This document provides an overview of a neurological examination, including tests of higher mental functions, cranial nerves, reflexes, and sensory examination. It describes methods for testing various aspects such as level of consciousness, orientation, memory, attention, calculations, abstract thinking, insight and judgement. Specific tests are outlined for frontal lobe dysfunction and speech disorders. Each cranial nerve is discussed in terms of origin, function and testing methods. Dermatomes from C2 to T6 are defined.

1. NEUROLOGICAL
EXAMINATION
-Dr. Aishwarya Rai, PT
MPT 1st Year
Jyoti Rao Phule Subharti College of
Physiotherapy.

2. HIGHER MENTAL FUNCTIONS

3. I. LEVEL OF CONSCIOUSNESS
1. Full Consciousness
2. Lethargy
3. Obtundation
4. Stupor
5. Coma
II. ORIENTATION
1. Time
2. Place
3. Person

6. III. MEMORY
1. Immediate Memory (Immediate Recall)
2. Short- term Memory
3. Long- term Memory
4. Verbal Memory
5. Visual Memory
IV. ATTENTION
•It is the capacity of brain to process in information
from the environment or long term memory.
•Occur in individuals with delirium, brain injury,
dementia, mental retardation or performance anxiety

7. 1. Selective Attention
2. Sustained Attention
3. Alternating Attention
4. Divided Attention
METHODS OF TESTING ATTENTION
a) Digit span forward (Test for immediate memory)
• Numbers given @ rate 3 or 4 per second.
• Expected performance- 7±2
b) Backward digit span
• Repetition of series of number in reverse order
• Expected performance- 5±1

8. c) Three step task
d)Line bisection test
e) Patient to signal whenever “A” is heard from
string of random letters dictated by examiner or
having the patient cross all the “A’s” on a written
sheet.
V. CALCULATIONS
Dyscalculia- Characteristic of lesions of dominant
parietal lobe, particularly angular gyrus.

9. METHODS OF TESTING CALCULATION
a)Simple arithematic either verbally or on paper.
b)Serial 7 test
• Subtracting serial 7s from 100.
VI. ABSTRACT THINKING
• Patient asked to tell differences and
similarities; interpretation of proverbs.
• Its disorders common with frontal lobe
disorders.

10. VII. INSIGHT AND JUDGEMENT
• Insight to one’s own problem, medical illness.
• Artificial situations given for judgment testing

13. FRONTAL LOBE DYSFUNCTION TESTS
1. Wisconsin card sort test
• Used to determine patient’s ability to shift between
tasks.
• In this test, a number of cards are presented to the
participants. The figures on the cards differ with
respect to color, quantity, and shape. The
participant is told to match the cards, but not how
to match; however, he or she is told whether a
particular match is right or wrong.
• The test takes approximately 12–20 minutes to
carry out

15. 2. Trail Making Test
•Used for visual attention and task switching.
•The task requires a subject to 'connect-the-dots' of
25 consecutive targets on a sheet of paper or
computer screen. There are two parts to the test:
i. Part-A:- In this the targets are all numbers (1,2,3,
etc.) and the test taker needs to connect them in
sequential order.
ii. Part-B:- in which the subject alternates between
numbers and letters (1, A, 2, B, etc

16. •Part A is used primarily to examine cognitive
processing speed. Test B, is used to examine executive
functioning.

19. 3. Luria’s fist edge down test
• Test of executive function.
• In this test, the examiner instructs a subject to
sequentially place one of the subject's hands in
three different positions called fist, edge, and palm.
Difficulty performing this task is often suggestive of
frontal lobe dysfunction.
4. Copying tasks
• Drawing simple figures with multiple loops.
• Insertion of extra loops shows perseveration*.
*Perseveration- It is the repetition of a particular response, such as a word, phrase, or
gesture, despite the absence or cessation of a stimulus.

20. 6. Stroop Test
• It consists of-
a)Little-big Test
b)Colour names are written in non-matching
colours

22. SPEECH DISORDERS
•Aphasia refers to all the disorders of understanding,
thought and word finding.
•Dysphonia refers to disorder of voice production
•Articulation refers to disorders of articulation.

