which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait? This is a topic that many people are looking for. bluevelvetrestaurant.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, bluevelvetrestaurant.com would like to introduce to you Neurology – Topic 11 – Extra pyramidal examination. Following along are instructions in the video below:
Were next going to look at how to examine the extra primal system and and the best way as always is to look at how what youre looking in a normal person before we go on and examine a patient for example with parkinsons and the problem at the cardinal features as weve discussed before of parkinsons are braddock and easier tremor rigidity and postural instability. So we have to see how we examine someone normally. And say these things are not present so peter thank you very much for coming.
I appreciate as always your help so im going to ask you to walk away now this time very slowly. If you dont mind to the pillar turn slowly. If you will you dont need to over exaggerate and halfway back.
Id ask you to stop. And i will talk over whats going at what im looking for okay. If you dont mind.
So. Im looking primarily for how he starts off easy. Bradley kinetic or slow to start.
Im looking for the swing of his arms often some of the parkinsons doesnt swing one arm or the other when they turn they turn slowly called statue turning and when theyre coming back. Im looking for a flexed posture and a fascinating gauge where the gauge is kind of chasing itself. Feste knows to hurry so when he stops as weve asked we go to the usual routine and say now can you walk heel to toe please stand beside the patient because they can have postural instability.
But this should be okay. If your reassuring enough thats fine lovely. I asked them to do romberg sign as usual posterior columns.
Vestibular and vision not relevant to extrapyramidal. But always go through the motions hold the patients hands. Its a no mind ask them standing their toes.
Should not be a problem down again arent your heels nowhere. But is a foot drop should not be present so all of these things should not be present other than how you view the patient with a flexed posture their turns. The shuffling gait and their body can easier.
What might be present. What is slightly different in extrapyramidal syndromes is the postural reflexes are the writing or ig ht ing reflexes. So if i could ask you to stand with your feet.
Reasonably far apart. Now you must communicate. I know i go on about it.
But youre must communicate because the patients will cooperate. If you do so im going to gently pull you towards me okay dont fall over now. I always give a warning shot thats what im going to do dont fall on top of me now.
Im going to do a more exaggerated one. And its a good tug like that okay he doesnt fall over so no problem. Then you step behind the patient and say now im going to pull you back towards me gently and now heavily and a parkinsonian patient will tend to go back like this okay the next thing when examining someone with parkinsons are extra primal disorders.
I should be more specific is you take an overview as before start from head to toe. You look at the patient now peter obviously is is just demonstrating for a survey. But you look at the patient and they tend to have whats called hypo me mia or mask like faces faces thats a an expressionless face.
They dont look particularly happy. Even though they may well be very happy you look at their skin. And it tends to be kind of a mixture of greasy and dry its called seborrhoeic dermatitis and they tend not to be able to its not a question of feeling.
But they had produce it a bit too much saliva and they can have a little bit of salivation around their mouths. So these are the things you look for and it should be able to diagnose this if its florid by the time. The patient comes into the weight room you see someone coming in with a flexed posture.
A tremor hypo mimic or expressionist face and when they talk and this is crucial their voice is hypotonic and or dis phonic. And that simply means hoarseness and so the pitch of the voice is a little lower. Its not dysphasia.
Its not dysarthria. Its not dystonia its dysphonia. So difficulty with the pitch of the voice.
And you this can be retrained. The next thing i look for then is the tremor so i ask you to put your hands down my side and when youre talking to someone youre chatting away. But if youre going to learn neurology properly whole thing is observation the tremor one gets in parkinsons isnt one on intention.
But its its a resting tremor and its as if youre holding a pill between your forefinger and your thumb. Its rhythmical and it goes at a frequency of four to six hertz per second. So literally.
Its a rhythmical tremor. Which is present at rest. And if you see a present rest you can again subtly examine the patient by saying can you just lift up your hand.
So. The tremor will go like this and you lift up your hand and momentarily be gone. It will be gone and then after a few seconds.
Itll come back here so its only in the resting position that it tends to occur. We then move on to examine tone you follow the same routine if you dont mind you band at the elbow you banded the wrist and then you turn but for extrapyramidal conditions. You really are looking at for increased tone at the elbow like this and dont rush.
And dont hurt the patient. And this is called lei if its increased its called lead pipe rigidity and ill exaggerate. It here.
It should look like this as if youre trying to open a lead pipe and bend. The lead pipe. I should say and then the other one is then you take your hand and remember your examiners are looking at you and you put on the patients wrist and again.
Its literally flexion extension. And what im looking for here is cogwheel rigidity and this will look like this or feel like this. Like the cogs are like something moving on a cogwheel and you can exaggerate these a fraction that you can take your left hand and i want you to tap it slowly on your left thigh.
So this can bring out lead pipe rigidity and it can bring out or make more manifest cogwheel rigidity. Now in the uk thats known as the kenya wilson maneuver named after and the gentleman who they know ill just to describe wilsons disease in europe those known as fromans sign for ome nts. So a bit of variation.
We can just call it a distraction. If you want to be a bit more simplistic now thank you so once youve looked at gait tremor rigidity. You must look for brandy can easier.
Braddy is slow can easiest movement. So possibly or slowness of movement. So i usually do it this way if you put your hands out in front of you and with your right hand just mimic me and open and close and then you go as quickly as you can and we get a little bit faster.
Now theres two things here is one is if its slow slower than me you say oh i wonder if this is bratty kinesia. But you also softly again look at the left hand. Peters left hand this instance for sometimes mimicry are seen kind easier.
So hell be doing this and the other hand will be kind of mimicking it at the same time so we look for all these subtle signs as well as the more and manifest ones another way of doing. It is if you could hold your hand up like that and pretend youre changing one of the older light bulbs and make a full turn like that because this bratty kinetic movements can be obvious than the other side and you dont do them simultaneously do them separately and in the legs. Sometimes tremor can start in the legs and rigidity in the leg.
And you think oh is it a stroke. But actually what happens in parkinsons and you get this extinction of movement. So people can start off doing a movements like this for example and then it gets smaller and smaller more easily done with the feet.
If you like and i just ask people to tap out as if theyre listening to a song so i want you to tap your foot loudly. I got on the floor. And i literally just close my eyes and listen and make the same noise.
Okay. So im going to close my eyes. And listen okay.
While you tap hard perfect. And with someone with the parkinson syndrome. Itll tend to go like and extinguish gradually over time and the other features are of parkinsons that you look for our parkinsons plus syndrome.
So if you say it looks like parkinsons rigidity tremor bradykinesia and postural instability. But there are a few features that arent quite specific who are quite quite right i should say are quite typical for example. The signs are bilateral from the start the tremors bilateral or the rigidity is more central then you think of just briefly.
Think of things like multi system. Atrophy and thats associated with orthostatic hypotension. So you do lying and standing blood pressure.
You think of lewy body domains here in which case you ask the patient about visual rusa nations. Or more. Simply you ask a patient about progressive supranuclear.
Palsy or psp. I need to do that you look at vertical gaze. So you say look at my finger here and you look down.
Im going to hold your eyelids. If you dont mind. And if someone can look right down.
Like that they have no problem with vertical gaze. A lot of people over a certain age have a problem looking up. But most people dont have a problem looking down and a problem with vertical gaze.
Particularly downwards might in the setting of an extra pyramidal and disorder might suggest psp or progressive super super nuclear palsy you .
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