Cerebellar Examination

Subject summary

This station involves examining the gait and co-ordination. You may get a different station asking you to examine one or the other so you can use this as a guide.

  1. Start by introducing yourself to the patient. Explain what the examination involves and obtain consent.

  2. Gait:

  3. Ask the patient to stand up. Observe the patient’s posture and whether they are steady on their feet.

    Ask the patient to walk, e.g. to the other side of the room, and back. If the patient normally uses a walking aid, allow them to do so.

    1. Ask the patient to walk
      Ask the patient to walk

  4. Observe the different gait components (heel strike, toe lift off). Is the gait shuffling/waddling/scissoring/ swinging?

    Observe the patients arm swing and take note how the patient turns around as this involves good balance and co-ordination.

    Ask the patient to walk heel-to-toe to assess balance.

    1. Heel-to-toe test
      Heel-to-toe test

  5. Perform Romberg’s test by asking the patient to stand unaided with his eyes closed. If the patient sways or loses balance this test is positive. Stand near the patient in case he falls.

    1. Romberg’s test
      Romberg’s test

  6. Co-ordination:

  7. Look for a resting tremor in the hands.

    1. Look for a resting tremor in the hands
      Look for a resting tremor in the hands

  8. Test tone in the arms (shoulder, elbow, wrist)

    1. Test tone in the shoulder
      Test tone in the shoulder
    2. Test tone in the elbow
      Test tone in the elbow
    3. Test tone in the wrist
      Test tone in the wrist

  9. Test for dysdiadochokinesis by showing the patient to clap by alternating the palmar and dorsal surfaces of the on hand. Ask to do this as fast as possible and repeat the test with the other hand.

    1. Test for dysdiadochokinesis 1
      Test for dysdiadochokinesis 1
    2. Test for dysdiadochokinesis 2
      Test for dysdiadochokinesis 2

  10. Perform the finger-to-nose test by placing your index finger about two feet from the patients face. Ask him to touch the tip of his nose with his index finger then the tip of your finger. Ask him to do this as fast as possible while you slowly move your finger. Repeat the test with the other hand.

    1. Finger-to-nose test
      Finger-to-nose test

  11. Perform the heel-to-shin test. Have the patient lying down for this and get him to run the heel of one foot down the shin of the other leg and then to bring the heel back up to the knee and start again. Repeat the test with the other leg.

    1. Heel-to-shin test
      Heel-to-shin test

  12. Thank the patient and finish by summarising your findings to the examiner and offering a differential diagnosis. Common conditions include Parkinson’s disease and cerebellar ataxia.