs (distal extremities)

corticobulbar tract function

connects cerebral cortex to brainstem motor nuclei (LMN), to control fave, head, and neck movements

if the subcortical nuclei fires unanswered, there will be an increase in _____.

tone

the red nucleus and rubrospinal tract are responsible for what?

posturing of the limbs

cortical injury and inhibition affecting the red nucleus would have what result on musculature?

produces flexion of UE and extension of LE (decorticate posturing)

what tract would be responsible for postural control and catching us when we fall?

vestibulospinal tract

a cortical lesion of the vestibular nucleus and vestibulospinal tract would have what effect on the body?

increase in tone

a cortical lesion would affect the reticular formation and reticulospinal tract how?

increase in tone

the corticospinal tract splits into what 2 portions?

lateral corticospinal tract, anterior corticospinal tract

_____% of the corticospinal tract will decussate at the medullary pyramids and ___% will stay not cross

90, 10

lateral corticospinal tract fxn:

voluntary skill movement, distal mms, hands fingers, feet.

anterior corticospinal tract fxn:

axial and proximal mms.

what part of the basal ganglia is responsible for producing dopamine?

substantia nigra

lack of dopamine leads to what disease?

parkinsons

cerebellum function

motor learning, adaption of movement, execution of movement plan

vestibular organ sense are _____ of the cortex

independent

what senses does the DCML pick up?

proprioception, vibration, 2 pt discrimination, graphesthesia

what senses to the anterior and lateral spinothalamic tracts pick up?

pain, temperature, crude touch, pressure

what information does the spinocerebellar tract pick up?

proprioceptive mm, and joint sense information from posture mm and LE

descending pathways travel in the _____ and _____ SC. ascending pathways travel in the _____ and ____ SC

lateral, anterior, posterior, medial

autonomic tracts are found in the _____ spinal cord

thoracic

what are the two motor components of the peripheral nervous system?

alpha motor neurons, gamma motor neurons

muscle spindles, GTOs; fxn:

tell us where mms are in space

joint proprioception:

tells us where joints are in space

mechanoreceptors fxn:

sensations of light touch, vibration, pain and temperature

what system makes up 80% of total cerebral blood flow?

internal carotid system

what system makes up 20% of blood flow to the brain

vertebral basilar system

what cerebral artery is most likely to infarct?

middle cerebral a. because its the first small vessel of ant. circulation

spasticity

increased tone or muscular resistance to movement

a coordination deficit usually indicates an injury where?

cerebellum

a sensory and perception deficit usually indicates injury to what?

sensory cortex or higher cortical sensations

describe an UMN lesion:

injury to anything in the cortex, descending tracts, CNS

describe an LMN lesion

peripheral nervous system injury

what symptoms would you see in someone with an UMN lesion?

slight atrophy, spastic w increased DTRs, + babinski, - fasicular twitches, normal NVC, no denervation in EMG

what are some common diagnoses that are UMN?

CVA, MS, Huntingtons disease, parkinson’s, head injury

what are some symptoms of a LMN

pronounced individual muscle atrophy, decreased tone, no DTR - babinski, + fascicular twitches, abnormal NCV, + EMG with fibrillationc

common diagnoses of LMN

bells palsy, carpal tunnel, Gillian barre, herpes zoster