1. UNDERSTANDING THE CHILD WITH ATAXIA Robyn Smith Department of Physiotherapy University of Free State 2012

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 Underlying low tone NB Increase postural tone Distal spasticity Improve balance Improve coordination Resisted exercises Work on grading movement Frenkel type exercises Pushing objects, ankle weights Proprioception

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 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 ????

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)