Cerebral palsy notes for explanations

1- Muscle tone:
It is a mild resistance to passive flexion and extension of limbs (tension in the relaxed ms).
Aim: to maintain our posture.
Mechanism: it is a reflex arc which has an upper motor control by motor cortex (area 4 & 6),
basal ganglia and cerebellum.

motor cortex in ms tone has inhibitor impulses.

basal ganglia in ms tone have inhibitor impulses.
cerebellum in ma tone have facilitator impulses.

In normal conditions muscle tone results from equilibrium between them

Any defect in
Motor cortex: results in hypertonia
Basal ganglia: results in hypertonia
Cerebellum: results in hypotonia

*The difference between hypertonia in motor cortex and basal ganglia

In motor cortex: it is called spasticity (initial resistance followed by rapid decrease in the
resistant #realse#). We call it clasp knife hypertonia.
In the basal ganglia: it is called rigidity (resistance along the whole movement of the ms.
We call it lead pipe or cog wheal.

2- Deep tendon reflex:

ms tendon contain receptors called ms spindle which is sensitive to stretch.
We stimulate these receptors vis tapping on tendon using hummer >> ms contraction.
Mechanism: it is a reflex arc which has an upper motor control by motor cortex (area 4 & 6),
basal ganglia and cerebellum.

motor cortex has inhibitor impulses.

Basal ganglia have facilitator impulses.
Cerebellum has facilitator impulses.

In normal conditions muscle tone results from equilibrium between them

Any defect in
Motor cortex: results in hyperreflexia (exaggeration of deep tendon reflex
Basal ganglia: results in hyporeflexia
Cerebellum: results in hyporeflexia

affect motor cortex causing hypertonia & hyperreflexia.

affect basal ganglia causing hypertonia & hyporeflexia.
affect cerebellum causing hypotonia & hyporeflexia.

arachute reaction.
 This reflex occurs in slightly older infants when the child is held upright, and the baby’s body is
rotated quickly to face forward (as in falling). The baby will extend their arms forward as if to
break a fall, even though this reflex appears long before the baby walks.

Clonus
Involuntary rhythmic contractions due to recycling of discharges in reflex arc secondary to
excessive facilitatory impulses

extensor planter responses (Babinski)

it is a primitive reflex.
This extensor response occurs because the corticospinal pathways that run from the brain down
the spinal cord are not fully myelinated at this age, so the reflex is not inhibited by the cerebral
cortex. The extensor response usually disappears - giving way to the flexor response - by 12
months of age. Its persistence beyond age 2-3 indicates a problem in the brain or spinal cord.
Normally after one year of age flexion must occur.

Pseudobulbar palsy refers to upper motor neuron (UMN) dysfunction of corticobulbar fibers to
medullary brainstem motor nuclei. no affection of cranial nerves 9-10
Bulbar palsy refers to similar clinical features due to lesions involving the lower motor neurons (LMN)
innervating oropharyngeal muscles.

dystonia - snake like

chorea - dancing movement (sudden jerky movement affection big joints
athetosis - piano like play (affecting small joints _fingers_)