Cerebellar Function Tests

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Several tests can be performed to assess cerebellar function. To check the gait, ask the patient to walk a few steps in a straight line, and then turn and walk back. A wide-based, unsteady, and staggering gait is called ataxia and is typical of cerebellar disorder. To further challenge the patient’s gait and balance, assess tandem walking by asking the patient to walk forward while placing the heel of one foot directly in front of the toes of the other.
Perform the Finger to Nose test by asking the patient to extend their arm fully and then touch the tip of their nose and repeat the test several times as fast as possible. Normally the patient should be able to complete the task quickly and accurately. In cerebellar dysfunction, the patient would be unable to precisely place their finger on the tip of their nose and would either undershoot or overshoot. This is called dysmetria. In addition, if you observe a hand tremor that increases as the patient’s hand approaches their nose, this is called an intention tremor, which is also a sign of cerebellar dysfunction.
To further challenge coordination, perform the Finger to Finger test. Hold your index finger out at full reach from the patient and ask them to alternately touch their nose and your finger several times. Now move your finger to different locations and observe the patient’s accuracy and smoothness of movement. Repeat the procedure with the patient’s other hand. To test for rapid alternating movements, ask the patient to place one hand over the other and flip the top hand back and forth as fast as possible. Observe the accuracy, speed and smoothness of their movement. An inability to correctly perform this activity is called dysdiadochokinesia. Repeat the procedure with the patient’s other hand.
To test for the Rebound Phenomenon of Stewart and Holmes, begin by protecting the patient with your arm and pulling their forearm away from them. Ask the patient to resist as you continue to pull. Now, abruptly release the patient’s arm. Normally the antagonistic muscles will stop the arm from moving too far toward the patient's body. In cerebellar disease, arm movement will be excessive.
To perform the Heel to Shin test, support the patient’s leg and ask them to place the heel of the opposite foot on the patella and slide their heel down their shin in a straight line and then back up to the knee. Ask them to repeat this several times. Normally, the patient should be able to perform this action smoothly. If the patient is unable to control the movement accurately, this is called dysmetria and suggests cerebellar dysfunction. Repeat the test with the opposite leg. This concludes our presentation of cerebellar function tests.

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