Pathology of Ataxia and Gait Disorders

Question 1

What is ataxia?

1 - being able to stand up against gravity
2 - altered motor control affecting balance and gait
3 - involuntary muscle spasms
4 - all of the above

Answer 1

2 - altered motor control affecting balance and gait

• uncoordinated control between agonist and antagonist muscles

Question 2

What % of people experience gait abnormalities by the time they reach 60?

1 - 1.5%
2 - 15%
3 - 30%
4 - 60%

Answer 2

2 - 15%

Question 3

What % of people experience gait abnormalities in >85 y/o?

1 - 6%
2 - 16%
3 - 35%
4 - 80%

Answer 3

4 - 80%

Question 4

What are the 3 key phases of an individuals gait in the correct order?

1 - heel strike, mid stance, toe off
2 - heel strike, toe off, mid stance
3 - mid stance, toe off, heel strike
4 - toe off, heel strike, mid stance

Answer 4

1 - heel strike, mid stance, toe off

Question 5

What is required for an evaluation of complete gait cycle?

1 - biomechanical equipment
2 - recording of the patient
3 - foot strike from the same foot following alternative foot strike

Answer 5

3 - foot strike from the same foot following alternative foot strike

Question 6

When we look at the phases of gait, there are 3 measures that we can also take, what are they?

1 - cadence, step, time
2 - cadence, time, stride
3 - cadence, step, stride
4 - time, step, stride

Answer 6

3 - cadence, step, stride

Question 7

When we look at the phases of gait, there are 3 measures that we can also take. One of these is cadence, what is the definition of cadence?

1 - steps/minute
2 - distance per stride
3 - distance per step
4 - step number

Answer 7

1 - steps/minute
- normal = 115/minute

Question 8

When we look at the phases of gait, there are 3 measures that we can also take. One of these is stride, what is the definition of stride?

1 - steps/minute
2 - distance per stride
3 - distance per step
4 - step number

Answer 8

2 - distance per stride
- stride is consecutive initial contacts of the same foot with the ground

Question 9

When we look at the phases of gait, there are 3 measures that we can also take. One of these is cadence, what is the definition of step?

1 - steps/minute
2 - distance per stride
3 - distance per step of alternating legs
4 - step number

Answer 9

3 - distance per step of alternating legs

Question 10

When we talk about our gait cycle, aprox 60% can be described as the stance phase. What is the stance phase?

1 - foot is in the air
2 - foot is in contact with the floor

Answer 10

2 - foot is in contact with the floor

• when the foot is in contact with the floor
• when we are weight bearing

Question 11

When we talk about our gait cycle, aprox 60% can be described as the stance phase, which is when the foot is in contact with the floor and we are weight bearing. The stance phase can be further subdivided into 3 stages, what are they?

1 - support, heel off and toe-off phases
2 - strike, toe-off phases and heel strike
3 - strike, support, and toe-off phases
4 - strike, support, and heel-off phases

Answer 11

3 - strike, support, and toe-off phases

Question 12

When we talk about our gait cycle, aprox 40% can be described as the swing phase, what is the swing phase?

1 - foot is in the air
2 - foot is in contact with the floor

Answer 12

• when the foot leaves the ground and then the same foot touches the ground again

Question 13

When we talk about out gait cycle, aprox 40% can be described as the swing phase, which is when the foot leaves the ground and then the same foot touches the ground again. This can be further sub-dived into 2 phases, what are they?

1 - heel strike and swing phase
2 - leg lift and swing phases
3 - leg lift and heel strike
4 - heel strike and mid stance

Answer 13

2 - leg lift and swing phases

Question 14

What is the difference between the single and double support phase when we look at gait cycle?

Answer 14

• single = one foot in contact with the ground giving support
• double = both feet in contact with the ground giving support

Question 15

During the initial contact of heel strike there are 3 key groups of muscles that are involved. Which muscle group acts on the hip to slow down the forward motion of the lower limb?

1 - psoas major
2 - gluteal maximus
3 - semitendinosus
4 - iliacus

Answer 15

2 -gluteal maximus

Question 16

During initial contact of heel strike there are 3 key groups of muscles that are involved. What key muscle of the quadriceps keeps the leg extended at the knee and the thigh flexed at the hip?

