Types of neurological disorders, symptom and syndrome in neurology. Classification

Psychomotor disorders are manifested by sudden thoughtless actions without motivation, as well as complete or partial motor immobility. They can be the result of various mental illnesses, both endogenous (schizophrenia, epilepsy, bipolar affective disorder (BAD), recurrent depression, etc.), and exogenous (intoxication (delirium), psychotrauma). Also, psychomotor disorders can be observed in some patients with neurosis-like and neurotic spectrum pathology (dissociative (conversion), anxiety and depressive disorders, etc.).

Hyperkinesia - states with motor excitation

Conditions associated with inhibition of motor activity

Akinesia - a state of complete immobility - stupor.

• Depressive - inhibition of motor activity at the height of depression.
• Manic - at the height of manic excitement, periods of stupor.
• Catatonic - accompanied by parakinesia.
• Psychogenic - occurs as a result of mental trauma ("imaginary death reflex" according to Kretschmer).

parakinesia

Parakinesias are paradoxical motor reactions. In most sources, a synonym is catatonic disorders. Occurs only in schizophrenia. This type of violation is characterized by pretentiousness and caricature of movements. Patients make unnatural grimaces, have a specific gait (for example, only on the heels or along the tangent of geometric shapes). They arise as a result of a perverted volitional action and have opposite options for the development of symptoms: catatonic stupor, catatonic excitation.

Consider the symptoms characteristic of catatonic states:

Catatonic symptoms also include impulsive actions that are characterized by unmotivated, short duration, sudden onset and end. In catatonic states, hallucinations and delusions are possible.

Among parakinesias, there are conditions in a patient when opposite tendencies are characteristic in his behavior:

• Ambivalence - mutually exclusive relationship (the patient says: "How I love this cat", but at the same time hates animals).
• Ambition - mutually exclusive actions (for example, the patient puts on a raincoat and jumps into the river).

conclusions

The presence of one or another type of psychomotor disorder is an important symptom in the diagnosis of a mental illness, when the history of the disease, complaints and the mental state of the patient in dynamics are taken into account.

Motor function disorders that occur with various local lesions of the brain can be divided into relatively elementary, associated with damage to the executive, efferent mechanisms of movements, and more complex, extending to voluntary movements and actions and associated mainly with damage to the afferent mechanisms of motor acts.

Relatively elementary movement disorders occur with damage to the subcortical links of the pyramidal and extrapyramidal systems. With damage to the cortical link of the pyramidal system (4th field), located in the precentral region, movement disorders are observed in the form paresis or paralysis a specific muscle group: arms, legs or torso on the side opposite to the lesion. The defeat of the 4th field is characterized by flaccid paralysis (when the muscles do not resist passive movement), which occurs against the background of a decrease in muscle tone. But with foci located anterior to the 4th field (in the 6th and 8th fields of the cortex), there is a picture of spastic paralysis, i.e., loss of the corresponding movements against the background of an increase in muscle tone. The phenomena of paresis, together with sensory disorders, are also characteristic of the defeat of the postcentral sections of the cortex. These disorders of motor functions are studied in detail by neurology. Along with these neurological symptoms, damage to the cortical link of the extrapyramidal system also gives violations of complex voluntary movements, which will be discussed below.

When the pyramidal tracts are damaged in the subcortical areas of the brain (for example, in the area of ​​​​the internal capsule), a complete loss of movements (paralysis) occurs on the opposite side. Complete unilateral prolapse of the movements of the arm and leg (hemiplegia) appears with gross foci. More often in the clinic of local brain lesions, phenomena of a partial decrease in motor functions on one side (hemiparesis) are observed.

When crossing the pyramidal path in the zone of the pyramids - the only zone where the pyramidal and extrapyramidal paths are anatomically isolated - arbitrary movements are realized only with the help of the extrapyramidal system.

The pyramidal system is involved in the organization of predominantly precise, discrete, spatially oriented movements and in the suppression of muscle tone. The defeat of the cortical and subcortical links of the extrapyramidal system leads to the appearance of various motor disorders. These disorders can be divided into dynamic (i.e., movement disorders) and static (i.e., postural disorders). With damage to the cortical level of the extrapyramidal system (6th and 8th fields of the premotor cortex), which is associated with the ventrolateral nucleus of the thalamus, the globus pallidus, and the cerebellum, spastic motor disorders occur in the contralateral limbs. Irritation of the 6th or 8th fields causes turns of the head, eyes and torso in the opposite direction (adversions), as well as complex movements of the contralateral arms or legs. Damage to the subcortical striopallidary system caused by various diseases (parkinsonism, Alzheimer's disease, Pick's disease, tumors, hemorrhages in the area of ​​the basal nuclei, etc.) is characterized by general immobility, adynamia, and difficulty in movement. At the same time, violent movements of the contralateral arms, legs, and head appear - hyperkinesis. In such patients, there is also a violation of the tone (in the form of spasticity, rigidity or hypotension), which forms the basis of the posture, and a violation of motor acts (in the form of increased tremor - hyperkinesis). Patients lose the ability to serve themselves and become disabled.

