neuro eval lecture 8

• coordinated activity - fluid movement and postures
• comparison of motor activities (did the movement match the pre-movement plan?)
• modification of motor output based on sensory input and prior motor output
• compensation for motor tasks
• predictive/anticipatory mvmnts - to get body read for mvmnt -like bracing when you see someone running towards you
• learning new motor programs

• have pt stand eyes closed feet together
• someone who's impaired will sway, and won't catch himself until he's falling - he won't react to the loss of balance until it's too late to do a simple adjustment

the cerebellum plays a big role in learning...

• lesions --> inability to utilize vestibular inputs - therefore an inability to adjust to those inputs...
• vestibular nuclei

• input from spinocerebellar tracts
• movement completion and muscle tone (this tone regulation is unrel to spasticty -it's about support muscle tone - like tightening your core as you pick up a heavy box - w/cerebellar lesions force becomes erratic -- pushing a button you'll vacillate between lots and little pressure)

• lateral cerebellar hemispheres
• input from pontine nuclei
• output to thalamus, motor and premotor cortex

• control of rapid movement
• precise movement control
• motor planning

cerebrocerebellum / neocerebellum

• (due to lesion in the cerebrocerebellum/neocerebellum)
• inability to accurately jude the speed, force, or distance needed for a task

movement decomposition - lack of movement fluidity

• dysmetria
• asynergia/dysynergia
• rebound phenomena
• tremor
• hypotonia
• ataxic gait
• cerebellar speecy - dysarthria
• nystagmus and impaired extraocular movements

• "lack of check"
• pt flexes arm to 90 and tries to keep it here while PT tries to push it down
• when PT suddenly releases arm should go up just once - if there's a lesion it'll bounce up and down and up and down

due to loss of control over diaphram, this speech will sporadically change in volume and intensity

• finger-nose-finger at diff ranges, speeds, location
• heel-shin test

don't mistake weakness, spasticity, sensory loss for dysmetria!

difficulty w 2 alternating movements / impaired ability to perform rapid, alternating movements in hands or feet

don't mistake weakness, spasticity, contraction, or sensation troubles for a pos dis sign

• lengthening/shortening
• force
• timing
• speeds

• flip flop hands on thighs
• tap toes heels toes heels on floor

the cerebelum is densly packed, so there's a good probability of neuroplasticity

• cerebellar issues of the neck
• fyi - can have cerebellar findings for jut one area - eyes, neck, etc