POE REVALIDA

PART I. PATIENT HISTORY TAKING

RATIONALE
Good morning ma’am/sir, my name is _____. I’m here today with members of our team
and we will be your physical therapists for today. Our agenda for today is we will be having a
thorough examination so that we will be able to properly diagnose you ma’am/sir, in order to
identify what route we’re going to be taking in order to create your treatment plan so that we
can help you achieve your goal.

PATIENT DEMOGRAPHICS
● Name
● Age
● Religion
● Address
● Civil Status
● Occupation
● Handedness
● Medication

CHIEF COMPLAINT
● What brings you hear in the clinic mam/sir
● What happened to you??? (Anong nangyari sayo?)
● Character
○ What type of pain are you experiencing?
○ Is it throbbing(ngut-ngut), gnawing(ngul-ngul), radiating(koryenti), sharp shooting,
pins & needles
● Location
○ Can you touch the area ma’am?
○ Do you feel any numbness in the area? Or weakness?
● Onset
○ When did the pain start?
○ Was it sudden or gradual?
● Radiation
○ Does the pain move towards other parts of the body?
○ (Describe how it radiates)
● Intensity
○ I am going to show you a pain rating scale. On a scale of 0 to 10, 0 is no pain, 5 is
distressing pain, and 10 is the most painful pain. Could you rate your pain?
● Duration
○ Can you tell me if your pain goes on and off, or is it constant?
 ■ If intermittent, how many hours are you in pain, and how many hours are you
without pain?
● Palliative factors
○ What do you usually do to relieve pain?
○ Do you apply any liniments like, omega, efficascent, vicks, essential oil?????
● Provocative
○ May I ask what activity or movement that worsens the pain?
○ When you are resting do you still feel pain?
● (Depending if our patient has any occupation)
○ About your occupation ma’am/sir, does your pain affect your work?
○ And if it does, how does it affect your work?

HISTORY OF PRESENT ILLNESS

● May I ask what activities you did before the pain?
● Did you feel any pain before you felt the pain now?
● Do you remember the exact date when the pain started?
○ Do you remember the time of day?
● What did you do afterwards to ease the pain? Did you apply any ice pack, hotpack,
liniments, etc?
● Did you go visit the doctor when you felt the pain?
○ If so, when did you visit? Who was the doctor?
○ Did they ask you to take any medications?
■ What medications, how many mg?

PAST MEDICAL HISTORY

● Have you recently been admitted to a hospital in the past 5 years? If Yes:
○ When were you admitted?
○ Where were you hospitalized? Or what is the name of the Hospital?
○ Who was the doctor in charge?
○ What was the cause of the admission ?
○ How long were you confined?

FOOD AND DRUG ALLERGIES

● Are you allergic to anything?
○ If food
■ What type of food
■ Reaction
● What is the reaction of your body
○ Aside from food, are you allergic to pollen / dust / fur / chu chu
■ What it is
■ Reaction
 ○ If Medication
■ What medication, how many mg
■ Reaction
● NOTE: If they only mention 1 of the 3 allergies ask about the others

HEREDITO-FAMILIAL DISEASES

(+) (-) Patient Mother Father

Cardiac
Arthritic/Arthritis
Cancer
Asthma
Diabetes
Hypertension

Significance:

HOME SITUATION

● What type of house do you live in? (2-story, condo, bungalow)

● How many people are living with you?
● Do you have any support system? And who are they?
● Is your house near the highway ma'am/sir? Or naay gate before the main door?

For UE Case
1. If naay gate, What type of handle? How high is it?
2. What type of main door? (sliding, push/pull?)
a. Type of handle?
3. What type of handles do you use for the other doors in your home?
4. If there is stairs, ask about if there is handrails, and let them describe
5. Kitchen cabinets located above the head or below the hips?
6. Room cabinets located above the head or below the hips?
7. Do you use kabo or have a showerhead?
8. Are your furniture and kitchenware heavy to carry?
 For LE Case
1. How many steps from the main gate to the front door? (if a main gate is present)
a. Is the pathway rocky, smooth (let patient describe the terrain)
2. Where do you usually stay/spend most of your time in the house?
3. If there is 2nd floor, Steps from “X” to the stairs
a. How many steps from first floor to second, type used?
4. Steps from “X” to the main door?
5. Steps from “X” to the CR?
6. Steps from “X” to kitchen?
7. Steps from “X” to the living room?
● NOTE: LET X BE THE PLACE WHERE THE PATIENT STAYS MOST IN THE
HOUSE
8. What type of flooring do you have in your house? (Wood, Tiles, etc)
9. Do you have a lot of furniture in the house?
10. How wide or high is your bed and or couches?

PATIENT LIFESTYLE
● What is your usual daily routine
● Do you cook your own food
● What do you do on your free time
● What are your hobbies
● Sir, just to give you a heads up, I will be asking some sensitive questions because it is
part of essential information we need to collect, but don't you worry cause everything
that we'll be talking about is confidential okay?
○ Do you smoke?
■ How many sticks would you finish per day?
■ Howlong have you been smoking?
○ Do you drink alcohol?
■ What type of liquor do you usually drink?
■ How frequent?
○ Do you use recreational drugs?
■ What are these?
■ When did you start?

PATIENT GOALS
● What do you want to happen/ what are your goals in this session?
PART B. PHYSICAL EXAMINATION SKILLS (INCLUDING A SYSTEM REVIEW)

GENERAL SURVEY
● Body Type
○ Ectomorph(skinny), Mesomorph(normal), Endomorph(thick)
● Unusual Appearance
○ If Pt has kyphosis, lordosis, scoliosis, forward head, abnormal gait
○ Patient has/doesn’t have unusual appearance
❖ FOR Body type and Unusual appearance (assess them together visually); this is also
your first impression of the patient
● Facial Expression
○ Can you do 3 facial expressions for me?
○ Patient is able to show three facial expressions.
● Consciousness (3xC)
○ Patient is conscious as in CCC, conscious coherence cooperative.
● Orientation (Mental Awareness)
○ Who is/are with you today?
○ Do you know where this place is??
○ What time is it today?
○ Patient is mentally aware as in PPT, person place time
● Ability to Communicate
○ Patient has good verbal and nonverbal communication.
● Body and Breathe Odors
○ Patient doesn’t seem to have any foul smell to his breath and body.
❖ FOR Consciousness, Ability to communicate, Body and Breathe Odors, we can mention
to them that while taking the history of the patient you already assessed/have an idea
about this.

