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Neuromus 3 > cere disorders > Flashcards

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
Q

what cause spinocere ataxia

A

progressive degeneration of the cerebellum
(but can also affect other regions, including the brainstem)

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26
Q

is SCA common

A

no it is rare

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27
Q

Core triad of symptoms of SCA

A

gait axtai/incoordination

nystagmus/visual problems

dysarthria

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28
Q

is there a medical cure for SCA

A

no

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29
Q

what is the medical treatment for SCA

A

currently pharmacological molecules target downstream pathways and geneitc therapies aim to decrease toxic polyQ gene

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30
Q

what is the role of PT in SCA

A

address core triad symptoms and other associated impairments

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31
Q

are cere strokes common

A

no 10% of the pop

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32
Q

what are the symptoms of a cere stroke

A

vertigo,
poor coordination,
abnormal reflexes,
difficulty swallowing,
difficulty speaking or slurred speech, uncontrollable eye movement, unconsciousness – sudden onset

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33
Q

what can causea cere stroke

A

blood clot

hemorraghe

of the vessels of the cere
PICA, AICA, SCA

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34
Q

how is a CERE stroke diagnosed

A

with MRI
MRA, CT, CT angiogram, ultrasound

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35
Q

treatment hemmorage

A

control bleeeding the swelling

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36
Q

treatment for blood clot

A

surgical removal vs medication to dissolve

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37
Q

PT/OT/SLP to treatment for cere stroke

A

motor skills/mobility/function

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38
Q

is there a cure for any cere degradation

A

no but medication can be prescribed for tremors and dizziness

39
Q

Balance and Equilibrium Impairment seen with cere disorders

A

Postural sway

Poor trunk control

Delayed equilibrium reactions

Use of vision is an ineffective compensatory strategy

40
Q

Ataxia - gait

A

Fluctuating base of support, uneven step length, lack of rhythm and timing, increased step height

41
Q

what region can axtia effect

A

trunk, head, limbs, mouth, tongue

42
Q

what is Dysmetria

A

Deficit in reaching a target

hypometric or hypermetric - Hypermetric is more common

43
Q

what is Dysdiadochokinesia

A

Rapid alternating movements are impaired

Realted to agonist/antagonist muscle activity

Difficulty with movements requiring bursts of speed

44
Q

what is an Intention tremor

A

Oscillations that increase with movement

45
Q

what is Postural tremor

A

Oscillations that are present when mainstaining a static posture or holding a limb against gravity

46
Q

what does Dysarthria effect

A

Affects muscles of speech (larynx, mouth, tongue)

47
Q

characteristic of speech that change with dsyarthria

A

Changes in pitch and force (variable volume)

Slower rate and irregular rhythm

Poor pronunciation

Inappropriate pauses

Slurred speech

Poor articulation

48
Q

Visual Disturbances seen with cere disorders

A

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
Q

what does DANISH stand for

A

Dysdiadochokinesia/dysmetria
Ataxia
Nystagmus
Intention tremor
Speech – slurred or scanning
Hypotonia

50
Q

what are Cerebellar Eye Signs

A

Abnormal Saccades and Smooth Pursuits

Misalignment

Spontaneous nystagmus
Positional nystagmus

VOR

Gaze Holding

Postsaccadic drift

51
Q

what is the HINT exam

A

Head Impulse Test (HIT)
Nystagmus
Test of Skew
Finger Rub Hearing Test

52
Q

Head Impulse Test (HIT)
peri vs central

A

peri: catch up saccade

53
Q

Nystagmus peri

A

uni directional

54
Q

nys central

A

bidirectional

55
Q

skew peri

A

no skew

56
Q

skew central

A

skew present

57
Q

finger rubbing hearing test peri

A

no hearing loss

58
Q

finger rubbing hearing test central

A

new hearing loss

59
Q

what is Dyssynergia

A

any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements

60
Q

how can we test Dyssynergia

A

Finger-to-nose; Finger-to-therapist’s finger; Alternate heal-to-knee; Toe-to-examiner’s finger

61
Q

how do we test rebound phen

A

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
Q

in cerebellarsyndrome what does rebound phen look like

A

the arms will shoot upward when pressure is released and will oscillate before returning to the original position.