23. WERNICKE’S APHASIA (SENSORY APHASIA)
Poor comprehension, fluent but often meaningless speech. No
repetition.
BROCA’S APHASIA (MOTOR APHASIA)
Preserved comprehension, non-fluent speech. No repetition.
CONDUCTIVE APHASIA
Loss of repetition with preserved comprehension and output.
TRANSCORTICAL SENSORY APHASIA
As in Wernicke’s aphasia but preserved repetition.
Repetition.
TRANSCORTICAL MOTOR APHASIA
As in motor aphasia but preserved

26. EXAMINATION OF CRANIAL NERVES
1. OLFACTORY NERVE
2. OPTIC NERVE
3. OCCULOMOTOR NERVE
4. TROCHLEAR NERVE
5. TRIGEMINAL NERVE
6. ABDUCENS NERVE

27. 7. FACIAL NERVE
8. VESTIBULOCOCHLEAR NERVE
9. GLOSSOPHARYNGEAL NERVE
10. VAGUS NERVE
11. ACCESSORY NERVE
12. HYPOGLOSSAL NERVE

28. OLFACTORY NERVE
Origin:- From olfactory epithelium
Type of nerve:- Sensory nerve
Function:- Olfaction
Testing:-
Apply the clove oil or other substances which are not irritating
such as peppermint or tincture of asafetida to each nostril
seperately, and ask the subject if he recognizes it or not.
1. Exclude local changes in the nose itself. Eg: common cold.
2. Irritating substances such as ammonium chloride which act
partially through trigeminal nerve should be avoided. It
may lead to difficulty in recognizing the smell.

29. OPTIC NERVE
Origin:- From the retina
Type of Nerve:- Sensory nerve
Function:- Transmission of visual sensations to the brain
Testing:-
Each eye should be separately be examined for following:-
1. Visual acuity
2. Field of vision
3. Colour of vision
4. Examination of fundus by microscope (Opthalmoscopy)

30. VISUAL ACUITY- It is defined as the measure of the smallest
retinal image that can be appreciated with reference to its
shape and size.
Tested by:-
1. Jaeger’s Chart- For Near Vision
Patient holds the chart at 30 cms distance and is asked to
read the sections of the print.
2. Snellen’s Chart- For Distant Vision
Patient stands 6m away from a well-lit chart. Ask him to
read down from the largest letters to the smallest.
Recording results:- distance of subject from the
chart/normal distance at which it should be seen. For eg:6/24

31. FIELD OF VISION
1. Confrontation Test (Donders' test): The examiner will ask
the patient to cover one eye and stare at the examiner.
Ideally, when the patient covers their right eye, the
examiner covers their left eye, and vice versa. The examiner
will then move his hand out of the patient's visual field and
then bring it back in. Commonly the examiner will use a
slowly wagging finger or a hat pin for this. The patient
signals the examiner when his hand comes back into view.
This is frequently done by an examiner as a simple and
preliminary test.
2. Perimetry

32. COLOUR VISION
Inability of an individual to recognise colours is called
Colour Blindness.
Testing:-
i. Yarn (spun thread) matching test or Holmgren’s skeins
of coloured wool test
ii. Ishihara’s Chart

35. REFLEXES
1. Light reflex-
Afferent-Optic nerve
Efferent- Occulomotor nerve
2. Accomodation reflex
Afferent-Optic nerve
Efferent- Occulomotor nerve

36. OCCULOMOTOR, TROCHLEAR AND ABDUCENT
NERVES
3rd Nerve Innervation:-
1. Ciliary muscle
2. Iris(sphincter) pupillae
3. Levator palpebrae superioris
4. All extraocular muscles except superior oblique and
lateral rectus.
4th Nerve Innervation:-
Superior oblique
6th Nerve Innervation:-
Lateral rectus

39. TRIGEMINAL NERVE
Origin:- From lateral surface of Pons
Type:- It is a mixed nerve
Function:- It has three divisions:-
1. First or Opthalmic Division-
i. It supplies the conjuctival surface of the upper lid only;
lacrimal gland.
ii.The skin of the medial part of the nose as far as the tip, the
upper eyelids, the forehead, and the scalp as far as the
vertex.