Selective damage to the pallidum zone (older than the striatum) can lead to athetosis or choreoathetosis(pathological wave-like movements of the arms and legs, twitching of the limbs, etc.).

The defeat of striopallidar formations is accompanied by another type of motor symptoms - a violation facial expressions And pantomime, i.e., involuntary motor components of emotions. These disturbances can act either in the form of amimia (a mask-like face) and general immobility (absence of involuntary movements of the whole body with various emotions), or in the form of forced laughter, crying or forced walking, running (propulsion). Quite often at these patients the subjective experience of emotions suffers also.

Finally, in such patients, the physiological synergies - normal combined movements of different motor organs (for example, waving arms while walking), which leads to the unnaturalness of their motor acts.

The consequences of damage to other structures of the extrapyramidal system have been studied to a lesser extent, with the exception, of course, of the cerebellum. Cerebellum is the most important center for the coordination of various motor acts, the "organ of balance", which provides a number of unconditional motor acts associated with visual, auditory, skin-kinesthetic, vestibular afferentation. Damage to the cerebellum is accompanied by a variety of motor disorders (primarily disorders of coordination of motor acts). Their description is one of the well-developed sections of modern neurology.

Defeat of pyramidal and extrapyramidal structures spinal cord is reduced to a violation of the functions of motor neurons, as a result of which the movements controlled by them fall out (or are disturbed). Depending on the level of damage to the spinal cord, the motor functions of the upper or lower extremities (on one or both sides) are impaired, and all local motor reflexes are carried out, as a rule, normally or even increase due to the elimination of cortical control. All these movement disorders are also discussed in detail in the course of neurology.

Clinical observations of patients who have a lesion of one or another level of the pyramidal or extrapyramidal system made it possible to clarify the functions of these systems. The pyramidal system is responsible for the regulation of discrete, precise movements, completely subject to voluntary control and well afferent by "external" afferentation (visual, auditory). It controls complex spatially organized movements in which the whole body participates. The pyramidal system regulates mainly the phasic type of movements, i.e., movements precisely dosed in time and space.

The extrapyramidal system controls mainly the involuntary components of voluntary movements; in addition to the regulation of tone (that background of motor activity on which phasic short-term motor acts are played out), they include: maintaining a posture; regulation of physiological tremor; physiological synergies; coordination of movements; general coordination of motor acts; their integration; body plasticity; pantomime; facial expressions, etc.

The extrapyramidal system also controls a variety of motor skills, automatisms. In general, the extrapyramidal system is less corticolized than the pyramidal system, and the motor acts regulated by it are less voluntary than the movements regulated by the pyramidal system. However, it should be remembered that the pyramidal and extrapyramidal systems are a single efferent mechanism, the different levels of which reflect different stages of evolution. The pyramidal system, being evolutionarily younger, is to a certain extent a “superstructure” over more ancient extrapyramidal structures, and its emergence in humans is primarily due to the development of voluntary movements and actions.

4. Violations of arbitrary movements and actions. Apraxia problem.

Violations of voluntary movements and actions are complex motor disorders, which are primarily associated with damage to the cortical level of motor functional systems.

This type of motor dysfunction is called apraxia in neurology and neuropsychology. Apraxia refers to such disorders of voluntary movements and actions that are not accompanied by clear elementary movement disorders - paralysis and paresis, obvious disorders of muscle tone and tremor, although combinations of complex and elementary movement disorders are possible. Apraxia denotes primarily violations of voluntary movements and actions performed with objects.

The history of the study of apraxia dates back many decades, but so far this problem cannot be considered completely solved. Difficulties in understanding the nature of apraxia are reflected in their classifications. The most famous classification, proposed at the time by G. Lipmann and recognized by many modern researchers, distinguishes three forms of apraxia: ideational, suggesting the collapse of the “idea” about the movement, its design; kinetic, associated with a violation of the kinetic "images" of movement; ideomotor, which is based on the difficulties of transferring "ideas" about the movement to the "centers of the execution of movements." G. Lipmann associated the first type of apraxia with diffuse lesions of the brain, the second - with lesions of the cortex in the lower premotor region, the third - with lesions of the cortex in the lower parietal region. Other researchers identified forms of apraxia in accordance with the affected motor organ (oral apraxia, apraxia of the body, apraxia of the fingers, etc.) or with the nature of disturbed movements and actions (apraxia of expressive facial movements, object apraxia, apraxia of imitative movements, gait apraxia, agraphia etc.). To date, there is no single classification of apraxia. A. R. Luria developed a classification of apraxia based on a general understanding of the psychological structure and brain organization of a voluntary motor act. Summing up his observations on disorders of voluntary movements and actions, using the method of syndromic analysis, isolating the main leading factor in the origin of violations of higher mental functions (including voluntary movements and actions), he identified four forms of apraxia. the first he labeled as kinesthetic apraxia. This form of apraxia, first described by O.F. Foerster in 1936, and later studied by G. Head, D. Denny-Brown and other authors, occurs when the lower parts of the postcentral region of the cerebral cortex are affected (i.e., the posterior sections of the cortical nucleus motor analyzer: 1, 2, partly of the 40th field, predominantly of the left hemisphere). In these cases, there are no clear motor defects, muscle strength is sufficient, there are no paresis, but the kinesthetic basis of movements suffers. They become undifferentiated, poorly managed (symptom "shovel hand"). In patients, movements are disturbed when writing, the ability to correctly reproduce various postures of the hand (apraxia of the posture); they cannot show without an object how this or that action is performed (for example, how tea is poured into a glass, how a cigarette is lit, etc.). With the preservation of the external spatial organization of movements, the internal proprioceptive kinesthetic afferentation of the motor act is disturbed.

