Testing for ataxia

Definition:
Ataxia and ataxic disorders are a group of neurological conditions where by a combination of balance, speech and co-ordination may be affected.

Test procedure:
These assessments are designed to test for motor control and co-ordination.

Rapid alternating movements

1. Patient extends arms. Instruct the patient to swipe one palm alternately with the palm and dorsum of the other hand for a brief period of time. Then instruct the patient to alternate hands after a period.

Finger to Nose to Finger Test

2. The patient is instructed to touch his/her nose and then without delay touch the examiners extended finger and again touch his/her own nose. This sequence is repeated for a period. During the test the examiner should always be sitting/standing in the same position within easy reach of the patient but the examiner should move his/her finger to alternate positions in front of the patient.

Heel to Shin Test
1. With patient lying supine. Instruct the patient to raise one leg and with their heel touch their opposite knee, dragging the heel along the skin, along the shin toward the ankle and then slowly back up to the knee. Both legs are tested in similar fashion.
Observe Gait
2. Assess the patient as they walk across the room away from you and then turn and walk back towards you.
Note any irregularities in stance, posture, leg swing, foot drop issues and any difficulty maintain an even trajectory or when turning around.
Further Gait Assessments
3. Heal to toe in a straight line (employed by Police officers to assess suspected drunk-drivers by the roadside). As before the patient walks back and forth but the balance is assessed by instructing the patient to walk in way where their heel touches their other toe with each step.
4. Instruct the Patient to walk back and forth but instruct them to walk each time in different ways, such as;
1. On their toes.
2. On their heels.
3. On the outside of their feet as if there was an illusory varus tilt at play.

Romberg’s Test
1. The patient stands upright with feet together. The patient is instructed to stand in this way with eyes closed. Balance is tested. During Romberg’s test the examiner must stand close by ready to prevent any fall in case of poor balance. To test the patient further if required the examiner can gently nudge the patient back and forth to check if the patient can easily compose themselves and return to the starting position.

Test findings:
Any abnormal results and failure to maintain normal gait and balance should be recorded.

Considerations:
The examiner must always stand close to the patient in these tests in case he/she is required to prevent the patient from falling. Many Ataxias are inherited but they may be caused by stroke, trauma, MS or intoxication. Referral is required if the patient can not maintain normal balance and motor control.