Coordination and Gait Introduction
Coordination and gait are usually described together because cerebellar disorders can disrupt coordination or gait while leaving other motor functions relatively intact. There is much overlap, however, between the systems being examined in this section and those examined in the earlier, general motor exam section as well as in other parts of the exam. Keep in mind that disturbances of coordination and gait can be caused by lesions in many systems other than the cerebellum.
The term ataxia is often used to describe the abnormal movements seen in coordination disorders (see KCC 15.2 in Neuroanatomy through Clinical Cases 3e). In ataxia there are medium- to large-amplitude involuntary movements with an irregular oscillatory quality superimposed on and interfering with the normal smooth trajectory of movement (see Figure 3.4B in Neuroanatomy through Clinical Cases 3e). Overshoot is also commonly seen as part of ataxic movements and is sometimes referred to as past pointing when target-oriented movements are being discussed. Another feature of coordination disorders is dysdiadochokinesia—that is, abnormal alternating movements.
Cerebellar lesions can cause different kinds of coordination problems depending on their location. One important distinction is between truncal ataxia and appendicular ataxia (see KCC 15.2 in Neuroanatomy through Clinical Cases 3e). Appendicular ataxia affects movements of the extremities and is usually caused by lesions of the cerebellar hemispheres and associated pathways (see Figure 15.3 in Neuroanatomy through Clinical Cases 3e). Truncal ataxia affects the proximal musculature, especially that involved in gait stability, and is caused by midline damage to the cerebellar vermis and associated pathways.