With increased visual control, movements can be compensated to a certain extent. With damage to the left hemisphere, kinesthetic apraxia is usually bilateral in nature, with damage to the right hemisphere, it often manifests itself only in one left hand.

Second form apraxia, allocated by A. R. Luria, - spatial apraxia, or apractognosia, - occurs with damage to the parieto-occipital cortex at the border of the 19th and 39th fields, especially with damage to the left hemisphere (in right-handed people) or with bilateral foci. The basis of this form of apraxia is a disorder of visual-spatial synthesis, a violation of spatial representations (“top-bottom”, “right-left”, etc.). Thus, in these cases, visuospatial afferentation of movements suffers. Spatial apraxia can also occur against the background of preserved visual gnostic functions, but more often it is observed in combination with visual optical-spatial agnosia. Then there is a complex picture of apractoagnosia. In all cases, patients have posture apraxia, difficulties in performing spatially oriented movements (for example, patients cannot make a bed, get dressed, etc.). Strengthening visual control over movements does not help them. There is no clear difference when performing movements with open and closed eyes. This type of disorder includes constructive apraxia- difficulties in constructing a whole from individual elements. With a left-sided lesion of the parieto-occipital cortex, often there is opto-spatial agraphia due to the difficulties of the correct spelling of letters differently oriented in space.

Third form apraxia - kinetic apraxia- is associated with damage to the lower sections of the premotor area of ​​the cerebral cortex (6th, 8th fields - the anterior sections of the "cortical" nucleus of the motor analyzer). Kinetic apraxia is included in the premotor syndrome, i.e., it occurs against the background of a violation of automation (temporal organization) of various mental functions. It manifests itself in the form of the disintegration of "kinetic melodies", i.e., violations of the sequence of movements, the temporal organization of motor acts. This form of apraxia is characterized by motor perseverations, manifested in the uncontrolled continuation of a once started movement (especially serially performed).

This form of apraxia was studied by a number of authors - K. Kleist, O. Foerster and others. It was studied in particular detail by A. R. Luria, who established in this form of apraxia the generality of disorders in the motor functions of the hand and the speech apparatus in the form of primary difficulties in automating movements, developing motor skills . Kinetic apraxia is manifested in the violation of a wide variety of motor acts: object actions, drawing, writing, in the difficulty of performing graphic tests, especially with the serial organization of movements ( dynamic apraxia). With damage to the lower premotor cortex of the left hemisphere (in right-handers), kinetic apraxia is observed, as a rule, in both hands.

fourth form apraxia - regulatory or prefrontal apraxia- occurs when the convexital prefrontal cortex is damaged anterior to the premotor regions; proceeds against the background of almost complete preservation of tone and muscle strength. It manifests itself in the form of violations of the programming of movements, turning off conscious control over their implementation, replacing the necessary movements with motor patterns and stereotypes. With a gross breakdown of voluntary regulation of movements, patients experience symptoms echopraxia in the form of uncontrolled imitative repetitions of the experimenter's movements. With massive lesions of the left frontal lobe (in right-handers), along with echopraxia, echolalia - imitative repetition of heard words or phrases.

Regulatory apraxia is characterized by systemic perseverations, i.e., perseveration of the entire motor program as a whole, and not of its individual elements. Such patients, after writing under dictation to the suggestion to draw a triangle, outline the contour of the triangle with movements characteristic of writing, etc. The greatest difficulties in these patients are caused by a change in programs of movements and actions. The basis of this defect is a violation of voluntary control over the implementation of movement, a violation of speech regulation of motor acts. This form of apraxia is most demonstratively manifested in cases of damage to the left prefrontal region of the brain in right-handers.

The classification of apraxia, created by A. R. Luria, is based mainly on the analysis of motor function disorders in patients with damage to the left hemisphere of the brain. To a lesser extent, the forms of violation of voluntary movements and actions have been studied in case of damage to various cortical zones of the right hemisphere; this is one of the urgent tasks of modern neuropsychology.

