Cerebellar Function Assessment | Cerebellar Signs | CNS Examination | Pediatrics — Transcript

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1. 0:00hello everyone
2. 0:02today i'm going to tell you one of the
3. 0:04part of the cns examination i have
4. 0:07already covered the higher mental
5. 0:09function meningeal irritation sign
6. 0:10cranial now motor system and the sensory
7. 0:13system now the next step is cerebellar
8. 0:16function assessment so i will tell you
9. 0:19all the details of cerebellar function
10. 0:21assessment
11. 0:23the structure which are
12. 0:26included in the cerebellum are the
13. 0:28cerebellar hemisphere vermix and the
14. 0:30flocculone nodular loop
15. 0:33and the lesion
16. 0:34in particular area will lead to the
17. 0:36specific cerebellar signs
18. 0:39so what are the signs or what are the
19. 0:41tests we will perform for the cerebellar
20. 0:44function
21. 0:45we will observe for the eye signs then
22. 0:47we will assess the speech then there are
23. 0:49various coordination moments which we
24. 0:52will check and then we have to check the
25. 0:54tone and dtr then ultimately
26. 0:57gate should be assessed
27. 1:00so in eye signs child may be having the
28. 1:03nystagmus skew deviation so in this
29. 1:06video you can see the child is having
30. 1:08nystigmoid eyes movement
31. 1:10these are the gauge peritectic nystigmas
32. 1:13and it is because of the vestibulo
33. 1:15cerebellar pathway involvement
34. 1:17and this child is not able to sustain
35. 1:20the eccentric gaze and child will
36. 1:22require the repeated seconds movements
37. 1:25to gaze literally
38. 1:27some time child is having the skew
39. 1:29deviation or ocular dysmetria or
40. 1:32fluttering movement or obsoclonus and
41. 1:35sometimes child is having rebound
42. 1:37nystigmas which is a unique feature of
43. 1:39the cerebellar diseases in which fast
44. 1:42component is in the direction of lateral
45. 1:45gage
46. 1:46in this video you can see the child is
47. 1:48having nystagmus movement with the skew
48. 1:51deviation which is characteristic of the
49. 1:54cerebellar disease
50. 1:57now after the
51. 1:59eye signs
52. 2:00we should observe the and we should
53. 2:02speak to the child so to assess the
54. 2:05speech of the child
55. 2:07child is having the dysarthria skinning
56. 2:10or sticketto speech in this we have to
57. 2:13tell the child to speak some words and
58. 2:15we have to observe because of the defect
59. 2:17in articulation child will have the
60. 2:21slow atexic or slurred or sometimes
61. 2:24jerky speech
62. 2:26and it is because of the uh this energy
63. 2:28of the phonation muscles
64. 2:31and when we will tell the child child
65. 2:33will scan the world example if i am
66. 2:35going to tell the child to speak the
67. 2:37chocolate child will speak
68. 2:44so child will scan the word
69. 2:47and speak in monosyllable words instead
70. 2:50of speaking normally child will
71. 2:55break each word into the monosyllabus so
72. 2:58the characteristic
73. 2:59type of the dysarthria in cerebral
74. 3:03diseases is scanning or sticker to
75. 3:05speech
76. 3:06now after the assessment of the speech
77. 3:10then we should perform the various
78. 3:13assessment
79. 3:14tests for the coordination in upper lip
80. 3:16finger moves
81. 3:18rebound this did recognition
82. 3:20look for the intentional treatment
83. 3:22handwriting test
84. 3:24in lower limb heal shin test
85. 3:27look for the cerebellar atexia tandem
86. 3:29walking walk around shear and the two
87. 3:32walking all these i will tell you the
88. 3:34details one by one
89. 3:37so in uh
90. 3:38coordination of movement we should
91. 3:40remember it's not possible to assess the
92. 3:43coordination in less than six years age
93. 3:45group and if the
94. 3:47child is having muscle power less than
95. 3:50grade 3 then again it is not possible to
96. 3:52assess
97. 3:54so for the finger nose test we have to
98. 3:56tell the child to touch the tip of the
99. 3:58index finger of the examiner and
100. 4:01then touch the tip of the nose
101. 4:03and child is not able to do in
102. 4:06cerebellar disease as in this video
103. 4:09child is having the intention tremor
104. 4:12also having the pass pointing known as
105. 4:15dysmetria because child is missing the
106. 4:17target
107. 4:18dysmetria mean when the child is having
108. 4:21error in judging the distance
109. 4:23and
110. 4:25child is either overshooting the target
111. 4:27known as hypermatria or
112. 4:31fail to reach the target known as
113. 4:33hypomatria both are the part of this
114. 4:36matriarch
115. 4:38and after the finger nose test we have
116. 4:40to perform the rebound test
117. 4:44next is the rebound test known as
118. 4:46rebound phenomena in which child will
119. 4:48keep the arm in
120. 4:50shoulder adapted elbow flex position and
121. 4:53supinated forearm
122. 4:55and we have to hold the child's wrist
123. 4:57and we will try to extend the forearm
124. 5:00and child will resist this movement and
125. 5:02we have to suddenly release the
126. 5:05our grip over the wrist and a normal
127. 5:08child
128. 5:09this sudden unloading contraction of the
