Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 13
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30OCULOMOTOR EXAMINATION
Spontaneous nystagmus central gaze +/- ___________________________________________________
Jerk
Skew
Pendular
Alternating
Periodic
Irregular
Horizontal
L
R
Suppressed with visual fi xation
Yes
No
Vertical
Upbeat
Downbeat
Suppressed by convergence
Torsional
Increased by fi xation
Spontaneous nystagmus eccentric gaze +/-________________________________________________
Spontaneous nystagmus eccentric gaze +/-________________________________________________
Spontaneous nystagmus eccentric gaze +/-
Increased with looking towards fast phase
Provoked on lateral or upward gaze
Horizontal nystagmus
Small unsustained eye movements at end range
Saccadic eye movements
+/-______________________________________________________________
Hypometria
Saccades during fi xation on target
Hypermetria
Oscillating horizontal saccades with gaze shift
Horizontal saccades with vertical test
Smooth pursuit testing
+/-________________________________________________________________
HEARING EXAMINATION
Weber test
Midline
L
R
Rinne test
Bone conduction > air conduction
Bone conduction ≤ air conduction
AROM EXAMINATION
Asterixis
+/-
Myoclonus
+/-
Chorea
+/-_____________________________________
______________________________________________________________________________________
______________________________________________________________________________________
LIMB ATAXIA EXAMINATION
Finger-to-nose test
Intention tremor L+/R+/-
Overshooting L+/R+/-
Finger-to-fi nger-test
Horizontal overshooting L+/R+/-
Vertical overshooting
Heel-to-shin test
Intention tremor L+/R+/-
Overshooting L+/R+/-
Toe-to-fi nger test
Intention tremor L+/R+/-
Overshooting L+/R+/-
Dysdiadochokinesia
Finger tapping +/-
Pronation-supination +/-
Toe tapping +/-
Barre test L+/R+/-_______________________________________________________________________
PROM EXAMINATION
Hypotonia
+/-
Rigidity
+/-
Spasticity
+/-
Clonus
+/- ___________________________
______________________________________________________________________________________
______________________________________________________________________________________
Stability tests___________________________________________________________________________
PPIVM/PAIVM___________________________________________________________________________
STRENGTH EXAMINATION ______________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
REFLEX EXAMINATION
Hoffman’s refl ex
L+/R+/-
Babinski sign
L+/R+/- DTR _________________________
_______________________________________________________________________________________
SENSATION TESTS_______________________________________________________________________
Joint position sense______________________________________________________________________
Vibration sense_________________________________________________________________________
VERTEBROBASILAR EXAMINATION
De Kleyn-Nieuwenhuyse test L+/R+/-________________________________________________________
Latency
_____sec
> 60 sec
Vertical downbeat nystagmus
Duration
____ sec
Non-accommodating
Other nystagmus
Fatigable
Y/N
Geotropic
Horizontal nystagmus
Apogeotropic
Torsional nystagmus
234 / The Journal of Manual & Manipulative Therapy, 2005
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