{"id":2305,"date":"2024-03-12T15:11:58","date_gmt":"2024-03-12T19:11:58","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/motor-function-and-cerebellar-testing-2\/"},"modified":"2024-05-31T10:51:49","modified_gmt":"2024-05-31T14:51:49","slug":"motor-function-and-cerebellar-testing-2","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/motor-function-and-cerebellar-testing-2\/","title":{"raw":"Motor Function and Cerebellar Testing","rendered":"Motor Function and Cerebellar Testing"},"content":{"raw":"To evaluate the central and peripheral nervous systems, you must assess motor functions related to the spinal nerves, spinal column, cerebellar function, and the brain.\r\n\r\nTogether, the [pb_glossary id=\"2419\"]motor system[\/pb_glossary] and the [pb_glossary id=\"2421\"]cerebellum[\/pb_glossary] have several functions including maintaining muscle tone, muscle strength, movement, coordination, and balance. Specific to motor function, the spinal nerves innervate all portions of the body from the neck down to the toes and transmit sensory information to the cerebellum and brain (via afferent nerves) and to all areas of the body (via efferent nerves). The cerebellum relies on effective functioning of the musculoskeletal system, but is specifically responsible for coordination of movement. Cerebellar dysfunction can result in [pb_glossary id=\"2423\"]ataxia[\/pb_glossary] and is associated with incoordination, tremors, and difficulty with rapid and fine motor movements, as well as walking and balance. An abnormal finding associated with motor function and cerebellar testing could indicate a problem with the spinal nerves, spinal column, cerebellum, or the brain. These findings should be considered in the context of a complete neurological assessment.\r\n\r\nThe following assessment is completed to evaluate motor function and cerebellar testing.\r\n<ol>\r\n \t<li style=\"font-weight: 400\"><strong>Inspect<\/strong> and <strong>palpate skeletal muscles<\/strong> of limbs for bulk (size), symmetry, and involuntary movements. Note any abnormalities such as atrophy, asymmetry, and twitches. For more information, refer back to the chapter on <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing2\/chapter\/objective-assessment-2\/\" target=\"_blank\" rel=\"noopener\">musculoskeletal assessment<\/a>.<\/li>\r\n \t<li style=\"font-weight: 400\"><strong>Assess ROM<\/strong> and <strong>manual muscle testing.<\/strong> Note any abnormalities such as asymmetry, decreased ROM, decreased muscle resistance (including [pb_glossary id=\"2425\"]flaccid\/atonic[\/pb_glossary]), and increased muscle resistance\/hypertonia (including [pb_glossary id=\"2427\"]rigidity[\/pb_glossary] and [pb_glossary id=\"2429\"]spasticity[\/pb_glossary]). Recall the techniques presented in the objective section of the <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing2\/chapter\/objective-assessment-2\/\" target=\"_blank\" rel=\"noopener\">musculoskeletal testing resource.<\/a><\/li>\r\n \t<li style=\"font-weight: 400\">Assess <strong>pronator drift<\/strong> by asking the client to close their eyes while extending their arms straight out in front of them with palms of hands facing upward (supination) for about 30 seconds. This can be done in a sitting or standing position.\r\n<ul>\r\n \t<li style=\"font-weight: 400\">Normally, the client should be able to maintain this position.<\/li>\r\n \t<li>Pronator drift is when one forearm begins to pronate, move downward, and sometimes the elbow begins to flex (this finding may be associated with upper motor neuron diseases of the brain and spinal cord). See <strong>Video 15<\/strong>\u00a0demonstrating pronator drift and an abnormal finding: the left arm lowers and shifts from supination to pronation.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n[embed]https:\/\/youtu.be\/o8zkr3tmszQ?si=NWN9wsvsGvcviMaP[\/embed]\r\n\r\n<strong>Video 15<\/strong>: Pronator drift.\r\n<ol start=\"4\">\r\n \t<li style=\"font-weight: 400\">Use the past pointing test as previously described related to CN VIII - Vestibulocochlear Nerves.<\/li>\r\n \t<li style=\"font-weight: 400\">Similar to pronator drift, you can assess <strong>lower extremity weakness<\/strong> by having the client lie in a supine position with head on a pillow. Ask them to flex their knees as they keep their feet flat on the exam table for about 30 seconds (<strong>see Video 16<\/strong>).\r\n<ul>\r\n \t<li style=\"font-weight: 400\">Normally, the client should be able to maintain this position.<\/li>\r\n \t<li style=\"font-weight: 400\">An abnormal finding is when one leg begins to extend out.