Exam 3 ppt 1 Cerebellar Disorders

Question 1

What are the three main parts of the cerebellum callded by their functional names?

Answer 1

vestibulocerebellum
spinocerebellum
pontocerebellum or cerebrocerebellum

Question 2

What are the three main parts of the cerebellum called by their phylogenic names (matched with thier functional names in parentheses)?

Answer 2

archicerebellum (vestibulocerebellum)

paleocerebelum (spinocerebellum)

neocerebellum (pontocerebellum)

Question 3

Vestibulocerebellum (Archicerebellum) is composed of which anatomical parts?

Answer 3

Flocculonodular lobe (flocculus and nodule)

Picture: cerebrocerebellum is the same as pontocerebellum

Question 4

Spinocerebellum (Paleocerebellum) is composed of which anatomical parts?

Answer 4

Vermis and intermediate parts of the hemispheres (“paravermis”)

Picture: the cerebrocerebellum is another name for pontocerebellum

Question 5

Pontocerebellum (neocerebellum) is composed of which anatomical parts?

Answer 5

Lateral parts of the hemispheres

Picture: Cerebrocerebellum is the same as pontocerebellum

Question 6

what is the defining functions of the vestibulocerebellum?

Answer 6

•Maintaining equilibrium and coordinating eye, head, neck movement.

Question 7

what is an example of a pathology that involves the vestibulocerebellum?

Answer 7

Torticolis (specifically spasmotic torticolis which is a form of dystonia - cervical dystonia)

Question 8

what are the defining functions of the spinocerebellum?

Answer 8

•Coordinated truck and LE movements

Question 9

what are the defining functions of the pontocerebellum?

Answer 9

quick finely controlled limb movement (mainly UE coordination)

Question 10

what is an example of a pathology that involves the spinocerebellum?

Answer 10

Friedreich’s ataxia

Question 11

what is an example of a pathology that involves the pontocerebellum?

Answer 11

Chorea

(as in Huntington’s Dance or Huntington’s Chorea)

Question 12

what is friedreich’s ataxia?

Answer 12

Friedreich’s ataxia is an autosomal recessive inherited disease that causes progressive damage to the nervous system. It manifests in initial symptoms of poor coordination such as gait disturbance; it can also lead toscoliosis, heart disease and diabetes, but does not affect cognitive function. The disease progresses until a wheelchair is required for mobility. Its incidence in the general population is roughly 1 in 50,000

from wikipedia

Question 13

does damage to the three regions of the cerebellum occur in isolation?

Answer 13

doesn’t have to

can have injuries that inovle one, two, or three of the areas

Question 14

Is the cerebellum isolated?

Answer 14

No It has conneections the basal ganglia, etc.

Question 15

Ataxia definition

Answer 15

shappy: reeling wide-based movements related to gate

(I dissagree that it is mainly just gait. Ataxic gait is mainly gait, but ataxia seems to just mean uncoordinated movments from my experience outside of shappy’s class. Wikipedia does seem to make special effort to point out the gait aspect though)

Wikipedia:

Ataxia (from Greek α- [a negative prefix] + -τάξις [order] = “lack of order”) is a neurological sign consisting of lack of voluntarycoordination of muscle movements that includes gait abnormality. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum. Several possible causes exist for these patterns of neurological dysfunction. Dystaxia is a mild degree of ataxia. Friedrich’s ataxia has gait abnormality as the most common presenting symptom.[1]

Question 16

what is “decomposition of movement”?

Answer 16

-inability to correctly sequence fine coordinated movements/acts

Question 17

define dysarthria:

Answer 17

–Inability to articulate words (motor function). “speech problems” per Dr. Shappy

Question 18

•Dysdiadochokinesia:

Answer 18

–Inability to produce rapid alternating movement (Examples: flipping hands, moving leg up and down shin)

Question 19

Definition of Dysmetria:

Answer 19

–Inability to control ROM (hard to pick up specific objects)

Question 20

define hypotonia

Answer 20

flaccidity

Question 21

define Nystagmus

Answer 21

• –Rapid alternating eye movement (back and forth of the eyes; rapid alt of the eye movements)
• –Involuntary
• –Some people live in this state

Question 22

define Scanning Speech:

Answer 22

• –Slow enunciation and a tendency for hesitation
  
  • •It’s there, but it is slow and interrupted (almost a stutter)
  • •Typically more at beginning of word or sylable

(slow speech, interrupted, hesitated)

Question 23

define tremor (brief definition of it generally)

Answer 23

rhythmic ocillatitory movement

• –“another garbage tern”
• –Many types of tremors
• –Rhythmic alternating oscillatory movements of anything
  
  • •Facial twitches

Question 24

What are three things that an MD considers when making a medical diagnosis for cerebellar disorders?

