Ataxia

1. Amy Wedge, PT, DPT
Board Certified ClinicalSpecialist in Neurologic PhysicalTherapy
Certified Brain Injury Specialist
LSVT BIG® & PWR!Moves® Certified Therapist
Department of PhysicalTherapy
EastCarolinaUniversity
Physical Therapy Evaluation &
Treatment of Cerebellar Ataxia
Andrew Newnam, PT, DPT
PWR!Moves® Certified Therapist
Department of RehabilitationServices
VidantMedical Center
Session Time: 13:30-15:30, Saturday,October8, 2021
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2. Disclosures
 None, no conflicts of interest
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3. O bjectives
1. Understand cerebellar ataxia linking symptoms to neuroanatomy.
2. Discuss specific physical therapy evaluation measures for cerebellar
ataxia based on currentresearch.
3. Provide examples of specific clinical interventions for cerebellar ataxia
based on available evidence.
4. Utilize a case study to further improve understanding of translating
cerebellarataxia researchinto clinical practice.
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4. What is Ataxia?
 “Incoordinationof movement
followingdamage of the sensoryor
cerebellum system.”(Bastian AJ, 1997)
 Greek – “disorderly”or “without
order”
 Commonly associated with disease
pathology of the cerebellum, but it
can stem from other areas
www.ataxi a.org
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5. Role of Cerebellum
 Main Functions
 Coordination
 Movementquality
 Other Functions
 Motor learning
 Motor control
 Automaticity
 Posture
 Balance
 Cognition
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6. Motor Control and Motor Learning
Motor Control
 Ability to regulatemechanisms
essentialfor movement
 Involves initiating, directing, and
grading movement
 Planexecutionfine tuning
(Cerebellum)
Motor Learning
 Process by which a new motor task
is acquired
 Requires practice
 Cerebellum plays a critical role
 Levels of mastery (automaticity)
 Optimization facilitates outcomes
(Shumway-Cook A, Woollacott M; 2007) (Kitago T, et al 2013)
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7. (Criscimagna-Hemminger SE, et al; 2010)
Motor Learning after Cerebellar Lesion
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8. https://nba.uth.tmc.edu/neuroscience/m/s3/chapter05.html
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9. Functional Zones of Cerebellum
 Vestibulocerebellum
 Spinocerebellum
 Cerebrocerebellum
Vestibulocerebellum:
• Balance
• Postural adjustments
• Coordination of eye
movements
Spinocerebellum:
• Muscle tone
• Coordniation
Cerebrocerebellum:
• Motor planning
• Learning
• Memory
Cerebellum
Unfolded
https://learninglink.oup.com/access/content/watson3e-student-resources/watson3e-chapter-5-a-step-further- 4
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10. (Leggio, M, et al.; 2018)
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11. CerebellarRegion
Lateral hemispheres
Function Motor Pathways Influenced
Motor Planningfor extremities Lateralcorticospinal tract
Intermediatehemispheres Distal limbcoordination Lateralcorticospinaltract,
rubrospinal tract
Vermis and Flocculonodular
lobe
Proximal limb and trunk
coordination
Balance and vestibulo-ocular
reflexes
Anteriorcorticospinaltract,
reticulospinaltract,
vestibulospinaltract,
tectospinaltract
Medial longitudinalfasciculus
(Blumenfeld, H; 2010)
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12. Principle Signs of Cerebellar Dysfunction
 Ataxia
 Appendicular
 Truncal
 Hypotonia
 Tremor
 Ocularmotorabnormalities
 Coordination Impairments
 Dysrhythmia
 Dysmetria
 Dyssynergia
 Dysdiadochokinesia
 Loss of check (rebound)
(Blumenfeld, H; 2010)
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13. Vestibulocerebellar Functions
 Enhancesbalance by coordinating postural adjustments(anticipatoryand
compensatory)
 Controls eye movementsvia VOR’s
 Dysfunction
 Imbalance
 Disequilibrium
 Nystagmus
 Truncal ataxia
 Significant swaying during standing, staggering during gait
 Fall
Slide used with permission from Dr. James Lin
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14. Spinocerebellum
 Coordination of synergistic movementpatterns needed for specific task
 Particularly movements of proximal limb and trunk
 Detectsand aids in adjustment of movementsrelative to desired vs actual
 Dysfunctions
 Dyssyngeria
 Dysmetria
 Lock of movement check (rebound)
 Ataxia of gait and stance
Slide used with permission from Dr. James Lin
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