Cerebellar Examination

The cerebellar examination is performed in patients with neurological signs or symptoms of cerebellar pathology e.g dizziness, loss of balance or poor co-ordination. There are many causes of cerebellar dysfunction and include vascular e.g. stroke, space-occupying lesions, multiple sclerosis and genetic conditions such as Friedreichs Ataxia, to name a few. The cerebellar examination needs to reflect these symptoms and as such involves examining the gait, balance and co-ordination.

Subject steps
1. Wash your hands, introduce yourself to the patient and clarify their identity. Explain what you would like to do and obtain consent 2.

Gait:

Ask the patient to stand up. Observe the patients 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.

Ask the patient to walk

3. 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.

Heel-to-toe test

4. Perform Rombergs test by asking the patient to stand unaided with their eyes closed. If the patient sways or loses balance then this test is positive. Stand near the patient in case they fall.

Romberg's test

5. Check for a resting tremor in the hands by placing a piece of paper on the patients outstretched hands.

Look for a resting tremor in the hands

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

Test tone in the shoulder

Test tone in the elbow

Test tone in the wrist

7.

Co-ordination:

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

Palm up

Palm down

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

Finger-to-nose test

9. Perform the heel-to-shin test. Have the patient lying down for this and get them 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.

Heel-to-shin test

10. Finish by washing your hands and thanking the patient. Summarise your findings to the examiner and offer a differential diagnosis. Common conditions include Parkinson - See more at: http://www.osceskills.com/e-learning/subjects/cerebellarexamination/#sthash.McfXmV0p.dpuf