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Upper vs Lower Motor Neuron

 
 
Reply Fri 3 Apr, 2015 07:03 pm
I have a sample case study practice that I am looking at in class but I am confused about whether it's upper or lower motor neuron it says:
Case History: Whilst attending the ward in the morning for handover you are notified that a new patient had been admitted late the previous afternoon for rehabilitation following a stroke 5 weeks ago. Her initial presentation to the acute hospital reported an acute onset of right-sided weakness and loss of speech. The client’s name is June and yesterday was her 60th birthday. She was seen by one of the Rehabilitation Registrars on admission, whose examination revealed ongoing paresis of her right arm and leg, a right facial droop, and marked expressive speech difficulties. He had arranged a series of further investigations and requested a speech pathology assessment.
An initial MRI investigation identified an infarct primarily in the left frontal area extending into the insular region.
June lives at home with her husband and has two children who live close by. She works as a receptionist at a GP surgery.
You decide to briefly introduce yourself to June to gather some initial information. She looks up as you enter the room, and attempts a smile. You notice her right-sided facial weakness. When you ask how her talking is going her eyes well up with tears and she points to her mouth, shaking her head. June appears to follow your questions appropriately and she is using gesture, intonation and facial expressions to respond and convey basic intent. Her verbal output is extremely limited.
Further informal probing reveals that June is unable to whistle, puff her cheeks or clear her throat to command. You ask June to copy some oral movements and see marked groping. Her ability to copy oral movements improve with visual models and tactile prompts or placement cues. The strength and range of movement appears mildly reduced on the right side of her lips and tongue. When asked to count from 1 to 10 independently her speech movements are awkward with notable groping and off target movements of her lips and jaw. She is able to achieve a gross approximation for each number when counting in unison with visual cues and pacing support. Her automatic speech is slow and effortful. Distorted production, dysprosody and groping for articualtory postures are noted.



Is this upper or lower motor neuron?
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roger
 
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Reply Fri 3 Apr, 2015 07:08 pm
@sugars888,
That's certainly well presented, but I'm not sure anyone here can come up with a good response.
fresco
 
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Reply Sat 4 Apr, 2015 01:56 am
@sugars888,
https://www.ole.bris.ac.uk/bbcswebdav/institution/Faculty%20of%20Medicine%20and%20Dentistry/MB%20ChB/Hippocrates%20Year%203%20Medicine%20and%20Surgery/Neurology%20-%20Presenting%20complaints/page_29.htm
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Miller
 
  1  
Reply Sat 4 Apr, 2015 02:01 am
@roger,
I could provide an excellent reponse, but I'd have to be paid a very large fee for my efforts.

Miller
 
  1  
Reply Sat 4 Apr, 2015 02:09 am
@Miller,
@roger,

I could provide an excellent response, but I'd have to be paid a very large fee for my efforts.
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fresco
 
  1  
Reply Sat 4 Apr, 2015 02:26 am
@sugars888,
Quote:
An initial MRI investigation identified an infarct primarily in the left frontal area extending into the insular region.


Presumably, this is the key phrase to distinguish between "upper" and "lower".
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