Unit 2 - OA 101.pptx

Orthopedic Assessments OA 101 AXIOM CAREER COLLEGE Clinician Contact Points Postural Assessment PLUMB LINES AND POSTURE Postural Assessment  Definition:   Evaluation of a person’s body position and/or structure in standing; assessed in 4 positions: anterior, lateral X 2 and posterior F...

Orthopedic Assessments OA 101 AXIOM CAREER COLLEGE Clinician Contact Points Postural Assessment PLUMB LINES AND POSTURE Postural Assessment  Definition:   Evaluation of a person’s body position and/or structure in standing; assessed in 4 positions: anterior, lateral X 2 and posterior Factors affecting posture:  Structural  Structural – anatomical variations  Leg length discrepancy  Scoliosis  Age  Respiratory conditions  Orthotics/prosthetics  Orthopedic Assessments – pg. 40 Postural Assessment  Factors affecting posture:  Functional:  Pain  Mm spasm/imbalance  Adhesions & scar tissue  Joint dysfunction (subluxation)  Work  Poor habits  Excess weight  Footwear  Fatigue/depression  Orthopedic Assessments – pg. 40 Postural Assessment Normal Posture Maladaptive Posture Assessment Seated posture Upper & Lower Cross Syndromes  Upper back rounded forward, shoulders shrugged  Head forward & chin pokes (ext of c/s)  Chest breathing over belly breathing  Postural fault = mm patterns of tightness & weakness Plumb line assessment notes Lateral postural assessments should be performed from both sides to detect any rotational abnormalities that might go undetected if observed from only one lateral perspective. Anterior to lateral malleolus, fibular head, greater trochanter, acromion, bodies of cervical vertebrae, and auditory canal. 1.Head and neck: Plumbline: the line falls through the ear lobe to the acromion process. (common faults include *forward head: the head lies anterior to the plumb line. It may be due to -excess Gait Analysis  Why it’s so important  When a person’s gait is abnormal  Different ways people walk and how it affects the rest of their body  Shoe patterns  It simply means the observation of moving posture Gait Cycle  Stance Phase  Swing Phase  Orthopedic Assessments – pg. 46 & 47 Running Gait  Stance Phase  Swing Phase Heel Strike – Shoe vs bare foot Gait Cycle Video  https://www.youtube.com/watch?v=1u6d1CX7o9c Abnormal Gaits Antalgic Limp Ataxic – abnormal, uncoordinated movements/drunk Hemiplegic/Hemiparetic - impaired natural swing at the hip and knee with leg circumduction – leg swing Propulsive – head & neck falling forward, steps are short & shuffling Spastic – dragging of the feet Scissor - primarily associated with spastic cerebral palsy. Spastic bilateral adductors of hips Steppage/Drop foot – characterized by lifting the thigh up high & the foot slaps the ground Waddling – side to side Orthopedic Assessment – pg. 45 Abnormal Gaits  Gluteus Medius (Trendelenburg) gait – Weak glut med mm.  Gluteus Maximus gait - posterior leaning of the trunk at heel strike in order to keep the hip extended during the stance phase. It is caused by weakness of the gluteus maximus. Lurching gait  Back Knee Gait – knee locked hyperextension during stance phase, difficulty with stairs  Psoatic limp - The affected leg moves in external rotation, flexion and adduction. The limp may be accompanied by exaggerated trunk and pelvic movement.  Quadriceps avoidance – limited ROM, pain, swelling, crepitus  Short leg - leg length discrepancy Abnormal Gaits  Spastic Diplegia     Cerebral palsy  Chronic neuromuscular condition  Increased spasticity  Manifested in constant tightness & or stiffness of the legs, hips & pelvis Neuropathic (sensory)  Steppage - foot drop due to loss of dorsiflexion  Stomping/stamping Myopathic  Parkinsonism   Muscle disease tremor, bradykinesia, rigidity, and postural instability. It is found in Parkinson's disease (PD), after which it is named Choreiform  repetitive and rapid, jerky, involuntary movement that appears to be well-coordinated; often seen in Huntington's disease  Hyperkinetic – muscle spasm Abnormal Gait Video  https://www.youtube.com/watch?v=Q98WKpwIpkE  6 common abnormal gaits Palpation Application of manual pressure to determine abnormalities  Pulsations  Tenderness  Masses  Tone  Position  Texture  Tissue mobility  Temperature  Shape  Pain 4 T’s of Palpation Temperature  Hot = inflammation  Cool = ischemia Texture    Swelling or edema Boggy, congested edema Healthy tissue has an even texture throughout  Trophic = mm wasting, feeling soft w/ little resilience in the tissue  Adhesions = feels like tissue stuck together, less