NCS > Cerebellar Dysfunction > Flashcards

Cerebellar Dysfunction Flashcards

(106 cards)

Study These Flashcards
1
Q

What are the 3 lobes of the Cerebellum?

A
  1. Anterior
  2. Posterior
  3. Flocculonodular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are the lobes connected to the brainstem?

A

Via cerebellar peduncles (superior, middle, and inferior cerebellar peduncle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Flocculonodular Lobe (Vestibulocerebellar) Movement (3)

A
  • VOR
  • Gaze/Eye movements
  • Posture and Balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Flocculonodular Lobe (Vestibulocerebellar) Dysfunction (3)

A
  • Nystagmus
  • Impaired VOR
  • Balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Medial Zone (Spinocerebellar) Movement (4)

A
  • Gaze/Eye Movements
  • Postural Tone
  • Balance
  • Locomotion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medial Zone (Spinocerebellar) Dysfunction (4)

A
  • Oculomotor deficits
  • Hypotonia
  • Falls
  • Gait Ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Intermediate Zone (Spinocerebellar) Movement (2)

A
  • Limb movements
  • Coordinate agonist-antagonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Intermediate Zone (Spinocerebellar) Dysfunction (6)

A
  • Imbalance
  • Gait ataxia
  • Tremor
  • Lack of check
  • Dysmetria
  • Dysdiadochokinesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lateral Zone (Cerebrocerebellar) Movement (4)

A
  • Complex multi-joint voluntary movements
  • Visually guided movements
  • Motor planning
  • Sensorimotor Error
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lateral Zone (Cerebrocerebellar) Dysfunction (4)

A
  • Dysdiadochokinesia
  • Dysmetria
  • Dyssynergia
  • Decomposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the primary function of the cerebellum?

A

Coordinating to generate smooth and fluid multi-joint movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does the cerebellum predict movement?

A

Based on stored knowledge of limb dynamics (to help generate the correct, precise movement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Timer Hypothesis?

A

Cerebellum encodes the precise timing of muscle activation leading to “learning” or changing movements based on activity and outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Common Acquired Cerebellar Diagnoses (8)

A
  1. Cerebellar Tumors
  2. Cerebellar Strokes
  3. Structural (Chiari Malformation)
  4. Toxicity
  5. Immune Mediated (MS)
  6. Trauma (TBI)
  7. Infection (Cerebellitis)
  8. Endocrine (Hypothyroidism/Hasimoto’s Thryoiditis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an early sign of Cerebellar Tumors?

A

Ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patient population most commonly affected by Cerebellar tumors?

A

Children > adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is typical of adult cerebellar tumors?

A

Typically are metastasis and more aggressive with poorer prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What % of all strokes are cerebellar strokes?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

S&S of Ischemic Cerebellar Stroke? (4)

A
  • Ipsilateral limb ataxia
  • Nystagmus
  • Vertigo
  • N/V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

S&S of Hemorrhagic Cerebellar Stroke? (5)

A
  • Nystagmus
  • imbalance
  • vertigo
  • n/v
  • headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Recovery is best when what structures are NOT damaged?

A

Cerebellar nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

S&S of stroke in Superior Cerebellar Artery (4)

A
  • Dysmetria of ipsilateral arm movements
  • Unsteadiness in walking
  • Dysarthria
  • Nystagmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

S&S of stroke in Anterior Inferior Cerebellar Artery (4)

A
  • Both cerebellar AND extracerebellar signs
  • Dysmetria
  • Vestibular signs
  • Fascial sensory loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

S&S of stroke in Posterior Inferior Cerebellar Artery (5)

