This ppt covers the content about cerebellar syndrome and a case presentation with assesment and treatment strategies to be followed at basic level , it covers the muscle length testing ducan ely test thomas and etc and basic level assesment for a physiotherapist can able to do and the scaling system to record the improvement in treatment

1. Cerebellar syndrome
by
S.Christy sopna
PHYSIOTHERAPIST

3. Functions of cerebellum
• Regulation of equilibrium
• Regulation of posture
• Regulation (or coordination) of voluntary movements
comparator
damping
planning the sequence and timing of movements
• Cerebellum in motor learning
• Role of cerebellum in rapid and ballistic movements.(through short loop)

4. SPINOCEREBELLUM
AFFECTED MAY CAUSE
HYPERTONICITY

5. CASE STUDY
A 46 year old male came with a problem of not able to walk without
assistance since 9 years and its gradually progressed. He works as an
fisherman, he has an reduced grip in his left upper limb. He has an
familial history of his elder sibling had a similar condition like him
he got bedridden and died before 5 years . The patient left
alcoholism and smoking before 5 years.

6. On observation
• Body built : mesomorphic
• The patient had stooped posture and forward porked chin
• Increased thoracic kyphosis
• Hoarseness of the voice
• Staccato speech
• Spastic dysarthria
• Gait : absence of heelstrike
wide BOS (staggering or reeling gait )
• Attitude of the limb : hip external rotated knee extended, foot
dorsiflexed , toe in extension

7. On palpation
• Tenderness: tenderness in the gluteal fold .
• Tone : hypertonicity (spasticity )
• Gripping is affected in the left hand
• Patellar clonus is present
• Ankle clonus is present

8. SENSORY EXAMINATION
SUPERFICIAL SENSATION RIGHT LEFT
Pain Normal Normal
Temperature Normal Normal
Touch Normal Normal
Pressure Normal Normal
DEEP SENSATION RIGHT LEFT
Movement sense Normal Normal
Position sense Normal Normal
Vibration Normal Normal

9. CORTICAL SENSATION RIGHT LEFT
Tactile localization Normal Normal
2 point discrimination Normal Normal

10. MOTOR EXAMINATION
MUSCLE GIRTH Right Left
Arm 30cm 30cm
Forearm 27cm 27cm
Thigh 52cm 52cm
Calf 38cm 38cm
Modified Ashworth Scale Right Left
Upper extremity 1 1
Lower extremity 3 3
TONE : spasticity
1-slight increase in the
muscle tone manifested by
a catch and release or by
minimal resistance toward
the end of the movement
when the affected part is
moved in flexion or
extension.
3- considerable increase in
muscle tone, passive
movements difficult

11. Muscles Right Left
Hip
Flexors 5 5
Extensors 5 4+
Abductors 4+ 5
Adductors 5 5
Medial rotators 5 5
Lateral rotators 5 5
knee
Flexors 5 5
Extensors 5 5
Ankle
Dorsiflexors 4 4
Plantarflexors 5 5
Invertors 5 5
Evertors 5 5
MUSCLE POWER
ASSESMENT

17. SELECTIVE CONTROL ASSESMENT OF THE LOWER EXTREMITY
GRADE RIGHT LEFT
SCALE 8/10 8/10
HIP AND ANKLE IS IMPAIRED
TESTS RIGHT LEFT
Thomas Normal Normal
Ducan ely Normal Normal
Popliteal angle Spasticity Spasticity
Silverskiold test Spasticity Spasticity
Limb flexion synergy is present

18. REFLEXES RIGHT LEFT
Biceps (C5-C6) 3+ 3+
Triceps (C7-C8) 3+ 3+
Brachioradialis (C5-C6) 3+ 3+
Knee (L3-L4) 3+ 3+
Ankle (S1-S2) 4 4
Plantar reflex Extensor Extensor
Wartenberg reflex 3+ 3+
Hoffmans reflex Present Present
Grip and release test – unable to perform 5 repititions in 10 secs slowness
in movement
HOLMES STEWARD MANOEUVRE-under damping patient unable to stop
the movement suddenly

19. Tests Right left
Finger to nose 1 1
Finger opposition 1 1
Mass grasp 3 3
Pronation
supination
2 1
Rebound test 1 1
Tapping(hand) 1 1
Tapping (foot) 1 1
Heel to shin 1 1
Drawing a circle
(hand)
1 1
Drawing a circle
(foot)
0 0

20. EQUILIBRIUM TESTS
EQUILIBRIUM TESTS GRADE
Standing :normal posture 2
Standing :normal posture with vision
occluded
0
Standing : feet together 2
Standing on one foot 0
Standing lateral trunk flexion 0
Tandem walking 0
Walking :sideways 0
Walk:backwards 0
Walk in a circle 0
Walk on heels 0
Walk on toes 0

33. SCALES SCORE
Berg balance scale 8/56
Scale for the assessment and rating of ataxia(SARA)
gait
stance
sitting
speech disturbances
finger chase rt-3 lt-4
nose to finger test rt-1 lt-3
fast alternating hand movement rt-4 lt-4
heel-shin slide rt-4 lt-4
5/8
4/6
0/4
3/6
3.5/4
2/4
4/4
4/4

34. PHYSIOTHERAPEUTIC MANAGEMENT
GOALS TREATMENT
To correct posture Posture correction exercises
Breath control exercise
To maintain flexibility Stretching exercises , ROM exercises
To reduce spasticity Stretching exercises, AROM exercises .
To reduce involuntary movements PNF exercises
Weight bearing exercises
To improve coordination Frenkel exercise
To improve balance Strengthening core muscles
To improve grip Hand coordination exercises
Gripping activities

35. SPINAL MUSCLES STRETCHES

36. PLANTARFLEXOR STRETCHING
HAMSTRING STRETCH

38. Motor Output
● Erector spinae
● Abdominals
● Iliopsoas
● Gluteus medius
● Tensor fascia latae
● Biceps femoris
● Gastrocnemius/soleus
● Tibialis anterior

39. TRUNK AND BODY BALANCE EXERCISES

40. MOBILITY EXERCISES

41. Wall squats Plantigrade position

42. POSTURE CORRECTION
BREATHING EXERCISEPECTORALIS STRETCHSCAPULAR RETRACTION

43. FRENKEL EXERCISE

44. Hand eye
coordination – hand
games

45. FINGER TO NOSEDRAWING 8 IN AIR

46. D1 FLEXION – hip flexion ,adduction external rotation,
foot inversion ,dorsiflexion with toes extension.
D2 FLEXION – hip flexion, abduction ,internal rotation,
foot inversion ,dorsiflexion with toes extension .
GRIPPING ACTIVITIES
PNF