From the Guidelines
To screen for ataxia on clinical exam, the most efficient approach is to perform a focused neurological assessment that includes finger-to-nose testing, heel-to-shin testing, rapid alternating movements, and gait evaluation. This approach is based on the most recent and highest quality study available, which emphasizes the importance of a thorough clinical examination in evaluating ataxia 1. The clinical evaluation should include a detailed history and physical examination to identify signs and symptoms of ataxia, such as clumsiness, nystagmus, dysmetria, abnormal or unsteady gait, dysdiadochokinesis, or dyssynergia.
Some key points to consider when performing a clinical examination for ataxia include:
- Finger-to-nose testing to evaluate coordination and intention tremor
- Heel-to-shin testing to assess proprioception and cerebellar function
- Rapid alternating movements to evaluate dysdiadochokinesia
- Gait evaluation to assess for a wide-based, unsteady walking pattern
- Additional tests such as Romberg's test, tandem gait, and speech assessment for scanning speech can also be useful in evaluating cerebellar dysfunction.
It is essential to note that ataxia can result from various causes, including cerebellar dysfunction, sensory pathway abnormalities, and vestibular system disorders 1. A thorough clinical examination can help identify the underlying cause of ataxia and guide further investigation with imaging or specialized testing. By prioritizing a focused neurological assessment, clinicians can effectively screen for ataxia and improve patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Screening for Ataxia
To screen for ataxia (cerebellar dysfunction) on a clinical examination, several methods can be employed.
- A detailed clinical examination can reveal core features of ataxia, including dysarthria, truncal, gait, and limb ataxia, as well as oculomotor dysfunction 2.
- The finger-to-nose test (FNT) is a useful test for assessing upper limb ataxia, and can be performed at the bedside or using quantitative testing techniques 2, 3, 4.
- Other tests, such as the finger chase test (FCT), finger tapping test (FTT), and dysdiadochokinesia test (DDKT), can also be used to assess ataxia 3.
- These tests can be used to identify ataxia and assess its severity, and can be performed in a clinical or laboratory setting 3.
Clinical Assessment
Clinical assessment of ataxia involves evaluating the patient's movement and coordination.
- This can include assessing the patient's gait, balance, and ability to perform coordinated movements 2.
- The clinical examination should also include an assessment of oculomotor function, including saccades and the vestibulo-ocular reflex (VOR) 2.
- A comprehensive clinical examination can provide valuable information for diagnosing and managing ataxia 5.
Diagnostic Tests
While clinical examination is essential for diagnosing ataxia, diagnostic tests can also be useful.
- Neuroimaging, such as MRI, can play a pivotal role in diagnosing cerebellar ataxia, particularly in childhood cases 6.
- Electrophysiological tests, such as electroencephalography and nerve conduction velocity, can also be used to assess ataxia 2.
- Genetic testing may be necessary to diagnose hereditary forms of ataxia 5.