Gait and Cerebellar Examination Flashcards
What are the main points you are looking for in a cerebellar examination
Dysdiadoochokinesia Ataxia - gait, posture Nystagmus Intention tremor Slurred, staccato speech Hypotonia, heel shin test
Introduction
Wash hands + PPE
Introduce yourself
Patient ID DOB
Explanation
-I’d like to assess the function of a part of your brain called the cerebellum.
-I will ask you to do some small tasks that assess your coordination, reflexes and movements
Repositioning - sitting
Pain?
Is this ok?
General inspection
- patient
- objects, equipment
Patient
Posture and gait - truncal ataxia?
-instability in sitting, drunken sailor broad based gait
Speech - slurred staccato speech
Scars - past neurosurgery
Walking aids - ataxia
Hearing aids - acoustic neuroma/pathology at the CPA compressing cerebellum
Prescriptions
Truncal stability - sitting on the edge of the bed
Proximal weakness assessment - cross arms over chest and stand up
Gait testing
- risks involved in testing gait
- what are we looking for
- how would we assess this?
INCREASED FALLS RISK - stay close to the patient during the assessment
Ask the patient to walk to one end of the room, turn and return
Stance - broad based gait => midline cerebellar, chronic alcohol excess?
Stability - staggering, slow, unsteady
-unilateral cerebellar disease => veer towards side of lesion
Turning - difficult
Heel toe gait - exacerbates underlying unsteadiness
-midline cerebellar issues (alcohol induced?)
Stand on heels
Stand on toes
-difficulty due to neuropathic or myopathic weakness
Common causes of cerebellar degeneration
Chronic alcohol use
B12 deficiency
Paraneoplastic disorders
Neurological conditions - MS
Romberg’s test
- how would you do this
- what are you assessing for
- interpretations
Assess for loss of proprioceptive or vestibular function in SENSORY ATAXIA (non cerebellar causes of ataxia)
Position yourself within arms reach of the patient to allow you to intervene if they start to fall
Ask patient to place feet together, arms by their sides, close eyes
Fall without correction => positive - sensory ataxia
-proprioceptive dysfunction - joint hypermobility, B12 def, PD, ageing
-vestibular dysfunction - vestibular neuronitis, Menieres
Sway with correction => negative but occurs in cerebellar disease due to truncal ataxia
Speech
- how would assess speech
- what are you looking for
Ask patient to repeat
- British constitution
- Baby hippopotamus
Staccato/scanning speech - very syllabic with pauses, varying volume
Slurred - mistaken for intoxication
Eyes nystagmus
- how would assess eye function
- what are you looking for
Ask patient to report any double vision throughout the assessment
- look straight ahead - look for nystagmus
- keep head skill but track your finger mv with eyes => H
- look for multiple beats of nystagmus - a few beats at extremes of gaze are physiological nystagmus
Nystagmus
Direction of nystagmus (fast jerk) - towards cerebellar lesion
Direction of gaze - nystagmus present on horizontal or vertical gaze
Plane of nystagmus - beat in horizontal or vertical plane?
Eyes saccades
- how would you assess the eyes
- what are you looking for
When asking patient to track the H
Normal - eyes should move smoothly
Abnormal - multiple jerky small movements (saccadic)
Position hand 30cm to side of your head
Ask patient to look at your hand and then at your nose
Repeat on the other side
Normal - quick and accurate
Cerebellar issues - overshoot and correction
Upper limbs
- what are we assessing for
- how would we assess the upper limbs
Tone
-look for hypotonia
Reflexes
-biceps, triceps, supinator
Coordination
-resting tremor
-pronator drift - palms up to the sky, close eyes => UMN
-bradykinesia - touch thumb to each finger, keep going
-dysdiadochokinesia - pancake hands
-intention and past pointing - nose finger
Lower limbs
- what are we assessing for
- how would we assess the lower limbs
Tone
-leg roll
-knee lift
-clonus
Reflexes
-knees, ankles, plantars
Coordination
-heel shin - dysmetria and slow (cerebellar)
To complete the examination
History
Neurological examination of upper, lower limbs, cranial nerves
MRI head - concerns about space occupying lesion or demyelination
Formal hearing assessment - pure tone audiometry if concerned about vestibulocochlear function
