- Identify the patient
- Explain the procedure
- Finger-to-Nose Testing: With the patient seated, position the index finger at a point in space in front of the patient. The patient should then trace an imaginary line from your finger to their nose. After each attempt, reposition the finger.
- The patient should be able to do this at a reasonable rate of speed, in a straight path, and hit the end points accurately. If they miss the mark (dysmetria), it may be indicative of disease.
- Rapid Alternating Hand Movements: ask the patient to touch the ventral and dorsal side of one hand repeatedly against their thigh, for both hands.
- Should be done with speed and accuracy. Inability (dysdiadochokinesia) may also be indicative of cerebellar disease.
- Rapid Alternating Finger Movements: ask the patient to touch the tips of each finger to the thumb of the same hand, for both hands.
- The movement should be fluid and accurate. If they are unable to perform this (dysdiadochokinesia) may be indicative of cerebellar disease.
- Heel to Shin testing: direct the patient to trace a straight line along the shin (knee to ankle) with their heel.
- Straight, and at an appropriate rate should be noted. If unable, it may be indicative of cerebellar dysfunction.
- Romberg’s Test: have the patient stand with feet together and arms at the side.
- If a loss of balance is noted, it is interpreted as a positive Romberg sign (vestibular dysfunction).
- Tandem Gait: have the patient walk a straight line heel-to-toe for each step. Other abnormalities may only manifest when the patient is asked to walk on their heels, toes, or the insides or outsides of their feet, to stand or hop on one leg, or to walk up stairs.
- Patients with truncal ataxia caused by damage to the cerebellar vermis or associated pathways will have difficulty with this task (tends to have a wide-based, unsteady gait, and becomes more unsteady with close feet).
- Gait involves multiple sensory and motor systems (vision, proprioception, lower and upper motor neurons, basal ganglia, the cerebellum, and higher-order motor planning)