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Flashcards in Managing Mvt Disorders and Ataxia Deck (36):

3 types of tremors

1. Intention
2. Action
3. Terminal


Intention Tremor

most common
begins as soon as you begin engaging in the activity
worsens as you get closer to the target


2 variables that affect intention tremors

1. amount of precision (more precision = more tremor)
2. Level or risk (hot liquid = more tremor)
*best way to work with this pt is to distract them


Action tremor

Once on the target, you remain tremulous


Terminal tremor

tremors at the end of movement
considered less severe, but just as functionally damaging


Hypotonia- what lesions do you see this with

Cerebellar/more posterior lesions



inability to do rapid alternating movements; dependent on speed (faster they go, more they break down)
- foot taping, finger taping, pressing a break, brushing teeth, washing yourself, house activities, sexual activities


Dysmetria: definition and 2 types

problem with end point related to the hand and foot
1. hypometric
2. hypermetric


Hypometric dysmetria

undershooting the target (missing the curb because you're infront of it)
* more functional than hypermetric; safer in terms of BOS; pts may be able to figure out how to adjust to hypometric functioning


Hypermetric dysmetria

Overshooting the target



"robotic movement"
- movement of one joint at a time to accomplish a movement


What are the 2 main issues for pt with movement disorders?

1. impaired postural responses
2. profound deficits in multi-joint movements as compared to single joint movements (inability to control degrees of freedom)


Cause of Impaired timing of postural responses

common with cerebellar dysfunction- results in LE/trunk responses coming in too early with limb movement
- unable to counteract destabilizing effects of arm mvt
- ataxic presentation
- unable to tandem walk
- PT implicaiton: proximal stability is KEY


PT implication of inability to control degrees of freedom

try to remove degrees of freedom one at a time to control the motion (adding supports and orthoses- soft collar, adductor pillows, wrist braces, etc)


Standard Evaluation Scales for pts with movement disorders
NOTE: all are impairment based!

1. International cooperative ataxia rating scale (ICARS)
2. Scale for the Assessment and Rating of Ataxia (SARA)
3. Brief Ataxia Rating Scale (BARS)


International Cooperative Ataxia Rating Scale (ICARS)

developed to monitor effects of medications
- limb ataxia
- stance disorders
- postural disorders
- dysarthria
- occulomotor disorders


Scale for the Assessment and Rating of Ataxia (SARA)

Quantifies the major impairment areas (gait, stance, sitting, speech, dysmetria, tremor, RAMS)
* more comprehensive than the BARS- more # of items


Brief Ataxia Rating Scale (BARS)

Quantifies the major impairment areas (gait, speech, kinetic arm/leg function


Frequency Measures

Tapping tests


Time Measures used in movement disorders

1. Pegboard
2. Phrase pronunciation
3. writing/drawing
4. standing


Issue with the standard impairment based measures for movement disorders versus ADL monitoring

Measurements will capture an improvement in impairments that is not necessarily correlating with improvement in activity functioning


Key Interventions for Movement Disorders

1. Decrease degrees of freedom in the limbs and trunk (decrease number of joints moving simultaneously)
2. Provide proximal stability (both internal and external)
3. Change velocity (longer reach = slower, shorter = faster)
4. Provide Adaptive Devices to stabilize and control degrees of freedom
5. Utilize assistive technology
6. Weights (first line of defense and the last resort)
7. biofeedback (only case study report support)
8. compression garments (neoprene sleeve, anecdotal evidence)


Stable Slide

AD addressive feeding, writing, putting on makeup, oral and face care
- holds arm so it is not hangin in place
- provides stabilization and locks out degrees of freedom
- very complex movement into simple elbow motion



AD for women who can't cath themselves (could be game changer for d/c)
- hardest part = initial intention to get cath into urethra
- has a loop to hang device on your hand instead of holding in (removal of DOF)
- Use task training; practice over and over
- stabilize at the pelvis for optimal success



Tremor dampening device for feeding (microprocessor in base of spoon that predicts tremors and keeps utensil parallel to the plate)
- improvement in feeding and transferring, but NOT the holding task
- 71-76% decrease in tremor with the device on


Weights as intervention

using weights for immobilization (weighted cuffs, vests, ADs, ADL devices, etc)
Initially works, but long term function is not there
NOT to be used EVER with MS- makes them worse!


Jones et. al: Effectiveness of OT and PT in MS patients with ataxia of the upper limb and trunk

Therapy used to improve dynamic postures and methods of performing functional tasks can result in improvements of functional ability


Strokoy et. al: Beneficial effects of postural intervention on prehensile action for an individual with ataxia resulting from brainstem stroke

Improvement in postural control influences upper extremity function affecting the speed and accuracy of the movement
- postural training sessions 1hr 3x/wk, 4wks
- increases in Fugl-Myer score and PASS score


Richards et. al: Response to intensive UE therapy by individuals with ataxia from strok

Intense motor practice can improve the UE motor function in pts with ataxia from stroke


Lig et. al: Intensive coordinative training improves motor performance in degenerative cerebellar disease

Intensive coordination training resulted in improvements of personally meaningful goals in everyday life (measured with the GAS)
Continuous training = crucial for stabilizing improvements
should become a standard of care


Miyai et. al: Cerebellar ataxia rehab trial in degenerative cerebellar diseases

Group that received immediate therapy showed significantly greater functional gains in ataxia, gait speed, and ADLs than the control group


Recommended Evaluation Steps/Procedures with Movement Disorders

1. Interview (canadian occupational performance measure)
2. Observe (impact of limb and trunk ataxia)
3. Change task parameters; what dampens or exacerbates ataxia?
4. Retrain task performance integrating techniques, movements, equipment, and positions that dampened ataxia and enhanced function
5. Re-evaluate and Re-interview


Methods to change task parameters to dampen ataxia

1. Control the degrees of freedom
2. manual stabilization of head, upper trunk, and pelvis (soft collar)
3. WB through hand or forearm
4. UEs stabilized against trunk (elbows in)
5. emotionally stable (if upset, worse)
6. decrease reaching into space
7. increase postural security (insecurities = increased titurbation)
8. Decrease cognitive effort
9. increase target size
10. adjust velocity of movement
11. add weights (last resort)


Methods of using the environment for stability

1. High back chairs
2. forearm WB
3. stabilize head on wall
4. sit at table against wall
5. use corner of wall
6. pillow and foam
7. stabilize with one arm holding chair


Methods of retraining movements

1. maintain arm contact with surface or body (slide dont reach)
2. move in flexion and adduction
3. co-contract trunk
4. push head into back of chair
5. break down movement pattern to change target (scoop, near your mouth, in your mouth)
6. slow v quick movements
7. slide objects/tool on counter (avoid reach in space)


TherEx useful in diminishing ataxia/movement disorder symptoms

1. close chain strengthening
2. proximal stability (core/scapula)
3. body weight as resistance
4. postural alignment
5. bridges, POE, quadruped, wall squats, kneeling, w/c pushup