University:
The University of British Columbia
Course:
MEDD 448 | Transition into Postgraduate Education and Practice
Academic year:

2024
Views:

448

Pages:

2
Author:

O. Touhami

‭Hypertonia and Motor Deficits: Understanding Patterns and Causes‬ ‭-‬ ‭Reminder of hypertonia: o‬ ‭Spasticity: type of hypertonia also called elastic hypertonia or pyramidal‬ ‭hypertonia, hypertonia increases as the joint moves, if we let go of the‬ ‭limb it returns to its original position. Due to damage to the main motor‬ ‭pathway.‬ ‭o‬ ‭Plastic or lead pipe hypertonia or extrapyramidal hypertonia: when you‬ ‭let go of the limb it remains in the same place. Hypertonia of‬ ‭parkinsonian syndromes.‬ ‭o‬ ‭Oppositional hypertonia.‬ ‭-‬ ‭Paraparesis = motor deficit of both lower limbs.‬ ‭-‬ ‭Monoparesis = motor deficit of one of the two lower limbs - therefore gait by‬ ‭mowing on the injured side.‬ ‭-‬ ‭Hemiparesis = motor deficit of a single limb.‬ ‭-‬‭Either it is accompanied by spasticity: o‬ ‭Spastic hypertonia predominates on the muscles:‬ ‭o‬ ‭Upper limb flexor. Lower‬ ‭o‬ ‭limb extensors.‬ ‭o‬ ‭Damage to the first motor neuron - pyramidal syndrome:‬ ‭o‬ ‭Hypertonia.‬ ‭o‬ ‭Reflexes preserved.‬ ‭o‬ ‭Intermittent: spinal cord claudication.Intermittent = medullary‬ ‭o‬ ‭Painless.‬ ‭o‬ ‭Slow spinal cord compression (cervicarthrose), MS, etc.‬ ‭o‬ ‭Permanent: monoparesis, hemiparesis, paraparesis, etc.‬ ‭o‬ ‭If there are problems at the start of walking, the patient is asked‬ ‭if it is in one leg or both legs:‬ ‭o‬ B ‭ ilateral: medullary (because there is a low probability of right and‬ ‭left‬ ‭brain damage).‬ ‭o‬ ‭Monolateral: upper lesion.‬ ‭o‬ ‭Mowing gait, gallinaceous gait. Slow spinal‬ ‭o‬ ‭cord compression (spinal syndrome).‬ ‭-‬‭Either it is accompanied by peripheral neurogenic signs. o‬ ‭Damage to the second motor neuron.‬ ‭o‬ ‭Hypotonia.‬ ‭o‬ ‭Areflexia.‬ ‭o‬ ‭Steppage = walking disorder which results from peripheral‬ ‭motor damage localized to the levator pedis muscle. As the‬ ‭patient can no longer lift his foot, he bends his knee to‬ ‭compensate. Unilateral‬ ‭o‬ ‭stepping: SPE, L5 root.‬ ‭o‬ ‭Bilateral stepping: polyneuropathies= sock anesthesia, hair‬ ‭removal, weak reflexes, hypotonia, etc. found in chronic‬ ‭alcoholics. Unilateral‬ ‭o‬ ‭proximal deficit: quadriceps paresis.‬ ‭o‬ ‭Bilateral proximal deficit: waddling gait (myopathies).‬ ‭-‬‭Either it is a sudden and transitory deficit. o‬ ‭Drop Attack = transient vascular accident of the brain stem causing‬ ‭transient ischemia. It can be responsible for gross motor skills‬ ‭disorders.‬