CARDIOPULMONARY ASSESSMENT

VITAL SIGNS (assigned for cardiopulmo)

● Blood Pressure

Systolic BP Diastolic BP
(mmHg) (mmHg)

Normal <120 <80

Elevated 120-129 <80

Stage 1 Hypertension 130-139 80-89

Stage 2 Hypertension ≥140 ≥90

● Respiratory Rate
○ Normal: 12-20 breaths per minute
● Pulse Rate
○ Normal: 60-100 beats per minute
● Temperature
○ Normal: 37 degrees

● Cardiovascular Auscultation

Heart Palapte Auscultation Heart Sound

Aortic ● Right side 2nd Right Intercostal S2 (Dub)

● Mid Clavicle Space
● Sternal end / Sternal
Border of clavicle
● Inferiorly: 1st Rib
● Intercostal Space
● 2nd Rib to 2nd
Intercostal

Pulmonic Same with aortic but found 2nd Left Intercostal Space S2 (Dub)
on the Left

Erb’s Point ● Heart sound 3rd Left Intercostal Space S1 & S2

● 3rd intercostal space
● Sternal Border

Tricuspid ● Left 4th Left Intercostal Space S1 (Lub)

● Located at the 4th
intercostal space
● Level at nipple line
● But sternal border

Mitral ● Left 5th Left Intercostal Space S1 (Lub)

● Located at the 5th
intercostal space
 GRADATIONS OF MURMURS (Abnormal Heart Sound)

GRADE DESCRIPTION

Grade 1 Very faint, heard only after listener has “tuned in”, may not be heard in all
position

Grade 2 Quite, but heard immediately after placing the stethoscope on the chest

Grade 3 Moderately loud

Grade 4 Loud, with palpable thrill

Grade 5 Very loud, with thrill. May be heard when the stethoscope is partly off the chest

Grade 6 Very loud, with thrill. May be heard with a stethoscope entirely off the chest.

● Pulmonary Auscultation

Lung Segment Location

Anterior Segment

Apical Segment (Bronchovesicular) 1st ICS (start from the right then left)

Anterior Segment (Bronchial) 3rd ICS (Start from the left then right)

Medial and Lateral Segment - R (Vesicular) In line with xiphisternal junction (right below anterior segment)

Superior and Inferior Lingular Segment - L (Vesicular) In line with the xiphisternal junction (left to medial and lateral segment)

Anterior Basilar Segment (Vesicular) Inline with the xiphoid process → go laterally (midclavicular segment -
towards axilla)
 Posterior Segment

Posterior Segment (Bronchial) Midway of the spinous process of T2 vertebra (next to spine of scapula)

Superior Segment (Bronchial) Midway of the spinous process of T6 vertebra (inferior angle of scapula,
1-2 fingers going up)

Posterior Basilar Segment (Vesicular) Midway of the spinous process of T9 vertebra (inferior angle of scapula,
1-2 fingers going down)

Medial and Lateral Posterior Segment (Vesicular) Midscapular area to connect with T9 (more laterally and in line with
inferior angle of scapula)

VESICULAR (lower) DURATION OF SOUNDS:

Inspiratory sounds last longer than expiratory
ones.

INTENSITY OF EXPIRATORY SOUND:

Soft

PITCH OF EXPIRATORY SOUND:

Relatively Low

LOCATION WHERE HEARD NORMALLY:

Over most of both lungs

BRONCHOVESICULAR (Apical) DURATION OF SOUNDS:

Inspiratory and Expiratory sounds are about
equal.

INTENSITY OF EXPIRATORY SOUND:

Intermediate

PITCH OF EXPIRATORY SOUND:

Intermediate

LOCATION WHERE HEARD NORMALLY:

Often in the first and second interspaces
anteriorly and between the scapulae

BRONCHIAL (upper) DURATION OF SOUNDS:

Expiratory sounds last longer than inspiratory
sounds.

INTENSITY OF EXPIRATORY SOUND:

Loud

PITCH OF EXPIRATORY SOUND:

Relatively High

LOCATION WHERE HEARD NORMALLY:

 Over the manubrium, if heard at all.

TRACHEAL DURATION OF SOUNDS:

Inspiratory and Expiratory sounds are about
equal.

INTENSITY OF EXPIRATORY SOUND:

Very Loud

PITCH OF EXPIRATORY SOUND:

Relatively High

LOCATION WHERE HEARD NORMALLY:

Over the Trachea in the Neck.
There is no wheezing and no crackles

● Chest Expansion
○ Fourth Lateral Intercostal Space (A)
■ Position of PT: in front of Pt
■ Position of Pt: sitting down
■ Landmarks: Before the nipple line
○ Axilla (B)
■ Position of PT: in front of Pt
■ Position of Pt: sitting down
■ Landmarks: Armpit
○ Nipple Line (C)
■ Position of PT: at the back of Pt
■ Position of Pt: sitting down
■ Landmarks: Nipple Line
○ Tenth Rib (D)
■ Position of PT: at the back of Pt
■ Position of Pt: sitting down
■ Landmarks: Xiphoid Process

inhale (take the measurement)

then exhale (take the measurement)
MEASURE IN THE CENTER

NOTE: NORMAL DIFFERENCE: 3 – 7.5 cm (1 to 3 inches)

● Pulse Site

ARTERY SITE

Temporal Anterior and adjacent to the ear

Carotid Inferior to the angle of the mandible and

anterior to the sternocleidomastoid muscle

Brachial Medial to the biceps in the antecubital fossa

or on the medial aspect of the mid shaft of the
humerus

Radial At the wrist on the volar forearm medial to the

stylus process of the radius.

Femoral At the femoral triangle slightly lateral and

anterior to the inguinal crease

Popliteal In the midline of the posterior knee crease

between the tendons of the hamstring
muscles

Dorsal pedal Along the midline or slightly medial on the

dorsum of the foot (between 1st and 2nd
toe)

Posterior tibial On the medial aspect of the foot inferior to the

medial malleolus

GRADING
➔ GRADE 0 (Absent): No perceptible pulse even with maximum pressure
➔ GRADE 1+ (Thready): Barely perceptible, easily obliterated with slight pressure; fades in
and out
➔ GRADE 2+ (Weak): Difficult to palpate; slightly stronger than thread; can be obliterated with
light pressure
➔ GRADE 3+ (Normal): Easy to palpate; requires moderate pressure to obliterate
➔ GRADE 4+ (Bounding): Very strong; hyperactive; is not obliterated with moderate pressure

15 secs x 4 = pulse rate

INTEGUMENTARY ASSESSMENT
A. Skin assessment
● Texture: rough, smooth, scaly, oily
● Color (take note for yellowish color that can determine whyunderlying disease)
● Pigmentation
● Moles and its color
● Mobility of skin (raise extremity, and 2 fingers making circular or up and down
motion) if there is fibrotic adhesion it can harden skin
● Skin turgor (slightly pinch skin, lift, then release); normal goes back to its original
position
● Skin circulation (put pressure on the area, and there can be blanching or whitening
around the area, and it should go back pinkish
● Edema (pitting and non-pitting). Apply pressure w thumb. If there is indentation,
there is pitting edema.
● Normal thermis, hypothermic, and hyperthermic
● If there is swelling on area, do not assess
● Discoloration (cyanosis vs. contusion)
 B. Nail Bed assessment
● Texture
● Shape (square, circle, pointed or concave tip)
● Unusual appearance (for underlying disease such as onycholysis & spoon nails)
● Color (normally pinkish)
● CRT (slightly pinch nail bed and check the color. Blanches and becomes pink. If it
remains white there is circulation disruption)