Answer 24

1. •Family history
2. •Neuroimaging/MRI
3. •Genetic testing

Question 25

What are the things the PT can identify and evaluate in a pt with a cerebellar disorder? (9 examples)

Answer 25

The PT assists in diagnosis, outcome measures, assessment

1. Ataxia
2. Decomposition of Movement
3. Dysarthria
4. Dysdiadochokinesia
5. Dysmetria
6. Hypotonia
7. Nystagmus
8. Scanning Speech
9. Tremor

Question 26

Etiology of Cerebellar Disorders: 3 categories

Answer 26

1. Congenital Malformations
2. Hereditary Ataxias
3. Acquired Conditions

Question 27

Congenital Malforations: Characteristics/Details (3)

Answer 27

•Congenital Malformations

1. –Manifest early in life
   
   • –Example: maybe cerebellum maybe just didn’t form)
2. –doesn’t progress (won’t get worse)
3. –Variety of deficits is possible

Question 28

Two types of Hereditary Ataxias

Answer 28

1. Freidreich Ataxia
2. Spinocerebellar Ataxia

Question 29

What is Friedreich ataxia?

Answer 29

Shappy Notes: Genetic mutation; Progressive disorder

(see video: https://www.youtube.com/watch?v=ThMH3WCUU4A)

(also is the crossfit guy vidio: https://www.youtube.com/watch?v=rHlC1W9r704)

Wikipedia:

Friedreich’s ataxia is an autosomal recessive inherited disease that causes progressive damage to the nervous system. It manifests in initial symptoms of poor coordination such as gait disturbance; it can also lead to scoliosis, heart disease and diabetes, but does not affect cognitive function. The disease progresses until a wheelchair is required for mobility. Its incidence in the general population is roughly 1 in 50,000.

http://en.wikipedia.org/wiki/Friedreich%27s_ataxia

Question 30

What are Spinocerebellar ataxias

Answer 30

Shappy’s Notes:

• •Ataxia, parkinsonism, dystonia, facial twitching
  
  • –Will go into more detail with some of these later

Inherited

Wikipedia:

Spinocerebellar ataxia (SCA) or also known as Spinocerebellar atrophy or Spinocerebellar degeneration, is a progressive, degenerative,[1] genetic disease with multiple types, each of which could be considered a disease in its own right. An estimated 150,000 people in the United States are diagnosed with Spinocerebellar Ataxia. SCA’s are the largest group of this hereditary, progressive, degenerative and often fatal neurodegenerative disorder. There is no known effective treatment or cure. Spinocerebellar Ataxia can affect anyone of any age. The disease is caused by either a recessive or dominant gene. In many times people are not aware that they carry the ataxia gene until they have children who begin to show signs of having the disorder.[2]

http://en.wikipedia.org/wiki/Spinocerebellar_ataxia

Question 31

What are some examples of aquired conditions? (9)

Answer 31

1. –Cerebellar strokes,
2. systemic disorders,
3. MS,
4. repeated TBI,
5. toxins,
6. idiopathic,
7. heat stroke,
8. alcohol abuse (the withdrawal part)
9. brain tumor,
10. etc.

Question 32

Tremor: Basic definition

Answer 32

•Rhythmic alternating oscillatory movements of anything

Question 33

What is the difference between physiologic and pathologic tremor?

Answer 33

• –Physiological just means it’s there, but its not interfering or getting worse. Not sign of an underlying condition.
  
  • •Typically barely perceivable until stress provokes it or ability to inhibit it are down
• –Pathologic is a sign of an underlying condition

Question 34

Tremmor Occurance: What is the

Pattern?

Severity?

acuity?

Answer 34

•Occurrence
–Pattern- could be intermittent or constant (any type of tremor)
–Severity- large or small oscillations, duration, etc. Amplitude
–Acuity- gradual onset or abrupt onset

Question 35

What is the pathophysiology of tremor? (three main)

Answer 35

•Pathophysiology-

1. lesions of brain stem,
2. extrapyramidal,
3. cerebellum

–Is complex, lots of stuff.

