CEREBELLAR FUNCTION TESTS

EXPERIMENT 29: MD-1C GROUP 5

 INTRODUCTION

The cerebellum
located at the posterior cranial
fossa
posterior to the fourth ventricle,
pons and medulla
It is connected to the posterior
brainstem by the three cerebellar
peduncles
superior cerebellar peduncle
connects it to the midbrain
middle cerebellar peduncle to the
pons
inferior cerebellar peduncle to the
medulla
INTRODUCTION
has two cerebellar
hemispheres which
are joined by the
vermis
divided into three
main lobes, the
anterior, middle and
the flocculonodular
lobes which are
separated from
each other by three
fissures.
 INTRODUCTION
The cerebellar cortex, the
outer layer of the
cerebellum, is made up of
grey matter.
It has three layers:
the molecular cell layer
(external layer and is
composed mainly of stellate
and basket cells)
the middle purkinje cell layer
the internal granular layer.
 INTRODUCTION

The inner layer is composed of white matter where

the cerebellar nuclei are found.
There are four masses of grey matter on each side
of the midline: (from lateral to medial)
dentate nucleus
emboliform nucleus

globose nucleus

fastigial nucleus
INTRODUCTION
FUNCTIONS OF CEREBELLUM:
control of posture and voluntary movement
has an unconscious influence on the coordination of the
actions and the smooth contraction of the skeletal
muscles
Receives information regarding balance from the
vestibular nerve.
INTRODUCTION
A lesion in one cerebellar hemisphere manifests its
signs and symptoms on the same side of the body
since the pathways by which is it connected are also
on the ipsilateral side.
In instances where cerebellar dysfunction is present,
the movements become uncoordinated and are
often much chaotic than the normal movement.
This overshoot of movement is called DYSMETRIA
and it often leads to ATAXIA.
INTRODUCTION
A number of tests for ataxia, dysmetria and
coordination may be done by a physician. These
tests include past pointing, finger-nose test, finger-
finger-nose test, counting, dysdiadochokinesia, the
knee-heel test, draw a circle test, performing of
everyday tasks such as dressing or undressing and
walking on a straight line.
PROCEDURE
Finger-nose test.
The subject is asked to extend his arm to the side and
then touch the tip of his nose with the tip of his index
finger, first with the eyes open followed by the eyes
closed. The opposite limb is tested similarly. A normal
subject is should be able to perform these actions
accurately, both slowly and rapidly.
PROCEDURE
Dysdiadochokinesia
The subject is asked to make fists, and then flex
theforearm to right angles, tuck the elbows into his
sides, and then alternately pronate and supinate
his forearms as rapidly as possible.
PROCEDURE
Heel-knee test.
The subject is asked to lie on his back, and then to
lift one foot high in the air, place its heel on the
opposite knee, and then to slide the heel down the
leg towards the ankle. The test is done first with the
eyes open and then with eyes closed, and it is
repeated on the other side.
PROCEDURE
Tandem Walking
The subject is asked to walk along a straight line and
then is observed by the examiner carefully as the
subject walks back to where he or she came from. The
subject may also be asked to walk along a line, placing
the heel of one footimmediately adjacent to the toes of
the foot behind. If incoordination is present, the subject
soon deviates to one or the other side and takes a
zigzag course like that of a drunk.
RESULTS AND DISCUSSION
To be able to identify or confirm the presence of
cerebellar lesions and diseases, it is necessary to
perform various tests for the motor functions.

measures of muscle tone

coordination of muscular activity

gait
RESULTS AND DISCUSSION

MUSCLE TONE
continuously maintained state of slight tension or
tautness in the healthy muscles even when they appear
to be at rest
HYPERTONIA - An increase in tone is
known which occurs in lesions of upper
motor neurons and extrapyramidal
systems
HYPOTONIA - a decrease in tone which
is commonly seen in lower motor neuron
disease and cerebellar lesions
A spinal-reflex mechanism, although the
anterior cerebellum has a facilitatory
effect on it via the subcortical
structures.
RESULTS AND DISCUSSION