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n[embed]https:\/\/youtu.be\/DeAxqHOOXEs[\/embed]\r\n\r\n<strong>Video 16<\/strong>: Lower extremity weakness test.\r\n<ol start=\"6\">\r\n \t<li style=\"font-weight: 400\">To perform the <strong>Romberg test<\/strong>, ask the client to remove their shoes. Ask them to stand at the bedside in case they get dizzy and need to sit down; you can also stand near them for safety. Next, ask the client to move their feet together with their arms\/hands down at their sides or crossed in front of them. Start by asking the client to stand in this position for 20 seconds with their eyes open to ensure balance (and cerebellar functioning). Next, ask the client to maintain this position with their eyes closed for up to one minute (this tests proprioception, i.e., one\u2019s location in space). See <strong>Figure 16.<\/strong><\/li>\r\n<\/ol>\r\n<ol>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li style=\"font-weight: 400\">Normally, the client should be able to maintain this position with eyes opened and eyes closed, possibly with mild swaying.<\/li>\r\n \t<li>An abnormal or positive finding is unusual swaying or moving their feet: this may be associated with the posterior column of the spinal cord. If the swaying happens when eyes are opened, this finding may be associated with the cerebellum.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/03\/Romberg-Test-1.jpg\" alt=\"\" width=\"451\" height=\"339\" class=\"aligncenter wp-image-558 size-full\" \/><strong style=\"text-align: initial;font-size: 1em\">Figure 16<\/strong><span style=\"text-align: initial;font-size: 1em\">: Romberg test.<\/span>\r\n<ol start=\"7\">\r\n \t<li><strong>Assessment of posture and gait <\/strong><span style=\"font-size: 1em\">can be done in several ways. At this point, you have probably already evaluated the client\u2019s ability to sit or stand as part of the Brief Scan of the Neurological System. Now, ask the client to walk from point A to point B (usually about 20 feet\/6 metres) and then turn around and walk back to point B. To emphasize any balance or coordination issues, ask the client to walk in a heel-to-toe manner for about half the distance (10 feet\/3 metres). See <\/span><strong style=\"text-align: initial;font-size: 1em\">Video 17<\/strong><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li>Normally the client should be able to sit or stand upright with their head up and in a midline position, maintain their balance, and walk smoothly in a coordinated manner with their arms swinging at their sides.<\/li>\r\n \t<li>Abnormal findings include inability to sit upright, drooping of head, lack of balance, wide stance, incoordination of legs and arms when walking, or lack of arm movement.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n[embed]https:\/\/youtu.be\/IaHf4DylXmU[\/embed]\r\n\r\n<strong>Video 17<\/strong>: Gait test.\r\n<ol start=\"8\">\r\n \t<li>To further test coordination and cerebellar function, complete the finger-to-nose and finger-to-finger test; the client may be sitting or standing for these tests. For the <strong>finger-to-nose test<\/strong>, ask the client to extend both arms out to the sides and then bend one arm slowly to touch their nose with their index finger, alternating with each arm a 3 to 4 times. Next, ask the client to close their eyes and repeat the same movements more quickly, about 3 to 4 times. Then, ask them to open their eyes. For the <strong>finger-to-finger test<\/strong>, place your finger an arm\u2019s length away from them, ask them to touch it with their index finger, then touch their nose, and repeat this activity 3-4 times moving your finger to a new location each time (in a high, middle and low location). Repeat with the other arm. The <strong>heel-to-shin test<\/strong> is similar to this test but specific to lower extremities: ensure the client is in a supine position and ask them to place their heel on the contralateral shin at the knee level and slide their heel down the shin. Repeat for the other leg. See <strong>Video 18<\/strong>\u00a0for the finger-to-nose and finger-to-finger tests and <strong>Video 19<\/strong>\u00a0for the heel-to-shin test.\r\n<ul>\r\n \t<li>Normally, the client\u2019s movement should be accurate and steady in motion.<\/li>\r\n \t<li>Abnormal findings include inaccurate and unsteady movement.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n[embed]https:\/\/youtu.be\/4z39gHGYQ4k[\/embed]\r\n\r\n<strong>Video 18<\/strong>: Finger-to-nose test and finger-to-finger test.