Skin sensation

With eyes closed, the subject must say when a touch to the skin is felt, using either light hand stroking, or contact with the blade of a vibrating tuning fork. 

The base of a vibrating tuning fork can be pressed against the fingertips or the toes to test for vibration sensitivity. 

Vibration sensitivity

The base of a vibrating tuning fork is pressed against the fingertips or toes, and the subject reports whether he can feel the vibration.

Facial sensitivity

The examiner lightly strokes various regions of the subject's face in a symmetrical manner, the subject reporting whether the stimulus is felt equally on both sides.

Proprioception

In the first part of this test, the subject is required to extend both arms horizontally at the same level, and – with the eyes shut – maintain their stationary position. Failure of effective static proprioceptive regulation is obvious as an increasing drift of arm position.

In the second part, with the subject's eyes still shut, the examiner touches one of the fingers: the subject must then touch the nose with that finger. This tests dynamic proprioception and coordination.

Visual fields

In the first part of this test, the subject shuts one eye and fixates one of the examiner's eyes. The examiner holds his hands out in the periphery of the subject's visual field, then moves his fingers on one side or the other: the subject must point at the movement.

In the second part, with the subject still monocularly fixating the examiner's eye, the examiner brings the tip of a wand in from the extreme periphery: the subject must say when the tip is first seen.

Ophthamological examination

The subject is instructed to fixate a distant point. The examiner switches on the ophthalmoscope, and looking through it moves his eye up to the subject's, to examine the retina. It is important that the right eye is used to examine the subject's right eye and vice versa, otherwise – as seen in the final section of the clip – there can be conflict!

Hearing

The examiner whispers in one of the subject's ears, whilst rubbing the other ear to make a sound that will prevent it picking up the whisper: in this way each ear can be tested separately. The subject is asked to say whether he can hear what is whispered.

Arm reflexes

The arms are placed in a relaxed position, and stretch reflexes evoked from the wrist and elbow using a light tap with a tendon hammer. Note the technique in which the examiner places his thumb on the tendon, and then taps the thumb rather than the tendon itself. This allows more precise application of the stimulus, and the reflex response can be felt as well as seen.

Arm tone

The examiner tests the resting tone of the arms while the subject is relaxed by sensing the muscular resistance when the various joints are manipulated.

Leg reflexes and tone

The resting tone in the legs is estimated by sensing the resistance when the relaxed subject's leg joints are manipulated. Stretch reflexes are then evoked by using the tendon hammer, tapping the examiner's own hand as it grasps the foot. Then the plantar reflex is tested by firm upward stroking of the sole of the foot. The normal response (as here) is an inward curling of the toes; an upward-going big toe – the positive Babinski sign – would suggest impairment of descending cortical control.

Arm coordination

In the first part of this test, the subject is required to extend both arms horizontally at the same level, and – with the eyes shut – maintain their stationary position. Failure of effective static proprioceptive regulation is obvious as an increasing drift of arm position.

In the second part, with the subject's eyes still shut, the examiner touches one of the fingers: the subject must then touch the nose with that finger. This tests dynamic proprioception and coordination.

Neck motor function

Here the examiner tests the strength of the neck muscles, by sensing the force exerted when the subject contracts different muscles against resistance. First, by raising the shoulders; then by attempting to bend the head forward; finally by turning the head to one side. In the second half of the clip, a close-up shows how the various tendons (trapezoidal and sternomastoid) become prominent as the muscles are activated.

Throat

The subject is asked to yawn voluntarily, lowering the tongue and raising the epiglottis. Well-directed illumination from a pen-torch is essential.

Tongue

In the first part of this test, the subject is required to extend both arms horizontally at the same level, and – with the eyes shut – maintain their stationary position. Failure of effective static proprioceptive regulation is obvious as an increasing drift of arm position.

In the second part, with the subject's eyes still shut, the examiner touches one of the fingers: the subject must then touch the nose with that finger. This tests dynamic proprioception and coordination.

Tiptoe

A simple test of gastrocnemius strength, but also to some extent of balance. The subject raises the heels to stand on tiptoe, then returns to the normal position; there may be transient postural instability on return.

Standing up

A simple test of leg strength, coordination and balance. The subject begins seated, raises the arms above the head, stands, then lowers the arms and sits again.

Walking

The subject is required to walk a short distance, turn, and walk back with heel-to-toe apposition. This permits the examiner to gain an overall of gait and its coordination and possible asymmetry, as well as of dynamic postural stability and balance.

Eye movements

The subject is asked to follow the tip of the examiner's wand as it is moved in various directions. Slow horizontal or vertical movements of the wand evoke smooth pursuit, rapid movements evoke saccades, and movement of the wand towards or away from the subject should produce vergence. Weakness or paralysis in individual muscles can then quite easily be spotted.

Face muscles

The subject first screws up his eyes, then bares his teeth.

Reflexes

This shows how the coordination and reflex tests shown individually above are connected together into a complete sequence. The first test is of arm coordination, followed by arm stretch reflexes, then leg stretch and plantar reflexes.

Other function

This shows the connected sequential testing first of visual fields, then eye movements and facial sense. This is followed by ophthalmoscopy, then examination of the throat and tongue and hearing. Finally the strengths of the muscles of the neck are examined.