Lecture 19: physical therapy management of cerebellar dysfunction and ataxia

cerebellum regulates...

movement, postural control, muscle tone

regulation occurs by fine tuning motor output through

timing, scaling, error detection

4 main roles of cerebellum in movement

feedforward command, feedback from movement, comparison, error correction

what happens with an injury to the spinocerebellum (vermis)

trunk ataxia, orthostatic tremor and gait instability, impaired postural sway, abnormal postural reactions

what happens with an injury to the lateral hemispheres and dentate nuclei

limb ataxia, kinetic/action tremor, dysarthria, hypotonia

what happens with an injury to the flocculonodular node

impaired vestibular control, complaints of dizziness, balance difficulty

blood supply to the cerebellum

superior cerebellar artery, AICA, PICA

common genetic conditions causing cerebellar dysfunction

spinocerebellar ataxia, friedreichs ataxia

common acquired conditions causing cerebellar dysfunction

stroke, MS, infection, nutrition, ETOH toxicity, vitamin deficiency, endocrine

common structural conditions causing cerebellar dysfunction

chiari malformation, dandy walker, hypolasia

clinical signs of cerebellar dysfunction

issue impaired feedback and feedforward control, motor deficits

examples of motor deficits with cerebellar dysfunction

dysmetria, dysdiadochokinesia, intention tremor, decomposition, timing errors, poor rhythm

how cerebellar injury impairs reaching

dysmetria, decomposition, increased movement time, spatial and temporal variability, difficulty adapting to changes

how cerebellar injury impairs gait

irregular step timing and placement, excessive variability in step length/width, difficulty with obstacle negotiation and dual task

how cerebellar injury impacts oculomotor and gaze stabilization

gaze evoked nnystagmus, saccadic dysmetria, impaired VOR adaptation leading to oscillopsia and reduced visual stability during head movement

clinical presentation and functional impact of ataxia

wide BOS, asymmetrical and irregular stepping, postural instability, falls, ADL difficulty, decreased mobility

cerebellar vs sensory vs vestibular ataxia - cerebellar

tumor, stroke, degeneration; impaired timing, scaling, coordination

cerebellar vs sensory vs vestibular ataxia - sensory

peripheral neuropathy, B12 deficiency; relies on vision, positive romberg

cerebellar vs sensory vs vestibular ataxia - vestibular

inner ear disorders (neuritis, hypofunction); dizziness, nystagmus, balance deficits

what condition can cause autoimmune ataxia

MS