Unit 1: Ataxia
what are the 5 principles of training for ataxia
1. proximal stabilization 2. stabilization and control through isometrics, CKC, PNF combo if isotonics, developmental transitions, rhythmic stabalizations 3. EO and EC 4. Compensatory methods and AD should be used when necessary 5. treatment should be supported by HEP
compensatory strategies
AD's, weighted devices
What is dysarthria?
Explosive or slurred speech caused by incoordination of muscles involved in speech. Classified as a neuromotor problem.
What are the 3 subcategories of ataxia?
Sensory (friedreichs ataxia) vestibular cerebellar (main one)
target training
UE at the board or on a table LE target patterns on the floor in sitting position progressing to standing
developmental sequences
all positions and transitions
Cerebellar ataxia movement dysfunctions
asthenia dysnergia dysarthria and scanning speech hypotonia dysmetria nystagmus dysdiadochokinesia tremor rebound phenomenon gait
Strenghtening
at pelvis/hip core alternating isometric stabilization exercises
Damage that causes ataxia
by tumor, stroke, neurologic or metabolic disease symptoms can be unilateral or bilateral depending in affected areas
Sensory ataxia
caused by damage to any area in the sensory system from the periphery to cortex. Can be distinguished from other types because these patients have problems with movement when their vision is removed
Cerebellum ataxia
cerebellum regulated movements, postural tone, and muscle tone. Provides error correction-> coordinated movement
What is dysnergia?
decomposition of complex movements
Friedreich's ataxia
degeneration of the spinal and peripheral nerves and to a lesser degree, the cerebellum. Results in awkward unsteady movements and impaired sensory function
What is asthenia
generalized weakness
proprioceptive exercises
good for sensory ataxia examples: PNF, uneven surface training, balance boards, dynamic CKC
vestibular training
head turning in supine/sitting rolling supine-> sit head turns with gait
Interventional goals
improve balance and posture reactions improve postural stability improve UE/LE functioning develop functional gait
dysmetria
inability to judge distance/ROM-> decreased target accuracy
coordination exercises
intralimb: movements with a single limb-> reversing motions interlimb: refers to 2 or more limbs working together synchronously or asynchronously Encourage slow, controlled, and reciprocal multi joint movement involves proximal fixation to allow distal motion include exercises for dexterity and agility: finklesteins
Ataxia definition
movement dysfunction that describes uncoordinated limb movements and inadequate postural control often resulting in balance and gait disturbances can include difficulty initiating movements as well as errors in rate, rhythm and timing of movement
dysdiadokinesia
rapidly alternating movements
balance exercises
standing balance feet apart, together with vest, romberg, split stance, weight shift, semi tandem, tandem, high kneel, lunge
gait training
stepping without AD weight vest forward and backward walking, turning ambulate on various surfaces, ambulate while reading training on treadmill with body weight support gait with 4 wheeled walker gait with u step walker footsteps on the floor
swiss ball activities
to control proximally
intervention strategy
you can use areas of poor performance on the tests or coordination as a starting point for intervention. Turn the test into an an exercise and create others with similar challenges. The items on a test can direct your exercise and activity selection but you can be creative with development of activities and insert them into real life situations