CEREBELLAR DODS PARTS 1-3

Question 1

Functions of cerebellum in motor performance

Answer 1

tone
smoothness
coordination
accuracy
postural control

Question 2

Functions of cerebellum in motor learning

Answer 2

-small movements integrated into complex behaviors –> consolidate movements into motor programs
-acquisition and modification of skilled action
-acts as a comparator in real time; predictions for movement initiation and termination
-may predict upcoming sensory events
-learning based on error-driven motor learning process

Question 3

What are the 3 functional zones of the cerebellum?

Answer 3

vestibulocerebellum

spinocerebellum

cerebrocerebelum

Question 4

vestibulocerebellum functions

Answer 4

maintenance of balance, control of eye movements, regulates VOR, postural control

IF DAMAGED: impaired VOR, nystagmus, postural instability/impaired balance

Question 5

spinocerebellum functions

Answer 5

regulation of muscle tone, coordination of skilled voluntary movement

-limb movements
-balance
-locomotion
-gaze and eye movements

IF DAMAGED: oculomotor deficits, hypotonia, gait ataxia, lack of check, dysmetria, dysdiadochokinesia, tremor, imbalance/falls

Question 6

cerebrocerebellum functions

Answer 6

planning and initiation of voluntary activity

-visually guided movements
-motor planning
-sensorimotor error assessment
-agonist-antagonist coordination –> rapid alternating movements

*capabilities are very refined

IF DAMAGED: dysdiadochokinesia, dysmetria, dyssynergia, decomposition

Question 7

3 layers of each functional zone of the cerebellum

Answer 7

cerebellar cortex - superficial
white matter layer - intermediate
nuclei - deep

Question 7

3 layers of each functional zone of the cerebellum

Answer 7

cerebellar cortex - superficial
white matter layer - intermediate
nuclei - deep

Question 8

vestibulocerebellum nuclei

Answer 8

vestibular nuclei located in pontomedullary junction of the brainstem- 4 TOTAL NUCLEI

the inner ear apparatus has a fast track connection to the cerebellum, bypassing the nuclei

Question 9

spinocerebellum nuclei

Answer 9

fastigial nucleus

interposed nucleus
–globose
–emboliform

**buried deep in each cerebellar hemisphere

Question 10

cerebrocerebellum nucleus

Answer 10

dentate nucleus

Question 11

How to test for hypotonia

Answer 11

test by asking person to relax and move their limbs

floppy feels

due to decreased drive to vestibulospinal and reticulospinal tracts

usually does not present with problems in physical function

Question 12

Postural tremor vs kinetic tremor

Answer 12

postural- occurs in muscles maintaining a static position against gravity

kinetic- during voluntary mvmt
—intention tremor: one form of kinetic tremor that occurs during the termination of visually guided movements toward a target

Question 13

What are the two main types of nystagmus?

Answer 13

spontaneous

gaze evoked- when they move in a specific plane of movement

Question 14

TESTS OF OCULOMOTOR CONTROL

Answer 14

saccades

smooth pursuit

VOR

VOR cancellation

gaze-evoked nystagmus

Question 15

Dyssynergia def:

Answer 15

impairment of multi-joint movement related to dysmetria and deficits in limb dynamics predictions

Question 16

movement decomposition def:

Answer 16

Breaking down of a movement sequence or multi-joint movement
into a series of separate movements to simplify the movement

-this may be considered a compensatory strategy

Question 17

dysmetria

Answer 17

Impaired ability to scale movement distance; slow movements tend to produce hypometria and fast produce hypermetria

** go not far enough or too far from target

Question 18

dysdiadochokinesia

Answer 18

deficits in coordinating agonist-anatagonist muscle pairs, elicited during rapid alternating movements/rapid reversals

TEST: alternate flipping hands on lap, DF/PF alternating, heel to shin

Question 19

lack of check

Answer 19

inability to halt an unintended movement

-excessive rebound

ex: large rebound on MMT

-could cause LOB or a fall

Question 20

Common balance deficits in ppl with cerebellar disorders

Answer 20

increased postural sway- observed in sitting or standing

-excessive (hypermetric) or diminished (hypometric) postural responses- observe ankle, hip, stepping strategies

-poor postural control during head or limb movement

Question 21

What are the characteristics of gait ataxia that is common among individuals with cerebellar disorders?

