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Neurology > Cerebellum > Flashcards

Cerebellum Flashcards

1
Q

3 (flexible) hierarchical levels and their contribution to motor control

A

•Highest level: basal ganglia and neocortex
•Middle level: motor cortex and cerebellum
• Lowest level: brainstem and SC
* each level can influence another depending on task demands

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2
Q

3 (flexible) hierarchical levels and their contribution to motor control: highest level

A

• associative areas of neocortex and basal ganglia- concerned with strategy: the movement strategy that best achieves the goal

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3
Q

3 (flexible) hierarchical levels and their contribution to motor control: middle level

A
  • motor cortex and cerebellum
  • concerned with tactics: sequences of muscle contractions, arranged in space and time, required to smoothly and accurately achieve the goal
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4
Q

3 (flexible) hierarchical levels and their contribution to motor control: lowest level

A
  • Brainstem and spinal cord
  • concerned with execution- activation of the motor neuron and interneuron pools that generate goal directed movement and make necessary adjustments in posture
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5
Q

Motor control

A
  • the ability of the CNS to control or direct the neuromotor system in purposeful movement and postural adjustment by selective allocation of muscle tension across appropriate joint segments
  • components include: normal muscular tone, postural response mechanisms, selective movement, and coordination
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6
Q

Coordination

A
  • the ability to execute, smooth, accurate, controlled motor responses
  • dependent upon somatosensory, visual and vestibular input as well as a fully intact neuromuscular system from the motor cortex to the SC
  • coordinated movements are characterized by: appropriate speed, distance, direction, timing, and muscular tension. Additionally, they involve appropriate synergistic influences (muscle recruitment), easy reversal between opposing muscle groups (appropriate sequencing, contraction and relaxation), and proximal fixation to allow distal motion or maintenance of a posture.
  • terms associated with coordination include: dexterity- the skillful use of fingers during fine motor tasks and Agility: the ability to rapidly and smoothly initiate, stop, or modify movement while maintaining postural control and balance.
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7
Q

Cerebellum function

A

regulates movement, postural control, and muscle tone

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8
Q

input to cerebellum to produce and maintain balance

A
  • the motor cortex and brainstem provide the commands for the intended motor response which is compared to sensory input from;
  • Visual: eyes
  • Vestibular: ears, vestibular apparatus, semicircular canals, otoliths
  • Proprioceptors: mechanoreceptors- muscle spindles, GTO’s joint and cutaneous receptors
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9
Q

Cerebellum as comparator and error correcting mechanism

A
  • the cerebellum compares the commands for the intended movement transmitted from the motor cortex with the actual performance of the body segment
  • this occurs by a comparison of the info received from the cortex with that obtained from the peripheral feedback system- feedforward control
  • this feedback provides continual input regarding posture, balance, position, rate, rhythm, and force of slow movements
  • if the input from the feedback systems does not compare correctly with the intended command, the cerebellum supplies a corrective influence through corrective signals to the cortex to modify the ongoing movement
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10
Q

feedback

A

control uses sensory info received during the movement to monitor and adjust output. It is part of a close looped system employing feedback for comparison, computation of error and correction.

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11
Q

feedforward

A

control is a proactive strategy that uses sensory info obtained from experience. Signals are sent in advance of movement allowing for anticipatory adjustments in postural control of movement. It is an open loop system using a motor program which is a memory or pre programmed pattern. Gait and equilibrium responses tend to be feedforward until environment requires changes.

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12
Q

ataxia

A

Loss of muscle coordination which may affect gait, posture and patterns of movement

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13
Q

gait ataxia

A

: ambulatory patterns that typically demonstrate a broad base of support. Upright stability is poor arms may be held in high guard appearance, stepping pattern is irregular in direction and distance.

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14
Q

ataxic dysarthria/scanning speech

A

Disorder of the motor component of speech articulation. The speech pattern is typically slow, may be slurred and hesitant, with prolonged syllables and inappropriate pauses
*also seen with MS

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15
Q

Dysdiadochokinesia

A

Impaired ability to perform rapid alternating movements, such as supination, pronation.
Movements are irregular with a rapid loss of range and rhythm especially as the speed is increased

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16
Q

Dysmetria

A
  • Inability to judge the distance or range of movement.
  • There may be an overestimation- hypermetria, or underestimation- hypometria of the range needed to reach an object or goal.
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17
Q

Nystagmus

A

Rhythmic, quick, oscillatory back and forth movement of the eyes.
Typically apparent as the eyes move away from midline to fix on an object in either the medial or lateral visual field.
Patient has difficulty holding gaze on object in peripheral field.
An involuntary drift back to midline with immediate return to the object may be observed.
Causes difficulty with accurate fixation

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18
Q

rebound phenomenon

A

Loss of check reflex, which functions to halt forceful active movements when resistance is eliminated

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19
Q

Intention (kinetic tremor)

A
  • Involuntary oscillatory movement occurring during voluntary motion of a limb which increases as the limb nears its intended goal or speed is increased.
  • They are diminished or absent at rest
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20
Q

Postural/ Static Tremor

A

Back and forth oscillatory movement of the body when maintaining a standing posture or an up and down oscillatory movement of a limb when it is held against gravity.
Titubation- rhythmic oscillations of the head (side to side or forward- backward.

