week 7

Question 1

role of the cerebellum

Answer 1

role in adjusting posture and coordinating movement.
* Indirect influence on movement.
* Influences movement through connection to the vestibulospinal tracts, reticulospinal tracts, medial and lateral corticospinal tracts.

Question 2

Cerebellar ataxia - ethanol- prenatal

Answer 2

• Cerebellum is vulnerable to ethanol during development-> may be associated with foetal alcohol spectrum disorder
• Pathophysiology: (rodent models) Purkinje cells and granule cells are vulnerable to damage by ethanol – depletion of cells.
• Prenatal exposure may be associated with reduced attention and impaired motor skills e.g. fine motor control and hand eye skills.

Question 3

Spinocerebellar ataxia Type 1 (SCA1)

Answer 3

Inheritance pattern = Autosomal dominant
Causes degeneration and loss of the Purkinje and Granule cells
Symptom onset in 3rd or 4th decade
Impairments include
* Ataxic gait
* Dysarthria
* Dysphagia
* Abnormal eye movements

Question 4

Cerebellar ataxia - ethanol- adult

Answer 4

Acute effects: ataxia appears immediately after excessive alcohol is consumed – gait instability, reduced postural stability and dysarthria.
Pathophysiology: Synaptic dysfunction Granule cells and Purkinje cells. Reduction in cerebellar inputs and outputs which disrupt motor and cognitive coordination.
Chronic effects: atrophy of the superior vermis and reduction in white matter
Gait and postural instability – large sway, irregular stepping, limb ataxia and dysarthria, impairment of cognitive skills

Question 5

Cerebellar ataxia

Answer 5

• Caused by structural or function change to the cerebellum or cerebellar pathways
• Results in appearance of ataxic movements

Question 6

Sensory Ataxia

Answer 6

• Caused by structural or functional change to the sensory nerves
• Results in interruption of the sensory feedback
• Results in appearance of ataxic movements

Question 7

Rhomberg’s test to differ between Sensory ataxia and Cerebellar ataxia

Answer 7

stand with feet together and balance 30 sec eyes open and compare with eyes closed.
Sensory ataxia – patient should be stable with eyes open and unstable eyes closed.
Cerebellar ataxia - unstable eyes open and eyes closed.

Question 8

Finger nose test to differ between Sensory ataxia and Cerebellar ataxia

Answer 8

patients index finger to their nose to examiners finger quickly and accurately.
Sensory ataxia – may demonstrate signs of ataxia when eyes are closed.
Cerebellar ataxia - may demonstrate signs of ataxia when eyes are open and closed
*Sensory ataxia will not have impairments such as dysarthria or nystagmus

Question 9

Dysmetria

Answer 9

Dysmetria: inaccurate size of movement
* Hypermetria – overshoots target
* Hypometria – undershoots target

Question 10

Dysmetria assessment, abnormal test results

Answer 10

using Finger to Nose Test
overshoots or undershoots target.

Question 11

Dysmetria Functional area of the cerebellum that
may be affected:

Answer 11

Spinocerebellum

Question 12

Intention tremor is

Answer 12

: involuntary, oscillatory and rhythmic movement

Question 13

Intention tremor assessed and abdnormal results

Answer 13

Assessed: through observation during movement such as the Finger Nose Test
Abnormal test result: tremor evident as approach the target

Question 14

Intention tremor Functional area of the cerebellum that may be affected:

Answer 14

Spinocerebellum

Question 15

Dysdiadochokinesia is

Answer 15

difficulty with rapid alternating movements. eg flexion into extension

Question 16

Dysdiadochokinesia assessed and abdnormal test results

Answer 16

Assessed: through observation of rapid movements with change of direction. E.g. finger tapping, hand tapping, foot tapping, supination / pronation (palm up / palm down)
Abnormal test result: slowed reversal of movement, poor rhythm / timing of movement, decreased size of movement.

Question 17

Dysdiadochokinesia Functional area of the cerebellum that may be affected

Answer 17

Spinocerebellum

Question 18

Ocular dysmetria

Answer 18

eyes are not able to be moved accurately to a target.
Hypometric saccade – eye undershoots target
Hypermetric saccade – eye overshoots

Question 19

Ocular dysmetria assessed

Answer 19

: through observation of the eyes as they move from one target to another target.

Question 20

Ocular dysmetria Functional area of the cerebellum that may be affected:

Answer 20

Vestibulocerebellum

Question 21

Nystagmus is

Answer 21

: is an involuntary oscillation of the eye.

Question 22

Nystagmus assessed and abnormal test results

Answer 22

Assessed: through observation of the eyes in primary gaze and during movement.
Abnormal test result: nystagmus is present during forward gaze or during movement.

Question 23

Nystagmus Functional area of the cerebellum that may be affected:

Answer 23

Vestibulocerebellum

Question 24

Movement decomposition

Answer 24

describes a compensation adopted by a person to make movement easier – where movement at one joint is fixed (stopped) whilst moving another joint.

