Balance reflexes sensation

Question 1

How do you test for coordination?

Answer 1

1. Rapid rhythmic alternating movements
   - Alternate turning palms up/down on lap or alternate PF/DF
   - Alternative test: touch thumb to each finger and back on the same hand
   - Increase speed gradually
2. Accuracy of movement
   - Finger-to-nose test or alternate finger-to-nose test
   - Alternative test: heel-to-shin test
3. Impairments may indicate cerebellar disease

Question 2

Impairment of rapid rhythmic alternating movement

Answer 2

Disdiadocokinesia

Question 3

Overshooting target when evaluating accuracy of movement

Answer 3

hyermetria

Question 4

Overshooting target when evaluating accuracy of movement

Answer 4

Hypometria

Question 5

How do you test for balance?

Answer 5

1. Equilibrium
   - Romberg test
   - 4 Stage Balance test
2. Gait
   - Observe the expected gait sequence, noting simultaneous arm movements and upright posture
   - Heel-toe walking

Question 6

What is the 4 stage balance test?

Answer 6

1. stand with feet side by side
2. place instep of one foot so it is touching the big toe of the other foot
3. place one foot in front of the other, heel touching toe
4. stand on one foot
   (5. hopping of one foot)\
   - first three should be able to be done for 10s to be normal
   - last should be done for at least 5s

Question 7

What is the Romberg test

Answer 7

Standing with feet side by side with eyes closed

• slight sway is normal
• points to loss of vestibular function or proprioception
• cerebellar will be unsteady with eyes open

Question 8

Wat initiates a reflex arc response?

Answer 8

Spinal afferent (sensory) neuron

Question 9

What are the superficial sensations to be tested?

Answer 9

1. Light Touch
2. Pain (sharp/dull)
3. Temp
4. Pressure

Question 10

What are the deep sensations to be tested?

Answer 10

1. Position sense
2. Kinestesia
3. Vibration

Question 11

How do you test position sense?

Answer 11

1. Move a distal joint up/down/in/out

2. Ask patient to describe the position at end range

Question 12

How do you test kinesthesia?

Answer 12

1. Move a distal joint up/down/in/out very slowly
   - Pt recognizes while your moving
2. Ask patient to describe the position while you are moving

Question 13

What are the combined (cortical) sensations to be tested?

Answer 13

1. Stereognosis
2. Two point discrimination
3. Extinction phenomenon
4. Graphesthesia
5. Tactile localization (often tested with light touch)

Question 14

How do you test extinction phenomenon?

Answer 14

1. Simultaneously touch 2 areas on each side of the body

2. Ask patient to tell how many stimuli are felt

Question 15

How should interpretation of monofilament testing be interpreted?

Answer 15

4. 17 monofilament = 1 gram pressure = decreased sensation
5. 07 monofilament = 10 grams pressure = loss of protective sensation
6. 10 monofilament = 75 grams of pressure = absent sensation