Cerebellum

Symptamatology

Primary Manifestations

• Hypotonia

• Ataxia

• Cerebellar Dysarthria

• Tremor

• Occular dysfunctions

Hypotonia

• Reduced Muscle tone

• Mostly acute hemispheric lesions

• Mostly in the proximal musculature

• Occurs only with Neocerebellar lesions

• Involves the dentate nucleus

• Pendular reflexes

Tests for hypotonia

• Ashworth scale for muscle tone

• Passive movement

• EMG

Testing-Adults

• Passive movement

• Pronator drift for tone

Testing-Children

Ataxia

• PRIMARY cerebellar sign

• Disturbances of speed, timing , force, range

• Includes dyssynergia, dysmetria, dysdiadokinesia

• Gait distrubances

• Titubation

Testing

• Dyssynergia – perform complicated movements of the upper extermity –look for smoothness

• Dysmetria- finger to nose• Dysdiadokinesia – perform rapid alternating

movements• Heel to shin test for dysmetria• Gait analysis- wide base clumsy movement

with high guard

• Truncal instability

• Difficulty in tandem walking

Differentation from sensory ataxia

Cerebellar

• side to side sway

• High guard

• Romberg’s NEGATIVE

• Giddiness on closing eyes- occasionally

Sensory

• AP sway

• Loss of feeling of the legs

• Romberg POSITIVE

• No giddiness

Dysarthria

• Incoordination of the vocal cords

• Stat taco speech – machine gun speech

• Difficulty in articulation and prosody – completion of paragraph

• Volume changes

• Facial grimacing to control muscles

• Slurring , explosive

Tremor

• Kinetic tremor ( intention tremor) – end of movement tremor

• No termor on gross movement

• Needs the movement to be fine eg. Finger to nose test.

• Differentiate from other forms – almost 13 different forms present.

Non Motor manifestation

• Spatial dysgraphia

• Emotinal disturbances

• Motor learning problems

• Cognitive affllictions- disinhibitions, sporadic laughter, inapproprate behaviour

Occular dysfunctions

• Nystagmus- typical – pendular

• Saccadic pursuit

• Opsoclonus

• Skew devation

• Failure to supress the VOR