Question 36

What is an essential tremor? (2)

Answer 36

•Essential tremor-

1. familial condition typically;
2. rhythmic shaking of almost any body part

Question 37

What is a resting tremor?

Answer 37

–Happens at rest or when body part is in gravity supported position., but goes away with intentional movment

Question 38

what is an action tremor?

Answer 38

–Happens when body is in movement. It may or may not change when the target is reached.

there are at least three types

Question 39

What is a kinetic tremor?

what amplitude?

Answer 39

A type of Action tremor (happens when body is in movement).

1. tend to appear in the last part of the movement toward the target.
2. Typically small amplitude

Question 40

what is a intention tremor?

Answer 40

A type of Action tremor (happens when body is in movement).

1. occurs during the movement towards the target.
2. Might go away when target is reached.

Question 41

what is a postural tremor?

Answer 41

A type of Action tremor (happens when body is in movement).

1. Postural tremor: maximal when a limb is maintained in a fixed position against gravity.
2. large movments

Question 42

What are complex tremors?

Answer 42

A combination of any kind of tremor

Question 43

what are the classifications of tremors based on? (at least the classifications that Dr. shappy gave us)

Answer 43

based on when the tremor occurs

Question 44

What are three types of Pathologic Tremors?

Answer 44

1. Action or postural tremor
2. Resting tremor
3. Intention Tremor

Question 45

Pathologic Tremor: Action or Postural Tremor details/causes (3)

Answer 45

Action or Postural Tremor:

1. •Essential tremor (non-familial)
2. •Alcohol or drug withdrawal- DT’s (Delerium Tremins - what happens during alcohol/drug withdrawal)
3. •Endocrine, metabolic or toxic conditions-
   
   • encephalopathy,
   • renal,
   • hepatic,
   • hypoglycemia,etc.

Question 46

Pathologic Tremor: Resting Tremor, two diseases that commonly have resting tremor

Answer 46

Resting Tremor

1. •Parkinson’s- pill rolling, chin, leg; shuffling gait, bradykinesia, cogwheel rigidity, micrographia
2. •Progressive supranuclear palsy- coarse or jerky tremor with eye gaze issues (typically difficulty looking down)

Question 47

What are some symptoms of Parkinson’s Dz? (5)

Answer 47

1. Resting tremor
   
   • pill rolling,
   • chin
   • leg
2. shuffling gait,
3. bradykinesia,
4. cogwheel rigidity,
5. micrographia

Question 48

What are some symptoms of Progressive supranuclear palsy? (2)

Answer 48

•Progressive supranuclear palsy-

1. coarse or jerky tremor with
2. eye gaze issues (typically difficulty looking down)

Question 49

Pathologic Tremor: Intention Tremor, two examples of causes/symptoms

Answer 49

1. •Cerebellar lesions- low frequency, unilateral, ataxia, dysmetria, dysdiadochokinesia, dysarthria
2. •History of drug use- tremor when stopping

Question 50

What is Motor Control?

Answer 50

Dr Bringman:

Motor control is

• the ability to maintain and change posture and movement
• the result of a complex set of neurological and mechanical process.

Shappy Notes: Motor control

(she said we must have some knowledge of this side beyond this slide and that we got it from Bringman. She did not talk more about it really)

Question 51

What is Motor Coordination?

Answer 51

from Wikipedia:

Motor coordination is the combination of body movements created with the kinematic (such as spatial direction) and kinetic (force) parameters that result in intended actions.

More if you feel like it:

Motor coordination is achieved when subsequent parts of the same movement, or the movements of several limbs or body parts are combined in a manner that is well timed, smooth, and efficient with respect to the intended goal. This involves the integration of proprioceptive information detailing the position and movement of the musculoskeletal system with the neural processes in the brain and spinal cord which control, plan, and relay motor commands. The cerebellum plays a critical role in this neural control of movement and damage to this part of the brain or its connecting structures and pathways results in impairment of coordination, known as ataxia.

http://en.wikipedia.org/wiki/Motor_coordination

(We did not talk of it in class I don’t think)

Question 52

What are Five types of Motor Coordination?