Literature:

1. II International Conference in memory of A. R. Luria: Collection of reports “A. R. Luria and the psychology of the 21st century.” / Ed. T. V. Akhutina, J. M. Glozman. - M., 2003.

2. Topical issues of functional interhemispheric asymmetry. – 2nd All-Russian Conference. M., 2003.

3. Luria, A. R. Lectures on General Psychology - St. Petersburg: Peter, 2006. - 320 p.

4. Functional interhemispheric asymmetry. Reader / Ed. N.N. Bogolepova, V.F. Fokin. - Chapter 1. - M., 2004.

5. Chomskaya E.D. Neuropsychology. - St. Petersburg: Peter, 2006. - 496 p.

6. Reader on neuropsychology / Ed. ed. E. D. Khomskaya. - M .: "Institute for General Humanitarian Research", 2004.

Movement disorders make it most difficult to carry out active rehabilitation treatment. It is persons with motor disorders that make up a significant part of all patients of the rehabilitation neurological department, are the least adapted to vigorous activity, including self-service, and most often need outside care. Therefore, the restoration of motor functions in people with diseases of the nervous system is an important part of their rehabilitation.

Higher motor centers are located in the so-called motor zone of the cerebral cortex: in the anterior central gyrus and adjacent areas. The fibers of the motor cells from the indicated region of the cortex pass through the inner capsule, the subcortical regions and at the border of the brain and spinal cord make an incomplete decussation with the transition of most of them to the opposite side. That is why, in diseases of the brain, motor disorders are observed on the opposite side: with damage to the right hemisphere of the brain, paralysis occurs in the left half of the body, and vice versa. Further, the fibers descend as part of the bundles of the spinal cord, approaching the motor cells (motoneurons) of the anterior horns of the latter. The motor neurons that regulate the movements of the upper limbs lie in the cervical thickening of the spinal cord (level V-VIII of the cervical and I-II thoracic segments), and the lower ones in the lumbar (level I-V of the lumbar and I-II sacral segments). To the same spinal motor neurons, fibers are also sent, starting from the nerve cells of the nuclei of the base nodes - the subcortical motor centers of the brain, from the reticular formation of the brain stem and cerebellum. Thanks to this, the regulation of coordination of movements is ensured, involuntary (automated) movements are carried out and voluntary movements are prepared. The fibers of the motor cells of the anterior horns, which are part of the nerve plexuses and peripheral nerves, end at the executive organs - the muscles.

Any motor act occurs when an impulse is transmitted along the nerve fibers from the cerebral cortex to the anterior horns of the spinal cord and then to the muscles. In diseases of the nervous system, the conduction of nerve impulses is difficult, and there is a violation of the motor function of the muscles. Complete loss of muscle function is called paralysis (plegia), and partial - paresis. According to the prevalence of paralysis, there are: monoplegia (lack of movement in one limb - arm or leg), hemiplegia (damage to the upper and lower limbs of one side: right-sided or left-sided hemiplegia), paraplegia (impaired movement in both lower limbs is called lower paraplegia, in the upper - upper paraplegia) and tetraplegia (damage to all four limbs). When peripheral nerves are damaged, paresis occurs in the zone of their innervation, which is called the corresponding nerve (for example, paresis of the facial nerve, paresis of the radial nerve, etc.).

To correctly determine the severity of paresis, and in cases of mild paresis, sometimes to identify it, it is important to quantify the state of individual motor functions: muscle tone and strength, and the volume of active movements. There are many scale systems for assessing motor functions described by various authors. However, some of them suffer from inaccurate formulations characterizing individual scores, others take into account only one function (muscle strength or tone), and some are overly complex and inconvenient to use. We propose to use a unified 6-point scale for assessing all three motor functions (muscle tone and strength, range of voluntary movements), which we have developed and convenient in practical terms, which makes it possible to compare them with each other and effectively control the results of rehabilitation treatment both in outpatient clinics and in hospitals. stationary conditions.

To study muscle tone, a passive antagonistic movement is performed (for example, when the forearm is extended, the tone of the forearm flexors is assessed), while the patient himself tries to completely relax the limb. When determining muscle strength, the patient provides maximum resistance to movement, which makes it possible to assess the strength of tensed muscles (for example, when extending the hand, the patient tries to bend the hand - this allows us to assess the strength of the flexor muscles of the hand).

The state of muscle tone is graduated from 0 to 5 points:

• 0 - dynamic contracture: the resistance of the antagonist muscles is so great that the examiner cannot change the position of the limb segment;
• 1 - a sharp increase in tone: applying maximum effort, the researcher achieves only a small amount of passive movement (no more than 10% of the normal volume of this movement);
• 2 - a significant increase in muscle tone: with great effort, the examiner manages to achieve no more than half of the volume of normal passive movement in this joint;
• 3 - moderate muscle hypertension: the resistance of the antagonist muscles allows only about 75% of the total volume of this passive movement to be carried out in the norm;
• 4 - a slight increase in resistance to passive movement compared with the norm and with a similar resistance on the opposite (symmetrical) limb of the same patient. A full range of passive movement is possible;
• 5 - normal resistance of muscle tissue during passive movement, no "looseness" in the joint.