mobile  Crepitus = palpable roughness in Jt or Tenderness  Pain can indicate if Pt winces or pulls away with tissue compression  Some structures may be to painful to palpate  Chart findings Tone  Hypertonic = tight ( tone)  Hypotonic = flaccid ( tone)  Tone and Strength do no correlate  If a mm is tight, does not mean it is strong Palpation  Use the least amount of pressure possible  Use broad or flat contact  Closing eyes may increase palpatory sense  Compare results bilaterally Palpation  Palpation is the placement of the therapist’s hands on the patient tissue to assess their condition  Primary tool for massage therapists  As a student your skills will refine with experience and time  The more people you work on the greater variation of tissue your exposed too  Need to practice with conscious awareness Palpation 3 most common palpation errors 1. Lack of concentration 2. Too much movement of MT fingers 3. Excessive pressure  Obtain consent  Palpate bilaterally to compare and contrast  Note reaction to palpation Feel differences in mm/skin  Temperature  Tone  Texture  Wincing  Increase respiration  Palpate systematically  Use broad palmer surface and get specific where necessary Soft Tissue Palpation 1. Dermal layer  2. Palpation & assessment of temperature, texture, sensitivity Subcutaneous & deeper layers  Fascia and muscle  Palpation & assessment of texture, sensitivity, tenderness, tone, edema, spasm, guarding  Orthopedic Assessments – pg. 56 Bony Palpation  Location of landmarks  Assess contours for tenderness or anomalies  Bony tenderness may result from joint dysfunction, direct trauma, fractures, osteoporosis etc  Orthopedic Assessments – pg. 56 Motion Palpation  Definition: Use of hands to assess & treat joint motion (active or passive) and joint play  Purpose: assessment of motion quality, end feel, joint play and symptoms that may occur  Requires understanding of functional anatomy, biomechanics and patho-mechanics  Each joint has unique patterns and ROM  Needs to be performed slow and smoothly  Compare bilaterally  Orthopedic Assessments – pg. 56 Pain Scale Assessing Pain  Subjective (unique to each person and their perception, experiences, etc)  Ask Pts about pain and mark it on scale  Watch Patients:  Body language  Facial expressions  Apprehensive  Muscle guarding  Flinching  Drawing body back/away Consent to Assess  Intent: ROM Orthopedic Testing  Risks: The purpose of this assessment is not to hurt you; however during ROM & testing we may recreate some of the symptoms you are feeling . Let me know what you are feeling.  Benefits: I’m doing this to get a better understanding of your condition and what’s going on so I can treat you accordingly.  Empowerment:  Questions:  Consent: Right of refusal/to stop. Do you have any questions? Are you comfortable with this assessment? May I proceed? ROM – Range of Motion Range of Motion – the motion allowed by the shape of the joint and the soft tissue surrounding it. ROM occurs in planes of flexion, extension, abduction, adduction, and internal & external rotation and lateral flexion. ROM assessment is to establish a patient baseline of ability (outcome marker), locate dysfunction Dysfunction  Muscle activated  Tissue stretch  Motion restrictions ROM – Range of Motion 1. Active ROM (AROM) 2. Passive ROM (PROM) 3. Resisted ROM (RROM) 4. Active Assisted (AAROM) How to Organize Testing  It is overwhelming, give it time – you will learn it with practice  Experienced MT have years of experience to decide what order to perform tests and often develop protocols General  Sometimes Pts symptoms will dictate order of testing  Sometimes after observation and palpation Rule-out Testing 1. Gross observation  Pain in arm 2. AF ROM – pain free  3. Palpation Testing from neck to fingers and rule-out conditions or causes of symptoms 4. PR ROM – info about joints 5. Mm strength and length 6. Orthopedic (special) testing How to Organize Testing  In some cases  Vascular or neurological test need to be preformed after AF ROM   Sometimes position of Pt will dictate order of tests  Screen vascular or neurological pathologies Differentiating Sources of Pain   Test between conditions that have similar symptoms  Do all the necessary test while Pt is in one potions before you move them to another position Test should be preformed bilaterally  1st on unaffected side to have a reference point  Then affected side Assessment  Assessment is in the scope of practice of massage therapists in Canada  Is a component of