• Affect, mood, appearance, behavior, and grooming.
• Clarity of speech and coherence.
• Alertness, lethargy, confusion, obtundation, stupor.
• Orientation to person, place, time.

• Involuntary movements, muscle symmetry, atrophy.

Muscle Tone

• Flex and extend wrists, elbows, ankles, and knees; slight, continuous resistance to passive movement is normal.
• Note any decreased (flaccid) or increased (rigid or spastic) muscle tone.

Motor Strength

• Have Pt move against resistance. (See Muscle Strength Grading Scale in Musculoskeletal Assessment section.)

• Stroke lateral aspect of sole of each foot with reflex hammer.
• Normal response is flexion (withdrawal) of toes.
• Positive (abnormal) Babinski's reflex is characterized by extension of big toe with fanning of other toes.

Clonus

• With knee supported in partially flexed position, quickly dorsiflex foot.
• Rhythmic oscillations are positive for clonus.

Deep Tendon Reflexes

• 0..........................................Absent
• 1+........................................Diminished
• 2+........................................Normal
• 3+........................................Hyperactive without clonus
• 4+........................................Hyperactive with clonus

Do not force Pts to attempt tasks beyond their limitations.

• Observe gait while Pt walks across room and back.
• Have Pt walk heel-to-toe or on heels in a straight line.
• Have Pt hop in place on each foot.
• Have Pt do shallow knee bend.

Do not force Pts to attempt tasks beyond their limitations.
Rapid Alternating Movements

• Instruct Pt to tap tip of thumb with tip of index finger as fast as possible.

Point-to-Point Movements

• Instruct Pt to touch his or her nose and your finger alternately.
  Continually change position of your finger during test.

Romberg's Test

Be prepared to catch Pt!

• Request that Pt stand with feet together, eyes closed for 10 sec. If Pt becomes unstable, test result is positive, indicating proprioceptive or vestibular problem.

Proprioception

• Instruct standing Pt to close eyes and alternate touching index fingers to nose.

• Using your finger and a toothpick, instruct Pt to distinguish between sharp and dull sensations.
• Compare left with right (Pt's eyes closed).