Cerebellar Disorders

Front 1

What 3 things can cerebellar disorders result in?

Back 1

1. disorganization of mvmt
2. decreased posture control and balance and eye mvmt
3. decreased motor learning ability (procedural learning)

Front 2

What 3 things are disorganization of mvmt due to?

Back 2

1. decomposition of mvmt--timing is disrupted
2. intention tremors
3. dysmetria--overshoots due to delayed antagonist not breaking mvmt

Front 3

What is dysmetria like for a cerebellar pt verses PD pt?

Back 3

Cerebellar tends to overshoot mvmt due to delayed antagonist

PD pt tends to undershoot mvmt (hypokinesia)

Front 4

What 3 things can cerebellar dysfunction be a result of?

Back 4

1. tumors
2. stroke (specifically pos circulation)
3. MS

Front 5

What path does alpha/gamma motor neurons influence tone and mvmt?

Back 5

No direct path, but influences go through cortex and BS

Front 6

What are the 3 functional divisions of the cerebellum?

Back 6

1. vestibulocerebellum
2. spinocerebellum
3. cerebrocerebellum

Front 7

What is the vermal + flocculonodular lobe referred to?

Back 7

vestibulocerebellum

Front 8

What is the vestibulocerebellum responsible for?

Back 8

Balance and eye mvmt to the vestibular nuclei

Front 9

What is the vermal + paravermal areas referred to?

Back 9

spinocerebellum

Front 10

What is the spinocerebellum responsible for?

Back 10

motor execution to medial and lateral descending systems

Front 11

What is the lateral areas referred to?

Back 11

cerebrocerebellum

Front 12

What is the cerebrocerebellum responsible for?

Back 12

motor planning to motor and pre-motor cortices

Front 13

What are the 3 deep nuclei?

Back 13

1. fastigial
2. interposed (globose and emboliform nuclei)
3. dentate

Front 14

What deep nuclei serves the vestibulocerebellum area?

Back 14

fastigial

Front 15

What deep nuclei serves the spinocerebellum area?

Back 15

interposed (globose and emboliform nuclei)

Front 16

What deep nuclei serves the cerebrocerebellum area?

Back 16

dentate

Front 17

What zone is the vestibulocerebellum in?

Back 17

median zone

Front 18

What zone is the spinocerebellum in?

Back 18

paramedian zone

Front 19

What zone is the cerebrocerebellum in?

Back 19

lateral zone

Front 20

What are the 3 lobes of the cerebellum?

Back 20

1. anterior
2. posterior
3. flocculonodular

Front 21

What lobe does the vestibulocerebellum reside?

Back 21

flocculonodular

Front 22

What lobe does the cerebrocerebellum reside?

Back 22

posterior

Front 23

What resides in the anterior lobe?

Back 23

vestibulocerebellum and spinocerebellum

Front 24

What structures does the cerebellum communicate to the brain?

Back 24

peduncles

Front 25

What does the inferior peduncle do?

Back 25

brings afferent input from the BS and SC

Front 26

What does the superior peduncle do?

Back 26

connects midbrain and cerebellum (contains most of the cerebellar efferents)

Front 27

What does the middle peduncle do?

Back 27

info from cerebral cortex and back to the cortex

Front 28

What structure brings afferent input from the BS and SC?

Back 28

inferior peduncle

Front 29

What structure connects the midbrain and the cerebellum (contains most of the cerebellar efferents)?

Back 29

superior peduncle

Front 30

What structure brings info from the cerebral cortex and back to it?

Back 30

middle peduncle

Front 31

How does the cerebellum get most of its input from the SC and cerebral cortex?

Back 31

by mossy fibers

Front 32

Where does the vestibulocerebellum get its input from?

Back 32

vestibular, visual and auditory inputs (ex. SCC, utricle, saccule and vision inputs)

Front 33

Where does the vestibulocerebellum send output to?

Back 33

vestibular nuclei to affect medial descending systems such as the trunk, head, neck and eye mvmts

Front 34

A lesion in the vestibulocerebellum can result in what?

Back 34

poor postural control and problems with vision

*Look for central signs in oculomotor exam (tracking, saccades, VOR/VOR cancellation)

Front 35

What area are you testing in the cerebellum when looking for central signs in the oculomotor exam (tracking, saccades, VOR/VOR cancellation)?

Back 35

vestibulocerebellum

Front 36

What is spinocerebellum involved with?

Back 36

gross limb mvmt and motor execution

Front 37

Where does spinocerebellum get its input?

Back 37

proprioceptors in SC, spinal motor generators and cortex

Front 38

What is the medial vermal area of the spinocerebellum concerned with?