post-graduate courses (Continuing education)  Assessments is in the orthopedic assessment texts written by Dr geared towards practitioners of manual medicine, which clearly shows how to perform and interpret the tests   Manual medicine: physiotherapy, massage therapy, chiropractic etc MT use assessment when evaluating the nature of a condition Assessment vs Diagnosis  Massage Therapists do NOT diagnose or provide diagnosis  Assessment: Difference b/t investigating the nature of a condition  Diagnosis: Naming a specific condition that is in fact present  Physicians  X-rays, uses assessment and interpretation of MRI and other medical imaging  Laboratory  tests MT are not specifically trained to perform, order or interpret results from diagnostic tools Why Do an Assessment? Assessment allow MTs to not just “treat the pain”  Is an essential tool for massage therapist   Is about gathering info from Pt Health history questions  Observation  Palpating tissue  ROM  Orthopedic testing (special testing)  Read Pg 108 – Why do Assessment, paragraph 3-5 MTs identifies the source/cause of said pain  Identify compensating structure  This allows MT to target and treat structures that can be vital in restoring health and function for a Pt  Assessment provides foundation for designing and performing a safe, knowledgeable and effective treatment Kind of like detective work   What if the Pt has been Previously Diagnosed?  MT should always prefer an assessment    Examples  Even if previously diagnosed by and MD, physio, chiro or other MT It is important for you as a MT to achieve your own understanding of the Pts condition to provide a safe, effective treatment It is possible that diagnosis could be incomplete or inaccurate One clinician could diagnosis or Rx treatment to a hamstring   When after assessment you discover their quad is the root problem Pt diagnosis with common flexor tendinitis and recommend frictions to the tendon  Assessment discovered it was an extensor mm strain and tx of mm belly will have more benefit Assessment Results Assessment results give the following information  The history of the Pts health  Pts present symptoms and chief complaint  Overall tissue health  Functional ability such as walking or sitting and ability to move joints freely and comfortably  Contraindications: these could be absolute or require treatment modifications  Determine if the condition is out of the scope of practice for massage therapy  Determine if they need a referral or complimentary therapy   Specific structures involved such as mm, tendons, or joints  An educated idea of the suspected condition b/c the Pt needs more than massage – example, chiropractic adjustments in conjunction with massage Interpreting the Assessment    Takes practice and clinical experience Utilizes critical thinking and problem-solving skills Assessment won’t always paint a clear pictures    What to do if you do not have definitive answers?  Do not lie and try to “wing it”  Review the individual data and confirm what the condition is not  Sometimes reassessment during and after treatments will help  Educate yourself between treatments  Slowly build a clearer picture of the problem with each successive tx May not have the answers Answers may not be in black and white Interpreting the Assessment  Keep an open mind  Avoid drawing conclusions until the entire assessment is completed   Preconceptions of structures affected, or a specific condition can lead to missed information or misinterpreted data  Can result in an unsafe or ineffective treatment  Be PATIENT with yourself and learning the process of assessment  Practice feeling comfortable asking questions in an organized manner  Observe a Pts posture, movement  Familiarize what tests to conduct and the order to conduct them in  Record information so it is no forgotten School helps you build a road map, so you have a clear sense of how to proceed with treatment Reassessment Reassessment should be done    after each treatment  Just the testing that is pertinent to that tx Beginning of the next one this information in your SOAP notes, ongoing tx notes End of tx reassessment doesn’t have to include all testing initially performed +  Record  test reassessment A thorough reassessment can be preformed in 4-6 weeks  Or after 3-5 treatments Treatment Plan Decisions As a result of assessment, decision are made about the following for a treatment plan  Duration of treatment  Positioning the Pt  Treatment of symptoms and structures to be addressed  Specific techniques, both