cere disorders Flashcards
what is the Cerebellum’s Role in Motor Function
movement, postural control, and muscle tone regulation
controls anticipatory movements
controls modification of a person’s response to the change in the conditions of the task
by hwt methods does the cere contribute to Cerebellum’s Role in Motor Function
comparator mechnism
error correcting mech
what is the comparator mechanism
feedforward control
Intended movement (internal feedback from motor cortex)
Actual movement (external feedback from periphery)
compares movement intention with performance,
active during mental rehearsal of movement
what is the error correcting mech
when the movement deviated from intended command the cere supplies a corrective imput
is the cere feedforward or feeedback mech
feedforward
what does feedfoward mean
the modification or control of a process using its anticipated results or effects.
what learning process does the cere help with
learning by trail and error
can motor learning tak eplace in the cere if it is diseased/patho
yes
what is the funnction of the Vestibulocerebellar system
controls balance and eye movements
what is the function of the Spinocerebellar system
Role in controlling ongoingexecution of movements
what is the function of the Cerebrocerebellar system
Movement inpreparation/anticipation andinitiation(feedforward control)
Sequence timing ofagonist-antagonist interactions
Coordination of movements to avisual target
what is Olivopontocerebellar Atrophy (OPCA)
degeneration of the neurons of the pons, cerebellum and inferior olives
when does Olivopontocerebellar Atrophy (OPCA) normally occur in life
30-50
is there a cure for OPCA
no medical cure
slow and progressive death within 20 year of onset
what are the symptoms of OPCA
ataxia, tremor, rigidity, spasms, sleep disorders, depression
what is the role of PT in OPCA
exercise, stretching, assistive device,home modifications, gait and balance training
how does one get Friedrich’s Ataxia
inherited genetically
defect in the FXN gene
what is the pathophysiology of Friedrich’s Ataxia
degeneration of ascending and descending fibers in the spinal cord (spinocerbellar tracts)
potential involvement of dorsal columns and corticospinal tracts
when do the symptoms of FA normally show up
5 -15 year old
what are the symptom of FA
Trouble walking,
tiredness,
loss of sensation starting in legs spreading to arms and trunk,
loss of reflexes,
slow or slurred speech,
hearing and vision loss,
chest pain, shortness of breath, heart palpitations
is there a medical cure fro FA
no
what is the role of PT for FA
maintain comfort/function with PT, OT, SLP, bracing/dme
is there medication for FA
Medications for heart problems and minimizing symptoms
how doe sone get Spinocerebellar Ataxia (SCA)
Inherited (autosomal dominant) heterogeneous group
what cause spinocere ataxia
progressive degeneration of the cerebellum
(but can also affect other regions, including the brainstem)
is SCA common
no it is rare
Core triad of symptoms of SCA
gait axtai/incoordination
nystagmus/visual problems
dysarthria
is there a medical cure for SCA
no
what is the medical treatment for SCA
currently pharmacological molecules target downstream pathways and geneitc therapies aim to decrease toxic polyQ gene
what is the role of PT in SCA
address core triad symptoms and other associated impairments
are cere strokes common
no 10% of the pop
what are the symptoms of a cere stroke
vertigo,
poor coordination,
abnormal reflexes,
difficulty swallowing,
difficulty speaking or slurred speech, uncontrollable eye movement, unconsciousness – sudden onset
what can causea cere stroke
blood clot
hemorraghe
of the vessels of the cere
PICA, AICA, SCA
how is a CERE stroke diagnosed
with MRI
MRA, CT, CT angiogram, ultrasound
treatment hemmorage
control bleeeding the swelling
treatment for blood clot
surgical removal vs medication to dissolve
PT/OT/SLP to treatment for cere stroke
motor skills/mobility/function
is there a cure for any cere degradation
no but medication can be prescribed for tremors and dizziness
Balance and Equilibrium Impairment seen with cere disorders
Postural sway
Poor trunk control
Delayed equilibrium reactions
Use of vision is an ineffective compensatory strategy
Ataxia - gait
Fluctuating base of support, uneven step length, lack of rhythm and timing, increased step height
what region can axtia effect
trunk, head, limbs, mouth, tongue
what is Dysmetria
Deficit in reaching a target
hypometric or hypermetric - Hypermetric is more common
what is Dysdiadochokinesia
Rapid alternating movements are impaired
Realted to agonist/antagonist muscle activity
Difficulty with movements requiring bursts of speed
what is an Intention tremor
Oscillations that increase with movement
what is Postural tremor
Oscillations that are present when mainstaining a static posture or holding a limb against gravity
what does Dysarthria effect
Affects muscles of speech (larynx, mouth, tongue)
characteristic of speech that change with dsyarthria
Changes in pitch and force (variable volume)
Slower rate and irregular rhythm
Poor pronunciation
Inappropriate pauses
Slurred speech
Poor articulation
Visual Disturbances seen with cere disorders
Diplopia
Saccadic dysmetric movements
Difficulty focusing on objects when head/body in motion (VOR)
Loss of abiliy to cancel the vestibulo-ocular reflex
Nystagmus
what does DANISH stand for
Dysdiadochokinesia/dysmetria
Ataxia
Nystagmus
Intention tremor
Speech – slurred or scanning
Hypotonia
what are Cerebellar Eye Signs
Abnormal Saccades and Smooth Pursuits
Misalignment
Spontaneous nystagmus
Positional nystagmus
VOR
Gaze Holding
Postsaccadic drift
what is the HINT exam
Head Impulse Test (HIT)
Nystagmus
Test of Skew
Finger Rub Hearing Test
Head Impulse Test (HIT)
peri vs central
peri: catch up saccade
Nystagmus peri
uni directional
nys central
bidirectional
skew peri
no skew
skew central
skew present
finger rubbing hearing test peri
no hearing loss
finger rubbing hearing test central
new hearing loss
what is Dyssynergia
any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements
how can we test Dyssynergia
Finger-to-nose; Finger-to-therapist’s finger; Alternate heal-to-knee; Toe-to-examiner’s finger
how do we test rebound phen
Patient is asked to maintain his arms in the outstretched position with eyes closed
Downward pressure is applied to the arms and is released suddenly
in cerebellarsyndrome what does rebound phen look like
the arms will shoot upward when pressure is released and will oscillate before returning to the original position.
