Ataxia

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brau2308
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273005
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Ataxia
Updated:
2014-05-03 16:24:04
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ataxia neuro
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review of ataxia lecture 4-18 from neuro
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  1. Ataxia is most frequently caused by _______ damage.
    cerebellar
  2. The cerebellum can be damaged by:
    • brain injury
    • CVA
    • MS
    • end-stage alcoholism
  3. What does cerebellum mean?
    little brain
  4. The cerebellum has a large role in:
    • motor learning
    • motor control
    • connecting regions of the brain and spinal cord
  5. The cerebellum is responsible for:
    • coordinating movement
    • planning
    • motor actvities
    • learning and remembering
    • physical skills
    • some cognitive function
  6. The size of this brain region w/in any mammal species is a good indicator of:
    its physical capability
  7. The cerebellum controls movement by:
    collecting sensory nerve inputs, such as limb position, blaance info, and vision, and synthesising them together to control movement by sending nerve transmissions down motor nerve outputs
  8. In the cerebellum, learning physical tasks is largely:
    • trial and error
    • This learning is stored into cerebellar memory
  9. Why do we never forget certain skills such as riding a bike?
    cerebellar memory
  10. There is some evidence that mental activities are also co-ordinated in the cerebellum which could explain why:
    cognitive dysfunction is sometimes associated w/ damage to the cerebellum
  11. The cerebellum is divided into ____ hemispheres by the ______ _____.
    • two
    • central vermis
  12. The suface of each hemisphere is made up of:
    grey matter surrounding a large mass of white matter (nerve cells w/ myelinated axons)
  13. The whole structure of the cerebellum is connected to the rest of the CNS by three very broad tracts of white matter called the:
    cerebellar peduncles
  14. What are the cerebellar peduncles?
    brachium pontis which connects to the pons, the restiform body which connects to the medulla, and the brachium conjunctivum which connects to the mesencephalon
  15. The cerebellum plays an important role in movements which require:
    • careful timing and interaction of many mm
    • maintaining posture
    • walking
    • eating
    • playing musical instruments
    • tracking movements with the eyes
  16. Individuals w/ cerebellar damage may still be able to walk, gesture and eat, but the movements may appear...
    difficult and clumsy
  17. In the cerebellum, connections to the motor systems are:
    ipsilateral
  18. In the cerebellum, connections w/ the cortex and other brain structures are:
    contralateral
  19. Damage to the cerebellum affects motor control on ______ side of the body.
    ipsilateral
  20. The cerebellum communicates with the rest of the brain through 3 sets of _________.
    nuclei
  21. When the cerebellum is damaged, quite predictable syndromes can result. This include:
    • predictable ataxia
    • muscle tone problems
    • incoordination
    • among others
  22. Doctors and other health care professionals frequently refer people w/ cerebellar ataxia to OT and PT to assist w/:
    function
  23. Ataxia:
    incoordination or clumsiness of movement that is not the result of muscle weakness
  24. Ataxia can affect:
    • gait
    • UE
    • LE
    • speech
    • eye movements
  25. How do people react to ataxia?
    • automaticity is gone
    • the movements of my normal arm are done subconsciously, but I have to think out each movement of my affected arm. 
    • can't do anything at the same time (walking and chewing gum)
