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7 Neuro Dysfunction > L1 Cerebellum Disorders > Flashcards

L1 Cerebellum Disorders Flashcards

1
Q

Function of normal motor system

A

Voluntary movements, facilitated by motor plan from cortex, delivered by LMN and sensory input

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2
Q

Function of cerebellum

A
  1. integrates sensory and other inputs from multiple regions of cortex and four spinal cord pathways
  2. (Inferior olivary nucleus) Compares the efferent and afferent copies to calculate motor error, and sends those errors back, updating the motor plan
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3
Q

Efferent copy of information

A

copy of motor plan from M1

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4
Q

Afferent copy

A

sensory info relaying what happened in periphery during task

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5
Q

Cerebellum uses info that it receives to…

A
  1. smoothly coordinate ongoing movements
  2. coordinate the sequencing of voluntary muscle contraction
  3. contribute to motor planning
  4. contribute to motor learning
  5. contribute to language, decision making, affect
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6
Q

Peduncles

A

are how info travels in and out of cerebellum

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7
Q

Lateral hemisphere of cerebellum

A

helps with motor planning for extremities

influences the lateral corticospinal tract

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8
Q

Intermediate hemisphere of cerebellum

A

function: distal limb coordination

influences lateral corticospinal tract, rubrospinal tract

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9
Q

Vermis and Flocculonodular lobe

A

function: proximal limb and trunk coordination. balance and VOR

influences anterior corticospinal tract, reticulospinal tract, vestibulospinal tract, tectospinal tract, MLF

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10
Q

Lateral motor systems

A

lateral corticospinal tract
rubrospinal tract

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11
Q

Medial Motor Systems

A

anterior corticospinal tract
reticulospinal tract
M/L vestibulospinal tract
tectospinal tract

impacted by vermis and flocc. nodules

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12
Q

Cerebellar Dysfunction

A

causes ataxia or a lack of order

movements have abnormal timing, trajectories through space

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13
Q

Ataxia

A

disordered contractions of agonist and antagonist muscles and resulting lack of coordination between movements at different joints seen in patients with cerebellar dysfunction

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14
Q

Dysmetria

A

abnormal trajectories through space. Undershoot or overshoot

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15
Q

Dysrhythmia

A

abnormal timing and rhythm of movements

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16
Q

Lateral lesions

A

present with ipsilateral deficits

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17
Q

Lesions of vermis

A

have bilateral deficits

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18
Q

Truncal ataxia

A

lesions affecting the cerebellar vermis primarily affect the medial motor systems

results in drunk like gait

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19
Q

Appendicular ataxia

A

lesions affecting the intermediate and lateral cerebellar regions affect the lateral motor systems

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20
Q

Sensory ataxia

A

damage to the lateral columns leading to a lack of peripheral proprioceptive input

improves with visual feedback

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21
Q

Dysdiadochokinesia

A

abnormalities of rapid alternating movements

22
Q

Postural tremor

A

tremor seen when the limb muscles are activated to hold a particular position

23
Q

Essential tremor

A

low amplitude postural tremor

24
Q

Action or intention tremor

A

appendicular ataxia during movements toward a target

25
Q

Ocular dysmetria

A

overshoot or undershoot of the target during saccades

26
Q

Nystagmus

A

rhythmic beating that can change direction, occasionally upbeating with cerebellar dysfunction

27
Q

Cerebellar S/S: Eye

A

Ocular Dysmetria
Nystagmus
inability to suppress VOR

28
Q

Cerebellar Tremors

A

postural
essential
action or intention

29
Q

Cerebellar S/S Speech

A

-speech has ataxic quality with fluctuations in rate and volume
-speech may be slurred and difficult to understand

30
Q

Possible pathologies for Cerebellar disorders

A

Developmental
Metabolic
Progressive Degenerative
Trauma
Stroke
Tumor

31
Q

Friedrich’s Ataxia

A

(progressive degenerative)

