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Flashcards in Ataxia Deck (19):
1

Define Ataxia

Abnormal coordination that affects T.A.A.F (timing, amplitude, accuracy, and force of movements)

2

List ataxic motor impairments

Dysmetria
Rebound phenomenon
Dysdiadochokinesia
Dyssynergia
Tremor
Hypotonia
Dysarthria (red coordination of speech mm's)
Nystagmus (oscillatory movements of the eyes; sign of vestibular dysfunction)

3

Define dysmetria

Reaching a target precisely and with speed; disorder of movement termination (where you overshoot or undershoot the target; hyper or hypometria)

4

Define Rebound phenomenon

Delayed antagonist response

5

Define dysdiadochokinesia

reduce coordination of RAPID ALTERNATING MOVEMENTS

6

Define dyssynergia

Loss of smoothness, joints moving independently of each other or at abnormal rates; reduced coordination of antagonists + agonists

7

Adaptive motor behaviours - UL

1. excessive preshaping
2. use of support surface to brake the reach

*restricted amplitude of movement
*restricted degrees of freedom of movement
*increased variability of performance from trial to trial

8

Adaptive motor behaviours - LL

1. wide BOS
2. excessive use of the arms
3. excessive stepping when standing
4. faster walking
5. difficulty slowing down

*restricted amplitude of movement
*restricted degrees of freedom of movement
*increased variability of performance from trial to trial

9

Palliyath et al (1998) - this study charted the force production at the ankles, knees, and hips - what did they find?

Reduced amplitude of movement - especially noticeable at the ankles (and hips)

10

Bastian et al (1996) - had people point to a target in front of them so their hand had to take a path to the object. Pt is instructed to just be accurate or FAST + accurate. What did they find?

Regardless of speed, the control group path of movement was more direct and precise; not so with the cerebellar lesion group - and this group overshot the target when fast movement is instructed

CLINICAL IMPLICATION - whote task training where possible that stresses speed and accuracy; sometimes you'll have to modify as necessary

11

Bastian et al (2000) - this study had pt's move their hands to a target at 1 joint whilst the elbow was supported and unsupported. What did they find?

For controls - good accuracy regardless of support
For patients - much better accuracy with elbow supported

CLINICAL IMLPLICATION: fixing a joint improves accuracy but not great for learning; so if they have potential for relearning skills stopping them using the support will aid with coordination

12

Deiner & Dichgans (1992) - this study had people to a calf raise. What did they find?

In normal people - TA came on first, then quads, then plantar flexors; mm's reached peak quickly

In cerebellar patients - although the same SEQUENCING was present, took a long time to reach peak force prod

CLINCAL IMPLICATION: whole task training; focus on power + timing

13

Lang & Bastian (2002) - this study had people do a figure 8 (25 x 8s) pattern with and without concurrent auditory vigilance task. What did they find?

The cerebellar group did get better with practice but as soon as the auditory task was introduced they fell apart.

IMPLICATIONS - cerebellar patients DO improve with practice but you cant assume that they will perform as well with added cognitive tasks/distractions as without

14

Klintsova et al (1998) - investigated the effect of rehab motor training on rats that had their cerebellum destroyed. Groups were divided into 1) Inactive, 2) Motor Control (rats walk on a flat surface with no challenges), 3) Rehab motor skill training (walking with challenges). What did they find?

The rehab motor skill group fared better and histologically there was more connections in the cerebellum

IMPLICATION - exercises need to be COMPLEX to stimulate improvement!

15

Langton Hewer et al (1972) - Added weights to upper limb to see how it affected the trace of a hand moving to a target. What did they find?

Addition of weights = reduced intention tremor in 58% of subjects

16

Manino (2003) - investigated the effects of weights on intention tremor and task performance. What did they find?

Weights improved intention tremor but not task performance; due to stiffening of limb not increase in coordination

IMPLICATION - use weights as adaptive strategy; but must train coordination seperately

17

Recommendations for adding weight with reaching?

1. At the wrists
2. 60g increments upto 2kg
3. Test with finger-nose or spiral test (drawing a spiral)

18

Recommendations for adding weight with walking?

1. At ankles, knees, or around waist
2. Ankles - upto 1kg
Waist - 1-2 kg
3. Test with walking on narrow BOS

19

How can you introduce flexibility of performance in ataxic patients?

1. Reduce external support
2. Reduce support from UL
3. Increase amplitude of movement
4. Increase speed and accuracy of movement
5. Reduce manual guidance
6. Reduce BOS
7. Add concurrent tasks to challenge automaticity