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NCS > Cerebellar Dysfunction > Flashcards

Cerebellar Dysfunction Flashcards

1
Q

Vestibulocerebellum, spinocerebellar, cerebrocerebellum

A

V- floculonodular lobe
S - vermis/paravermal hemispheres
C - lateral hemisphere

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2
Q

Superior cerebellar peduncle connection to brainstem

A
  • Attaches to midbrain

- Contains cerebellar efferent fibers

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3
Q

Middle cerebellar peduncle connection to brainstem

A
  • Attaches to the pons

- Contains afferent fibers from cerebral cortex

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4
Q

Inferior cerebellar peduncle connection to brainstem

A
  • Attaches to the medulla
  • Contains afferent fibers from the brain stem and SC
  • ALSO contains efferent fibers from the vestibular and reticular nuclei
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5
Q

Pathways: IPSI or BIL

A

Most are ipsilateral except vestibulocerebellum has bilateral control

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6
Q

Input fibers

A
  • Mossy fibers (information)

- Climbing fibers (timing)

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7
Q

Output fibers

A
  • Purkinje cells
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8
Q

Vestibulocerebellum function and inputs

A
  • Function: Regulates equilibrium

- Inputs: Vestibular nuclei and superior colliculus (eye and head position/movement)

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9
Q

Vestibulocerebellum outputs and deep cerebellar nucleus

A
  • Outputs: Med vestibular nuclei ( VOR) +
    lat vestibular nuclei, reticulospinal system, PMC (postural reactions)
  • DCN: Fastigial
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10
Q

Spinocerebellum function and inputs

A
  • Function: Regulates gross limb movement

- Inputs: Spinocerebellar tracts

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11
Q

Spinocerebellum outputs and deep cerebellar nucleus

A
  • Outputs: Vestibulospinal + reticulopinal tracts, motor cortex + red nucleus
  • DCN: Emboliform, globose
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12
Q

Cerebrocerebellum function and inputs

A
  • Function: Regulates distal limb voluntary movements, motor planning, and timing
  • Inputs: Cerebral cortex via pontine nuclei
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13
Q

Cerebrocerebellum outputs and deep cerebellar nucleus

A
  • Outputs: Motor + premotor cortices via thalamus, red nucleus to activate rubrospinal tract
  • DCN: Dentate
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14
Q

Wernicke-Korsakoff syndrome

A

Vitamin B/thiamine deficiency due to alcohol abuse

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15
Q

Pharmacological agents that can cause ataxia

A
  • Anti-convulsants
  • Anti-neoplastics
  • Lithium (BIPOLAR)
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16
Q

Drugs that can cause ataxia

A

Cocaine + heroine

17
Q

Infections that can cause ataxia

A

Chickenpox is most common

18
Q

Endocrine issues that can cause ataxia

A
  • Hypothroidism (reversible with thyroid replacement therapy)
  • Hashimoto’s (no responsive to thyroid replacement therapy)
19
Q

Nutrition issues that can cause ataxia

A

GLUTEN

20
Q

Spinocerebellar ataxia

A
  • Degenerative condition that is based on autosomal dominant or recessive genes
21
Q

Friederich’s ataxia

A
  • Age of onset 8-15 years
  • Presents as clumsiness with gait
  • Common to have scoliosis and gait deformities
  • Eventually dies of heart failure
22
Q

Dandy-Walker syndrome

A
  • Congenital malformation characterized by enlarged 4th ventral and complete/partial absence of vermis
  • Intellectual problems common due to hydrocephalus
23
Q

Dyssynergia

A

Impairments in ability to coordinate multi-joint movements

24
Q

Motor control and learning impairments

A
  • Cerebellum plays an important role in motor memory formation of coordination tasks
  • Important for shifting movement performance to more automatic state
  • Cerebellar dysfunction can hinder learning and cause slower rate of learning
  • Disrupts feedforward but doesn’t effect feedback
25
Q

Error-based vs reinforcement learning

A
  • Reinforcement learning provides greater retention
  • Reinforcement learning is intact in individuals with cerebellar damage but greater variability with performance (poor retention with error-based learning)
26
Q

Compensatory approaches to ataxia

A
  • Simple, single joint movements
  • Visual/verbal cues to improve gait
  • Assistive devices for posture/balance/mobility
  • Compression garments
  • Cooling a limb may have temp benefit
27
Q

Recovery approaches to ataxia

A
  • Biofeedback via EMG activity of mm activation/postural sway with computer game
  • Strengthening/balance/ocular exercises to improve postural stability
  • Locomotor training
28
Q

PT + rTMS and ataxia

A
  • Amplitude of lateral head and body sway reduced = improved dynamic balance in earlier stages of disease
  • No effect on gait speed
29
Q

Scale for the Assessment and Rating of Ataxia (SARA)

A
  • Provides quantitative assessment of impairments related to cerebellar ataxia
  • Also used in ataxic stroke
  • Evaluates gait, stance, sitting, speech, and various limb coordination tasks
30
Q

SARA cut-off scores

A
  • Gait: <8 = independent; <11.5 = quad cane; <12.25 = walker
  • ADL dependence: <5.5 = independent; <10 = Min A; <14.25= Mod A; >23 = Max A
31
Q

International Cooperative Ataxia Rating Scale (ICARS)

A
  • Evaluates impairment as a result of hereditary ataxia with regard to postural/gait disturbance, limb ataxia, dysarthria, oculomotor disorders
  • Higher the score = greater impairment (0-100)
  • No cut-off scores
32
Q

Friedereich’s Ataxia Rating Scale (FARS)

A
  • Assess ataxia and impairment based on diagnosis by same name
  • 3 subscales: ataxia, ADLs, neuro eam
  • Higher the score = greater impairment (0-159)
  • No cut-off scores
33
Q

Push and Release Test

A
  • Assesses postural instability by ability to regain balance
  • Lean posteriorly into examiner’s hands and hands are removed, number of steps is score
  • No cut-off scores
34
Q

Push and Release Test scoring

A

0 - Recovers ind with 1 step
1 - 2 to 3 steps required but able to recovers ind
2 - 4 or more steps required but recovers ind
3 - Able to step but requires assist to prevent fall
4 - Falls without attempting to step/unable to stand without assistance

35
Q

Retropulsive Pull Test

A
  • Assesses nonvestibular-related balance impairment (PD)

- Examiner stands behind subject and pulls subject’s shoulders backwards

36
Q

Retropulsive Pull Test scoring

A

0 - recovers independent with 1-2 steps or ankle reaction
1 - Recovers independent with 3+ steps
2 - Requires assistance to prevent fall
3 - Very unstable; loses balance spontaneously
4- Unable to stand without assist

NCS (19 decks)

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