OF LESION CORTICOSPINAL TRACTS GRAY Disorder Stroke Parkinsonism Sensation Impaired or absent: depends on Not affected location of lesion: contralateral sensory loss Tone Hypertonia/spasticity velocity- ↑ uniform resistance: leadpipe dependent clasp knife initial rigidity flaccidity: cerebral shock Rachet-like at wrist or forearm: cogwheel; independent of rate Reflexes ↑ hypereflexia Normal or maybe ↓ Strength Contralateral weakness/paralysis: Slowness of movement hemiplegia Bulk Normal: acute; disuse atrophy: Normal or disuse atrophy chronic Involuntary Spasms Resting tremor movements Voluntary Dyssynergic: abnormal timing, Bradykinesia/akinesia slowness, movements coactivation, activation, lack of spontaneous and automatic fatigability movements Postural Impaired or absent, depends on Impaired: stooped control the lesion location Gait Impaired: gait deficits due to Impaired: shuffling , festinating gait abnormal synergies, spasticity, timing deficits Spasticity: hypertonic motor d/o characterized by velocity-dependent resistance to passive stretch. Thus the larger and the quicker the sretch, the stronger the resistance of the spastic muscle. clasp knife response: during rapid movement, initial high resistance (spastic catch) may be followed by a sudden inhibition or letting go of the limb (relaxation) in response to a stretch stimulus, termed clasp-knife response. Dyssynergia: impaired ability to associate muscles together for complex movement; decomposition of movement leadpipe rigidity: a hypertonic state characterized by increased uniform resistance that persists throughout the whole ROM & is independent of the velocity of movement. Associated c lesions of the basal ganglia system (extrapyramidal syndromes). Pts demonstare stiffness, inflexibility & significant functional limitation cogwheel rigidity: a hypertonic state of rigidity c superimposed rachet-like jerkiness; characterized by and alternating giving way & then increased resistance to movements (e.g., wrist and elbow flexion & extension). It may represent the presence of tremor superimposed on rigidity. Resting tremor: involuntary oscillatory movements that occur when a body segment is at rest; typically disappears or decreases c purposeful movement. Bradykinesia: extreme slowness and difficulty maintaining movement Akinesia: inability to initiate or execute movement
Differential diagnosis: comparison of UMN & LMN syndromes
UMN lesion LMN lesion Location of CNS Cranial nerve nuclei/ nerves lesion, Cortex, brainstem, corticospinal SC: anterior horn cells, Structures tracts, spinal cord spinal roots, peripheral involved nerve d/o Stroke, TBI, SCI Polio, GBS, PNI, peripheral neuropathy, radiculopathy Tone Increased: hypertonia, clonus Decreased or absent: Velocity dependent hypotonia, flaccidity Not velocity dependent Reflexes Increased: hyperreflexia, clonus Decreased or absent: Exaggerated cutaneous and hyporeflexia autonomic reflexes + Babinski Cuaneous reflexes decreased or absent Involuntary Muscle spasms: flexor or extensor C denervation: movements fasciculations Strength Weakness or paralysis: ipsilateral Ltd distribution: segmental (stroke) or bilateral (SCI) or focal pattern, root- Corticospinal: contralateral if above innervated pattern decussation in medulla; ipsilateral if below Distribution: never focal Muscle bulk Variable, disuse atrophy Neurogenic atrophy; rapid, focal, severe wasting Voluntary Impaired or absent: dyssynergic Weak or absent if nerve movements patterns, obligatory synergies interrupted Flaccidity/hypotonia: terms used to define decreased or absent muscular tone. Resistance to passive movement is diminished, stretch reflexes are dampened or absent, and limbs are easily moved (floppy) Babinski: dorsiflexion of the great toe c fanning of the other toes on stimulation of the lateral sole of the foot
Short Wave Diathermy Is Defined As The Clinical Application of High Frequency Alternating Current, at A Frequency of 27.12Mhz and Wavelength of 11.06 Meter