1 - vastus lateralis
2 - vastus medialis
3 - rectus femoris
4 - biceps femoris

Answer 16

3 - rectus femoris
- as its origin is on the anterior inferior iliac spine

Question 17

During initial contact of heel strike there are 3 key groups of muscles that are involved. What 3 muscles of the anterior compartment of the leg help maintains ankle dorsiflexion, positioning the heel for the strike:

1 - T.anterior, E.hallucis longus + E.digitorum longus
2 - T.anterior, E.pollicis longus + vastus lateralis
3 - T.anterior, E.hallucis longus + soleus
4 - plantar, E.pollicis longus + E.digitorum longus

Answer 17

1 - T.anterior, E.hallucis longus + E.digitorum longus
- ANKLE DORSIFLEXORS

Question 18

During the stance phase where there is a loading response, where there is the initial double stance phase (2 feet in contact with the floor). What muscles in the thigh are involved in stabilising the knee with leg flexion?

Answer 18

• quadriceps
• vastus medialis, intermedius lateralis and rectus femoris
• LEG FLEXORS

Question 19

During the stance phase where there is a loading response, where there is the initial double stance phase (2 feet in contact with the floor). Which muscle of the anterior compartment of the leg contracts eccentrically to control plantarflexion?

1 - flexor digitorum longus
2 - extensor hallucis
3 - tibialis anterior
4 - soleus

Answer 19

3 - tibialis anterior

Question 20

During the mid stance of the gait cycle, which is where there will be single leg support (as we can see below), what muscle in the thigh region contracts eccentrically?

1 - sartorius
2 - gluteus medius
3 - pectineus muscle
4 - gluteus maximus

Answer 20

2 - gluteus medius

Question 21

During the mid stance of the gait cycle, which is where there will be single leg support (as we can see below), what muscle in the leg contract eccentrically?

1 - gastrocnemius and extensor digitorum longus
2 - tibialis anterior and soleus
3 - gastrocnemius and plantar
4 - gastrocnemius and soleus

Answer 21

4 - gastrocnemius and soleus
- CALF MUSCLES

Question 22

During the terminal stance phase of the gait cycle (just prior to the pre-swing phase, as we can see below), what muscle in the leg contract during heel rise and continues until the opposite foot heel touches the floor?

1 - gastrocnemius
2 - tibialis posterior
3 - plantar
4 - soleus

Answer 22

2 - tibialis posterior

Question 23

During the terminal stance phase of the gait cycle (just prior to the pre-swing phase, as we can see below), what muscle in the foot contract during heel rise and continues until the opposite foot heel touches the floor?

1 - flexors of the toes
2 - extensors of the toes
3 - adductors of the toes
4 - abductors of the toes

Answer 23

• TOE FLEXORS
• abductor hallucis, Flexor Digitorum Brevis, Lumbricals, Quadratus Plantae, Flexor Digiti Minimi Brevis,

Question 24

During pre-swing phase (as we can see below), which is the second double support, what muscle group will then contract to propel the hips forward through hip flexion?

1 - hip flexors
2 - hip extensors
3 - knee flexors
4 - knee abductors

Answer 24

1 - hip flexors

Question 25

The hip flexors are important during pre-swing phase (as we can see below), which is the second double support. The hip flexors are composed of 5 muscles, label the image below, using the labels:

psoas major
iliacus
pectineus
rectus femoris 
sartorius

Answer 25

1 - iliacus
2 - rectus femoris 
3 - psoas major
4 - pectineus
5 - sartorius

Question 26

During swing phase (as we can see below), what muscle group will then contract to propel the hips forward through hip flexion?

1 - hip flexors
2 - hip extensors
3 - knee flexors
4 - knee abductors

Answer 26

1 - hip flexors
- contract to pull the hip forward

Question 27

The mid-swing of the gait cycle is when the foot needs to clear the floor. What group of muscles is involved in achieving this?

1 - knee flexors
2 - hip flexors
3 - ankle plantarflexors
4 - ankle dorsiflexors

Answer 27

4 - ankle dorsiflexors

Question 28

The ankle dorsiflexors are important in the mid-swing of the gait cycle to ensure the foot clears the floor. What 3 muscles of the ankle dorsiflexors are important here?

