Speech Rapid Alternating Movements

Having the patient say lah-pah-kah can test rapid alternating movements of the tongue, lips, and palate.


Patient's arms are held outstretched and fingers extended. Watch for postural or essential tremor.


Tap outstretched arms. Patient's arms should recoil to original position.

Check Reflex

Examiner pulls on actively flexed arm then suddenly releases. The patient should be able to check or stop the arm's movement when released.

Hand Rapid Alternating Movements

Finger tapping, wrist rotation and front-to-back hand patting. Watch for the rapidity and rhythmical performance of the movements noting any right-left disparity.


The patient moves her pointer finger from her nose to the examiner's finger as the examiner moves his finger to new positions and tests accuracy at the furtherest outreach of the arm.

Foot Rapid Alternating Movements

Patient taps her foot on the examiner's hand or on the floor.


The patient touches her toe to the examiner's finger repetitively as the examiner moves his finger to new positions.


The patient places her heel on the opposite knee then runs the heel down the shin to the ankle and back to the knee in a smooth coordinated fashion.


Have the patient stand still. Note the position of the feet and how steady the patient is with eyes open. In the demonstrated exam, the patient is asked to hop and pat at the same time. This is a good way to test upper and lower extremity coordination and balance simultaneously.

Natural gait

The patient should be observed walking as she normally would.

Tandem gait

The patient is asked to walk heel-to-toe. Note steadiness. Tandem gait requires the patient to narrow the station and maintain balance over a 4-5 inch width. Patients with midline ataxias have difficulty with tandem gait.

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