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Motor Exam
Gait WNL
Qaulity of Gait
• • •
Dual Task WNL
Dual Task Gait Quality
• • •
Sway WNL
Sway Quality
• • •
Heel to Toe WNL
Heel to Toe Sway Quality
• • •
Fakuda Step WNL
Fakuda Step Quality
• • •
Titubation Present
Titubation Quality and Direction
Supination/Pronation WNL
Supination/Pronation Quality
• • •
Finger Tap WNL
Finger Tap Quality
• • •
Piano Playing WNL
Piano Playing Quality
• • •
Hand open/close WNL
Hand Open/Close Quality
• • •
Finger to Nose WNL
Finger to Nose Quality
• • •
Finger to Nose to Finger WNL
Finger-Nose-Finger Quality
• • •
Toe Tap WNL
Toe Tap Quality
• • •
Foot Tap WNL
Foot Tap Quality
• • •
Heel to Shin WNL
Heel to Shin Quality
• • •
Go/No-Go WNL
Go/No-Go Quality
• • •
Sensory Exam
Pinwheel WNL
Pinwheel Notes
Vibration WNL
Vibration Notes
Light Touch WNL
Light Touch Notes
Touch / Pin Prick Discernment WNL
Touch / Pin Prick Notes
2-point Discrimination WNL
2-Point Discrimination Notes
Joint Position Sense
Joint Position Sense Notes
Stereognosis WNL
Stereognosis Notes
Barognosis WNL
Barognosis Notes
Graphesthesia WNL
Graphesthesia Notes
Digits Between WNL
Digits Between Notes
Muscle Testing Patterns
Ipsi CB Pattern
Triceps L/R
/
Deltoids L/R
/
Gluteus Max L/R
/
Ipsi Cb/Contra Red Nucl BG pattern
Biceps L/R
/
Psoas L/R
/
Ipsi Cortical PMRF pattern
Wrist Extension L/R
/
Finger Extension L/R
/
Finger Abduction L/R
/
Thumb Extension L/R
/
Toe Dorsiflexion L/R
/
Contra Cortical Pattern
Wrist Flexion L/R
/
Finger Flexion L/R
/
Other Muscles tested
Masseter L/R
/
Hip Flexion L/R
/
Hip Adduction L/R
/
Hip Abduction L/R
/
Ankle Plantarflexion L/R
/
Ankle Dorsiflexion L/R
/
Knee Flexion L/R
/
Knee Extension L/R
/

Neuro Motor and Sensory Exam Medical Form

Chiropractor

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Published: March 27, 2016, 4:45 p.m.
Doctor: Dr. History Physical
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