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AClrn CARE II:\NDBOOI( fOR I'IIYI)ICAI Till' ItAl'I')l,

Table 4-17. Coordination Tests

Test

Method

Upper extremity

Finger to nose

Ask the patient to touch his or her nose. Then, .1sk

patient to touch his or her nose and then touch

your finger (which should be held an arm\

length :nvay). Ask the patient to repeat this

rapIdly.

Supination and

Ask the patient to rapidly and alternately 'iupinate

pronation

and pronate his or her forearms.

Tapping

Ask the patient ro rapidly tap hi\ or her hands on

a surface simultaneousl)', alternately, or both.

Arm bounce

Have the patienr flex his or her shoulder to 90

degrees with elbow fully extended and wrist III

the neutral position, then apply a brief downward pressure on the arm. (ExceSSive 'iwinging

of the arm indicates a positive test.)

Rebound phenome

Ask the patient to flex his or her elbow to approxnon

imately 45 degrees. Apply resistance to elbow

flexion, then suddenly release the resistance.

(Striking of the face indICates a positive test.)

Lower extremity

Heel to shm

Ask the patient to move IllS or her heel down the

opposite shm and repeat mpH.liy.

Tapping

Ask the patient to rapidly tap his or her feer on

the floor simultaneously, alternately, or both.

Romberg test

Ask the patlcnr to stand (heels mgether) with eyes

open. Observe for swaying or los\ of balance.

Repeat with eyes closed.

Gait

Ask the patient to walk. Observe galt pattern,

posture, and balance. Repeat with t�tndcll1

walklllg to exaggerate deficits.

Source: Dat:l from KW l.mdsay, J Bone, R C:lllandcr (cd!» . f\!curolngy and Ncurmurgcry Illustrated (2nd cd). Edinburgh, UK: Churchill LlvmgslOnc, 1 99 1 .

NERVOUS SYSTEM

301

dislocation, spondylosis, spur, or stenosis, especially after trauma or if

there are motor or sensory deficits.14,23

Computed Tomography

In computed tomography (CT), coronal or sagittal views of the head,

with or without contrast media, are used to assess the density, displacement, or abnormality ( location, size, and shape) of the cranial vault and fossae, cortical sulci and sylvian fissures, ventricular system,

and gray and white matter. CT is also used to assess the presence of

extraneous abscess, blood, calcification, contllsion, cyst, hematoma,

hydrocephalus, or tumor. "·2J CT of spine or otbits is also available.

Head CT is the preferred neuroimaging test for the evaluation of

acute cerebrovascular accident (CVA), as it can readily distinguish a

primary ischemic from a primary hemorrhagic process and thus determine the appropriate use of tissue plasminogen activator (tPa) ( see Appendix IV)."

Magnetic Resonance Imaging alld AlIgiography

Views in any plane of the head, with or without contrast, taken with

magnetic resonance imaging (MRI) are llsed to assess intracranial

neoplasm, degenerative disease, cerebral and spinal cord edema,

ischemia, hemorrhage, arteriovenous malformation (AVM), and congenital anomalies."·2J Magnetic resonance angiography (MRA) is used to assess the intracranial vasculature for eVA, transient ischemic

attack (TIA), venous sinus thrombosis, AVM, and vascular tumors or

exrracranially for carotid bifurcation stenosis.2s

Doppler Flowmetry

Doppler f/owmetry is the use of ultrasound to assess blood flow.

Transcranial Doppler Sonography

Transcrallial Doppler sOllography (TCD) involves the passage of

low-frequency ultrasound waves over thin cranial bones (temporal)

or over gaps in bones to determine the velocity and direction of

blood flow in the anterior, middle, or posterior cerebral and basilar

302 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

arteries. It is used to assess arteriosclerotic disease, collateral circulation, vasospasm, and btain death, and to identify AVMs and their supply arreries.14•2J

Carotid Nonjnvasives

Carotid noninvasives use the passage of high-frequency ultrasound

waves over the common, internal, and external carotid arteries to

determine the velocity of blood flow in these vessels. It is used to

assess location, presence, and severity of carotid occlusion and

stenosis.14•23

Digital-Sttbtractiolt Altgiography

Digital-subtraction angiography (DSA) is the computer-assisted

radiographic visual ization of the catotids and cetebral vessels with

a minimal view of background tissues. An image is taken before

and after the injection of a contraSt medium. The first picture is

"subtracted" from the second, a process that creates a highlight of

the vessels. Digital-subtraction angiography is used to assess aneurysm, AVM, fistula, occlusion, or stenosis. It is also used in the operating room (i.e., television display) to examine the integrity of

anastomoses or cerebrovascular rcpairs. 14,2]

Cerebral Altgiography

Cerebral angiography involves the radiographic visualization (angiogram) of the displacement, patency, stenosis, or vasospasm of intraor extracranial arteries after the injection of a radiopaque contrast medium via a catheter (usually femoral). It is used ro assess aneurysm,

AVMs, or intracranial lesions as a single procedure or in the operating

room to examine blood flow after surgical procedures (e.g., after an

aneurysm c1ipping).'4

Clinical Tip

Patients are on bed rest with the involved hip and knee

immobilized for approximately 8 hours after cerebral

angiography to ensure proper healing of the catheter insertion site.