Rapid Yet Thorough Bedside Assessment of Eye-Hand Coordination

Eye-hand coordination (EHC) is critical for activities of daily living. EHC dependent on the integrity multiple brain systems and therefore often disrupted by central nervous system pathology. Impairments can occur in ocular motor, manual or ocular-manual motor control, that is, eye, hand, EHC. Impaired affects visually guided actions, such as reaching, grasping, wielding tools, manipulating objects. This true acute pathologies, stroke neurotrauma, well more chronic neurodegenerative conditions, Parkinson disease.1Cano S.J. Hobart J.C. Hart P.E. Korlipara L.V.P. Schapira A.H.V. Cooper J.M. International Cooperative Ataxia Rating Scale (ICARS): appropriate studies Friedreich's ataxia?.Mov Disord. 2005; 20: 1585-1591Crossref PubMed Scopus (55) Google Scholar, 2Kim B.R. Lim J.H. Lee S.A. et al.Usefulness Assessment (SARA) ataxic patients.Ann Rehabil Med. 2011; 35: 772-780Crossref 3Perenin M.T. Vighetto A. Optic ataxia: a specific disruption visuomotor mechanisms. I. Different aspects deficit reaching objects.Brain. 1988; 111: 643-674Crossref (646) 4Andersen R.A. Andersen K.N. Hwang E.J. Hauschild M. from Balint's syndrome to parietal reach region.Neuron. 2014; 81: 967-983Abstract Full Text PDF (70) 5Rodrigues M.R.M. Slimovitch Chilingaryan G. Levin M.F. Does Finger-to-Nose Test measure upper limb stroke?.J Neuroeng Rehabil. 2017; 14: 6Crossref (18) Scholar Despite its clinical relevance, not systematically assessed. Using 3 simple measures (fig 1), health care providers may rapidly identify characterize deficits while also assessing visual function eye movement. Figure 1 flow diagram rapid assessment. The patient performs assessments: finger-to-nose, finger-to-knee, finger chase. finger-to-nose with target both peripheral vision; if are noted, tests repeated providing proprioceptive ± audio feedback.General Examination Instructions all assessments:•Sit front patient’s midline about arm’s length away•Have sit comfortably. If necessary, support feet trunk (head/body aligned forward/central position)•Patient 5 trials each assessment, emphasizing speed accuracy.•Test arms whenever possible, score side separately; test less affected arm first ensure task comprehension.•Start hand/arm resting knee be tested arm/shoulder mildly flexed•One trial (cycle) starts when hand moves ends back knee•Reach distance should ∼50% span Finger-to-nose (FtN) has 2 defined steps. Step 1. brings their nose. 2. nose examiner then returns subsequently knee. completes cycle. cycles. Nose-to-finger (examiner) movements require guidance optic ataxia but influenced primary (eg, tremor, akinesia, chorea, clumsiness). Patients inaccurate visualized target. FtN movement provide relatively pure dysfunction. Note, patients cerebellar overshoot moving display characteristic tremor worsens approaches target; this case, pay close attention chase, which these apparent. Note discrepancies between nose-to-finger segments (inaccuracy and/or tremor) inform your decision making. Instructions: “Lift touch Then tip my finger. return touching Finally, Try do fast accurately possible positions I indicate. You move eyes follow keeping head still.” Examiner instructions 3): •Use index finger.•Place at locations random order. Outcome measures: •Time completion: record total time completion (from leaves it returns) using stopwatch.○Fatigue: note any prolongation over trials•Reach accuracy: quantify degree error (0-5, see below) type (over-/undershoot)○0=No error○1=Mild (<5cm)○2=Moderate (<15cm)○3=Severe (>15cm)○4=Unable perform pointing movements•Tremor: presence noted during (0-3, below scale):0=Normal1=Slight2=Moderate3=Severe •Types tremors (optional): fine, coarse, high-amplitude, high-frequency, resting, intention•Miscellaneous: other neurologic abnormalities incidentally (impairment movements, impairments somatosensory somatomotor function, etc). trouble performing tasks, repeat manually guide improve information location. In contrast, misreaching due deficits, supplemental will help. nose, you miss targets, help have task.” instructions: •Follow A1 instructions.•If misses finger, them trial.•Document outcome measures. Reaching targets engages wider network neural reveal observed foveated targets. Hemispatial neglect, subtle field impairment translating hand-based spatial coordinate systems, working memory worsen performance vision (when they looking target) Same A1, except ask look times. going ultimately possible. Look times head.” A1. ∗If difficulty B1, B2: trial. “You first, whole don’t missed B1 (see fig 2). Significance: To distinguish contrast entails body schema proprioception, FtN, requires (especially, (examiner). “Start lifting Repeat times, possible.” “Now same task, •Ask open closed. part extremity continuously following Cerebellar (an uncontrolled oscillation perpendicular axis becomes worse become exaggerated “Using it, precisely follow/chase it.•Make sudden different locations.•Movements 30 cm (∼12 in) frequency every s. described herein, combined, systematic reproducible assessment eye-hand coordination. While abnormal finding battery assist triggering referrals experienced neurologists physiatrists, granular details generated, characterization impairment, downstream clinicians, physical occupational therapists, tailor rehabilitative therapeutics, stage prognosis, and, ultimately, stimulate novel directions dyscoordination.