\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/E_FdZ52V5qM[\/embed]\r\n\r\n<strong>Video 19<\/strong>: Heel-to-shin test.\r\n<ol start=\"9\">\r\n \t<li>While the client is seated, perform <strong>rapid alternating movements<\/strong> of the upper and lower limbs. Start by asking the client to stick out one hand with the palm facing upward, then place the back of their other hand in this palm, and then turn the top hand over (palm to palm): repeat this process and increase the speed about 3\u20134 times. Repeat on the other side. See <strong>Video 20<\/strong>. Next, ask the client to remain seated with feet flat on the floor; ask them to repeatedly tap one of their feet on the floor and repeat this with increased speed (about 3\u20134 times is sufficient). Repeat for the other foot.\r\n<ul>\r\n \t<li>Normally, the client can repeat the action smoothly, quickly, and symmetrically.<\/li>\r\n \t<li>Abnormal findings include slow and uncoordinated movements.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n[embed]https:\/\/youtu.be\/ipF_FczU4dE[\/embed]\r\n\r\n<strong>Video 30<\/strong>: Rapid alternating movements.\r\n<ol start=\"10\">\r\n \t<li>Note the <strong>findings<\/strong>:\r\n<ul>\r\n \t<li style=\"font-weight: 400\">Normal findings might be documented as: \u201cLimb muscles symmetrical bilaterally with no atrophy, no involuntary movements, full range of motion, equal muscle resistance bilaterally. No pronator drift. No lower extremity weakness observed. Client able to maintain standing position with mild swaying with Romberg test. Smooth coordinated gait. Accurate and steady motion with finger-to-nose, finger-to-finger, and heel-to-shin test. Smooth, quick and symmetrical rapid alternating movements of hands and feet.\u201d<\/li>\r\n \t<li style=\"font-weight: 400\">Abnormal findings might be documented as: \u201cPronator drift observed right arm. Ataxia observed with walking and wide stance.\u201d<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\">Clinical Tip<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\" style=\"text-align: center\">\r\n\r\nConsider safety when completing tests, especially those that require a client to stand or walk. Reflect back on fall safety interventions and strategies in relation to each client\u2019s health condition. You may decide not to complete the Romberg test, particularly if a client has symptoms of dizziness or is at risk of a fall.\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\">Contextualizing Inclusivity<\/h2>\r\nConsider the client\u2019s age, health condition, and prior limitations. For example, some older people have age-related conditions resulting in loss of muscle mass and strength. Some may have conditions associated with pain or amputations, which can affect movement. In addition to being patient, you may need to provide accommodations for accessibility reasons.\r\n\r\nNeurological testing can be time-consuming, and it may be helpful to frame tests as a fun experience, like a game, especially for children.\r\n\r\n<\/div>\r\n<h2 style=\"text-align: center\">Activity: Check Your Understanding<\/h2>\r\n[h5p id=\"125\"]\r\n<h3><strong>References<\/strong><\/h3>\r\nCampbell, W., &amp; Barohn, R. (2020). DeJong\u2019s The Neurological Examination. Wolters Kluwer.","rendered":"<p>To evaluate the central and peripheral nervous systems, you must assess motor functions related to the spinal nerves, spinal column, cerebellar function, and the brain.<\/p>\n<p>Together, the <button class=\"glossary-term\" aria-describedby=\"2305-2419\">motor system<\/button> and the <button class=\"glossary-term\" aria-describedby=\"2305-2421\">cerebellum<\/button> have several functions including maintaining muscle tone, muscle strength, movement, coordination, and balance. Specific to motor function, the spinal nerves innervate all portions of the body from the neck down to the toes and transmit sensory information to the cerebellum and brain (via afferent nerves) and to all areas of the body (via efferent nerves). The cerebellum relies on effective functioning of the musculoskeletal system, but is specifically responsible for coordination of movement. Cerebellar dysfunction can result in <button class=\"glossary-term\" aria-describedby=\"2305-2423\">ataxia<\/button> and is associated with incoordination, tremors, and difficulty with rapid and fine motor movements, as well as walking and balance. An abnormal finding associated with motor function and cerebellar testing could indicate a problem with the spinal nerves, spinal column, cerebellum, or the brain. These findings should be considered in the context of a complete neurological assessment.