With a decrease in muscle tone (muscle hypotension), the researcher experiences less resistance than on a symmetrical healthy limb. Sometimes such "looseness" in the joint even creates the impression of a complete lack of resistance during passive movement.

A more accurate measurement of muscle tone is made by using special devices. To assess the elasticity (density) of the muscles under study, myotonometers designed by Uflyand, Sirmai and other authors are used. More important is the quantitative characteristic of contractile (i.e., associated with muscle stretching) tone, since in all cases, in the absence of devices, it is precisely by the resistance of the studied muscle group to passive stretching that doctors assess the degree of increase in its tone (as described in detail above). Contractile muscle tone is measured using a special attachment (tenzotonograph) to any ink-writing device (for example, to an ELCAR type electrocardiograph). Thanks to preliminary calibration, the results of measuring the tone when using a tensotonograph are expressed in units that are familiar and convenient for processing - in kilograms.

Muscle strength is also expressed in points from 0 to 5:

• 0 - no visible movement and no muscle tension is felt during palpation;
• 1 there is no visible movement, but tension in the muscle fibers is felt on palpation;
• 2 active visible movement is possible in a lightened initial position (the movement is performed under the condition that gravity or friction is removed), but the patient cannot overcome the resistance of the examiner;
• 3 implementation of a full or close to it volume of arbitrary movement against the direction of gravity when it is impossible to overcome the resistance of the researcher;
• 4 - a decrease in muscle strength with a pronounced asymmetry on healthy and affected limbs with the possibility of a full range of voluntary movement with overcoming both gravity and the resistance of the researcher;
• 5 - normal muscle strength without significant asymmetry in a bilateral study.

In addition, the strength of the muscles of the hand can be measured using a hand-held dynamometer.

The volume of active movements is measured using an goniometer in degrees, and then compared with the total volume of the corresponding movements in a healthy person and expressed as a percentage of the latter. The interest received is converted into points, with 0% equating to 0 points, 10% to 1, 25% to 2, 50% to 3, 75% to 4 and 100% to 5 points.

Depending on the localization of the lesion of the nervous system, peripheral or central paralysis (paresis) occurs. With the defeat of the motor cells of the anterior horns of the spinal cord, as well as the fibers of these cells, which are part of the nerve plexuses and peripheral nerves, a picture of peripheral (flaccid) paralysis develops, which is characterized by a predominance of symptoms of neuromuscular prolapse: limitation or absence of voluntary movements, a decrease in strength muscles, decreased muscle tone (hypotension), tendon, periosteal and skin reflexes - hyporeflexia (or their complete absence), often there is also a decrease in sensitivity and trophic disorders, especially muscle atrophy.

In some cases, when motor cells are damaged in the motor zone of the cerebral cortex (anterior central gyrus) or their axons, a syndrome of "flaccid" (atonic) paralysis is also observed, which is very reminiscent of the picture of peripheral paralysis: in both cases there is muscle hypotension, hyporeflexia, movement disorders and trophic. However, with central "flaccid" paralysis, there is no reaction of muscle degeneration (see below), and pyramidal foot pathological symptoms of Babinsky, Oppenheim, Rossolimo, etc. appear, which never happens with damage to the peripheral nervous system.

Of great importance for the selection of composition and prediction of the results of restorative treatment of patients with peripheral paralysis is the study of the electrical excitability of muscles and nerves using the method of classical electrodiagnostics. To do this, various types of universal electric pulsers (UEI) are used, influencing galvanic and tetanizing currents on the motor points of peripheral nerves and muscles. A push-button active electrode connected to the negative pole (cathode) of the apparatus is placed on the motor point, and a larger flat indifferent electrode connected to the positive pole (anode) is placed on the interscapular region (when examining the upper limb) or lumbosacral (for the lower limb). limbs).

Normally, when exposed to the motor point of the nerve, galvanic and tetanizing currents cause a rapid contraction of the muscles innervated by the nerve under study. Under the influence of both types of current directly on the muscle, even with a small force (1-4 mA), a rapid contraction occurs. For the appearance of muscle contraction under the influence of galvanic current, its smaller force is required when shorting on the cathode than on the anode (GLC > ACS).

In persons with peripheral paralysis, destruction and death of the motor fibers of the nerves occur and characteristic changes in their electrical excitability occur, called the reaction of nerve degeneration. Prognostically, the most favorable for restoring the conduction of nerve impulses is a partial reaction of degeneration, when the excitability of the nerve to both types of current decreases, as well as the excitability of the muscle to the tetanizing current. Galvanic current causes a sluggish worm-like contraction of the muscle, and when the polarity of the current changes, the contraction from the anode occurs at a lower strength than from the cathode (AZS > KZS).

