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PT Rehab II > Movement Dysfunctions with Cerebellar Damage > Flashcards

Movement Dysfunctions with Cerebellar Damage Flashcards

1
Q

Damage can occur from:

A

Stroke, Tumor, Degenerative Disease, Trauma

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2
Q

The most remarkable and debilitating effect of damage to the cerebellum is:

A

Ataxia

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3
Q

Hallmark features of cerebellar damage:

A

Incoordination of movements without obvious muscle weakness

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4
Q

A stroke to the superior cerebellar artery would present with:

A

Dysmetria of ipsilateral arm movements, unsteadiness in walking, dysarthritic speech, and nystagmus

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5
Q

A stroke to the anterior inferior cerebellar artery would present with:

A

Cerebellar and extracerebellar signs (involvement of the pons) including dysmetria, vestibular signs and facial sensory loss

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6
Q

A stroke to the posterior inferior cerebellar artery would present with:

A

Initially: vertigo, unsteadiness, walking ataxia, and nystagmus

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7
Q

True or False: A stroke affecting the anterior inferior cerebellar artery is the most benign type of cerebellar stroke.

A

False; posterior inferior cerebellar artery is the most benign

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8
Q

True or False: Tumors in the posterior fossa occur more often in children.

A

True

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9
Q

True or False: Children with cerebellar tumors often have a worse prognosis than those in adults

A

False; Children with cerebellar tumors often have a good prognosis than those in adults

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10
Q

What factor regarding cerebellar tumor damage predicts recovery?

A

Damage of the deep cerebellar nuclei predicts recovery (more than age)

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11
Q

True or False: Spinocerebellar ataxias have onset in midlife and are slowly progressive

A

True

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12
Q

How long to periods of hereditary episodic ataxias last?

A

Minutes to hours

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13
Q

How are hereditary episodic ataxias triggered?

A

Exercise, stress, or excitement

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14
Q

What are examples of structural cerebellar damage?

A

Chiari Malformation, agenesis, hypoplasia

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15
Q

What are examples of cerebellar damage by toxicity?

A

Alcohol, heavy metals, drugs

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16
Q

What are examples of immune-mediated cerebellar damage?

A

Multiple sclerosis, gluten ataxia

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17
Q

What defines dysmetria?

A

Impaired ability to properly scale movement distance

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18
Q

True or False: Many clients with cerebellar lesions will show only hypermetric dysmetria.

A

False; many clients with cerebellar lesions will show both hypermetric and hypometric forms of dysmetria

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19
Q

True or False: Cerebellar Dysmetria is greatly exacerbated during multijoint reaching condition.

A

True

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20
Q

True or False: Only hypermetria is greatly exacerbated during the multijoint reaching condition

A

False; both types of dysmetrias should be seen in the multijoint reaching condition

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21
Q

What defines dyssynergia?

A

Movements of specific segments are not properly sequenced (in range or direction)

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22
Q

True or False: Clients may show greater impairments during single joint movements than multi-joint movements

A

False; greater impairments are more seen in multi-joint movements

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23
Q

True or False; Dyssynergia appears to be related to dysmetria

A

True

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24
Q

What defines decomposition?

A

Breaking down a movement sequence into a series of separate movements, each simpler than the combined movement.

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25
Q

What does decomposition reflect more of?

A

Compensatory strategy for dealing with impaired multijoint movements than it does a primary sign of cerebellar damage

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26
Q

What does “without order” mean?

A

Without order means that you have no sequence to a movement

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27
Q

What is the vestibulocerebellum’s function?

A

Balance control, posture, control of gaze

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28
Q

What is the spinocerebellum’s function?

A

Posture, coordination

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29
Q

What is the cerebrocerebellum’s function?

A

Coordination, motor learning, initiation of movements

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30
Q

What are tumors usually treated with?

A

Surgical resection, chemotherapy, radiation therapy, or a combination of the three

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31
Q

True or False: Most SCAs have onset in early life and are slowly progressive.

A

False; most SCAs have onset in midlife and are slowly progressive

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32
Q

What defines as dysdiadochokinesia?

A

Deficit in the coordination between agonist-antagonist muscle pairs elicited during voluntary rapid alternating movements

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33
Q

What is dysdiadochokinesia caused by?

A

Poor regulation of timing of cessation of agonist muscle activity and the initiation of antagonist muscle activity

34
Q

How can you tell if someone has dysdiadochokinesia?

A

Excessive slowness along with the inconsistency in the rate and range, worsen as the movement continues

35
Q

What defines lack of check?

A

Inability to rapidly and sufficiently halt movement of a body part after a strong isometric force (sudden release)

36
Q

What is the rebound test?

A

Applying resistance to the agonist muscle and see if they are able to come to a complete halt or “check” unintended movement

37
Q

What causes a lack of check?

A

Delayed cessation of agonist and/or delayed activation of antagonist muscles

38
Q

Tremors involve:

A

Fast agonist and antagonist contractions

39
Q

Action tremors are associated with cerebellum damage; what are the two types of action tremors that we see with cerebellum damage?

A

Postural Tremor and Kinetic Tremor

40
Q

What is a postural tremor?

A

Postural tremor occurs in muscles maintaining a static position against gravity

41
Q

What is a kinetic tremor?

A

Kinetic tremor occurs in muscles producing an active voluntary movement (occurs at relatively low frequencies (~2-5 Hz)

42
Q

What is an Intention Tremor?

A

A specific form of kinetic tremor that occurs during the terminal portions of visually guided movements toward a target.