Answer 28

1 - tibialis anterior
2 - extensor hallucis longus
3 - extensor digitorum longus

Question 29

The terminal swing phase of the gait cycle is the point from where tibia is vertical to just prior to initial contact. What group of muscles are important in controlling the movement of the limb forwards?

1 - hip extensors
2 - knee extensors
3 - ankle plantarflexors
4 - knee flexors

Answer 29

4 - knee flexors
- more commonly referred to as hamstrings

Question 30

What 3 muscles make up the hamstrings?

Answer 30

1 - bicep femoris
2 - semimembranosus
3 - semitendinosus

Question 31

What is the centre of gravity?

Answer 31

• the balance point of your body

Question 32

What is the normal centre of gravity in humans?

1 - 5cm anteriorly to L2 vertebral of the spine
2 - 5cm anteriorly to T2 vertebral of the spine
3 - 5cm anteriorly to S2 vertebral of the spine
4 - 5cm anteriorly to S4 vertebral of the spine

Answer 32

3 - 5cm anteriorly to S2 vertebral of the spine

Question 33

During the normal gait cycle what happens to the centre of gravity in men?

1 - remains the same
2 - moves horizontally 5 degrees
3 - moves backwards 5 degrees
4 - moves vertically 5 degrees

Answer 33

2 - moves horizontally 5 degrees
- only horizontal in men

Question 34

During the normal gait cycle the centre of gravity (COG) is able to move vertically and horizontally in women. What stage of the gait cycle would the COG be highest?

1 - mid swing phase
2 - swing phase phase
3 - heel strike phase
4 - mid stance phase

Answer 34

4 - mid stance phase

Question 35

During the normal gait cycle the centre of gravity (COG) is able to move vertically and horizontally. What stage of the gait cycle would the COG be lowest?

1 - mid swing phase
2 - swing phase phase
3 - double limb support
4 - mid stance phase

Answer 35

3 - double limb support
- we generally drop slightly forward when walking in this stage

Question 36

What can happen to our centre of gravity when we walk on different terrains?

Answer 36

• will adjust to the terrain (up or down hill for examples)

Question 37

Why can some musculoskeletal conditions affect our gait?

Answer 37

• alters normal gait to relieve pain or other symptoms
• i.e. arthritis, Tendinopathy, Ligament injury, Muscle problems, Skeletal abnormalities

Question 38

Why can some neurological conditions affect our gait?

Answer 38

• affects muscle co-ordination

Question 39

At what age is normal gait acquired?

1 - 1-4 y/o
2 - 4-8 y/o
3 - 10 y/o
4 - 12 y/o

Answer 39

• 2 - 4-8 y/o

Question 40

If a patient has significant knee osteoarthritis, what other joints could be affected?

Answer 40

• ankle
• hip
• back

Question 41

During the normal gait cycle what happens to the centre of gravity in women?

1 - remains the same
2 - moves horizontally and vertically 5 degrees
3 - moves backwards 5 degrees
4 - moves vertically 5 degrees

Answer 41

2 - moves horizontally and vertically 5 degrees

Question 42

Which of the following is NOT involved in balance and coordinated movement?

1 - basal ganglia
2 - thalamus
3 - cerebellum
4 - corpus callosum
5 - vestibular system
6 - motor cortex

Answer 42

4 - corpus callosum

Question 43

What is the name of the main tract involved in coordinated gait, movement and balance involved in the limbs and trunk?

1 - corticospinal tract
2 - spinocerebellar tract
3 - spinothalamic tract
4 - all of the above

Answer 43

1 - corticospinal tract
- message travels from the cortex (cortico) into the spine (spinal)

Question 44

Are neurons that travel in the corticospinal tract referred to as upper or lower motor neurons?

Answer 44

• upper motor neurons
• lower motor neurons are those that begin in the spinal cord and end at target tissue

Question 45

From the cortex the corticospinal tract moves through the corona radiata, internal capsule, pons, midbrain, before teaching the caudal medulla. What is the name of where these fibres meet?

