Cerebellar Function Tests

Cerebellar dysfunction is an interruption of the integration of afferent sensory feedback and efferent motor output. Loss of joint position sense can produce some uncoordination, which can be substantially worse when the eyes are closed. The following tests attempt to evaluate the patient’s coordination and joint position sense.

If any of the tests are positive, suspect an ipsilateral cerebellar syndrome. This syndrome may be caused by demyelination, vascular disease, trauma, tumor, or abscess. If any of the tests are positive bilaterally, suspect a bilateral cerebellar syndrome. This syndrome may be caused by alcohol consumption, demyelination, or vascular disease.

Upper Extremity

Finger–Nose Test

Procedure

With the patient standing or sitting with eyes closed, ask him or her to touch both index fingers to the nose simultaneously (Fig. 19-1).

Rationale

The patient should be able to perform this procedure smoothly and easily. If the patient cannot perform this procedure, cerebellar function is impaired.

Figure 19-1

Finger–finger Test

Procedure

Ask the patient to place his or her finger on your finger. Repeat this several times with the patient’s eyes open and closed (Figs. 19-2 and 19-3).

Rationale

The patient should be able to perform this procedure smoothly and easily. If the patient cannot perform this procedure, cerebellar function is impaired.

Figure 19-2

Figure 19-3

Pronation–Supination Test

Procedure

Ask the standing patient to extend the arms forward. Next, ask the patient to pronate and supinate the arms rapidly (Figs. 19-4 and 19-5).

Rationale

The patient should be able to perform these movements smoothly and with an even rhythm. If the patient cannot perform the movements or performs them in a spastic or uncoordinated manner, suspect cerebellar dysfunction.