Neuro Exam 4.7

  1. Muscle tone:
    partial state of contraction of extrafusal fibers
  2. Who needs some muscle tone?
  3. When is it most efficient to contract a muscle?
    when it is already partially contracted
  4. Posture is a consequence of:
    muscle tone
  5. Posture is a result of:
    • constant responses to proprioception input from adjustment of mm to shifts in gravity
    • adjust to have a steady platform on which to function
  6. What 3 primary factors determine muscle tone?
    • intrinsic characteristics of extrafusal fibers (skeletal m cells)
    • gravity pulling on skeletal mm and activating stretch reflexes (Ia and alpha motor neurons)
    • gamma bias -finessing system of m tone
  7. An alpha motor neuron is the type of neuron that stimulates:
    the skeletal mm and is under voluntary control
  8. Gamma motor neurons are involved in:
    reflexes and adjusting tension on muscle spindles
  9. Muscle spindles are components of mm that:
    tell the brain the state of contraction of the mm
  10. Gamma motor neurons are not under:
    voluntary control
  11. Gamma motor neuron has effect on:
    • alpha motor neurons
    • Ex: helps w/ coordination and is what is activated when you are nodding off; increased stretch in neck activates gamma motor neuron which tells your brain that your head is moving, causing the reflex that contracts your neck mm and brings your head back up
  12. What is Gamma bias due to?
    supraspinal descending pathways influencing gamma motor neurons (LMN)
  13. Where do the gamma bias influences (descending supraspinal input) originate from?
    • cerebellum
    • reticular formation of brainstem
  14. What does the cerebellum do?
    maintain and influence muscle tone
  15. Where are the cell bodies of gamma motor neurons?
    ventral horn of SC
  16. What do gamma motor neurons innervate?
    contractile portion of intrafusal fibers
  17. Are gamma motor neurons bigger or smaller than alpha motor neurons?
  18. When do gamma motor neurons discharge?
  19. What do gamma motor neurons not do?
    • not excited monosynaptically by Ia fibers (no peripheral input)
    • do not respond to type II
    • GTO (Ib) don't influence gamma motor neuron activity
    • don't respond to peripheral input
    • not involved with Renshaw cell activity
  20. What is the effect of gamma motor neurons?
    to alter sensitivity of muscle spindle by altering length of intrafusal fiber and tension they exert
  21. What does gamma bias allow?
    muscles to be reset
  22. When gamma motor neurons fire, they cause:
    • skeletal mm aspect of intrafusal fiber to contract
    • makes it easier for Ia fibers to fire b/c more sensitive to fire which increases muscle tone
    • --this can also work in opposite manner, making it harder to fire Ia fiber; intrafusal fiber becomes slacked
  23. When does gamma bias prime skeletal muscle tone?
    • when you anticipate something
    • ex: waiting in the blocks as a sprinter
    • ex: waiting the last few minutes of class (about to get up and leave)
  24. What are some clinical conditions of muscle tone?
    • hypotonia
    • hypertonia
  25. Hypotonia:
    • decreased m tone
    • decreased resistance to passive movement
  26. How do you get hypotonia?
    • eliminating LMN (transected N); no reflex arc
    • eliminate afferent sensory input, alpha motor neurons don't know what to do/when to contract
    • lesions of cerebellum; doesn't send info down, or influence gamma bias, therefore no sensitivity
  27. Hypertonia:
    • excessive m tone
    • increased resistance to passive movement
  28. What are types of hypertonia?
    • spasticity
    • rigidity
  29. What is spasticity characterized by?
    hyper-reflexia of DTR due to UMN damage
  30. Spasticity:
    increased resistance to passive movement
  31. What is an example of spasticity?
    clasp knife phenomenon
  32. Clasp Knife Phenomenon
    an initial increase in resistance followed by a sudden disappearance of resistance (or all of a sudden relaxation)
  33. What can cause spasticity?
    • traumatic brain injury
    • heart attack (with ischemia)
  34. What characterizes rigidity?
    increase in m tone in all mm, although strength and reflexes are not affected
  35. What are two expressions used to describe rigidity?
    • lead pipe rigidity
    • cog-wheel rigidity
  36. What is lead pipe rigidity?
    • plastic
    • uniform throughout ROM
    • damage to basal ganglia
  37. What is cog-wheel rigidity?
    • rigidity is a series of jerks during ROM
    • seen in Parkinson's due to basal ganglia dysfunction
  38. What are the primary functions of the cerebellum?
    • coordinates voluntary mm activity
    • coordinates equilibrium activity
    • influence mm tone (can have too much/too little)
  39. Damage the cerebellum then we will have what kind of problem?
  40. Does the cerebellum project directly to SC?
    no, it doesn't directly tell LMN what to do
  41. Does the cerebellum initiate voluntary m movement?
  42. If you damage the cerebellum, you can still have movements b/c:
    • it indirectly projects to SC
    • you never see paralysis if you damage just the cerebellum, can cause problems though
