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cere disorders Flashcards

1
Q

what is the Cerebellum’s Role in Motor Function

A

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

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2
Q

by hwt methods does the cere contribute to Cerebellum’s Role in Motor Function

A

comparator mechnism

error correcting mech

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3
Q

what is the comparator mechanism

A

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

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4
Q

what is the error correcting mech

A

when the movement deviated from intended command the cere supplies a corrective imput

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5
Q

is the cere feedforward or feeedback mech

A

feedforward

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6
Q

what does feedfoward mean

A

the modification or control of a process using its anticipated results or effects.

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7
Q

what learning process does the cere help with

A

learning by trail and error

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8
Q

can motor learning tak eplace in the cere if it is diseased/patho

A

yes

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9
Q

what is the funnction of the Vestibulocerebellar system

A

controls balance and eye movements

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10
Q

what is the function of the Spinocerebellar system

A

Role in controlling ongoingexecution of movements

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11
Q

what is the function of the Cerebrocerebellar system

A

Movement inpreparation/anticipation andinitiation(feedforward control)
Sequence timing ofagonist-antagonist interactions

Coordination of movements to avisual target

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12
Q

what is Olivopontocerebellar Atrophy (OPCA)

A

degeneration of the neurons of the pons, cerebellum and inferior olives

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13
Q

when does Olivopontocerebellar Atrophy (OPCA) normally occur in life

A

30-50

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14
Q

is there a cure for OPCA

A

no medical cure

slow and progressive death within 20 year of onset

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15
Q

what are the symptoms of OPCA

A

ataxia, tremor, rigidity, spasms, sleep disorders, depression

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16
Q

what is the role of PT in OPCA

A

exercise, stretching, assistive device,home modifications, gait and balance training

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17
Q

how does one get Friedrich’s Ataxia

A

inherited genetically

defect in the FXN gene

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18
Q

what is the pathophysiology of Friedrich’s Ataxia

A

degeneration of ascending and descending fibers in the spinal cord (spinocerbellar tracts)

potential involvement of dorsal columns and corticospinal tracts

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19
Q

when do the symptoms of FA normally show up

A

5 -15 year old

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20
Q

what are the symptom of FA

A

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

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21
Q

is there a medical cure fro FA

A

no

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22
Q

what is the role of PT for FA

A

maintain comfort/function with PT, OT, SLP, bracing/dme

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23
Q

is there medication for FA

A

Medications for heart problems and minimizing symptoms

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24
Q

how doe sone get Spinocerebellar Ataxia (SCA)