1 - cerebral peduncle
2 - thalamus
3 - pyramids
4 - inferior olives

Answer 45

3 - pyramids

Question 46

The corticospinal tract moves from the cortex to the caudal medulla where it forms the pyramids. What % of fibres then decussate here?

1 - 8%
2 - 20%
3 - 50%
4 - 80%

Answer 46

4 - 80%

• the other 20% travel down the ventral corticospinal tract on the same side

Question 47

When we look at the corticospinal tract, not all fibres originate from the motor cortex. Of the following, where do the majority of fibres originate from?

1 - primary motor cortex,
2 - premotor and supplementary
motor cortex
3 - parietal lobe and primary
somatosensory area

Answer 47

3 - parietal lobe and primary
somatosensory area
- 40% of fibres originate here

• 31% are from the primary motor cortex,
• 29% are from the premotor and supplementary motor cortex

Question 48

Which system do emotional movements originate from?

1 - nigrostriatal
2 - mesocortical
3 - mesolimbic
4 - tuberoinfundibular

Answer 48

3 - mesolimbic

• involved in emotions
• could involve fight or flight responses

Question 49

Which lobe is sensory information processed in that helps us coordinate and plan our voluntary gaits?

1 - frontal lobe
2 - parietal lobe
3 - temporal lobe
4 - occipital lobe

Answer 49

2 - parietal lobe
- specifically the posterior parietal lobe
- involved in visual, tactile, and proprioceptive information
- the sensory information is then sent to the motor cortex

Question 50

Sensory information from the posterior parietal lobe is received and delivered to the motor cortex. The motor cortex can be divided into 3 parts, which of the following is NOT one of these parts?

1 - Primary Motor Cortex (Brodmann’s area 4)
2 - Premotor cortex
3 - Supplementary motor area
4 - motor end cortex

Answer 50

4 - motor end cortex

• Primary Motor Cortex = located on precentral gyrus and referred to as M1

Question 51

There are 3 parts of the motor cortex. 2 of these parts are important for planning and coordinating high levels movements. Which of these 3 parts of the motor cortex are involved in simple movements?

1 - Primary Motor Cortex (Brodmann’s area 4)
2 - Premotor cortex
3 - Supplementary motor area

Answer 51

1 - Primary Motor Cortex (Brodmann’s area 4)

• involved in simple movements

Question 52

If we damage any of the 3 motor complex areas of the brain:

• Primary Motor Cortex (Brodmann’s area 4)
• Premotor cortex
• Supplementary motor area

Does the patient experience weakness and impaired executive function on the ipsilateral (same side) or contralateral (opposite side)?

Answer 52

• contralateral
• corticospinal tract decussates at the pyramids in the medulla

Question 53

What is the prefrontal cortex function in gait and voluntary, coordinated movements?

1 - plan movements
2 - organise thoughts about movements
3 - make decisions about movements
4 - all of the above

Answer 53

4 - all of the above

Question 54

Prior to the execution of movement, is the pre-motor cortex or the primary motor cortex more active?

Answer 54

• pre-motor cortex
• the primary motor cortex is only involved in initiaing the movement

Question 55

Which of the following does NOT provide sensory information in relation for voluntary movement and gait?

1 - visual
2 - cerebellum
3 - proprioception
4 - vestibular

Answer 55

2 - cerebellum

Question 56

Information is gathered before we walk. Which of the following is NOT involved in bringing all this information together and integrating it prior to voluntary movement and gait?

1 - cerebellum
2 - cerebral cortex
3 - occipital lobe
4 - brain stem

Answer 56

3 - occipital lobe

Question 57

Damage to the cerebral cortex can cause what?

1 - unilateral weakness
2 - vertigo
3 - difficulty changing direction
4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Answer 57

1 - unilateral weakness

Question 58

Damage to the basal ganglia can cause what?

1 - unilateral weakness
2 - vertigo
3 - difficulty changing direction
4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Answer 58

3 - difficulty changing direction

Question 59

Damage to the thalamus can cause what?

1 - loss of proprioception
2 - vertigo
3 - difficulty changing direction
4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Answer 59

1 - loss of proprioception

Question 60

Damage to the cerebellum can cause what?