  43. What information does the cerebellum need?
    • position, state of contraction (m tone), and activity of m and joints (unconscious proprioceptive)
    • equilibrium state of body (needs to know what inner ear is doing)
    • info being sent via corticobulbar and corticospinal tracts to skeletal mm of body
  44. How does the cerebellum receive info about the position, state of contraction and activity of m and joints?
    via anterior (enters cerebellum through superior peduncle) and posterior (inferior peduncle) spinocerebellar tracts
  45. How does the cerebellum receive info about equilibrium?
    • via vestibulocerebellar tract (vestibular nuclei [90% in pons, 10% in medulla] enters cerebellum through infoerior peduncle to pons)
    • transmits unconscious proprioception
  46. How does the cerebellum receive info being sent via corticobulbar and corticospinal tracts to skeletal mm of body?
    via inferior and middle cerebellar peduncles
  47. Characteristics of cerebellar control of body:
    • each hemisphere controls info on ipsilateral side (R hemi controls R body)
    • clinically, cerebellar symptoms will be ipsilateral (b/c cerebellum has several double decussation patterns)
    • cerebellum doesn't initiate voluntary movement (initiation comes from corticospinal/corticobulbar tracts --no paralysis in cerebellar injury)
  48. How many functional lobes of the cerebellum are there?
  49. If you have damage to the cerebellar lobes, the damage will:
    always be on the same side
  50. Ipsilateral ataxia on the R side of your body is due to:
    R sided posterior lobe damage
  51. What are the lobes of the cerebellum?
    • anterior
    • posterior
    • flocculonodular
  52. What is another name for the anterior cerebellar lobe?
    spinocerebellum paleocerebellum
  53. What does the anterior cerebellar lobe do?
    maintains m tone, posture, gross voluntary movement, and gait
  54. Is the anterior cerebellar lobe bilateral or unilateral?
    bilateral structure
  55. What does the posterior cerebellar lobe do?
    coordination of fine, voluntary movement
  56. What are other names for the posterior cerebellar lobe?
  57. What is the function of the flocculonodular cerebellar lobe?
    maintenance of equilibrium
  58. What is another name for the flocculonodular cerebellar lobe?
  59. What are some classical cerebellar symptoms?
    • general ataxia
    • hypotonia
    • nystagmus
    • (may be attributed to R/L side and to a specific lobe)
  60. General ataxia:
    abnormality in muscular coordination leading to abnormality of voluntary movement
  61. What are the symptoms of general ataxia?
    • mm contract weakly and irregulary
    • intentional tremor/terminal tremor (may occur when approaching a target --closer you get more you shake)
    • unsteady or drunken gait
    • feet spaced far apart to stabilize and get a broader BOS
    • lean or lurch to affected side
    • dysmetria
    • dyssynergia
    • dysdiadokinesia
    • dysarthria
  62. Which cerebellar lobe is responsible for mm contract weakly and irregularly with general ataxia?
  63. Which cerebellar lobe is responsible for intentional tremor/terminal tremor with general ataxia?
    posterior lobe
  64. Which lobe is responsible for unsteady or drunken gait with general ataxia?
  65. Which lobe is responsible for feet spaced far apart to stabilize with general ataxia?
  66. Which lobe is responsible for lean or lurch to affected side with general ataxia?
  67. Dysmetria:
    inability to stop a m movement at a desired point (finessed dysfunction)
  68. Which lobe is responsible for dysmetria with general ataxia?
  69. dyssynergia:
    voluntary movements are jerky and tremor like
  70. Which lobe is responsible for dyssynergia with general ataxia?
  71. Dysdiadokinesia:
    • inability to perform rapid, alternating movements
    • i.e., rapid pronation/supination of forearm quickly
  72. Which cerebellar lobe is reponsible for dysdiadokinesia with general ataxia?
  73. Dysarthria:
    • slurred or hesitant type of speech; scanning speech
    • give old people time to respond to your question.  They can comprehend (unless there's a cognitive problem) the question, just takes more time, esp. as you age
  74. Which cerebellar lobe is responsible for dysarthria with general ataxia?
  75. Hypotonia:
    loss of m tone
  76. Which cerebellar lobe is responsible for hypotonia?
  77. Hypotonia with DTR:
    pendular swinging after DTR is diagnostic for cerebellar dysfunction
  78. Pendular knee jerk:
    after knee jerk --swings through normal sport for a while (this is abnormal and indicates cerebellar dysfunction)
  79. What does hypotonia cause?
    diminished resistance to passive movement b/c mm tone has been reset at a lower level
  80. Is the cerebellum damaged?
    no influence to gamma bias, therefore hypotonia occurs b/c little sensitivity
  81. Nystagmus:
    • rhythmic oscillation of eyes
    • ataxia of the eyes due to influence of cerebellum on the extrinsic eye mm
    • rapid and slow tracking phase
  82. Which cerebellar lobe is responsible for nystagmus?
    flocculonodular lobe
  83. What is the rapid phase of nystagmus called?
  84. What is the slow phase of nystagmus called?
    slow tracking component
  85. How is nystagmus named?
    named in the direction of the saccades
  86. What should you rule out before diagnosing nystagmus (a cerebellar dysfunction)?
    proprioceptive, vestibular nuclei, or ear problems
Card Set
Neuro Exam 4.7
review of neuro part 7 for exam 4