40. 2. Second or Maxillary Division-
i. It supplies the cheek, the front of the the temple, the lower
eyelid and its conjuctival surface, the sides of the nose, the
upper lip, the upper teeth or root joins it and
ii.The mucous membrane of: the nose, upper part of
pharynx, the roof of mouth, parts of soft palate, tonsils and
medial inferior portion of cornea
3. Third or Mandibular Division
i. It supplies lower part of the face, the loer lip, the ear, the
tongue, and lower teeth.
ii. Parasympathetic fibres of salivary glands

41. iii. Motor root joins it and supplies muscles of mastication
except buccinator which is supplied by facial nerve.

42. TESTING
A. Sensory Function:-
1. Touch, pain, pressure and temperature sensations are
checked for all the three branches.
2. Testing of corneal reflex.
B. Motor function
1. Ask the subject to clench the teeth, the temporalis and
masseter muscle will stand out.
2. Ask the subject to open his mouth; on opening the
mouth, the jaw will deviate towards the paralysed side.

43. FACIAL NERVE
Origin:- From pons lateral to the sixth nerve nucleus
Function:- It has three sets of fibres:-
1. Motor fibre supplies:-
i. All muscles of face,and scalp except levator palpabrae
superioris.
ii. Stylohyoid
iii. Buccinator
iv. Stapedius
2. Sensory fibres:-
It brings taste sensation from anterior 2/3rd of tongue (salt,
sour and sweet)
3. Secreto-motor fibres:-
It supplies lacrimal gland, sublingual and submandibular
salivary glands

44. Testing
A. Tests for muscles of the face and scalp results in:-
a) Look for
i. Facial expression
ii. Symmetry of the face
iii. Furrows over forehead
iv. Nasolabial folds and its movement with deep breathing
v. Angle of mouth
vi. Width of palp;pebral fissure
vii.Eyebrows position

45. VESTIBULOCOCHLEAR NERVE
Origin
From the groove between the junction of pons and medulla.
Function
It is a pure sensory nerve consisting of two sets of fibres:-
i. One set supplies the vestibule and semicircular canals
and is concerned with maintainence of equillibrium,
balance and sensation of bodily displacement.
ii. Other set supplies the cochlea and is concerned with
hearing.

46. Effect of Paralysis
1. Lesion of vestibular nerve results in:-
i. Vertigo i.e. a sense of instability, often with a sensation of
rotation, therefore, the person complains of feeling of
giddiness or dizziness.
ii. Nystagmus i.e. involuntary rhythmic to and fro movement
of the eyeball.
2. Lesion of cochlear nerve results in loss of hearing on the
affected side.

47. Testing
A. Tests for vestibular functions
i. Ask if any history of vertigo or nstagmus.
ii. Romberg’s Sign
iii. Barany’s caloric Test
B. Tests for cochlear functions
i. Watch Test
ii. Tuning Fork tests
a) Rinne’s Test:-
b) Weber’s Test
c) Schwabach Test
d) Absolute Bone Conduction Test
C. Audiometry

48. GLOSSOPHARYNGEAL NERVE
Origin:-
It is attached by five to six rootlets to upper part of the
medulla oblangata
Function:-
It is a mixed nerve consisting of three set of fibres:
1. Motor fibres supply stylopharyngeous muscle (inferior
constrictor of the pharynx which helps in swallowing)
2. Sensory fibres bring taste sensation from posterior 1/3rd
of tongue and mucous memberane of pharynx
3. Secreto-motor fibres supply parotid gland

49. TESTING
1. Test for taste sensation in posterior 1/3rd portion of the
tongue
2. Palatal reflex- Tickle at the back of the pharynx with
finger or swab stick and note its reflex contraction(Palatal
reflex). This is absent on the side of the damaged nerve.

