COMPS
SCORE
Slow movements
Outward
inward
2
2
1
1
0
0
2
2
1
1
0
0
2
2
1
1
0
0
Total score:
/12
Number of rotations
R ( ) L( )
B( )
4
4
4
3
3
3
2
2
2
1
1
1
Total score:
/12
Symmetry
Quality of Performance
Speed
Rapid forearm rotation
SUBCATEGORY
(INSTRUCTIONS)
Finger Nose touching
R
R
L
Moving arm
3
2
1
3
2
1
3
2
1
L
Symmetrical
Some asymmetry
Completely asymmetrical
Smooth
Some irregularity
jerky
5 or more seconds
3 to 4 seconds
0 to 2 seconds
9 or more rotations in 10
seconds
4-8 rotations in 10 seconds
1-3 rotations in 10 seconds
unable to complete
OPEN
CLOSED
OPEN
CLOSSED
3 Smooth, direct
2 Irregular or weaving
1 Unable to sustain
COMMENTS
Extended arm
Force of touch
Missed contact
Lowest score for each
column
Prone Extension
0
0
3
2
1
3
2
1
3
2
1
3
2
1
3
2
1
3
2
1
0
3
2
1
3
2
1
3
2
1
Quality
Assumes
2
1
0
Head
2
1
0
Upper Trunk
2
1
0 Finger – nose pattern
3
2
1
3
2
1
3
2
1
Completely extended
< 30 degrees elbow flexion
> 30 degrees elbow flexion
Light touch
< 2 times pushing
> 3 times pushing
0 – 1 miss nose or finger
< 2 miss nose or finger
> 2 miss both nose & finger
Total :
/12
All body parts simultaneously
Segmentally
Cannot assume
Face raised forward, neck
extended > 45 degrees
Face looking at mat or slightly
forward, neck extended < 45
degrees
Head on mat
Definite arch, elbows and
shoulders even
Minimal arch, elbows forward,
0
Thighs
2
1
0
Knees
2
1
0
Maintains (based on
first 15 sec)
2
1
Total score :
ATNR
/12
0
10-12 points = 3
7-9 points = 2
3-6 points = 1
0-2 points = 0
Quality score:
/3
3 – Elbow flexion from
0-30 degrees,
including visible
muscle tone changes
2 – elbow flexion 3160 degrees, with slight
or varies
Chest on mat
Clearly off midthigh distally
Barely off mat or intermittent
extension
Thighs on mat
Flexion < 45 degrees
Flexion 45 – 90 degrees
Flexion > 90 degrees
Maintains and counts
Maintains but body sways,
limbs move, grimaces or does
not count, holds breath
Not assumed or maintained
Duration: 3 – 30 seconds
2 – 20-29 seconds
1 – 6-19 seconds
0 – 0-5 seconds
Duration score:
/3
depression of
shoulder
Total head to left
(right arm scores)
Supine Flexion
1 – elbow flexion < 60,
no loss of balance or
lifting contralateral leg.
Shoulder depressed
and trunk movement
0 – elbow flexed < 60
degrees, loss of
quadrupedal position
(collapse), forearm
touching, or
contralateral leg
leaving
0 – score o if child
locks elbows in spite
of verbal & physical
prompts
R
L
L
R
3
3
3
3
2
2
2
2
1
1
1
1
0
0
0
0
Total head to right (
left arm scores)
Quality
Assumes
R
L
L
3
3
3
2
2
2
1
1
1
0
0
0
Right +Left =
Total :
/12
R
3
2
1
0
divided by 2
2
1
0
Neck
2
1
0
Upper trunk
2
1
0
Hips
2
1
0
Knees
2
1
0
Maintains ( based on
first 15 secs)
2
1
0
All body parts simultaneously
Segmentally
Cannot assume
Chin tucked, neck extended
>45degrees
Chin protrudes, neck extended
< 45 degrees or varies
Head not raised
Definite trunk flexion
Trunk in neutral or extended
position or varies
Back on floor
Flexed > 90 degrees
Flexed 45-90 degrees or varies
Flexed < 45 degrees
Flexion > 90 degrees
Flexion 45-90 Degrees
Flexion < 45 degrees
Maintains and counts
Maintains but body sways,
limbs move, grimaces, doesn’t
count or holds breath
Not assumed or maintained
Total (quality) score:
/12
Quality score:
10-12 points = 3
7-9 points = 2
3-6 points = 1
0-2 points = 0
Quality score:
/3
Duration:
3 – 30 seconds
2 – 20-29 seconds
1 – 6-19 seconds
0 – 0-5 seconds
Duration score:
/3
Clinical Observation
Hyperactive/distract
Tactile defensiveness
Muscle Tone
Eye Preference
-S’s eye through ring of
Ex’s finger at 15cm
-S’s eye through hole in
paper
- S’s eye through
different objects ie.
cone, kaleidoscope,
telescope
3 – normal activity
2 – slight hyperactivity
1 – def. hyperactivity
3 – no response
2 – 1 or ? response
1 - 2 responses or
def.
