SENSORY EXAM CHECKLIST

YES NO SENSORY EXAM

Light Touch
Pain
Temperature
Position Sense
Vibration Sense
Cortical Sensation
2-Point Discrimination
Graphesthesia
Stereognosis
Tactile Extinction/ Double Simultaneous Tactile Stimulation

Dermatomal Map
 REFLEXES CHECKLIST

GRADE REFLEX
Biceps Reflex
Triceps Reflex
Knee Jerk Reflex/ Patellar Reflex
Ankle Reflex
Babinski Reflex/ Plantar Reflex
Finger Flexors/ Hoffman’s Sign
Clonus

Reflexes Grading
5+ Sustained clonus
4+ Very brisk, hyper reflexive, with clonus
3+ Brisker or more reflexive than normal
2+ Normal
1+ Low normal, diminished
0 No response