Life Care Planning for Acquired Brain Injury
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
Musculoskeletal complications are very common following brain injury. Injury to the motor nerves in the brain may result in the upper motor neuron syndrome, which consists of the constellation of symptoms of spasticity, weakness, and hyperreflexia. Areas of weakness can vary depending on where the injury is located in the brain. Due to the brain's structural organization, injury on one side of the brain results in weakness on the opposite side of the body. Additionally, the weak side is frequently associated with spasticity. If unchecked, spasticity and immobility may ultimately result in contractures, which is tightening of the soft tissues and shortening of tendons around a joint resulting in a reduction in the patient's mobility. As a result of associated trauma, patients with brain injuries also frequently have associated fractures, peripheral nerve injuries, or soft tissue injury that can also make rehabilitation difficult. An interesting musculoskeletal problem that sometimes occurs following TBI is heterotopic ossification, a condition in which bone is formed inappropriately in soft tissue areas. This problem, if left untreated, can result in ankylosis, or fusion of a joint, such that moving it is impossible. Extremity pain may also be a problem, due to inherent injury to the extremity or from neurological damage to the sensory pathways.
Chemical Dissolution of a Herniated Lumbar Disc: A Review
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
As with all interventions careful judgment needs to be utilized in selecting patients for chemonucleolysis. A routine, spine-specific, physical exam should be performed and includes a thorough neurologic assessment. A screening assessment to rule out upper motor neuron abnormalities should be performed. Lumbar radiculopathy and the clinical level are confirmed through a careful assessment of the dermatomes, myotomes, and deep tendon reflexes. Nerve root tension assessment, straight leg raise (with or without bowstring or ankle dorsiflexion reinforcement) or femoral stretch test, should be carried out and considered positive if the patient’s radicular symptoms are reproduced (7,12). The presence of a positive straight leg raise test has been shown to correlate with improved good and excellent outcomes following chemonucleolysis (90%) compared with patients with an absent or mild straight leg raise (60%) (12).
Low Back Pain and Sciatica: Pathogenesis, Diagnosis and Nonoperative Treatment
Gary W. Jay in Practical Guide to Chronic Pain Syndromes, 2016
Lower motor neuron versus upper motor neuron syndromes and the level of spinal dysfunction should be identified by the examining physician. Rectal examination is indicated in patients when myelopathy, especially cauda equina syndrome, is of diagnostic concern. Tone of the anal sphincter and the presence or absence of anal wink should be correlated with motor, sensory, and reflex findings in these cases. In all spinal examinations, a general overview of the patient’s health must be confirmed by examination. Extremities affected by chronic pain may demonstrate abnormal skin with a rough, leathery texture or shiny skin with trophic changes including hair loss, edema, abnormal temperature, and discoloration (bluish, reddish, or brownish hues). These changes may infer the presence of chronic pain, sympathetic nervous system involvement, or vascular insufficiency. Knowledge of cardiovascular and peripheral vascular status obtained by examination is pivotal in cases of claudication or reduced exercise tolerance for determining a diagnostic and treatment plan (1) (Tables 2 and 3).
Transcranial Direct Current Stimulation of Motor Cortex Enhances Spike Performances of Professional Female Volleyball Players
Published in Journal of Motor Behavior, 2023
Seung-Bo Park, Doug Hyun Han, Junggi Hong, Jea-Woog Lee
In another aspect, although electrical stimulation was applied to the specific cortical area of M1 induced by tDCS in the present study, it might have affected adjacent areas, resulting in a somewhat more widespread area of target stimulation. This means that the premotor cortex, complex system of interconnected frontal lobe areas anterior to the primary motor cortex, s mainly responsible for motor functions. The upper motor neurons in the premotor cortex regulates motor behavior via extensive reciprocal connections with the primary motor cortex and axons projecting through the corticobulbar and corticospinal pathways that affect local circuit and lower motor neurons of the spinal cord and brainstem (Purves et al., 2001). In particular, the left dorsal premotor cortex activity is associated with complex motor coordination performance, meaning that tDCS has potential to improve visuomotor coordination (Pavlova et al., 2014). According to Tzvi et al. (2022), the cerebellum plays an essential role in the process of visuomotor adaptation. They noted that interaction with cortical structures, especially the premotor cortex, contributed mainly to this process. The cerebellum plays a central role in coordinating voluntary movements and motor skills including balance, coordination, and posture (Manto et al., 2012). These relationships suggest that activation of the premotor cortex and its interactions with the cerebellum could enhance the process of motor coordination by tDCS (Kwon et al., 2015; Tzvi et al., 2022).
The Role of Primary Motor Cortex: More Than Movement Execution
Published in Journal of Motor Behavior, 2021
Sagarika Bhattacharjee, Rajan Kashyap, Turki Abualait, Shen-Hsing Annabel Chen, Woo-Kyoung Yoo, Shahid Bashir
Early investigation of the motor cortex in humans (Penfield & Boldrey, 1937; Woolsey, 1952) had functionally divided the motor cortex into two major areas: the primary motor cortex (M1) and premotor area (PMA; Fulton, 1935). M1 is located in the precentral gyrus of the frontal lobe that plays a crucial role in the execution of voluntary movements (Pearson, 2000). Histological examination of M1 has revealed the presence of giant pyramidal neurons called Betz cells. Betz cells are also known as upper motor neurons because they send axons to the lower motor neurons situated in the gray column of the spinal cord. The upper motor neuron contributes to the corticospinal pathway, whereas the lower motor neurons innervate the skeletal muscle fibers situated at the periphery (Porter & Lemon, 1993). With this structural construct, M1 is predominantly considered to only have a role in motor execution.
A case of vertebral artery compression syndrome mimicking primary lateral sclerosis
Published in International Journal of Neuroscience, 2022
Huimin Cai, Bin Zhang, Biao Huang, Lijuan Wang, Limin Wang
A 65-year-old right-handed man with a history of hypertension was referred to our neurology department in the suspect of possible PLS by the referring neurologist. The patient presented with a 10-year history of involuntary jerk characterised by brisk extension of the left lower extremity while he was sitting. Seven years after onset, he developed intermittent painful spasms with a tendency to drag his left leg. In the preceding year, his symptoms progressed to the left upper extremity marked by brisk flexion of the elbow, causing difficulty holding objects occasionally. He reported the symptoms aggravated with higher blood pressure and attenuated with optimal blood pressure. He also noticed the symptoms were worse when he lied down. He was able to walk independently without any assistance. There was no family history of neurodegenerative diseases. Neurological examination revealed upper motor neuron signs. The patient had generalized bilateral hyperreflexia and sustained left-sided ankle myoclonus. Jaw jerk reflex and Hoffman’s sign were absent. Babinski’s sign and Chaddock’s sign were positive in the left lower limb. He had increased muscle tone in the left extremities with spasticity, but normal muscle tone in the right extremities. Subtle pyramidal weakness (Medical Research Council (MRC) grade 4+) was noted in the left extremities. Muscle atrophy, fasciculation, sensory deficits, and cerebellar signs were not detected.
Related Knowledge Centers
- Betz Cell
- Brainstem
- Cerebral Cortex
- Interneuron
- Lower Motor Neuron
- Muscle Contraction
- Neuromuscular Junction
- Primary Motor Cortex
- Pyramidal Cell
- Skeletal Muscle