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Cerebellum Examination

 Introduce self, clarify patient identity


 Wash hands
 Explain procedure, ask for consent
 Inspection
o End of bed – obvious signs of distress, walking aids etc
 Gait
o Watch patient standing up – observe posture and steadiness
o Ask patient to walk to other side of room and back
 Looking for any changes in stance, arm swinging, shuffling, waddling
etc
o Ask patient to walk heel-to-toe – exaggerated unsteadiness in cerebellar
problems
o Romberg’s test – ask patient to stand with feet close together, arms by their
sides and close eyes – keep as still as possible. +ve test indicates
proprioceptive problem
 Stand close to pt in case they fall
 Speech
o Ask patient to repeat “british constitution” and/or “baby hippopotamus”
 Nystagmus
o Do the H pattern – looking for nystagmus at ends of vision
 Arms
o Observe for resting tremor “rest hands on your lap and close your eyes” or
“hold your hands out straight while I rest this piece of paper on them”
o Observe for intention tremor - e.g. remove watch, write sentence
o Examine muscle tone – tell patient to fully relax and put joints through full
ROM – elbow flex/extend, wrist flex/extend/adduct/abduct
o Test for dysdiadochokinesis
o Finger-to-nose test – “can you touch your nose, then my finger, and keep
doing that”
o Fine finger movements – get pt to oppose thumb with each finger in turn as
fast as possible
o Test for reflexes (biceps, triceps, supinator) or state would normally do so
 Legs
o Repeat tone and reflexes if necessary
o Heel-to-shin test
 Thank the patient
 Wash hands

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