50. VAGUS NERVE
Origin:-It is attached to the lateral aspect of medulla below
the origin of ninth nerve.
Function:- It is a mixed nerve and consists of two sets of
fibers:-
Motor and sensory
1. Motor fibres supply:
i. Involuntary muscles of respiration, heart and GIT (upto
right 2/3rd of transverse colon)
ii. Voluntary muscles:-
a. All constrictor muscles of pharynx
b. All intrinsic muscles of larynx
c. Muscles of soft palate

51. 2. Sensory fibers are distributed to:
i. Mucous membrane of GIT (upto right 2/3rd of transverse
colon)
ii. Mucous membrane of larynx, pharynx and soft palate
TESTING
1. For Palate:
i. Ask the subject about any history of regurgitation of
fluids through nose during swallowing
ii. Observe any nasal twang
iii. Palatal reflex
iv. Examining soft palate movements during phonation.
2. For the Larynx:
Larygoscopy is done.

52. SPINALACCESSORY NERVE
Origin:-
It originates from two separate locations
1. Cranial part:- Arises from medulla below the oorigin
of vagus nerve. Its fibers get distributed along with
motor branches of the vagus nerveto the larynx and
pharynx.
2. Spinal part:- Arises from the spinal nucleus of lateral
part of anterior grey column of the spinal cord
extending upto fifth cervical segment.
Function:-
It is a motor nerve and supplies two muscles
i. Sternocleidomastoid
ii. Trapezius

53. HYPOGLOSSAL NERVE
Origin:-
It takes origin from the lowermost of the medulla oblongata.
Function:-
It is a motor nerve and supplies all muscles of the tongue.
This helps in articulation of tongue during speech and
proper mixing of food with saliva.
Testing:-
1. Ask the subject to protrude out his tongue.
2. Ask subject to move his tongue from side to side

54. SENSORY
EXAMINATION

55. •Superficial (exteroceptive) sensations are tested first,
followed by the deep (proprioceptive) and then combined
cortical sensation.
•Generally tested distal to proximal direction.

56. SUPERFICIAL SENSATIONS
1. Pain
2. Touch
3. Temperature
4. Pressure
DEEP SENSATIONS
1. Kinesthesia
2. Proprioception
3. Vibration

57. COMBINED CORTICAL SENSATIONS
1. Sterognosis
2. Tactile Localisation
3. Two- point discrimination
4. Double simultaneous stimulation
5. Graphaesthesia
6. Texture recognition
7. Barognosis

58. DERMATOMES
C2- occipital protuberance at the of base of the skull, 1 cm
right and left of the occipital protuberance.
C3-apex of supraclavicular fossa.
C4-over acromioclavicular joint.
C5- on the lateral side of antecubital fossa just proximal to the
elbow.
C6- on the dorsal surface of the proximal phalanx of the
thumb.
C7- on the dorsal surface of the proximal phalanx of the middle
finger

59. C8- on the dorsal surface of the proximal phalanx of the little
finger.
T1- on medial(ulnar) side of the antecubital fossa, just
proximal to the medial epicondyle of the humerus
T2- at the apex of axilla
T3- at midclavicular line andd third intercostal space
T4- at midclavicular line and the fourth intercostal space
located at the level of nipples.
T5- at midclavicular line and the fifth intercostal space located
between the level of nipples and xiphisternum

60. T6- at midclavicular line located at the level of xiphisternum
T7- at midclavicular line located at one quarter the distance
between the level of the xiphisternum and the umblicus.
T8- at midclavicular line located at one half the distance
between the level of the xiphisternum and the umblicus.
T9- at midclavicular line located at threequarter the distance
between the level of the xiphisternum and thhe umblicus.
T10- at the midclavicular line located at the level of the
umblicus.
T11- at the midclavicular line located midway between the
level of the umblicus and the inguinal ligament.

