Sensory Ataxia: Difference between revisions
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[[Ataxia|ATAXIA]] is a general term used to describe the combined influence of cerebellar and sensory dysfunction on gait, posture, and patterns of movement. | [[Ataxia|ATAXIA]] is a general term used to describe the combined influence of cerebellar and sensory dysfunction on gait, posture, and patterns of movement. | ||
Ataxia due to sensory | === Ataxia due to Sensory Impairment. === | ||
Sensory ataxia is caused by the impairment of somatosensory nerve leading to the interruption of sensory feedback signals and body incoordination. Ataxia is mainly reflected by gait disturbance<ref>Ashizawa T, Xia G. Ataxia. ''Continuum (Minneap Minn)''. 2016;22(4 Movement Disorders):1208-1226. </ref><ref name=":0">Zhang Q, Zhou X, Li Y, Yang X and Abbasi QH. “Clinical Recognition of Sensory Ataxia and Cerebellar Ataxia.” Frontiers in human neuroscience. 2021; vol. 15 639871. </ref>. | |||
Causes are: | |||
* Peripheral nerve: Peripheral neuropathy (especially Diabetic, Alcoholic and Nutritional), Peripheral neuritis. | * Peripheral nerve: Peripheral neuropathy (especially Diabetic, Alcoholic and Nutritional), Peripheral neuritis. | ||
* Posterior root: Tabes dorsalis. | * Posterior root: Tabes dorsalis. | ||
* Posterior column: Subacute combined degeneration of the cord, Demyelination changes of the posterior column. | * Posterior column: Subacute combined degeneration of the cord, Demyelination changes of the posterior column. | ||
MECHANISM/ PATHOPHYSIOLOGY: | === MECHANISM/ PATHOPHYSIOLOGY: === | ||
SA is caused by interference in the sensory transmission to the cerebellum caused by a lesion. It is the sensory damage to the posterior column due to loss of connection between the cerebellum and spinal cord due to lack of proprioceptive information<ref>Hafiz S, De Jesus O. Ataxia. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK562284/</nowiki></ref>. | |||
==== CLINICAL PRESENTATION<ref name=":0" /> ==== | |||
* KINETIC TREMORS: appear only on the closure of the eyes. | |||
* PSUEDOATHETOSIS: random finger movements seen on outstretched hands with eyes closed may occur in sensory neuronopathy affecting the upper limbs. | |||
* DEEP SENSORY LOSS- proprioception, kinesthetic awareness, vibration sense. | |||
* RHOMBERG'S TEST<ref>Lanska DJ. The Romberg sign and early instruments for measuring postural sway. Semin Neurol. 2002 Dec;22(4):409-18.</ref>: when the patient stands with his feet close together & his eyes closed, his body sways & he may fall if not supported. The visual system can provide compensation information when the eyes are open, so the patient can remain upright and stable; Visual compensation would disappear when the eyes are closed, and patients will not be able to maintain upright stability. | |||
* SENSORY GAIT/HIGH STEPPING GAIT/FEET-SLAPPING GAIT | |||
SENSORY GAIT/HIGH STEPPING GAIT/FEET-SLAPPING GAIT | |||
When a normal person walks, the sensory nerve would be stimulated when the sole touches the ground, then the relevant information is transmitted to indicate the position of the feet. Since the patients with sensory ataxia lose the input of the stimulus, to know the time and place the feet land, the patient would put his feet on the ground heavily.<ref>Missaoui B, Bendaya S, Mane M, Thoumie P. Balance and gait parameters in sensory ataxia; effects of a balance training program. Annals of Physical and Rehabilitation Medicine. 2013;56.</ref> The key to this gait is that when patients can’t see their feet (e.g., in the dark), stepping will increase obviously. This gait is sometimes referred to as a stepping gait, because patients may lift their legs to a very high position. | When a normal person walks, the sensory nerve would be stimulated when the sole touches the ground, then the relevant information is transmitted to indicate the position of the feet. Since the patients with sensory ataxia lose the input of the stimulus, to know the time and place the feet land, the patient would put his feet on the ground heavily.<ref>Missaoui B, Bendaya S, Mane M, Thoumie P. Balance and gait parameters in sensory ataxia; effects of a balance training program. Annals of Physical and Rehabilitation Medicine. 2013;56.</ref> The key to this gait is that when patients can’t see their feet (e.g., in the dark), stepping will increase obviously. This gait is sometimes referred to as a stepping gait, because patients may lift their legs to a very high position. | ||
* Heavy strike of the ground on walking due to lost deep sensation. | |||
* High-stepping gait due to associated motor weakness | |||
feet-slapping gait - to assist with sound-induced sensory feedback. | feet-slapping gait - to assist with sound-induced sensory feedback. | ||
=== Physiotherapy Management === | |||
REFERENCES: | REFERENCES: | ||
__INDEX__ | __INDEX__ | ||
Revision as of 15:19, 18 April 2022
ATAXIA is a general term used to describe the combined influence of cerebellar and sensory dysfunction on gait, posture, and patterns of movement.
