This document provides information on diagnostic investigations and assessments for cerebellar ataxia. It lists various tests that can be done as part of the diagnostic workup including blood tests, imaging studies, genetic testing, and neurological exams. Specific tests are described to evaluate factors like balance, coordination, gait, dysmetria, and oculomotor performance that may be impaired with cerebellar ataxia. A thorough patient history and neurological exam incorporating several assessment scales are important for evaluating ataxia.

1. CEREBELLAR ATAXIA
NITHIN NAIR

2. DIAGNOSTIC INVESTIGATIONS
• Haematology: CBC, Creatinine, Liver
Enzymes, Electrophoresis, ESR, CRP, TFT,
Vitamin B12, Cholestrol – helps to evaluate overall
health and detect a range of disorders inculding
infection and heavy metal poisoning

3. DIAGNOSTIC INVESTIGATIONS
• Urine tests: Urine analysis may suggest –
systemic abnormalities related to some forms
of ataxia. Wilson’s disease – screen 24 hrs
urine collection for copper.

4. DIAGNOSTIC INVESTIGATIONS
• Imaging studies: A computerized
tomography (CT) scan or Magnetic Resonance
Imaging (MRI) of brain may help to determine
potential causes.

5. DIAGNOSTIC INVESTIGATIONS
• Genetic testing: It is done to determine whether
a patient, particularly a child has the gene mutation
that causes one of the hereditary ataxic conditions.
Chromosomal studies are performed on peripheral
blood lymphocytes and cultured skin fibroblasts

6. DIAGNOSTIC INVESTIGATIONS
• Brainstem Auditory Potential (BAEP or BAER):
Helpful to determine the presence of intact
central pathways and may also provide some
information about central (brainstem)
projection pathways associated with hearing.

7. DIAGNOSTIC INVESTIGATIONS
• Lumbar Puncture: CSF analysis is helpful
primarily to determine the presence of
inflammatory diseases.

9. ASSESSMENT
• HISTORY: History taking needs following consideration –
 Duration (Acute, subacute, chronic)
 Symmetry
 Rate of progression (static, episodic, progressive)
 Associated features (headache, vomiting, dystonia/chorea,
proprioceptive dysfunction, visual deficits, auditory
involement)
 Medical history (infection, medications/intoxications,
environmental exposures)
 Family history (suggest genetic disorder – autosomal recessive
transmission/ autosomal dominant inheritence)

10. ASSESSMENT
• ON OBSERVATION
• PAIN ASSESSMENT
• ON EXAMINATION
HIGHER CENTRES (COGNITION, MEMORY,
ORIENTATION, SPEECH, PROBLEM SOLVING)
CRANIAL NERVES (II, III, IV, VI, VIII)
SENSORY ASSESSMENT
MOTOR ASSESSMENT (TONE, REFLEXES,
ROM, MUSCLE POWER, VCA, TREMOR)

11. ASSESSMENT
 BALANCE (BBS, FUNCTIONAL REACH TEST, TIMED UP
& GO, FRIEDREICH ATAXIA RATING SCALE)
 GAIT (DGI, OBSERVATIONAL GAIT ANALYSIS-SPEED,
SYMMETRY, LEVEL OF INDEPENDENCE)
 CO-ORDINATION (EQUILIBRIUM, NON-EQUILIBRIUM)
 CARDIOVASCULAR (SUBMAXIMAL GRADED EXERCISE
TESTING)
 FATIGUE (MODIFIED FATIGUE IMPACT SCALE)
 FUNCTION AND DISABILITY (FIM, BARTHEL INDEX)
 SPECIFIC SCALES (INTERNATIONAL COOPERATIVE
ATAXIA RATING SCALE, SCALE FOR ASSESSMENT
AND RATING OF ATAXIA)

12. TYPICAL CLINICAL TEST
• HYPOTONIA:
SPECIFIC TEST POSITIVE
MUSCLE PALPATION Reduced firmness
PASSIVE SHAKING OF
LIMBS
Moves through greater arc of
motion
HOLD OBJECTS WHILE
CONVERSING
Drops when distracted
VOL.FLEXION-EXTENSION
OF KNEE OR ELBOW
(SUPPORTED/UNSUPPORTED)
Ataxic when unsupported,
controlled when supported
FLEX ONE FINGER ONLY All fingers flex