The prognosis is worse with a complete reaction of degeneration, when there is no contraction of the muscle, both when both types of current act on the nerve innervating it, and when the muscle itself is irritated by a tetanizing current; the muscle responds to the galvanic current with a worm-like contraction with a predominance of the anode-switching reaction (AZS > KZS). However, even in this case, under the influence of treatment, restoration of nerve conduction with normal muscle electrical excitability can occur.

In the case of a long-term absence of signs of recovery of movements in peripheral paralysis (for 1 year or more), a prognostically very poor complete loss of electrical excitability and nerves and muscles that do not respond to contraction to any type of current develops.

With paralysis of the central type, there is no destruction of the fibers of the peripheral nerves, and therefore there is no reaction of degeneration, only an increase in the threshold of the strength of both types of current, which causes muscle contraction, is noted.

A preliminary study of muscle electrical excitability is also necessary for performing some restorative procedures in the treatment of paralysis, especially for alcohol-novocaine blockades of spastic muscles, the methodology of which will be described below.

Biocurrents arise in any functioning muscle. The assessment of the functional state of the neuromuscular apparatus (including the determination of the magnitude of muscle tone) is also carried out using electromyography - a method of graphic registration of fluctuations in the bioelectrical activity of muscles.

Electromyography helps to determine the nature and location of damage to the nervous system or muscles, and also serves as a method of monitoring the process of restoring impaired motor functions.

In case of violation of the cortical-subcortical connections with the reticular formation of the brain stem or damage to the descending motor pathways in the spinal cord and, as a result, the function of the spinal motor neurons is activated as a result of a disease or brain injury, a syndrome of central spastic paralysis occurs. For him, in contrast to the peripheral and central "flaccid" paralysis, it is characterized by an increase in tendon and periosteal reflexes (hyperreflexia), the appearance of pathological reflexes that are absent in healthy adults (reflexes of Babinsky, Oppenheim, Rossolimo, Zhukovsky, etc.), occurrence when trying voluntary action of a healthy or paralyzed limb of friendly movements (for example, abduction of the shoulder outward when the forearm of the paretic arm is bent or clenching the paralyzed hand into a fist with a similar voluntary movement of a healthy hand). One of the most important symptoms of central paralysis is a pronounced increase in muscle tone (muscle hypertension), which is why such paralysis is often called spastic. At the same time, two features are characteristic of muscle hypertension:

1. it has an elastic character: muscle tone is maximum at the beginning of passive movement (the “penknife” phenomenon), and after the external influence is stopped, the limb tends to return to its original position;
2. the increase in tone in different muscle groups is uneven.

Therefore, for most patients with central paralysis in case of a disease or brain injury, the Wernicke-Mann posture is characteristic: the shoulder is brought (pressed) to the body, the hand and forearm are bent, the hand is turned palm down, and the leg is extended at the hip and knee joints and bent at the foot. This reflects a predominant increase in muscle tone - flexors and pro-nators of the upper limb and extensors - in the lower.

The occurrence of symptoms characteristic of central paralysis is associated with a decrease in regulatory influences from higher cortical motor centers in diseases of the brain and spinal cord and the predominance of facilitating (activating) influences of the reticular formation of the brain stem on the activity of spinal motor neurons. The increased activity of the latter explains the symptoms of central paralysis described above.

In some cases, the same patient may experience both peripheral and central paralysis at the same time. This occurs in the case of damage to the spinal cord at the level of the cervical enlargement, when the function of the nerve fibers going to the lower extremities is simultaneously impaired (this leads to the formation of a lower central mono- or, more often, paraparesis), and the motor cells of the anterior horns of the spinal cord, which provide innervation of the upper limbs, resulting in the formation of peripheral mono- or paraparesis of the upper limbs.

When the focus of the disease is localized in the region of subcortical motor centers, specific motor disorders appear that are not accompanied by paresis. Most often, there is a syndrome of parkinsonism (or trembling paralysis, as it is sometimes called), which occurs when one of the subcortical motor centers, the substantia nigra, is damaged, with subsequent involvement of other subcortical structures in the process. The clinical picture of parkinsonism consists of a combination of three main symptoms: a specific increase in muscle tone according to the extrapyramidal type (muscle rigidity), a sharp decrease in the motor activity of patients (physical inactivity) and the appearance of involuntary movements (tremor).

A typical change in muscle tone in diseases of the subcortical motor centers differs from that in central pyramidal paralysis. Extrapyramidal rigidity is characterized by the preservation of increased tone throughout the entire passive movement, due to which it occurs in the form of uneven shocks (a symptom of "gear wheel"). As a rule, the tone of antagonistic muscles (for example, flexors and extensors) is increased evenly. An increase in tone leads to the constant maintenance of a typical patient posture: with the head tilted forward, the spine slightly bent forward ("hunchbacked" back), arms bent at the elbows and unbent at the wrist joints, legs bent at the knee and hip joints. Patients with parkinsonism usually appear smaller than they actually are.