<\/p>\n<p>The following assessment is completed to evaluate motor function and cerebellar testing.<\/p>\n<ol>\n<li style=\"font-weight: 400\"><strong>Inspect<\/strong> and <strong>palpate skeletal muscles<\/strong> of limbs for bulk (size), symmetry, and involuntary movements. Note any abnormalities such as atrophy, asymmetry, and twitches. For more information, refer back to the chapter on <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing2\/chapter\/objective-assessment-2\/\" target=\"_blank\" rel=\"noopener\">musculoskeletal assessment<\/a>.<\/li>\n<li style=\"font-weight: 400\"><strong>Assess ROM<\/strong> and <strong>manual muscle testing.<\/strong> Note any abnormalities such as asymmetry, decreased ROM, decreased muscle resistance (including <button class=\"glossary-term\" aria-describedby=\"2305-2425\">flaccid\/atonic<\/button>), and increased muscle resistance\/hypertonia (including <button class=\"glossary-term\" aria-describedby=\"2305-2427\">rigidity<\/button> and <button class=\"glossary-term\" aria-describedby=\"2305-2429\">spasticity<\/button>). Recall the techniques presented in the objective section of the <a href=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing2\/chapter\/objective-assessment-2\/\" target=\"_blank\" rel=\"noopener\">musculoskeletal testing resource.<\/a><\/li>\n<li style=\"font-weight: 400\">Assess <strong>pronator drift<\/strong> by asking the client to close their eyes while extending their arms straight out in front of them with palms of hands facing upward (supination) for about 30 seconds. This can be done in a sitting or standing position.\n<ul>\n<li style=\"font-weight: 400\">Normally, the client should be able to maintain this position.<\/li>\n<li>Pronator drift is when one forearm begins to pronate, move downward, and sometimes the elbow begins to flex (this finding may be associated with upper motor neuron diseases of the brain and spinal cord). See <strong>Video 15<\/strong>\u00a0demonstrating pronator drift and an abnormal finding: the left arm lowers and shifts from supination to pronation.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Pronator Drift | NEJM\" width=\"500\" height=\"375\" src=\"https:\/\/www.youtube.com\/embed\/o8zkr3tmszQ?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 15<\/strong>: Pronator drift.<\/p>\n<ol start=\"4\">\n<li style=\"font-weight: 400\">Use the past pointing test as previously described related to CN VIII &#8211; Vestibulocochlear Nerves.<\/li>\n<li style=\"font-weight: 400\">Similar to pronator drift, you can assess <strong>lower extremity weakness<\/strong> by having the client lie in a supine position with head on a pillow. Ask them to flex their knees as they keep their feet flat on the exam table for about 30 seconds (<strong>see Video 16<\/strong>).\n<ul>\n<li style=\"font-weight: 400\">Normally, the client should be able to maintain this position.<\/li>\n<li style=\"font-weight: 400\">An abnormal finding is when one leg begins to extend out.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Lower Extremity Weakness Test\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DeAxqHOOXEs?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 16<\/strong>: Lower extremity weakness test.<\/p>\n<ol start=\"6\">\n<li style=\"font-weight: 400\">To perform the <strong>Romberg test<\/strong>, ask the client to remove their shoes. Ask them to stand at the bedside in case they get dizzy and need to sit down; you can also stand near them for safety. Next, ask the client to move their feet together with their arms\/hands down at their sides or crossed in front of them. Start by asking the client to stand in this position for 20 seconds with their eyes open to ensure balance (and cerebellar functioning). Next, ask the client to maintain this position with their eyes closed for up to one minute (this tests proprioception, i.e., one\u2019s location in space). See <strong>Figure 16.<\/strong><\/li>\n<\/ol>\n<ol>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"font-weight: 400\">Normally, the client should be able to maintain this position with eyes opened and eyes closed, possibly with mild swaying.<\/li>\n<li>An abnormal or positive finding is unusual swaying or moving their feet: this may be associated with the posterior column of the spinal cord. If the swaying happens when eyes are opened, this finding may be associated with the cerebellum.