Cerebellar ataxia is a common symptom in multiple sclerosis that can cause motor and cognitive signs. Cerebellar lesions and ataxia are associated with poorer prognosis. Symptoms vary depending on the location of lesions within the cerebellum and connections. While training programs have shown benefits for motor function in cerebellar degenerations, the effects of specific oculomotor training in MS are unclear. Recovery from cerebellar damage may occur through substitution within the cerebellum or recruitment of other brain areas through mechanisms like synaptic plasticity.
Vestibular and Cerebellar Ataxia - Julius King KwedhiDr. Julius Kwedhi
The word "ataxia", comes from the Greek word, "a taxis" meaning "without order or incoordination". The word ataxia means without coordination. (http://www.ataxia.org/learn/ataxia-diagnosis.aspx)
Inability to coordinate voluntary muscle movements; unsteady movements and staggering gait. (WordWeb Dictionary)
Methods used in pediatric rehabilitation Zaid Hjab
Zaid Hjab
In rehabilitation of children, varying approaches and techniques are
used, ranging from very conservative and conventional techniques, such as muscle
strengthening, manual stretching, and massage, to more complex motor learningbased theories, such as neurodevelopmental treatment, conductive education, and
several others. The motor disorders seen in pediatric are frequently accompanied
by disturbances of sensation, cognition, communication, perception, and/or
behavior disorders; thus, therapy approaches are arranged to meet the individual
child’s needs. The approaches can be divided into two groups as with equipment
and without equipment. Examples for without equipment rehabilitation
approaches are neurodevelopmental treatment, conductive education constraintinduced movement therapy, and task-oriented therapy, whereas robotic therapy,
virtual reality, and horse-back riding therapy are the examples of rehabilitation
approaches with equipment. Application of evidence-based methods ensures
maximum gains in children. The concept that intense, task-specific exercises
capitalize on the potential plasticity of the CNS and thus improve motor recovery
has led to the development of several successful interventions for children. Also
approaches that improve the patient’s motivation and target the activities of daily
living and participation are the most effective approaches for functional recovery
of the children.
Vestibular and Cerebellar Ataxia - Julius King KwedhiDr. Julius Kwedhi
The word "ataxia", comes from the Greek word, "a taxis" meaning "without order or incoordination". The word ataxia means without coordination. (http://www.ataxia.org/learn/ataxia-diagnosis.aspx)
Inability to coordinate voluntary muscle movements; unsteady movements and staggering gait. (WordWeb Dictionary)
Methods used in pediatric rehabilitation Zaid Hjab
Zaid Hjab
In rehabilitation of children, varying approaches and techniques are
used, ranging from very conservative and conventional techniques, such as muscle
strengthening, manual stretching, and massage, to more complex motor learningbased theories, such as neurodevelopmental treatment, conductive education, and
several others. The motor disorders seen in pediatric are frequently accompanied
by disturbances of sensation, cognition, communication, perception, and/or
behavior disorders; thus, therapy approaches are arranged to meet the individual
child’s needs. The approaches can be divided into two groups as with equipment
and without equipment. Examples for without equipment rehabilitation
approaches are neurodevelopmental treatment, conductive education constraintinduced movement therapy, and task-oriented therapy, whereas robotic therapy,
virtual reality, and horse-back riding therapy are the examples of rehabilitation
approaches with equipment. Application of evidence-based methods ensures
maximum gains in children. The concept that intense, task-specific exercises
capitalize on the potential plasticity of the CNS and thus improve motor recovery
has led to the development of several successful interventions for children. Also
approaches that improve the patient’s motivation and target the activities of daily
living and participation are the most effective approaches for functional recovery
of the children.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
Practical management of ataxia and balance impairment: Part 2MS Trust
This presentation by Dr Lisa Bunn looks at the practical management of ataxia and balance impairment among people with MS. It includes information on assessing ataxia, the rehabilitation of balance, and relevant research studies.
It was presented at the MS Trust Annual Conference in November 2013.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
Practical management of ataxia and balance impairment: Part 2MS Trust
This presentation by Dr Lisa Bunn looks at the practical management of ataxia and balance impairment among people with MS. It includes information on assessing ataxia, the rehabilitation of balance, and relevant research studies.
It was presented at the MS Trust Annual Conference in November 2013.
