UNDERSTANDING THE CHILD WITH ATAXIA

Robyn Smith Department of Physiotherapy

University of Free State2012

Characterised by

In-coordinated movement

Usually noted proximally

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

Importance of Cerebellum

Responsible for ensuring smooth, coordinated movement

Important role in the execution of the motor plan

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

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

Associated problems

• 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

Frenkel type

exercises

Pushing objects,

ankle weights

Proprioception

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)

•

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)