Neurological Exam Week 7

What is the best/most reliable low-tech standardized test for balance?

BESS

What are the 3 components of balance?

Sensory information (Joint positions sense (JPS), visual information)

Vestibular System

Cerebellum

What does sensory ataxia refer to issues with?

Vestibular or ocular systems

What does motor ataxia refer to issues with?

Cerebellum

What is a positive for a Romberg's test?

If their balance got noticeably worse with closing their eyes, especially if they take a step to regain balance or grab out to hold onto something

T or F: swaying/falling over regardless of foot position or closing eyes is a positive Romberg's test

False (only positive if they step out of stance with eyes closed)

What does swaying/falling over regardless of foot position or closing eyes indicate?

Cerebellar ataxia

What does a positive Romberg's test indicate?

Proprioceptive or vestibular disorder

What are the 3 potential causes of joint position sense issues?

Sensory dysfunction with the DCML

Spinal and peripheral nerve dysfunction

Polyneuropathy

What are the 3 potential causes of vestibular issues?

Vestibular apparatus damage

Vestibulocochlear nerve damage

Vestibular nuclei

What can affect the vestibular apparatus?

Meniere's disease

Dihiscence

What can affect the vestibulocochlear nerve?

vestibular neuronitis

acoustic neuroma/vestibular schwannoma

What can affect the vestibular nuclei?

TBI

Migraine

What concurrent presentations occur with sensory ataxia due to DCML issues?

Diminished vibration in toes, foot, ankle

Diminished joint positions sense in lower extremity and toes

What concurrent presentations occur with sensory ataxia due to vestibular issues?

Visual issues/disturbances such as nystagmus

Nausea/vertigo

What is the term for a more difficult Romberg's test using a foam cushion to make the patient unstable?

Perturbation

What does CTSIB ttand for?

clinical test of sensory interaction in balance

What is the first trial of the modified CTSIB?

eyes open on a solid surface

What does the first trial of the modified CTSB test?

proprioception, vision, and vestibular input combined

What is the second trial of the modified CTSIB?

eyes closed on a solid surface

What does the second trial of the modified CTSB test?

mainly proprioceptive input

What is the third trial of the modified CTSIB?

Eyes open on a foam pad

What does the third trial of the modified CTSB test?

mainly visual input

What is the fourth trial of the modified CTSIB?

eyes closed on a foam pad

What does the fourth trial of the modified CTSB test?

mainly vestibular input

What are the 6 key aspects of gait analysis?

Symmetry, balance, feet width, stride length, arm swing, heel strike (SBSSAF)

What issues can be observed in gait?

Pain (antalgic walking)

Neurological lesions/disturbances

biomechanics/subluxations of spine and extremities

What does heel walk test?

L5 / common peroneal nerve

What does toe walk test?

S1 / tibial nerve

What can cause a CNS JPS loss?

MS

Cervical spondylotic myelopathy

Subacute combined systems disease

Tabes dorsalis (tertiary syphilis)

What is subacute combined systems disease caused by?

Vitamin B12 deficiency

What is the AKA of subacute combined systems disease?

Posterolateral sclerosis

What can cause a PNS JPS loss?

Diabetes

Alcoholism

Heavy metal poisoning

(Polyneuropathy)

What ar esigns of cerebellar ataxia in gait?

Broad stance

Gait is messy with vary levels of balance and unsteadiness

Turns are difficult and balance gets worse

What does a spastic hemiplegic gait indicate?

UMNL

What is the most common cause of spastic hemiplegic gait?

cerebrovascular disease (contralateral internal capsule stroke) or ipsilateral spinal cord lesions ABOVE C5

What does a scissor gait indicate?

Spastic paraparesis

What is the most common cause of a scissor gait?

cerebral palsy

spinal cord compression

What does a steppage gait indicate?

paresis of foot dorsiflexors

What is the most common cause of a steppage gait?

L5 lesion or common peroneal nerve lesion

What is the most common cause of propulsion/festinating gait?

Parkinson's disease

What is the primary issue with Parkinson's disease?

degeneration of substantia nigra in the midbrain causing a decrease in dopamine production

What is the most common cause of a waddling gait?

Pelvic girdle weakness (gluteus medius) or muscular disease (myopathy) such as muscular dystrophy or polymyositis