UNDERSTANDING THE CHILD WITH ATAXIA Robyn Smith Department of Physiotherapy University of Free State...
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UNDERSTANDING THE CHILD WITH ATAXIA
Robyn Smith Department of Physiotherapy
University of Free State2012
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Characterised by
In-coordinated movement
Usually noted proximally
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Etiology
Damage to the Cerebellum
Cerebellar malformations Cerebellitis Trauma Asphyxia Poisoning/overdose e.g.
Tegretol and Epilum toxicity Metabolic disorders Neoplastic (tumors) Infective brain conditions Genetic causes
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Importance of Cerebellum
Responsible for ensuring smooth, coordinated movement
Important role in the execution of the motor plan
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Typical clinical features
• Generally low toneBut.....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
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Typical clinical features
• Unsteady gait patternTruncal sway when walkingUneven stride lengthstaggering gait with wide baseAppear to be clumsy, and fall frequently
due inadequate balance reactions
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Associated problems
• Visual problems
• Speech problems
• Problems with swallowing
• Perceptual and motor planning problems
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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
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Treatment principles
Frenkel type
exercises
Pushing objects,
ankle weights
Proprioception
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Vestibular dysfunction
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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
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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
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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 ????
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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)