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Speech Rapid Alternating
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).
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).
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.
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.
Rapid Alternating Movements
Movements are slow and irregular with imprecise timing. Inability to perform
repetitive movements in a rapid rhythmic fashion is called dysdiadochokinesia.
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.
rapid alternating movements Movements are slow and irregular with imprecise timing of agonist and
antagonist muscle action.
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
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.
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.
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.
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
COMPARISON OF NORMAL versus ABNORMAL EXAM FINDINGS