Cerebral Ataxia PT

Da iyoli Taal
PHYSIOTHERAPY ASSESSMENT FOR CEREBELLAR ATAXIA

History :Gradual onset (tumor / atrophy), sudden onset (infarction)
> General observation of patient
" Postural tremor, Tone (hypotonic), Gait (ataxic/staggering/reeling'drunkard), External
appliances (walking aid), Nystagmus (Central - upbeatidownbeat)
" Posture
" Sit with an increased thoracic kyphosis &forward head
C
Sit with hyperlordosis due to abdominal muscle weakness
" Stand with a wide base of support
> Examination of communication & cognitive skills (Higher mentalfunction)
May exhibit delirium (restlessness, irritability, tremors, confusion, disorientation or
hallucination), dementia or short-term memory problems in patients with alcoholic
CD
May experience dysarthria (scanning speech, peculiar speech)

Cranial nerve examination - may be affection of trigeminal, facial, glossopharyngeal,
vagus & hypoglossal
> Sensory evaluation - affection of movement sense, joint position sense in cerebellar
ataxia. (affection of Barognosis, Stereognosis &Graphaesthesia in sensory ataxia)
Motor evaluation- muscle power
Asthenia (generalized muscle weakness on ipsilateral side)
" Need arm support to rise from floor or a chair due to lower limb or trunk weakness
Tone -Hypotonia in the ipsilateral side
ROM & flexibility- Reduced AROM
Reflex integrity -
" Decreased DTR or pendular due to hypotonia
Normal righting reflexes
Delayed or absent protective extension &equilibrium reactions
Presence of cerebellar signs- Ataxia, Intension tremor, Postural tremor, Nystagmus,
Postural imbalance
Co-ordination & balance assessment- predict risk of fall
Intention tremors
UL &LL coordination problems
Positive Rebound Test
Dysdiadochokinesia (inability to maintain rhythm range when foot-tapping or in
supination or pronation)
Dysmetria (undershooting or overshooting target during finger-to-nose &finger-to
examiner's finger tests)
Movement decomposition (inability to move smoothly while performing ADL)
Difficulty learning new motor tasks due to cognitive impairment
1 P/B- DR. NIYATIPATEL (PT)

Affection of non-equilibrium &equilibrium
Specialtest
> Romberg's test: The extent of the sway envelope when standing with about 4inches
between the feet can be 10° in the sagittal plane and 16° in the frontal plane. (eye
closing forl min)
Romberg's test -negative in cerebellar ataxia ( Pt cannot hold standing position with
normal B0S with eye opening &eye closing)
Romberg's test - positive in sensory ataxia (Pt can hold standing position with normal
BOS with eye opening but not maintaining with eyes closing)
Feet logather Semýlander Tandem
.Balance (Sharpened Fombeig l6s(), Paient tands wth loot

ogethe, sorntandem, and 1andern, with eyes open lor 10 seconds then
cosod for 10 sgconds in each pcsion
Sharpen/tandem Romberg's test- negative in cerebellar ataxia ( Ptcannot hold stand

position with the feet in the heel to toe position with eye opening &eye closing)
> Sharpen/tandem Romberg's test-positive in sensory ataxia (Pt can hold stand position
with the feet in the heel to toe position with eye opening but not maintaining with eyes
closing)
Investigations
o CT scan, MRI
Cerebellar atrophy
" Cerebellar tumour
Cerebellar infarction
Tonsilar invagination &hydrocephalus
Amold chiari malformation
2 P/B- DR. NIYATI PATEL (PT)

PHYSIOTHERAPY MANAGEMENT FOR CEREBELLAR ATAXIA
> Psychological support
" Maintain a non threatening interaction
Give positive reinforcenment
" Gain confidence of the patient
" Patient should not be isolated
" Family &care giver advice
> Improve relaxation
" Relaxed passive motion
General rocking movement
Relaxed positioning
Deep breathing exercise
Yoga therapy
" Meditation
" PNF technique
Massage
Relaxation techniques
> Active general exercise
" AROM ex & other free ex
Mat exercises
Reaching activities
Spot marching
Gymball activities
Weight shifting exercises
> Balance exercise
Weight shifting
Alteration in the complexity of the activity, speed &duration
Slowly withdraw external control
Increase amplitude of movement
Training of complex dual task
Balance board exercise, Gymball activities, Trampoline activities
Progress by giving external perturbations
Distract attention by speaking during exercise
> Gait training
" Lengthen stride length
Concentrate on heel to toe pattern
Improve arm swing
Parallel bar activities
3 P/B- DR. NIYATIPATEL (PT)

" Walk on printed foot prints
Marching on spot with arm swing
Walking in straight line
Walking in circle
Walking sideways with outstretch hand
Reduce fatigue
" Modification of task, breaking into component parts
Pacing of exercise speed & rate
Proper rest periods
" Complex activities are broken
down to simpler parts
expenditure are used
Exercise which requires minimum energy
" Over exercise is avoided
Strengthening exercise
muscles
Simple pendular exercise for very weak
Assisted & resisted exercise
concentric control
Theraband exercise to improve eccentric &
Muscle energy technique
> Ataxia management
movements by using aids, cues & feedback
" Promote accuracy of limb
ordination, balance &
Combined activities of the trunk & limbs to improve co
automaticity of movement
" Frenkel'sexercise (Main important exercise)
during activities to increase
Small weight cuffs, ankle & wrist bands can be used
awareness of the limbs
Weight bearing exercise of UL & LL
> Functional training
Development of problem solving skills
Transfer training
Training of ADL activities
Environmental modifications & architectural changes
" Ankle foot orthosis
the
Recreational activities- ballroom dancing, treadmill walking, throwing ball in
basket
" Sit to stand exercise
> Tremor management
Weight bearing exercise
" Push ups
" Use weighted utensils & weighted canes
" As discussed for ataxia
4 P/B- DR. NIYATI PATEL (PT)

For bed ridden
patients
Skin care advice
Respiratory &cardiac care
> Aerobic training with recumbent
Family & patient cycling
education
Home exercise program
5 P/8- DR. NIYATI PATEL (PT)

Cerebral Ataxia PT

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Da iyoli Taal

PHYSIOTHERAPY ASSESSMENT FOR CEREBELLAR ATAXIA

May experience dysarthria (scanning speech, peculiar speech)

1 P/B- DR. NIYATIPATEL (PT)

Feet logather Semýlander Tandem

.Balance (Sharpened Fombeig l6s(), Paient tands wth loot

Sharpen/tandem Romberg's test- negative in cerebellar ataxia ( Ptcannot hold stand

2 P/B- DR. NIYATI PATEL (PT)

3 P/B- DR. NIYATIPATEL (PT)

4 P/B- DR. NIYATI PATEL (PT)

5 P/8- DR. NIYATI PATEL (PT)

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