-no medical cure
-most common autosomal recessive disease
-results in deficiency of frataxin
-onset is at 15 yo
-life expectancy is 37.5 yo

32
Q

Results of frataxin deficiency

A

-lesions in DRG, causing peripheral neuropathy
-dentate nuclei
-reduction in SC diameter, especially in DCML in spinocerebellar tracts
-impacts on CV and endocrine systems

33
Q

CP of Friedrich’s Ataxia

A

-hallmark feature is ataxia
-peripheral neuropathy
-absent LE reflexes
-reduction of proprioception and vibration sense
-LE weakness and pes cavus
-DM
-VO impairments
-cardiomyopathy

34
Q

Ataxia is usually…

A

ipsilateral to side of a cerebellar lesion

this is because pathways from cerebellum are double crossed

35
Q

Crossings of lateral motor pathways

A

First = cerebellar outputs exit in decussation of superior cerebellar peduncle in midbrain

Second = corticospinal and rubrospinal tracts descend in the SC at the pyramids

36
Q

Lesions of lateral and intermediate hemispheres case

A

S/S of proximal and distal limbs, including ataxia, intention tremor, dysdiadochokinesia

37
Q

Midline lesions of cerebellar vermis or Flocculonodular lobes causes…

A

unsteady gait due to truncal ataxia and vestibulooccular dysfunction

does not cause unilateral deficits b/c medial motor systems influence trunk bilaterally

eye movements abnormalities and intense vertigo, nausea, vomiting due to connection to flocculonodular lobe

38
Q

Eye patching of impaired eye

A

gives it a rest and prevents fatigue and double vision

39
Q

Eye patching of non-impaired eye

A

to allow weaker eye an opportunity to work without the distraction of double vision

40
Q

Impairment Examination includes

A

appendicular ataxia
truncal ataxia
vestibular tests
oculomotor tests

41
Q

Appendicular Ataxia Exam

A

finger to nose
heel to shin
rapid alternating movements
toe tapping
finger tapping

indicates that proprioception is intact

42
Q

Truncal Ataxia Exam

A

Tandem Gait
Romberg Test (not the best)
Titubation
Normal Gait

43
Q

Titubation

A

rhythmic tremor mainly of the head and/or upper trunk with a frequency of 3-4 cycles/second

seen in any position or during activities

44
Q

Gait in cerebellar dysfunction

A

Wide-based, unsteady gait

tandem gait will fall toward side of lesion

45
Q

Saccades for cerebellum

A

abnormal with present of undershoot or overshoot

smooth pursuit would be abnormal with the presence of saccadic intrusions

46
Q

Nystagmus cerebellum results

A

might be present and would likely be direction changing

47
Q

Dorsal Column Lesion

A

visual feedback will improve ataxia
no dizziness, vertigo, nausea
loss of proprioception/touch

48
Q

Lacunar Stroke

A

can lead to ataxia hemiparesis syndrome

combo of unilateral UMN signs and ataxia of same side

49
Q

Scale for the assessment and rating of ataxia (SARA)

A

8 item performance based scale, yielding a total score of 0 (no ataxia) to 40 (most severe)

patient performs gait, stance, sitting, speech, finger chase, nose to finger, fast alternating hand movements, heel shin slide

50
Q

Cueing/Facilitation for Cerebellar Involvement

A

Use tactile, verbal, visual cues, fading over time

use extrinsic cueing

practice should be random, whole, and high repetition

51
Q

DOs of Cerebellar Ataxia Treatment

A

-proximal stability when necessary
-start with lower degrees of freedom
-external cues
-high repetition practice
-progress to targeting distal accuracy
-compensatory strategies are OK

52
Q

DONTs of Cerebellar Ataxia Treatment

A

-start with work on distal accuracy
-weight the limb for increased proprioceptive feedback
-randomize practice
-emphasize strength training (most have normal strength, but not good motor control)

7 Neuro Dysfunction (7 decks)

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