Other lower urinary tract disorders
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Examination should be undertaken in the standing position for kyphosis, scars and hernia and in the supine position to assess abduction/adduction of the hips and hyperaesthetic areas. A neurological assessment is important to exclude an upper motor neuron lesion. The S2, S3, S4 nerve roots innervate the bladder and particular regard should be paid to these dermatomes. An abdominal examination will rule out a mass or large distended bladder. Vaginal examination should be performed with pain mapping of the vulvar region and vaginal palpation for tenderness of the bladder, urethra, levator and adductor muscles of the pelvic floor. Tenderness might be graded as mild, moderate or severe. Assessment of prolapse should also carried out via vaginal examination in the supine and standing positions.
Clinical Neuroanatomy
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Lesions affecting the whole facial nucleus or the peripheral part of the nerve should cause total unilateral facial weakness. In some instances, weakness may be more marked in the lower face, which can happen in the early or recovery phase of a simple Bell’s palsy and an upper motor neuron lesion may be incorrectly suspected. Much less commonly, a very dense upper motor neuron lesion may mimic a lower motor neuron lesion by affecting all facial movements. These difficulties are stressed as the distinction is of immense diagnostic importance and mistakes are easily made. It is also worth stressing that ptosis of the eyelid is not a feature of either a lower or upper motor neurone facial palsy – a droopy eyelid should never be accepted as part of a facial weakness.
Injuries of the Spine and Thorax
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Complete transection of the cord results in either paraplegia (thoracic and lumbar lesions) or quadriplegia (cervical lesions). Initially there is complete flaccid paralysis and anaesthesia, with loss of the anal reflex (spinal shock). At this stage, and for the first 24 hours, the diagnosis cannot be absolutely certain. However, if the anal reflex returns during the first 48 hours and the neural deficit persists, the cord lesion must be assumed to be complete. Gradually the features of an upper motor neuron lesion appear, with spastic paralysis and exaggerated reflexes.
Effect of oral baclofen on spasticity poststroke: responders versus non-responders
Published in Topics in Stroke Rehabilitation, 2018
Shiho Mizuno, Kotaro Takeda, Shinichiro Maeshima, Sonoda Shigeru
Clonus and increased muscle tone during fast stretch are both positive signs for an upper motor neuron lesion. The mechanism of increased muscle tone during fast stretch is summarized below. Stretch of the extrafusal muscle fiber is detected by the muscle spindle and transmitted to the central nervous system by Ia afferents that project through the dorsal roots and make connections with the α motor neurons in the spinal cord. The α-motor neurons also receive input from the upper motor neurons. After upper motor neuron lesion, a net loss of inhibition impairs the descending control over the attached α-motor neurons. Additionally, loss of inhibitory control over the interneuronal pathways in the spinal cord also occurs. Thus, increased signals are passed to the α-motor neuron, leading to excessive muscle contraction.22
Potential contributing factors to upper limb associated reactions in people with acquired brain injury: an exploratory study
Published in Disability and Rehabilitation, 2022
Michelle B. Kahn, Ross A. Clark, Benjamin F. Mentiplay, Kelly J. Bower, John Olver, Gavin Williams
The demographic data for the 42 participants are presented in Table 1. All participants had a stable non-progressive upper motor neuron lesion with an apparent hemiplegia. Where any bilateral deficits were present, the hemiplegic upper limb was evaluated. Most data were normally distributed, except for the outcome measure scales (Arm Activity Measures A and B, Short Form Berg Balance Scale, Short Falls Efficacy Scale International, Hospital Anxiety and Depression Scale) which therefore underwent non-parametric correlation analyses. All KDSw scores were normally distributed, therefore, parametric analyses were used for between-group differences.
Elucidating factors influencing machine learning algorithm prediction in spasticity assessment: a prospective observational study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Natiara Mohamad Hashim, Jingye Yee, Nurul Atiqah Othman, Khairunnisa Johar, Cheng Yee Low, Fazah Akhtar Hanapiah, Noor Ayuni Che Zakaria
It is worthwhile to note some limitations of this study. The sample of this study did not cover all possible upper motor neuron lesion populations. The sample size was small to allow more robust MLM classifier training. Samples of data for MAS 3 and MAS 4 were very scarce due to a very limited pool of patients with severe spasticity as the preventive strategies have been instituted earlier in the course of the diseases. For future recommendations, the data should include all possible diseases with upper motor neuron lesions. The repetitions of stretching should be minimized to reduce the dampening of the stretch reflex in mild cases.
Related Knowledge Centers
- Cranial Nerve Nucleus
- Lower Motor Neuron Lesion
- Multiple System Atrophy
- Traumatic Brain Injury
- Stroke
- Spinal Cord
- Multiple Sclerosis
- Cerebral Palsy
- Cranial Nerves
- Anterior Grey Column