exam 3: cerebellar dysfunction & ataxia Flashcards
international cooperative ataxia rating scale (ICARS):
- quantifies:
- time to administer vs SARA
- 4 subscales?
- 0 = ; 100 =
- severity of cerebellar ataxia
- longer
- posture and gait disturbance, limb movements, speech, oculomotor function
- 0 = no ataxia
100 = severe ataxia
Scale for assessment and rating of ataxia (SARA):
- quantifies:
- pro of SARA vs ICARS?
- 8 subscales?
- 0 = ; 40 =
- 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
what 3 things does the assessment of stance in the SARA look at?
- stand in natural position
- feet together in parallel
- in tandem
what are some notable balance deficits with postural ataxia?
- standing without coordination
- quiet posture (increase sway in static standing or postural tremor)
- hypermetric sway in standing balance
how do you test for balance deficits in postural ataxia?
can vision help balance in these patients?
- perturbations
- no –> similarly with EO and EC
what outcome measure can you use to test functional mobility in someone with postural ataxia?
5x sit to stand
what is an outcome measure used for postural stability in postural ataxia patients?
Berg balance scale
- 45-56 = independent
- < 45 = fall risk
patients with gait ataxia will present like:
inconsistent step timing, length, direction of steps
variable performance –> support time and weight shifting
frequent LOB
gait decomposition = slow and inefficient
what are two PT considerations for someone with gait ataxia?
unpredictable
relearning gait activities is going to take longer
what are 2 outcome measures to assess gait in gait ataxia patients?
- observational gait assessment (OGA)
- timed up and go (TUG)
why would you choose to do the 6 minute walk test with your gait ataxia patient?
to assess their fatigue and endurance
typical findings specific to cerebellar assessment:
- coordination testing:
ataxia when tested at full speed, full range, with supported trunk
need to have strength and cognition to assess accurately
typical findings specific to cerebellar assessment:
- rebound testing:
inability to stop rapid movement of a body part after isometric resistance is suddenly removed
typical findings specific to cerebellar assessment:
- oculomotor testing:
saccades with smooth pursuits and gaze-evoked nystagmus
typical findings specific to cerebellar assessment:
- balance/postural stability:
reactive vs anticipatory - feedback and feedforward mechanisms are affected most
increased time to perform functional tasks
typical findings specific to cerebellar assessment:
- fatigue/endurance:
fatigue is common
coordination, balance, gait should all deteriorate
prognosis for cerebellar dysfunction depends on:
etiology, extent, damage to other regions, comorbidities, and age
does static or progressive ataxia have a better prognosis?
static and specific to areas being affected
what are some examples of unfavorable prognosis for someone with ataxia?
progressive forms
severity
central cerebellar with PNS involvement (sensory or vestibular loss)
depression/motivation
limited family support
in someone with progressive ataxia what kind of interventions are you going to focus on?
compensatory interventions –> highest level of function by using remaining abilities
energy conservation
using _______ interventions along with compensatory interventions maximizes patients function with their condition is expected to worsen over time
restorative
this is an example of what type of intervention?
- patient with hemiplegia learns to dress using the less-affected UE
substitutive compensation
true or false. there are only evidence based practice interventions for use with ataxia patients
false - no EBP interventions, limited research
what are some intervention considerations to improve static/dynamic postural stability in ataxia patients?
put to LOS
practice and error-based learning
task-specific perturbations
balance in standing and during gait rather than LE coordination and movement
how do we learn a new task?
- develop a ____
- ___ and ____ leads to plasticity
- if prognosis is expected improvement, then ____
- general internal model for a task
- practice and errors
- focus interventions here
what is often considered the most important structure in development of error-based learning?
cerebellum
you should treat gait ataxia by working on ______ with gait not _____ of stepping
balance
coordination
what are some compensatory strategies to improve gait in someone with ataxia?
external cueing or use of vision
slow down
reduce dual task and environmental distractions
with or without AD
to limit secondary fatigue deficits in someone with ataxia, what should you do?
focus on improving aerobic endurance
–> treadmill training may not be the answer
what are some other ways to prevent deconditioning and other impairments of someone with ataxia?
stretching and strengthening
oculomotor exercises
consider patient-focused interventions
what are Frenkel’s exercises?
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
what is the goal of Frenkel’s exercises?
eventually remove vision and perform automatically
the brain learns to compensate for motor deficits in the cerebellum
what are some ways we assess outcomes?
consistency, efficiency, flexibility
