Week 4.4 Ataxia Handouts PDF

DPT 6410 Neuromuscular Practice - Adult Ataxia Objectives Identify the neuroanatomy involved in ataxia Identify the causes of ataxia Examine interventions and strategies for management of ataxia Common Cause – Damage to Cerebellum Role of Cerebellum in Motor Control Compares movement to intended out...

DPT 6410 Neuromuscular Practice - Adult Ataxia Objectives Identify the neuroanatomy involved in ataxia Identify the causes of ataxia Examine interventions and strategies for management of ataxia Common Cause – Damage to Cerebellum Role of Cerebellum in Motor Control Compares movement to intended output Predictive/anticipatory modifications in preparation for movement Motor learning Learns, memorizes and stores motor programs Adaptation Other Roles of Cerebellum Balance and equilibrium Control of muscle tone Accurate direction, extent, force and timing Movement compositon Role in speech production Control of eye movement and gaze S/S Cerebellar Infarct Cerebellar Dysfunction Disorganization of movement, especially rapid movements Impaired balance Impaired postural control Hypotonicity Dysmetria Decomposition Ataxia Dysdiadochokinesia Tremor Asthenia Dysarthria Ocular dysmetria, nystagmus, etc.. Mechanism of Cerebellar Damage Acquired Stroke Tumor Structural (Chiari malformation, agenesis, hypoplasia) Toxicity (alcohol, heavy metals, drugs, solvents) Immune-mediated (MS, gluten ataxia) Trauma Infection (cerebellitis) Endocrine (hypothyroidism) Mechanisms of Cerebellar Damage Degenerative Non-Hereditary Multiple system atrophy Idopathic late-onset cerebellar ataxia Hereditary Autosomal dominant disorders (episodic ataxias, spinocerebellar ataxias) Autosomal recessive disorders (Friedreich ataxia, early onset cerebellar ataxia) X-linked disorders (mitochondrial disease, fragile X- associated tremor) Ataxia Without order or incoordination Slurred speech, stumbling, falling, incoordination Trouble eating and swallowing Eye movement abnormalities Tremors Cardiac issues Outcome Measures Traditional function/activity measures FIM Balance/Postural control measures Gait measures Ataxia specific International Cooperative Ataxia Rating Scale (ICARS) https://www.sralab.org/rehabilitation-measures/internationalcooperative-ataxia-rating-scale Scale for the Assessment and Rating of Ataxia (SARA) https://www.sralab.org/rehabilitation-measures/scale-assessmentand-rating-ataxia Treatment Not lots of evidence Treat the symptoms Postural stability Gait Balance Accuracy of limb movements Treatment Intensive long term motor training Supervised as well as home exercise programs Intensive coordination training HEP focused on static and dynamic balance activities Sitting and standing Effect on walking Bastian A, Keller JL, Neurorehabil Neural Repair, 2014 Body weight supported treadmill training Minimal research support Treatment Use of biofeedback and/or bandwith feedback Decreasing degrees of freedom Activities that focus on stability, co-contraction, midrange control Use of resisted movements Compensatory Strategies Slow down movements Reduce number of segments moving at any given time Widen BOS Minimal environmental distractions Weighting (axial v limb) Assistive devices Orthotics Again… more when we get to lab!