CLINICAL CHARACTERISTICS
Extended internally rotated shoulders; extended elbows; flexed wrists, fingers; extended internally rotated hips, extended knees, ankle plantar flexion, inversion; increased rigidity when awake
Decerebrate rigidity
Spasticity
Bed/chair positioning, ROM, weight bearing, neuromuscular blocks, inhibitive casting, enteral and intrathecal medications, tendon releases, relaxation techniques
Midbrain, pons, diencephalon
Decerebrate rigidity
Rigidity and bradykinesia; parkinsonism
Velocity-independent resistance; lead pipe, cogwheel types of rigidity; worse when awake
Velocity-dependent resistance, hyperreflexia/clonus, muscle shortening; present in face, neck, trunk, limbs; worse when awake and with effort
Spasticity
Tremor
Weighted devices, weight bearing, medications, neuromuscular blocks, appropriate assistive devices
Substantia nigra, extrapyramidal pathways; also with medications that block dopamine
Rigidity and bradykinesia; parkinsonism
Decorticate Rigidity
Internally rotated shoulder; flexed elbow, wrists, fingers; extended, internally rotated hips; knee flexion; ankle plantar flexion, inversion; increased rigidity when awake
Sudden irregular flinging movements starting in the hip or shoulder, occasionally facial or oral with or without rotator component; worse with arousal/excitement, absent in sleep
Hemiballismus/ballismus
Decorticate Rigidity
Positioning, ROM, neuromuscular blocks, early casting
Upper motor neuron syndrome; corticospinal pathways
Spasticity
Chorea
Involuntary dancelike or jerky movements without rhythmic pattern; distal
Dynamic contraction/relaxation of muscles with slow, writhing or repetitive twisting movements or sustained contortions; usually distal limb(s)
Dystonia
Athetosis
Relaxation techniques, taper offending medications
Contralateral neostriatum, thalamus
Chorea
Tremor
Involuntary rhythmic oscillations while awake
Postural dystonia with fragmentary athetosis, with or without bradykinesia; often preserved intellect/personality
Pseudobulbar athetoid syndrome
Myoclonus
Medications, neuromuscular blocks
Bilateral pyramidal tract
Pseudobulbar athetoid syndrome
Torticollis
Dystonic posture of the neck; spasticity and/or contracture of the sternocleidomastoid, splenius muscles