Coordination

Performance of voluntary movement with least energy and time

The movement must be:

• Accurate
• Smooth
• Speedy
• Effective

Incoordination may be due to

• Weakness ∆
• Tremors Extra ∆
• Sensory defect  Ataxia
• Cerebellar affection  Ataxia
Ataxia
Incoordination of voluntary motor activity in absence of paresis or extrapyramidal lesion.
Types:
•Cerebellar
•Sensory
•Vestibular
•Combined
•Hysterical
 lobe Function Tracts Dysfunction

Paleocerebellum Ms.Tone Vent.,Dorsal Hypotonia

Ant. Spino-cerebellar
Lobe
Neocerebellum coordination DRTCT 2N
Post.
Dentato-Rubro- Nystagmus
Lobe Thalamo-Cortical Nodding
2D
Dysarthria
Deviation
2T
Titubation
Tremors
FNL Archicerebellum Equilibrium Vestibulocerebellar Dist. EQ
Flocculo Stand swaying
Nodular Walking wide base
lobe
Clinical manifestations of cerebellar lesion:
1.Hypotonia.
2.Dysmetria: can not estimate the proper range of movement.
3.Decomposition of movement.
4.Adiadokokinesis or Dysdiadokokinesis : can not alternate movement accurate
rapidly.
5.Rebound phenomenon :can not stop the movement in perfect time.
6.Ocular sign: Nystagmus (Bilateral, Horizontal, Biphasic )
7.Staccato speech: Jerky, explosive, slow, interrupted. If ass. with ∆ Scanning.
8.Gait:
•Central lesion Trunkal ataxia (staggering gait, wide base, leg opened, fall
backward> foreword )
•Hemispherical lesion staggering gait with deviation to side of lesion
9. Reflexes  Pendular knee jerk
10. Tremors Kinetic intension tremors “increase at the end of the movement”
How to examine:

During : sleep, sitting, standing, marching on straight line (Tandum gait), eye opened
and closed

1.Finger to nose test.

•Dysmetria
2.Finger to finger test.
3.Finger to doctor’s finger test. •Kinetic intension tremors
4.Dysdiadokokinesis •Decomposition of movement
5.Rebound phenomenon.
6.Buttoning and unbuttoning test “earliest sign”
7.Hell to knee test.
8.Walking along straight line.
9.Tabbing test.
10.Hand writing
Sensory Ataxia
Loss of proprioceptive deep sensations
Ch. By:
•Kinetic tremors on closure of eyes
•Rhomberg’s test
•Stamping gait
•Deep sensory loss
•Hypotonia & hyporeflexia.

Vestibular Ataxia
Lesions of the Vestibular division of 8th CN.
Ch. By:
•Vertigo
•Tinnitus
•Deafness
•Nystagmus
•Impaired tests for vestibular function.
 Cerebellar Ataxia

Acquired Inherited

Infectious: Encephalitis
Mass lesion: Abscess, Neoplasm
Traumatic
Vascular: Stroke
Toxins: Phenytoin
Systemic: Celiac dis.

Immune mediated: Multiple sclerosis , paraneoplastic

 Inherited
Cerebellar Ataxia

AR Metabolic
AD XL Mitochondrial
Abnormalities

Marie’s Friedreich’s
Ataxia Ataxia