LYMPH NODE ASSESSMENT

● To check any swelling
● Carotid [neck]
● Axillary [armpit]
● Inguinal [the V]
● Popliteal [behind knee]
● Trochlear [near cubital area, lateral part]

MUSCULOSKELETAL ASSESSMENT
NOTE: For ROM and MMT guys need ta mo refer sa atong kines na mga books, ang kaning
Gross ROM and MMT kay superficial rani siya kay mao mani ato gi buhat during ROS na
practicals pero pag musculoskeletal pracs nato kay ga base nata sa kines na ROM and MMT
● Gross ROM of Joint
○ Upper ex
■ R hand: R-L shoulder [back], R-L [scapula]
■ L hand: R-L shoulder [back], R-L [scapula]
○ Lower ex
■ Cross legs (male - 4 or female)

BOOK: Norkin, Cynthia C._ White, D. Joyce - Measurement of joint motion _ a guide to g…

● Gross MMT
○ UE
■ Perform 2x (palm to palm-push, back of palm-pull)
■ [I’m gonna pull/push you try to resist] Arms straight in front, hold still, don’t let
me push/pull u
■ Take note of the displacement
■ [L & R palm; Pt was able to do the action]
○ LE
■ Sitting/standing
■ Place object in front of pt
■ Let pt kick/push the object forward using the sole of your feet and pull the
object backward [push with heel, pull with dorsal [above] side of foot]

BOOK: Daniels and Worthingham’s Muscle Testing Techniques of Manual Examination an…
● Muscle Bulk Test
○ Biceps | triceps | Brachioradialis | hamstrings | quads | gastroc | Tibialis ant
○ Start with unaffected muscle
■ Normal Difference 1 - 1.5 cm
■ Hypertrophic: beyond 1.5 cm
■ Hypotrophic: Less than 1 cm

○ Landmarks:
■ Biceps (shoulder extension): Humeral Epicondyle
● Bend the arm (shoulder flexion)
■ Triceps: Medial epicondyle
● Straighten the elbow.
■ Brachioradialis: Lateral epicondyle
● Bend the arm (elbow flexion)
■ Hamstrings: Femoral condyles or gluteal folds.
● Stand up and bend the knee (Knee Flexion)
■ Quadriceps: Base of the patella
● Stand up and lift foot off the ground while legs are straightened (hip
extension)
■ Gastrocnemius: Apex of the Patella
● Pt sitting down and ask to tiptoe in the air (plantarflex)
■ Tibialis Anterior: Apex of the Patella/Tibial Tubercle
● Pt sitting down and ask the patient to raise the toe with the heel still in
contact with the ground (dorsiflex)
○ Measure circumference: highest point
■ 1st Palpate area for landmarks
■ Ask pt to flex - isometric resistance (note highest point of the belly)
■ then ask pt to unflex
■ Measure from landmark to the highest point (ex. 4 inches from the landmark
to the HP)
■ then, measure the circumference
■ Measure the other limb - make sure you use the same distance from the
other limb
○ Significance: there is no significant muscle atrophy/hyper-hypo-trophy present in
the affected limb.
● Limb Girth Measurement
○ good side 1st
■ Normal Difference 1 - 1.5
■ Beyond 1.5: Edema
■ Less than 1: atrophied muscle/hypotrophic
○ Landmark:
■ Lower Leg: Lateral or Medial Malleoli or Tibial Condyles
■ Thigh: Femoral Epicondyles or Greater Trochanter.
■ Upper arm: Humeral Epicondyle
 ■ Forearm: Humeral Epicondyle (proximal) or Ulnar Head (distal, pinky)
■ Wrist: Ulnar Styloid Process (figure of 8)
■ Ankle: Lateral Malleolus (figure of 8)
○ NOTE: Palpate - ask if there is pain
■ Measure every 2-4-6 in above & below;
■ If the whole area has swelling measure the circumference of the middle joint
keep measuring till you reach the part that is not divisible by 2, then measure
the end joint
■ If wrist area start at ulnar head then figure 8 (palmar side ull see 2 lines)
■ If ankle & foot start at medial / lateral malleolus
■ If both limbs are affected you will compare which is more edematose (is that
the right word?)
■ If [affected knee], measurement [continue 2-4-6-8-10]; only until 10
○ Significance: There are no signs of edema.
● Leg Length Discrepancy
○ (Good side 1st; Palpate 1st; Normal Difference is 1 - 1.3 cm/ 0.5 - 1 in)
○ Landmarks
■ True: ASIS to Lateral / Medial Malleolus (bone)
● before locating ASIS start with iliac crest, follow the bone forward to
feel the ASIS
● From birth
■ Apparent: Umbilicus to Lateral / Medial Malleolus (muscle imba, joint
contracture)
● from accidents, or any underlying conditions which lead to the length
discrepancy
● caused by muscle imbalance?
■ Segmental: Greater trochanter - lateral femoral condyle then Head of the
fibula - the lateral malleolus
● Pips in w/c
○ Significance: to see the length difference of their bones (tibia na femur) →
sniffing some weak drugs
○ NOTE: If you started with the lateral, then the other side should be the same.

NEUROLOGIC ASSESSMENT
● Cranial Nerve Assessment
CRANIAL NERVE COMP FUNCTION TEST AB’N FINDINGS

I Olfactory S Smell Close off nostril and let Anosmia

pt smell odor (3
ODORS)

II Optic S Vision Snellen chart Blindness

Test visual fields by Myopia (far)
confrontation (face Presbyopia (near)
 forward, let pt check
periphery)
Test visual acuity

III Oculomotor M Supplies medial, Observe eye position Strabismus: eye pulled
superior, & inferior or test eye movements upwards by CN VI
rectus, & inferior
oblique; turns the eye
up, down & in

IV Trochlear M Superior oblique: turns Test eye movements Cannot look down
eye down when when eye is adducted
adducted

V Trigeminal B S: Face Face: Test pain, light Loss of facial

touch sensations
sensations,foreheache
eks, jaw.