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21
Q

asthenia

A

muscle weakness

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22
Q

Dyssynergia/ Movement decomposition

A

movement performed in a sequence of component parts rather than as a single, smooth activity

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23
Q

Hypotonia

A

decreased muscle tone with diminished resistance to passive movement

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24
Q

Nonequilibrium tests

A 
O’Sullivan 7th: 199-200
In 4 steps- include at end if appropriate: 
Step# 5- bilateral symmetrical movement
Step # 6- bilateral asymmetrical movment
Step # 7- increase speed
Step # 8- eyes closed
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25
Q

vertigo

A

a sense that the environment is moving or spinning (the hallmark symptom of vestibular dysfunction)

26
Q

lightheadedness

A

a feeling of faintness (usually caused by non vestibular factors such as hypotension, hypoglycemia, anxiety, OH, or cardiac in origin)

27
Q

Dysequilibrium

A

sensation of being off balance (may be associated with LE weakness, decreased proprioception from neuropathy)

28
Q

Oscillopsia

A

subjective experience of motion of objects in the visual environment that are known to be stationary

29
Q

Peripheral vs Central vestibular pathology symptoms

A

Balance Deficits:
•Peripheral: mild to moderate
•Central: severe, ataxia usually present
Hearing Loss:
•Peripheral: accompanied by fullness of the ears and tinnitus
• Central: rare, if it occurs it’s usually sudden and permanent
Nystagmus:
• Peripheral: unidirectional in all gaze positions/ decreases with visual fixation
• Central: changes direction in different gaze positions/ no change with visual fixation
Nausea:
• Peripheral: can be severe
• Central: variable, may be absent
Additional neurological impairment:
• Peripheral: usually not present
• Central: can include diplopia, altered consciousness, lateralpulsion

30
Q

cataracts

A

cloudy or opaque area in lens of the eye= blurred or distorted vision sensitive to light or glare.

31
Q

Glaucoma

A

damage to optic nerve that causes blind spots in peripheral vision (tunnel vision)

32
Q

Macular degeneration

A

macula is the section in the center of the retina. Blind spots develop in center of vision.

33
Q

disorders affecting somatosensory systems

A
  • DM- peripheral neuropathy
  • Dorsal columns affected: syphilis (tabes dorsalis), MS, Incomplete posterior cord spinal cord injury
  • Injury to joints affecting receptors, loss of ROM etc…
34
Q

sarcopenia

A

age associated loss of skeletal muscle mass as well as changes in the ability of muscle tissue to regenerate.

35
Q

Age-related changes affecting coordination and balance

A

Decreased strength- sarcopenia: age associated loss of skeletal muscle mass as well as changes in the ability of muscle tissue to regenerate.
Slowed reaction time
Decreased range of motion- linked to biological aging of joint surfaces, degenerative changes in collagen fibers, dietary deficiencies, and sedentary lifestyle
Postural changes- forward head, kyphosis, increase in hip and knee flexion, potential loss of preparatory postural adjustments before movement
Impaired balance/postural control- decreased limits of stability and functional reach and increased postural sway.

36
Q

Basal Ganglia

A
  • Initiation and regulation of gross intentional movements
  • planning and execution of complex motor responses
  • facilitation and inhibition of selective movement responses
  • ability to perform automatic movements and postural adjustments
  • maintaining normal background muscle tone by inhibition of motor cortex and brainstem
37
Q

meds that increase risk of falls

A 
increased risk in older individuals who take four or more meds and those taking certain meds:
hypnotics
sedatives
tricyclic antidepressants
tranquilizers
antihypertensives
38
Q

most common risk factors for falls among the elderly

A 
Muscle weakness
History of falls
Gait deficit
Balance deficit
Use of assistive device
Visual deficit
Arthritis
Impaired ADL’s
Cognitive impairment
Age >80 year old
39
Q

motor strategy changes in the elderly

A
  • More frequent use of a hip strategy for balance control
  • Limitations in ability to maintain balance when challenged with perturbations of increasing magnitude and velocity
  • Impaired anticipatory postural adjustments- may explain high incidence of falls when walking, lifting, carrying objects
  • Divided attention when doing two tasks simultaneously can lead to postural instability and falls.
  • Fear of falling rises more from fear of institutionalization than fear of injury-> Individuals with fear of falling demonstrate perceived limits of stability that are reduced from their actual ability producing changes in gait such as decreased stride length, reduced speed, increased stride width and double support time.
40
Q

safety during balance training

A

Use a gait belt any time the patient practices exercises or activities that challenge or destabilize balance
Stand slightly behind and to the side of the patient- one hand at gait belt, other on trunk – near shoulder
Perform exercise near railing or in parallel bars
Do not perform exercises near sharp edges
Have one person in front and one behind with patients at high risk of falling
Check equipment- make sure it is functioning properly
Guard patient when getting on and off equipment ( treadmills, stationary bicycles)
Ensure the floor is clean and free of debris.

