Albuquerque Public Schools
Modality
Mental
Status
Cranial
Nerves
Table 1
Traditional Neurological Examination
Examiner Items
Possible Pathological Signs
Alertness/responsiveness
Speed and overall appropriateness of
responses to examiners questions
Listlessness, lethargy, confusion, agitation
combativeness
General Knowledge
Familiarity with issues of common knowledge
Confusion, incorrect or absent answers
Mood/Affect
Orientation
General physical appearance; apparent
emotional state
Correct knowledge of date, location and name
Poor hygiene, disheveled, sadness, depression,
euphoria, hostility
Incorrect or absent responses to questions
Motor
Resting muscle tone, strength and mobility
Weakness, paralysis, asymmetrical, facial
musculature, drooping of eyelids, mouth
Extra-occular movements
Strabismus (fixed or intermittent deviation of one or
both eyes), nystagmus (fine darting movements of
eyes during visual pursuit)
Pain (pin prick)
Decreased or absent sensation
Simple touch
Decreased sensation, poor discrimination
Visual and Auditory acuity
Decreased hearing or vision
Pupillary responses
Unequal papillary size; absent, decreased or unequal
papillary constriction to light stimulus
Decreased or absent sensation
Sensory
Smell and taste
Cranial
Nerves
Gross and Fine
Motor
Sensation
Stance &
Gait
Reflexes
Fundoscopic
.
Inspection of optic disc (head of optic
nerve)
Inspection of Retinal and retinal blood vessels
Pallor, edema (swelling)
Resting muscle tone
Palpation of muscles and resistance
to passive movement
Hypotonia (decreased muscle tone)
Hypertonia (increased muscle tone)
Muscle Strength
Ability to flex and extend against resistance
Weakness or paralysis
Pain
Pin prick
Decreased or absent response
Temperature
Hot/cold application
Poor discrimination
Touch
Touch with Q-tip
Poor localization
Proprioception
Position/movement in space
Inability to determine direction of movement
Stereognosis
Discrimination of size/shape
Inability to recognize common objects by size/shape
Two point discrimination
Simultaneous touch in 1 or 2 place
Poor discrimination/localization
'Cerebellar" functions
Normal gait, heel, tip-toe and tandem
(includes assessment of
gait
cerebellum, vestibular system
and basal ganglia)
Coordination/smoothness of
movements
Hemorrhage, narrowed blood vessels
Ataxia (broad based "drunken" gait)
Tremors, irregularity, inconsistent
rhythms
Rhomberg sign
Inability to maintain stance with arms extended, feet
together and eyes open
Deep Tendon Reflexes
Tapping on tendons at knee, heel and
elbow with percussion hammer
Increased, decreased or asymmetrical
reflexes
Babinski Reflex
Light scratching on lateral surface of sole with
sharp object
Upper movement of great toe and fanning of other
toes
* Not comprehensive but examples of possible questionable/abnormal findings
232 * JOSH 0 August 1984, Vol. 54, No. 7
6-95/neuroexm
Section IV: Screening and Assessment
APS Nursing Manual
Page 1 of 3
Albuquerque Public Schools
Table 2
Neurological Soft Signs*
Gross Motor
Fine Motor
Sensory
Test Items
1. Normal walking/running gait
Abnormal Result
Stiff legged; foot slapping quality. Unusual posturing of arms.
2.
3.
4.
5.
6.
7.
Difficulty in remaining on heels (10 ft.)
Difficulty remaining remaining on toes (10 ft.)
Difficulty walking heel to toe. Unusual posturing of arms (10 ft.).
Inability to remain standing on one foot for more than 5 -10 seconds.
Inability to rhythmicalIy hop on ea.ch foot alternatively.
Difficulty in maintaining stance with arms extended in front, feet together and eyes
closed: drifting of arms: mild writhing movements of hands/fingers.
Heel walking
Tip-toe walking
Tandem gait
One foot standing
Hopping in place
Motor-stance persistence
1. Visual tracking
Difficulty in visually following with eyes from side to side without moving head;
nystagmus (fine darting movement of eyes)
2. Rapid opposition of fingers
Difficulty in rapidly opposing thumb to fingers in sequence; overflow to other hand
3. Rapid alternating movements of Irregular speed and rhythm
hands
4. Finger-nose test
Inability to consecutively touch examiner's finger and own nose
1. Right-left discrimination
Inability to identify right and left sides of self or examiner
2. Two point discrimination
3. Graphesthesia
Reflexes
1. Deep tendon reflexes
2. Plantar reflex
Difficulty in localizing/discriminating when touched in one or two
places
Inability to identify geometric shapes drawn with examiner's finger on child's open
palm.
Asymmetric reflex responses
Upward movement of great toe and fanning of other toes on
stimulation of sole (Babinski reflex)
Table 3
Developmental and Neurological Soft Signs
Developmental
1. Synkinesia-inability to suppress mirror movements of hand not
being tested on rapid thumb to finger opposition
2. Diadochomkinesia - uneven irregular movements in rapid
movements in hands
3. Difficulty in hopping, heel-toe walking, poor rhythm foot
dropping
4. Uneven irregular visual tracking
5. Poor right-left discrimination
Neurological
1. Subtle abnormalities of muscle tone (mild flaccidity or rigidity)
2. Asymmetrical deep tendon reflexes
3. Mild choreoathetosis writhing movements of hands/fingers on
testing of motor stance persistence
Table 4
Neurodevelopmental Evaluation*
Behavioral:
1. Selective attention
2. Distractibility
Affective:
1. Anxiety
2. Spontaneity
Fine Motor:
1. Imitative finger movements
2. Motor speed
3. Impulsivity
4. Motor activity
3. Self stability
4. Rapport
3.
Finger opposition
Section IV: Screening and Assessment
APS Nursing Manual
Page 2 of 3
Albuquerque Public Schools
Orientation:
1. Identification of body parts
Gross Motor:
1. Motor stance
Fine Visual-Motor:
1. Visual matching
2. Discrimination of shapes
(stereognosis)
2. Rapid alternating movements
2. Sentence copying
3. Visual tracking
3. Heel/toe walking
3. Visual tracking
Visual Processing:
1. Visual matching
4 Tandem gait
5. Catching ball
Sequential:
1. Object span
4. Figure copying
5. Block construction
Linguistic:
1. Oral directions
2. Visual recognition
2. Word span.
2
3. Left-right discrimination
4. Visual retrieval
3. Digit span 1
4. Counting aloud
5. Telling time
3. Serial commands
4. Naming pictures
5. Naming symbols
Complex sentences
Levine MD: "The Pediatric Examination of Educational Readiness" Educators Publishing Services, Inc., Cambridge, MA. 1982, and Levine MID: "The Pediatric Early Elementary
Examination" Educators Publishing Services, Inc., Cambridge, MA. 1982.
233 0 JOSH 0 August
1984, Vol. 54, No. 7
6-95/neursign
Section IV: Screening and Assessment
APS Nursing Manual
Page 3 of 3