COORDINATION OF MUSCULAR
ACTIVITY OR MOVEMENTS
refersto the smooth interaction and cooperation of
groups of muscles to be able to perform motor tasks
evaluated by testing the patient's ability to perform
rapidly alternating and point-to-point movements
correctly (tests which involve the upper and lower limbs)
RESULTS AND DISCUSSION

GAIT
refersto the manner, style, or pattern of walking
dependent on the same vestibular, proprioceptive, and
integrative systems as stance and balance. However, it
requires direction from the central gait mechanism in
the frontal lobes, basal ganglia, brain stem, and
descending motor systems.
RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Spastic (hemiplegic) Gait
Knee cannot be flexed and
foot is not properly lifted off
the ground as patient is
instructed to walk on a narrow
base. As a result, patient
drags his/her foot on the
ground and tends to describe
a semicircle with the affected
leg.
RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:

Stamping Gait
- Patient raises each foot
suddenly and brings it
down on the ground
with a thump
-Seen in sensory ataxia
 RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Drunken or reeling gait
Also an ataxic gait
Seen in cerebellar lesions
Characterized by a clumsy, and
zigzagging-like gait of a drunkard as
the patient is instructed to walk on a
broad base with his/her feet apart
Ataxia is equally severe whether
the eyes are closed or open
 RESULTS AND DISCUSSION
four common forms of abnormal gait seen in
neurological conditions:
Festinant Gait
Seen in Parkinsons disease
Characterized by slow-paced
walking and short shuffling
steps, and uncontrolled
acceleration while walking
Inability to stop when patient
is pushed forward or pushed
back
 RESULTS AND DISCUSSION
TESTS FOR UPPER RESULTS NORMAL ABNORMAL FINDINGS
LIMB FINDINGS
Slight tautness in the Hypertonia increased tone; patients
TONE NORMAL muscle. Resistance offered muscles resist the passive movements
to passive movements Hypotonia decreased tone; movements are
done by the examiner is free and the joints can be hyperextended
normal. *impaired check and rebound

Able to perform the acts Finger tends to overshoot the target;

FINGER-NOSE TEST NORMAL accurately, both slowly Kinetic Tremors or
and rapidly intention tremors with irregularities in
control of timing and force of movement

*Tremor is an involuntary, regular rhythmic

and purposeless movement due to alternate
contraction and relaxation of agonists and
antagonists. Fine tremor is seen in anxiety
and hyperthyroidism. Coarse tremor is seen
in Parkinsons disease, cerebellar lesions,
alcoholism, barbiturate and heavy metal
poisoning.
 RESULTS AND DISCUSSION
TEST FOR UPPER LIMB RESULTS NORMAL FINDINGS ABNORMAL
FINDINGS
Accurate movement and Kinetic tremors
FINGER-FINGER-NOSE NORMAL
remains accurate even with
TEST closed eyes

Normal coordination (+) inability to perform rapid

DYSDIADOCHOKINESIA NORMAL
includes ability to arrest one movements
motor impulse and
substitute the opposite; clumsy movements

Absence of hand tremors Cannot properly thread the

THREADING A NEEDLE NORMAL
and ability to easily thread a needle due to hand tremors
needle

Normally the antagonist Patient is unable to stop

REBOUND NORMAL
muscles will contract and movement
PHENOMENON stop their arm from moving promptly; response is
in the desired direction. completely absent causing to
limb to continue moving in
the desired direction
 RESULTS AND DISCUSSION
TEST FOR LOWER RESULTS NORMAL FINDINGS ABNORMAL FINDINGS
LIMB

TONE NORMAL Slight tautness in the Hypertonia increased tone;

muscle. Resistance offered patients muscles resist the passive
to passive movements movements
done by the examiner is Hypotonia decreased tone;
normal. movements are free and the joints
can be hyperextended
*impaired check and rebound

GAIT NORMAL normal posture and Lesion in mid-cerebellum:

coordinated arm movements are in all directions
movements Lesion in lateral cerebellum:
staggering/falling are toward the
side of the lesion
 RESULTS AND DISCUSSION
TEST FOR LOWER RESULTS NORMAL ABNORMAL FINDINGS
LIMB FINDINGS

