Cerebellar Ataxia

Question 1

Quais as principais funções do cerebelo?

Answer 1

• Wide range of tasks, including sensorimotor control, language, spatial and executive functions.
• Different regions of the cerebellum process information from different domains.
• Influences through projections to other motor areas.
• Key role in motor learning and adaptation.
• Effects proprioception but only during active movement.

There is no evidence that other motor areas can approximate the role of the cerebellum - no plasticity.

Question 2

Então que disfunções pode causar uma lesão cerebelar?

Answer 2

As cerebellum manages and calibrates/predicts where you are, a damage results in inability to internally adjust and an abnormal pattern of movement (feed forward).

Damage also impairs timing or amplitude scaling in the agonists, the antagonists, or both – Unable to produce muscles torques that predict, accommodate, and compensate for dynamic interactions.

Question 3

Qual é a diferencia entre ataxia sensorial e a ataxia cerebelar?

Answer 3

• Sensory is due to the loss of proprioception.
• Distinguish between the two by comparing the movement with eyes open and eyes closed.
• If the problem is sensory ataxia, presentation will worsen with eyes closed, compared to cerebellar ataxia.

Question 4

Quais os sintomas da ataxia cerebelar?

Answer 4

• Ataxia – Incoordination of movement;
• Dysmetria – Overshooting (hyper, go past a point unintentionally, especially through traveling too fast or being unable to stop) or undershooting (hypo) target during rapid tracking movements;
• Tremor – Intention tremor, postural tremor, titubation (head and neck);
• Dyssynergia – Decomposition of multijoint movements;
• Dysdiadockokinesia – Inability to alternating tapping;
• Weakness and fatigue;
• Nystagmus – Abnormal eye movements.

Question 5

Porque é que as pessoas com lesões no cerebelo tem grande risco de queda?

Answer 5

Lack of anticipatory adjustments will result in a high risk for falls when the patient performs self-generated movements – If they don’t anticipate leaning forward when preparing to stand up on toes will result in them pushing themselves backwards.

Question 6

Que achados costumam estar presentes na marcha deste tipo de utentes?

Answer 6

• Prolonged time in double stance;
• Poor inter-limb coordination;
• Increase in variability in both stride length and individual joint kinematics;
• Dysmetria and dyssynergia affecting lower extremities;
• High incidence of falls.

Question 7

E no que diz respeito à intervenção?

Answer 7

• Research to guide choices is weak with few outcome measures consistently utilized, lots of case reports or small case series and poor methodological scoring.
• Some Considerations:
– Compensatory Approaches
– Task specific training
– Gait/Balance Training
– Proximal Strengthening
– Intensive Coordinated Training