To Study the Efficacy of Electromyographic Biofeedback Training on Dynamic Eq...IOSR Journals
Abstract: Cerebral palsy (CP) is caused by static lesion to a developing nervous system that primarily affects
motor function. Spastic motor involvement is characteristic of most of these individual.Dynamicequinus is a
common deformity that worsens the ambulatory ability of both diplegic and hemiplegic conditions. The use of
electromyographic (EMG) biofeedback has been suggested as a training tool to improve the ability to increase
activation of weak and partially paralyzed muscles and to decrease the activation of muscles affected by spasm
or spasticity without regard to specific diagnosis. However, very few studies have reported the effects of EMG
biofeedback on ankle function among children with spastic cerebral palsy .Objectives of the study was to
increase the activation of tibialis anterior and to improve the functional ambulation.40 subjects were made part
of the study on the basis of inclusion and exclusion criteria divided into two groups group A and B.Group A
received traditional physical therapy exercises and electromypgraphic biofeedback and group B received only
exercise program.The treatment duration was for 4weeks 3 sessions a week.The results were analysed using
statistical tests that were paired and unpaired t-test and mannwhitneytest.The results showed significant
improvement in the pre and post treatment.The conclusion of the study lended a favourable outlook to use
biofeedback training in treatment of CP children, to improve functional ambulation and gait. Keywords: Cerebral palsy, dynamic equinus deformity, gait, electromyography, biofeedback.
The Chiro Hub is at the forefront of providing advanced treatment in the field of balance, dizziness and postural disorders. Physiosensing, using unparalleled accuracy in obtaining objective measures, is superior when it comes to the management of conditions such as concussion, whiplash, neurologic and orthopaedic conditions.
The ability of the neurons to change their function, chemical profile ( amount and types of neurotransmitters produced) or structure is referred to as neuroplasticity.
The plastic changes in neuron can occur
Physiologically according to activity and skill.
Pathologically due to injury or disease of CNS.
pediatric electrodiagnostic for cerebral palsy,
A diagnosis of CP is often made based on MRI, delay of motor milestones and the presence of gait abnormalities in young children
Although the initial brain injury is non-progressive, the musculoskeletal impairments and functional limitations associated with CP are progressive
Three main classes of CP include spastic, dyskinetic and ataxic
In-service project for clinical affiliation with Hingham PT, Inc. (Januay 2014-April 2014)
Review of vestibular system, common diagnosis and how to examine, evaluate and treat.
I also reviewed and supplied the clinic with the Four Step Square Test and Dynamic Gait Index in order to allow them to implement these outcome assessments into their clinic for individuals with balance/vestibular deficits
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Similar to Cerebellar Ataxia in Multiple Sclerosis (20)
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
4. Cerebellar Ataxia in MS: Clinical
• In brainstem/cerebellar signs in clinically isolated syndromes(CIS) predicts long term disability
Sastre- Garriga et al 2010
• Cerebellar Relapse at disease onset associated with increased risk of cerebellar involvement during subsequent relapses
• 10% relapses are cerebellar
• Cerebellar relapses associated with poor relapse recovery and earlier onset of progressive disease onset
Wilikins 2017
• Motor Cerebellar Signs are the main clinical symptom in 11-33% of pw MS
Wenshenker et al 1996
• Poor Prognostic indicator for Rehabilitation
Langdon and Thompson,1999
5. Superior Cerebellar Peduncle
Middle Cerebellar
Peduncle
Inferior Cerebellar Peduncle
Pons
Olive
Cross Section of the Cerebellum
Cerebellar
Cortex
Pons
4th Ventricle
Dentate
Interpositus
Fastigial
(Snell, 1992 Clinical Neuroanatomy for medical students)
6. Cerebellar Ataxia in MS: Pathology
• In clinically definite MS
• Gray and White matter pathology in cerebellum seen
• Demyelination affects 14-39% of cerebellum on average
• Axonal damage and neuronal loss seen with cerebellar cortical lesions – can occur independent of focal lesions
Parmar et al 2018
• Cerebellar peduncles are common lesional sites
• In Animal models (EAE) models Purkinje cell loss and altered ion channels and firing patterns seen.
• Demyelination and volume loss predicts deficits in motor skills and cognitive dysfunction
Parmar et al 2018
Demyelination in MS PL staining
Wilkins Front Neurology 2017 Article 312
10. Signs and Symptoms
• Oculomotor abnormalities
• Dysarthria
• Deficits of Limb Movements
• Abnormalities of gait and posture
• Cognitive and affective Signs
14. Oculomotor Abnormalities
Gaze Evoked Nystagmus
Nystagmus-associated gray matter
degeneration in medial cerebellar,
posterior medullar, central
pontine, and superior collicular regions.