1 - loss of proprioception
2 - vertigo
3 - ataxia
4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Answer 60

3 - ataxia
- impairment of the smooth performance
of goal-directed movement

Question 61

Ataxia is an impairment of the smooth performance of goal-directed movement and can be caused by damage to cerebellum. Which of the following is NOT a type of ataxia?

1 - Cerebellar Ataxia
2 - Central Sensory ataxia
3 - Corticospinal Ataxia
4 - Posterior Column Ataxia

Answer 61

3 - Corticospinal Ataxia

• Cerebellar Ataxia = irregular movement due to a lesion in a cerebellar hemisphere & it’s connections
• Central Sensory ataxia = impaired proprioception due to lesion in somatosensory cortex, thalamus, or the thalamocortical pathways to the parietal lobe
• Posterior Column Ataxia = lesions in afferent somatosensory pathways in the dorsal portion of the spinal cord
  (fasciculus gracilis and fasciculus cuneatus)

Question 62

Damage to the brain stem can cause what?

1 - loss of proprioception
2 - vertigo
3 - ataxia
4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Answer 62

4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Question 63

Damage to the vestibular system can cause what?

1 - loss of proprioception
2 - vertigo
3 - sensory loss and weakness
4 - slurred speech, diplopia (double vision), facial weakness, vertigo

Answer 63

2 - vertigo

Question 64

Damage to the peripheral nerves can cause what?

1 - loss of proprioception
2 - vertigo
3 - sensory loss and weakness
4 - weakness

Answer 64

4 - weakness

Question 65

Damage to the muscles can cause what?

1 - loss of proprioception
2 - vertigo
3 - sensory loss and weakness
4 - peripheral weakness

Answer 65

4 - peripheral weakness

Question 66

Dysarthria can be caused by cerebellum dysfunction/damage. What is dysarthria?

1 - inability to control range of movement
2 - inability to perform rapid movements
3 - inability to articulate words correctly
4 - decreased muscle tone

Answer 66

3 - inability to articulate words correctly
- may also slur and use inappropriate phrasing

Question 67

Dysdiadochokinesia can be caused by cerebellum dysfunction/damage.
What is dysdiadochokinesia?

1 - inability to control range of movement
2 - inability to perform rapid movements
3 - inability to articulate words correctly
4 - decreased muscle tone

Answer 67

2 - inability to perform rapid movements

Question 68

Dysmetria can be caused by cerebellum dysfunction/damage. What is dysmetria?

1 - inability to control range of movement
2 - inability to perform rapid movements
3 - inability to articulate words correctly
4 - decreased muscle tone

Answer 68

1 - inability to control range of movement

Question 69

Damage to the cerebellum can result in a tremor, which is rhythmic, oscillating and alternating movement of limbs and muscles. There are intentional, resting and postural tremors. Match the type with the description below:

• muscle movement when a patient is trying to walk or balance
• when a patients limb is approaching its target
• when a patient is sat still doing nothing

Answer 69

• intentional = when a patients limb is approaching its target
• postural = muscle movement when a patient is trying to walk or balance
• resting = when a patient is sat still doing nothing

Question 70

What is the most common cause of autosomal ataxia?

1 - Friedreich ataxia
2 - Louis-Bar syndrome
3 - Ataxia-Telangiectasia
4 - Hypokinesia

Answer 70

1 - Friedreich ataxia
- autosomal mitochondrial disease
- affects chromosome 9

Question 71

In Friedreich ataxia children normally present with ataxia between the ages of 5-15. Which of the following symptoms are also present in Friedreich ataxia?

1 - dysarthria (difficulty speaking)
2 - paresis (muscle weakness) especially the lower extremities
3 - cognitive impairments
4 - reflexes and position senses are lost
5 - all of the above

Answer 71

5 - all of the above

Question 72

The cerebellum can be divided into 3 functional sections related to their functions. These parts are:

• Midline vermis (paleocerebellum)
• Lateral hemispheres (neocerebellum)
• Archicerebellum (Vestibulo-cerebellum)

Which of these 3 parts is important in coordinating eye, head, and neck movements?