61. T12- at the midclavicular line over the midpoint of inguinal
ligament.
L1- midway between key sensor points for T12 and L2
L2- on the anteromedial thigh midway on a line between the
midpoint of the inguinal ligament and the medial femoral
condyle above the knee.
L3- at the medial femoral condyle above the knee.
L4- over the medial malleolus.
L5- on the dorsum of the foot at the third metatarsal
phalangeal joint.

62. S1- on the lateral side of the heel.
S2- in the popliteal fossa at the midpoint.
S3- over the ischial tuberosity
S4/5– in the perianal area

64. REFLEXES
Superficial reflexes are motor responses to scraping of the
skin. They are graded simply as present or absent.
1. ABDOMINAL REFLEX
•It is a superficial neurological reflex stimulated by stroking of
the abdomen around the umbilicus.
• It can be helpful in determining the level of lesion in a
neurology case.
Method-
• Make the subject lie down comfortably on a bed in the supine
position.
• Uncover the abdomen and see that his abdominal muscles are
well relaxed.

65. •With a blunt object gently stroke on the abdominal skin from
lateral to the medial aspect in all four quadrants.
•Observe the contraction of the abdominal muscles resulting in
deviation of umbilicus towards the area stimulated.
•A normal positive response usually involves a contraction of
the abdominal muscles, and the umbilicus moving towards the
source of the stimulation.
•Roots involved - Thoracic 7th - 12th segments are involved

67. 2. PLANTAR RESPONSE (S1,S2)
•The normal planter response occurs when scratching the
sole of the foot from the heel along the lateral aspect of the
sole and then across the ball of the foot to the base of the
great toe.
•This normally results in flexion of the great toe (a "down-
going toe") and, indeed, all of the toes.

69. 3. THE CREMASTERIC REFLEX
• Is a superficial (i.e., close to the skin's surface) reflex
observed in human males.
• This reflex is elicited by lightly stroking or poking the
superior and medial (inner) part of the thigh - regardless
of the direction of stroke. The normal response is an
immediate contraction of the cremaster muscle that pulls
up the ipsilateral testis.
• Roots involved:- L1, L2

71. 4. SUPERFICIAL ANAL REFLEX
•In response to stroking or pricking of the skin or mucous
memberane of perianal region contraction of external
anal sphincter (anal wink) occurs.
• Roots involved:-S2-S5

72. DEEP TENDON REFLEXES
BICEPS - Musculocutaneous nerve(C5,C6)
TRICEPS – Radial nerve (C6,C7)
BRACHIORADIALIS- Radial nerve (C5,C6)
QUADRICEPS – Femoral nerve (L2,L3,L4)
ANKLE JERK- Tibial nerve(S1 ,S2)

73. GRADING
0 :- Absent
1+ :- present but diminished
2+ :-Normal
3+ :- increased but not necessarily pathological
4+ :- marked hyperactive with beats of clonus (fatigable)
5+ :- marked hyperactive with sustained clonus

74. MUSCULOSKELETAL
EXAMINATION

75. 1. TONE EXAMINATION
a) Flaccidity/Hypotonia:-
•Decreased or absent muscular tone
•Resistance to passive movement is diminished
•Stretch reflexes are dampened or absent
•Limbs can be easily moved i.e. they are floppy
•Occurs in LMN syndromes, resulting from lesion
affecting-
i. Anterior horn cell
ii. Peripheral nerve (Eg- peripheral neuropathy,
cauda equina lesion, radiculopathy)

76. b) Dystonia:- Characterised by disordered tone
c) Spasticity:-
• It is a hypertonic disorder characterised by velocity-
dependent resistance to passive stretch.
• It arises from injury to corticospinal pathways.
b) Rigidity:-
• Leadpipe Rigidity
• Cogwheel Rigidity

77. MODIFIED ASHWORTH SCALE

78. 2. MUSCLE GIRTH MEASUREMENT
Arm- 8cm up from olecranon
Forearm- 5cm from olecranon
Thigh- 10cm from superior border of patella
Calf-15cm from apex of patella

