Finger-to-Nose Coordination Test

What is a Finger-to-Nose Coordination Test?

The Finger-to-Nose Test or Finger-to-Nose Coordination Test is a diagnostic technique designed to evaluate cerebellar function, which is critical for maintaining equilibrium, coordinating voluntary movements, and ensuring fluidity. It is a pivotal component to assess coordination or check for any cerebellar neurological signs within the comprehensive neurological examination.

The Finger-to-Nose Test can also provide valuable insights into the integrity of upper limb coordination and detect potential neurological anomalies affecting such precision.  In certain cases, the finger-to-nose test is one of the field sobriety tests that a police officer may use when assessing a driving-under-the-influence (DUI) suspect.

It is crucial to note that impairment or damage to the cerebellum can significantly impede an individual's proficiency in performing this test.

How to do the Finger-to-Nose Coordination Test

The following provides a step-by-step guide on how to conduct the finger-to-nose test:

Step 1: Preparation

To familiarize yourself with the instructions and possible interpretations of the results of the finger-to-nose test, you may download a copy of the template provided in this guide by clicking the "Download" or "Use Template" button. Otherwise, you may find and access a copy in Carepatron's template library by searching for "Finger to Nose Test" in the search bar.

Step 2: Introduction and explanation

When it's time to conduct the test, introduce yourself to the examinee and explain the purpose of the Finger-to-Nose Test.

Step 3: Positioning

Ensure the examinee is in a comfortable and relaxed standing or sitting position. Maintain a clear line of sight between yourself and the examinee's open eyes.

Step 4: Demonstration (optional)

Feel free to demonstrate the Finger-to-Nose Test to the examinee to ensure a clear understanding of the task. Perform a sample trial by touching your nose with your index finger and guiding them to touch their index finger with yours. Explain the desired smooth and coordinated movement.

Step 5: Testing

Instruct the examinee to extend their arm and touch their nose with their index finger. After this, instruct them to reach out and touch your index finger. Observe the movement for smoothness and coordination. Repeat this step as necessary to ensure the examinee comprehends the task. Once this has been accomplished, you may also do test variations.

Step 6: Observe and interpret

Throughout the test, carefully observe for signs of intentional tremor, dysmetria, or cerebellar ataxia. Look for any difficulty in controlling the range of movement, such as undershooting or overshooting the target stimuli. Consider the findings in the context of potential pathology or neurological impairment. Record observations of the examinee's performance in the template, including any tremors, dysmetria, or challenges in coordination. Document any difficulties encountered during the test.

Step 7: Communicate

Conclude the test by providing feedback on their performance to the examinee. If necessary, discuss any observed abnormalities and their potential implications.

Afterward, don't forget to store the template with the test results and your observations securely. We recommend adding it to Carepatron's patient portal files to ensure security and easy access for future reference.

Interpreting the results of the test

The interpretation of Finger-to-Nose Coordination Test results is contingent upon the observed movements during the examination:

Normal movement

If the finger moves directly between the examinee's nose and the examiner's finger, this signifies an unremarkable and coordinated upper-extremity movement, indicative of normal neurological and motor function.

Postural tremor

If an increasing tremor accompanies the movement of the affected arm and finger, but the severity remains consistent as the finger approaches the target, the patient has a postural tremor, suggesting further investigation for potential underlying causes.

Intention tremor

An intention tremor initiates smoothly but exhibits an escalating body tremor as the finger approaches the target. This pattern suggests a cerebellar lesion, emphasizing the potential impairment in cerebellar function, and may signify neurological abnormalities affecting coordination and smoothness of movement.

It is imperative to recognize that these are general interpretations, and any concerns or deviations from the expected outcomes should prompt further evaluation by a qualified healthcare professional. A comprehensive examination and consideration of the individual's medical history are crucial for an accurate diagnosis and appropriate intervention.

Next steps

Following the Finger-to-Nose Coordination Test, a comprehensive neurological examination unfolds, delving into diverse facets of cerebellar function. Some sequential tests to augment the assessment (Stanford Medicine, 2019) are:

• Rapid movement testing: This test asks the patient to perform rapid alternating movements, like hand flipping, and evaluates the movements for smoothness.
• Rebound phenomenon (of Stewart & Holmes): During this test, the patient pulls on the examiner's hand, and a positive sign manifests as an exaggerated "rebound" in the opposite direction.
• Heel-to-shin test: During this test, the patient will be asked to run the heel down the contralateral shin.
• Gait examination: Here, the patient will be asked to walk, and their gait will be scrutinized for irregularities, particularly a broad-based gait associated with cerebellar pathology.

In conjunction with the finger-to-nose test, the aforementioned tests construct a comprehensive evaluation of abnormal cerebellar function. The detection of abnormalities prompts further diagnostic steps, including imaging studies (MRI or CT scans) and additional neurological assessments.

Benefits of doing the Finger-to-Nose Coordination Test

The Finger-to-Nose Coordination Test offers a spectrum of benefits within the field of neurological assessment:

• Cerebellar exam: This noninvasive test swiftly evaluates cerebellar function, a crucial determinant of muscle tone, and assesses coordination.
• Detection of neurological dysfunction: By identifying intentional tremor or balance dysmetria, the test serves as an effective indicator of potential cerebellar disease or damage, such as stroke, infection, brain tumors, etc.
• Versatility: The test's applicability extends across diverse settings, including physical and occupational therapy, and it requires no specialized equipment.
• Ease of use: Both administration and comprehension are uncomplicated, enhancing patient cooperation.
• Informative: Results from the test provide healthcare professionals with valuable insights into a patient's neurological health.
• Guidance for further testing: Recognition of abnormalities prompts subsequent diagnostic avenues, guiding targeted testing and intervention.

Reference

Stanford Medicine. (2019, September 3). Cerebellar exam. https://stanfordmedicine25.stanford.edu/the25/cerebellar.html