  26. Causes of cerebellar ataxia:
    • result of damage to cerebellar input and output structures
    • -thalamus
    • -vestibular nucleus
    • -result of sensory neuropathy
  27. Medial and intermediate zones of the anterior lobe appear to control:
    • equilibrium
    • involved in gait and stance
  28. People w/ lesions to the medial and intermediate zones of the anterior lobe have difficulty w/:
    • standing still
    • walking
    • higher level gait
  29. Lateral cerebellar structures control:
    • multijointed limb movements especially reaching and pinching
    • movement to visual targets
  30. People w/ lesions to the lateral cerebellar structures have difficulty with:
    ADLs
  31. What is the oldest lobe in the cerebellum?
    flocculonodular lobe
  32. Flocculonodular lobe is highly connected w/ the ______ system.
    vestibular
  33. Lesions to the flocculonodular lobe cause what disruptions?
    • balance and equilibrium
    • pronounced oculomotor disturbances
    • produce most severe mobility
  34. What might you observe in a client w/ ataxia during an assessment?
    • balance and equilibrium problems
    • muscle tone changes
    • dysmetria
    • movement decomposition
    • tremor
    • eye movements
    • dysarthria
  35. Ataxia:
    balance and equilibrium problems-
    • increased postural sway
    • delayed equilibrium reactions
    • lack of response to environmental cues
    • loss of motor learning about gait
  36. Ataxia:
    muscle tone changes-
    in isolation, cerebellar lesions generally produce hypotonicity...however lesions are seldom in isolation
  37. Patients can correct hypotonicity w/ attention to:
    the task at hand, but when attention is diverted, the limbs get weak
  38. The problem of muscle tone is essentially a decrease in the ability to:
    • stabilize a limb...thereby making distal movements almost impossible
    • joint coordination w/in limbs become very difficult
  39. When the limb is supported, it is easier to do:
    smaller tasks
  40. If part of the limb is supported, the rest may be able to:
    • move quite appropriately
    • this may clue you into an intervention technique
  41. dysmetria:
    deficit in reaching a target
  42. Clients w/ dysmetria can't control:
    direction, extent, force, or liming of limb movement...all functions of the cerebellum
  43. Dysmetria is tested clinically by:
    the finger to nose test
  44. Sudden release of force by examinar (as in a MMT) can lead to:
    extreme movement
  45. People w/ dysmetria can't make appropriate...
    anticipatory control movements
  46. People w/ dysmetria lack the ability to:
    • dampen and control multi-joint activities
    • including reaching grasping and gait
  47. Movements of the shoulder in people with dysmetria thus become separated from movements of the:
    • elbow
    • movements of the knee become separated from the hip
  48. Strength of grip is not appropriate for the task at hand for people with dysmetria.
    People w/ ataxia will crush a paper or styrofoam cup if they walk while carrying it
  49. Movement decomposition
    inter joint movements are disconnected
  50. Dysdiadochokinesia:
    inability to perform rapid alternating movements -- loss of range and  rhythm
  51. Bastian speculated that decomposition of movement may actually be a compensatory strategy that reduces..
    the complexity of the multijointed movement
  52. Adiadochokinesia:
    inability to make rapid, alternating movements of a limb and seems to reflect abnormal agonist- antagonist muscle control
  53. Tremor
    • attention tremor
    • postural tremors can occur
  54. Postural tremors:
    people are unable to hold a posture against resistance, or are unable to stabilize an arm or leg on a stable trunk w/ or w/o resistance
  55. resting tremor:
    midbrain
  56. intentional tremor
    cerebellar
  57. Eye movements:
    deficits include nystagmus, impaired ability to smoothly track objects, and abnormal vestibulo-ocular reflex (VOR)
  58. How do clinicians test eye movements of clients?
    ask them to track moving objects and to fixate on objects while turning their heads back and forth
  59. dysarthria
    • difficulty in controlling the mm (including vocal cords) that control speech
    • speech is distorted, slurred, or difficult to understand
  60. Testing for ataxia: Primary importance is functional testing-
    • bed mobility and posture
    • ability to move supine to sit
    • maintain a sitting posture
    • sit to stand
    • maintaining a standing posture
    • ambulation
    • dress, groom, eat, toilet, etc
  61. Clinical tests for ataxia:
    • postural sway
    • -in quiet standing
    • -w/ eyes closed
    • -w/ feet close together
    • gait analysis
    • reaching analysis
    • sensory testing
    • strength testing
    • endurance testing
  62. Cerebellar Clinical testing
    • finger-to-nose test
    • to maximally elicit deficits, make sure that the finger-to-nose test require movement at more than one joint
    • people w/ ataxia tend to move more normally when they limit movement to only one joint
  63. Intervention: therapist need to synthesize the results of assessment
  64. what systems are involved?
    what systems are intact?
  65. Intervention - things that help:
    • require compensation
    • little to NO neuro-plasticity exists in cerebellum
    • tend to worsen over time and w/ normal aging
    • add an assistive device
    • add splints and orthotics
    • add bracing if possible
    • use power mobility
    • modify the household
    • change tasks and make ADLs easier
  66. Specific intervention:
    • change movement patterns (reduce number of joints needed to control; reduce speed of movement)
    • strength and endurance training
    • if sensation not involved, teach clients to compensate w/ either vision, or by conscious proprioception

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