Function: Integrates (sensory and other Direct Pathway: Stimulates Thalamus
information from multiple regions of cortex, Movement brainstem, and spinal cord) Lesion: Hypokenisis Vision, Proprioception, Muscle Strength, Muscle Indirect Pathway: Inhibits ThalamusInhibits Tone, Movement Vestibular, Pressure Lesion: Hyperkenisis (Globus pallidus • Uses inputs to partitipate in motor planning External/Subthlalamic Nucleus Sign • Coordinates ongoing movements Reversal) *Thalamus projects to motor areas in the cortex. Lateral Hemisphere: Motor planning Extremities, lateral corticospinal tract 1. Unilateral Flapping/Flingining (Hemiballism)(Hyperkinetic, Indirect Pathway, Intermediate Hemisphere: Distal Limb Contral lateral Lesion in Subthalamic Nuclei) Coordination, lateral corticospinal tract, 2. Irregular Jerking Movements/Marital Problems; rubrospinal tract decrease tone (Hyperkinetic, Indirect Pathway, Decreased Size of Caudate)Huntingtons Disease Vermis/Flocculonodular Lobe: Proximal limb/trunk 3. Assymetrical resting tremor, rigidity, movements; Anterior corticospinal tract etc.. bradykinesia, gait difficulties , decreased facial Balance/VOR reflex, medial longitudinal fasiculus Expression(Hypokinesia, Direct Pathway) Parkinson’s CEREBELLAR DYSFUNCTION: INCOORDINATION 1.Appendicular Ataxia – difficulty with smoothy Huntington’s Disease: Atrophy of Basal coordinated movements: Agonist/Antagonist Ganglia; Progressive disease; Autosomal Muscles aren’t coordinated; jerky movements; Dominant; Involuntary movements: chorea(dance IPSILATERAL TO LESION like movements), athetosis (movement 2. Dysdiadochokinesia-imparied repetitive hands/feet); Memory loss +cognitive dysfunction; movements (supination/pronation) IPSILATERAL psychiatric disturbances (Indirect TO LESION pathway/Hyperkinetic) 3. Titubation (truncal ataxia)- difficulty maintaining upright posture: Agonist/antagonist Parkinson’s Disease: Hypokinetic, Lesion in muscles of Trunk; jerky head/thorax *LESION Direct Pathway , Decrease in Dopamine in VERMIS/FLOCCULONODULAR LOBE Substatia Nigra compacta. Treatment: Dopamine 4. Impaired Suppression of VOR- jerky eye 1. Tremor at Rest movements/blurred vision fixation on moving 2. Rigidity object due to intermittent triggering of VOR 3. Bradykinesia *VOR maintains fixation on stationary object while head is moving; VOR suppressed by VERMIS when Stereotactic Surgery: Surgery to correct watching a MOVING object to fixate and keep movement focus even if you are moving. (hitting 1)Bradykinesia correction via indirect pathway baseball)*MIDLINE CEREBELLAR LESION (Pallidotomy: Globus pallidus; Subthalamic N,) 5. Gait Imbalance- wobbly/erratic gates leg 2) Severe Tremor/Hyperkinesia correction via ataxia/ impaired VOR supression direct pathway (Thalamotomy: Thalamus) 6. Scanning Dysarthria- syllables are clipped and can not put words togetherNot Aphagia! Stereotactic Surgery: Option for Can communicate Slow speech Bradykinesia/RigidityDeep Brain Electric 7. Decreased Muscle Tone/ Decreased Stimulation (inhibition Subthalamic Nucleus) Less Reflexes inhibition=more movement