S: Cornea Cornea: touch lightly Loss of corneal reflex

w/ wisp of cotton ipsilaterally

M: muscles of Open mouth, move jaw Weakness of

mastication side to side, then close mastication muscles
mouth and deviation of jaw
Clench teeth when opened to
Palpate temporal & ipsilateral side
masseter muscles

VI Abducens M Lateral rectus: turns Observe eye position Estropia (eye pulled
eye out Test eye movements inward)

VII Facial B S: tastes from ant. 2/3 Apply saline & sugar Incorrectly identifies
of tongue (sweet, salty, sol’n using a cotton solution
sour) swab

M: Facial expressions Raise eyebrows, Cannot close eye

frown, show teeth, Drooping mouth corner
smile. Close eyes Difficulty with speech
tightly. Puff out both articulation
cheeks. Bell’s palsy (PNI)
Guillain-Barré
Stroke

VIII S Hearing (Cochlear -Weber Test-

Vestibulocochlear functioning)
Put the tuning fork on Deafness
top of the patient’s Unilateral loss: sound
head and this will lateralized to impaired
produce sounds, ear
Where does the sound
loudest? Is it in the left
ear, right ear or at the
middle.
 -Rinne Test- Sensorineural loss:
sound heard longer
Position A: Air through air
Conditioning

Putting the tuning fork

perpendicular to the
ear of the patient.

Position B: Bone
Conditioning

Base of the tuning fork

would be put at the
mastoid bone of the
patient (found at the
back of the ear).

Let the patient perform

Balance (Vestibular tandem walking where Vertigo
functioning) the patient needs to Nystagmus
walk in a straight line.

IX Glossopharyngeal B S: Bitter Taste Let the patient taste

something bitter (bitter —-----
gourd)

M: Gag reflex Through using a tongue

depressor, let the patient Absent reflex: lesion of
open his/her mouth then CN IX & X
put the tongue depressor
inside it.

X Vagus M Phonation & swallowing Listen to voice quality Dysphonia

Examine for difficulty in Dysphagia
swallowing through letting
the patient either drink
water or letting the patient
swallow. You must
touch/palpate the patient’s
throat when he/she is
swallowing.

XI Spinal accessory M Innervation of SCM & SCM: Turn head to each Atrophy, fasciculations,
trapezius muscles side against resistance weakness (PNI): inability
to shrug ipsilateral
shoulder; shoulder droops

Trapezius: Shrug both Inability to turn head to

shoulders upward against opposite side
resistance

XII Hypoglossal M Tongue movements Listen to patient’s Dysarthria (lesions of CN

articulation X or CN XII), atrophy,
Examine tongue fasciculations of tongue,
movements and impaired movements
 Examine resting position
of tongue

MOVEMENTS OF THE
TONGUE THAT NEEDS
TO BE ASSESSED:

Upward
Downward
Protraction
Retraction
Sidewards

NOTE: Only for Oculomotor, Trochlear and Abducens Nerve

CN III (Oculomotor)
● Superior Rectus
● Inferior Rectus
● Medial Rectus
● Inferior Oblique
CN IV (Trochlear)
● Superior Oblique
CN VI (Abducens)
● Lateral Rectus

● Sensory Assessment
○ Superficial Sensation
NOTE: always remember to first test the unaffected side.
SUPERFICIAL RECEPTOR SPINAL PATHWAY SIGNIFICANCE EQUIPMENT INSTRUCTION

Pain perception Nociceptor – Anterolateral To test if you can Sharp/dull tip or Introduce stimuli
specifically Free spinothalamic system sense and distinguish reflex hammer Perform eyes open,
nerve endings sharp and dull then closed
sensation
- 10x sharp & dull for
Left limb
- 10x sharp & dull for
right limb
- 10x sharp & dull
(testing together
both limbs)
 Temperature Thermoreceptors To test if you can 2 test tubes (warm Introduce stimuli
awareness sense and distinguish and cold) Perform eyes open,
warm and cold then closed
sensation
- 10x warm & cold for
Left limb
- 10x warm & cold for
right limb
- 10x warm & cold
(testing together both
limbs)

Touch awareness Mechanoreceptors - To test if you can Brush or cotton ball Introduce stimuli
specifically Merkel’s sense light touches Perform eyes open,
discs then closed

- 10x brush the Left

limb
- 10x brush the right
limb
- 10x brush (testing
together both limbs)

Pressure perception To test if you can Index finger Introduce stimuli

sense pressure when Perform eyes open,
applied then closed

- 10x put pressure on

the Left limb
- 10x put pressure on
the right limb
- 10x pressure
(testing both limbs
together)

GRADING FOR SUPERFICIAL:

Grade 8 - 10: Either there was a minor issue in giving the stimulus (intact) or it could be there is
a disturbance

Grade 5: Automatic Impaired Pathway

Grade 5 and below: Cut off on sensory pathway

○ Deep Sensations
NOTE: always remember to first test the unaffected side.
DEEP SENSATION RECEPTOR SPINAL PATHWAY SIGNIFICANCE EQUIPMENT INSTRUCTION

Kinesthesia Muscle receptor – Dorsal Column - To test your hand Introduce

awareness specifically your Medial Lemniscal awareness of movement/direction.(
muscle spindles System movement upward, downward,
sidewards)
Perform eyes open,
then eyes closed
“As i move your
(arm), please tell me
where the direction it
is heading to”

Proprioceptive Joint Receptors – To test your hand Introduce

awareness specifically your free awareness of movement/position
nerve endings position (initial, mid, terminal)
Perform eyes open,
then closed
“As i position your
(hand) please tell me
where it is located”
Vibration perception Muscle Receptor – To test if you can Tuning fork (reflex Introduce sensation
specifically your sense vibrations hammer) (vibrating &
Pacinian Corpuscles non-vibrating) in bony
prominences.
Perform eyes open,
then closed.
“Please tell me
whether you feel the
area vibrating or not”

NOTE FOR VIBRATION PERCEPTION: In using a reflex hammer you must tap it first before
putting it on to the bony prominence. Take note of how many seconds the patient felt the
vibration. You will do 3 trials then assess if the patient felt the patient consistently.

● Reflex Assessment
○ DTR

DEEP TENDON REFLEX

(Reflex Hammer)

Reflex Site of Stimulus Normal Response Nerve

Jaw Site: Mandible Mouth closes CN V

Position: Pt. is sitting, jaw

relaxed & slightly open.

Procedure: Place finger on top of

chin; tap downward on top of
finger in a direction that causes
the jaw to open.

Biceps Site: Biceps Tendon Elbow Flexion C5 - C6

Musculocutaneous N.
Position: Pt is sitting with arm
flexed and supported.

Procedure: Place thumb over the

biceps tendon in the cubital fossa,
stretching it slightly. Tap the
 thumb or directly on the tendon.

Brachioradialis Site: Brachioradialis Tendon Elbow Flexion or C5 - C6

Pronation of forearm Radial N.
Position: Pt is sitting with arm
flexed onto the abdomen.

