Final - Assessing Station, Gate Cerebellar Function Flashcards
what are the 4 parts to the physical exam for station, gate and cerebellar function
- Romberg’s test
- pronator drift
- gait
- cerebellar function
What are the three parts to the cerebellar function exam?
- finer to nose test
- rapid alternating movements
- heal to shin test
What 3 systems are required for balance to function optimally
- vision
- vestibular system (ability to know where one’s head is in space)
- proprioception (sense of where one’s body is in space)
Where are the afferent and efferent signals for balance organized?
Cerebellum
Romberg’s assesses _________. Abnormalities occur in patients with (2 things)
Proprioception
- peripheral neuropathy (diabetes, alcoholism)
- dorsal column disease (tabes dorsalis, B12 deficiency)
For Romberg’s, the doctor should stand close to the patients and the patient should have feet (together/apart?) and eyes (open/closed) and arms at the side
Together
Open first and closed later if ok
Why can patient with peripheral neuropathy or dorsal column disease still stand fairly well with eyes open?
because vision & vestibular input compensate for the limb loss of proprioception
What is a normal Romberg’s with eyes closed?
upright posture maintained with eyes closed (only very minimal swaying may be observed)
What is a positive Romberg’s?
- Patient begins swaying or has to move the feet to avoid falling once their eyes are closed
If it’s diffi
Cerebellar, vestibular, or visual disorder
Pronator drift assess ______ not _____
It occurs with subtle paresis (aka partial paralysis) originating from a (upper/lower?) motor neuron lesion of the contralateral side
Motor strength NOT balance
Upper
What are the instruction for pronator drift?
- Instruct patient to hold both arms forward with palms facing up and close eyes
- Hold for 20-30 seconds
What is an abnormal pronator drift?
One arm drifts downward and pronates
What are the three tests to assess gate?
- Observe casual walking for any characteristic abnormalities of gait
- Test tandem walking if normal casual walk - heel to toe, in a straight line
- Walk on toes (tests plantar flexion), walk on heels (tests dorsiflexion) – also tests balance
When you have the patient stand up, walk across the room (or down the hall), turn and come back, watch for:
- posture
- balance
- swinging of the arms
- movement of legs
What is a normal gait
Normal = easy; arms swing at the sides; turns are smooth; 10 feet in 10 seconds
Difficulty with turning could reveal a _______ or _______
Cerebellar problem or musculoskeletal condition
Ex: weakness in the lower extremities, degenerative joint disease
Describe an ataxic gait. What is it due to?
- broad based
- feet are far apart
- patient veers and staggers from side to side
- due to any cerebellar dysfunction (infection, trauma, stroke, tumor, etc)
Describe the circumduction aka hemiplegic gait
- Patient moves weak leg in curricular motion
- arms is often flexed at the elbow, across the abdomen as the patient walks
Describe the diplegic or spastic gait
What is it due to?
- short steps that cross on each other - patient may be forced to walk on tip toes
- scissor-like or crouching appearance
Due to cerebral palsy
Describe the sensory or stomping gait
What causes it?
- patient stomps the feet down firmly, unsure of their location
- watches foot placement
- worse in the dark
Associated with peripheral poly neuropathies and dorsal column diseases
Describe the high stoppage gait
What causes it?
- slapping gait due to foot drop (equine gait)
Injury to L5 nerve root (or compression of the common perineal nerve at the fibulae head which is rare)
Describe Parkinson’s gait
- slow, shuffling gait
- decreased arm swing
- forward flexion (head bowed with back bent over)
What are additional cerebellar signs?
- speech is often affected- may be slurred
- possible vertigo & nystagmus
- but NORMAL sensory exam