Answer 72

• Archicerebellum (Vestibulo-cerebellum)

Question 73

The cerebellum can be divided into 3 functional sections related to their functions. These parts are:

• Midline vermis (paleocerebellum)
• Lateral hemispheres (neocerebellum)
• Archicerebellum (Vestibulo-cerebellum)

Which of these 3 parts is important in coordinating the trunk and leg movements?

Answer 73

• Midline vermis (paleocerebellum)
• a lesion here could result in
  abnormalities of stance and gait

Question 74

The cerebellum can be divided into 3 functional sections related to their functions. These parts are:

• Midline vermis (paleocerebellum)
• Lateral hemispheres (neocerebellum)
• Archicerebellum (Vestibulo-cerebellum)

Which of these 3 parts is important in controlingl quick and finely coordinated limb movements, predominantly
of the arms and hands?

Answer 74

• Lateral hemispheres (neocerebellum)
• typically only present in advanced species like humans

Question 75

What is the most common cause of cerebellar disorders?

1 - vascular (stroke or haemorrhage)
2 - iatrogenic
3 - alcohol
4 - infective

Answer 75

3 - alcohol
- called Alcoholic Cerebellar Degeneration
- cerebellum atrophies
- patients lose ability to walk over months to years

Question 76

Which of the following is FALSE about Dandy-Walker syndrome?

1 - congenital
2 - cystic malformation in cerebellum stopping CSF from leaving the brain
3 - causes a reduced pressure in the brain
4 - increased pressure in brain
5 - impaired motor skill function such as ataxia
6 - all of the above

Answer 76

6 - all of the above
- symptoms are sporadic, occur at a young age and are not progressive

Question 77

What is the function of the spinocerebellar tract?

1 - incorporate proprioceptive information to coordinate movement and balance
2 - receive pain sensations from peripheral stimulus
3 - process cognitive functions
4 - all of the above

Answer 77

1 - incorporate proprioceptive information to coordinate movement and balance

Question 78

Spinocerebellar ataxias are those where these is an abnormality in the Spinocerebellar tract. Is this autosomal dominant or recessive?

Answer 78

• autosomal dominant

Question 79

Which of the following are signs of genetic abnormalities causing Spinocerebellar ataxias?

1 - neuropathy
2 - pyramidal signs
3 - restless leg syndrome
4 - all of the above

Answer 79

4 - all of the above

Question 80

Which of the following is NOT an acquired cause of ataxia?

1 - vascular (stroke or haemorrhage)
2 - iatrogenic
3 - alcohol
4 - infective
5 - spinocerebellar ataxias

Answer 80

5 - spinocerebellar ataxias
- this is an autosomal dominant genetic condition

Question 81

Can tumours or cancers cause ataxia?

Answer 81

• yes

Question 82

General signs of an alcohol-related neurological disease can include all of the following, EXCEPT:

1 - memory loss
2 - frequent blackouts
3 - loss of coordination
4 - impaired RAAS
5 - dehydration, seizures,
6 - nystagmus & death

Answer 82

4 - impaired RAAS

Question 83

Neuroinflammation can occur in patients who consume excessive alcohol. What affect can chronic alcohol use have on myelin?

1 - increased myelin production
2 - fibrosis of myelin
3 - reduced myelin expression and damage to myelin sheath
4 - all of the above

Answer 83

3 - reduced myelin expression and damage to myelin sheath

Question 84

Neuroinflammation can occur in patients who consume excessive alcohol which can damage the myelin sheath and impair neurological communication causing:

• alcohol dementia
• pre-frontal cortex dysfunction
• wernicke syndrome and Korsakoff syndrome

Deficiencies in which of the following has been linked with neurological damage in excessive alcohol consumption?

1 - thiamine (vitamin B1)
2 - folate (vitamin B9)
3 - vitamins C6 and B12
4 - all of the above

Answer 84

4 - all of the above

• alcohol can have enough calories so patients typically do not eat well

Question 85

If a patient stops drinking, they can develop delirium tremens, which is a severe form of alcohol withdrawal. Is this dangerous?

Answer 85

• yes
• can be a medical emergency
• 1st line treatments are typically 1 - chlordiazepoxide and thiamines