Procedure: Place finger on the

radial tuberosity and tap finger
with hammer.

Triceps Site: Distal Triceps tendon (above Elbow Extension C7 - C8

the elbow) Radial N.

Position: Pt is sitting with arm

supported in abduction, elbow
flexed. Palpate triceps tendon just
above olecranon. Tap directly on
the tendon.

Finger Flexors Site: PT’s finger across the distal Finger Flexion C6 - T1
phalanges of pt. Median N.

Position: Hold hand in neutral

position. Place finger across
palmar surface of distal
phalanges of four fingers
Procedure: Tap the PT’s finger

Patella Site: Patellar T. Leg Extension L3 - L4

Femoral N.
Position: Patient is sitting with
the knee flexed and foot
unsupported.

Procedure: Tap the tendon of

quadriceps muscle between the
patella and tibial tuberosity.

Hamstrings
Medial Site: Semimembranosus Knee Flexion L5 - S1
Lateral T.(pinaka medial sa back of the S1 - S2
knee) Tibial Branch Sciatic N.
Site: Biceps Femoris T.

Position: Patient is prone with

knee semiflexed and supported.
Palpate tendon at the knee.

Procedure: Tap on finger or

directly on tendon

Tibialis Posterior Site: Tibialis Posterior T. behind Plantar Flexion of the foot L4 - L5
the Medial Malleolus Sciatic N.

Position: Pt. sitting with the knee

extended. Palpate the Tibialis
Posterior T.

Procedure: Tap on the finger with

hammer

Achilles SIte: Achilles T. Plantar Flexion of the Foot S1 - S2

Tibial N.
Position: Pt is prone with foot
over the end of the plinth or sitting
with knee flexed and foot held in
slight dorsiflexion.

Procedure: Tap tendon just

above its insertion on the
 calcaneus. Maintaining slight
tension on the
gastrocnemius-soleus group
improves the response.

○ Superficial

SUPERFICIAL REFLEXES

Reflex Materials Position Stimulus Response Nerve Root

Abdominal Brush Lie on your back Stroke near navel & Umbilicus moves T7 - T9 (Upper)
(Supine) stroke move up it Up/down towards the
slanting area being stroked T11 - T12 (Lower)

Cremasteric Brush Supine, Legs slightly Stroke upper portion Scrotum will elevate T12, L1
Abducted of knee to the [ipsilaterally]
inguinal area (so like
you tracing your
sartorius); distal to
proximal 3x

Plantar Brush Sitting, knees Stroke the lateral Flexion of toes S1-S2
extended aspect of the sole

Gluteal Method 1
Brush Lie on belly [prone] Brush the gluteal Skin tenses in gluteal L4-L5, S1-S3
folds area [gluteal muscles
will contract]

Method 2 standing
Paper Skin tenses in gluteal
Ask pt to contract area [cheeks will
gluteal muscles after crumple the paper]
putting paper in
between the butt
cheeks

Anal Brush, gloves Lie on supine, bridge Brush the anus with constriction/contracti S2-S4
position the dominant hand, on of anal sphincter
(Lithotomy- childbirth while the
position) nondominant hand
will be placed inside
the anus.

Bulbocavernosus Gloves Lie on supine, bridge Girl: constriction/contracti S2-S4

position Dominant hand on of anal sphincter
will
pinch clitoris.
None dominant in
the
butt hole (maybe)
Boy:
Dominant hand
will
pinch glans penis.

PATHOLOGICAL REFLEXES

RATIONALE: We are going to have an assessment called pathological reflexes using ______. The
purpose of doing this is for me to assess if you are going to have a positive response to this which
indicates that you have abnormalities.
Material needed: Reflex Hammer

NOTE: Remember that having a reaction towards this test means that there is an abnormal
reaction.

<Babinski>

● Position of the Patient: Long sitting or supine

● Stimulus: Brush the sole of the patient laterally starting in the heel and until the big toe,
brush it in a Inverted letter ‘J’.
● Normal Response: No reaction
● Positive Response: Extension of big toe and fanning of four small toes - Dorsiflexion

<Chaddock’s>

● Position of the Patient: Long sitting or supine

● Stimulus: Stroking of the lateral side beneath the lateral malleolus.
● Normal Response: No reaction
● Positive Response: Extension of big toe and fanning of four small toes - Dorsiflexion

<Oppenheim’s>

● Position of the Patient: Long sitting or supine

● Stimulus: Stroking the anteromedial tibial surface (or shin bone).
● Normal Response: No reaction
● Positive Response: Extension of big toe and fanning of four small toes - Dorsiflexion

<Gordon’s>

● Position of the Patient: Supine or feet are dangling

 ● Stimulus: Squeeze the gastrocnemius or calf muscle.
● Normal Response: No reaction
● Positive Response: Extension of big toe and fanning of four small toes - Dorsiflexion

<Piotrowski’s>

● Position of the Patient: Prone (Supine?) or feet are dangling

● Stimulus: Percuss the Tibialis anterior muscle (lateral side of the shin bone).
● Normal Response: No reaction
● Positive Response: Dorsiflexion and supination (inversion) of foot

<Brudzinski’s>

● Position of the Patient: Supine

● Stimulus: Flex the hip or knee of one limb then extend the whole LE upward.
● Normal Response: No reaction
● Positive Response: Similar movement occurs in opposite limb

<Hoffman> Digital

● Position of the Patient: Sitting

● Stimulus: Flicking of the index, middle or ring finger.
● Normal Response: No reaction
● Positive Response: Reflex flexion of distal phalanx of thumb and of distal phalanx of
index or middle finger (whichever one was not “flicked”)

<Rossolimo’s>

● Position of the Patient: Long sitting or supine

● Stimulus: Purely tap the toes or plantar surface of the patient.
● Normal Response: No reaction
 ● Positive Response: Plantar flexion of toes

<Schaeffer’s>

● Position of the Patient: Long sitting or supine

● Stimulus: Pinch the achilles tendon.
● Normal Response: No reaction
● Positive Response: Flexion of foot and toes

