exam 3: cerebellar dysfunction & ataxia

Question 1

international cooperative ataxia rating scale (ICARS):
- quantifies:
- time to administer vs SARA
- 4 subscales?
- 0 = ; 100 =

Answer 1

• severity of cerebellar ataxia
• longer
• posture and gait disturbance, limb movements, speech, oculomotor function
• 0 = no ataxia
  100 = severe ataxia

Question 2

Scale for assessment and rating of ataxia (SARA):
- quantifies:
- pro of SARA vs ICARS?
- 8 subscales?
- 0 = ; 40 =

Answer 2

• severity of cerebellar ataxia
• less items to test –> faster
• gait, stance, sitting, speech disturbances, finger movement, and limb coordination functions
• 0 = no ataxia
  40 = severe ataxia

Question 3

what 3 things does the assessment of stance in the SARA look at?

Answer 3

1. stand in natural position
2. feet together in parallel
3. in tandem

Question 4

what are some notable balance deficits with postural ataxia?

Answer 4

• standing without coordination
• quiet posture (increase sway in static standing or postural tremor)
• hypermetric sway in standing balance

Question 5

how do you test for balance deficits in postural ataxia?
can vision help balance in these patients?

Answer 5

• perturbations
• no –> similarly with EO and EC

Question 6

what outcome measure can you use to test functional mobility in someone with postural ataxia?

Answer 6

5x sit to stand

Question 7

what is an outcome measure used for postural stability in postural ataxia patients?

Answer 7

Berg balance scale
- 45-56 = independent
- < 45 = fall risk

Question 8

patients with gait ataxia will present like:

Answer 8

inconsistent step timing, length, direction of steps
variable performance –> support time and weight shifting
frequent LOB
gait decomposition = slow and inefficient

Question 9

what are two PT considerations for someone with gait ataxia?

Answer 9

unpredictable
relearning gait activities is going to take longer

Question 10

what are 2 outcome measures to assess gait in gait ataxia patients?

Answer 10

• observational gait assessment (OGA)
• timed up and go (TUG)

Question 11

why would you choose to do the 6 minute walk test with your gait ataxia patient?

Answer 11

to assess their fatigue and endurance

Question 12

typical findings specific to cerebellar assessment:
- coordination testing:

Answer 12

ataxia when tested at full speed, full range, with supported trunk
need to have strength and cognition to assess accurately

Question 13

typical findings specific to cerebellar assessment:
- rebound testing:

Answer 13

inability to stop rapid movement of a body part after isometric resistance is suddenly removed

Question 14

typical findings specific to cerebellar assessment:
- oculomotor testing:

Answer 14

saccades with smooth pursuits and gaze-evoked nystagmus

Question 15

typical findings specific to cerebellar assessment:
- balance/postural stability:

Answer 15

reactive vs anticipatory - feedback and feedforward mechanisms are affected most
increased time to perform functional tasks

Question 16

typical findings specific to cerebellar assessment:
- fatigue/endurance:

Answer 16

fatigue is common
coordination, balance, gait should all deteriorate

Question 17

prognosis for cerebellar dysfunction depends on:

Answer 17

etiology, extent, damage to other regions, comorbidities, and age

Question 18

does static or progressive ataxia have a better prognosis?

Answer 18

static and specific to areas being affected

Question 19

what are some examples of unfavorable prognosis for someone with ataxia?

Answer 19

progressive forms
severity
central cerebellar with PNS involvement (sensory or vestibular loss)
depression/motivation
limited family support

Question 20

in someone with progressive ataxia what kind of interventions are you going to focus on?

Answer 20

compensatory interventions –> highest level of function by using remaining abilities
energy conservation

Question 21

using _______ interventions along with compensatory interventions maximizes patients function with their condition is expected to worsen over time

Answer 21

restorative

Question 22

this is an example of what type of intervention?
- patient with hemiplegia learns to dress using the less-affected UE

Answer 22

substitutive compensation

Question 23

true or false. there are only evidence based practice interventions for use with ataxia patients

Answer 23

false - no EBP interventions, limited research

Question 24

what are some intervention considerations to improve static/dynamic postural stability in ataxia patients?

Answer 24

put to LOS
practice and error-based learning
task-specific perturbations
balance in standing and during gait rather than LE coordination and movement

Question 25

how do we learn a new task?
- develop a ____
- ___ and ____ leads to plasticity
- if prognosis is expected improvement, then ____

Answer 25

• general internal model for a task
• practice and errors
• focus interventions here

Question 26

what is often considered the most important structure in development of error-based learning?

Answer 26

cerebellum

Question 27

you should treat gait ataxia by working on ______ with gait not _____ of stepping

Answer 27

balance
coordination

Question 28

what are some compensatory strategies to improve gait in someone with ataxia?

Answer 28

external cueing or use of vision
slow down
reduce dual task and environmental distractions
with or without AD

Question 29

to limit secondary fatigue deficits in someone with ataxia, what should you do?

Answer 29

focus on improving aerobic endurance
–> treadmill training may not be the answer

Question 30

what are some other ways to prevent deconditioning and other impairments of someone with ataxia?

Answer 30

stretching and strengthening
oculomotor exercises
consider patient-focused interventions

Question 31

what are Frenkel’s exercises?

Answer 31

set of exercises consisting of slow, repeated movements which increase in difficulty over the time of the program
patient uses visual cues by watching their hand or arm movements and corrects them as needed

Question 32

what is the goal of Frenkel’s exercises?

Answer 32

eventually remove vision and perform automatically
the brain learns to compensate for motor deficits in the cerebellum

Question 33

what are some ways we assess outcomes?

Answer 33

consistency, efficiency, flexibility