79. RANGE OF MOTION
1. Passive ROM
2. Active ROM

80. QUALITY OF MOVEMENT
•Bradykinesia
•Akinesia
•Synergy pattern in upper and lower limbs

81. MYOTOMES
C1/C2: neck flexion/extension
C3: neck lateral flexion
C4: shoulder elevation
C5: shoulder abduction
C6: elbow flexion/wrist extension
C7: elbow extension/wrist flexion
C8: finger flexion
T1: finger abduction
L2: hip flexion
L3: knee extension
L4: ankle dorsi-flexion

82. L5: great toe extension
S1: ankle plantar-flexion/ankle eversion/hip extension
S2: knee flexion
S3–S4: anal wink

83. STRENGTH TESTING
1. Manual Muscle testing
2. Voluntary Muscle Grading

84. VOLUNTARY CONTROL GRADING FOR ASSESSING
SYNERGY PATTERNS :
GRADE 0 : NO CONTRACTION
GRADE 1: FLICKER OF CONTRACTION PRESENT PRESENT
OR INITIATION OF MOVEMENT
GRADE 2: HALF RANGE OF MOTION IN SYNERGY OR
ABNORMAL PATTERN
GRADE 3: FULL RANGE OF MOTION IN SYNERGY OR
ABNORMAL PATTERN
GRADE 4: INITIAL HALF RANGE IS PERFORMED IN
ISOLATION AND THE LATTER HALF IN PATTERN
GRADE 5: FULL RANGE OF MOTION IN ISOLATION BUT
GOES INTO PATTERN WHEN RESISTANCE IS OFFERED
GRADE 6: FULL RANGE OF MOTION ISOLATION AGAINST
RESISTANCE

85. TIGHTNESS/ CONTRACTURE / DEFORMITY
1. Thomas Test
2. Modified Thomas test
3. Ely’s test
4. Ober’s test
5. Adduction contracture test
LIMB LENGTH DISCREPANCY
• True
• Apparent

86. INVOLUNTARY MOVEMENTS
• Athetosis
• Chorea
• Hemiballismus
• Intention tremors/resting tremors:- Can be either
fine or coarse
• Postural tremors

87. PATHOLOGICAL MOVEMENTS
•Clonus
•Spasms-flexor spasms or extensor spasms

88. BALANCE
EXAMINATION

89. I. Static Postural control
It is the ability to maintain postural stability and orientation
with centre of mass over the BOS while body is at rest.
For eg- stability during sitting, standing etc.
II. Dynamic postural control
It is the ability to maintain postural stability and orientation
with centre of mass over the BOS while parts of body are in
motion. For eg- reaching out in various directions, shifting
weight, rotating head etc.

90. FUNCTIONAL BALANCE GRADES
Normal
Patient able to maintain steady balance with hand held support
(Static);
Patient accepts maximal challenges and can shift weight easily
within full range in all directions (Dynamic).
Good
Patient able to maintain handheld support, limited postural
sway (Static);
Patient accepts moderate challenge; able to maintain balance
while picking up object from the floor(Dynamic).

91. Fair
Patient able to maintain balance with handhold support may
require minimal assistance (Static);
Patient accepts minimal challenge; able to balance while
turning head /trunk(Dynamic).
Poor
Patient requires support and moderate to maximal assistance
to maintain a position (Static);
Patient unable to accept challenge or move without loss of
balance (Dynamic).

92. FUNCTIONAL BALANCE TESTS
1. Romberg Test
• Patient instructed to stand with feet together with eyes
open unaided for 20 to 30 seconds. If patient falls then test
is over.
• The patient is then asked to stand with eyes closed. In a
negative test there is only minimal sway.
• Test is considered positive, if patient is able to stand with
eyes open but demonstrates increased instability or fall
with eyes closed.
• Romberg positive is seen posterior column lesions in
spinal cord (tumour, degenerative spinal cord disease,
tabes dorsalis) and peripheral neuropathy.