BALANCE, COORDINATION AND VESTIBULAR

● Non-equilibrium
● Nonequilibrium tests address components of limb movements.
○ Finger to Nose (Eyes closed)
- The shoulder is abducted to 90° with the elbow extended.
- Ask Pt to bring the tip of the index finger to the tip of his nose.
- Simple: Unilateral (5x)
- Complex: both Arms (5x)
○ Finger - PT’s Finger
- Pt & PT sit opposite each other
- PT index finger is held in front of the Pt.
- Asked to touch the tip of his or her index finger to the PT’s index finger.
- Simple: 1 arm 5x
- Complex: both Arms (5x) & alter position and ask them to do it faster
- Not allowed for visual occlusion
○ Finger - Finger (Eyes closed)
- Both shoulders are abducted to 90° with the elbows extended.
- Pt is asked to bring both hands toward the midline and approximate the index
fingers from opposing hands.
- 5x
○ Alternate nose to finger
- Pt & PT facing each other
- PT’s e elbows extended with finger pointing.
- Ask Pt to touch the tip of his nose then PT’s Fingers
- Direction of PT’s will change
- Simple: 5x right 5x left
- Complex: both (no bilateral)
- Not allowed for visual occlusion
○ Finger opposition
- Thumb to tip of little finger and so on
- Simple: Unilateral (5x)
 - Complex: bilateral (5x)
- Slow pace into fast pace
○ Mass grasp
- Opening and closing fist (from finger flexion to full extension)
- Simple: Unilateral
- Complex: Bilateral
- Speed may be gradually increased
○ Pronation/supination
- With elbows flexed to 90° and held close to the body, the patient alternately
turns the palms up and down. ( shoulders flexed to 90° a
- nd elbows extended)
- Speed may be gradually increased.
- ability to reverse movements between opposing muscle groups can be
examined at many joints. Examples include active alternation between flexion
and extension of the knee, ankle, elbow, or fingers.
- Simple: Unilateral (5x)
- Complex: Bilateral (5x)
○ Rebound test (1x per side)
- Instruct pt to contract - elbow flexion
- Dominant hand - resist; Nondominant Hand - protect
- While performing elbow flexion - isometric apply manual resistance, after
suddenly release resistance - if there is an equal contraction, muscle won’t
bounce back
○ Tapping hand
- Sitting - Arm at side elbows flex on top of knees
- Simple: Unilateral (5x)
- Complex: Bilateral (5x)
- Ride side, tap [wrist flexion]
○ Tapping foot
- Sitting
- Foot in contact with floor - heel contact [dorsiflex] to down (tapping)
○ Pointing and past position
- PT & pt are facing each other - either sitting or standing.
- Both Pt & therapist bring shoulders Flex 90° with elbows extended
- Index fingers are touching or the patient’s finger may rest lightly on the
therapist’s.
- The patient is asked to point toward the ceiling and then return to initial
-position.
- Simple: Unilateral (5x)
- Complex: Bilateral (5x) Increase speed
- Normal response consists of an accurate return to the starting position.
- Abnormal response, there is typically a “past pointing,” or movement beyond
the target.
○ Alternate heel to knee; heel to toe
 - supine position
- Ask Pt is asked to touch the knee and big toe alternately using the heel.
- with the heel of the opposite extremity.
- 5x R 5X L[uni] no bilateral
○ Toe - Examiners FInger
- supine position,
- Instruct Pt to touch the examiner’s finger with his big toe.
- Simple: Unilateral
- Complex: Bilateral (fast)
- Not allowed for visual occlusion
○ Heel on shin
- Supine position,
- the heel of one foot is slid up and down the shin of the opposite LE.
○ Drawing a circle
- Ask Pt to draw an imaginary circle in the air with either UE or LE
- Simple: circle
- Complex: Figure of 8
○ Fixation or position
- Make sure patient is able to balance
- UE: holds arm horizontally while sitting or standing
- LE: holds knee in an extended position
- Do unilateral (r arm, r leg)
- 5-10 seconds
● Equilibrium
○ Equilibrium or balance tests consider the ability to maintain the body in
equilibrium with gravity both statically and dynamically.
■ 4 Normal: Able to maintain steady balance without handhold support (static)
Accepts maximal challenge and can shift weight easily within full range in all
directions (dynamic)
■ 3 Good: Able to maintain balance without handhold support, limited postural
sway (static) Accepts moderate challenge; able to maintain balance while
picking object off floor (dynamic)
■ 2 Fair: Able to maintain balance with handhold support; may require
occasional minimal assistance (static) Accepts minimal challenge; able to
maintain balance while turning head/trunk (dynamic)
■ 1 Poor: Requires handhold support and moderate to maximal assistance to
maintain position (static) Unable to accept challenge or move without loss of
balance (dynamic)
■ 0 Absent: Unable to maintain balance

1. Sitting in a normal comfortable position - chair without backrest (stool)

2. Sitting, weight shifting in all directions
3. Sitting, multidirectional functional reach
4. Sitting, picking an object up off floor
 5. Standing in a normal comfortable posture
6. Standing, feet together (narrow base of support)
7. Standing on one foot
8. Standing, with one foot directly in front of the other (tandem position)
9. Standing: eyes open (EO) to eyes closed (EC) (Romberg Test)
10. Standing in tandem position: EO to EC (Sharpened Romberg Test)
11. Standing, multidirectional functional reach
12. Walking, placing feet on floor markers
13. Walk: sideways
14. Walk: backwards
15. Walk: cross-stepping
16. Walk: in a circle, alternate directions
17. Walk: on heels
18. Walk: on toes
19. March in place
20. Walk with horizontal and vertical head turns
21. Step over or around obstacles
22. Stair Climbing with handrail
23. Stair Climbing without handrail
24. Stair Climbing: one step at a time
25. Stair Climbing: step-over-step
● Balance [table 6.7 - 235]
○ In this test sir I’ll check if you have a Balance problem existing & for us to know
what caused it. This is in order to predict risk of falls and to determine effectiveness
of intervention.
○ Significance: To check if there are any balance disorders.

Functional reach test

- provide a quick screen of balance problems in older adults
- Measure side of wall
- measure [pt’s] acromion level to wall, then mark wall
- Starting sa mark, put tape measure in a straight line
- Pt stands 2 inches away sa wall
- Instruct pt to raise arm forward [fisted] : basis is knuckle of third metacarpal
- Instruct to maintain position
- knees are 4 inches apart, knees extended
- 3x (get average)
Women N: 14.6 (± 2.2) Inches

Get up & go / Timed Get up & Go

- To measure the dynamic balance & mobility
- Seated on a chair with arms and back resting against the chair.
 - Pt is then instructed to stand momentarily, and then walk 3 m (10 ft) toward a
chair (with no back rest) at normal walking speed, turn without touching the chair,
return to the chair, turn, and sit down.
- As i said go, pls stand and walk towards the other chair and return to the
chair
- Scored using a five-point ordinal scale ranging from
- 1, Normal (no risk of falls)
- 2, Very Slightly Abnormal
- 3, Mildly Abnormal (increased risk of falls)
- 4, Moderately Abnormal;
- 5, Severely Abnormal (high risk of falls).
- If an assistive device is required, the type is recorded. (belong to the 3 to 5
grade so make sure be ready to guard)
- For Timed Get up & go you need a stopwatch
- Healthy adults inless than 10 seconds.
- Older adults (ages 60 to 80) average scores less than 10 (mean of 8).
- Scores of 11 to 20 seconds are considered within typical for frail elderly or
individuals with a disability;
- scores over 30 seconds are indicative of impaired functional mobility and
high fall risk. used to examine functional mobility deficits in patients with
stroke and Parkinson’s disease

- There is a grade found in the book; and a the right range for their age

Dynamic gait index (272 page)

- Bring pt in a room that is spacious with no barriers since we need to let them
walk around
- starting : pt PT standing beside each other
- Just walk forward, from time to tim ill ask ask u change directions, so just listen to
my instructions
- Max score is 0 (cannot do it) - 3 (normal) 8 different directions (3 points per
direction ) if you can see a positive sign stop immediately
- A score below 19 is indicative of increased fall risk
- Go walk forward, then turn to left then right… in different directions like ipa turn
around…
- Notice the balance of the pt.
- Make sure you are near the patient to catch the pt….
- Gait belt can be worn for protection

Berg Balance
- Naa sa book or WS

Poma (tinetti) theres a pic?