Whenever you get closer to the target, the tremor increases. Requires more focus and corrective movements

43
Q

What drives multiple corrective movements with intention tremor?

A

Visual feedback

44
Q

How can Intention Tremor be decreased in clients?

A

Adding an inertial load to the limb

45
Q

What causes hypotonia and what pathways are affected?

A

Decreased excitatory drive to vestibulospinal and reticulospinal pathways

46
Q

True or False: Hypotonia usually manifests as a decrease in the flexor tone necessary for holding the body upright against gravity

A

False; Hypotonia usually manifests as a decrease in the extensor tone

47
Q

What do we typically see with those who have postural instability?

A

Increased postural sway, excessive or diminished postural responses to perturbations, poor control of equilibrium during voluntary movements of the head, arms or legs

48
Q

What is a titubation?

A

Abnormal oscillations of the trunk

49
Q

What are the signs of gait ataxia?

A

Walking is slowed, steps are short, irregular in timing and unequal in length

50
Q

Gait ataxia leads to falls, which direction do these patients typically fall?

A

Backwards and towards the side of the lesion

51
Q

True or false: the trajectory of walking is more predictable with difficulty with stops or turns.

A

False; The trajectory of walking is less predictable with difficulty with stops or turns

52
Q

What are saccadic pursuits?

A

“Choppy” pursuit; Fixation between two points

53
Q

What characterizes saccadic pursuits?

A

Hypermetric or hypometric; slowed

54
Q

True or false: with oculomotor deficits, the ability to cancel the VOR may be impaired or absent.

A

True

55
Q

What would abnormal nystagmus look like with someone who has oculomotor deficits?

A

Could see choppier movements, overshooting/undershooting between two points

56
Q

What’s the difference between saccades and VOR?

A

Saccades: eye movement between two points

VOR: Eyes fixated on one point with movement on the head and body

57
Q

What do speech impairments involve?

A

Planning and prediction of movements rather than the execution of speech components

58
Q

What is ataxic dysarthria?

A

Impaired articulation (the correct pronouncement of speech sounds) or impaired prosody (the pattern of stress & intonation of certain syllables or words)

59
Q

True or False: Patients with cerebellar dysfunction have a reduced capability of motor adaptation.

A

True

60
Q

Cerebellum-dependent motor learning is driven by errors directly occurring during the movement… do the knowledge of results matter?

A

Not really.

61
Q

True or False; Cognitive roles exist with the cerebellum

A

True

Functional imaging studies showed increased cerebellum activation during tasks with a predominant cognitive component such as language processing

62
Q

What are five of the many factors that can determine the extent of recovery?

A

Source of damage

Severity, location and volume of damage

Presence or absence of damage to other brain regions

Presence or absence of other co-existing medical conditions

Age

63
Q

What are tests for muscle tone?

A

Hypotonia: postural extensor muscle groups

64
Q

What are tests for oculomotor performance?

A

Smooth pursuit

Saccades

Gaze-evoked nystagmus

65
Q

How many specific activities are listed on the International Cooperative Ataxia Rating Scale?

A

The ICARS lists 19 specific activities or movements using an ordinal scale.

66
Q

What are the subscales listed on the ICARS?

A

Posture & gait, limb movements, speech, oculomotor performance

67
Q

What is the total score range for ICARS?

A

Total score ranges from 0 (no ataxia) to 100 (most severe ataxia)

68
Q

Would you rather administer the Scale for the Assessment and Rating of Ataxia or the International Cooperative Ataxia Rating Scale if you were crunched on time?

A

The SARA; there are only 8 items;

Total score ranges from 0 (no ataxia) to 40 (most severe ataxia)

69
Q

What is the progression for VOR?

A

Visually fixate on stationary target, slow head movements

Visually fixate on target moving in opposite direction, slow head movements

Visually fixate on target moving in same direction, slow head movements

70
Q

What are ways to make things more challenging for VOR?

A

Increase and vary speed

Perform eyes closed (necessary for imagery)

Add complexity to background

71
Q

What would be the progression from standing on foam with feet apart, arms across chest, eyes closed briefly and intermittently?

A

Narrow BOS, increase time with eyes closed

72
Q

What would be the progression from narrow BOS, increase time with eyes closed?

A

Semitandem stance, arms across chest, eyes closed briefly and intermittently

73
Q

What do slower movements lead to as compensatory strategies?

A

Less dyssynergia and less hypermetria with movements

74
Q

What assistive device would be best for a compensatory strategy for uncoordinated gait?

A

Rolling or hemiwalker

75
Q

Adding weights would help with the coordination of multijoint movements, but what would happen once the weight is removed?

A

The coordination can worsen, increasing the amplitude after removing the weight.

76
Q

What are Frenkel Exercises?

A

A series of motions of increasing difficulty performed by ataxic patients to facilitate the restoration of coordination

77
Q

What are the three components for movements in regards to Frenkel Exercises?

A

Concentration of attention, repetition, and precision

78
Q

What is the progression for Frenkel Exercises?

A

Initially: speed, range, complexity of the exercise

Later: Speed of consecutive movement, stopping and starting to command

Lying > sitting > standing > walking

79
Q

How can intention tremor be tested?

A

By repeating the test movement with eyes closed; which the tremor is significantly reduced during isometric conditions or when vision is removed

80
Q

How does hypotonia manifest?

A

As a decrease in the extensor tone necessary for holding the body upright against gravity

81
Q

What is defined as impaired articulation?

A

Incorrect pronouncement of speech sounds

82
Q

What is defined as impaired prosody?

A

The pattern of stress and intonation of certain syllables and words

PT Rehab II (5 decks)

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