sensory and cerebellum

light touch dermatome

cotton swab

test cotton swab on sternum

test bilaterally on random dermatomes on upper and lower extremity

pain and temperature

paper clip

test sharp and dull on sternum

patient close eyes and STATE whether sensation is sharp or dull on upper and lower extremity

vibration

128 tuning fork

test tuning fork on patients sternum

patient close eyes and report when sensation starts and stops on most DISTAL joint on hand and foot

* if vibration is impaired move to proximal joint

test on 2 digits per side

graphesthesia

draw a number or letter on patient palm and dorsal of foot

statognosis

joint position with patient eyes closed

move digits up or down and have them report to you what it is

sterognosis

instruct patient to close their eyes and place an identifiable object in patient palm and ask to identify

two point discrimination

using the end of an open paperclip demonstrate one vs two points on patient sternum

on palms and foot ask patient to identify one vs two points

romberg test

stand close to patient with them having feet next to each other with eyes open for 30 seconds

repeat with eyes closed and test for lesion of posterior column

dysdiadokokinesia

upper extremity:

seated patient to simultaneously tap hands on thighs while alternating pronation and supination

lower extremity:

instruct seated patient to rapidly tap balls of feet on ground

- SPEED

- RHYTHM

- SMOOTHNESS

point to point movement

upper extremity: finger to nose

instruct patient to touch nose to my finger back and forth while moving side to side

lower extremtiy:

instruct patient to lie supine and place heel on opposite ankle and move proximal to shin

testine cerebellum

gait

cerebellum and l4/5 and s1

TANDEM GAIT:

instruct patient to walk heel toe for a few steps

HEEL WALK/TOE WALK

instruct patient to walk on heel for a few steps and return to toes for a few steps

- balance: cerebellum

- inability to heel walk: l4/5 toe walk: s1

babinski test

semi sharp object on lateral aspect of sole from heel to the ball of foot

abnormal: extension and abduction of toes