Neurological Examination : Coordination And Diadochokinesis

Question 1

What is coordination ?

Answer 1

Harmonic interplay of various muscle required for balanced performance of certain movement.

Question 2

Of what is composed the cerebellar system ?

Answer 2

The anterior lobe and cerebellar vermis : regulate coordination of trunk, standing and walking

The cerebellar hemispheres : coordination of limb movement.

Question 3

What are the afférent system ?

Answer 3

Proprioception, vision, vestibular.

2 of the 3 must be intact for coordination and equilibrium to function correctly.

Question 4

What is diadochokinesis ?

Answer 4

Unimpaired ability to make successive movement in different direction.

Question 5

Step and result of the heel to shin test :

Answer 5

Patient eyes closed :
- move heel of one leg onto the knee of the other
- slide the leg towards the foot along the shin

If the heel miss the knee repeatedly (hypermetria) or heel slip of the shin (ataxia) : patient should perform eyes open
- improvement => proprioceptive disorder
- remains => cerebellar disorder

Question 6

Step of the finger to nose test :

Answer 6

Patient eyes closed :
- hold arms to the side
- touch nose with index successively
- move arm in large arc after each touch

Watch out : hypermetria, intention tremor, ataxia
- ask them to perform eyes open

Question 7

Step of the fingertip test :

Answer 7

Patient eyes open :
- patient index touch examiner index then patient nose
- examiner move index 50 cm away from patient nose

Question 8

Step of the finger to finger test

Answer 8

Overshooting test for hypermetria
- patient hold index 1 cm away from examiner index
- examiner move index suddenly
- patient finger should mirror the mouvement

If there’s a cerebellar disorder : patient will overshoot then make a corrective movement towards the finger

Question 9

How to test diadochokinesis ?

Answer 9

Ask the patient to make rapid alternating movement , like :
- opening closing fist
- pronation / supination of forearm
- tapping one hand with the other
- tapping the floor with toes and heels

Question 10

Step to test fine motor skills :

Answer 10

Place thumb on the time of the other fingers as quickly as possible
- note suppleness and speed

Question 11

What is ataxia ?

Answer 11

Loss of coordination not solely due to motor loss or dyspraxia.

Question 12

What are the indication, of a cerebellar disorder ?

Answer 12

Abnormal test even with open eyes because it is the central processing of input that is impaired.
It could cause hypermetria and mild intention tremor in severe cases.

Question 13

What are symptoms of cerebellar disorder ?

Answer 13

Unsteady equilibrium
Broad based gait, abnormal heel to toe
Dysdiadochokinesia
Macrographie : large irregular handwriting
Cerebellar dysarthria : slow dragging monotone speech
Unilateral ataxia with intention tremor => homolateral disorder in the cerebellum

Question 14

What are the signs of a proprioceptive disorder ?

Answer 14

Exacerbated symptoms with eyes closed.
Patient hesitate and miss the target before placing it correctly in heel to shin and finger to nose tests.
Abnormal sens of motion and direction

Question 15

What are the signs of a vestibular disorder ?

Answer 15

Complaints of rotational vertigo
Nystagmus (eyes make repetitive uncontrollable movement) may occur
Patient tend to fall on the same side