Understanding the child with ataxia

1. Robyn Smith Department of Physiotherapy University of Free State 2012 Understanding the child with ataxia

2. Characterised by In-coordinated movement Usually noted proximally

3. 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

4. Importance of Cerebellum Responsible for ensuring smooth, coordinated movement Important role in the execution of the motor plan

5. 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

6. 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

7. Associated problems • Visual problems • Speech problems • Problems with swallowing • Perceptual and motor planning problems

8. 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

9. Treatment principles Proprioception Pushing objects, ankle weights Frenkel type exercises

10. Vestibular dysfunction

11. 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

12. 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)

13. Symptoms of a vestibular dysfunction • Nausea • Nystagmus • Developmental delays • Visual spatial problems • Poor hand-eye and hand-foot co-ordination

14. Vestibular Rehabilitation Therapy VRT Can we incorporate principles in our Treatment children with ATAXIA ???? 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

15. 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)