Question 25

Movement decomposition assessed and abnormal test results

Answer 25

Assessed: Observation of movements that require multiple joints for e.g. Finger Nose Test or Heel Shin Slide Test Abnormal test result: Person may fix a one joint and then move the joints in a sequence

Question 26

Movement decomposition Functional area of the cerebellum that may be affected

Answer 26

Spinocerebellum

Question 27

Ataxic dysarthria

Answer 27

Ataxic dysarthria: change in the force, timing, range and direction of movement of the articulators that gives a very slurred 'drunk' sounding presentation

Question 28

Ataxic dysarthria assessed and abnormal test results

Answer 28

Assessed: Assessment of articulation and prosody Abnormal test result: dysarthria changes in prosody

Question 29

Ataxic dysarthria Functional area of the cerebellum that may be affected:

Answer 29

Spinocerebellum & Cerebrocerebellum

Question 30

Ataxic Gait is

Answer 30

* Wide base of support and feet may be angled out * Large variability in the walking pattern - variable step length and variable trajectory of the movement * Slower walking speed * Increased risk of falls – also related to postural instability

Question 31

Ataxic Gait assessed and abnormal test results

Answer 31

* Assessed: Observation of walking, timing of walking and measurement of footstep pattern. * Abnormal test result: Slow, irregular, wide-based gait pattern

Question 32

Ataxic Gait * Functional area of the cerebellum that may be affected:

Answer 32

Spinocerebellum

Question 33

Cerebral palsy: definition

Answer 33

an umbrella term for a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.

Question 34

Causes and risk factors of cerebral palsy

Answer 34

* Prematurity <37 weeks * Low birth weight < 1500g * Prenatal exposures (e.g. toxic substances) * Multiple gestations * Bacterial and viral infections during pregnancy – rubella * Hypoxic brain injury during delivery - small percentage of infants with CP * Stroke is the most common cause of CP in babies after one month of age

Question 35

Diagnosis of cerebral palasy

Answer 35

* From soon after birth to 24 months * Can be a complex, lengthy process * Requires a multidisciplinary approach to assessment * A number of assessments are required to build a ‘clinical picture’, including: * Medical imaging (CT/MRI brain) * Genetic testing * General movements assessment * Communication, feeding and swallowing assessments

Question 36

cerebral palsy Motor type – spastic

Answer 36

most common type * Arises from damage to the motor cortex * Characterised by hypertonia which arises from damage to the cortical motor area * Muscle tightness, jerky movements and joint stiffness are characteristic of spastic CP * People may have difficulty with positional change, controlling isolated movements needed to perform certain tasks like handling objects or speaking * Poor coordination during deliberate movements are consistent, dominant symptoms.

Question 37

Motor type – ataxia of cerebral palsy

Answer 37

* Ataxic CP affects a person’s balance, coordination, and depth perception * Ataxia means “incoordination” or being “without order.” * It arises from damage to the cerebellum. * Movements are often jerky or erratic. difficulty performing tasks requiring fine motor skills and uncontrollable shaking during deliberate actions, such as reaching for an object. * They also have an unsteady gait pattern. * Muscles are often weak and this exacerbates other issues * often experience difficulty moving their eyes to where they want to look, have difficulty swallowing and with speech.

Question 38

Motor type – dyskinesia of cerebral palsy

Answer 38

* Dyskinetic CP is characterized by fluctuations in muscle tone (dystonia) and abnormal involuntary, uncontrolled movement (athetosis) * Slow writhing purposeless movement = athetosis * Abrupt jerky movement = chorea * ++ involuntary movement * It arises from damage to the basal ganglia nuclei * The lack of controlled movement of the upper and lower limbs, face and other parts of their bodies in unpredictable and unexpected ways. * People with dyskinetic CP Movements tend to become more severe in times of emotional stress, and often subside completely during periods of rest.

Question 39

CP 5 classification

Answer 39

Gross Motor Function (GMFCS) Manual Ability (MACS) Eating and drinking (EDACS) Visual function (VFCS) Communication (CFCS)

Question 40

Communication and associated impairments.

Answer 40

* 24% - 32% of people with CP have severe communication impairment and are classified as non-verbal * 50% have motor speech disorder = dysarthria * 38% will have receptive and/or expressive language impairment * 20-28% have moderate-severe intellectual impairment

Question 41

Impairment of motor functioning is the defining feature of CP, results in:

Answer 41

* Developmental delay * Impaired mobility: 33% non-ambulatory as adults * Difficulty with fine motor tasks – including for self-care and ADLS * Orthopaedic intervention – from small (e.g. tenotomy) to large procedures (e.g. de-rotational osteotomy) * 75% experience higher levels of pain than general population * 40% experience higher levels of fatigue than general population * Higher risk of co-morbidities