Proprioception and Cerebellar Exams Flashcards
Are lesions of the cerebellum and posterior column contralateral or ipsilateral?
Ipsilateral
What are the clinically testable proprioceptive functions?
Motion, position, vibration, pressure and deep pain
What makes the pathway for proprioception different?
Stimuli is carried by a first order sensory neuron that ascends the spinal cord ipsilateraly in the posterior columns before it first synapses in the lower brain stem.
What are the principle receptors for proprioception?
Neuromuscular and neurotendinous spindles, the Golgi tendon organ, and 4 varieties of mechanoreceptors
Pallanesthesia
Loss of vibratory perception
How do you perform the Romberg test?
Standing, feet close together, first with eyes open and then with eyes closed.
Normal finding of Romberg test?
Patient maintain posture.
Little or no swaying.
Abnormal finding of Romberg test?
Patient steps to maintain posture or falls.
Patient falls with eyes open, whats wrong?
Cerebellar lesion
Patient falls with eyes closed, whats wrong?
Posterior (dorsal) column lesion
Patient falls with eyes closed and open, whats wrong?
Cerebellar or Vestibular Deficit.
How to perform hopping on one foot test?
Patient hops on one foot with eyes open and then closed. Then repeats on opposite leg.
What is required to be intact to be able to hop on one foot?
The long motor and sensory tracts, cerebellum, basal ganglia, and peripheral nerves
Normal finding of hoping on one foot?
Patient maintains posture with eyes open and closed.
Abnormal finding of hoping on one foot?
Patient takes a step to maintain posture or falls.
What is a good test to find minor weakness in the lower extremity?
Squatting on one foot
What is required to be intact to be able to squatting on one foot?
The long motor and sensory tracts, cerebellum, basal ganglia, and peripheral nerves.
How to perform squatting on one foot test?
Patient squats on one leg with eyes open and then with eyes closed.
How to perform Finger-to-Nose test?
Patient has arms straight out to the side and attempts to touch their nose with the tip of their finger, bilaterally. First with eyes open and then with them closed.
Normal finger-to-nose test?
Smooth, accurate movements
Abnormal finger-to-nose test?
Dyssynergia: uncoordinated movement
Dysmetria: inaccuracy in measuring distance
How to perform finger-to-finger test?
Patient has arms straight out to the sides and attempts to touch the tips of their index fingers together, straight out in front of them. First with eyes open, then closed.
Normal finger-to-finger test?
Smooth, accurate movements.
Abnormal finger-to-finger test?
Dyssynergia: uncoordinated movement
Dysmetria: inaccuracy in measuring distance
How to perform finger-to-nose test?
Dr. stands with their finger 2 feet from patient and has patient alternate touching their finger from their nose to the doctor’s finger. Doctor changes positions of their finger. Eyes open only.
Normal finger-to-nose test?
Smooth and accurate movements
Abnormal finger-to-nose test?
Dyssynergia: uncoordinated movement
Dysmetria cannot be done.
How to perform heel-to-shin test?
Patient attempts to run their feel from one side down the anterior shin from the knee to the ankle of the opposite leg. Performed bilaterally. First eyes open, then closed.
Normal heel-to-shin test?
Smooth, accurate movements
Abnormal heel-to-shin test?
Dyssynergia: uncoordinated movement
Dysmetria: inaccuracy in measuring distance
3 possible tests for the ability to perform rapid alternating movements?
Patting knees rapidly, tapping forefinger to thumb, and pronation/supination of hands.
Normal findings of rapid alternating movements?
Diadochokinesia: performing actions properly
Abnormal findings of rapid alternating movements?
Dysdiadochokinesia: inability to perform actions properly indicates possible cerebellar dysfunction.
How to perform Holmes Rebound Phenomenon?
Patient contracts the flexors of the forearm against resistance of the doctor. Doctor releases arm quickly. Performed with eyes open then closed.
Normal Holmes Rebound Phenomenon?
See a normal “check reflex”– patient will stop themselves from hitting themselves.
Abnormal Holmes Rebound Phenomenon?
Dyssynergia: uncoordinated movement
Dysmetria: inaccuracy in measuring distance
Patient may hit themselves.
How to perform Tandem Gait?
Patient walks in a straight line on the floor, heel to toe, forwards and then backwards, facing forward with eyes open and then eyes closed.
Normal tandem gait findings?
Patient is able to perform both tasks with eyes open and closed. Patient should not fall over
Abnormal tandem gait findings?
Dyssynergia: uncoordinated movement
Dysmetria: inaccuracy in measuring distance
Patient may fall over with eyes open, closed, or both.
How to perform joint position test?
Patient closes eyes. Dr. examines one digit of patient’s hand or foot and holding it from the sides. Flexing or extending that digit, asking patient to indicate whether digit has been moved up or down.
Abnormal joint position finding?
Patient cannot determine whether digit has been moved up or down. Possible posterior column disease.
Where in the nervous system are deep pain and pressure sensation mediated?
Dorsal columns of the spinal cord.
What would be noted as positive in deep pain and pressure sensation?
Loss of pain sensation
What is Abadie’s sign?
Pinching of Achilles tendon
What is Pitres’ sign?
Pinching of the testicles
What is Biernacki sign?
Pinching to striking the ulnar nerve
Pressure on the eye is testing deep or superficial pain?
Deep pain
When pain sensation is diminished it is indicative of..
Dorsal column disease (ex: tabesdorsalis). Spinal cord tumor also possible.
What are multimodal sensations?
A combination of both superficial and deep sensations which are subject to integration with higher cortical functions and memory.
What is Stereognosis?
Placing a common object in patients hands with their eyes closed. Check both hands
What is Barognosis?
Patient assess the relative weight of similarly sized and shaped objects with different weights.
What is Topognosis?
Touch patient somewhere and on skin. Patient must be able to point to where was touched with eyes closed.
What is Graphognosis?
Write a number or letter on the patients hand and have them identify it.
What is 2-point discrimination?
Determining at which point the patient can detect 2 different points.
What is the discrimination distance on the fingertips? Dorsum of fingers? Palm? Dorsum of hand?
Fingertips: 2-4mm
Dorsum of fingers: 4-6mm
Palm: 8-12mm
Dorsum of hand: 20-30mm
What is somatognosis?
The ability for the patient to know a body part is their own.
How do you test somatognosis?
Placing doctors arm next to patient’s arm. Have patient close eyes and touch their own arm with their finger.
What is Nosognosis?
The ability for the patient to know a they are ill.