13. TYPICAL CLINICAL TEST
• ASTHENIA
SPECIFIC TEST POSITIVE
MAINTAIN ARM IN 90°
POSITION OF FLEXION OR
ABDUCTION
Arm(s) tire quickly
MAXIMAL RESISTED
MUSCLE CONTRACTION FOR
MAJOR MUSCLE GROUPS
Weaker on involved side or
unable to work against
resistance
REPEATED SUBNMAXIMAL
MUSCLE CONTRACTIONS –
RISING ON TOES, PUSHUPS,
SQUEEZING TENNIS BALL
Tires quickly

14. TYPICAL CLINICAL TEST
• BALANCE AND POSTURAL CONTROL
SPECIFIC TEST POSITIVE
OBSERVATION-
STANDING POSTURE
Feet apart, trunk flexed slightly,
needs to hold for stability,
postural tremor of legs
HOLD LIMB AGAINST
PULL OF GRAVITY
Postural tremor
NUDGE CLIENT
UNEXPECTEDLY WHEN
SITTING OR STANDING
Loses balance
STAND ON ONE FOOT OR
WALK BACKWARD
Loses balance

15. TYPICAL CLINICAL TEST
• DYSMETRIA
SPECIFIC TESTS POSITIVE
FLEX ARMS TO 90°, QUICKLY
ELEVATE OVERHEAD AND THEN
RETURN TO 90° POSITION
Not able to resume 90° position
without initial error
PUT PEG IN A HOLE, TRACE CIRCLE
WITH PENCIL, TRACE CIRCLE ON
FLOOR WITH GREAT TOE, SLIDE
HEEL DOWN SHIN SLOWLY, PLACE
FEET ON WALKERS WHEN WALKING
Intention tremor, undershoots or
overshoots target
THERAPIST RESISTS CLIENT’S
ELBOW FLEXION AND RELEASES
UNEXPECTEDLY
Arm rebounds

16. TYPICAL CLINICAL TEST
SPECIFIC TESTS POSITIVE
MARCH TO CADENCE Unable to follow rhythm
WALK ON HEELS OR TOES Loses balance and rhythm
WALK CLOCKWISE AND
COUNTERWISE
Stumbles in one direction
WALK ON UNEVEN GROUND Cannot compensate and stumbles
OBSERVATION- TYPICAL GAIT
PATTERN
Slow, stumbles easily, not rhythmical,
step length irregular
GAIT DISTUBANCE

17. TYPICAL CLINICAL TEST
• DYSDIADOCHOKINESIA
SPECIFIC TESTS POSITIVE
TAP HAND ON KNEE OR
TOES ON FLOOR
Rapidly loses rhythm and range
WALK AS FAST AS
POSSIBLE
Gait become impaired when fast
OBSERVATION –ADL’S Unable to brush teeth, stir food...

18. TYPICAL CLINICAL TEST
• MOVEMENT DECOMPOSITION:
SPECIFIC TESTS POSITIVE
SUPINE- CLIENT TOUCHES
HEEL TO OPPOSITE KNEE
Movement broken into separate
phases – does not flow
OBSERVATION – TYPICAL
MOVEMENT
Activity appears as if in a slow
motion – mechanical like a
puppet

19. TYPICAL CLINICAL TEST
• OCULOMOTOR PERFORMANCE
TYPES PROCEDURE
SMOOTH PURSUIT
(MOVING TARGET)
Sit Head still Follow pen tip with⇨ ⇨
eyes Test in all movement planes⇨
and directions Vary speed.⇨
SACCADES
(STATIONARY TARGET)
Verbally promted Client alternately⇨
fixes gaze on a pen tip and the
examiner’s nose Vary target⇨
locations Observe for dysmetria⇨
GAZE EVOKED NYSTAGMUS Client maintains gaze in variety of
locations including near end ranges of
lateral gaze Observe for nystagmus⇨

20. REFERENCE....
Neurological Rehabilitation - Darcy
Umphred (5th
and 6th
edition)
Neurorehabilitation (Neurogen) – Dr.
VC Jacob
Text book of Neurology – Navneet
kumar