Anatomical divisions of cerebellum

1) 2)

3)

The midline The hemispheres(right controlling the right side of the body and left controlling the left side of the body) The posterior part(flocculonodular lobe,archicerebellum)

DYSFUNCTIONS OF DIVISIONS OF CEREBELLUM 1)The midline-titubation,truncal ataxia,gait

imbalance 2)The hemispheresdysdiadochokinesia,dysmetria,dysarthria ,hypotonia 3)the posterior-posture imbalance,gait imbalance,nystagmus

TITUBATION
POSTURE IMBALANCE CHARACTERISED BY SWAYING HEAD OR TRUNK WHILE SITTING

TRUNCAL ATAXIA
Loss of cordinated muscle movements for maintaing normal posture of the trunk

DYSDIADOCHOKINESIA
It is impaired ability to perform rapid alternating movements.The movements are irregular,with loss of range of motion and rhythm. eg.rapid alternation between supination and
pronation of forearm

DYSMETRIA
It is inability to judge the distance or range of a movement.It may be manifestated by an overestimation (hypermetria) or an underestimation (hypometria) of the required range needed to reach an object or goal.

Definition of ataxia
Incoordination

of voluntary motor activity with or without dis equilibrium in absence of motor weakness

Assessment of ataxic patients

Assessment must be done bilaterally even in unilateral lesion Assessment must be done in quiet place to avoid distraction Age and psychological state must be considered

Assessment of ataxic patients cont.

Motor assessment including muscle tone and muscle test Sensory assessment including superficial and deep sensation ROM Orofacial function assessment including facial expression ,lip &jaw closure Senstivity of face Coordination of respiration with swallowing and speech

Assessment of ataxic patients cont.

Coordination assessment (the most important item) including non equilibrium and equilibrium subtypes Non equilibrium coordination tests Finger to nose Finger to finger Finger to doctors finger Adiadokokinesia Rebound phenomenon Buttoning and unbuttoning Heal to knee Walking along a strieght line

Cerebellar Function
Requires Assessed

by:

integration of:
Motor system Cerebellar

Rapid alternating

system Vestibular system Sensory system

movements Finger-to-Nose / Heel-to-Knee Test Rombergs Test Gait

Finger-to-Nose Test
Finger-to-nose

with moving target

Stationary

finger-to-nose with eyes closed

Heel-to-Knee Test

Rapid Alternating Movements

First with hands Repeat with feet Diadochokinesia = ability to perform RAM Dysdiadochokinesis = slow, irregular, clumsy movements

Rombergs Test

Station & Stance

Pt stand with feet together
First, eyes open

Romberg Test
Then, close eyes
If okay with eyes open, but

sways w/ eyes closed = + Romberg Mainly tests position sense

Vision can compensate for loss of

position sense

Assessment of ataxic patients cont.

Equilibrium coordination tests Static and dynamic balance Observation of patient position during different position and during movement respectively to determine any hesitation or titubation . Gait assessment

Problem of ataxic patients

Lack of balance Inco-ordination of movement Instability around shoulder & pelvise Difficulty in sustaining activity againest gravity & he cant manipulate objects so activity is limited Poor visual fixation &eye hand contact due to tremor ,nystagmus &nodding of the head Orofacial dysfunction Poor posture Gait problems (wide base gait-drunken gait)

Problem of ataxic patients

Deviation toward one side Zigzag gait High steppage gait (hypermetria ) Stamping gait

Plane of treatment

Long term goal: To make the patient indepedent as much as possible Short term goal: Improve proximal stability Improve eye hand contact Regain co-ordination by regulating interplay between agonist and antagonist Enable patient to control movement against gravity

Plane of treatment cont.

Methods of treatment: PNF technique 1- Rhythmic stabilization to improve proximal stability 2-Reversal tech. to improve ability to alternate movement from agonist and antagonist 3-Approximation to improve proximal fixation

Plane of treatment cont.

Tapping and weight bearing increasing stability Using ankle and wrist weight to decrease tremor Balance can improved in antigravity position in normal base of support Postural stability is improved by using antigravity position in the developmental sequence Frenkels exercises improve co ordination

Frenkels exercises
Definition : a series of gradual progressive exercises designed to increase coordination Aim : Establishing control of movement by use of any part of sensory mechanism which remain intact as sight & hearing to compensate for the loss of kinethetic sensation

Frenkels exercises cont

I-lying -------- flexion-extension Abduction adduction Each movement will be performed unilaterally fast then slow then interrupted by hold bilateral performance simultaneusely then alternatively

Frenkels exercises cont

Sitting : 1-Slide heel to reach a mark on the floor 2-change standing and sit again Standing : 1-transfer weight from foot to foot 2- walking side ways 3-placing foot on specific marks

Frenkels exercises cont

For arms : Sitting with arm supported on a table and placing hand at specific mark Try to reach an object Picking up objects Put the hand in a ring or hole