Neurologic System The Motor System and the Cerebellar Function

Motor Pathways & Type of Movements Corticospinal or Pyramidal Tract Voluntary, skilled, discrete, purposeful (writing) Extrapyramidal Tracts Maintain muscle tone and control body movements (walking) Cerebellar System Coordinates movement, maintains equilibrium and posture….Operates on subconsious level

Corticospinal or Pyramidal Tract

Voluntary, skilled, discrete, purposeful (writing)

Extrapyramidal Tracts

Maintain muscle tone and control body movements (walking)

Cerebellar System

Coordinates movement, maintains equilibrium and posture….Operates on subconsious level

Question for Thought Describe 3 major motor pathways in the CNS including the type of movements mediated by each?

Describe 3 major motor pathways in the CNS including the type of movements mediated by each?

Chapter 21 Cerebral Cortex Figure 21-1. p. 688.

Cerebral Cortex

Upper and Lower Motor Neurons Upper motor neurons All descending motor neurons that impact on the lower motor neurons Located in the CNS Convey impulses from motor areas of cerebral cortex to lower motor neurons in the cord Diseases = CVA, Cerebral palsy, Multiple sclerosis

Upper motor neurons

All descending motor neurons that impact on the lower motor neurons

Located in the CNS

Convey impulses from motor areas of cerebral cortex to lower motor neurons in the cord

Diseases = CVA, Cerebral palsy, Multiple sclerosis

Upper and Lower Motor Neurons Lower motor neurons In the peripheral nervous system 12 cranial nerves 31 pairs of spinal nerves and all branches Final direct contact with the muscles Movement translated into action Reflex arc Examples = cranial nerves, spinal nerves Diseases = spinal cord lesions, poliomyelitis, ALS

Lower motor neurons

In the peripheral nervous system

12 cranial nerves

31 pairs of spinal nerves and all branches

Final direct contact with the muscles

Movement translated into action

Reflex arc

Examples = cranial nerves, spinal nerves

Diseases = spinal cord lesions, poliomyelitis, ALS

Question for Thought Differentiate an upper motor neuron from a lower motor neuron?

Differentiate an upper motor neuron from a lower motor neuron?

Subjective Data In the Interview Any shakes or tremors in the hands or face? Worsen with anxiety, fatigue Relieved with activity, alcohol ADL’s affected Weakness Where? When? Why?

In the Interview

Any shakes or tremors in the hands or face?

Worsen with anxiety, fatigue

Relieved with activity, alcohol

ADL’s affected

Weakness

Where? When? Why?

Subjective Data Incoordination Balance, falling, Legs give out Clumsy Numbness/ Tingling Describe ( pins and needles) Significant past history TIA’s, Atrial Fib.

Incoordination

Balance, falling,

Legs give out

Clumsy

Numbness/ Tingling

Describe ( pins and needles)

Significant past history

TIA’s, Atrial Fib.

Assessment of Motor System Body position Involuntary movements Muscle size ( bulk) Muscle tone Muscle strength

Body position

Involuntary movements

Muscle size ( bulk)

Muscle tone

Muscle strength

Body Position Observe during movement Observe at rest

Observe during movement

Observe at rest

Involuntary Movements Tremors, tics, fasciculations, myoclonus Note: Location Quality Rate Rhythm Amplitude

Tremors, tics, fasciculations, myoclonus

Note:

Location

Quality

Rate

Rhythm

Amplitude

Involuntary Movements Note the involuntary movement in relation to : Posture Activity Fatigue Emotion Other factors

Note the involuntary movement in relation to :

Posture

Activity

Fatigue

Emotion

Other factors

Terms to Describe Movement Flexion Extension Abduction Adduction Pronation Supination

Flexion

Extension

Abduction

Adduction

Pronation

Supination

More Terms for Movement Circumduction Inversion Eversion Rotation Protraction

Circumduction

Inversion

Eversion

Rotation

Protraction

Terms of Movement Continued Retraction Elevation Depression

Retraction

Elevation

Depression

Muscle Size Compare size and contour Atrophy Unilateral/bilateral Proximal/distal

Compare size and contour

Atrophy

Unilateral/bilateral

Proximal/distal

Muscle Tone A relaxed muscle maintains a slight residual tension referred to as muscle tone. Hypo tonic, Flaccidity. Spasticity. Lead-pipe rigidity.

A relaxed muscle maintains a slight residual tension referred to as muscle tone.

Hypo tonic, Flaccidity.

Spasticity.

Lead-pipe rigidity.

Muscle Strength Test muscle strength by asking the client to move actively against your resistance or to resist your movement. A muscle is strongest when shortest and weakest when longest.

Test muscle strength by asking the client to move actively against your resistance or to resist your movement.

A muscle is strongest when shortest and weakest when longest.

Terms to Describe Strength Weakness (paresis) Paralysis (plegia) Hemiparesis Hemiplegia Paraplegia Quadriplegia

Weakness (paresis)

Paralysis (plegia)

Hemiparesis

Hemiplegia

Paraplegia

Quadriplegia

Grading Muscle Strength Scale 0-5 0 - no muscular contraction 1 – slight contraction 2 – Full ROM, gravity eliminated

Scale 0-5

0 - no muscular contraction

1 – slight contraction

2 – Full ROM, gravity eliminated

Grading Muscle Strength 3 – Full ROM against gravity 4 – Full ROM against gravity, some resistance 5 – Full ROM against gravity full resistance without evident fatigue = Normal Muscle Strength

3 – Full ROM against gravity

4 – Full ROM against gravity, some resistance

5 – Full ROM against gravity full resistance without evident fatigue = Normal Muscle Strength

Cerebellar Function Balance tests Gait Observe normal walk Tandem Walking ( heel – to- toe ) Romberg Test (stand, feet together, arms at side, close eyes) Shallow knee bend or hop on one leg What findings would you expect to see when assessing gait and balance in an older adult?

Balance tests

Gait

Observe normal walk

Tandem Walking ( heel – to- toe )

Romberg Test (stand, feet together, arms at side, close eyes)

Shallow knee bend or hop on one leg

What findings would you expect to see when assessing gait and balance in an older adult?

Cerebellar Function Coordination and Skilled Movements RAM ( Rapid alternating movements) Pat Knees Thumb to each finger Finger to finger Finger to nose Heel to shin

Coordination and Skilled Movements

RAM ( Rapid alternating movements)

Pat Knees

Thumb to each finger

Finger to finger

Finger to nose

Heel to shin

Question for Thought List and describe 3 tests of cerebellar function?

List and describe 3 tests of cerebellar function?

Charting Sample For Normal Muscle Strength (objective) Able to maintain flexion against resistance and without tenderness For Motor ( objective) No atrophy, weakness or tremors. Gait smooth and coordinated, able to tandem walk, negative Romberg. RAM, finger-to-nose smoothly intact

For Normal Muscle Strength (objective)

Able to maintain flexion against resistance and without tenderness

For Motor ( objective)

No atrophy, weakness or tremors. Gait smooth and coordinated, able to tandem walk, negative Romberg. RAM, finger-to-nose smoothly intact