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Brain Motor Centers and Pathways
Published in Nassir H. Sabah, Neuromuscular Fundamentals, 2020
Whereas hypokinesia is associated with increased inhibition of the thalamus by the basal ganglia, a decrease in this inhibition results in hyperkinesia, or excessive, involuntary movement. These include rapid uncoordinated movement of body parts (chorea), twisting movements and sustained abnormal postures in the neck, trunk, and extremities (dystonia); and hemiballism, characterized by involuntary movements of the limbs on one side of the body. Hemiballism is caused by damage to the STN, which reduces excitation of the GPi and disinhibits the thalamus. The increased excitation and altered firing pattern of thalamocortical neurons cause these neurons to respond in an exaggerated manner or to discharge spontaneously, resulting in rapid, involuntary, and repetitive movements associated with violent flailing and swinging of the limbs and usually accompanied by a decrease in muscle tone.
Exercise Prescription for Apparently Healthy Individuals and for Special Populations
Published in James M. Rippe, Lifestyle Medicine, 2019
When possible, persons with disabilities should perform the same physical activity recommended for more able-bodied adults.3 When this is not possible, they should perform as much physical activity as they are able to accomplish without undue fatigue. Aerobic, resistance, and flexibility exercise should all be practiced. Even when exercise tolerance is very low, physical inactivity should be avoided to maintain as much functional independence as possible and to avoid hypokinetic diseases.
Movement Disorders of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Declan Costello, John S. Rubin
Idiopathic PD accounts for around 80% of cases of Parkinsonism; it is a nigrostriatal disorder characterized by a deficiency of dopamine. Generalized rigidity is seen, along with bradykinesia (slowness of movement). These two aspects are collectively described as hypokinesia. Tremor (typically a ‘pill-rolling’ tremor) is a very common feature. PD is a relatively common neurological disorder, with a prevalence of 1 per 1000 of the population, rising to around 1 per 100 in the over-60 age group.1 Although PD is usually thought of as a condition of older age, it can also affect younger patients.
VMAT2 Inhibitors for the Treatment of Tardive Dyskinesia
Published in Issues in Mental Health Nursing, 2022
Barbara Warren, Dawn Vanderhoef, Jessica Johnson
The key features of TD and other common antipsychotic-induced movement disorders (parkinsonism, acute akathisia, and acute dystonia) are summarized in Figure 2. The differentiation of TD can be challenging, as the movements associated with TD can look similar to those of other movement disorders. Additionally, TD can present together with other drug-induced disorders (e.g., parkinsonism) in the same patient. Finally, TD movements are sometimes mistaken for abnormal movements or behaviors associated with advanced age or underlying psychiatric conditions (Caroff & Campbell, 2016; Hauser et al., 2020; Savitt & Jankovic, 2018). It is helpful to consider the timing of onset (acute versus tardive), along with the type of movement (hypokinetic versus hyperkinetic). Acute syndromes usually present within hours or days of initiating antipsychotic treatment, while tardive syndromes often develop after more prolonged antipsychotic exposure (i.e., months or years). Hypokinetic syndromes (e.g., parkinsonism) are characterized by slow or insufficient movements. In contrast, hyperkinetic syndromes (e.g., TD, akathisia, and dystonia) are characterized by excessive abnormal movements with increased velocity, frequency, and amplitude. For an excellent summary of TD and other drug-induced movements, along with helpful video links depicting the various movements, we recommend a recent publication by Hauser et al. (Hauser et al., 2020).
Treatment of psychiatric disturbances in hypokinetic movement disorders
Published in Expert Review of Neurotherapeutics, 2019
Isabella Berardelli, Daniele Belvisi, Massimo Pasquini, Andrea Fabbrini, Federica Petrini, Giovanni Fabbrini
An evaluation of psychiatric abnormalities should be part of the routine clinical assessment in all patients with hypokinetic movement disorders. The diagnosis of psychiatric disorders should, when possible, be based on standardized instruments. A growing awareness of the risk for the development of ICD is likely to lead to a reduction in the incidence of these conditions in the coming years. Significant advances may also be expected in the treatment of psychosis in PD as innovative pharmacological tools become available. Carefully planned clinical trials are warranted to determine which type of physical therapy is most effective in PD patients. The organization of services aimed at providing psychotherapy and facilitating socialization, art and music therapy in specialized centers should be considered for PD patients. Multicenter trials should be planned to investigate whether pharmacological and non-pharmacological interventions may provide an effective means of treating neuropsychiatric disturbances in MSA, PSP, CBD and DLB.
Does dual task walking affect gait symmetry in individuals with Parkinson’s disease?
Published in European Journal of Physiotherapy, 2019
Tatiana S. Ribeiro, Angélica C. de Sousa, Larissa C. de Lucena, Lorenna M. M. Santiago, Ana Raquel R. Lindquist
Studies have shown reduction of joint excursion of the lower limbs in PD [9,36,38,39]. In fact, reduced joint excursion is characteristic of hypokinesia exhibited by these patients. Under normal circumstances, basal ganglia have an action on movement control, keeping the motor set, predetermined by the cortical motor regions to ensure proper completion of the motor plan. Thus, faced with an environmental demand that requires a certain stride length, cortically predetermined length is then executed by means of changes at all lower limb joints to suit the predetermined movement to the desired movement [9]. In PD, the basal ganglia are unable to match preselected stride length with intended stride length [35]. Thus, a reduced range of motion is verified, which occurs in all lower limb joints across three movement planes [9]. According to this study and previous studies [35–37], deficit in the basal ganglia seems to promote symmetrical reduction of the range of motion of lower limbs, without right-left differences.