63
Q

is the rhomberg positive or negative for cere disorders

A

negative

64
Q

m-CTSIB and cere disorders

A

Postural sway and delayed balance reactions

65
Q

Cerebellar lesion and gait presentation

A

ait characterized by a wide base, unsteadiness, irregular steps (short step-length alternated irregularly with longer step length)
Notearm swing and trunkmotion during walking

66
Q

what are some outcome measure for axtia

A

SARA (Scale for the Assessment andRating of Ataxia)
ICARS (International CooperativeAtaxia Rating Scale)
Brief Ataxia Rating Scale (BARS)

67
Q

Activity-level outcome measures

A

berg balance

TUG

10m WT

68
Q

Participation-level outcome measures

A

barthel index

functionl ind measure

goal attainment score

69
Q

what does Independent head-eye movement indicative of

A

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
Q

how do those with cere issue repsond to therapy

A

it depends on were the lesion is

rehab is worse when the areas of the cere critical for relearneding are impacted

71
Q

cerebellar disease vs cere stroke

A

those with disease normally show slower progression compared to their stroke counterparts

72
Q

how do we approach ataxia and uncoordination

A

learning methods to enhance neural plasticity

73
Q

Treatment approach targets signs/symptoms and compensatory strategies used

A

Simple functional tasks within their ability

Purposeful repetition during ADLs

Visual or Auditory External Cues

Progress to more complex multilevel tasking

74
Q

Coordinative PT program for cerebellar disease

A

1-hour/day, 3x/week, 4-week duration of a gained functional performance on SARA

75
Q

Progression of Exercises for cere disorders - complexity

A

Simple to more complex (multilevel tasking) movements

76
Q

Progression of Exercises for cere disorders - weight shifting

A

Lateral weight shift  anterior-posterior weight shift  rotational weight shifting

All activities should be performed bilaterally!

77
Q

what were the most reported PT techniques for cere damage

A

Proprioceptive neuromuscular facilitation (PNF)

Frenkel exercises

Vestibular habituation exercises

Range of activities aimed at retraining balance.

78
Q

PNF agonist and antgonist

A

improves the coordination between A and A

through implamnetation of reverse movements with gentle resistance

79
Q

PNF nromal seq.

A

enhances normal movement by emphasizing the distal and proximal seq. in these patterns

80
Q

what are Cawthorne-Cooksey Exercises

A

vestibular habituation exercises

81
Q

Habituation is defined as what

A

behavioral response decrement that results from repeated stimulation and that does not involve sensory adaptation/sensory fatigue or motor fatigu

82
Q

what are included in Vestibular Habituation exercises

A

rep movements of

eye
head (EC and EO)
trunk (EC and EO, multidirectional)
lying down (EC and EO, rolling head and body)

83
Q

Visuomotor coordination essential for what

A

hand eye coordination

84
Q

does impaired vision impact hand movement

A

yes

85
Q

Visuomotor performance changable in these with cere disorders

A

yes as well as those with MS

86
Q

when looking at trunk stablity what do we focus on first

A

Establish central (trunk) stability before promoting proximal (shoulder and pelvic girdles) or distal (limb) control

87
Q

Goals of Intervention should address for cere disorders

A

postural stablity

function

accuracy of limb movement with activity

improving VOR/eye movements

88
Q

does adding weight decrease axtia

A

hmm - the evidence is limited

89
Q

what to focus on for gait training in those with cere disorders

A

control over speed

90
Q

what are some examples of coordination exercises

A

reaching for targets

toe or heel to target

91
Q

treatment implications

A

slow down the movements

reduce the complexity of the moevements

may benefit from blocked practice

92
Q

what kind of conditions would rely more on compensatory stratigies

A

genetic conditions and degreneration

all other conditions depend on personal factors and recovery

93
Q

what are some examples of compensatory strategies

A

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
Q

single point cane and cere issues

A

this may be hard because it is a unilateral device

Neuromus 3 (7 decks)

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