Coordination > Abnormal

Home (Exam)

NeuroLogical Cases

PediNeuroLogic Exam

INTRODUCTION

MENTAL STATUS EXAM
Anatomy
Normal Exam
Abnormal Examples
Quiz
Media Resources

CRANIAL NERVE EXAM
Anatomy
Normal Exam
Abnormal Examples
Quiz
Media Resources

COORDINATION EXAM
Anatomy
Normal Exam
Abnormal Examples
Quiz
Media Resources

SENSORY EXAM
Anatomy
Normal Exam
Abnormal Examples
Quiz
Media Resources

MOTOR EXAM
Anatomy
Normal Exam
Abnormal Examples
Quiz
Media Resources

GAIT EXAM
Anatomy
Normal Exam
Abnormal Examples
Quiz
Media Resources

NEUROLOGICAL CASES

SITE INDEX
...by Exam
...by Topic

Credits
Copyright
Contacts
How to Use This Site
Download Movie Instructions
Download Exam Movies Page
Movie Re-Use Guidelines
Creative Commons License
Password to Unlock Zipped Movies
How to Fix Messy Fonts
How to Fix Movie Captions
How to add QuickTime to PowerPoint
Health Content Disclaimer
Site Production Notes
Home

HELP WITH MOVIE
DOWNLOADS...

Read Download Movie Instructions
Password to Unlock Zipped Movies
Movie Re-Use Guidelines

This site requires
QuickTime

QuickTime and the QuickTime Logo are trademarks of Apple Computer, Inc., registered in the U.S. and other countries. The Get QuickTime Badge is a trademark of Apple Computer Inc., used with permission.

Coordination > Abnormal

SECTIONS

Speech Rapid Alternating Movement

Tremor

Rebound

Check Reflex

Hand Rapid Alternating Movement

Finger-to-nose

Foot Rapid Alternating Movement

Toe-to-finger

Heel-to-shin

Station

Natural Gait

Tandem Gait

COMPARISON OF NORMAL versus ABNORMAL EXAM FINDINGS

MOVIES CAN BE VIEWED ONLINE, OR DOWNLOADED.

CLICK HERE FOR HELP WITH VIEWING MOVIES.
CLICK HERE FOR HELP WITH MOVIE DOWNLOADS.


Speech Rapid Alternating Movements Dysarthria Impaired speech articulation of cerebellar origin is characterized by being slow, indistinct, and scanning (scanning refers to decomposition of words into monosyllabic parts and loss of normal phrasing and intonation).	ii

Tremor A cerebellar intention tremor (1st scene in this movie) arises mainly from limb girdle muscles and is maximal at the most demanding phase of the active movement. This must be distinguished from a postural tremor (fine distal 8-13 Hz)(2nd scene) or resting tremor (coarse distal 5-6 Hz pill-rolling type of tremor)(3rd scene).	ii Third Video Courtesy of Alejandro Stern, Stern Foundation

Rebound Increased range of movement with lack of normal recoil to original position is seen in cerebellar disease.	ii

Check Reflex The patient is unable to stop flexion of the arm on sudden release so the arm may strike the chest and doesn't recoil to the initial position. This is most likely due to failure of timely triceps contraction.	ii

Hand Rapid Alternating Movements Movements are slow and irregular with imprecise timing. Inability to perform repetitive movements in a rapid rhythmic fashion is called dysdiadochokinesia.	ii

Finger-to-nose Under (hypometria) and over (hypermetria) shooting of a target (dysmetria) and the decomposition of movement (the breakdown of the movement into its parts with impaired timing and integration of muscle activity) are seen with appendicular ataxia.	ii

Foot rapid alternating movements Movements are slow and irregular with imprecise timing of agonist and antagonist muscle action.	ii

Toe-to-finger Same as finger-to-nose except for the lower extremities. For both the upper and lower extremities, it is important to always compare right versus left.	ii

Heel-to-shin The patient with ataxia of the lower extremity will have difficulty placing the heel on the knee with a side-to-side irregular over- and undershooting as the heel is advanced down the shin. Dysmetria on heel-to-shin can be seen in midline ataxia syndromes as well as cerebellar hemisphere disease so there is overlap between the two types of ataxias for this finding.	ii

Station Patient's feet will be placed wider apart then usual in order to maintain balance (broad or wide-based station). Midline ataxias cause instability of station with eyes opened or closed.	ii

Natural Gait Wide-based, unsteady, irregular steps with lateral veering; ataxia is most prominent when sudden changes are needed such as turning, standing up or stopping.	ii

Tandem Gait Patients with ataxia have difficulty narrowing the station in order to walk heel to toe. Tandem gait is helpful in identifying subtle or mild gait ataxia.	ii

COMPARISON OF NORMAL versus ABNORMAL EXAM FINDINGS
EXAM	NORMAL	ABNORMAL
Speech Rapid Alternating Movements
Tremor
Rebound
Check Reflex
Hand Rapid Alternating Movements
Finger-to-nose
Foot rapid alternating movements
Toe-to-finger
Heel-to-shin
Station
Natural Gait
Tandem Gait