Final - Assessing Station, Gate Cerebellar Function

Question 1

what are the 4 parts to the physical exam for station, gate and cerebellar function

Answer 1

• Romberg’s test
• pronator drift
• gait
• cerebellar function

Question 2

What are the three parts to the cerebellar function exam?

Answer 2

• finer to nose test
• rapid alternating movements
• heal to shin test

Question 3

What 3 systems are required for balance to function optimally

Answer 3

• vision
• vestibular system (ability to know where one’s head is in space)
• proprioception (sense of where one’s body is in space)

Question 4

Where are the afferent and efferent signals for balance organized?

Answer 4

Cerebellum

Question 5

Romberg’s assesses _________. Abnormalities occur in patients with (2 things)

Answer 5

Proprioception

• peripheral neuropathy (diabetes, alcoholism)
• dorsal column disease (tabes dorsalis, B12 deficiency)

Question 6

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

Answer 6

Together

Open first and closed later if ok

Question 7

Why can patient with peripheral neuropathy or dorsal column disease still stand fairly well with eyes open?

Answer 7

because vision & vestibular input compensate for the limb loss of proprioception

Question 8

What is a normal Romberg’s with eyes closed?

Answer 8

upright posture maintained with eyes closed (only very minimal swaying may be observed)

Question 9

What is a positive Romberg’s?

Answer 9

• Patient begins swaying or has to move the feet to avoid falling once their eyes are closed

Question 10

If it’s diffi

Answer 10

Cerebellar, vestibular, or visual disorder

Question 11

Pronator drift assess ______ not _____

It occurs with subtle paresis (aka partial paralysis) originating from a (upper/lower?) motor neuron lesion of the contralateral side

Answer 11

Motor strength NOT balance

Upper

Question 12

What are the instruction for pronator drift?

Answer 12

• Instruct patient to hold both arms forward with palms facing up and close eyes
• Hold for 20-30 seconds

Question 13

What is an abnormal pronator drift?

Answer 13

One arm drifts downward and pronates

Question 14

What are the three tests to assess gate?

Answer 14

1. Observe casual walking for any characteristic abnormalities of gait
2. Test tandem walking if normal casual walk - heel to toe, in a straight line
3. Walk on toes (tests plantar flexion), walk on heels (tests dorsiflexion) – also tests balance

Question 15

When you have the patient stand up, walk across the room (or down the hall), turn and come back, watch for:

Answer 15

• posture
• balance
• swinging of the arms
• movement of legs

Question 16

What is a normal gait

Answer 16

Normal = easy; arms swing at the sides; turns are smooth; 10 feet in 10 seconds

Question 17

Difficulty with turning could reveal a _______ or _______

Answer 17

Cerebellar problem or musculoskeletal condition

Ex: weakness in the lower extremities, degenerative joint disease

Question 18

Describe an ataxic gait. What is it due to?

Answer 18

• broad based
• feet are far apart
• patient veers and staggers from side to side
• due to any cerebellar dysfunction (infection, trauma, stroke, tumor, etc)

Question 19

Describe the circumduction aka hemiplegic gait

Answer 19

• Patient moves weak leg in curricular motion

- arms is often flexed at the elbow, across the abdomen as the patient walks

Question 20

Describe the diplegic or spastic gait

What is it due to?

Answer 20

• 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

Question 21

Describe the sensory or stomping gait

What causes it?

Answer 21

• 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

Question 22

Describe the high stoppage gait

What causes it?

Answer 22

• 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)

Question 23

Describe Parkinson’s gait

Answer 23

• slow, shuffling gait
• decreased arm swing
• forward flexion (head bowed with back bent over)

Question 24

What are additional cerebellar signs?

Answer 24

• speech is often affected- may be slurred
• possible vertigo & nystagmus
• but NORMAL sensory exam

Question 25

What is the finger-to-nose test?

Answer 25

Patient quickly alternates between touching his or her own nose and the examiner’s finger

Question 26

On the finger-to-nose test, if the patient persistently overshoots the target (finger or nose), they have ____

Answer 26

Dysmetria or past pointing

Question 27

In the finger-to-nose if the patient is unable to smoothly pursue targets; tremor as the finger approaches the target they have an _____

Answer 27

intention tremor

Question 28

What is the rapid alternating movement test?

Answer 28

Patient rapidly pronates and supinate one hand on the other

Question 29

What is abnormal and normal rapid alternating movement test?

Answer 29

Normal: able to perform, called diadochokinesia

Abnormal: patient unable
to perform (Dysdiadochokinesia)

Question 30

What is the heel-to-shin test

Answer 30

Patient slides the heel of one extremity down the shin of the other extremity

Question 31

What is Normal and abnormal heel-to-shin test?

Answer 31

Normal: smooth movement, heel stays on shin
Abnormal: the heel wobbles from side to side