Answer 52

Coordination

1. –Dexterity
2. –Agility
3. –Intra limb coordination
4. –Inter limb coordination
5. –Visual motor coordination
   
   • •Hand-eye coordination

Question 53

What is Dexterity?

Answer 53

From Wikipedia, since we didn’t explicity discuss it:

Fine motor skills (or dexterity) is the coordination of small muscle movements—usually involving the synchronization of hands and fingers—with the eyes. The complex levels of manual dexterity that humans exhibit can be attributed to and demonstrated in tasks controlled by the nervous system. Fine motor skills aid in the growth of intelligence and develop continuously throughout the stages of human development.

http://en.wikipedia.org/wiki/Fine_motor_skill

Other definitions:

skillfulness in the use of one’s hands or body.

Fine Motor Control: Ability to perform delicate manipulations with the hand requiring steadiness, muscle control, and simultaneous discrete finger movements.
Synonym(s): dexterity, fine coordination, fine motor control.

http://medical-dictionary.thefreedictionary.com/dexterity

Question 54

What is Agillity?

Answer 54

1. the power of moving quickly and easily; nimbleness (http://dictionary.reference.com/browse/agility)

From Wikipedia, since we didn’t discuss much in class:

Agility or nimbleness is the ability to change the body’s position efficiently, and requires the integration of isolated movement skills using a combination of balance, coordination, speed, reflexes, strength, and endurance. Agility is the ability to change the direction of the body in an efficient and effective manner and to achieve this requires a combination of

balance – the ability to maintain equilibrium when stationary or moving (i.e. not to fall over) through the coordinated actions of our sensory functions (eyes, ears and the proprioceptive organs in our joints);
static balance – the ability to retain the centre of mass above the base of support in a stationary position;
dynamic balance – the ability to maintain balance with body movement; speed - the ability to move all or part of the body quickly; strength - the ability of a muscle or muscle group to overcome a resistance; and lastly,
co-ordination – the ability to control the movement of the body in co-operation with the body’s sensory functions (e.g., in catching a ball [ball, hand and eye co-ordination]).

In sports, agility is often defined in terms of an individual sport, due to it being an integration of many components each used differently (specific to all of sorts of different sports). Sheppard and Young (2006) defined agility as a “rapid whole body movement with change of velocity or direction in response to a stimulus”.[attribution needed]

Agility is also an important attribute in many role playing games, both computer games and as Dungeons and Dragons. Agility may affect the character’s ability to evade an attack or navigate uneven terrain.

http://en.wikipedia.org/wiki/Agility

Question 55

What is intra-limb coordination?

Answer 55

From Wikipedia:

Intra-limb coordination involves the planning of trajectories in the Cartesian planes.[4] This reduces computational load and the degrees of freedom for a given movement, and it constrains the limbs to act as one unit instead of sets of muscles and joints. This concept is similar to “muscle synergies” and “coordinative structures.” An example of such concept is the Hogan and Flash minimum-jerk model,[15] which predicts that the parameter that the nervous system controls is the spatial path of the hand, i.e. the end-effector (which implies that the movement is planned in the Cartesian coordinates). Other early studies showed that the end-effector follows a regularized kinematic pattern[16] relating movement’s curvature to speed and that the central nervous system is devoted to its coding.[17] In contrast to this model, the joint-space model postulates that the motor system plans movements in joint coordinates. For this model, the controlled parameter is the position of each joint contributing to the movement. Control strategies for goal directed movement differ according to the task that the subject is assigned. This was proven by testing two different conditions: (1) subjects moved cursor in the hand to the target and (2) subjects move their free hand to the target. Each condition showed different trajectories: (1) straight path and (2) curved path.[18]

http://en.wikipedia.org/wiki/Motor_coordination#Intra-limb

Question 56

What is Inter-limb coordination?

