Assessment Cerebellar

functions of cerebellum

motor picture of the body via input from various sensory systems
provides information to the cortex for comparison of intended vs actual movements
adjusts, compensates, and engages in trail and error processes
remembers complex movements and long term memory
creates refined fluid and accurate movements

coordinated movements are complex

cerebellar → collect info and provide feedback to cortex
motor → provides muscle strength (how much muscle and weight to use)
vestibular + visual → provides visual and equilibrium info
sensory → proprioception / position sense

past medical history

trauma to head
spinal cord injury
TIA / CVA
poor nutrition

family history

neurofibromatosis
huntington chorea
muscular dystrophy
gait disorders

neurofibromatosis

tumors in brain, spinal cord, nerves
treatment, no cure
type I: children
type 2 and 3: adults

Huntington chorea

nerve cells break down and can’t be regenerated
involuntary movement
30-50 years old
no cure

muscular dystrophy

progressive weakness, loss of muscle mass
no cure

gait disorders

hemiplegic gait
spastic gait
neuropathic gait
ataxia

social history

alcohol use
vitamin deficiency - E, B12, thymine
environmental exposure - metal / mercury

coordination exam components

rapid alternating movement (RAM)
point to point movements
gait assessment
proprioception position sense

RAM

a test for dysdiadochokinesia
observing for speed, rhythm, and smoothness of movement
clumsy, slow, irregular movements are abnormal

RAM testing

as patient to tap each of their fingers to their thumb
ask patient to pronate and supinate on a flat surface
ask patient to tap your hand quickly with ball of their foot

point to point movements

test for dysnergia (inability to join complex movements into 1 smooth movement), dysmetria (amount of strength / distance needed) and intention tremor
observe accuracy and smoothness of movements

point to point movement tests

upper extremity: ask patient to touch finger to their nose then touch your finger, move your finger
lower extremity: patient place heel to opposite knee and run down shin, repeat with eyes closed

gait observation

have patient walk and turn and come back
observe for posture, balance swinging of arms, and movement of legs
ask patient to walk heel to toe (tandem walking)
walk on tippy toes and heels

spastic hemiparesis possible conditions and description of gait

conditions: lesion of corticospinal tract
gait: affected area is immobile, elbow, wrists, and fingers flexed

scissors gait possible conditions and description of gait

condition: bilateral spastic paresis of legs
gait: stiff gait, like walking in water

steppage gait possible conditions and description of gait

conditions: foot drop, secondary to lower motor neuron disease
gait: unable to walk on heels

sensory ataxia possible conditions and description of gait

conditions: loss of proprioception / position
gait: position sense lost in feet / legs

cerebellar ataxia possible conditions and description of gait

conditions: disease of cerebellum
gait: wide unsteady gait, person will fall toward side disorder, will sway with eyes open or closed

parkinsonian gait possible conditions and description of gait

condition: basal ganglia deficits such as parkinson’s disease
gait: forward bending of thoracic spine and head, immobile arms, short / shuffling steps

gait of old age possible conditions and description of gait

condition: aging process
gait: decreased speed, balance, shuffling, short steps

romberg test

ask patient to stand with feet together and eyes opened then close eyes for 20 seconds without support
observe patient’s ability to maintain upright posture with minimal swaying
in ataxia due to loss of position sense, vision compensates for the sensory loss. in other words, the patient stands fairly well with eyes open, but loses balance when they are closed (a + romberg sign)

pronator drift

ask patient to stand for @20 seconds with both arms straight forward, palms up, and eyes closed (can do in a sitting position as well)
observe patient’s arms normally a person can hold their arm position well
the pronation of one forearm suggests a contralateral lesion of the corticospinal tract downward drift of arm with flexion at the fingers and the elbow may occur

dix hallpike manuever

with patient sitting up, turn the head 45 degrees to one side
lie the patient down with head overhanging the edge of the bed and look for nystagmus
repeat on the contralateral side
positive if gets vertigo and nystagmus

EPLEY maneuver

patient is seated upright facing examiner, gasping examiner’s forearm with both hands for stability, then moved rapidly into supine position with head extending just beyond examining table, right ear downward
examiner moves to head to table, repositioning hands
head is quickly rotated to the left, stopping with right ear upward, position is held for 30 seconds
patient rolls onto left side while examiner rapidly rotates head until nose is angled toward floor. position is held for 30 seconds
patient is rapdily lifted into sitting position. entire sequence is repeated until no nystagmus can be elicited

hennebert sign

disequilibrium and nystagmus after increased CSF pressure
commonly seen in meniere syndrome, congenital syphilis, superior semicircular canal dehiscence syndrome (thinning of bone overlying the superior semicircular canal) and perilymph fistula (abnormal opening between middle and inner ear)

hemiparesis vs. hemiplegia vs. paraplegia vs. quadriplegia

hemiparesis: weakness of one side
hemiplegia: paralysis of one side
paraplegia: paralysis of legs
quadriplegia: paralysis of all 4 limbs