1. The cardinal signs of cerebellar dysfunction are ataxia, tremor, hypotonia, and asthenia. Tests include finger-nose coordination, rapid alternating hand movements, and gait. 2. Cerebellar lesions can cause dysarthria, scanning speech, nystagmus, and impaired eye movements like dysmetric saccades. 3. Clinical exams test arm and leg coordination through tasks like finger tapping, heel-shin rubbing, and tandem walking. Hypotonia is shown through floppy posture and pendular reflexes. Strength and endurance may also be reduced.

1. Prepared by :
Dr. RZGAR H. ABDWL
Cerebellar examination

2. CLINICAL SIGNS OF CEREBELLAR DYSFUNCTION
*4 cardinal cerebellar signs consist of
1-Ataxia (=dystaxia)
2-Tremor (intention tremor and postural)or static type
of action tremor or end-point, or kinetic tremor
3-hypotonia
4- Asthenia.
*The unsteady oscillations of the head and trunk are also
called titubation, occur a few times per second, and while
it may be seen in cerebellar dysfunction is not
pathognomonic or localizing.
* The uncoordinated, slurred speech is called dysarthria,
like any neurogenic disturbance of voice articulation

3. # The effect of cerebellar lesions on speech
1- Dysarthria (slowness, slurring of words)
2- scanning speech: the Pt’s voice varies from a low
volume to a high volume as if scanning from peak to peak.
Thus accentuating the wrong syllables or words.
# The effects of cerebellar lesions on eye movement
1- Nystagmus(gaze evoked)
2- Dysmetria of saccades: have the Pt look straight ahead
and place your index fingers in the temporal fields. Ask the
Pt to look first at one finger and then the other and then
direct the Pt to look rapidly from one to the other several
times and it will be noted that the eyes over or undershoot
the target.
3- Jerky rather than smooth pursuit
4- Slowness in initiating eye movements
5- Skew deviation

5. # Clinical tests for dystaxia of station (stance) and gait
* Inspect the Pt for swaying when standing, and for ataxia
of gait.
* lateropulsion is the tendency to move from side to side.
* To compensate for unsteadiness of stance and gait, the
cerebellar Pt assumes a broad-based stance and a
broad-based gait, just as a toddler does before gaining
coordination, or an elderly os asks the Pt to stand with the
feet together.
* Ask the Pt to step along a straight line, placing the heel of
one foot directly in front of the toe of the other, the so-called
tandem walking, a sensitive test for gait ataxia.

6. Clinical tests for arm dystaxia
1- Postural tremor and tremor of the arms during the finger-
to-nose test
a. Ask the Pt to extend the arms straight out in front:
- Inspect the arms for wavering indicating incoordination for
frank, rhythmic postural tremor.
- Having the Pt hold the fingers a little apart in front of the nose,
with the arms elevated horizontally, in “the batswing” position,
also demonstrates postural instability of the arms or postural
tremor
b. Do finger nose test: look for intention tremor , dysmetria
And dysenergia.
- A tremor of the outstretched hands is called a postural tremor.
- A tremor that increases as the finger approaches the nose or is
reaching a target is called a (Positional Intention type of kinetic
tremor (called terminal or end-point tremor by
some investigators) tremor.

7. - Dysmetria: undershoots or overshoots the target during
finger nose test.
2- The rapid alternating-movements tests for dystaxia
and dysmetria (dysdiadochokinesia)
* The Pt holds out the hands and pronates and supinates
them as rapidly as possible. Test the hands separately and
together.

8. 3- The thigh-patting test: the Pt by lightly slapping your
own thigh, alternating first by slapping the palm and then
the back of the hand, as rapidly and rhythmically as
possible. Be sure to make an audible sound with each
pat.

9. 4- The finger-tapping test: Listen for dysrhythmia and
slowness

10. Overshooting and checking tests of the arms
1- Rebound sign:
* Pt stand with eyes closed and arms outstretched.
* Tell the Pt, “I am going to tap your arms. Hold them still.
Do not let me budge them.
* The Ex delivers to the back of the Pt’s wrist a quick push,
strong enough to displace the arm.
* The normal subject’s arm returns quickly to its initial
position.
# The cerebellar Pt’s arm oscillates back and forth , It
overshoots several times
2- The arm-pulling test :
* The Ex pulls hard against the Pt’s flexed arm. When the
Ex suddenly releases the Pt’s arm, the cerebellar Pt fails to
check the arm’s flight

12. Clinical tests for leg dystaxia:
1. heel-to-shin test :
* Have the Pt supine (or sitting).
* Instruct the Pt to place one heel precisely on the opposite
knee,Then direct the Pt to run the heel in a straight line
precisely down the shin
* observe for a positional tremor
2. heel-tapping test:
* ask the Pt to place one heel over the other shin and to tap
the shin with the heel as rapidly as possible on one spot.
* The cerebellar Pt misses the spot (dysmetria) and taps
dysrhythmically (dysdiadochokinesia).

13. 3- Gait examination:
a. If the patient is able to walk, a good test of lower limb
coordination consists of asking him to walk along a straight
line.
b. Tandem walk: Ask the patient to walk along straight line on
the floor placing the heel of one foot immediately adjacent to
the toe of the one behind.
4. Combus test:
Ask the patient to walk to a known point and then to return
back to the original place. In patient with cerebellar lesion he
will continuously deviate to the side of the lesion until he
finally makes a combus.

14. Clinical tests for hypotonia
* Muscle tone is defined as the muscular resistance the Ex
feels when moving the Pt’s resting extremity(Passive
movement)
* Hypotonic Pt assumes floppy postures ,rag-doll or
dumped-in-a-heap postures.
* When walking, the hypotonic Pt presents a floppy,
sagging, loose-jointed appearance.
* The arms fail to swing properly, the knees may bend
backward slightly (genu recurvatum), and the head and
trunk bob—a rag-doll gait, as seen in drunkenness.

15. # Pendular or hypotonic muscle stretch reflexes
(MSRs)
* In cerebellar Pts: After the quadriceps MSR is elicited,
the leg normally stops swinging after one or two excursions
but The cerebellar Pt’s leg swings to-and-fro several times,
like a pendulum.
# Effect of cerebellar lesions on strength and
endurance
* The cerebellar Pt may experience mild asthenia, that is,
weakness, fatigability, and a reluctance to move.
* Destruction of the pathway that connects the cerebellar
cortex with the cerebral motor cortex might explain the
asthenia.