UBC Medicine Neurology Clinical Skills – Gait and Coordination Examination



we will start with an assessment of nation then proceed to assessing Birk test and finish our exam by examining gate hi Paulina I'd like to conclude the neurological examination with an examination of your coordination balance and gait that ok if we proceed great I'll just be asking you to various movements with your limbs and walk for me in certain ways ok ok great we're going to start with an examination of the coordination in your upper extremities we're going to look at to find finger movements first so what I'm going to ask you to do one hand at a time is you're going to take your index finger and tap it into the crease of your thumb like this trying to make quick regular movements like that ok could you try that with your right hand please there are many ways to test for fine finger movements but one common exam is this finger thumb test look for rate rhythm amplitude and accuracy abnormalities and these parameters can indicate different pathologies and this will be addressed in a separate video great that's good so I was looking for the rate rhythm amplitude and precision of your movements and they were brisk they had a good regular rhythm amplitude was full and nice and precise and equal on both sides so that's completely normal so we're gonna move on to testing rapid alternating movements there's many ways to do that but the way I'd like you to do it for me today please is you're going to put your right hand over top of your left hand and you're going to go back and forth like this again trying to do it quickly but making a full movement and aiming for the same spot every time ok so could you just start with your right hand on top of your left hand and try that for me look for rate rhythm amplitude and accuracy of the movements try that with your left hand now that's great okay we'll move on to doing the finger to nose test so as you can imagine this requires you to take your finger and you're going to touch your nose and then I'm going to hold my finger out in front of you and you're going to go and touch my finger and go back to your nose back and forth like this okay so could you take your right index finger and touch your nose and then come and touch my finger here and go back and forth back to your nose back to my finger look closely for accuracy of the patient's finger and for presence of intention tremor great let's try that with the left arm now so take the index finger touch my finger go back and forth that's great okay I was normal on both sides so next we're going to move on to tests of the lower extremities and for the first couple of tests I'm going to want your feet against the floor so I'm just going to reach and get a stool for you to sit on okay so do you mind coming sitting on the stool great sit nice and square with your feet on the floor and we're going to look at some toe tapping so one foot at a time I'd like you to tap your toes like this as if you're tapping along to music make the movements as large and quick as you can okay look for rate rhythm amplitude and accuracy of the toe tap great and try that with the left foot normal and symmetric on both sides that's great we're gonna move on to heel tapping now so this time I'm gonna ask you to lift your whole leg off the floor and tap your heel on the same spot again try to make the movements nice and quick and try to lift your heel about ten centimeters off the floor so what I mean is something like this just tap like that try that with your right leg again look for rate rhythm amplitude and accuracy of the heel tap and try it with the left leg great again that's normal on both sides so the next test we're going to do is the heel – in test for this one I'm gonna ask you if you can just lift your gown up so we can see your shins and what I'm going to ask you to do is to take your heel and put it onto the bottom of the opposite shin and slide it up along your shin up to the knee and back down again over and over again in a smooth rapid movement okay I'll show you what I mean you put your heel on your shin and up and down like this try that with the right leg on top of the left leg first that's great can you try that with the left heel on top of the right leg this test can be done either with the patient sitting or supine look for smooth coordinated movements of the heel perfect that's normal on both sides okay Polina we're gonna look at your balance in Gaeta now would you mind coming off of the bed and standing up we're gonna do the Romberg test now I'm going to ask you to stand with your feet close together like a soldier at attention your arms down the side close your eyes and hold your balance like that I'm gonna watch you to make sure you don't fall okay the human body maintains balance through three systems proprioception the vestibular system and vision two of these three body systems must be functional to maintain balance when a patient closes their eyes during a Romberg test vision is eliminated so proprioception and vestibular function must both remain intact to maintain balance if the patient cannot balance after closing their eyes this in conjunction with other consistent findings from a neurological exam may signify that their proprioceptive or vestibular function has been compromised have the patient hold this position for at least 15 seconds patients with a positive Romberg's sign will sway noticeably and may fall so make sure to stand behind the patient to catch them in case this happens while this is not necessary you can test for pronator drift at the same time before the patient begins to walk observe to see if the patient is using any gait aids such as canes poles a walker orthotic shoes or knee braces watch as the patient stands up can they stand up smoothly without extra help or effort as the patient begins to walk inspect the patient's movements as he or she walks normally pay close attention to stance stride width stride length step height gait speed swing and 180 degree turns it's good practice to pay attention to these clues when the patient first enters the room while the patient is not feeling self-conscious about their gait that's great thanks Paulina now I'd like you to walk a tandem walk heel to toe as if you're walking on a tightrope having your patient demonstrate a tandem gait will exaggerate strain on the postural reflexes bringing out any truncal ataxia note that abnormalities in tandem gait may also be due to poor proprioception vestibular function and leg tremors in addition to a cerebellar lesion that's great you could do that normally I'd like to watch you walk on your tiptoes now up on your toes please having your patient walk on their toes will test their plants reflection from the gastrin amia sand soleus muscles supplied by the s-1 nerve root great okay now could you walk back to me on your heels having your patient walk on their heels will test their dorsiflexion from the tibialis anterior muscle supplied by the l4 nerve root Thank You Paulina that concludes the gate exam everything looked really normal

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