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/03\/Romberg-Test-1.jpg\" alt=\"\" width=\"451\" height=\"339\" class=\"aligncenter wp-image-558 size-full\" \/><strong style=\"text-align: initial;font-size: 1em\">Figure 16<\/strong><span style=\"text-align: initial;font-size: 1em\">: Romberg test.<\/span><\/p>\n<ol start=\"7\">\n<li><strong>Assessment of posture and gait <\/strong><span style=\"font-size: 1em\">can be done in several ways. At this point, you have probably already evaluated the client\u2019s ability to sit or stand as part of the Brief Scan of the Neurological System. Now, ask the client to walk from point A to point B (usually about 20 feet\/6 metres) and then turn around and walk back to point B. To emphasize any balance or coordination issues, ask the client to walk in a heel-to-toe manner for about half the distance (10 feet\/3 metres). See <\/span><strong style=\"text-align: initial;font-size: 1em\">Video 17<\/strong><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Normally the client should be able to sit or stand upright with their head up and in a midline position, maintain their balance, and walk smoothly in a coordinated manner with their arms swinging at their sides.<\/li>\n<li>Abnormal findings include inability to sit upright, drooping of head, lack of balance, wide stance, incoordination of legs and arms when walking, or lack of arm movement.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><iframe loading=\"lazy\" id=\"oembed-3\" title=\"Assessment of Gait and Posture\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/IaHf4DylXmU?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 17<\/strong>: Gait test.<\/p>\n<ol start=\"8\">\n<li>To further test coordination and cerebellar function, complete the finger-to-nose and finger-to-finger test; the client may be sitting or standing for these tests. For the <strong>finger-to-nose test<\/strong>, ask the client to extend both arms out to the sides and then bend one arm slowly to touch their nose with their index finger, alternating with each arm a 3 to 4 times. Next, ask the client to close their eyes and repeat the same movements more quickly, about 3 to 4 times. Then, ask them to open their eyes. For the <strong>finger-to-finger test<\/strong>, place your finger an arm\u2019s length away from them, ask them to touch it with their index finger, then touch their nose, and repeat this activity 3-4 times moving your finger to a new location each time (in a high, middle and low location). Repeat with the other arm. The <strong>heel-to-shin test<\/strong> is similar to this test but specific to lower extremities: ensure the client is in a supine position and ask them to place their heel on the contralateral shin at the knee level and slide their heel down the shin. Repeat for the other leg. See <strong>Video 18<\/strong>\u00a0for the finger-to-nose and finger-to-finger tests and <strong>Video 19<\/strong>\u00a0for the heel-to-shin test.\n<ul>\n<li>Normally, the client\u2019s movement should be accurate and steady in motion.<\/li>\n<li>Abnormal findings include inaccurate and unsteady movement.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><iframe loading=\"lazy\" id=\"oembed-4\" title=\"Finger to Nose Test and Finger to Finger Test\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/4z39gHGYQ4k?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 18<\/strong>: Finger-to-nose test and finger-to-finger test.<\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-5\" title=\"Heel to Shin Test\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/E_FdZ52V5qM?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 19<\/strong>: Heel-to-shin test.<\/p>\n<ol start=\"9\">\n<li>While the client is seated, perform <strong>rapid alternating movements<\/strong> of the upper and lower limbs. Start by asking the client to stick out one hand with the palm facing upward, then place the back of their other hand in this palm, and then turn the top hand over (palm to palm): repeat this process and increase the speed about 3\u20134 times. Repeat on the other side. See <strong>Video 20<\/strong>. Next, ask the client to remain seated with feet flat on the floor; ask them to repeatedly tap one of their feet on the floor and repeat this with increased speed (about 3\u20134 times is sufficient). Repeat for the other foot.\n<ul>\n<li>Normally, the client can repeat the action smoothly, quickly, and symmetrically.<\/li>\n<li>Abnormal findings include slow and uncoordinated movements.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><iframe loading=\"lazy\" id=\"oembed-6\" title=\"Rapid Alternating Movements Test  Upper Limbs\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/ipF_FczU4dE?