Coordination is evaluated by testing the patient's ability to perform rapidly alternating and point-to-point movements correctly.

Rapidly Alternating Movement Evaluation
Ask the patient to place their hands on their thighs and then rapidly turn their hands over and lift them off their thighs. Once the patient understands this movement, tell them to repeat it rapidly for 10 seconds. Normally this is possible without difficulty. This is considered a rapidly alternating movement.

Dysdiadochokinesis is the clinical term for an inability to perform rapidly alternating movements. Dysdiadochokinesia is usually caused by multiple sclerosis in adults and cerebellar tumors in children. Note that patients with other movement disorders (e.g. Parkinson's disease) may have abnormal rapid alternating movement testing secondary to akinesia or rigidity, thus creating a false impression of dysdiadochokinesia.

Point-to-Point Movement Evaluation
Next, ask the patient to extend their index finger and touch their nose, and then touch the examiner's outstretched finger with the same finger. Ask the patient to go back and forth between touching their nose and examiner's finger. Once this is done correctly a few times at a moderate cadence, ask the patient to continue with their eyes closed. Normally this movement remains accurate when the eyes are closed. Repeat and compare to the other hand.

Dysmetria is the clinical term for the inability to perform point-to-point movements due to over or under projecting ones fingers.


Next have the patient perform the heel to shin coordination test. With the patient lying supine, instruct him or her to place their right heel on their left shin just below the knee and then slide it down their shin to the top of their foot. Have them repeat this motion as quickly as possible without making mistakes. Have the patient repeat this movement with the other foot. An inability to perform this motion in a relatively rapid cadence is abnormal.
The heel to shin test is a measure of coordination and may be abnormal if there is loss of motor strength, proprioception or a cerebellar lesion. If motor and sensory systems are intact, an abnormal, asymmetric heel to shin test is highly suggestive of an ipsilateral cerebellar lesion.


Assessment of Coordination