Bede et al 2018 Front in Neurology v9 article 691
17. Oculomotor Retraining in people
with MS and Cerebellar Signs
OPTIMEYES
Oculomotor Re-training in Progressive MS
with Cerebellar Signs
Intervention N=15 Vs n=13 Control
Commercially Available
Apps
Vision Tap
Focus BuilderClinical Measures Lab based measures of
Motor Control
Box and Blocks
Functional Reach SARA
9 Hole Peg Test
Eye-Hand Tracking
Postural SwaySmooth Pursuit
&
Saccades
• Differences seen between
Healthy Controls and pwMS
Significant changes in eye-hand tracking
No change in clinical outcome
Subjective reports of improvements
With balance in complex environments
19. Dysarthria
Test
Sustained Vowel phonation “ah” “ee”
Pa/ta/ka
Read test / repeat sentence
Characteristics
Scanned speech 71%
Slowness 62%
Slurring 48%
Not Understand syllables/words 29%
Add pauses 24%
Loss of intonation 24%
Voice tremor 10%
Hestitations
Accentuate some syllables
Omit appropriate pauses
Add inappropriate pauses
Left Superior Paravermal
Anatomy
20. Dysarthria
Rusz et al 2018 Multiple Scleosis and Related disorders 62-69
Rusz et al 2019 Brain and Language 58-64
56% pw MS have dysarthria
Pyramidal (spastic)
Ataxic
Mixed
Differences between Ataxic-pyramidal and pyramidal presentation
• Oral diadochokinesis
• Excessive loudness variation
• Slow speech
Reduced maximum speed during Oral diadochokinesis test
associated with cerebellar volume loss
28. Abnormalities of Gait and Posture
• Stance eyes open / closed
• Single leg / tandem
• Mini- Best Test
• Berg Balance Scale
• Timed Up and Go
• ICARS
• SARA Winser et al APMR 2017 270-276
Tests
Sway Reactive Balance Anticipatory Postural Adjustments
29. What is wrong with Cerebellar Gait?
Postural Control and Gait
Lateral Excursion
During Weight Shifting
Error of foot
Placement onto
Visual Target
Morton & Bastain, 2003 J Neurophysiol
30. Cerebellar Postural Control and MS
• Diffusion tensor imaging:
• Superior cerebellar peduncle integrity with kinetic deficits and poor
postural sway with eyes open
• Inferior cerebellar peduncle integrity associated with worse reactive
balance and poor postural sway with eyes open and closed
• Fallers have smaller gray and white matter cerebellar volume compared to non-
fallers
Gera et al 2019
Kalron et al 2018
32. Cognitive and Affective Signs
(Schmahann and sherman, 1998. Brain)
Bilateral Posterior Inferior
Cerebellar Artery Infarct
• Disturbances of executive
function
• Visuospatial disorganisation
and impaired visual memory
• Personality change
• Linguistic difficulties
(Schmahmann and Sherman 1997)
Post recovery
3 months later
Post-infectious
Cerebellitis
Normal
Rey-Osterrieth
figure
33. •More pronounced after
large bilateral + acute
disorders
•Especially with lesions of the
posterior lobe
•The vermis consistently
involved with pronounced
affective presentations
Cognitive and Affective Signs
Post recovery
3 months later
Post-infectious
Cerebellitis
Normal
Rey-Osterrieth
figure
34. Cognitive and Affective Signs in MS
Cerebellar Lesion in MS worse on:
Information processing speed tests
Verbal fluency
Weier et al 2014 ; Cerasa et al 2013
SDMT α cerebellar intracortical lesion load
α cerebellar volume
Damasceno et al 2014 Weier et al 2014
Middle cerebellar Peduncle lesion can result in cognitive impairment
Tobyne et al 2017
36. N=42 Degenerative Diseases
RCT
Therapy 4 weeks (6hrs / week)
Strength exercises
Range of Motion
Static and Dynamic Balance
Walking outside / Stair Climbing
Improvements
Walking Speed
Reduction in falls
Maintained at 12 weeks
Miyai et al 2012 Neurorehab and Neural Repair 26(5) 515-522
Intensive Co-ordination Training
Cerebellar (n=10) or Afferent
pathway degeneration (n=6)
4 weeks 3hrs / week
Improvements in Walking
And Co-ordination
Ilg et al 2009 Neurology 73 1823-1830
Trials in Degenerative Ataxias
37. Mechanisms of Recovery I
Substitution: Within the Cerebellum
Contralateral Cerebellum
(Amrani et al 1996)
38. Changes in Cerebellar Peduncle Integrity with
training in MS
12 weeks of video-based balance training associated with increased integrity in the superior cerebellar peduncles
Prosperini et al 2014
39. Mechanisms of Recovery II
Substitution: Other Sensorimotor Areas
Somatosensory Cortex (Keller et al, 1990; Mackel, 1987)
Deep Cb Nuclei
Lesion
Recovery over
30-40 days
Lesion Sensory Cx
Symptoms re-appear Synapses Sensory Cx to
Motor Cx Pyramidal Cells
40. Improvements in Hand Function with Motor
Cortex Stimulation
Rapid TMS Motor Cortex Stimulation
(5HZ Stimulation 10 stimuli x 18)
100% Resting motor Threshold
8 pw MS + cerebellar Signs
Percentage improvement in 9HPT
Immediately after 10 min later 20 min later
Koch et al, 2008 MS 14 995-998
41. Summary
• Motor and Cognitive signs can be seen
• Poor Prognostic Indicator for Recovery
• Cerebellar Signs and symptoms vary with lesion location
• Effects of training oculomotor control in pwMS and cerebellar dysfunction unclear
• RCTs in pure cerebellar degenerations highlight that functional improvements can occur with training
• Potentially several mechanisms of Recovery