A

most benign
- vertigo
- unsteadiness
- walking ataxia
- nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Populations most likely to be affected by Chiari Malformation (2)
Woman > Men Younger > Older
26
How is cerebellum damaged with Chiari Malformation?
Increased pressure and mechanical deformation of the cerebellum on or through the foramen magnum
27
Toxicity factors related to Cerebellar dysfunction (2)
1. Exposure to heavy metals 2. Chronic alcoholism
28
How does involvement of cerebellum w/TBI impact outcome?
Worse outcomes w/cerebellar involvement
29
What is Cerebellitis? (4)
Inflammation of cerebellum leading to - cognitive changes - ataxia - dizziness - balance challenges
30
2 virus examples that can lead to cerebellitis?
1. Epstein-Barr 2. Varicella
31
How can Hypothyroidism impact the cerebellum?
Causes cerebellar degeneration d/t autoimmune attack *possible reversible cause of ataxia
32
Degenerative Nonhereditary Cerebellar Diagnoses (2)
1. Multiple System Atrophy - C (Cerebellar Variation) 2. Idiopathic Late-Onset Cerebellar Ataxia (ILOCA)
33
Symptoms of MSA-C (5)
- rigidity/bradykinesia/postural instability - ataxia - bladder dysfunction - cognitive impairments - orthostatic hypotension (ANS dysfunction)
34
Symptoms of ILOCA
Pure ataxia w/UMN symptoms such as spasticity or weakness
35
Age of onset of ILOCA
Late onset > 50 years of age
36
Prognosis of ILOCA
Slow progression
37
Hereditary Cerebellar Diagnoses (6)
1. Episodic Ataxias 2. Spinocerebellar Ataxias (SCA) 3. Friedreich Ataxia 4. Early Onset Cerebellar Ataxia 5. Mitochondrial Disease 6. Fragile X-associated tremor
38
Episodic Ataxias (2)
*Autosomal Dominant - periods of ataxia lasting minutes to hours brought on by exercise, stress, or excitement
39
Spinocerebellar Ataxias (SCA) (4)
*Autosomal Dominant - 46 distinct types - midlife onset - slowly progressed
40
Friedreich Ataxia (8)
*Autosomal Recessive *Most common form of inherited ataxia - S&S: - falls - gait ataxia - areflexia - imbalance - neuropathy - chronic fatigue
41
Early Onset Cerebellar Ataxia (2)
*Autosomal Recessive - < 25 years of age
42
Mitochondrial Disease (3)
* X-linked - ataxia is the major defining feature - d/t mitochondrial disruption to the purkinje cells (inhibitory neurons in cerebellum) and motor neurons
43
Fragile X-associated tremors (4)
* X-linked - adult onset (> 50 years) - M > F - associated w/intention tremors and balance problems
44
Dysmetria (4)
Difficulty to scale movement distance - Hypermetric - Hypometric More involved joints = more errors
45
Hypermetric Movement (2)
Overshoots targets - usually caused by FAST movements
46
Hypometric Movements (2)
Undershoots targets - usually caused by SLOW movements
47
Dysdiadoschokinesia (4)
Deficit in coordinating agonist-antagonist muscle groups during voluntary rapid alternating movements - slowness - inconsistent rate and range of movements - movements worsen as time continues vs. correct/improve
48
Lack of Check (3)
Excessive rebound or inability to stop the movement of a body part after a strong isometric force - d/t delayed agonist cessation or delayed activation of antagonist - may cause damage/injury to patient or provider
49
Cerebellar Tremor (3)
Action tremor (absent at rest) - driven by visual feedback (decreases or goes away when eyes are closed) - typically happen at end of a action as cerebellum cannot regulate to stop movement
50
2 Types of Cerebellar Tremor
1. Postural 2. Kinetic
51
Postural Cerebellar Tremor
Of postural muscles (neck/trunk)
52
Kinetic Cerebellar Tremor
Muscles that facilitate movement (arms/hands)
53
Cerebellar Imbalance (4)
- Increased postural sway - excessive postural response to perturbations - poor equilibrium during voluntary movement - titubation (abnormal oscillations of the trunk)
54
What are the 2 Cardinal signs of cerebellar damage?
- Postural instability in both static AND dynamic states - Ataxic Gait
55
Ataxia Gait (6)