A

Inherited (autosomal dominant) heterogeneous group

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25
what cause spinocere ataxia
progressive degeneration of the cerebellum (but can also affect other regions, including the brainstem)
26
is SCA common
no it is rare
27
Core triad of symptoms of SCA
gait axtai/incoordination nystagmus/visual problems dysarthria
28
is there a medical cure for SCA
no
29
what is the medical treatment for SCA
currently pharmacological molecules target downstream pathways and geneitc therapies aim to decrease toxic polyQ gene
30
what is the role of PT in SCA
address core triad symptoms and other associated impairments
31
are cere strokes common
no 10% of the pop
32
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
33
what can causea cere stroke
blood clot hemorraghe of the vessels of the cere PICA, AICA, SCA
34
how is a CERE stroke diagnosed
with MRI MRA, CT, CT angiogram, ultrasound
35
treatment hemmorage
control bleeeding the swelling
36
treatment for blood clot
surgical removal vs medication to dissolve
37
PT/OT/SLP to treatment for cere stroke
motor skills/mobility/function
38
is there a cure for any cere degradation
no but medication can be prescribed for tremors and dizziness
39
Balance and Equilibrium Impairment seen with cere disorders
Postural sway Poor trunk control Delayed equilibrium reactions Use of vision is an ineffective compensatory strategy
40
Ataxia - gait
Fluctuating base of support, uneven step length, lack of rhythm and timing, increased step height
41
what region can axtia effect
trunk, head, limbs, mouth, tongue
42
what is Dysmetria
Deficit in reaching a target hypometric or hypermetric - Hypermetric is more common
43
what is Dysdiadochokinesia
Rapid alternating movements are impaired Realted to agonist/antagonist muscle activity Difficulty with movements requiring bursts of speed
44
what is an Intention tremor
Oscillations that increase with movement
45
what is Postural tremor
Oscillations that are present when mainstaining a static posture or holding a limb against gravity
46
what does Dysarthria effect
Affects muscles of speech (larynx, mouth, tongue)
47
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
48
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
49
what does DANISH stand for
Dysdiadochokinesia/dysmetria Ataxia Nystagmus Intention tremor Speech – slurred or scanning Hypotonia
50
what are Cerebellar Eye Signs
Abnormal Saccades and Smooth Pursuits Misalignment Spontaneous nystagmus Positional nystagmus VOR  Gaze Holding Postsaccadic drift 
51
what is the HINT exam
Head Impulse Test (HIT) Nystagmus Test of Skew Finger Rub Hearing Test
52
Head Impulse Test (HIT) peri vs central
peri: catch up saccade
53
Nystagmus peri
uni directional
54
nys central
bidirectional
55
skew peri
no skew
56
skew central
skew present
57
finger rubbing hearing test peri
no hearing loss
58
finger rubbing hearing test central
new hearing loss
59
what is Dyssynergia 
any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements
60
how can we test Dyssynergia 
Finger-to-nose; Finger-to-therapist's finger; Alternate heal-to-knee; Toe-to-examiner's finger
61
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
62
in cerebellar syndrome what does rebound phen look like
the arms will shoot upward when pressure is released and will oscillate before returning to the original position. 
63
is the rhomberg positive or negative for cere disorders
negative
64
m-CTSIB and cere disorders
Postural sway and delayed balance reactions
65
Cerebellar lesion and gait presentation
ait characterized by a wide base, unsteadiness, irregular steps (short step-length alternated irregularly with longer step length) Note arm swing and trunk motion during walking
66
what are some outcome measure for axtia
SARA (Scale for the Assessment and Rating of Ataxia) ICARS (International Cooperative Ataxia Rating Scale) Brief Ataxia Rating Scale (BARS)
67
Activity-level outcome measures
berg balance TUG 10m WT
68
Participation-level outcome measures
barthel index functionl ind measure goal attainment score
69
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). 
70
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
71
cerebellar disease vs cere stroke
those with disease normally show slower progression compared to their stroke counterparts
72
how do we approach ataxia and uncoordination
learning methods to enhance neural plasticity
73
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
74
Coordinative PT program for cerebellar disease
1-hour/day, 3x/week, 4-week duration of a gained functional performance on SARA
75
Progression of Exercises for cere disorders - complexity
Simple to more complex (multilevel tasking) movements
76
Progression of Exercises for cere disorders - weight shifting
Lateral weight shift  anterior-posterior weight shift  rotational weight shifting All activities should be performed bilaterally!
77
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.
78
PNF agonist and antgonist
improves the coordination between A and A through implamnetation of reverse movements with gentle resistance
79
PNF nromal seq.
enhances normal movement by emphasizing the distal and proximal seq. in these patterns
80
what are Cawthorne-Cooksey Exercises
vestibular habituation exercises
81
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
82
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)
83
Visuomotor coordination essential for what
hand eye coordination
84
does impaired vision impact hand movement
yes
85
Visuomotor performance changable in these with cere disorders
yes as well as those with MS
86
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
87
Goals of Intervention should address for cere disorders
postural stablity function accuracy of limb movement with activity improving VOR/eye movements
88
does adding weight decrease axtia
hmm - the evidence is limited
89
what to focus on for gait training in those with cere disorders
control over speed
90
what are some examples of coordination exercises
reaching for targets toe or heel to target
91
treatment implications
slow down the movements reduce the complexity of the moevements may benefit from blocked practice
92
what kind of conditions would rely more on compensatory stratigies
genetic conditions and degreneration all other conditions depend on personal factors and recovery
93
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
94
single point cane and cere issues
this may be hard because it is a unilateral device

Neuromus 3 (7 decks)

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