Coordination Exam

1. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
1
Testing
co-ordination

2. Normal co-ordination
•Requires intact sensory, motor and vestibular
systems
•This includes sensory information carried in the
pathways already discussed AND normal vision
•The motor element of co-ordination requires
normal cerebellarfunction and connections

3. A person with normal co-ordination
can:
•Accurately approach/touch a target with tip
of finger with eyes open and closed
•Accurately slide heel down the opposite shin
•Maintain standing balance with eyes closed
•Walk in a straight line

4. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
4
Definitions
•Ataxia
–lack of co-ordination
•Proprioception
–Proprioceptorsin your muscles, tendons and
joints enable you to judge your body position and
enable you to co-ordinate movement
–Loss of proprioception can be accommodated for
by looking at your movement. However when the
eyes are closed, controlled movement becomes
very difficult

5. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
5
Finger-nose co-ordination
•Ask patient to repeatedly touch their
nose and then the examiner’s finger
(held at the patient’s arm’s length)
•Test done slow and fast
•Repeat with eyes open and closed
Look for
•intention tremor
–increasing tremor as approaches target
•past pointing
–overshoots target
both occur with cerebellardisease

6. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
6
Heel-shin co-ordination
•Patient runs heel down
front of the leg as quickly
and accurately as possible
to end with heel on big toe
•Repeat with eyes closed
•Cerebellardisease
–foot wanders side to side and
overshoots; eye closure
makes little difference
•Proprioceptiveproblems
–worsens with eyes closed

7. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
7
Dysdiadochokinesis
•The patient is asked to
place one hand on top of
the other
•Then is asked to
repeatedly and quickly
pronate and supinate one
hand
•In cerebellar disease the
motion is slow and
clumsy

8. Patterns of Ataxia
Cerebellar
•Intention tremor
–+/-past pointing
•Dysdiadochokinesis
•Heel-shin ataxia
•Gait ataxia
•Often associated with
–nystagmus
–dysarthria
Sensory
•Ataxia evident on eye
closure
•Rombergism
•Impaired joint position
–+/-other sensory loss on
bedside testing
•Gait ataxia

9. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
9
Testing gait
http://library.med.utah.edu/neurologicexam/html/gait_abnormal.html#01

10. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
10
Gait
•Ask the patient to walk
normally for a few metres,
turn quickly and return
•Observe for
–Stride length
–Pattern of leg movements
–Posture
–Arm swing
–Balance
–Symmetry
Both legs
should be
clearly
exposed

11. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
11
Heel-toe gait
•Ask the patient to walk a
few steps, putting heel of
one foot directly ahead of
the contralateral toes -
“As if walking on a
tightrope”

12. 10/13/2011
© Clinical Skills Resource Centre, University
of Liverpool, UK
12
Some examples
•Hemplegic
–leg rigid and swings in a semi-circular motion
•Paraplegic
–typical “scissor” gait
•Parkinsonian
–small stepped, shuffling -loss of arm swing
•Cerebellar
–wide based, staggering towards side of the lesion
•Sensory ataxia
–stepping, stamping gait -needs to watch the floor
Remember possible musculoskeletal disorders