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DPT 620: Neuro > Management of Individuals with Cerebellar Disorders > Flashcards

Management of Individuals with Cerebellar Disorders Flashcards

1
Q

do cerebellar disorders result in lack of mobility or stability?

A

lack of stability

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2
Q

what part of the cerebellum is the spinocerebellum?

A

the vermis

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3
Q

what part of the cerebellum is the cerebrocerebellum?

A

cerebellar hemispheres

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4
Q

what part of the cerebellum is the vestibulocerebellum?

A

the floculonodular lobe

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5
Q

what is the role of the spinocerebellum?

A

regulation of muscle tone and coordination

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6
Q

what does damage to the spinocerebellum result in?

A

lack of truncal control/truncal ataxia

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7
Q

what is the role of the cerebrocerebellum?

A

planning and timing of movt

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8
Q

what does damage to the cerebrocerebellum result in?

A

limb ataxia

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9
Q

what is the role of the vestibulocerebellum?

A

postural control and eye movt

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10
Q

what does damage to the vestibulocerebellum result in?

A

visual ataxia

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11
Q

what are the key roles of the cerebellum?

A

motor coordination, accuracy, and amplitude (gross and fine limb control)

balance and posture

fine motor control

motor learning and adaptation

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12
Q

a majority of interventions for cerebellar injury should be focused on what?

A

proximal stability

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13
Q

the cerebellum plays a huge role in what kind of balance?

A

anticipatory postural control (which then effects reactive postural control)

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14
Q

what are the gross motor control functions affected in cerebellar injury?

A

dysmetria and dysdiadochokinesia

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15
Q

what are common symptoms of cerebellar disorders?

A

ataxia

intention tremor

dysmetria (over/undershoot)

dysdiadochokinesia (impaired RAMs)

nystagmus

dysarthria (ataxic speech)

gait disturbances

balance impairments

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16
Q

what is intention tremor?

A

tremor with movt

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17
Q

what are the fxnal impacts of cerebellar disorders?

A

excessive mobility and lack of stability

difficulty with ADLs requiring gross and fine motor control

decreased trunk control/stability

increased fall risk

challenges with mobility

decreased control of ambulation

coordination of respiratory and postural control muscles

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18
Q

are pts with cerebellar disorders are risk of falling forward or backward?

A

backward bc they are retropulsive

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19
Q

do pts with cerebellar injury fall towards or away from the side of injury?

A

towards the side of injury

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20
Q

what do pts with cerebellar disorders often do to gain trunk stability?

A

breath hold, especially early on

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21
Q

what is titubation of the trunk?

A

underlying trunk tremor that looks like ataxia but is smaller, high frequency movt

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22
Q

does slow or fast movt lead to movt decompensation?

A

slow movt

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23
Q

slow movt results in what three things?

A

movt decomposition

dysynergia

hypometria

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24
Q

does slow movt result in overshooting or undershooting movts?

A

undershooting (hypometria)

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25
Q

does fast movt result in overshooting or undershooting movts?

A

overshooting movts (hypermetria)

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26
Q

what tests can be used for slow movts?

A

foot to nose (FTN)

heel to shin (HTS)

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27
Q

fast movt results in what three things?

A

hypermetria

dysdiadochokinesia

abnormal APRs

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28
Q

what tests can be used for fast movts?

A

rapid eye movts (RAMs)

finger to nose (FTN)

finger chase

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29
Q

what are the motor learning tasks the cerebellum is responsible for?

A

adjusting and refining voluntary limb movts

making and adjusting eye movts

preparing for movt and recovering balance after a perturbation

learning new walking patterns

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30
Q

pts with cerebellar disorder demonstrate slower rates of ____, decreased magnitude of ____, or no _____ at all

A

adaptation

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31
Q

is there increased or decreased procedural learning in cerebellar disorders?

A

decreased

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32
Q

do we want to include or avoid error augmentation in treatment of pts with cerebellar disorders?

A

avoid error augmentation

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33
Q

why do we want to limit errors in treatment with cerebellar disorders?

A

bc they have limited/no ability to correct errors

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34
Q

how can we bypass the circuitry injured in cerebellar injury?

A

errorless learning and high repetitions

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35
Q

what are the causes of cerebellar disorders?

A

vascular injury

degenerative disorders

toxic/metabolic causes

infections

neoplasms

trauma

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36
Q

what are vascular events that can cause cerebellar disorder?

A

cerebellar infarcts or hemorrhages

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37
Q

what are the degenerative disorders that can result in cerebellar disorder?

A

MSA-c

spinocerebellar ataxia

Friedreich’s ataxia

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38
Q

why is HD (and hyperkinetic disorders) treated similarly to cerebellar disorders?

