Grading DTR's (Deep Tendon Reflex)

0 – Absent
1 – Decreased but present
2 – Normal
3 – Brisk and excessive
4 – With clonus
 Vibration Sensation
Strike a low-pitched tuning fork on the heel
of your hand and hold the base on the medial
malleolus and the joint of the great toe
Position Sensation
Ask client to close both eyes. Then hold
client’s fingers and move up, down or laterally.
Ask client to tell you the direction it is moved
 Stereognosis Test
Ask client to close both eyes. Place a familiar
object such as coin, paper clip or key in the
client’s hand and ask the client to identify it.
Graphesthesia Test
Ask client to close both eyes. Use a blunt
object to write a number on the palm of the
client’s hand and ask the client to identify the
number
 Two-point discrimination
Ask client to close both eyes. Ask the
client to identify the number of points
(one or two) felt when touched with the
o b j e c t u s e d . M e a s u re t h e d i sta n c e
between the two points when the client
can no longer distinguish the two points as
separate
 Extinction
Ask client to close both eyes.
Simultaneously touch the client in the
same area on both sides of the body at
the same point. Ask the client to identify
the area touched.
 Palms to lower anterior leg
Ask the person to pat the knees with both hands,
lift up turn hands over, and put the knees with
the backs of the hands. Then ask the person to
this faster.
Thumb pad to different finger pads
Alternately ask the client to touch the thumb to
each finger on the same hand with the index
finger, then reverse the direction
 Finger-to finger test
With the client’s eyes open, ask that he/she use
the index finger to touch your finger and then
his/her nose. After a few times, moved finger to
different spots
Finger-to-nose test
Ask client to close both eyes and stretch out the
arms. Ask him/her to touch tip of nose with each
index finger alternating hands and increasing
speed.
 Heel to Shin Test
Ask the client who is in
supine position to place the
heel on the opposite knee and
run it own on the shin from the
knee to the ankle
 Romberg Test
Ask the client to stand with
feet together and arms at sides.
Once in a stable condition ask
the client to close eyes. Wait
for 20 seconds
 Tandem Walking
Ask the client to walk in heel
to toe fashion, next on the heels
then on the toes. Demonstrate
the walk first, then stand close
in case the client lose balance