129. 5:12elbow flexor immediately sees and child
130. 5:14will stop from hitting himself
131. 5:18while in the cerebellar disease
132. 5:20there will be patient cannot stop the
133. 5:23flexor contraction so a
134. 5:26child will
135. 5:27either hit the face or over the shoulder
136. 5:30it is known as rebound phenomena which
137. 5:33is present in the cerebellar disease
138. 5:35in this child can hit himself
139. 5:38another test in the upper limb
140. 5:40coordination is this didokinesia for
141. 5:42this we have to tell the child to move
142. 5:44the outer stress hands in the supination
143. 5:47and the pronation position alternatively
144. 5:50so in this video you can see the child
145. 5:52is performing this movement or we can
146. 5:54say the child to
147. 5:56paint the palm of
148. 5:58one hand over the palm of another hand
149. 6:01alternatively if child is able to
150. 6:03perform this test
151. 6:05that means child is having the normal
152. 6:07coordination in apple
153. 6:08if child is having movements which are
154. 6:11irregular incomplete which is
155. 6:13characteristically seen in the
156. 6:14cerebellar lesion
157. 6:18we have to observe the child for the
158. 6:20intention tremors which is
159. 6:21characteristic of the cerebellar disease
160. 6:23so for this we have to tell the child to
161. 6:25out stretch the hands and fingers so in
162. 6:27this video you can see
163. 6:29child is having the intention tremor
164. 6:31when child is keeping the
165. 6:33hands
166. 6:34out stretched
167. 6:36against gravity
168. 6:38so this is characteristic of cerebellar
169. 6:40disease
170. 6:49now for the assessment of coordination
171. 6:51in lower limb heel shin test in which we
172. 6:54will tell the child
173. 6:56to place the heel of one foot on the
174. 6:58knee of another leg then push the heel
175. 7:01along the tibial shin
176. 7:03in the straight line up to the grade 2
177. 7:06and repeat it several times if child is
178. 7:08able to perform this that means child is
179. 7:11having the normal coordination in lower
180. 7:13limb
181. 7:15in this video you can see child is able
182. 7:17to perform
183. 7:18in this video child is not able to
184. 7:21perform heal shin test child is even not
185. 7:25able to localize the knee and not able
186. 7:27to move the heel over the tbs chain
187. 7:30it is seen in cerebellar disease or
188. 7:33sometime in the sensory attacks there
189. 7:35also
190. 7:37child is having difficulty in localizing
191. 7:39the knee with the heel
192. 7:44now we have to assess the child for the
193. 7:47gate
194. 7:48so in cerebellar atexia child will have
195. 7:51the broad-based clumsy unsteady gate
196. 7:54i have already explained the detail of
197. 7:56the cerebellar atexia
198. 7:59about this key in this video you can see
199. 8:01the child is having broad-based clumsy
200. 8:04gate it is the cardinal sign of the
201. 8:06cerebellar involvement
202. 8:11then we have to assess the tandem
203. 8:13walking walk around chair in this video
204. 8:16you can see the child is walking
205. 8:18randomly
206. 8:20and if the child is having any
207. 8:22unsteadiness swing
208. 8:24that means child is having cerebellar
209. 8:26lesion and generally child will sway
210. 8:29toward the side of cerebellar lesion
211. 8:33then we will tell the child to perform
212. 8:35the toe walking
213. 8:37so in this video you can see the child
214. 8:38is performing the door walking if the
215. 8:40child is having cerebral lesion child
216. 8:42will not be able to perform the toe walk
217. 8:45child will have the more unsteadiness
218. 8:48and swelling
219. 8:50then we have to assess the tone
220. 8:53in cerebellar disease child will have
221. 8:54the hypotonia then we have to assess the
222. 8:57deep tendon reflex child will have the
223. 8:59pendular knee jerk which is
224. 9:00characteristic of the
225. 9:02cerebellar disease
226. 9:04so what are the various cerebral signs i
227. 9:07have already explained in the previous
228. 9:08slides child will have the atexia which
229. 9:10is the cardinal sign of the cerebellar
230. 9:12disease this synergia means child will
231. 9:15not be able to coordinate the muscle
232. 9:17contraction for the some particular act
233. 9:20label as a dysynergia it is the
234. 9:22essential feature of the cerebellar
235. 9:24disease this material child will not be
236. 9:27able to judge the distance when reaching
237. 9:29to the object this r3 or this dido
238. 9:31kinesia not able to perform the
239. 9:33alternate movements hypotonia nystagmus
240. 9:36pendulum knee jerk and a staggering gait
241. 9:39so according to the involvement of the
242. 9:42structure of the cerebellum various
243. 9:44clinical manifestations occur in
244. 9:46cerebellar hemisphere child will have
245. 9:48the lymph certixia or appendicularity in
246. 9:51cerebellar mix involvement child will
247. 9:54have the truncalatixia or gate
248. 9:56atixia
249. 9:58and in floccular nodular lobe
250. 9:59involvement child will have the eye sign
251. 10:01nystagmus
252. 10:03so this is all about the cerebellar
253. 10:05functional assessment thank you so much