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Clinical Motor Signs

Chloe Yap

http://www2.fiu.edu/~condon/motor.htm

Extrapyramidal

Cerebellar

Pyramidal

Confusing Terminology!

Confusing Terminology!

Cerebellum Functional Divisions

Input

Division

Function

"Pyramidal weakness" = UMN lesion!

[https://www-uptodate-com.ezproxy.library.uq.edu.au/contents/the-detailed-neurologic-examination-in-adults]

"Extrapyramidal signs" = basal ganglia!

  • Motor function (but wait, there's more!)
  • Associative: cognitive and executive behaviour eg. strategic planning
  • Limbic: motivation and regulation of behaviour and emotions
  • (Martin's Neuroanatomy)

Function

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543080/

"Pyramidal tracts": tracts passing through the medullary pyramids

  • 1. Corticospinal (voluntary, body)
  • 2. Corticobulbar (voluntary, face)

vs. "Extrapyramidal tracts": tracts originating in the brainstem, carrying motor fibres --> spinal cord

  • Rubro-, tecto-, vestibulo-, reticulospinal
  • Muscle tone, balance, posture, locomotion

Corticospinal

Corticobulbar

Motor functions

Green: direct pathway Red: indirect pathway

Wiring

Spinocerebellum

Vestibulocerebellum

Cerebrocerebellum

References

https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/overview-of-movement-and-cerebellar-disorders#v8305636

Martin's Neuroanatomy

Upper motor neuron lesion signs

Hyperkinetic disorders

(eg. Huntington's Disease)

Hypokinetic disorders

(eg. Parkinson's Disease)

  • Increased tone
  • Spasticity
  • Clonus
  • Hyper-reflexia
  • Babinski's reflex

Decrease cortical outflow

Increase cortical outflow

Disorders

Balance

Stabilise eyes during movement (vestibulo-ocular reflex)

Prox limb/trunk coord

Ataxia

Vertigo

Nystygmus

Muscle tone

Extremity coordination

Feedback: muscle stretch

+ tension receptors

Hypotonia

(eg. pendular knee jerk)

Distal limb coordination

Skilled movements

Procedural learning

Speech

Intention tremor

Over/undershoot

Heel-shin test

Dysdiadochokinesis

Outlines

  • Red: inhibited in this condition
  • Green: activated in this condition

Block colour activated together

Conditions and affected regions

Parkinson's: SNc

Dystonia: dopamine antagonists

Conditions and affected regions

Hemiballismus: STN

Chorea (Huntington's): striatum

Athetosis: putamen (indirect, striatum)

https://www.dartmouth.edu/~rswenson/NeuroSci/chapter_8B.html

  • Bradykinesia, akinesia
  • Decreased fine control
  • Micrographia, tremor

Spinal cord

Spinocerebellum

Trunk, limb

posture, mvmt

Cerebral cortex

Cerebrocerebellum

Planning mvmt

Nonmotor function

Vestibular

Vestibulocerebelllum

Balance

Head, eye mvmt

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