Swedish and nonSwedish  Hydrotherapy and remedial exercise to be used during or after the massage AROM - Active Range of Motion   Patient moves body part themselves (voluntary joint movement) Assess  *Important to get a baseline of function and for reassessment (tracking progress)  Provides info about :  Pts ability to move  Coordination  Muscle strength  Overall ROM Muscles & tendons (contractile tissue)  Can be limited d/t contracture  Can be stretched (to ↑flexibility) Ligaments, bursa, joint capsules   Stretching or compression If AROM is limited, painful or awkward then additional testing is needed to clarify the problem PROM - Passive Range of Motion Movement done by examiner without pt assistance – involuntary joint mov’t   Normally ROM is greater than active End feel or passive over pressure   This is where we apply overpressure to determine the endfeel Always stabilize opposite side Assess  Articular surfaces (joint surfaces)  Joint capsules  Ligaments  Fascia  Nerve tension  Muscles  tendons RROM - Resisted Range of Motion  Pt performs active ROM against examiners resistance  Strength/weakness testing  Helps determine strength of muscle contraction through full ROM  Ask pt to use 50% of their strength first AAROM – Active Assisted Range of Motion  AAROM is AROM performed when assistance is required by the client to complete the active motion. It’s used with ↓ mm strength. The therapist can provide the assistance in completing the motion.  Effects are generally the same as AROM ROM  Physiological barrier     Muscle shortening through ranges of motion.  Fascia shortening Elastic limit Anatomical limit  ex: bulky muscle The motions of sliding, rolling, spinning, or compressing that occur between bony surfaces within a joint when the bones move   Joint play End feel/ End play   Passive over pressure Paraphysiological space  the distance a joint can be moved beyond the passive end range (elastic barrier) without causing the tissue to rupture.  Adjusment Factors Affecting ROM   Age  Infants/toddlers  Older Adults Gender  Depends on the person  Pregnant women have ↑ ROM and can last up to 6 months post partum  Injury  Anatomical variation – Genetic disorders  Life style – active/sedentary  Orthopedic Assessment – pg. 59 Basic Rom Findings Overpressure and End Feel Overpressure  Term when MT gradually applies more pressure when the end of the available passive ROM is reached End Feel   Sensation transmitted to MT hands by tissue resistance at the end of the available range Soft tissue and joint surfaces determine ROM and normal end feel  May be normal or abnormal Normal EF  Exists when jt has full ROM and ROM is stopped by anatomy of jt Effects  Assess the specific structures that is limiting ROM or is injured  Mm length is also assessed at the end of the range End Feels Normal      Soft tissue approximation Muscular or Tissue Stretch Abnormal  Empty  Muscle Spasm  Boggy or Soft  Spongy Block or Internal Capsular Stretch or Leathery Bony Read Pg 125-126 Types of end feels Derangement  Ccapsular Stretch or Leathery  Bony Capsular Pattern CAPSULAR PATTERN NON-CAPSULAR PATTERN Pattern of limitation of movement at an injured or affected join  Limitation of movement of a jt but not in a capsular pattern  Restriction may be d/t an intraarticular mechanical blockage from  Injury to joint capsule or synovial lining  Limited in AF and PR ROM Cause  Fibrosing (thickening) of Jt capsule  Inflammation or jt effusion (oozing)  Swelling Only joints controlled by mm mov/t have capsular patterns  GHJt, Knee Torn pieces of cartilage  Menisci or intra-articular adhesions Cause    Extra-capsular lesions  Mm contractures  Myositis ossifications  Acute bursitis Normal End Feels Abnormal End Feels   Pathologic End feels Occur  Either at a different place in the ROM than expected – OR  Have an end feel that is not characteristic of the joint Limiting factors of end feel include:  Capsule  Ligaments  Passive mm tension  Neurological overlay (pain)  Contact of bony surfaces Common Types of Pain  Radicular Pain    Associated w/ nerve root compression Sharp, shooting, neurological signs like paresthesia corresponding to a dermatome or mm weakness Cutaneous Pain  Superficial tissue damage  Sharp, bright, burning and well localized   Deep somatic pain  from mm, tendons, jts and periosteum  More diffuse and can refer Visceral pain  Arises from visceral distention, ischemia, strong abnormal gastrointestinal contractions  Visceral pain is often diffuse Common Types of Pain  