-4Asses the patient: What is difference between upper and lower motor neuron lesion?

? UMNL LMNL Paralysis of Paralysis of movement. muscle. No atrophy. Atrophy. No fasciculation. Fasciculation. No reaction of Present. degeneration. Pyramidal Distribution of distribution. nerve. Spaciticity. Flaccidity. Hypertonia. Hypotonia. Exaggerated deep Loss of deep reflexes. reflexes. Paralysis of movement: According to representation in the brain, movement as a function is represented in the brain i.e. thumbs is represented by a large area in the brain than any other finger because it needs very fine and delicate movement. Fasciculation: Spontaneous contraction in some muscle fasicles seen by vision. Caused by: 1) Irritation of the partial cut of the nerve. 2) Denervation hypersensitivity: increase sensitivity of the muscle to acetylcholine the wall of the muscle are sensitive to acetylcholine fasciculation. (not only in the motor end plate) Reaction of degeneration: LMNL: loss of (faradic current) response and sluggish contraction to galvanic stimulation(A nodal

closing contraction is more than cathode closing contraction).

-5Why? Faradic: very short duration and nerve is more sensitive than muscle so it will stimulate the nerve which will lead to contraction of the muscle. Galvanic: long duration so it can stimulate nerves and muscles so both will react. Muscle tone: The resistance against passive movement. Hypotonia: decreased resistance. Hypertonia: increased resistance. Type of hypertonia: Rigidity Increase the muscle tone and its antagonist at the same time. Types: lead pipe (all through) b) cog wheel (+ tremor)
a)

Spasticity Increase tone of one group of muscle accompany by hypotonia or normotonia at the antagonist group. Type: Clasp knife ( causes/ extrapyramidal)

UMNL: may cause hypotonia i. Acute stage. ii. Motor neuron lesion.(mixed with L.M.N.L)

:Superficial reflex .Stimulation through a receptor present in the skin Deep reflex: Receptors are deep seated.

UMNL: increase deep reflexes ... (afferent present). LMNL: afferents are lost due to disease so no response which leads to lost reflexes.

-6Muscle power: Grade 0: no contraction. Grade 1: flickers of contraction don't lead to any movement at the Joint. Grade 2: movement of the joint with elimination of gravity. (with gravity not against it). Grade 3: movement against gravity not against resistance. Grade 4: movement against mild resistance. Grade 5: movement against strong resistance. This grade is very crude. Better is machine called (Dynamometer).

Types of joints: 1. Fibrous joint: symphsis pubis, sacroiliac joint, sutures. 2. Cartilaginous joint: doesn't allow great motion. 3. synovial joint:

Cartilaginous joint: Primary: between metaphysis and epiphysis. Secondary: axial as in inter vertebral disc.

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Synovial: bony ends covered with cartilage and surrounded by synovial membrane. axial: one plane one axis (inter phalingeal joint) bidirectional: metacarpophalangeal joints. condyloid: as wrist joint, carpal metacarpal of thumb. Ball and socket: shoulder and hip joint. (polydirection) Pivot: radio-ulnar, atlas and axis. Goniometry: measure range of motion.