1. Assess Level of Consciousness
1. Arousal (Wakefulness)
1. Voice Stimulation
2. Shouting
3. Shaking
4. Painful Stimuli (Central/Peripheral)
2. Awareness
1. Orientation
2. Language
3. Memory 
2. Assess Cranial Nerve Function
1. Olfactory (I)
1. smell
2. Optic (II)
1. Visual acuity (Snellen Chart)
2. Visual Fields by Confrontation (Peripheral Vision)
3. Ophthalmoscope exam (Optic disk)
3. Oculomotor (III), Trochlear (IV), Abducens (VI)
1. Pupil Size, Shape and Equality
2. Pupil Reaction to Light (Direct and Consensual)
3. Accommodation Reflex
4. Extraocular movements in 6 Cardinal Fields of Gaze
5. Doll's Head Maneuver (Doll's eyes)
4. Trigeminal (V)
1. Clench teeth (temporal and Masseter Muscles)
2. Corneal Reflex
3. Sharp vs. Dull
4. Light touch (Cotton ball)
5. Facial (VII)
1. Symmetry of face
2. Facial Movements (raise eyebrows, frown, smile, puff cheeks, close eyes)
3. Taste of sweet, sour, and salt (bitter-CN IX)
6. Acoustic (VIII)
1. Hearing
2. Weber and Renne Test
7. Glossopharyngeal (IX) and Vagus (X)
1. Uvula midline
2. Gag Reflex
3. Swallowing
4. Bitter taste-usually tested with CN VII
8. Spinal Accessory (XI)
1. Shrug shoulders
2. Rotate head
9. Hypoglossal (XII)
1. Tongue movement 
3. Assess Motor Response 

• Intact contractile mechanisms of muscles
• Neuromuscular transmission
• Cranial and spinal motor nerves
• Motor cortex
• Motor Pathways (Corticospinal and Extrapyramidal Tracks)
• Cerebellum 

1. Muscle tone
1. Hypotonia (LMN)
2. Hypertonia (UMN)
2. Posturing
1. Decortication-interruption of the corticospinal tracts (Flexion)
2. Decebration -midbrain and upper pons (Extension)
3. Involuntary Movements
1. Intention tremors
2. Nonintention tremors
3. Postural tremors
4. Tics
5. Choriform Movements
6. Athetosis
7. Dystonia
8. Fasciculations
9. Myoclonus
10. Tardive Dyskinesia
4. Muscle Strength
1. Grade 0-No Muscle Contraction (0%)
2. Grade 1-Trace (10%)
3. Grade 2-Active movement in the absence of gravity (25%)
4. Grade 3-Active movement against gravity (50%)
5. Grade 4-Active Movement against some resistance (75%)
6. Grade 5-Full Motor Strength against resistance (100%)
5. Hand Grasps
6. Foot Pushes
7. Pronator Drift
8. Muscle size
1. Atrophy (LMN)
2. Hypertrophy (UMN) 

1. Assess Coordination
1. Assess Gait
1. Hemiplegic
2. Spastic
3. Involuntary Movements of Gait
4. Ataxic (cerebellar)
5. Steppage (foot drop)
6. Festination Gait (Parkinson's Gait)
7. Scissors Gait
8. Waddling Gait
2. Heel-to-toe (Tandem walk)
3. Walk on Heels
4. Walk on Toes
5. Romberg test
6. Hop in Place on one foot
7. Shallow knee bends
8. Rapid Rhythmic Alternating Movements
1. Pat leg
2. Turn hand over and back
3. Touch each finger with thumb
4. Pat examiner's hand with ball of foot
9. Point to Point Testing
1. Touch index finger and nose rapidly
2. Run heel of foot down opposite shin
3. Figure 8 with foot 
2. Assess Sensory System
1. Pain/Temperature
1. Analgesia
2. Hyperalgesia
2. Light touch
1. Anesthesia
2. Hyperesthesia
3. Vibration
4. Position Sense
5. Discriminative Sensations
1. Sterognosis
2. Graphesthesia (number identification)
3. Point Localization
4. Two Point Discrimination 
3. Assess Reflexes 

• 4+ very brisk, hyperactive, clonus present (UMN)
• 3+ brisker than average
• 2+ average
• 1+ somewhat diminished
• 0 no response (LMN)
• Test for Clonus 

DEEP TENDON REFLEXES 

1. Biceps Reflex-Cervical 5,6
2. Triceps Reflex- Cervical 7,8
3. Brachioradialis Reflex - Cervical 5,6
4. Patellar Reflex (knee reflex) - Lumbar 2,3,4
5. Achilles Reflex - Lumbar 5, Sacral 1,2 

SUPERFICIAL REFLEXES 

1. Plantar Response (Babinski) - Lumbar 4,5, Sacral 1,2
2. Abdominal Reflexes - Thoracic 8,9,10,11,12
3. Cremasteric Reflex 

FRONTAL RELEASE SIGNS 

1. Grasp Reflex (Palmar Grasp)
2. Snout Reflex
3. Glabella (Myerson's Sign)
4. Sucking and Rooting
5. Plantar Grasp
6. Moro
7. Tonic Neck
8. Step in place 

MENINGEAL SIGNS 

1. Brudzinski's Sign- Flexion of Neck
2. Kernig's Sign - Flexion of Hip and Knee