Back 38

trunk, head and neck to control posture

Front 39

What is the lateral (paravermal) area of the spinocerebellum concerned with?

Back 39

control limb mvmt through the dorsal and ventral cerebellar tracts?

Front 40

What does the dorsal cerebellar tract (DCT) do and where is it located?

Back 40

In the spinocerebellum area

receives info from the periphery to give FB during mvmt (info about limb during mvmt)

Front 41

What does the ventral cerebellar tract (VCT) do and where is it located?

Back 41

in the spinocerebellum area

internally generated processes like automatic activities like walking, chewing, etc

Front 42

Where does spinocerebellum send its output to?

Back 42

interposed nuclei to the red nucleus to the motor cortex

Front 43

What 3 deficits result in a lesion in the spinocerebellum?

Back 43

1. reaching deficits
2. gait deviations
3. postural control

Front 44

What is the main area that causes problems with cerebellar pts?

Back 44

spinocerebellum

Front 45

How does the spinocerebellum area influence tone when there is a lesion?

Back 45

influences medial/lateral descending systems going through the interposed nuclei which are normally excitatory

if lesion here the will have less excitation to lateral/medial descending systems influencing alpha/gamma motor neurons to create low tone

Front 46

Is weakness a primary impairment of cerebellar pts with spinocerebellar lesions?

Back 46

No, appears to be weak but have decreased tone from the lesion of spinocerebellar area (less excitation to lateral/medial descending systems) influencing gamma motor neurons

Front 47

What will hypotonia feel like?

Back 47

Soft and heavy to lift

Front 48

What are 5 additional deficits resulting from lesions in the spinocerebellar area?

Back 48

1. hypotonia
2. pendular reflexes
3. dysmetria
4. dysdiadochokinesis
5. ataxia
6. intention tremors
7. asthenia

Front 49

What are pendular reflexes?

Back 49

Deep tendon taps displaying the limb shooting out fast, falling quickly and then oscillates (hyporeflexive)

Front 50

Why does overshooting occur with dysmetria in cerebellar pts?

Back 50

Overshoot due to agonist muscle contracting and not being breaked by the antagonist on time (delayed activation of antagonist)

Front 51

How does dysdiadochokinesis occur?

Back 51

Problem with the agonist and antagonist interaction where the antagonist does not shut off to do the rapid mvmts

Front 52

What results from loss sequencing and timing of muscles to occur?

Back 52

ataxia (trunk and limb) unsteadiness and incoordination due to regulating body's posture and directing limb mvmts

Front 53

What is an intention tremor and when does it occur with mvmt?

Back 53

oscillations seen at the end of mvmt and occurs when cerebellum tries to correct trajectory of the mvmt (overcorrects)

Front 54

What is asthenia? What need to occur to accomplish an activity?

Back 54

perception of heaviness and effort due to hypotonia

may need more supraspinal drive to accomplish activity that requires more conscious effort (more difficult to move)

Front 55

What area of the cerebellum is responsible for learning through practice and plays a role in visually guided mvmts (complex motor tasks)?

Back 55

cerebrocerebellar

Front 56

Where does cerebrocerebellar receive and send its input/output?

Back 56

from cortex to dentate nucleus to thalamus to cortex

Front 57

What 3 things result with a cerebrocerebellar lesion?

Back 57

1. problems with motor learning and mental rehearsal
2. decomposition of mvmt
2. impaired coordination of distal components (hands)

Front 58

What are 7 areas the ataxia rating scale assesses?

What additional tests need to be done?

Back 58

1. postural and gait disturbances
2. balance --body sway
3. knee to shin test
4. finger to nose test
5. dysdiadochokinesia
6. speech
7. oculomotor--does not test VOR

Additional--VOR, balance (CTSB, LOS, BOS, pull test, posture evoked response, ROM/strength), check-rebound, DGI, intentional tremor and tone

Front 59

What treatments are appropriate for cerebellar pts?

Back 59

1. balance and postural control
--eye mvmts
--static balance
--dynamic balance
--compensations
--scan environment
--decrease BOS
2. ataxic gait
--compensations
--PNF (stability and controlled mobility)
--weighted vests
--transitional mvmts
3. tremors
--small wts on limbs
--weighted walker
--reach exercises
--slow reversal holds

Front 60

What are 5 general treatments that can help cerebellar pts?

Back 60

1. practice functional training to complete ADLs (compensate or decrease DOF)
2. need controlled environment to keep focused
3. BWSTT to help with foot placement (lots of reps)
4. breathing/relax exercises
5. mental imagery as long as not cerebrocerebellar lesion