Chapter 2: Cerebellar Disorders

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Author:
dmshaw9
ID:
298134
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Chapter 2: Cerebellar Disorders
Updated:
2015-03-10 22:59:06
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Cerebellar Disorders
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NPTE,Chapter2
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NPTE: Chapter 2
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  1. Diseases/Lesions of the Cerebellum
    • Hereditary ataxia, Friedreich's ataxia
    • Neoplastic or metastatic tumors
    • Infection
    • Vascular stroke 
    • Developmental = ataxic CP, Arnold-Chiari syndrome
    • Trauma = TBI
    • Drugs, heavy metals
    • Chronic alcoholism
  2. Cerebellar lesions tend to produce ______ signs and symptoms
    Ipsilateral
  3. Lesions of the Archicerebellum
    • Central vestibular symptoms: ocular dysmetria, poor eye pursuit, dysfunctional VOR, impaired hand-eye coordination
    • Gait and trunk ataxia: poor postural control and orientation, wide-based gait
    • Little change in tone or dyssynergia of extremity movements
  4. Lesions of Paleocerebellum
    • Hypotonia
    • Truncal ataxia: dysequilibrium, static postural tremor, increased sway, wide BOS and high guard arm position; posture worse with eyes closed and narrow BOS (sharpened Rombeg)
    • Ataxic gait: unsteady, increased falls, uneven/decreased step length, increased step width
  5. Lesions of the Neocerebellum
    • Ataxic limb movements
    • Intention tremor
    • Dysdiadochokinesia: impaired RAM
    • Dysmetria: hypermetria (overshooting), errors or force, direction, amplitude, rebound phenomenon
    • Dysynergia: abnormal timing, movement decomposition of agonist/antagonist interactions, impairment of multipoint coordination
    • Errors in timing related to perceptual tasks
  6. Additional Impairments
    • Asthenia: generalized weakness (F to G muscle grades)
    • Hypotonia: especially in acute cerebellar lesions, difficulty with postural control of proximal (axial) muscles
    • Motor learning impairments: decreased anticipatory control, feedback, and learning delays
    • Cognition: deficits in information procession, attention deficits
    • Emotional dysregulation: changes in emotional behaviors
  7. PT Goals
    • Improve accuracy of limb movements
    • Improve postural stability and dynamic postural control
    • Improve functional mobility and safety
    • Stabilize VOR/vision
  8. PT Interventions:
    • Head-eye coordination exercise: slow head movements with visual fixation, active eye and head movements
    • Stability exercises: WB postures, carefully graded resistance, and approximation to promote steady holding; use TB, weights, and walkers to decrease ataxic movements
    • Dynamic stability exercises: promote small range control, smooth reversal of movement
    • Locomotor training: TT with BWS 
    • Therapeutic pool: water provides graded resistance, decreases ataxic movements and postural instability
    • Coordination exercises: PNF, ball gymnastics to promote balance
    • Stationary bike: reciprocal movements
    • Motor learning strategies: low-stimulus (closed) environment ideal, practice and repetition 
    • Biofeedback: augmented feedback to enhance stability and postural control

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