- Naa sa book or WS
● Vestibular
Head thrust
- Position: pt sitting in front of PT
- PT’s hand [both fingers] on pt’s back of ear [odontoid process] and thumb on jaw
- Before performing make sure cervical rom and mmt is normal [let them do the
ROM & MMT actions]
- Ask pt to relax since kaliton
- Bend pt’s head towards chin
- 30 degrees flexion
- instructions: we will now do ur head thrust, i'll be bending your head to
30 and i'll be turning your head to the right side then back to middle
[while maintaining head flexion]
- maintaining your gaze - look at the tip of my nose
- Sudden
- Observe pt’s eyes for nystagmus - not able to fixate [problem with gaze stability]
- if pt feels any discomfort do not proceed with the test
- Perform once

Head shaking
- Same position ^ w/ 30 degrees flexion
- Do oscillation instead of thrust (you shake)
- Same - flexion of head, rule out cervical rom and mmt
- Oscillate - 1-2-1-1, 1-2-1-2 1213 1214
- Inform pt first before doing the thing
- Stop if any manifestation of nystagmus
- 20 cycles

Dynamic Visual acuity test

- Combination of head shaking and cn 2 assessment - snellen’s chart [make chart]
- 20 ft from wall
- Pt sitting, while PT standing behind
- shake pt’s head - index & middle finger : jaw; thumb : occiput
- Ask pt to read from top to bottom, until he/she can't read na - take note of this
line , and this will be the lowest line
- For the lowest line ^ - instruct pt, “i will shake your head slowly, please read the
line”
- If the pt reads the line 2-3 above THAT [lowest] line (positive for gaze instability)

Dix-hallpike test (Benign Paroxysmal Positional Vertigo) [21.11 & .12]

- Supine [initial position: long sitting, facing PT]

(1) The pt sits on the examination table and the clinician

turns the head horizontally 45°.
 (2) As the examiner maintains the 45° rotation, pt is quickly
brought to a supine position and then with the neck extended 30°
beyond the horizontal.

The examiner must look for nystagmus and ask the patient if
vertigo is being experienced.

The patient is then slowly brought back to the starting position,

and the other side is tested. The side that reproduces nystagmus
and vertigo is the side that has the benign paroxysmal positional
vertigo (BPPV). Shown here for testing right posterior or right
anterior semicircular canal BPPV.

- Before putting pt in a supine position, turn head 45

degree to the R
- When supine, head is on the edge of the table - not
supported, neck extended to 30 degrees
- Take note of R eye, nystagmus [Vertical - unilateral
vestibular problems, Horizontal- bilateral vestib
problems]
- After, test L side

- Side lying [initial position: sitting/dangling]

(1)The patient sits on the edge of the examination table.

The clinician turns the head horizontally 45°.

(2) As the examiner maintains the 45° rotation, the patient

is quickly brought down to the side opposite the head
rotation (pictured here as the right side).

The examiner checks for nystagmus and vertigo, and then

slowly brings the patient to the starting position. The other
side is then tested

- No head extension
- Non dominant hand supports the occiput
- Just 45 degrees rotation
- Opposite - side lying R: L rotation
Caloric testing (Right Semicircular Dysfunction)
- hot water, cold water, dropper
- 1 drop
- If cold water dropped to R
- COWS - cold water opposite side manifest, warm water same side manifest [sa
eyes]
 - Pt, sitting slightly bend head
- If positive, COWS but if negative no effect ra

Cognition and Perceptual Deficits

RATIONALE OF EACH TEST

Cognitive, Perceptual, and Speech Disorders Ax:
To assess how you will take in, process and interpret the information given to you.
ATTENTION DEFICITS We are going to assess to know the extent of
your attention span. This is significant to
know if the patient is capable of concentrating
on the instructions.

BODY SCHEME AND BODY IMAGE To check if the patient has difficulties with
IMPAIRMENTS body awareness. This is significant to know if
an impairment in the patient’s body scheme
and body image exist.

SPATIAL RELATIONS DISORDER To check if the patient has a difficulty in

perceiving the relationship between the self
and two or more objects. This is significant to
know if a problem in the patient’s right parietal
lobe exists.

AGNOSIAS To check if the patient has an inability to

recognize or make sense of incoming
information despite intact sensory capacities.
This is significant to know if the patient can
still recognize familiar objects.

APRAXIA To check if the patient has a disability to

perform purposeful movements. This is
significant to know if the patient is positive for
an impairment of voluntary skilled learned
movement.

EXAMPLES/TEST

ATTENTION DEFICIT

Sustained Attention - capacity to attend *sustained attention for a long period of

to relevant information during activity. time*
 ● 2mins animated story video
● Reading a short story

Focused / Selective Attention - capacity *can be the same activity as sustained

to attend to a task despite environmental attention but with environmental stimuli*
visual or auditory stimuli. ● Conversing with the therapist while
there is background music
● Reading a short story while music
is in the background

Alternating Attention - capacity to move *shifting attention*

flexibly between tasks and respond ● A foreign song (kpop) would be
appropriately to the demands of each played and the patient will
task. alternate his/her attention from
listening to the song then reading
subtitles
● Watching anime where the patient
needs to alternate his/her attention
from watching the show and then
reading subtitles

Divided Attention - capacity to respond *Do two things at the same time*
simultaneously to two or more tasks or ● Let the patient draw a house, a cat,
stimuli when all stimuli are relevant and a tree while watching a video
(vlog, animation, etc.)
● Make patient write about his or her
biodata while listening to the
therapist talk

BODY SCHEME AND BODY IMAGE IMPAIRMENTS

Unilateral Neglect - inability to register and ● Let the patient wear gloves and
integrate stimuli and perceptions from one you must check if the patient would
side of the body (body neglect) and the wear the gloves both lateralities
environment or hemispace (spatial neglect of ● Let patient put lotion on his/her
the area surrounding one side of the body),
arm
which is not due to a sensory loss

Anosognosia - a severe condition including ● Ask the patient about the

denial and lack of awareness of the presence paralyzed limb: what happened to
or severity of one’s paralysis. the arm or leg, whether he or she
is paralyzed, how the limb feels,
and why it cannot be moved.

