Ataxia

Question 1

Define Ataxia

Answer 1

Incoordination of mov’t that is not the result of muscle weakness. Insufficient postural control and incoordination of multi-joint mov’ts.

Neurological SYMPTOM (not condition)

Mobility without stability

Question 2

What are the causes?

Answer 2

• MS
• Cerebellar damage (stroke, tumour, TBI, hypoxia at birth, hydrocephalus, infection, metabolic disease, drug & alcohol intoxication or exposure to other toxins)
• Hereditary conditions - recessive disorders, autosomal dominant disorders

Question 3

What is Sensory Ataxia?

Answer 3

Dysfunction of the proprioceptive input from the periphery and the ascending systems.

Proprioception and symptoms are more noticeable with eyes closed

Question 4

What happens when theres damage to the cerebellum?

Answer 4

Instability to fine tune & respond to sensory and motor information and affects spatial accuracy and timing of volunatry mov’ts

Question 5

What is the Clinical Presentation of Ataxia?

Answer 5

A range of functional difficulties - balance, walking, reaching, grasping, manipulation, eye mov’t, swallowing, speech intelligibility

Disorders of functional mobility:
- bracing segments (use of thighs against bed to stand)
- locking joints
- wide BOS
- ↑ reliance on vision

Disorders of gait:
- unsteady, irregular and staggering with lateral deviation from line of progression
- high risk of falling

Disorders of balance:
- ↑ postural sway
- poor anticipatory postural control
- abnormal balance reactions

Disorders of eye mov’t
- difficulties in accurate fixation of vision

Question 6

Dysmetria

Clinical Features of Ataxia

Answer 6

Inability to control distance, speed, ROM to perform fluid mov’ts.

Inability to judge distance/range leading to over/undershotting errors

Sign of cerebellar damage

Question 7

Dysdiadochokinesis

Clinical Features of Ataxia

Answer 7

impairment of ability to perform rapidly alternating mov’ts (e.g., pronate & supinate rapidly)

Question 8

Dyssynergia

Clinical Features of Ataxia

Answer 8

Muscular incoordination, decomposition of mov’t

Compensation strategy - mov’t is separated into series of components, rathr than a single smooth activity

Question 9

Rebound Phenomenom

Clincal Features of Ataxia

Answer 9

Reflex that occurs when a pt attemps to move a limb against resistance that has been suddenly removed.

Loss of the “check reflex” which functions to halt forceful, active mov’ts

Question 10

Intention Tremor

Clinical Features of Ataxia

Answer 10

Involuntary oscillatory mov’t resulting from alternate contractions of opposing muscle groups present with active purposeful mov’t - worsening before reaching endpoints

Question 11

Postural Tremor

Clinical Features of Ataxia

Answer 11

Occurs when holding a position against gravity
(e.g., keeping arms outstretched)

Involuntary oscillatory mov’t resulting from alternate contractions of opposing msucle groups of the proximal muscles

Question 12

Dysarthria

Clinical Features of Ataxia

Answer 12

Disorder of the motor component of speech articulation - lack of coordination of oral musculature and breathing

Question 13

What are some assessments you could perform?

Answer 13

Finger-nose
Heel-shin
Rapid Alternating Mov’t (RAMS)
Rebound Test
Positing holding
Berg Balance Scale
Timed Up and Go (TUG)

Faster mov’ts genreally amplify difficulties

Question 14

What is an outocme measure that could be used?

Answer 14

Scale for Assessment and Rating of Ataxia (SARA)
https://www.sralab.org/rehabilitation-measures/scale-assessment-and-rating-ataxia

Question 15

What is the goal of Ataxia management?

Answer 15

Improve the functional level of the pt through restorative techniques.

When this isnt possible, compensatory strats are used to make pt as independent as possible within thier present functional level

Question 16

What could management look like?

Answer 16

ALTER CONDITIONS IN WHICH MOV’T IS OCCURRING

• add sensory input - to enhance kinesthetic awareness & possible stimulate co-contraction of stabilizing muscle around joint & reduce tremor
  ➜ joint compression (e.g., pressing down on knee joint during sit-to-stand
  ➜ light resistance - (e.g., resistance on shoulders when during sit to stand)
  ➜ distal stabilization - used in the arm with stabilization provided distally via manual support or a supportive surface
• decrease speed
• visualization/conscious control - may include self-talk to relax and visualizing a smooth mov’t
• change target size - start with larger when reaching for items and progress to smaller targets
• reduce range of reaching - may begin with reaching activities closer to the body then progress to outer range

Question 17

Whar could mangement look like cont’d?

Answer 17

PROMOTING PROXIMAL STABILITY
- rhythmical stabilizations - isometric contractions against resistance without intention of mov’t
- facilitiate good alignment
- progress activities from larger BOS to smaller BOS

BALANCE EXERCISES

COMPENSATION - e.g., weihgts applied on limbs and/or body or on a piece of equipment as a form of compression/resistance

Question 18

Example exercises for Ataxia?

Answer 18

Static Balance
- quadruped standing - stabilize trunk, lift one arm

Dynamic Balance
- kneeling - put one foot in front and back alternately

Whole Body Mov’ts
- quadruped standing (e.g., 4-point kneeling) - lift 1 arm and the leg of the conralateral side - flex arm, leg and trunk - extend arm, leg and rtunk alternately
- Kneeling: sit beside the heel on the right side - kneeling - sit beside the heel on the L side alternately