Answer 21

-uneven step length
-irregular base of support
-absent rhythm
-feet often lifted too high
-can use a variety of gait aids–> dogs are very effective

Question 22

Examples of acquired cerebellar pathologies

Answer 22

stroke
MS
arnold chiari malformation
toxicity- heavy metals, TOH
posterior fossa tumors
trauma

Question 23

examples of hereditary cerebellar pathologies

Answer 23

Autosomal dominant - spinocerebellar ataxias

Autosomal recessive- Friedreichs ataxia, early onset cerebellar ataxia, X-linked disorders–> some ppl with less severe features of FA can live into their sixties or older
–MOST COMMON form of hereditary ataxia in the US

Question 24

examples of idiopathic cerebellar pathologies

Answer 24

Multiple System Atrophy --> similar presentation to Parkinson's at start Idiopathic Late Onset Cerebellar Ataxia

Question 25

4 main arteries that supply the cerebellum

Answer 25

superior cerebellar - coming off basilar anterior inferior cerebellar - coming off basilar posterior inferior cerebellar- coming off vertebral vertebral artery

Question 26

The anterior spinal artery and the paramedic branches of the vertebral artery supply the ______ nucleus

Answer 26

fastigial nucleus

Question 27

The PICA supplies the _________ nucleus

Answer 27

dentate nucleus

Question 28

The superior cerebellar artery supplies the __________ nucleus

Answer 28

emboliform nucleus globose nucleus * spinocerebellum

Question 29

Main cause of spinocerebellar ataxias + progression

Answer 29

increase in CAG triplets produces a protein that leads to neuronal death and CB degeneration ONSET: -typically midlife PROGRESSION: slowly progressive

Question 30

Friedrich ataxia symptoms and progression

Answer 30

-autosomal recessive -both male and female children can inherit -can live into sixties or older with less severe presentation -ONSET: 5-15 years of age --15% begin after age 25 (EARLY ONSET disease) 10-20 years after onset of symptoms --> confined to a wheelchair can become completely incapacitated at later stages of the disease life expectancy often shortened (due to heart disease)

Question 31

What has a better prognosis, limb or trunk ataxia?

Answer 31

trunk ataxia

Question 32

What has a better prognosis, ischemic or hemorrhagic stroke?

Answer 32

ischemic

Question 33

What has the worst prognosis if damaged due to MS: PICA, AICA, or SCA?

Answer 33

SCA has the worst prognosis PICA AND AICA have better prognoses

Question 34

When the CB nuclei are involved--> this leads to a _____ prognosis.

Answer 34

Worse

Question 35

People with ataxia also can commonly have these symptoms:

Answer 35

lack of coordination slurred speech trouble eating and swallowing eye movement abnormalities deterioration of finer motor skills difficulty walking gait abnormalities tremors heart problems

Question 36

Scanning speech/ataxic dysarthria DEF

Answer 36

spoken words broken up into separate syllables, noticeable pause, spoken with varying force -breath control impaired

Question 37

What often happens to motor learning in ppl with cerebellar disorders?

Answer 37

It often becomes impaired--> particularly procedural learning and errors requiring sensory prediction -use declarative learning strategies with verbal cues -use trial and error

Question 38

What kind of training should be considered when taking into account motor learning?

Answer 38

increased intensity, longer duration ex: 1 hx 3 d/wk x 4 weeks

Question 39

wrist weighting or weighted cutlery may be helpful for ___

Answer 39

controlling movement, incoordination, speed, timing

Question 40

Recommendation of training duration for coordination training and compensation?

Answer 40

3 h/w for 4 weeks plus 1 h/d of HEP -retention dependent on continuous training COMPENSATIONS: -add slower movement -break down multi joint to single joint -rehearse eye movement for goal directed stepping -train fall strategies and fall prevention

Question 41

Children with SCA will benefit from:

Answer 41

intensive and continuous PT -benefits may equal one or more years of natural disease progression

Question 42

Frenkel's three main tenants to coordination training and compensation for ppl with cerebellar disorders:

Answer 42

1. reduce the complexity of movements 2. perform slowly, with client watching the moving limb carefully 3. progress from moving limb with support, to moving without support at one joint of a limb, to moving the limb as a whole

Question 43

What can treadmill training improve in those with CB stroke?

Answer 43

intra-limb coordination increase difficulty by adding decline and obstacles

Question 44

What type of training may be beneficial for individuals with spinocerebellar ataxia?

Answer 44

high intensity motor training preparatory phase- to learn the pt's perception of their body, spatial awareness, simple motor movements operational phase- pt progressively learns complex tasks through repetition and improves anticipatory capabilities

Question 45

Example exercises for postural control:

Answer 45

-moving platforms for reactive balance -getting up from chair or floor -holding and throwing objects -trunk/prox strength on physioball -wall squats, single wall squats, lunges, weighted ball pass -CLOSED CHAIN EXERCISES

Question 46

DANISH mnemonic

Answer 46

D- dysmetria or dysdiadochokinesia A- ataxia N- nystagmus I-intention tremor S-speech H-hypotonia

Question 47

SARA outcome measure

Answer 47

scale for the assessment and rating of ataxia 40 total points possible

Question 48

What are the 4 main categories of the International Cooperative Ataxia Rating Scale

Answer 48

Posture and Gait disturbance Kinetic functions oculomotor disorders speech disorders

Question 49

4 categories of the Brief Ataxia Rating Scale (BARS)

Answer 49

gait knee-tibia test finger to nose test dysarthria 30- max score with severe abnormalities