PRAC VIVA Flashcards
(25 cards)
Ataxia- What is it?
- Incorrect programming of rate, range, duration and force of muscle contractions
- Inability to regulate posture with decreased efficiency of smoothness of gait
- Disruption in rhythm so swing and stance phase are irregular in duration
Ataxia- Components of Assessment
GOTCP
Gait- DGI
Oculomotor Tests- acuity, persuit/tracking, converg/diverg, saccades, nystagmus.
Tone- Tardieu, Ashworth
Coordination- Low level/high level- High level, jumping, hopping, heel toe, braiding, bouncing alternate hands
Posture/Balance- TUG, Tinnetii, Berg
What is the biggest assessment to use?
SARA Scale
FARS
ICARS
Ataxia- What are the main clinical presentations
DAT HO
- Hypotonia
- Ataxia
- Dysarthria
- Tremor
- Ocular Motor Dysfunction
Ataxia- How to Treat Coordination
- Clear, precise endpoints to movementss
- Slow to start, then progress to faster, then varied.
- Use fewer joints
- Increase base of support/provide trunk support
- Consider using weights on limbs
- Increase endurance and duak task
Ataxia- How to Treat Postural Control
- Go through positions of prone on elbows, sitting, standing, then 4 point kneeling
- Increase stability to hold position- self initiation pertubations
Ataxia- Combined Postural Control and Coordination Activities
Jumping, hopping, star jumps- All stationairy
Then move onto moving- Heel toe walking, walk sideways, braiding.
Ball bouncing, alternate hands, against wall
Ataxia- Spinocerebellum.
What happens if you have a lesion here?
What are the signs and symptoms?
Lesion here = randomised movements in all directions
HIRDH
Hypotonia- Less tension
Intention tremor- Tremor as you close in on target.
Rebound phenomenon
Deceleration issues
Hypermetria- Overshooting targets
Ataxia- Neocerebellum or Cerebrocerabellum.
What happens if you have a lesion here?
What are the signs and symptoms?
Lesion= Fall to side of lesion.
MADDDD
Movement decomposition, difficulty performing smooth movements.
Asthenia- generalised fatigue, weakness
Delayed initiation of movement
Dymetria- overshooting.undershooting, lack of control.
Dysdiadochokinesia- Inability to perform quick, rapid movements.
Dysarthia- slurred speech.
Ataxia- Vestibulocerebellum
What are the signs and symptoms?
Decreased postural reflexes
Postural instability during gait (postural sway and truncal ataxia)
Nausea
Ataxia- What are the areas affected?
Sensory
Frontal
Mixed
Vestibular
Cerebellar
Sensory Ataxia- What is it? What does it cause?
Damage to sensory nerves
Transmission of proprioceptive information
Heavy reliance on vision- (Ie worse with eyes closed)
+ve Rhomberg.
Caused by diabetic, alcoholic, MS, B12 deficiency
Frontal Ataxia. How does it present? What causes it?
Scissoring gait. Caused by tumours.
Mixed Ataxia- What causes it?
Caused by MS
Vestibular Ataxia. How does it present? What causes it?
Vertigo, nausea, loss of balance, nystagmus.
Damage to CN VIII
Vestibular System- Subjective Assessment, what else do you suspect?
- Cardiac
- Drug interactions
- Orthostatic hypotension
- Anxiety disorders
- Somatosensory loss
- VBI (Vertebrobasilar insufficiency)
- Central
Vestibular System- What is its role?
- Stabilising the head
- Orientation to vertical
- Sensing and percieving self motion
- Controlling centre of mass
Vestibular System- What is the objective assessment doing? And which tests do it?
Checking to see if there are central signs which are red flags, versus peripheral signs. If patient has acute onset (<72hrs) Do HINTS exam.
Normal vestibular exam- All of these below are Central Signs
- Gaze, occular ROM, smooth persuit
- Saccades
- Vergence
- VOR Cancellation
Vestibular System- Nystagmus. Difference between Vestibular Neuritis and BPPV.
BBPV- To affected side
Neuritis- To unaffected side
Vestibular System- Full Assessment, explain the steps.
- Cervical Spine ROM- Rotation and Ext/Flex
- Spontaneous nystagmus- Head still, see if eye movement doing nothing.
- Gaze evoked nystagmus- Get patient to move eyes to corners, up and down.
- Smooth pursuit/tracking- half a metre away and move in 30cm directions.
- Saccades – horizontal and vertical- Tip of pen. Velocity, accuracy.
- Convergence- Pen to nose
- VOR Cancellation- Arms out straight, thumbs out. Control head and arms, spin them on spot.
- Active VOR – vertical and horizontal- Take head in hands. Slow side to side and up and down.
- Head Impulse Test (HIT)- Same position but with rapid jerks.
- Dynamic visual acuity (DVA)- Get them to read while moving
- Headshake nystagmus (goggles)- Head shake is done at 30 degress flexion. 30 seconds or 20 shakes
HINT Exam- 3 tests. Head Impulse, Nystagmus, Test of Skew- HIT then eye movements up down, left and right, then hand over one eye, then the other
THEN – positional Ax (Dix-Hallpike and Roll Test
Vestibular System- How to tell which part of the canal is effect?
Vertical beat for posterior/anterior cannals
Horizontal if horizontal canal
BPPV Assessment. What do you do?
Dix-Hallpike is for Posterior/Anterior.
- testing unaffected side. Turn head 45 degress to side to be tested and 30 degrees extensions
Push back over pillow, hold head. Soft eyes, no locking of eyes.
Vestibular system- When it is caused by a central issue, what part of the brain is creating this?
Vestibular nuclei and the cerebellum
Central vestibular signs can be caused by
Lesions to the midbrain or cerebellum
