Lecture 3 - Ataxia

Question 1

What is Ataxia

Answer 1

abnormal coordination affecting timing, amplitude, accuracy, and force of movements

Question 2

Sensory Ataxia

Answer 2

loss of coordination due to loss of cutaneous proprioceptive sensation

Question 3

Cerebellar Ataxia

Answer 3

from TBI,Stroke, degenerative disease (alcohol abuse)

Question 4

What are the motor impairments of ataxia

Answer 4

Dysmetria - disorder of movement termination

Rebound Phenomena - delayed antagonist response

Dysdiadochokinesia - decreased coordination of rapid alternating movements

Dyssnergia - decrease timing of onset and offset of antagonist and agonists –> loss of smoothness, joints moved intependently

Tremor - terminal, postural

Hypotonia

Dysarthria - decrease coordination of speech production mm and speech and resp

Nystagmus - oscillation of eyes

Question 5

What are some adaptive behaviours for people with Ataxia

Answer 5

restriction of amplitude and degrees of freedom

UL - use of support surface, slow movement, excessive pre-phasing

LL - wide BOS, excessive use of arms, excessive stepping when standing, faster walking

Question 6

Palliyah study and implications?

Answer 6

Gait

people with cerebellar ataxia have less power, however, there mm turn on the same order as healthy individuals

Question 7

Bastian study and implications

Answer 7

patient extends arm to touch ball hanging in front

move one joint at a time, abnormal wrist paths

less accurate, overshoot when moving fast

Question 8

Bastian (2000) study and implications

Answer 8

hand moves up to touch ball, one unsupported, one supported

support allows ataxia patient to be more accurate, however, be aware they may not learn the skill, start with support and take away

Question 9

Deiner and Dichgans study and implications

Answer 9

rising onto tiptoes, with EMG

sequence of mm is same, but precise timing and power is disordered

Question 10

Lang and Bastian study and implications

Answer 10

reaching in standing - figure 8, using a concurrent vigilance task

cerebeallar pts improve with practice , but revert back when additional task is introduced - may need more practice

Question 11

Langton Hewer study and implications

Answer 11

weights on wrists

reduced intention tremor in 58% of patients

Question 12

Manino study and implications

Answer 12

weights reduced intention tremor but did not improve task

use weights as adaptive strategy, coordination needs to be done separately,

Reaching - wrists - 60g increments up to 2 kg

Walking – knees,hips - 1-2kg

Question 13

When is task practice appropriate

Answer 13

Spatial accuracy - tasks where excessive movements are constrained - feedback is implicit in task

Timing - closed task which require rhythm, open tasks require predictive timing

Question 14

Physo interventions to reduce ataxia

Answer 14

• decrease external support
• decrease possiblities for UL support
• decrease manual guidance
• decrease BOS
• imcrease amplitude of movement
• increase speed and accuracy
• add concurrent tasks to encourage automaticity