- falls backwards/towards side of lesion - slowed walking speed - step length is short and unequal - limb coordination is unequal and abnormal - cadence is irregular - WBOS
56
Oculomotor Impairments (5)
- saccades are slowed and dysmetric - smooth pursuits are saccadic or choppy - inability to cancel/suppress VOR - abnormal nystagmus may be present - affects coordination/accuracy of limb movements
57
Ataxic Dysarthria (4)
Poor coordination/timing of the muscles in the mouth that produce speech - impaired articulation - impaired word stress pattern and intonation of words - lack of or excessive loudness
58
What is the best Medical Management for Ataxia?
Limited success with pharmacology PT > meds
59
Supplements recommended for Ataxia Management (2)
- Vit E - CoQ10
60
Components of PT Exam (6)
1. Tone management 2. Voluntary Movement Coordination 3. Static and Dynamic Balance 4. Oculomotor Performance 5. Transitions/Transfers 6. Gait
61
PT Exam - Tone Management
Examine for HYPOtonia in extensor mm groups - more common in pediatric patients
62
PT Exam - Voluntary Movement Coordination Test (6)
1. Finger-to-nose 2. Alternating supination-pronation 3. Hand/finger tapping; Foot/toe tapping 4. Drawing/Handwriting 5. Holding a static position (arms outstretch/pronator drift) 6. Heel to Knee test
63
PT Exam - Voluntary Movement Coordination Guidelines (4)
1. Compare both sides 2. Repeat each test multiple times 3. Compare slow vs. fast speeds 4. Compare with and without vision
64
PT Exam - Seated Static Balance (4)
Perform w/ and w/o UE and LE and trunk support - Recovery Test: -- Self-imposted movements: head turns/arm movements -- External movements: perturbations
65
PT Exam - Standing Balance (4)
Perform w/ and w/o UE and LE support, w/ and w/o vision, and w/feet apart and together - Recovery Test: -- Self-imposted movements: head turns/arm movements -- External movements: perturbations
66
PT Exam - Oculomotor Performance (3)
- Smooth pursuits - Saccades - Gaze-evoked nystagmus
67
PT Exam - Bed Mobility (2)
- rolling - scooting
68
PT Exam - Transfers (2)
- sit <> stand - chair <> bed
69
PT Exam - Stair Climbing (4)
- Curbs - Stairs -- with/without handrail -- step-to vs. reciprocal
70
PT Exam - Gait (7)
- normal - narrow - tandem - inclines/declines - uneven surfaces - dual-tasking - turns, narrow areas
71
International Cooperative Ataxia Rating Scale
- 0-100 (0 = no ataxia; 100 = most severe ataxia) - Rates 19 specific activities - split into 4 categories
72
What are the 4 categories of the International Cooperative Ataxia Rating Scale?
1. Posture and Gait 2. Limb movements 3. Speech 4. Oculomotor Performance
73
Scale for Assessment and Rating of Ataxia (SARA)
8 test items - ordinal scale *does NOT categorize individual test items by body part*
74
What are the 4 intervention components of PT gait and balance training?
1.Gaze and Eye movement 2. Static Stance 3. Dynamic Stance 4. Gait (regular and complex)
75
Dynamic Stance Interventions (6)
- marching - toe taps - 360* turning - forward reaching - hip hinge/squats - positional changes
76
Why is aerobic exercise and resistance training recommended?
D/t increased energy expenditure and exertion required at baseline to produce purposeful movement - d/t increased fatigue, pts are more likely to trip and fall
77
What is the recommended treatment duration?
10hrs/wk (between PT and home) for up to 6 months *no min standard value
78
What is the most common component for a PT plan of care?
Compensatory strategies
79
Compensatory strategy recommendations (4)
1. slow down movements (less dyssynergia and less hypermetric) 2. Add in visual reference (vertical markings on doorways) 3. Widening stance w/cues (consider an AD requiring min UE control - walker > lofstrands) 4. Minimize distractions
80
Weighting... should we do it? (3)