is the rhomberg positive or negative for cere disorders
negative
m-CTSIB and cere disorders
Postural sway and delayed balance reactions
Cerebellar lesion and gait presentation
ait characterized by a wide base, unsteadiness, irregular steps (short step-length alternated irregularly with longer step length)
Notearm swing and trunkmotion during walking
what are some outcome measure for axtia
SARA (Scale for the Assessment andRating of Ataxia)
ICARS (International CooperativeAtaxia Rating Scale)
Brief Ataxia Rating Scale (BARS)
Activity-level outcome measures
berg balance
TUG
10m WT
Participation-level outcome measures
barthel index
functionl ind measure
goal attainment score
what does Independent head-eye movement indicative of
cerebellar lesion
When the patient is asked to look at an object at their side, they perform a quick head movement to the side before their eyes start moving toward the object
(or the head performs a quick rotational movement within the first 30 degrees after which the eyes start moving).
how do those with cere issue repsond to therapy
it depends on were the lesion is
rehab is worse when the areas of the cere critical for relearneding are impacted
cerebellar disease vs cere stroke
those with disease normally show slower progression compared to their stroke counterparts
how do we approach ataxia and uncoordination
learning methods to enhance neural plasticity
Treatment approach targets signs/symptoms and compensatory strategies used
Simple functional tasks within their ability
Purposeful repetition during ADLs
Visual or Auditory External Cues
Progress to more complex multilevel tasking
Coordinative PT program for cerebellar disease
1-hour/day, 3x/week, 4-week duration of a gained functional performance on SARA
Progression of Exercises for cere disorders - complexity
Simple to more complex (multilevel tasking) movements
Progression of Exercises for cere disorders - weight shifting
Lateral weight shift anterior-posterior weight shift rotational weight shifting
All activities should be performed bilaterally!
what were the most reported PT techniques for cere damage
Proprioceptive neuromuscular facilitation (PNF)
Frenkel exercises
Vestibular habituation exercises
Range of activities aimed at retraining balance.
PNF agonist and antgonist
improves the coordination between A and A
through implamnetation of reverse movements with gentle resistance
PNF nromal seq.
enhances normal movement by emphasizing the distal and proximal seq. in these patterns
what are Cawthorne-Cooksey Exercises
vestibular habituation exercises
Habituation is defined as what
behavioral response decrement that results from repeated stimulation and that does not involve sensory adaptation/sensory fatigue or motor fatigu
what are included in Vestibular Habituation exercises
rep movements of
eye
head (EC and EO)
trunk (EC and EO, multidirectional)
lying down (EC and EO, rolling head and body)
Visuomotor coordination essential for what
hand eye coordination
does impaired vision impact hand movement
yes
Visuomotor performance changable in these with cere disorders
yes as well as those with MS
when looking at trunk stablity what do we focus on first
Establish central (trunk) stability before promoting proximal (shoulder and pelvic girdles) or distal (limb) control
Goals of Intervention should address for cere disorders
postural stablity
function
accuracy of limb movement with activity
improving VOR/eye movements
does adding weight decrease axtia
hmm - the evidence is limited
what to focus on for gait training in those with cere disorders
control over speed
what are some examples of coordination exercises
reaching for targets
toe or heel to target
treatment implications
slow down the movements
reduce the complexity of the moevements
may benefit from blocked practice
what kind of conditions would rely more on compensatory stratigies
genetic conditions and degreneration
all other conditions depend on personal factors and recovery
what are some examples of compensatory strategies
vision to guide movements
visual imagery and planning the motion before completing the activity - expert opinion
use of AD - decrease the number of DF
single point cane and cere issues
this may be hard because it is a unilateral device
