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Cerebellar Problems
NDT Cerebellar Problems PPT
| Question | Answer |
|---|---|
| Main Cerebellar Connections | Vestibulocerebellum (to vestibular system); Spinocerebellum (ascending somatosensory tracts of SC); Cerebropontocerebellum (cerebral cortex) |
| Which side do cerebellar s/sx occur? | Ipsilateral |
| What are the DCN? | Dentate; Fastigial; Interposed |
| Cerebellum's vast & speedy connections allow what? | Cerebellum to compare ongoing movement with the motor command |
| Is input or output greater to the cerebellum? | Input greatly exceeds output- structure is integrative |
| How does cerebellum analyze movement? | Compares voluntary command for movement with sensory signals produced by the evolving movement; if 2 items not matched correctly, cblm provides corrective feedback; Can influence mvmt PRIOR to end of mvmt |
| Rather than simply providing corrections to ongoing voluntary mvmt what is the cerebellum assumed to do? | Perform predictive compensatory modification of reflexes in preparation for movement; Does this mostly by modifying sensitivity of the muscle spindle |
| Is the cerebellum a feedforward or feedback system? | Adaptive feedfoward that programs/models voluntary mvmt skills based on memory of previous sensory input & motor output |
| What happens if the cerebellum is damaged? | Learned motor programs can't be used; Mvmt guided by slow ssy feedback loops thru cerebrum & incoordination will results |
| Roles of different parts of cerebellum | Some may sequence simple mvmts that make up complex actions; Some may play role in acquisition & execution of sequential procedures that comprise complex learned motor acts; Some parts may detect & recognize event sequences |
| More roles of the cerebellum | Adaptation during trial & error learning (pts with cblr dx require many more practice sessions & may need alternative strategies); Active during mental imagery/practice; Involved in cognitive & emotional activities (thinking & verbal encoding) |
| Impairments in Balance & Equilibrium | Damage to vestibulocblm/fastigial nucleus- postural sway & delayed equilibrium rxns; Use of vision NOT effective in preventing loss of balance |
| Cblr Control of Mm Tone | Decrease in excitation from DCN to regions of brain that excite AMNs & GMNs; Mm feels less firm; Limbs feel heavier on PROM; If pt asked to hold arm vs gravity, arm falls slowly or pt will have postural tremor |
| More cblr control of mm tone | LEs- decreases in mm tone seen in a wide, flat footprint; DTRs typically normal but may be pendular mvmt of limb after initial mm contraction response |
| Incoordination of Limb Mvmt | Decreased ability to contract mm & stabilize limb; May have good distal control if limb has external support but unable to reach into space |
| Dysmetria | Deficit in accurately defining direction, extent, force & timing of limb mvmt; Multi-joint motions more affected; Pt may use abnormally tight grip, unable to adjust grip to environmental/task-specific demands; Mvmt decomposition |
| Dysdiadochokinesia | Problems with mvmt initiation & timing; Can't stop ongoing mvmt |
| Ataxia | Seen in trunk, extremities, head, mouth, tongue; Multijoint & patterns of mvmt more affected; Slurred speech; Uncoordinated gait |
| Asthenia | Affects strength so can affect posture; Sense of heaviness, excessive effort for simple tasks, early onset of fatigue |
| Tremor | Intention tremor most common; Postural tremor may be relieved by L-dopa |
| Speech (Cerebellar Dysarthria) | Grammar/word selection NOT changed; Melodic quality & rhythm of speech are changed; Words/syllables pronounced slowly; Accents misplaced; Pauses inappropriate lengths |
| What might cause cerebellar dysarthria? | Problems similar to dysmetria of limbs +/- hypotonicity of larynx |
| Control of eye movements & gaze | Acute lesion- both eyes deviate toward contralateral side |
| Ocular Dysmetria | Unable to move eyes accurately to target b/c of problems with saccadic mvmt; Problems with pursuit; Unable to initiate conjugate eye mvmt & must look lateral by vigorously moving head; Gaze evoked nystagmus |
| Total Cerebellectomy could cause what challenges? | Truncal ataxia, Limb dysmetria, Hypotonicity, Postural tremor early |
| What are the least obvious s/sx 4 weeks after a total cerebellectomy? | Dysmetria & Postural Tremor |
| Examination | Determine basic fxnal abilities; Test for specific mvmt disorders; Multiple sites of CNS involvement, s/sx caused by cblr damage may be masked by spasticity/ssy loss, so test these too! |
| Treatment Basic Rules | Lots of reps for slow mvmts & even more practice for execution of rapid mvmts; Complex motor skills SHOULD be used in treatment |
| What should you work on in treatment? | Head & trunk control; Sitting balance; Rising from supine/prone to sitting; Independent xfers & fxnal activities in sitting; Prepare for independ standing/walking; Walking |
| Activities for temporary reduction of dysmetria | Frenkel Ex's; Wt extremities- removal of wt often increases dysmetria but over time may be effective |
| Fetal Alcohol Syndrome | Alcohol crosses placenta; Developing brain with a high met rate may be affected even in absence of s/sx in mom; Binge drinking can also cause |
| Chronic Alcoholism | Cortical/cblr problems; Peripheral neuropathy |
| S/sx of Chronic Alcoholism | Ataxia (esp trunk/legs); Incoordination; Peripheral neuropathy; +/- seizures; Vestibular defects; Psych problems (Delirium Tremens & Wernicke-Korsakoff) |
| Delirium Tremens | Severe alcohol withdrawal involving sudden/severe mental/nervous system changes |
| Wernicke-Korsakoff Syndrome | Thiamine deficiency; Confusion; Ataxia; Vision changes; Can't create or retain new memories; Memory loss; Confabulation; Hallucinations |
| Pharm considerations & Medical Mgmt of Alcoholism | Librium for sedations & to reduce DTs; Replacement of body fluids/electrolytes (B1 supplement); Diet |
| What kind of commands would you give someone you're examining suspected of having alcoholism? | Short & Single commands |
| Other considerations for alcoholism patient | Goal setting/prognosis- pt may not be mentally alert to participate; Degree of recovery depends on abstinence; Mental status is crucial; Physical ex can help with general rehab; PT should e aware of CV/resp/general co-morbidities |
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1190550002
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