At the same time, pronounced general physical inactivity is also observed: patients are inactive, prone to long-term preservation of the previously adopted posture ("freezing" in it). The face is inexpressive, motionless (amimic) even when talking on the most exciting topics for the patient. Interestingly, such disorders of voluntary movements are not associated with the presence of paralysis: on examination, it turns out that all active movements are preserved, and muscle strength is not reduced. It is difficult for the patient to start a new movement: change position, move from one place, start walking, but having started the movement, in the future he can walk quite quickly, especially following another person, or holding an object (chair) in front of him. Walking is not accompanied by synkinesis common in healthy people: there are no accompanying hand movements. The ability to maintain a normal body position is also impaired, due to which a healthy person does not fall forward or backward when walking: the patient, especially if necessary to stop, is drawn forward (this is called propulsion), and sometimes at the beginning of the movement - back (retropulsion).

Often, violations of voluntary movements are accompanied by the appearance of involuntary ones in the form of trembling (tremor), which, with the course of the disease, intensifies and spreads to other parts of the limbs and head. Trembling increases with excitement, weakens with voluntary movements and disappears in sleep. Due to pronounced rigidity and trembling, patients sometimes become completely helpless: they cannot change their position in bed, get up, dress, toilet and eat on their own. In such cases, they need constant outside care, including during their stay in the rehabilitation department.

With extrapyramidal lesions, muscle rigidity, physical inactivity and involuntary movements occur with unequal frequency and are combined with each other in different proportions. In accordance with the predominance of certain symptoms, trembling, rigid, amyostatic (with a predominance of immobility) and mixed forms of the disease are distinguished, the latter being the most common.

Demidenko T. D., Goldblat Yu. V.

"Motor disorders in neurological disorders" and others

Psychomotor is a set of motor acts of a person, which is directly related to mental activity and reflects the peculiarities of the constitution inherent in this person. The term "psychomotorics", in contrast to simple motor reactions that are associated with the reflex activity of the central nervous system, denotes more complex movements that are associated with mental activity.

The impact of mental disorders.

With various kinds of mental illness, there may be violations of complex motor behavior - the so-called psychomotor motor disorders. Rough focal brain damage (for example, cerebral atherosclerosis) usually leads to paresis or paralysis. Generalized organic processes, such as brain atrophy (reduction of the brain in volume) are accompanied in most cases by lethargy of gestures and facial expressions, slowness and poverty of movements; speech becomes monotonous, gait changes, general stiffness of movements is observed.

Psychiatric disorders also affect psychomotor. So, manic-depressive psychosis in the manic phase is characterized by general motor excitation.

Some psychogenic disorders in mental illness lead to sharply painful changes in psychomotor. For example, hysteria is often accompanied by complete or partial paralysis of the limbs, reduced strength of movements, and frustrated coordination. A hysterical fit usually makes it possible to observe various expressive and protective mimic movements.

Catatonia (a neuropsychiatric disorder that manifests itself in a violation of voluntary movements and muscle spasms) is characterized by both minor changes in motor skills (weak facial expressions, deliberate pretentiousness of posture, gestures, gait, mannerisms), and vivid manifestations of catatonic stupor and catalepsy. The latter term refers to numbness or stiffness, accompanied by a loss of the ability to voluntary movements. Catalepsy can be observed, for example, in hysteria.

All movement disorders in mental illness can be divided into three types.

Types of movement disorders.

1. hypokinesia(disorders that are accompanied by a decrease in motor volume);
2. hyperkinesia(disorders that are accompanied by an increase in motor volume);
3. dyskinesia(disorders in which involuntary movements are observed as part of normally smooth and well-controlled movements of the limbs and face).

The category of hypokinesia includes various forms of stupor. Stupor is a mental disorder characterized by inhibition of any mental activity (movements, speech, thinking).

Types of stupor in hypokinesia.

1. Depressive stupor (also called melancholic stupor) manifests itself in immobility, a depressed state of mind, but the ability to respond to external stimuli (addresses) is preserved;

2. Hallucinatory stupor occurs with hallucinations provoked by poisoning, organic psychosis, schizophrenia; with such a stupor, general immobility is combined with facial movements - reactions to the content of hallucinations;

3. Asthenic stupor manifests itself in indifference to everything and lethargy, in unwillingness to answer simple and understandable questions;

4. Hysterical stupor is typical for people with a hysterical temperament (it is important for them to be the center of attention, they are overly emotional and demonstrative in expressing feelings), in a state of hysterical stupor, the patient lies motionless for a very long time and does not respond to calls;

5. Psychogenic stupor occurs as a reaction of the body to severe mental trauma; such a stupor is usually accompanied by increased heart rate, increased sweating, fluctuations in blood pressure and other disorders of the autonomic nervous system;

6. Cataleptic stupor (also called wax flexibility) is characterized by the ability of patients to stay in the position given to them for a long time.

Mutism (absolute silence) is also referred to as hypokinesia.

Hyperkinesia.