- benefit is present when weights are on but has little carry over once weights are removed - weighting can worsen hypermetria and lead to more errors - weighting can slow movement down which naturally leads to less hypermetria
81
What are the 2 forms of Normal Pressure Hydrocephalus (NPH)?
1. Idiopathic (primary) 2. Symptomatic (secondary)
82
What is Idiopathic NPH? (2)
- occurs spontaneously - more common in older adults
83
What is Symptomatic NPH? (2)
- d/t infection, hemorrhage, TBI, or radiation - effects people of all ages
84
Epidemiology of NPH? (3)
- average age of onset: 70 years old - M = F - accounts for 6% of all dementia cases (reversible dementia)
85
Anatomy of NPH
CSF backs up/builds in the ventricles of the brain causing them to enlarge, leading to pressure on important structures
86
NPH Physiology (5)
- decreased compliance of subarachnoid space - increased CSF pulse pressure - reduced reabsorption of CSF - cerebral blood flow reduction - increased resistance to CSF outflow
87
What structures can be affected in NPH? (3)
1. Brainstem - gait abnormalities 2. Periventricular white matter and cortex - dementia 3. Compression of corticospinal tract - gait abnormalities and bladder incontinence
88
Most common S/S of NPH (4)
1. Gait disturbances 2. Imbalance 3. Dementia 4. Urinary Incontinence
89
Gait disturbances in NPH (6)
- magnetic - shuffling - WBOS - astasia-abasia type (glue-footed) - difficulty turning - gait initiation and freezing of gait
90
Imbalance in NPH (3)
- worse w/eyes closed - requires WBOS - retropulsion
91
Dementia in NPH (4)
- inertia - forgetfulness - poor executive function - visuospatial dysfunction
92
Urinary Incontinence in NPH (2)
- detrusor overactivity - frequency and urgency
93
Labs and Imaging for NPH
1. CT (visualize anatomical brain changes; need MRI to confirm) 2. MRI* (can also perform CSF flow study, magnetic resonance spectroscopy (MRS)) 3. Spinal Tap Test (repeated 2-3 days in a row; pair w/pre- and post- gait walk test for assessment of removal of CSF)
94
What is the imaging of choice for NPH?
MRI
95
What functional outcome can be paired with Spinal Tap Test? (4)
- TUG - 10MWT - miniBEST - has seen Tinetti
96
What is the medical management of NPH if improvements are seen in Spinal Tap Test?
VP Shunt
97
What is the medical management of NPH if no improvements are seen in Spinal Tap Test?
Will consider lacunar stroke or Parkinsonism
98
What is VP Shunt? (4)
*ventriculoperitoneal shunt - 75% show improvement in gait - 60% show improvement in cog -.55% show improvement in incontinences
99
Positive Predictive Factors for NPH VP Shunt (7)
- secondary NPH - MCI < 2 years in onset - gait abnormality - hydrocephalus w/o sulcal enlargement - transependymal CSF flow - large-volume spinal tap - high normal opening pressure
100
Negative Predictive Factors for NPH VP Shunt (5)
- extensive white matter lesions - diffuse cerebral atrophy - moderate to severe cognitive impairment - cog impairment before gait abnormality - history of alcoholism
101
VP Shunt Risk Complications (3)
- positional headaches - wound infection - subdural hemotoma/hemorrage
102
Signs of a blocked shunt (7)
- headaches - N/V - excessive tiredness (difficulty waking up/staying awake) - changes in behavior/personality - loss of coordination/balance - difficulty concentrating - return of pre-treatment problems
103
What are sunsetting eyes?
Downward deviation of the eyes where the white part may be seen above the iris *typically present in infants and toddlers w/increased ICP
104
PT Treatment for NPH (3)
1. Stretching and ROM - active and passive 2. Balance training - Large amplitude movement training - multi-directional walking - functional task training 3. Gait training - obstacle management - turning - dynamic gait training
105
Duration of PT recommended for NPH?
2-3 sessions/wk 6-12 weeks
106
What may have a negative impact on NPH outcomes? (2)
- longer disease duration - older age
NCS
flashcards
Decks in class (26)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions