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Cerebellar Problems

NDT Cerebellar Problems PPT

QuestionAnswer
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
Created by: 1190550002