Referred pain   Emotional state  Culture  Past experiences  Learned behaviors Referred pain is well localized  Motivations Functional or psychogenic pain  Chronic pain can be accompanied by depression and anxiety  Do not let your own pain beliefs dictate, discredit or belittle the Pts pain perception    May come from cutaneous, deeper somatic and visceral tissue Pain experience can be influenced by   Can occur in tissue that has lesions or injury Believed to arise from emotions or psyche Experienced as though it originates from an organic disorder Tension vs. Length  Mm have maximum strength in the midrange of their AROM  Tension increase w/ passive lengthening (mm stretch)  Mov’t beyond anatomical limits = fiber tears at weakest point (strain, sprain or fracture)  Mm are ACTIVE stabilizers and ligaments are PASSIVE stabilizers  When mms fatigue we rely on ligaments for stability Joints of the body  Spine  Cervical  Thoracic  Lumbar  Sacrum  Pelvis & Coccyx  Sternum  Upper Limb  Lower Limb  Hand & Wrist  Foot & Ankle  Skull Common Joint Dysfunctions  Audible Click – body corrects by itself (ADL, yoga, stretch, ROM)  Intentional Self Correction – person self corrects (non specific twist of spine, or non specific movement through joints – these non specific corrections can cause hypermobility)  Superficial Subluxation – joint easily corrects, usually a hypermobile joint  Mild Subluxation – easily corrects with minimal manipulation  Moderate Subluxation – Requires moderate skill & experience – usually requires some soft tissue pre & post treatment – 1 week follow up  Severe Subluxation – Requires significant pre & post soft tissue treatment & skilled clinician– 1-2 days follow up is best  Mild Dislocation – Fracture must be ruled out – can be reduced with osseous manipulation – closed reduction (setting the bone without breaking the skin)  Severe Dislocation – Requires surgical intervention – refer to Dr. or ER Cervical ROM  Flexion – 80-90° - firm tissue stretch  Extension – 60-70° - hard (occiput on spinous process)  Lateral Flexion – 20-45° - firm tissue stretch  Rotation – 70-90° - firm tissue stretch   Orthopedic Assessments – pg. 63 Orthopedic Assessments – pg. 140 Shoulder ROM  Flexion – 160-180° - firm tissue stretch  Extension – 50-60° - firm tissue stretch  Abduction - 180° - firm tissue stretch  Adduction - 35° - soft tissue approximation  Medial (Internal) Rotation - 90° - soft tissue approximation  Lateral (external) Rotation - 80° - firm tissue stretch  Horizontal Abduction - 45° - firm tissue stretch  Horizontal Adduction - 130° - soft tissue approximation  Orthopedic Assessments – pg. 250 Elbow ROM  Flexion - ~150° - soft tissue approximation  Extension – 0-5° - bone to bone  Supination - ~90° - from thumbs up position – tissue stretch  Pronation - ~90° - from thumbs up position – tissue stretch  Orthopedic Assessments – pg. 290 Wrist ROM  Flexion (palmer) – 80-90° - tissue stretch  Extension (dorsi) – 70-90° - hard tissue stretch  Ulnar Flexion (adduction)– 30-45° - bone to bone  Radial Flexion (abduction) - ~15° - bone to bone  Supination – last 15° at wrist – tissue stretch  Pronation – last 15° at wrist - tissue stretch  Orthopedic Assessments – pg. 308 Metacarpal ROM  Finger Flexion  Finger extension  Thumb adduction  Thumb abduction  Fingertips to thumb  Make a fist  Finger abduction  Not a priority for ° with fingers. Thoracic ROM (trunk)  Flexion – 20-45° - tissue stretch – not a lot of need to apply overpressure  Extension – 25-45° - hard tissue stretch  Lateral Flexion – 20-40° - tissue stretch  Rotation – 35-50° - tissue stretch  Orthopedic Assessments – pg. 168 Lumbar ROM  Flexion – 40-60° - tissue stretch  Extension – 20-35° - hard tissue stretch  Lateral Flexion – 15-20° - tissue stretch  Rotation – 3-18° - tissue stretch  Assess Thoracic and Lumbar simultaneously Orthopedic Assessments – pg. 190 Hip ROM  Flexion (SLR) - 90° - tissue stretch  Flexion (knee bent) - ~120° - soft tissue approximation  Extension – 10-15° - hard tissue stretch  Abduction - 40° - hard tissue stretch  Adduction - 30° - soft tissue approx.  Medial rotation - 40° - tissue stretch  Lateral rotation - 50° - tissue stretch  Orthopedic Assessments – pg. 328 Knee ROM  Flexion – 130-150° - soft tissue approx.  