Somatoagnosia - a lack of awareness of the ● Let the patient point the body parts
body structure and the relationship of body that the therapist instructs (show
parts to oneself or to others. pictures of body parts and pinpoint)
Right-Left Discrimination - inability to ● Pinpoint specific laterality either
identify the right and left sides of one’s own upper limb or lower limb (example:
body or of that of the examiner right hand, left foot)

Finger Agnosia - can be defined as the ● Simple: ask the patient to point the
inability to identify the fingers of one’s own finger being asked (where is your
hands or of the hands of the examiner index finger, thumb, middle? etc.)
● Complicated: Let the patient
imitate finger movements on
command (can you curl the index
finger, touch the thumb to the
pinky)

SPATIAL RELATIONS DISORDERS

Figure-Ground Discrimination - inability to ● Gather a bunch of things in a box

visually distinguish a figure from the (put any stuff) and then ask the
background in which it is embedded patient to get the object you asked
Ex. ‘Sir can you get/ hand me the
eraser from the box?’

● Black bag and black book

Form Discrimination - inability to perceive or ● Prepare a toothbrush, pentel pen,

attend to subtle differences in form and pencil and highlighter. Let the
shape. patient guess what material he/she
is holding.

Spatial Relation - inability to perceive the ● Arranging books in the bookshelf

relationship of one object in space to another (arrange by height or color)
object, or to oneself

Position in Space - inability to perceive and ● Have a plate and a spoon and
to interpret spatial concepts such as up, instruct the patient to do a certain
down, under, over, in, out, in front of, and task (Put the spoon on top of the
behind plate, cover the spoon by using the
plate.. etc.)
● Book and eraser

Topographical Disorientation - difficulty in Options:

understanding and remembering the ● Ask the patient to describe the
relationship of one location to another lay-out of their house: ‘unsay naa
sa first floor etc.’
● Ask the patient to draw the lay-out
of their house.
Depth and Distance Perception - inaccurate Depth
judgment of direction, distance, and depth. ● Let patient refill a water (Half full,
Full, ½ full)
Distance
● Let patient reach your hands

Vertical Disorientation - distorted perception ● Place the object on the table

of what is vertical. horizontally first then ask the
patient to change its position
vertically.
● Let the patient flex his/her elbow
forward and then afterwards, ask
the patient to position it vertically.

AGNOSIAS

Visual Agnosias
● Simultanagnosia - inability to ● Simultanagnosia
perceive a visual stimulus as a - Show a picture that is
whole. composed of many
elements and let the patient
● Prosopagnosia - inability to name what elements he/she
recognize familiar faces. sees.

● Color Agnosia - inability to

recognize colors; it is not color
blindness.

● Prosopagnosia
- Show pictures of the
relatives of the patient (such
as the mother, father,
siblings etc.)
● Color Agnosia
- Show a color wheel picture
to the patient and let the
patient identify what specific
color it is (this is different
from color blind)
Auditory Agnosia - inability to recognize ● Play distinguishable sounds then
nonspeech sounds or to discriminate ask the patient to identify the
between them. sound.
- ‘Sir this is the first sound
<play>, this is the second
sound <play>, third sound
<play>. Can you tell me
what the first sound was?
etc.’

Tactile Agnosia or Astereognosis - inability ● Prepare a toothbrush, pentel pen,

to recognize forms by handling them, pencil and highlighter. Introduce
although tactile, proprioceptive, and thermal the material first to the patient and
sensations may be intact. then let the patient close his/her
eyes. Let the patient guess what
material he/she is holding.

APRAXIA

Ideomotor Apraxia - breakdown between ● Give the patient a pencil and let
concept and performance. the patient describe what is the
function and ask to do the function.

(NOTE: the patient will

AUTOMATICALLY perform the
intended task for the given material
which is the pencil)

(Positive Reaction: the patient will

perform the wrong functionality of
the material such as the patient
may use the pencil to stab
someone)

Ideational Apraxia - inability to perform a ● Give the patient a pencil and let
purposeful motor act, either automatically or the patient describe what is the
on command function and ask to do the function.

(NOTE: the patient will NOT

AUTOMATICALLY perform the
intended task for the given material
which is the pencil)

LOADING

(Positive Reaction: the patient will

 perform the wrong functionality of
the material such as the patient
may use the pencil to stab
someone)

Buccofacial Apraxia - difficulties with ● SIMPLE: Let the patient stick out
performing purposeful movements with the his/her tongue
lips, tongue, cheeks, larynx, and pharynx on ● COMPLEX: Let the patient blow a
command. whistle

LESIONS

ATTENTION DEFICITS

Sustained Attention ● Reticular formation

● Various sensory system
● Limbic and frontal region

Focused/Selective Attention ● Reticular formation

● Various sensory system
● Limbic and frontal region

Alternating Attention ● Reticular formation

● Various sensory system
● Limbic and frontal region

Divided Attention ● Reticular formation

● Various sensory system
● Limbic and frontal region

BODY SCHEME AND BODY IMAGE IMPAIRMENTS

Unilateral Neglect Inferior-posterior regions of the right parietal

lobe

Anosognosia Region of the supramarginal gyrus

Somatoagnosia Dominant Parietal lobe

Right-Left Discrimination Parietal lobe of either hemisphere

Finger Agnosia Parietal lobe, often in the region of the

angular gyrus of the left hemisphere

SPATIAL RELATIONS DISORDER

Figure-Ground Discrimination Parieto-occipital lesions of the right

hemisphere
Form Discrimination Parieto-temporo occipital region of the non
dominant lobe

Spatial Relation Predominantly the inferior parietal lobe or

parietal-occipital-temporal junction

Position in Space Non dominant parietal lobe

Topographical Disorientation Right retrosplenial cortex, with Brodmann’s

area 30

Depth and Distance Perception Posterior right hemisphere in the superior

visual association cortices

Vertical Disorientation Non dominant parietal lobe

AGNOSIAS

Visual Agnosias
● Simultanagnosia Occipito-temporo-parietal association areas
● Prosopagnosia
● Color Agnosia

Auditory Agnosia The dominant temporal lobe

Tactile Agnosia or Astereognosis Parieto-temporo occipital lobe

APRAXIA

Ideomotor Apraxia Left dominant hemisphere

Ideational Apraxia Dominant parietal lobe

Buccofacial Apraxia The frontal and central opercula, anterior

insula, and a small area of the first temporal
gyrus

SPECIAL TEST
??????