Answer 56

From Wikipedia:

Inter-limb coordination concerns how movements are coordinated across limbs. J. A. Scott Kelso and colleagues have proposed that coordination can be modeled as coupled oscillators, a process that can be understood in the HKB (Haken, Kelso, and Bunz) model.[13] The coordination of complex inter-limb tasks is highly reliant on the temporal coordination. An example of such temporal coordination can be observed in the free pointing movement of the eyes, hands, and arms to direct at the same motor target. These coordination signals are sent simultaneously to their effectors. In bimanual tasks (tasks involving two hands), it was found that the functional segments of the two hands are tightly synchronized. One of the postulated theories for this functionality is the existence of a higher, “coordinating schema” that calculates the time it needs to perform each individual task and coordinates it using a feedback mechanism. There are several areas of the brain that are found to contribute to temporal coordination of the limbs needed for bimanual tasks, and these areas include the premotor cortex(PMC), the parietal cortex, the mesial motor cortices, more specifically the supplementary motor area (SMA), the cingulate motor cortex (CMC), the primary motor cortex (M1), and the cerebellum.[14]

http://en.wikipedia.org/wiki/Motor_coordination#Intra-limb

Question 57

What is visula motor coordination (hand-eye coordination)?

Answer 57

the ability to coordinate vision with the movements of the body or parts of the body. (http://medical-dictionary.thefreedictionary.com/visual-motor+coordination)

From Wikipedia:

Eye–hand coordination (also known as hand–eye coordination) is the coordinated control of eye movement with hand movement, and the processing of visual input to guide reaching and grasping along with the use of proprioception of the hands to guide the eyes. Eye–hand coordination has been studied in activities as diverse as the movement of solid objects such as wooden blocks, sporting performance, music reading, computer gaming, copy-typing, and even tea-making. It is part of the mechanisms of performing everyday tasks; in its absence most people would be unable to carry out even the simplest of actions such as picking up a book from a table or playing a video game. While it is recognized by the term hand–eye coordination, without exception medical sources, and most psychological sources, refer to eye–hand coordination.[citation needed]

http://en.wikipedia.org/wiki/Eye%E2%80%93hand_coordination

Question 58

What are Four big categories of movement disorders?

Answer 58

1. Hypokinetic
2. Hyperkinetic
3. Rhythmic
4. Nonrhythimc

Question 59

Movement Disorders: What is a hypokinetic movement disorder characterizd by?

what are some goals for treatment?

Answer 59

–Hypokinetic- decreased or slow
•Treat: speed them up or prevent them from getting slower

Question 60

Movement Disorders: What is a hyperkinetic movement disorder characterizd by?

Answer 60

increased movement

Question 61

Movement Disorders: What are rhythmic movement disorder characterizd by?

Answer 61

–Rhythmic- regular alternating or oscillatory

Question 62

Movement Disorders: What are non-rhythmic movement disorder characterizd by?

Answer 62

can be slow, sustained, or rapid

Many types!

Question 63

Movement Disorders: what are seven types of non-rhythmic movement disorders?

Answer 63

1. •Athetosis:
   
   • movements that are non-rhighmic slow and rihging. Primarily distal muscles (Dr. Lake: common in CP pts). Tend to produce a flowing stream of movement.
2. •Chorea:
   
   • non-rhythmic jerky and rapid. Distal muscles or the face.
3. •Dystonias:
   
   • sustained muscle contractions. Typically alter posture or body position.
4. •Hemiballismus:
   
   • non rhythmic rapid movements. Violent, flinging, non-suppressible.
5. •Myoclonus:
   
   • rapid jerky. Shock like twitches. Restless leg falls under this category.
6. •Tics:
   
   • Tourets is the example. Rapid repetitive non-rhythmic. Pts usually have some urge to do it and get some sort of relief after they do it. There is some thought that urge can be suppressed.
7. •Tremor:
   
   • go back to other definitions she gave

(these will have a seperate flashcard for each also)

Question 64

Movement Disorders, non-rhythmic: what is athetosis?

Answer 64

movements that are non-rhythmic slow and wringing. Primarily distal muscles (Dr. Lake: common in CP pts). Tend to produce a flowing stream of movement.

Dr. lake gave us a youtube video of an adult man with CP with his fingers moving in his affected (and dysfunctioning) hand. I think he looked like he was from India or some similar country. His hand looked spastic or rigid with difficult continued movement of fingers.

Question 65

Movement Disorders, non-rhythmic: what is chorea?

Answer 65

•Chorea: non-rhythmic jerky and rapid. Distal muscles or the face are most common.

[My note: This is typical in Huntington’s Disease (aka Huntington’s Dance)]

Question 66

Movement Disorders, non-rhythmic: what is dystonia?

Answer 66

•Dystonias: sustained muscle contractions. Typically alter posture or body position.

Youtube gave an example where spasmotic torticolis is a type of dystonia. Other examples mentioned a dystonic storm that looks similar to a grand mal seizure. Some videos make it look like contortions or random contrations of the body. I reccomend looking up videos to get the idea.

