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NM II > CEREBELLAR DODS PARTS 1-3 > Flashcards

CEREBELLAR DODS PARTS 1-3 Flashcards

1
Q

Functions of cerebellum in motor performance

A

tone
smoothness
coordination
accuracy
postural control

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2
Q

Functions of cerebellum in motor learning

A

-small movements integrated into complex behaviors –> consolidate movements into motor programs
-acquisition and modification of skilled action
-acts as a comparator in real time; predictions for movement initiation and termination
-may predict upcoming sensory events
-learning based on error-driven motor learning process

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3
Q

What are the 3 functional zones of the cerebellum?

A

vestibulocerebellum

spinocerebellum

cerebrocerebelum

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4
Q

vestibulocerebellum functions

A

maintenance of balance, control of eye movements, regulates VOR, postural control

IF DAMAGED: impaired VOR, nystagmus, postural instability/impaired balance

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5
Q

spinocerebellum functions

A

regulation of muscle tone, coordination of skilled voluntary movement

-limb movements
-balance
-locomotion
-gaze and eye movements

IF DAMAGED: oculomotor deficits, hypotonia, gait ataxia, lack of check, dysmetria, dysdiadochokinesia, tremor, imbalance/falls

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6
Q

cerebrocerebellum functions

A

planning and initiation of voluntary activity

-visually guided movements
-motor planning
-sensorimotor error assessment
-agonist-antagonist coordination –> rapid alternating movements

*capabilities are very refined

IF DAMAGED: dysdiadochokinesia, dysmetria, dyssynergia, decomposition

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7
Q

3 layers of each functional zone of the cerebellum

A

cerebellar cortex - superficial
white matter layer - intermediate
nuclei - deep

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7
Q

3 layers of each functional zone of the cerebellum

A

cerebellar cortex - superficial
white matter layer - intermediate
nuclei - deep

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8
Q

vestibulocerebellum nuclei

A

vestibular nuclei located in pontomedullary junction of the brainstem- 4 TOTAL NUCLEI

the inner ear apparatus has a fast track connection to the cerebellum, bypassing the nuclei

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9
Q

spinocerebellum nuclei

A

fastigial nucleus

interposed nucleus
–globose
–emboliform

**buried deep in each cerebellar hemisphere

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10
Q

cerebrocerebellum nucleus

A

dentate nucleus

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11
Q

How to test for hypotonia

A

test by asking person to relax and move their limbs

floppy feels

due to decreased drive to vestibulospinal and reticulospinal tracts

usually does not present with problems in physical function

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12
Q

Postural tremor vs kinetic tremor

A

postural- occurs in muscles maintaining a static position against gravity

kinetic- during voluntary mvmt
—intention tremor: one form of kinetic tremor that occurs during the termination of visually guided movements toward a target

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13
Q

What are the two main types of nystagmus?

A

spontaneous

gaze evoked- when they move in a specific plane of movement

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14
Q

TESTS OF OCULOMOTOR CONTROL

A

saccades

smooth pursuit

VOR

VOR cancellation

gaze-evoked nystagmus

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15
Q

Dyssynergia def:

A

impairment of multi-joint movement related to dysmetria and deficits in limb dynamics predictions

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16
Q

movement decomposition def:

A

Breaking down of a movement sequence or multi-joint movement
into a series of separate movements to simplify the movement

-this may be considered a compensatory strategy

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17
Q

dysmetria

A

Impaired ability to scale movement distance; slow movements tend to produce hypometria and fast produce hypermetria

** go not far enough or too far from target

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18
Q

dysdiadochokinesia

A

deficits in coordinating agonist-anatagonist muscle pairs, elicited during rapid alternating movements/rapid reversals

TEST: alternate flipping hands on lap, DF/PF alternating, heel to shin

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19
Q

lack of check

A

inability to halt an unintended movement

-excessive rebound

ex: large rebound on MMT

-could cause LOB or a fall

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20
Q

Common balance deficits in ppl with cerebellar disorders

A

increased postural sway- observed in sitting or standing

-excessive (hypermetric) or diminished (hypometric) postural responses- observe ankle, hip, stepping strategies

-poor postural control during head or limb movement

21
Q

What are the characteristics of gait ataxia that is common among individuals with cerebellar disorders?

