Neurology- Co-ordination

Question 1

Co-ordination- Anatomy

Answer 1

• Cerebellum lies in the posterior fossa and has 2 hemispheres
• afferent and efferent pathways convey info to and from the motor cortex
• basal ganglia, thalamus, vestibule and other brainstem and spinal cord
• midline structures such as vermis, influence body equilibrium, while each hemisphere controls ipsilateral Co-ordination
• tests cerebellar function by assessing stance and gait (walk in straight line, heel-toe)
• eye movements (nystagmus), speech

Question 2

Co-ordination- examination finger to nose test

Answer 2

• ask the patient to touch the tip of their nose then touch your fingertip
• hold your finger at the extreme of the patients reach
• ask them to repeat the movement between nose and target finger as quickly as possible
• change the position of the finger when the patients finger is about to leave their nose
• look for cerebellar ataxia

Question 3

Rapid alternating movements

Answer 3

• demonstrate repeatedly patting the palm of your hand with the palm and then back of your opposite hand as quickly and regularly as possible

Question 4

Heel-to-shin test

Answer 4

• ask the patient lying supine, ask them to lift the heel into the air and place it on their opposite knee
• then slide their heel up and down their shin between knee and ankle

Question 5

Co-ordination- meanings

Answer 5

• finger-nose test may reveal a tendency to fall short of out overshooting the examiners finger (diametria or past pointing)
• in more severe cases, there may be a tremor as it approaches the finger or nose.
• The movement may be slow, disjointed
• The heel-shin test is the equivalent test for legs
• In abnormal tests the heel wavers away from the line of the shin
• weakness may produce false-positive in both tests so test power is normal first
• dysdiadochokenesis (impairment of rapid alternating movements) is evident as slowness, disorganisation and irregularity of movement
• dysarthria and nystagmus also occur with cerebellar disease include the rebound phenomenon (when the displaced outstretched arm may fly up past the original position), pendular reflexes and hypotonia
• in disorders affecting midline cerebellar structures such as tumour of the vermis and alcoholic cerebellar damage, the previous tests described may be normal and truncal ataxia (ataxic gait) may be the only finding.

Question 6

Apraxia- definition

Answer 6

• apraxia or dyspraxia, is difficult or inability to perform a task
• despite no sensory or motor abnormalities
• it is a sign of higher cortical dysfunction, usually localising to the non-dominant frontal or parietal lobes

Question 7

Apraxia- examination

Answer 7

• ask the patient to perform an imaginary act, such as drinking a cup of tea, combing their hair or folding a letter and placing it in an envelope
• ask the patient to copy movements you make with your fingers, such as pointing or making a V
• ask the patient to put on a pyjamas top, with one sleeve of which has been pulled inside out
• ask the patient to lie on the couch and perform cycling movements with their legs

Question 8

Apraxia- meaning

Answer 8

• The patients may be unable to initiate a task or may perform it in an off or bizarre fashion
• constructional apraxia (difficulty drawing a figure) is a feature of parietal disturbance
• dressing apraxia, often associated with spatial disorientation and neglect, is usually due to partial lesions of the non-dominant hemisphere.
• patients with gait apraxia have difficulty walking but are able to perform cycling movements on the bed surprisingly well