41
Q

Dysmetria- difficulty judging distances

Tests: the following tests showcase difficulty but also serve as treatments

A 
• Finger to nose
• Finger to therapists finger
• Toe to examiner finger
• Walking on foot markers
ADLs:
• Stairs
• Grooming
• Dressing
42
Q

Dysdiadochokinesia- difficulty with rapid alternating movement
Tests:

A
  • Tapping foot

* Pronation and supination

43
Q

Postural or static sway

test

A

Body: Rhomberg, just standing (feet together, feet together eyes closed

44
Q

Ataxia gait:

Tests:

A

walking a straight line

45
Q

Systems involved in maintaining balance: vision

A
  • occipital lobe
  • parietal lobe
  • PCA
  • MCA
46
Q

Systems involved in maintaining balance: somatosensory

A
  • parietal MCA or ACA depending on body part
  • ant/lateral spinothalamic
  • spinocerebellar
  • dorsal columns
  • CN
  • thalamus
47
Q

Systems involved in maintaining balance: vestibular

A
  • CN VII
  • Brainstem
  • Cerebellum
48
Q

Ankle strategy

A

slow and small perturbation on a large and stable surface. The contration proceeds distal to proximal
•Anterior perturbation (forward): plantarflexors, knee flexors, hip extensors, trunk extensors. UEs initially extend
•Posterior Perturbation- dorsiflexors, quads, hip flexors, trunk flexors, UEs go forward

49
Q

Hip strategy

A

use with fast and/or large perturbation, and/ or possibly a narrow surface. The contraction will proceed proximal to distal.
•Anterior perturbation: hip extensors, trunk extensors, UEs go back
Step will be anterior
Protective extension will be anterior
•Posterior perturbation: hip flexors, trunk flexors, UEs come forward
Step will be posterior
Protective Extension will be posterior

50
Q

Stepping strategy

A

in ankle strategy fails)- take steps to place COG within BOS. Always in direction of perturbation
Anterior perturbation- anterior step
Posterior pert- post step

51
Q

Protective extension

A

(if stepping strategy fails)- extend in direction of perturbation
Anterior perturbation- forward extension
Post per- post extension

52
Q

Lateral

A

R side tilt or push or perturbation in sitting or standing= head and trunk side bend to the left or shorten, R side elongates or WB, L UEs and LEs abduct and extend
Side step to the R and protective extension to the R

53
Q

Diplopia

A

(cerebellar problem)- double vision- Tx: eye patch, which decreases depth perception

54
Q

Central vs peripheral vestibular cont…

A 
Central (cerebellum):
• ataxia may be severe
• diplopia
• lateralpulsion
• nystagmaus- tends to not improve with visual fixation

Peripheral (inner ear):
• vertigo tends to be worse especially in acute phase
• hearing loss usually insidious and can recover, fullness in ears, and tinnitus
• Nystagmus- improves with visual fixation

55
Q

Conditions helped by vestibular rehab:

A
  • BPPV (benign paroxysmal positional vertigo)

* UVH (unilateral vestibular hypofunction)

56
Q

vestibular treatment

A

Brandt- daroff
Epley- semont liberatory
Canalith repositioning

57
Q

Contraindications to vest rehab:

A
  • Meniere’s (abnormal amount of fluid)
  • PLF (perilymphatic fistula) (a tear in either one of the membranes separating your middle and inner ear. Your middle ear is filled with air. Your inner ear, on the other hand, is filled with fluid called perilymph)
  • CSF fluid d/c
  • Sudden loss of hearing (indicates cerebellar problem)
58
Q

Central vestibular pathology s/s

A
  • ataxia often severe
  • s/s usually do not include hearing loss; if so it is often sudden and permanent
  • s/s may often include diplopia, altered consciousness, lateralpulsion
  • s/s of acute vertigo not usually suppressed by visual fixation
  • pendular nystagmus (eyes oscillate at equal speeds)
  • pure persistent vertical nystagmus persists regardless of positional testing
59
Q

Peripheral vestibular pathology

A
  • ataxia mild
  • positional testing may reproduce nystagmus
  • s/s may include hearing loss (insidious may recover), fullness in ears and tinnitus
  • s/s of acute vertigo usually intense (more than central vestibular pathology)
  • nystagmus will incorporate slow and fast phases (jerk nystagmus)
  • spontaneous horizontal nystagmus usually resolves within 7 days in a pt with UVH
60
Q

Contradictions to vestibular rehab

A

PT not appropriate for unstable vestibular disorders such as Meniere’s disease (except when Meniere’s results in unilateral vestibular hypofunction- chronic), uncontrollable migraine, perilymphatic fistula (PLF- rupture of membranes in the ear), or an unrepaired superior semicircular canal. Other conditions the PT should be alert to include sudden loss of hearing, and increased feeling of pressure or fullness to the point of discomfort in one or both ears, and severe ringing in one or both ears. When treating patients who have had a surgical procedure, the clinician must be observant for discharge of fluid from the ears or nose, which may indicate a CSF leak. Patients with acute neck injuries may not be able to tolerate some therapy.

Neurology (9 decks)

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