A

-uneven step length
-irregular base of support
-absent rhythm
-feet often lifted too high
-can use a variety of gait aids–> dogs are very effective

22
Q

Examples of acquired cerebellar pathologies

A

stroke
MS
arnold chiari malformation
toxicity- heavy metals, TOH
posterior fossa tumors
trauma

23
Q

examples of hereditary cerebellar pathologies

A

Autosomal dominant - spinocerebellar ataxias

Autosomal recessive- Friedreichs ataxia, early onset cerebellar ataxia, X-linked disorders–> some ppl with less severe features of FA can live into their sixties or older
–MOST COMMON form of hereditary ataxia in the US

24
Q

examples of idiopathic cerebellar pathologies

A

Multiple System Atrophy –> similar presentation to Parkinson’s at start

Idiopathic Late Onset Cerebellar Ataxia

25
Q

4 main arteries that supply the cerebellum

A

superior cerebellar - coming off basilar

anterior inferior cerebellar - coming off basilar

posterior inferior cerebellar- coming off vertebral

vertebral artery

26
Q

The anterior spinal artery and the paramedic branches of the vertebral artery supply the ______ nucleus

A

fastigial nucleus

27
Q

The PICA supplies the _________ nucleus

A

dentate nucleus

28
Q

The superior cerebellar artery supplies the __________ nucleus

A

emboliform nucleus

globose nucleus

  • spinocerebellum
29
Q

Main cause of spinocerebellar ataxias + progression

A

increase in CAG triplets produces a protein that leads to neuronal death and CB degeneration

ONSET: -typically midlife

PROGRESSION: slowly progressive

30
Q

Friedrich ataxia symptoms and progression

A

-autosomal recessive
-both male and female children can inherit
-can live into sixties or older with less severe presentation

-ONSET: 5-15 years of age
–15% begin after age 25
(EARLY ONSET disease)

10-20 years after onset of symptoms –> confined to a wheelchair

can become completely incapacitated at later stages of the disease

life expectancy often shortened (due to heart disease)

31
Q

What has a better prognosis, limb or trunk ataxia?

A

trunk ataxia

32
Q

What has a better prognosis, ischemic or hemorrhagic stroke?

A

ischemic

33
Q

What has the worst prognosis if damaged due to MS: PICA, AICA, or SCA?

A

SCA has the worst prognosis

PICA AND AICA have better prognoses

34
Q

When the CB nuclei are involved–> this leads to a _____ prognosis.

A

Worse

35
Q

People with ataxia also can commonly have these symptoms:

A

lack of coordination
slurred speech
trouble eating and swallowing
eye movement abnormalities
deterioration of finer motor skills
difficulty walking
gait abnormalities
tremors
heart problems

36
Q

Scanning speech/ataxic dysarthria DEF

A

spoken words broken up into separate syllables, noticeable pause, spoken with varying force

-breath control impaired

37
Q

What often happens to motor learning in ppl with cerebellar disorders?

A

It often becomes impaired–> particularly procedural learning and errors requiring sensory prediction

-use declarative learning strategies with verbal cues
-use trial and error

38
Q

What kind of training should be considered when taking into account motor learning?

A

increased intensity, longer duration

ex: 1 hx 3 d/wk x 4 weeks

39
Q

wrist weighting or weighted cutlery may be helpful for ___

A

controlling movement, incoordination, speed, timing

40
Q

Recommendation of training duration for coordination training and compensation?

A

3 h/w for 4 weeks plus 1 h/d of HEP

-retention dependent on continuous training

COMPENSATIONS:
-add slower movement
-break down multi joint to single joint

-rehearse eye movement for goal directed stepping
-train fall strategies and fall prevention

41
Q

Children with SCA will benefit from:

A

intensive and continuous PT

-benefits may equal one or more years of natural disease progression

42
Q

Frenkel’s three main tenants to coordination training and compensation for ppl with cerebellar disorders:

A
  1. reduce the complexity of movements
  2. perform slowly, with client watching the moving limb carefully
  3. progress from moving limb with support, to moving without support at one joint of a limb, to moving the limb as a whole
43
Q

What can treadmill training improve in those with CB stroke?

A

intra-limb coordination

increase difficulty by adding decline and obstacles

44
Q

What type of training may be beneficial for individuals with spinocerebellar ataxia?

A

high intensity motor training

preparatory phase- to learn the pt’s perception of their body, spatial awareness, simple motor movements

operational phase- pt progressively learns complex tasks through repetition and improves anticipatory capabilities

45
Q

Example exercises for postural control:

A

-moving platforms for reactive balance

-getting up from chair or floor
-holding and throwing objects

-trunk/prox strength on physioball
-wall squats, single wall squats, lunges, weighted ball pass
-CLOSED CHAIN EXERCISES

46
Q

DANISH mnemonic

A

D- dysmetria or dysdiadochokinesia
A- ataxia
N- nystagmus
I-intention tremor
S-speech
H-hypotonia

47
Q

SARA outcome measure

A

scale for the assessment and rating of ataxia

40 total points possible

48
Q

What are the 4 main categories of the International Cooperative Ataxia Rating Scale

A

Posture and Gait disturbance

Kinetic functions

oculomotor disorders

speech disorders

49
Q

4 categories of the Brief Ataxia Rating Scale (BARS)

A

gait

knee-tibia test

finger to nose test

dysarthria

30- max score with severe abnormalities

NM II (13 decks)

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