NDT Cerebellar Problems PPT
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
1190550002
Popular Physical Therapy sets