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Neuro E&I 2 > Cerebellar Dysfunction > Flashcards

Cerebellar Dysfunction Flashcards

1
Q

To which side of the body does the cerebellum sends information? (Ipsi or contralateral)

A

ipsilateral

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2
Q

What are the functional division of the Cerebellum?

A
  1. Vestibulocerebellum
  2. Spinocerebellum
  3. Cerebrocerebellum
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3
Q

Which lobe contains the vestibulocerebellum?

A

flocculonodular lobe

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4
Q

Vestibulocerebellum input from and output to?

A

Input

vestibular nuclei

CN8

output

Vestibular nuclei

lateral vestibular spinal tract

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5
Q

Function of the vestibulocerebellum

A

Integrates vestibular information and dictates motor control of neck and eye muscle

Allow to keep eye stable while head moves (gaze stabilization) & keep head over BOS

Control Gait and postural control

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6
Q

Injuries to the vestibulocerebellum can lead to….

A

ataxic gait (path deviation TOWARD the side of the lesion)

inability to stabilize gait

deficit in postural control

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7
Q

Which zone contains the spinocerebellum?

A

vermis

intermediate

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8
Q

input and output of the spinocerebellum

A

Input

spinal cord: Dorsal spinocerebellar tract & Vestibulocerebellar tract

Output

Vestibular nuclei

red nucleus

reticular formation

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9
Q

Function of the Dorsal spinocerebellar tract (DSCT)

A

sensory info from organ GTO, sensory, proprioception

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10
Q

Function of the ventral spinocerebellar tract (VSCT)

A

sensory from LE & Postural control

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11
Q

Function of the spinocerebellum

A

Integrates information from all decending motor tracts (VSCT)

real time information to be more successful with an intent action

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12
Q

location of the cerebrocerebellum

A

cerebellar hemispheres

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13
Q

input/output of the cerebrocerebellum

A

input:

deep pontine nuclei

output

thalamus

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14
Q

Function of the cerebrocerebellum

A

indirect information from all 4 cortical lobes

  • Areas 6,4,3,1,2,5
  • Primary visual cortext (17)
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15
Q

Lesions of the Cerebellum will lead to what types of deficits?

A

Impaired ability to perform controlled, precise, coordinated movements

must be large enough for symptoms to appear

hypotonia of MSRs (pendular reflex)

NO PARALYSIS and WEAKNESS (usually)

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16
Q

Function of Cerebellum in Movement

A

A regulator

feedback and feed-forward conrol ssytem

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17
Q

Cerebellum input/output

A

input:

information about body position and muscle action

output:

to descending motor systems at the brainstem level

18
Q

Role of spinocerebellum in movement

A

output occurs while motion is occuring

the state of the motion, drives the next command fromt he cerebellum

19
Q

Role of Cerebrocerebellum in movement

A

feed-forward

receives infromation from PMA, SMA< and primary motor and sensory areas

modify the action before it takes place

Theory: manages the model of control system

20
Q

Hallmark signs of Cerebellar Dysfunction

A
  1. Ataxia (limb movement, trunkal, gait)
  2. Nystagmus
  3. Dysmetria
  4. dysdiadochokinesia
  5. Decomposition of movement ipsilateral to leasion
21
Q

Clinical Presentation of Vestibulocerebellar injury

A

Mimics disease in vestibular nuclei or PVS

Ataxic gait (fall toward side of lesion, inadequate postural correction)

Nystagmus

Vertigo/dizziness

22
Q

What is nystagmus

A

oscillating eye movement in which eyes move slow in one direction and rapidly in the other direction

23
Q

Features of Gait Ataxia

A

High stepping

stagger to the side of lesion

irregular foot placement

irregular timing

patient use decomposition of complex movements to control incoordination which results in robotic look

24
Q

Clinical Presentation of Spinocerebellar and Cerebrocerebellar injury

A

impairment in precision of movement

Dysdiadochokinesia

Dysmetria

decomposition of movement

pendular muscle stretch reflex

hypotonia (limb feel heavy)

25
Q

Dysdiadochokinesia

A

disruption in timing of muscle

difficulty with Rapid alternating movement (RAM)

26
Q

Dysmetria

A

Performance deterioration as motor act progresses

27
Q

What test can be used to test for dysmetria?

A

finger to nose test

28
Q

Dysmetria vs. Tremor

A

Dysmetria: form of incoordination secondary to cerebellar dysfunction. Performance deteriorates as target is approached (cerebellar injury)

Tremor:

rhythmic movement at constant frequency and amplitude. Result of continuous oscillatory beavior in central motor areas (e.g. Parkinson)

29
Q

What is decomposition of movements?

A

poor timing of motor acts

normal synergistic movement of complex motor tasks is broken down and initiated separately

difficulty with sequencing repetitive task

ataxia

30
Q

Role of Cerebellar in motor learning

A

modification of function in relation to experience

e.g. riding a bike

transfer of motor tactics from conscious to unconscious

Adaptive feedforward control system

Internal stored model controls learned movement

31
Q

with cerebellar lesions, movement must use ______ and thus producing uncoordinated movements

A

slow sensory feedback loops

32
Q

Theory of motor learning & cerebellum

A

Theory I:

CB learns small simple programs, facilitates triggering of small programs, in order, for complex motor tasks, recognizes and detects event sequences

Theory II:

CB role in adaptation, anticipatory ms activity across several joints, modification activity

Theory III:

CB influence not purely motor, role in mental imagery/practice, role in rapid shifts of attention

33
Q

Examination of Cerebellum should include

A
  1. RAM
  2. gait
  3. dysmetria
  4. decomposition
  5. VOR
  6. change of symptoms with position changes
34
Q

Consideration when tx patient with CB injury

A
  1. Postural control
  2. Motor Learning (need more attention)
  3. Attention (problem with switching task)
  4. Motor control (less automatic)
  5. Functional tasks

Get tired very easily: block practice

decrease distraction/obstacles

1 feedback at at time

concurrent tactile feedback, auditory feedback att he end

35
Q

Ways to work on Dysmetria

A

Temporary reduction techniques

  • as primer for functional tasks
  • PNF
  • full body movements
  • T-band
  • Frenkel exercises (Progressive exercises for ataxia and coordiantion
  • Wt to dampen ataxia (use proximal not distal)
36
Q

Intervention for ataxic gait

A

Encourage stiffening of joints (ankle)

practice setup part to whole

frequent feedback

use of device (walker tends to get far away, encourage small steps)

37
Q

There is an increase firing of what structure during acquisition of complex motor task?

A

Cerebellum

38
Q

Effect of Visual-vestibular dysfunction

A

Diplopia

impact on function (decrease attention on sx)

Use of visual exercises (smooth pursuit, saccades, VOR)

habituation exercises (full body position changes to get used and not get dizzy)

39
Q

+ Prognosis of CB injury recovery

A

spared cerebral cortex

unilateral injury

degenerative disease vs acute injury

40
Q
  • prognosis of CB injury
A

bilateral injury

damage to deep CB nuclei

damage to others aspects of brain

concomitant abuse of alcohol

Neuro E&I 2 (8 decks)

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