93. • If unsteadiness is seen while eyes open then patient suffers
from cerebellar ataxia or vestibular dysfunction.
2. Functional Reach Test
• It is the maximal distance one can reach beyond arm’s length
while maintaining a fixed BOS in the standing position . The
test uses a yardstick mounted on the wall and positioned at
the height of the patient’s acromion.
• patient stands sidewards next to the wall (without touching),
feet normal stance width and weight equally distributed on
both feet.
• Shoulder is flexed to 90 degrees and elbow extended with
hand fisted.

94. • An initial measurement is made of the position of the 3rd
metacarpal along the yardstick.
• For forward reach, the patient leans forward as far as
possible without losing balance or taking a step.
• A second measurement is taken also using the 3rd
metacarpal for reference. The measurement is subtracted
from initial measurement.

96. 3. Multidirectional Reach Test
•A yardstick is affixed to the wall at the level of the subject’s
acromion process
•Prior to the reach the yardstick is leveled so that it is
horizontal to the floor
•The subject lifts an outstretched arm to shoulder height,
pauses for an initial reading and then reaches as far forward
as possible
•Instructions to the to the subject include, “without moving
your feet or taking a step, reach as far (direction given) as you
can and try to keep your hand along the yardstick.”

97. •For the backward direction, the subject is asked to “lean as far back
as you can.” Subjects use their typical strategy to accomplish the
task.
•Subjects use their arm of choice for the forward and backward tasks
and use the respective arm for the right and left reaches.
•Procedure is repeated for the backward reach, right reach and left
reach

99. 4. The Berg Balance Scale
• It is a widely used clinical test of a person's static and
dynamic balance abilities.
• It is a gold standard scale for measuring balance.
• The test takes 15–20 minutes and comprises a set of 14
simple balance related tasks, ranging from standing up
from a sitting position, to standing on one foot.
• The degree of success in achieving each task is given a score
of zero (unable) to four (independent), and the final
measure is the sum of all of the scores.

100. 5. Timed Up and Go Test
•The Timed Up and Go test (TUG) is a simple test used to
assess a person's mobility and requires both static and
dynamic balance.
•The time that a person takes to rise from a chair, walk three
metres, turn around, walk back to the chair, and sit down.
• During the test, the person is expected to wear their regular
footwear and use any mobility aids that they would normally
require.
•The TUG is used frequently in the elderly population, as it is
easy to administer and can generally be completed by most
older adults.

101. Interpretion of Score:-
•10 seconds or less indicate normal mobility.
•11-20 seconds are within normal limits for frail elderly and
disabled patients.
•Greater than 20-30 seconds means the person needs
assistance.
•30 seconds or more suggests that the person may be prone to
falls.

102. COORDINATION
EXAMINATION

103. I. Non-equillibrium Tests
• Finger to nose
• Finger to therapist’s finger
• Finger to finger
• Alternate nose to finger
• Finger opposition
• Mass grasp
• Pronation/ supination
• Rebound test
• Tapping (hand)
• Tapping (foot)
• Pointing and past pointing
• Alternate heel to knee; heel to toe
• Toe to examiner’s finger

104. • Heel on shin
• Drawing circle
• Fixation or position holding

105. RATING SCALE
4- Normal performance demonstrated
3- Movement accomplished with slightest difficulty
2- Moderate difficulty is demonstrated in
accomplishing the activity; Movements are
arrhythmic, and performance deteriorates with
increased speed.
1-Severe difficulty is noted; movements are
arrhythmic;significant unsteadiness or oscillations
are noted.
0- patient unable to accomplish activity

106. II. Equillibrium Tests
• Standing with normal BOS
• Standing with feet together
• Standing in tandem position
• Single leg standing
• Arm positions can be altered in all the above (i e. arms by
the side, over head, hands over the waist)
• Perturbations
• Standing (Functional reach test)
• Standing, laterally flex trunk to each side
• Romberg test