Ataxia due to Sensory Impairment.[edit | edit source]
Sensory ataxia is caused by the impairment of somatosensory nerve leading to the interruption of sensory feedback signals and body incoordination. Ataxia is mainly reflected by gait disturbance[1][2].
Causes are:
- Peripheral nerve: Peripheral neuropathy (especially Diabetic, Alcoholic and Nutritional), Peripheral neuritis.
- Posterior root: Tabes dorsalis.
- Posterior column: Subacute combined degeneration of the cord, Demyelination changes of the posterior column.
MECHANISM/ PATHOPHYSIOLOGY:[edit | edit source]
SA is caused by interference in the sensory transmission to the cerebellum caused by a lesion. It is the sensory damage to the posterior column due to loss of connection between the cerebellum and spinal cord due to lack of proprioceptive information[3].
CLINICAL PRESENTATION[2][edit | edit source]
- KINETIC TREMORS: appear only on the closure of the eyes.
- PSUEDOATHETOSIS: random finger movements seen on outstretched hands with eyes closed may occur in sensory neuronopathy affecting the upper limbs.
- DEEP SENSORY LOSS- proprioception, kinesthetic awareness, vibration sense.
- RHOMBERG'S TEST[4]: when the patient stands with his feet close together & his eyes closed, his body sways & he may fall if not supported. The visual system can provide compensation information when the eyes are open, so the patient can remain upright and stable; Visual compensation would disappear when the eyes are closed, and patients will not be able to maintain upright stability.
- SENSORY GAIT/HIGH STEPPING GAIT/FEET-SLAPPING GAIT
When a normal person walks, the sensory nerve would be stimulated when the sole touches the ground, then the relevant information is transmitted to indicate the position of the feet. Since the patients with sensory ataxia lose the input of the stimulus, to know the time and place the feet land, the patient would put his feet on the ground heavily.[5] The key to this gait is that when patients can’t see their feet (e.g., in the dark), stepping will increase obviously. This gait is sometimes referred to as a stepping gait, because patients may lift their legs to a very high position.
- Heavy strike of the ground on walking due to lost deep sensation.
- High-stepping gait due to associated motor weakness
feet-slapping gait - to assist with sound-induced sensory feedback.
Physiotherapy Management[edit | edit source]
REFERENCES:
- ↑ Ashizawa T, Xia G. Ataxia. Continuum (Minneap Minn). 2016;22(4 Movement Disorders):1208-1226.
- ↑ 2.0 2.1 Zhang Q, Zhou X, Li Y, Yang X and Abbasi QH. “Clinical Recognition of Sensory Ataxia and Cerebellar Ataxia.” Frontiers in human neuroscience. 2021; vol. 15 639871.
- ↑ Hafiz S, De Jesus O. Ataxia. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562284/
- ↑ Lanska DJ. The Romberg sign and early instruments for measuring postural sway. Semin Neurol. 2002 Dec;22(4):409-18.
- ↑ Missaoui B, Bendaya S, Mane M, Thoumie P. Balance and gait parameters in sensory ataxia; effects of a balance training program. Annals of Physical and Rehabilitation Medicine. 2013;56.