From Wikipedia (Because I still didn’t understand; Probably more than you need to know):

Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.[1] The movements may resemble a tremor. Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles.[2]

The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.[1] Treatment must be highly customized to the needs of the individual and may include oral medications, botulinum neurotoxin injections, physical therapy and/or other supportive therapies, and/or surgical procedures such as deep brain stimulation.

http://en.wikipedia.org/wiki/Dystonia

Question 67

Movement Disorders, non-rhythmic: what is hemiballismus?

Answer 67

•Hemiballismus: non rhythmic rapid movements. Violent, flinging, non-suppressible.

dr Lake taught us that it would be contralateral to the legion, and it is usually the upper extremity. Hemi means one sided, so it would just be one arm. Ballisums also exists, which would be bilateral (make sure you read carefully when taking the exam!)

Question 68

Movement Disorders, non-rhythmic: what is myoclonus?

Answer 68

Myoclonus: rapid jerky. Shock like twitches.

This is related to restless leg syndrome (RLS)

(I think it is a symptom that can be present but is not always present with RLS)

Question 69

Movement Disorders, non-rhythmic: what are Tics?

Answer 69

Tourette’s is the example. Rapid repetitive non-rhythmic. Pts usually have some urge to do it and get some sort of relief after they do it. There is some thought that urge can be suppressed.

Question 70

Movement Disorders, non-rhythmic: what are Tremor?

(general)

Answer 70

•Definition: Rhythmic alternating oscillatory movements of anything
many types (go back to other slides/flashcards for full story)

Question 71

what are some good questions to ask yourself when trying to treat movement disorders?

Answer 71

How can I control these movement disorders?

What does society say about what is appropriate or acceptable? (when deciding what to do to help pts with problems)

Question 72

What are three things you can test when evaluating movement disorders?

Answer 72

1. •Sitting balance
2. •Standing balance
3. •Gait

Question 73

List 8 functional balance tests

Answer 73

1. –Romberg test: (I noted that I should look it up)
   
   • •Often done when pulled over for DUI
   • •Stand on one leg, put head back, close eyes (or not) and touch nose alternating with fingers from outstretched arms.
2. –Functional Reach and Multidirectional Reach Tests
3. –Berg Balance Scale
4. –Performance-Oriented Mobility Assessment (POMA)
5. –Timed get up and go test (TUG)
6. Tinetti Assessment Tool
7. 4-Stage Balance Test
8. 30-Second Chair Stand Test

(see hand-outs)

Question 74

Describe (or just read) more details about Romberg Test

Answer 74

From Wikipedia:

Romberg’s test or the Romberg maneuver is a test used in an exam of neurological function, and also as a test for drunken driving. The exam is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to know one’s body in space); vestibular function (the ability to know one’s head position in space); and vision (which can be used to monitor [and adjust for] changes in body position).

A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is asked to close his or her eyes. A loss of balance is interpreted as a positive Romberg’s test.

The Romberg test is a test of the body’s sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord.[1]

The Romberg test is used to investigate the cause of loss of motor coordination (ataxia). A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a patient is ataxic and Romberg’s test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.

It is used as an indicator for possible alcohol or drug impaired driving and neurological decompression sickness.[2][3] When used to test impaired driving, the test is performed with the subject estimating 30 seconds in his head. This is used to gauge the subject’s internal clock and can be an indicator of stimulant or depressant use.

http://en.wikipedia.org/wiki/Romberg%27s_test

Question 75

What does POMA stand for?

Answer 75

–Performance-Oriented Mobility Assessment (POMA)

Question 76

What does TUG stand for?

Answer 76

–Timed get up and go test (TUG)

Question 77

Dr. Shappy spent a lot of time talking about an example of Dystonia, Spasmodic Torticollis. We should probalby watch the videos she posted.

Answer 77

• http://www.youtube.com/watch?v=pfDYLYyoUyw
• http://www.youtube.com/watch?v=28kMNZdNHaw
• http://www.youtube.com/watch?v=P6XhHb90ciQ
• http://www.youtube.com/watch?v=ElSYsIQMJZQ
• httphttp://www.youtube.com/watch?v=u_-UO2upGW8
• http://www.youtube.com/watch?v=I1bD5Dun7Ss