Extension – 0-15° - ligamentous or bone to bone  Knee must be bent to 90°  Medial rotation – 20-30° - ligamentous  Lateral rotation – 30-40° - ligamentous  Orthopedic Assessments – pg. 354 Ankle ROM  Dorsiflexion - 20° - ligamentous/stretch  Plantarflexion - 50° - ligamentous/stretch  Supination/Inversion– 45-60° - ligamentous/stretch  Pronation /Eversion– 15-30° - ligamentous/stretch  Orthopedic Assessments – pg. 388 Big Toe ROM  Flexion of MTP (metatarsalphalangeal joint – proximal) - 45° ligamentous/stretch  Flexion of IP (interphalangeal joint – distal) - 90° ligamentous/stretch  Extension of MTP - 70° - hard/stretch  Extension of IP - 0° - bone to bone/stretch Goniometry  Is the measurement of angles at joints by the bones of the body through ROM  Key concepts  Pts position  Pts stabilization  Goniometer positioning  Recording Data  Write down which joint you measured, what type of movement was done and the ROM in degrees. Ex: R elbow flexion, 150° Manual Testing ABCs of Manual testing  Active ROM  Break test  Concentric contraction  Stretch  Orthopedic Assessments – pg. 66 Rules of Muscle Testing  Pt in optimum posture  Examiner states “Don’t let me move you” or “resist my force”  State when how long Pt should hold and then they should relax  Hold position for 5 seconds and may repeat 3x  Little or no motion is better while testing  Examiner needs to have good ergonomics & biomechanics  Modify for mm that are stronger than examiner  Compare bilaterally  Orthopedic Assessments – pg. 66 Muscle Length Testing (Stretch)  Preformed to determine if any range of a muscle length is normal, limited or excessive  Increases the distance between origin and insertion  Passive or active-assisted movements to determine mm flexibility  Excessive length: usually indicates weak and allow adaptive shortening of opposing muscles and/or ligament laxity at the joint  Short Length: usually indicates strong and maintain opposing muscles in a lengthened position  Orthopedic Assessments – pg. 66 Muscle Strength Accurate & objective measurement of mm strength is useful for:  Neurological screen  Diagnostic aid  Therapeutic aid Common Findings  Strong painless resistance indicates normal tissue integrity  Weak & painless resistance indicates a loss of motor nerve supply or complete rupture of musculotendinous structure  Painful resistance indicates partial tear or rupture of musculoskeletal structure Grading Muscle Strength Grades of Mobilization Indications for Mobilization 1. Pain reduction & prevention 2. Faster healing time & prevention of chronic conditions 3. 4. 5. 6. Restore myofascial/joint optimal position  biomechanical function to prevent future injury  Promote optimal performance Stretches contracted (hypertonic) muscles to induce relaxation (decrease mm spasm) 7. Reduce soft tissue adhesions (scar tissue) Increase local blood flow to promote healing 8. Relieve nerve compression Increase passive ROM 9. Stress reduction 10. Placebo effect – pt’s belief in treatment Local soreness or mild bruising Mild strain/sprain of local tissue, hypermobility of ligaments (instability) Potential Negative Side Effects Headache, tiredness, lowered blood pressure (fainting) Vertebral & rib fractures (osteoporotic patients) Stroke – extremely low risk, estimated 1 out of 100 million manipulations have serious side effects Contraindications  When certain techniques are NOT indicated for given condition or situation  Clinician must modify or omit the treatment given  Value of the treatment must be considered with respect to the risk of the patient & clinician  Guidelines exists to protect the patient from further exacerbation of a condition and to help avoid legal action being taken against the clinician If in doubt…  It is best to omit the involved area or treatment altogether until you are sure you can safely treat the patient  Some of the absolute CI’s may become relative CI’s as experience and knowledge in clinical sciences and pathologies develops. Contraindications Systemic (general) conditions Local CI’s Types of Contraindication s Absolute CI’s Can be local or systemic Relative CI’s Can be local or systemic Contraindications to Mobilizations Contraindications for Cervical Spine 5D’s And 3N’s 1. Dizziness  2. Vertigo, giddiness Loss of consciousness Diplopia 1. Or other visual disturbances 4. Dysarthria - speech 5. Dysphagia - swallowing Ataxia  Drop attacks  3.  neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements. 1. Nausea & Vomiting 2. Numbness (unilateral) 3. Nystagmus A condition of involuntary (or voluntary, in some cases) eye movement, acquired in infancy or later in life, that may result in reduced or limited vision. Due to the involuntary movement of the eye, it has been called "dancing eyes". End of Unit 2