Movement Disorders Cbm Flashcards by Alex Stein

Massive amounts of ___ info enters the cbm

sensory

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Cerebellar output is vital for

normal movement

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Sever damage to cbm does NOT interfere with

sensory perception

muscle strength

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Severe damage to cbm interferes with

postural control

coordination of movement

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Cerebellar clinical disorders

Stroke
Tumors
Degeneration - acquired, hereditary

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Vestibulocerebellar

Output to vestibular nuclei to impact eyes and postural control

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Spinocerebellar

Vermis (trunk, posture?)
Paravermis (limbs?)
Gait and limb ataxia

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Cerebrocerebellar

Higher order deficits

Connected with motor cortex

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Unilateral lesions of the cbm affect which side of the body

same side

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Why are cbm sign ipsilateral

double crossing of cerebellar efferents and the red nucleus descending tracts

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Ataxia is what

without order

a movement disorder common to most lesions of the cbm

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Ataxia describes what

the voluntary, normal strength, jerky, and inaccurate movement that are not caused by spasticity or contracture

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Ataxia - common s/s

disorganized
poorly coordinated
clumsy

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What are the D’s of ataxia

Dysdiadochokinesia
Dysmetria
Decomposition

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Rebound, impaired check - why

impaired agonist/antagonist - losing the muscle spindle/GTO integration in the cbm

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Differentiating cerebellar from somatosensory ataxia

Not all ataxia is caused by cerebellar lesions

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If not a cerebellar lesion, what else can cause ataxia

interference with transmission of somatosensory information to the cbm with by lesions of spinocerebellar tracts or by peripheral neuropathy

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What tests can be used to differentiate between cerebellar and somatosensory ataxia

Romberg
Proprioception tests
Vibration sense
Ankle reflexes

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Romberg test measures what

the ability to use proprioceptive info for standing balance

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Criteria for failure of Romberg

moving the arms to maintain balance
opening the eyes during ec
beginnin to fall
requiring assistance

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Romberg - sensory ataxia

they will be able to stand steady with feet together and EO for 30 sec, but impaired balance with ec

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Romberg - cerebellar ataxia

impaired balance no matter what

normal vibratory sense, proprioception, and ankle reflexes

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Muscle strength - cerebellar lesion

normal

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Muscle bulk - cerebellar lesion

normal

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Involuntary mm contraction - cerebellar lesion

none

Muscle tone - cerebellar lesion

normal

movement speed and efficiency - cerebellar lesion

ataxic

postural control - cerebellar lesion

depends on location of lesion

Stroke can be

ischemic or hemorrhagic | Hemorrhagic is generally worse outcomes

Stroke - what arteries

SCA AICA PICA

Where does SCA come off of

basilar

where does AICA come off of

basilar

where does PICA come off of

vertebral

What percentage of all strokes are cerebellar

Less than 5%

Onset - cerebellar stroke

HA, nausea, vomit | Vertigo, nystagmus, ataxia, tremor

Studies on cerebellar stroke show what with outcome measures

Recovery is generally good!

stroke - Admission FIM score is generally higher in who

ischemic | BUT no statistical difference in d/c FIM

stroke - Better prognosis associated with who

those that presented with HA, vomit, nausea, BUT NOT weakness or impaired conciousness

Stroke - better prognosis with what arteries

AICA and PICA

Complications of cerebellar stroke

hydrocephalus | brain stem compression

Tumors - astrocytomas common with

children | 19-33% of all childhood tumors

Tumors - astrocytomas - metastasis?

Slow growing and generally do not metastasize

Tumors - astrocytomas - s.s

Ipsilateral limb ataxia dysmetria gait ataxia maybe also nystagmus

Tumors - astrocytomas - prognosis

Good with removal of the tumor

Tumors - medulloblastoma - what is it

Cancerous tumor that starts in the region of the brain at the base of the skull called the posterior fossa

Tumors - medulloblastoma - tends to spread where

brain and spinal cord

Tumors - medulloblastoma - how common is it

most common malignant brain tumor of childhood 250-500 cases a year in US more in M than F Usually under age 16

Tumors - medulloblastoma - signs and symptoms

HA, morning nausea, vomit that gets worse, clumsiness, problems with handwriting, visual problems

Tumors - medulloblastoma - signs and symtpoms if spread to spinal cord

back pain, trouble walking, problems controlling bowel and bladder functions

Tumors - medulloblastoma - does it spread

Yes

Tumors - medulloblastoma - how do you know if it spread

LOOK UP MORE | s/s

Tumors - medulloblastoma - treatment

Surgery Radiation therapy Chemotherapy

Tumors - medulloblastoma - survival rates

depend on age and how much spread If has not spread - about 70-80% If has spread to sc - 60% Children under age 3 have lower survival rate because their disease is more aggressive

Diseases that cause cerebellar degeneration can also involve other areas of the CNS including

the spinal cord, medulla oblongata, cerebral cortex, brainstem

Cerebellar degeneration may be the result of

inherited genetic mutations that alter normal production of proteins that are needed for survivial of neurons OR it can be acquired

Spinocerebellar ataxias (SCA)

Group of disorders - hereditary and progressive 60 diff types of gene mutations All will end up wc bound and PT will be compensatory

Acquired cerebellar degeneration can be from

Chronic alcoholism Fetal alcohol syndrome Small cell lung CA, ovarian CA

Acquired cerebellar degeneration - chronic alcoholism

Chronic alcohol use can lead to damage of the cbm due to nutritional deficiencies, thiamin B1 deficiency P cells more vulnerable if thiamine deficient

Acquired cerebellar degeneration - FAS

Hypoplasia, dysgenesis of cbm (incomplete or abnormal dev) | Cbm is so involved and vulnerable during development so gets targeted with FAS

Acquired cerebellar degeneration - Small cell lung CA, Ovarian CA

Cancers cause remote effects in cbm | Death of P cells

PT in cerebellar dysfunction - is it effective

YES

PT in cerebellar dysfunction - what do we do

Visual fixation on a stationary target Active eye head movements btw 2 stationary targets Visual fixation on moving target (VOR cancellation) Visual fixation on moving target (gaze stability) Imaginary visual fixation