Cerebellar
What are the major differences between Cerebellar Ataxia and Somatosensory ataxia?
Cerebellar: Gait with ataxic upper and lower limbs, Dizziness/vestibular impairment, decreased muscle tone, asthenia, gaze evoked nystagmus, NO somatosensory loss, titubation
Somatosensory: Ataxic gait, NO dizziness, muscle tone varies, asthenia varies, NO gaze evoked nystagmus, LOSS of somatosensory (proprioception) sensation, NO titubation
Both: Decomposition of movement, rebound phenomenon, dysmetria, dysdiadokinesia, Ataxia/intention tremor, balance impairment
What are primary symptoms that come directly from the cerebellum?
Dysmetria, dysdiadokinesia, decomposition of movement, rebound phenomenon, asthenia, intention tremor, hypermetria
What score is considered a community ambulator from the 10 meter walk test? What does it assess?
Community ambulator: >0.8 m/s
Limited community ambulator: 0.4-0.8 m/s
Household: <0.4 m/s
Assesses gait speed
When would you use Cawthorne-Cooksey exercises (Habituation) for a patient with cerebellar dysfunction?
What is Lhermitte's sign in MS?
Sharp shooting pain, spark like feelings down he spine and into the LE's with neck flexion
What is the vitamin deficiency that causes alcoholic ataxia (Wernicke-Korsakoff syndrome)? What symptoms does this cause?
Thiamine (vitamin B) deficiency
Causes: confusion, ataxia, ophthalmoplegia and nystagmus
What are the related symptoms in cerebellar dysfunction?
Titubation, postural tremor, dysarthria, staccato speech, nystagmus
Good score: <10 seconds
Assesses mobility, balance and fall risk
It has to be INTENSIVE!
What is a common first symptom of MS?
Visual changes:
- Optic neuritis (ice pick pain behind eye)
- Internuclear Ophthalmoplegia
What are some signs/symptoms of alcoholic ataxia?
Wide-footed, unsteady gait, slurred speech, clumsiness of hands, double vision, "slow legs", peripheral neuropathy, loss of vibration and DTRs
finger to nose, heel on shin, finger to therapist nose, finger opposition
What is a good score on the FGA? What does it assess?
Good score: higher (out of 30)
Assesses postural stability in different positions
What can a PT prescribe for a patient with cerebellar dysfunction who has visuomotor deficits?
Saccades, smooth pursuits, eye hand tracking, VOR x1 and x2
In the early stages of MS, what are the common impairments? What should the focus be on for treatment?
Impairments: motor symptoms present but don't affect daily activities
Interventions: mainly preventative/restorative --> REGULAR EXERCISE recommended, can also provide education about disease process and determine need for support, refer out if needed
What is the prognosis for alcoholic ataxia?
Longer recovery if cerebellar dysfunction
May take up to 6 months for full recovery
How would you assess for rebound phenomenon?
isometric contraction against any part of the body followed by a sudden release of resistance
What is the SARA outcome measure used for? What score indicates mild dependence vs maximal dependence?
Used to assess trunk and extremity ataxia, gait ataxia and talking
Mild dependence: 5.5 or LOWER
Maximal dependence: 23 or HIGHER
0= no ataxia, 40= most severe ataxia
If a person with MS has a lesion in on their optic nerve and brainstem, what deficits or symptoms would the patient have?
Optic nerve--> optic neuritis
Brainstem--> diplopia, vertigo, impaired speech and swallowing, paroxysmal symptoms
In the middle/moderate stages of MS, what are the main impairments and what should the focus be for treatment?
Impairments: min-mod activity impairments, ADLSs with modified dependence, difficulty with balance gait and postural stability
Treatments: preventative and compensatory --> REGULAR EXERCISE recommendations to maintain mobility/strength/flexibility, AD to maintain function along with education etc.
What is a good score on the Berg balance test?
41-56 --> low fall risk
How would you assess for Dysdidokinesia?
RAMs, forearm pronation/supination, heel-toe tap
What is important to remember when prescribing Frenkel exercises for coordination deficits?
They need to have vision available to see their limbs moving because that is their main source of feedback
If a patient with MS has a lesion in their spinal cord and cerebellum, what deficits/symptoms would they have?
Spinal cord--> weakness, spasticity, diminished dexterity, autonomic disturbances, pain
Cerebellum--> postural and action tremor, limb incoordination, gait instability, ataxia
In the Late/Advanced stages of MS, what are the main impairments and what should the focus be for treatment?
Impairment: severe limitations with dependence, a lot of difficulty with walking, assistance needed with ADLs, needs full time assistance, cognitive problems may be prominent
Interventions: Preventative --> maximize upright positioning and participation in ADLs to prevent contractures, pressure wounds and pneumonia. Compensatory--> education, pressure relieving devices, hospital bed