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 30<\/strong>: Rapid alternating movements.<\/p>\n<ol start=\"10\">\n<li>Note the <strong>findings<\/strong>:\n<ul>\n<li style=\"font-weight: 400\">Normal findings might be documented as: \u201cLimb muscles symmetrical bilaterally with no atrophy, no involuntary movements, full range of motion, equal muscle resistance bilaterally. No pronator drift. No lower extremity weakness observed. Client able to maintain standing position with mild swaying with Romberg test. Smooth coordinated gait. Accurate and steady motion with finger-to-nose, finger-to-finger, and heel-to-shin test. Smooth, quick and symmetrical rapid alternating movements of hands and feet.\u201d<\/li>\n<li style=\"font-weight: 400\">Abnormal findings might be documented as: \u201cPronator drift observed right arm. Ataxia observed with walking and wide stance.\u201d<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\">Clinical Tip<\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: center\">\n<p>Consider safety when completing tests, especially those that require a client to stand or walk. Reflect back on fall safety interventions and strategies in relation to each client\u2019s health condition. You may decide not to complete the Romberg test, particularly if a client has symptoms of dizziness or is at risk of a fall.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\">Contextualizing Inclusivity<\/h2>\n<p>Consider the client\u2019s age, health condition, and prior limitations. For example, some older people have age-related conditions resulting in loss of muscle mass and strength. Some may have conditions associated with pain or amputations, which can affect movement. In addition to being patient, you may need to provide accommodations for accessibility reasons.<\/p>\n<p>Neurological testing can be time-consuming, and it may be helpful to frame tests as a fun experience, like a game, especially for children.<\/p>\n<\/div>\n<h2 style=\"text-align: center\">Activity: Check Your Understanding<\/h2>\n<div id=\"h5p-125\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-125\" class=\"h5p-iframe\" data-content-id=\"125\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Motor Function and Cerebellar Testing H5P\"><\/iframe><\/div>\n<\/div>\n<h3><strong>References<\/strong><\/h3>\n<p>Campbell, W., &amp; Barohn, R. (2020). DeJong\u2019s The Neurological Examination. Wolters Kluwer.<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"2305-2419\" hidden><p>includes central and peripheral structures in the nervous system that supports the planning and executing of simple and complex motor functions such as movement.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2305-2421\" hidden><p>is a structure located at the back of the brain underneath the occipital and temporal lobes of the cerebral cortex and is responsible for actions such as balance, posture, and coordination of voluntary movements.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2305-2423\" hidden><p>refers to disorganized movement such as staggered gait or impaired fine motor skills.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2305-2425\" hidden><p>refers to muscles that have no resistance and no tone.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2305-2427\" hidden><p>is increased muscle resistance that is consistent at rest and with movement.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"2305-2429\" hidden><p>is increased muscle resistance that decreases with continuous movement and worsens at extreme ROM.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":17,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[88],"license":[56],"class_list":["post-2305","chapter","type-chapter","status-publish","hentry","contributor-june-2024-cu3e0lrwrt","license-cc-by-nc"],"part":2261,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2305","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":4,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2305\/revisions"}],"predecessor-version":[{"id":2480,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2305\/revisions\/2480"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/2261"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2305\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=2305"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=2305"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=2305"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=2305"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}