Immersion: Cerebellar Exam

The cerebellum integrates sensory input and coordinates movement. Weakness, numbness, or vision problems will interfere with your patient’s ability to perform all of these tests.

• Finger-to-nose test: Holding your hand in front of the patient, ask them to touch their nose then your finger, going back and forth. Observe for smoothness and accuracy, comparing the right and left sides. Unilateral incoordination indicates a problem with the cerebellum on that side
• Heel-to-shin test: Ask the supine patient to place one heel on the opposite shin, and run the heel up and down the shin. Observe for smoothness and accuracy, comparing the right and left sides. Unilateral incoordination again indicates a problem with the cerebellum on that side
• Gait: Ask the patient to walk across the room, turn and walk back. Then ask them to walk heel to toe in a straight line. Gait abnormalities can be caused by weakness, loss of sensation, or cerebellar problems. Healthy people over the age of 60 are often unable to heel-to-toe walk.
• Romberg test assesses the ability to stand upright with the feet together.  This requires intact cerebellar function plus at least two out of three sources of sensory input: vision, vestibular function (CN VIII), and position sense of the joints.  The patient is asked to stand with the eyes open and the feet together, with your hands at either side of them to catch them if they sway or fall. If they are not able to do this with the eyes open, a cerebellar problem is likely. Then ask them to close the eyes, again spotting them.
•  At least two of these sensory inputs plus a functioning cerebellum (which pulls it all together) are required to maintain balance