A

bc they both involved a lack of stability

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39
Q

what is the most common disorder causing ataxia?

A

Friedreich’s ataxia

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40
Q

what are toxic/metabolic causes of cerebellar disorders?

A

chronic alcoholism

meds (eg. anticonvulsants)

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41
Q

is AICA or PICA low BS?

A

PICA

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42
Q

is AICA or PICA high BS?

A

AICA

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43
Q

is lateral medullary/Wallenberg syndrome effecting the AICA or PICA?

A

PICA

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44
Q

what are the s/s of lateral medullary/Wallenberg syndrome (PICA)?

A

ipsi limb and gait ataxia

DYSPHAGIA, HOARSENESS

contra loss of pain and temp

vertigo and nystagmus

Horner’s syndrome

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45
Q

what are some common symptoms among PICA and AICA?

A

ataxia, Horner’s syndrome, and contra loss of pain and temp

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46
Q

what are the s/s of lat sup pontine/Marie-Foix syndrome (AICA)?

A

ipsi limb and gait ataxia

contra loss of pain and temp

propriocetive impairment LE>UE

falling toward lesion

VERTIGO (NYSTAGMUS), NAUSEA, VOMITING

ISPI HEARING LOSS/TINNITUS

FACIAL WEAKNESS

facial sensory disturbances

gaze paresis

hemiparesis or hemiplegia

Horner’s syndrome

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47
Q

does lat sup pontine/Marie-Foix syndrome affect AICA or PICA?

A

AICA

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48
Q

is dysphagia and hoarseness a sign of AICA or PICA?

A

PICA

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49
Q

is hearing loss a sign of AICA or PICA?

A

AICA

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50
Q

what does corticospinal involvement in AICA cause?

A

hemiplegia, hyperreflexia, spasticity, and other UMN signs

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51
Q

what is the difference bw central and peripheral nystagmus?

A

central nystagmus is caused by the BS and is vertical, combo, or changing directions/different in each eye

peripheral nystagmus is caused by the inner ear and is horizontal, linear, or torsional

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52
Q

what is an other name for spinocerebellar atrophy/ataxia (SCA)?

A

olivopontocerebellar atrophy

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53
Q

what is SCA?

A

degeneration of axons w/in multiple neural systems

progressive genetic disorder with over 35 subtypes

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54
Q

what neural systems are effected in SCA?

A

cerebellum

BS

BG

SC

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55
Q

when is the onset of SCA typically?

A

20-50 y/o but varies by subtype

typically adolescence

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56
Q

what is the prognosis for SCA?

A

rapid progression to dependence w/in a few years

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57
Q

what is the life expectancy of someone with SCA?

A

6-29 years after onset of symptoms

58
Q

what are confounding factors in SCA?

A

weight management

nutrition

comorbidities

59
Q

what is the most common subtype of SCA?

A

SCA 3 (Machado-Joseph’s disease)

60
Q

what is SCA 3 (Machado-Joseph’s disease)?

A

the most common subtype of SCA

UMN/LMN degeneration mix caused by mutation in the ATXN3 gene

61
Q

what are common symptoms of SCA?

A

dysarthria

oculomotor abnormalities

limb ataxia

progressive gait ataxia

62
Q

what additional impairments may be present in SCA depending on the subtype?

A

cognitive deficits

peripheral neuropathy

dystonia

dysphagia

63
Q

what are the early signs of SCA?

A

limb heaviness–>limb ataxia–> gait ataxia

fatigue

64
Q

what are the mental fxn impairments in SCA?

A

difficulty processing, learning, and remembering info

65
Q

what is the sensory fxn impairment in SCA?

A

peripheral neuropathy

66
Q

what is the CVP, hemo, and immuno fxn impairment in SCA?

A

excessive use of accessory respiratory muscles

67
Q

what is the voice and speech fxn impairment in SCA?

A

dysarthria

68
Q

what is the genitourinary and reproductive fxn impairment in SCA?

A

loss of bladder control

69
Q

what are the neuro MSK and movt related fxn impairments in SCA?

A

oculomotor slowing, nystagmus, diploplia

hyperreflexia, truncal/limb ataxia

decreased locomotion

progressive inability to maintain posture

dystonia

70
Q

what is Friedreich’s ataxia?

A

neurodegenerative, progressive genetic disorder affecting the CNS, PNS, pancreatic beta cells, and heart from a mutation in both copies of the FXN gene

71
Q

what is the role of the FXN gene?

A

frataxin protein for encoding mitochondrial fxn (ATP production)

72
Q

what is the most common form of autosomal recessive ataxia?

A

Friedreich’s ataxia

73
Q

what does a mutation of the FXN gene cause in Friedreich’s ataxia?