Patients can walk in a Subject deviates to one or the other

WALK ALONG NORMAL
straight manner without side and takes a zigzag course like that
STRAIGHT LINE deviating from the straight of a drunk
line.
Smooth, continuous rhythm Subject deviates to one or the other
TANDEM WALK NORMAL
side and takes a zigzag course like that
of a drunk

Patients will spread their legs apart to

widen the base of support, may
stagger when they walk (severe cases),
and falls toward one or both sides
while performing heel-toe walk.

Caused by midline lesions of the

cerebellum (vermis)
Normal force and rhythm of Abnormal force and rhythm of
KNEE-HEEL TEST NORMAL
movements movements
RESULTS AND DISCUSSION
TEST FOR LOWER RESULTS NORMAL ABNORMAL FINDINGS
LIMB FINDINGS
KNEE JERK NORMAL Hyperactive reflex Absence or decreased
concomitant hyperactive reflex
adduction of the known as Westphals
ipsilateral thigh sign.
DRAW A CIRCLE NORMAL Patient can properly Patient cannot properly
draw a closed circle draw a circle
ROMBERGS SIGN ABSENT Patient can maintain Loss of balance
balance
ANSWERS TO QUESTIONS
1. Name the organs responsible for
equilibrium.
The vestibular system is found in the ear,
particularly the inner ear, within the vestibule of the
bony labyrinth and has a utricle, saccule and three
semicircular canals.

2. Name the vestibular apparatus.

The vestibular apparatus includes the utricle, saccule
and the semicircular canals. The utricle and the
saccule detect gravity and linear movement.
3. Name the three types of cerebellum
phylogenetically.
Flocculonodular lobe / Archicerebellum
Oldest lobe and receives projections from the vestibular
nuclei
Anterior lobe/ paleocerebellum
Located in the vermal and paravermal portions and is the
second oldest part.
It receives projections from the spinocerebellar and
trigeminocerebellar pathways
Posterior Lobe/ Neocerebellum
Newest and largest part
Involved in planning of movement as well as in evaluation of
sensory information for action
4. Name the nucleus of the cerebellum
The cerebellum has four nuclei, from medial to
lateral:
The fastigial nucleus lies most medially, near the
midline in the vermis
the globose nuclei is composed of rounded cell groups

the emboliform nucleus is ovoid and the dentate is the

most lateral and largest among the cerebellar nuclei, it
has a shape of a crumpled bag.
5. What is dysdiadochokinesia? Examples

Dysdiadochokinesia is the inability to perform

alternating movements rapidly and regularly.
Example: inability to pronate and supinate forearm
alternately as rapidly as possible
6. What are intentional tremor and resting
tremor?
A tremor is involuntary, regular, rhythmic and purposeless
movement resulting from the alternatecontraction and
relaxation of agonists andantagonists.
An intentional tremor is the presence of oscillating
movement when a person with cerebellar dysfunction
performs a voluntary act such as lifting a glass of water.
A resting tremor occurs during periods when a muscle is
relaxed, such as when the hands are resting on the lap. It
is characterized by the shaking ofa persons hands, arms,
or legs even when they are at rest. Often, this only
affects the hand or fingers.
7. What is tetany?
Characterized by intermittent muscular spasms. It
may be due to very low calcium levels
(hypocalcemia) or magnesium or potassium
deficiency.
8. What is Rombergs Sign?
The Rombergs Sign is a test for loss of position
sense in the legs. In this test, a subject is asked to
stand with feet as close to each other as possible
and then is asked to close his or her eyes. Swaying
of the person from side to side as soon as the eyes
close is a confirmation of this sign. The individual is
steadier with the eyes open and more unsteady with
them closed. When the person is unsteady without
vision, there is sensory ataxia, when there is
unsteadiness whether the eyes are close or open,
there is cerebellar ataxia.
9. Name the two ascending spinocerebellar tracts.
a. Dorsal Column-Medial Lemniscal System the
two wholly myelinated tracts the fasciculi gracilis
and cuneatus (tracts of Goll and Burcach) in the
dorsal white columns of the spinal cord.
These tracts ascend to lower medulla where they
synapse on 2nd-order neurons in the nuclei gracilis and
cuneatus. The axons of 2nd-order neurons cross to the
opposite side in the medial lemnisci (sensory
decussation), reach the thalamus, relay in the nucleus
ventralisposterolateralis, from where 3rd-order neurons
project to somatic sensory areas 3,1,2.
9. Name the two ascending spinocerebellar tracts.