* Hypertonic
3 – Normal
2 – slight hypotonic
1 – def. Hypotonic
R/L differences
Eye
R
L
Hand used to hold
R
L
R
L
R
L
R
L
R
L
R
L
R
L
Independent eye closure
(optional) circle if
adequate, cross if
unable
Eye Movements
R/L Differences
Thumb Finger
Touching
Tongue to lip
Movement
Co-contractions – arm,
shoulder, neck
Postural Background
Movement
Across midline
3 - Midline
2 - Slight irr.
1 - Def. poor
Right
3 - normal
2 - slight irr.
1 - def. poor
3
2
1
3
2
1
3
2
1
Equilibrium Reactions
3
2
Upper lip
- normal
- slight irr.
- def. poor
- normal
- slight deficiency
- def. deficiency
- normal
- slight deficiency
- def. deficiency
Upright Kneeling
- normal
- slight def.
Pursuits in General
3 - Normal
2 - Slight irr.
1 - def. poor
Left
Convergence
3 - normal
2 - slight irr.
1 - def.poor
3 - normal
2 - slight irr.
1 - def. poor
Both Simul.
3 - normal
2 - slight irr.
1 - def. poor
Lower Lip
3 - normal
2 - slight irr.
1 - def. poor
Sides
3 - normal
2 - slight irr.
1 - def. poor
Quadruped
3 - normal
2 - slight def.
Long sitting
3 - normal
2 - slight def.
Quick Localization
3 - normal
2 - slight irr.
1 - def. poor
Protective Extension
Schilder’s arm
extension posture
Choreoathetosis
3 - normal
2 - slight
1 - defin.
R/L difference
Symmetrical TNR:
quadrupal, head
flexed, & extended
Rolling
Postural insecurity
supine position
Hopping
Skipping
Jumping feet together
1
3
2
1
-
def. deficiency
normal
slight def.
def. deficiency
Postural changes in
arms
3 - normal
2 - slight
1 defin
Arms raised
R
L
3 - no change in joint
flexion or extension
2 - slight change in
joint pos.
1 - definite change in
joint pos.
To Right
To left
3 - normal
2 - slight def.
1 - deficiency
Right
Left
1 - def. deficiency
1 - def. deficiency
Trunk rotation
3 - normal
2 - slight
1 - defin.
Head resist
3 - normal
2 - slight
1 - defin.
Elbows Hyperextended R
L
Discomfort
3 - normal
2 - slight
1 - defin.
Posture
VestibularSomatosensory of
postural control
Vestibulo-spinal
reflexes
TLR
Righting reactions
Standing on floor
(mini. Postural sway & main.
Balance with corr. At hip or
ankles & without stepping)
Organization postural
control in space
Ankle
Hip
Step strategy
Tone
Balance
Orientation
Dizziness
Visual
Vestibular
Side to side
Forward-backward
Shifting weight
Forward-backward
Head righting
Tone
Balance
Orientation
Dizziness
Shifting weight
Forward
Backwards
sideways
Body sway –
Mild
Moderate
Severe
Fall
Equilibrium Reactions
4 point Kneeling
Sitting
Kneel Standing
Binocularity
Unilateral cover test
Present
Delayed
Poor
Exotrophia
Esotrophia
Hypertropia
Hypotrophia
Exophoria
Esophoria
Hyperphoria
Hypophoria
See double
Alignment recovery
Within 3 inches of their
eyes
Brock’s String Test
Over-converging
Under-converging
Normal
Visual Midline Shift
Perceptual screening
Vestibular-Visual
Observations
Post-Rotary
Nystagmus (VOR)
standing
Visual Acuity
Midline
Rec’d
Left
N
Right
PRN excursion
Duration
Tested
Normal
Vestibulo-ocular
Reflex (VOR)
3 – Normal
2 – Slight Irr.
(detects presence of
strabismus)
Alternating cover test
(tendency for eyes to not stay
aligned)
Near point
convergence test
(slowly move target)
Y/N
Vision Reduced
Can’t find/loss of target
Saccadic adjustments
R near
R far
L near
L far
1 - Def. Difference
Gaze Stabilization
(VOR)
3 – Normal
2 – Slight Irr.
1 – Def. Difference
Smooth Pursuits
Horizontal
Vertical
Diagonal
3 – Normal
2 – Slight Irr.
1 – Def. Difference
Saccades
Horizontal
Vertical
Diagonal
Normal
3 – Normal
2 – Slight Irr.
1 – Def. Difference
Irregular
Spontaneous
Nystagmus
Visual lag
Redirects
Nystagmus
dizziness
Loss of target
Saccadic adjustment
Visual lag
Redirects
Elicits nystagmus
Discomfort
Loss of target
Redirection
Lag
Saccades
Midline jerk
(DEM)
Redirection
Unidirectional
Nystagmus
Multidirectional
nystagmus
Over shoot
Undershoot
Additional saccades