A

NS, cardiac, and metabolic dysfxn

74
Q

what are we concerned about with a pt with Friedreich’s ataxia?

A

exercise tolerance and adequate cardiac fxn for exercise

75
Q

when do symptoms develop in Friedreich’s ataxia?

A

in adolescence

76
Q

t/f: DM becomes more unstable as time goes on in Friedreich’s ataxia

A

true

77
Q

what is the prognosis for Friedreich’s ataxia?

A

progressive decline, typically WC by late teens, early 20s

78
Q

what is the #1 cause of mortality in Friedreich’s ataxia?

A

cardiomyopathy

79
Q

Friedreich’s ataxia causes atrophy of what structures?

A

cerebellum

spinocerebellar tract

medulla

corticospinal tract

DCML

80
Q

what is the clinical presentation of someone with Friedreich’s ataxia?

A

balance impairment

EARLY gait ataxia

vision changes (nystagmus and oculomotor slowing)

motor impairments (MUSCLE WEAKNESS and progressive limb ataxia)

SENSORY DEFICITS (vibration and proprioception)

dysarthria

SCOLIOSIS (>15-20 deg)

DM

HYPERTROPHIC CARDIOMYOPATHY

81
Q

what causes aggressive scoliosis in Friedreich’s ataxia?

A

abborant muscles pulling

82
Q

t/f: with truncal and gait ataxia in Friedreich’s ataxia, unsteadiness and balance changes appear first

A

true

83
Q

does Friedreich’s ataxia involve cerebellar or sensory ataxia?

A

both

84
Q

what is a disease-specific test/measure for cerebellar disorders?

A

Scale for the Assessment and Rating of Ataxia (SARA)

85
Q

what are the general tests/measures used in cerebellar disorders?

A

coordination tests (fine and gross motor)

gait analysis

balance

fxnal mobility

86
Q

what are disorder-specific tests/measures for cerebellar disorders?

A

oculomotor assessment

cardiopulmonary fxn and endurance

sensory testing

strength testing

scoliosis assessment

87
Q

what is the SARA?

A

a semi-quantitative assessment of cerebellar ataxia w a gait and ADL component (includes a standard clinical measure of coordination)

88
Q

what is the range for the score in SARA?

A

0 (no ataxia) to 40 (severe ataxia)

89
Q

what are the 8 items of the SARA?

A

gait

stance

sitting

speech

finger chase

FTN

HTS

RAMs

90
Q

what balance assessments can be used in cerebellar disorders?

A

Berg

MiniBEST

91
Q

what posture assessments can be used in cerebellar disorders?

A

mCTSIB

assess postural sway and limits of stability under varied sensory conditions

92
Q

what assessment can be used for fear of falling/confidence in mobility in cerebellar disorders?

A

ABC

93
Q

what tests for fxnal locomotion may be used in cerebellar disorders?

A

10mWT

3mBWT

FGA

4 square step test

TUG

94
Q

with disease progression, do we expect balance assessments to improve or worsen?

A

worsen due to disease progression

95
Q

what things would be noted in observational gait analysis in cerebellar disorders?

A

wide BOS

irregular control of limb advancement

irregular control of weight acceptance/single limb stance

decreased arm swing

trunk stiffness

96
Q

what are the tests for RAMs in cerebellar disorders?

A

supination-pronation

alternating toe tapping

97
Q

what are the tests for dysmetria (accuracy) in cerebellar disorders?

A

FTN

HTS

98
Q

what is finger chasing?

A

FTN with moving target

99
Q

what is the box and blocks test?

A

a test of gross motor fxn and dexterity

each UE tested for 1 minute picking up 1 block at a time and moving it from box 1 to box 2

100
Q

how do we document dysdiadochokinesia and dysmetria?

A

0 (normal) to 4 (severe)

101
Q

what is a 1 for dysdiadochokinesia and dysmetria?

A

slight

s/s cause no impact on fxn

102
Q

what is a 2 for dysdiadochokinesia and dysmetria?

A

mild

s/s cause modest impact on fxn

103
Q

what is a 3 for dysdiadochokinesia and dysmetria?

A

moderate

s/s impact considerably, but don’t prevent fxn

104
Q

what is a 4 for dysdiadochokinesia and dysmetria?

A

severe

s/s prevent fxn

105
Q

what are the fine motor control assessments used for cerebellar disorders?

A

9 hole peg test

perdue peg board

106
Q

what is the 9 hole peg test?

A

test for motor timing and accuracy

pegs taken from cup to board and back to cup with each UE

107
Q

what is the perdue pegboard test?

A

assessment for gross and fine finger dexterity strongly correlated with the UPDRS

involves assembly of pieces using each and both UEs

108
Q

what are the 3 components for interventions for proximal stability?