Types of excitations in hyperkinesia.

1. Manic excitement caused by an abnormally elevated mood. In patients with mild forms of the disease, behavior remains purposeful, although accompanied by exaggerated loud and rapid speech, movements remain well coordinated. In severe forms of movement and the patient's speech are not connected in any way, motor behavior becomes illogical.

2. Hysterical excitement, which is most often a reaction to the surrounding reality, this excitement is extremely defiant and intensifies if the patient notices attention to himself.

3. Hebephrenic arousal, which is a ridiculous, funny, meaningless behavior, accompanied by pretentiousness of facial expressions, is typical for schizophrenia.

4. Hallucinatory excitation - a live reaction of the patient to the content of his own hallucinations.

The study of psychomotor is extremely important for psychiatry and neurology. The patient's movements, his postures, gestures, manners are regarded as very significant signs for a correct diagnosis.

Violations and their causes in alphabetical order:

movement disorder

Movement disorders can occur both with central and peripheral damage to the nervous system. Movement disorders can occur both with central and peripheral damage to the nervous system.

Terminology
- Paralysis - a violation of the motor function that occurs due to the pathology of the innervation of the corresponding muscles and is characterized by the complete absence of voluntary movements.
- Paresis - a violation of the motor function that occurs due to the pathology of the innervation of the corresponding muscles and is characterized by a decrease in the strength and / or amplitude of voluntary movements.
- Monoplegia and monoparesis - paralysis or paresis of the muscles of one limb.
- Hemiplegia or hemiparesis - paralysis and paresis of both limbs, sometimes the face on one side of the body.
- Paraplegia (paraparesis) - paralysis (paresis) of both limbs (either upper or lower).
- Quadriplegia or quadriparesis (also tetraplegia, tetraparesis) - paralysis or paresis of all four limbs.
- Hypertonicity - increased muscle tone. There are 2 types:
- Muscle spasticity, or classic pyramidal paralysis, is an increase in muscle tone (mainly arm flexors and leg extensors), characterized by uneven resistance in various phases of passive movement; occurs when the pyramidal system is damaged
- Extrapyramidal rigidity - a diffuse uniform wax-like increase in muscle tone, equally pronounced in all phases of active and passive movements (muscle agonists and antagonists are affected), due to damage to the extrapyramidal system.
- Hypotension (muscle lethargy) - a decrease in muscle tone, characterized by their excessive compliance during passive movements; usually associated with damage to the peripheral motor neuron.
- Paratonia - the inability of some patients to completely relax the muscles, despite the instructions of the doctor. In milder cases, rigidity is observed with rapid passive movement of the limb and normal tone with slow movement.
- Areflexia - the absence of one or more reflexes, due to a violation of the integrity of the reflex arc or the inhibitory effect of the higher parts of the nervous system.
- Hyperreflexia - an increase in segmental reflexes due to a weakening of the inhibitory effects of the cerebral cortex on the segmental reflex apparatus; arises, for example, at defeat of pyramidal ways.
- Pathological reflexes - the general name of the reflexes found in an adult with damage to the pyramidal tracts (in young children, such reflexes are considered normal).
- Clonus - an extreme degree of increased tendon reflexes, manifested by a series of rapid rhythmic contractions of a muscle or muscle group, for example, in response to a single stretch.

The most common form of movement disorders are paralysis and paresis - loss or weakening of movements due to impaired motor function of the nervous system. Paralysis of the muscles of one half of the body is called hemiplegia, both upper or lower limbs - paraplegia, all limbs - tetraplegia. Depending on the pathogenesis of paralysis, the tone of the affected muscles can either be lost (flaccid paralysis) or increased (spastic paralysis). In addition, peripheral paralysis (if it is associated with damage to the peripheral motor neuron) and central (as a result of damage to the central motor neurons) are distinguished.

What diseases cause movement disorders:

Causes of movement disorders
- Spasticity - damage to the central motor neuron throughout its entire length (cerebral cortex, subcortical formations, stem part of the brain, spinal cord), for example, in a stroke involving the motor zone of the cerebral cortex or the corticospinal tract
- Rigidity - indicates dysfunction of the extrapyramidal system and is caused by damage to the basal ganglia: the medial part of the pale ball and the black substance (for example, with parkinsonism)
- Hypotension occurs in primary muscle diseases, cerebellar lesions and some extrapyramidal disorders (Huntington's disease), as well as in the acute stage of pyramidal syndrome
- The phenomenon of paratonia is characteristic of lesions of the frontal lobe or diffuse cortical lesions
- Coordination of motor activity may be impaired due to muscle weakness, sensory disorders or damage to the cerebellum
- Reflexes decrease with damage to the lower motor neuron (cells of the anterior horns, spinal roots, motor nerves) and increase with damage to the upper motor neuron (at any level above the anterior horns, with the exception of the basal ganglia).

Which doctors should I contact if there is a movement disorder:

Have you noticed a movement disorder? Do you want to know more detailed information or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

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