Wash hands Explain procedure, ask for consent Inspection o End of bed – obvious signs of distress, walking aids etc Gait o Watch patient standing up – observe posture and steadiness o Ask patient to walk to other side of room and back Looking for any changes in stance, arm swinging, shuffling, waddling etc o Ask patient to walk heel-to-toe – exaggerated unsteadiness in cerebellar problems o Romberg’s test – ask patient to stand with feet close together, arms by their sides and close eyes – keep as still as possible. +ve test indicates proprioceptive problem Stand close to pt in case they fall Speech o Ask patient to repeat “british constitution” and/or “baby hippopotamus” Nystagmus o Do the H pattern – looking for nystagmus at ends of vision Arms o Observe for resting tremor “rest hands on your lap and close your eyes” or “hold your hands out straight while I rest this piece of paper on them” o Observe for intention tremor - e.g. remove watch, write sentence o Examine muscle tone – tell patient to fully relax and put joints through full ROM – elbow flex/extend, wrist flex/extend/adduct/abduct o Test for dysdiadochokinesis o Finger-to-nose test – “can you touch your nose, then my finger, and keep doing that” o Fine finger movements – get pt to oppose thumb with each finger in turn as fast as possible o Test for reflexes (biceps, triceps, supinator) or state would normally do so Legs o Repeat tone and reflexes if necessary o Heel-to-shin test Thank the patient Wash hands