A

stability

controlled mobility

variable velocities

109
Q

how can we improve gait in cerebellar disorders?

A

by working on BALANCE

110
Q

what are the key considerations for intervention planning with cerebellar disorders?

A

motor learning optimization

safety and fall prevention

task-specific training of primary impairments

compensatory strategies (particularly for ADLs)

adaptive equipment needs

environment modifications

pt/caregiver education

interdisciplinary collaboration

long-term management strategies

111
Q

what are the goals of interventions in cerebellar disorders?

A

maximize fxn and safety

maintain independence

prevent complications

112
Q

t/f: we use pre-gait a lot in cerebellar populations

A

true

113
Q

what are good pre-gait positions to use in cerebellar populations?

A

quadruped

tall kneeling

1/2 kneeling

114
Q

what are motor learning challenges in cerebellar disorders?

A

impaired adaptation

difficulty with error detection and correction

115
Q

t/f: we are looking for ERRORLESS performance in cerebellar treatment

A

true

116
Q

what are some strategies for motor learning in cerebellar disorders?

A

use dependent learning (repetition to strengthen motor plans through neuroplasticity)

reward-reinforcement learning (engaging the BG to bypass impaired cerebellar circuitry)

conscious control strategies (verbal cues and visual feedback)

challenge-oriented treatment (gradually increase takes difficulty)

117
Q

t/f: we have to stabilize vision with nystagmus

A

true

118
Q

t/f: if the cerebellum isn’t totally destroyed, neighboring areas of the cerebellum can adapt or compensate for the impaired components

A

true

119
Q

what are some mechanisms of recovery after CNS lesions?

A

neural sprouting

fxnal reorganization

substitution

plasticity

120
Q

how should we include gaze stability and vision control exercises in interventions for cerebellar disorders?

A

incorporate visual activities into fxnal activities for anyone w/visual ataxia

121
Q

what are some interventions for proprioceptive loss in cerebellar disorders?

A

theraband pants and vest

propriceptive balance-based torso-weighting (BBTW) vest

approximation, heavy WB

122
Q

how can we stabilize pts with cerebellar disorders?

A

add proprioceptive input

123
Q

what is a BBTW vest?

A

strategic placement of small weights on the torso to counter balance the pts directional instability

124
Q

t/f: BBTW vest has immediate effects on stability

A

true

125
Q

t/f: BBTW vest allows for extensive practice and reduced errors for both sensory and cerebellar ataxia

A

true

126
Q

is there evidence to support weights for increased stability?

A

not currently

127
Q

what are interventions for trunk control and proximal stability?

A

PNF

CKC UE exercises (heavy WB)

trunk/core stability

BBTW vest

128
Q

what PNF techniques can be used for stability?

A

slow dynamic reversals and holds

alternating and rhythmic stabilization

overflow and irradiation

COIs

129
Q

what is the progression of positions to work through for trunk stability?

A

supine–>sitting–>tall/1/2 kneeling–>standing–>walking

130
Q

is pushing or pulling better for trunk stability in cerebellar disorders?

A

pushing, pulling may cause more errors

131
Q

what is the difference bw internally generated perturbations and externally generated perturbations?

A

internally generated perturbations are a response to self-generated challenges exceeding their capabilities from increased sway, change in body position, increase speed, or increased range (less weight)

externally generated pertubrations are a response to an increase/variable weight/force/resistance, or unpredictable surface change (more weight)

132
Q

what are some interventions for gait training in cerebellar disorders?

A

body weight supported treadmill training

split belt treadmill training

overground gait training w/visual gaze stabilization

harness based training

dual task training

added metronome or music for timing control

133
Q

t/f: split belt treadmill training has potential for improving step length symmetry

A

true

134
Q

t/f: split belt treadmill training improves 10mWT and standing balance

A

true

135
Q

t/f: split belt treadmill training improves interlimb coordination

A

false, it does not

136
Q

what are the focuses of gait training in cerebellar populations?

A

improving gait parameters (speed, step length, BOS)

enhancing dynamic balance during gait

practicing fxnal mobility tasks

137
Q

what are some interventions for coordinated muscles fxn in cerebellar disorders?

A

Frenkel exercises

task specific training

technology-assisted interventions

138
Q

what exercises work on the pts OWN coordination of muscles activity with slow coordinated movt w/even timing and are often given in an HEP?

A

Frankel exercises

139
Q

what are the Frankel exercises?

A

I will add these later after class thursday

140
Q

what positions are the Frankel exercises performed in?

A

lying

sitting

standing

walking

141
Q

what is the progression in Frankel exercises?

A

independent–> unilateral–> bilateral

DPT 620: Neuro (13 decks)

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