Transcript Types of Cerebral Palsy

UNDERSTANDING THE CHILD
WITH ATAXIA
Robyn Smith
Department of Physiotherapy
University of Free State
2012
Characterised by
In-coordinated
movement
Usually noted
proximally
Etiology
Damage to the Cerebellum
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Cerebellar malformations
Cerebellitis
Trauma
Asphyxia
Poisoning/overdose e.g.
Tegretol and Epilum toxicity
Metabolic disorders
Neoplastic (tumors)
Infective brain conditions
Genetic causes
Importance of Cerebellum
Responsible for ensuring
smooth, coordinated
movement
Important role in the
execution of the motor plan
Typical clinical features
• Generally low tone
 But.....spasticity may be present
• Intension tremor
 No co-contraction around joint.
 No proximal stability to give distal to moving part
• Overshoot/ Dysmetria
• Poor grading of movement
• Use eyes to “fixate” and may have nystagmus
Typical clinical features
• Unsteady gait pattern
Truncal sway when walking
Uneven stride length
staggering gait with wide base
Appear to be clumsy, and fall frequently
due inadequate balance reactions
Associated problems
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Visual problems
Speech problems
Problems with swallowing
Perceptual and motor planning problems
Principles to use when treating a child
with ataxia
Physiotherapy treatment aims to:
• Improve postural control
• Improve balance and co-ordination
• Improve their movement possibilities in a safe
environment
• Prevent stiffness, deformities and contractures
Treatment principles
Distal
spasticity
Work on
grading
movement
Proprioception
Improve
balance
Underlying
low tone NB
Increase
postural tone
Pushing
objects,
ankle
weights
Resisted
exercises
Improve
coordination
Frenkel
type
exercises
Vestibular dysfunction
Principles to use when treating a child
with vestibular dysfunction
• The vestibular system is the
part of the body responsible
for balance
• Located in the inner ear
• Important part of the sensory
system as it co-ordinates
information from all senses
• Results in the adjustment of
muscle tone, limb position,
arousal and balance
Sensory systems
involved in balance
• Vision
• Vestibular system
• Somato-sensory
system
Causes of vestibular dysfunctions:
• Chronic ear infections
• Infarcts and vascular
insufficiencies
• Neurological disorders
including cerebellar
degeneration, CP,
hydrocephalus
• Head and neck trauma
• Immune deficiency
syndromes e.g. HIV
• Tumors of the brain
(posterior fossa) and inner
ear (acoustic neuromas)
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Symptoms of a vestibular dysfunction
• Nausea
• Nystagmus
• Developmental delays
• Visual spatial problems
• Poor hand-eye and hand-foot co-ordination
Vestibular Rehabilitation Therapy
VRT
Sensory weighting- selection
occurs between visual, vestibular
and somatosensory inputs when
attempting to balance
VRT programme may include
• Cawthorne-Cooksey exercises
• Balance re-education
• Gaze stabilizing exercises
• Visual dependance exercises
• Somatosensory dependence
exercises
• Otholithic recalibration exercises
Start with eyes open progress to
eyes closed
Can we incorporate
principles in our
Treatment children
with ATAXIA ????
References
• Brown, E. 2001. NDT basic course
material (unpublished)
• Smith, R. 2009. Paediatric dictate, UFS
(unpublished)
• Smith, R. 2008. role of physiotherapy in
vestibular rehabilitation, PowerPoint
presentation
• Images courtesy of Google images (2009)