107. •Sharpened Romberg test
•Tandem walking
•Walking in a straight line
•Walking sideways, backward and cross-stepping
•March in place
•Alter speed of ambulatory activities
•Stop and start abruptly
•Walk and pivot on command
•Walk in a circle, alternate directions
•Walk on heels, toes
•Walk with horizontal and vertical head turns on command
•Step over and around the obstacles
•Stair climbing with and without rails
•Jumping jacks
•Sitting on a therapy ball; alternately flexing and extending
the knee

108. RESPIRATORY EXAMINATION
1. Respiratory rate
2. Depth of respiration:- Deep or Shallow
3. Rhythm of respiration
4. Auscultation of sounds of respirations:- Bronchial,
bronchiovesicular, vesicular and adventitious sounds
5. Type of breathing- Abdomino-thoracic or thoraco-
abdominal
6. Patterns of breathing: Normal, Ataxic, Cheyne stokes
respiration

109. 7. Chest expansion:- Checked at :
• Level of Axilla – 2-4 cm
• Level of Nipples – 4-5 cm
• Level of Xiphisternum- 6.5-7.5cm
8. Vital capacity-
Done by hand held spirometer

110. 9. Cough-
• Functional:
Strong enough to clear the secretions.
• Weak Functional:
adequate force to clear upper respiratory tract secretions
in small quantities; assistance is required to clear mucuc
secondary to infection.
• Non Functional:
unable to produce any cough force.

111. CARDIOVASCULAR EXAMINATION
•Blood Pressure
•Heart beat
•Cardiovascular endurance- 6 minute walk test
•Autonomic Dysreflexia
•Postural hypotension

112. SKIN EXAMINATION

113. •Any redness
•Temperature changes
•Any swelling/oedema
•Any wounds/ abrasions/burns

114. SWALLOWING
EXAMINATION

115. 1. Pharyngeal reflex or gag reflex-
• It prevents something from entering the throat except
as part of normal swallowing and helps prevent
choking.
•It is checked in the patients for dysphagia assessment
2. Any regurgitation is noted

116. BOWEL AND BLADDER EXAMINATION
• Fluid intake
•Urine output
•On palpation distension of the bladder is seen
•Type of bladder:-
1. Cortical bladder
2. Flaccid bladder
3. Spastic bladder

117. GAIT EXAMINATION

118. TYPES OF GAIT ANALYSIS:
I. KINEMATIC
II. KINETIC
KINEMATIC QUALITATIVE GAIT ANALYSIS
In this deviations from normal body postures and jint angles at
specific points in the gait cycle are examined.
1. Observational Gait Analysis (OGA)
RLA OGA involves a systematic examination of movement
patterns of the body segments at each point in the gait cycle:
foot, knee, hip, pelvis, and trunk

119. •The system uses 48 descriptors of common gait deviations
such as toe drag, excessive plantarflexion and dorsiflexion,
excessive varus and valgus at knee or foot, hip hiking and
trunk flexion.
•The observing therapist determines whether or not the
deviation is present and notes the occurrence and timing of
the deviation.
•Videography can be used.

120. KINEMATIC QUANTITATIVE GAIT ANALYSIS
•Used to obtain information on spatial and temporal gait
variables, as well as motion patterns.
• 6 minute walk test (used for determining speed and
cadence)
•Measurement of foot angle, width of BOS, step length, and
stride length are recorded by subject’s footprints. Footprints
can be taken by application of paints, ink, or chalk to the
bottom of patient’s foot or shoe or attaching marker to the
back of the patient’s shoe.

121. 1. Accelerometer
2. Gyroscopes
3. Walkways (GAITMAT II and GAITRite)
4. Electrogoniometers
KINETIC GAIT ANALYSIS
1. Motion Analysis Systems
Sophisticated and expensive method of determining joint
displacement and patterns of motion.
In this, markers are placed on the body segments such as
knee, ankle and hip are tracked by automated systems.

122. 2. Force Plate Technology
FUNCTIONAL STATUS EXAMINATION

123. FUNCTIONAL STATUS
AND
ACTIVITY LEVEL
EXAMINATION

124. 1. Barthel Index
2. Katz index
3. SF-36
4. Functional Independence Measures
5. Spinal Cord Injury Measures