Tests of coordination or ataxia?

Let's bid farewell to the overly general "coordination test" moniker

Coordination tests are frequently administered by physiotherapists in the assessment of patients undergoing neurorehabilitation. These tests have long been considered as tools to evaluate coordination, but are they truly assessing this aspect?

These tests were originally developed to detect incoordination i.e as a diagnostic/screening tests resulting from ataxia, both sensory and cerebellar types. They typically assess a patient's ability to perform rapid alternate movements (dysdiadochokinesia) and evaluate movement accuracy, exemplified by tests like the finger-to-nose and finger-to-finger tests, as well as the famous Romberg's test (examining lower limb movement coordination while standing, in the absence of proprioceptive inputs).

The use of the broad term "coordination test" instead of specifying "ataxia" (which refers to coordination problems arising from cerebellar involvement) can be misleading. Any motor system lesion or pathology will inevitably lead to issues in movement coordination. However, these coordination tests are designed specifically to differentiate cerebellar involvement from other motor system components, such as the cortex. Many common textbooks typically cautions that these tests should not be conducted when there is evident muscle weakness, often stemming from motor cortex involvement, further supporting this argument.

In light of this analysis, it is prudent to reconsider the terminology we employ. Rather than referring to these tests as all-encompassing coordination assessments, we should label them as "tests of ataxia."

Additionally, these tests should only be conducted when there is a reasonable suspicion ( as is true for any diagnostic test) that a patient may have cerebellar involvement, either based on their medical history or diagnostic imaging reports. Administering these tests indiscriminately to all patients with neurological conditions serves little purpose. Even in cases of cerebellar ataxia, one must question the utility of these diagnostic tests for physiotherapists in planning patient management.

Let's bid farewell to the overly general "coordination test" moniker and embrace a more precise terminology, acknowledging these assessments for what they truly are—tests designed to detect ataxia. By doing so, we can optimize their usage and ensure that they serve a meaningful purpose in the realm of neurological rehabilitation.

Prakash