b. Anterolateral Spinothalamic System the 1st-order

neurons (of DRG) sysnapse on the cell bodies of 2nd-
order spinothalamic neurons whose cell bodies are
located in the substantiagelatinosa of Rolandi and
nearby areas of dorsal gray columns of the spinal cord.
Most axons of these neurons cross to the opposite side at
succesiively higher levels to form the anterolateral
spinothalamic tract. It continues up to the brainstem as the
spinal lemniscus to join the medial lemniscus in upper pons,
the two lemnisci terminate in the thalamus from where 3rd-
order neurons project to somatic sensory cortex.
10. What is Dysmetria?
Dysmetria is a disturbance of the trajectory or
placement of a body part during active movements.

HYPOMETRIA - limb may fall short of its goal

HYPERMETRIA limb extends beyond its goal
11. What is nystagmus?
Persistent stimulation of hair cells in the ampulla of
semicircular canal cause the eyes to move slowly to
one side until they reach the physical limit and then
jerk quickly to the opposite side. These movements
occur repetitively in rapid succession and produce
tremor-like oscillations of the eyes known as
Nystagmus.
12. What is tinnitus?
Tinnitus is the ringing or roaring in the ear caused
by an injury to the sensory components of the inner
ear or to the fibers of CN VIII.

13. What is the receptor in the

semicircular canals and otolith organs?
Hair cells which respond to angular movements and
non-linear acceleration of the head
14. How is the cerebellum connected to
the brain stem?
The cerebellum is linked to the brain stem and other
parts of the CNS by numerous efferent and afferent
fibers that are grouped together on each side to
three large bundles or peduncles:
superior cerebellar peduncle connect cerebellum to
the midbrain
middle cerebellar peduncle connects cerebellum to
the pons
inferior cerebellar peduncles connects cerebellum to
the medulla oblongata
15. Which nucleus of the cerebellum is concerned with
coordination? Name the tract connecting this to the cortex.

Interposed nuclei (globose + emboliform)

16. Mention some abnormal gaits.
a. Spastic (hemiplegic) Gait. The patient walks on a narrow base. Since the knee cannot
be flexed and the foot properly lifted off the ground, he drags his foot on the ground
and tends to describe a semicircle with the affected leg, the toes scraping the ground.

b. Stamping gait. The patient raises each foot suddenly and brings it down on the
ground with a thump. It is seen in sensory ataxia (e.g. tabesdorsalis). He may be quite
steady as long as he can see the ground and the position of his feet.

c. Drunken or reeling gait. This ataxic gait is seen in cerebellar lesions, the patient walks
on a broad base, with the feet apart. The gait is clumsy and zigzagging like the gait of
a drunkard. The ataxia is equally severe whether the eyea are closed or open.

d. Festinant gait. This is seen in Parkinsons disease. Walking is usually slow and the
patient takes short, shuffling steps. Sometimes there is an uncontrolled acceleration while
walking, a process called festinant gait. When gently pushed forward, the patient may
be unable to stop as he chases his own center of gravity (propulsion). Similarly, when
pushed back, he is unable to stop (retropulsion)
REFERENCES
Ghai, CL. 2013. A textbook of practical physiology.
8th ed. JP Brothers Medical Publishers. New Delhi

Hall, J. E., & Guyton, A. C. (2011). Guyton and Hall

textbook of medical physiology. Philadelphia, PA:
Saunders Elsevier.