Appendicular Coordination

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Fine movements of the hands and feet should be tested, as discussed earlier under the general motor exam. Rapid alternating movements, such as wiping one palm alternately with the palm and dorsum of the other hand, should be tested as well.

Perhaps the most popular test of coordination, however, is the finger–nose–finger test, in which the patient is asked to alternately touch their nose and the examiner's finger as quickly as possible (see Figure 3.4 in Neuroanatomy through Clinical Cases 3e). Ataxia is best revealed if the examiner's finger is held at the extreme of the patient's reach, and if the examiner's finger is occasionally moved suddenly to a different location. Test for overshoot by having the patient raise both arms suddenly from their lap to the level of your hand. In addition, you can apply pressure to the patient's outstretched arms and then suddenly release it. To test the accuracy of movements in a way that requires very little strength, you can draw a line on the crease of the patient's thumb and then ask the patient to touch the line repeatedly with the tip of their forefinger. This test can help distinguish between irregular, wavering movements caused by limb weakness and abnormal movements caused by ataxia.

Similar tests can be done with the legs. In the heel–shin test the patient is asked to touch the heel of one foot to the opposite knee and then to drag their heel in a straight line all the way down the front of their shin and back up again. In order to eliminate the effect of gravity in moving the heel down the shin, this test should always be done in the supine position. Testing for ataxia is discussed further in KCC 15.2 in Neuroanatomy through Clinical Cases 3e.

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