Cerebellar Impairment Flashcards
Function of the Cerebellum
receives input from spinocerebellar tracts and compares ongoing movement with intended movement
then modulates information in descending tracts
MOTOR - ipsilateral influence - lesions don't cause paresis SENSORY - information about proprioception and muscle length and tension and ongoing movement via spinocerebellar tracts
Function of Peduncles
Inferior cerebellar peduncle - afferent fibres from medulla and efferent fibres to vestibular nuclei
Middle Cerebellar peduncle - afferent fibres from pontine nuclei
Superior cerebellar peduncle - efferent fibres to cerebellar nuclei and afferent fibres from spinocerebellar tract
Types of afferents and their specific information
Corticopontocerebellar afferents - info concerning volitional movement
Cerebro-olivocerebellar afferents - info about learned movement patterns
Cerebroreticulocerebellar afferents - infor about initiation of movement
Anterior Lobe
paleocerebellum and spinocerebellum
- anterior to primary fissure
- proprioception
- muscle tone
Posterior Lobe
neocerebellum and cerebrocerebellum
- back of cerebellar hemisphere
- muscular coordination
Floccunodular Lobe
archicocerebellum and vestibulocerebellum - most posterior part of vermis - equilibrium and posture VSR and VOR postural correction and balance
Cerebellar Functional Anatomy
vermis - median line connecting the two hemispheres
- movement of long axis
- postural functions
- articulation of speech
- vestibular function
area lateral to vermis
- distal limbs (hands and feet)
lateral zone each hemisphere
- planning of sequential movements of the entire body
- preparation for movement
floccunodular lobe
- vestibular function
- balance
- eye movement
- perception of head movement in relation to gravity
Causes of Cerebellar Dysfunction
stroke of cerebellum or brainstem (lateral medullary syndrome)
traumatic brain injury
multiple sclerosis
Friedrich’s Ataxia
Friedrich’s Ataxia
initially lose sensory neurons in dorsal root ganglion
secondary degeneration of spinocerebellar tracts, corticospinal tracts and dorsal columns
Features
- progressive gait and limb ataxia
- dysarthria
- loss of vibration and proprioception sense
- abnormal eye movements
- pyramidal signs - Babinski reflex, hyperreflexia, DDK, spasticity and weakness
Signs and Symptoms Cerebellar Impairment
Dysdiakokinesia Ataxia Nystagmus Intention tremor Speech issues - dysarthria Hypotonia
Adaptive motor behaviours
wide base of support use patterns of fixation reduced range of movement actively avoids multi joint movement slow movement avoids situations where balance is required
Physio Treatment
less potential for neuroplasticity - more compensatory approach
- train optimal patterns of movement
- prevent reliance on adpative strategies
- train control during functional movement
- use targets to train accuracy
- use timed tasks to improve timing
Physio Assessment
Rebound phenomenon test - assesses tone and DDK
Finger nose and Heel shin test - assesses intention tremor and dysmetria
DDK Test - rapidly alternate between supination and pronation, perform rapid PF and DF
Pendular Reflex/Patellar tendon reflex
Considerations for exercise
Want weight bearing activities to improve limb control
Want closed chain activities
May use small cuff weight on distal limbs
Use targets for functional movement
Rhythmic Stabilisation
Facilitate movement via guided resistance
