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A Guide to Objective Structured Clinical Examination (OSCE)

for the undergraduates
General rules (5):
▪ At the start of each examination please remember to:
1. Wash your hands
2. Introduce yourself
3. Ask the pt's permission for examination
4. Explain the test to the patient.
▪ At the end of each examination please remember to:
1. Re-position and re-cover the examined area.
2. Thank the patient
▪ Provide clear instructions to the patient.
▪ Emphasize your actions to the examiner, eg: if the test requires inspection:
demonstrate that clearly to the examiner, you may speak aloud that you are
inspecting for….
▪ Don't wait for the examiner's reaction.
During performing the Examination kindly be sure that the following steps are
fulfilled:
The olfactory nerve
Q: Test the Olfactory Nerve
• Inspection: confirm that the nostrils are clear.
• Use familiar nonirritant substance
• Examine each nostril separately
• Instructions:
1. Ask pt to close his eyes.
2. Introduce the substance close to one nostril while closing the other one.
3. Ask the patient to sniff
4. Q: can you smell?
5. Q: what is this smell?
6. Repeat the same with the other nostril.

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The Optic nerve

Q: Test for visual acuity:
• Inspection: exclude local abnormalities as corneal opacities, cataract, ocular
prosthesis, arcus senilis..
• Don't remove patient's glasses
• Test each eye separately by covering not closing the other eye
• Start by screening via counting fingers at 1m if vision is worse try at closer
distance then examine by hand movement' if no response examine for light
perception
Q: Examine field of vision by "Confrontation Test”
• Screen: that the patient has no visual complaint
• Proper position: The patient & examiner sit at the same eye level, 18-24 inch
apart
• Proper instructions: The examiner asks the pt to fix at the examiner's eye
opposite him and notify the examiner when he sees the target.
• Proper performance: Examine each eye separately: covering one eye, introduce
target(examiner's finger, colored pinhead )midway between examiner &
patient, then bring it slowly from the periphery along various meridians.
Reposition of the hand & repeating of the test (other eye)
The Oculomotor nerve
Q:Examine the Pupils:
• Equality in size (2-6mm) difference not more than 2mm
• Round and Regular
• Reactivity (direct and consensual):
• Light Reflex: Patient is asked to fix at distance (to avoid near reflex) the examiner
directs light from an oblique plane and notice contraction in both pupils.
• Accommodation Reflex: Patient is asked to fix at distance then quickly shifts
to a near target, notice pupil constriction & convergence.
Q: Examine the motility of Extra-Ocular muscles:
A-Inspection: Position of the head, abnormal lid position: ptosis (partial
/complete)….retraction(presence of rim of sclera).

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B- Motility assessment
1. Proper positioning :Ensure a reasonable visual acuity (as examination begins with
assessment of fixation)
2. Proper instructions & performance: a,b,c
a. Ask the pt to follow a target, then examine individual eye movement in the 6
cardinal positions.

b. Examine conjugate eye movement : (add primary gaze, upgaze and down gaze= 9
positions), instruct the patient to indicate if he sees more than one target at any
point.

c. Assess for Pursuit and Saccadic movement:

− Pursuit: ask patient to follow a smoothly moving target held 0.5-1m
away, vertical & horizontal.
− Saccadic: ask the patient to rapidly re-fixate between 2 targets (switch his gaze)
Q: Examine for Nystagmus:
A. Inspection: ask the pt to look in the primary gaze .notice if nystagmus is present.
B. Examine conjugate eye movement: to the right, left, upgaze and down gaze…note if
nystagmus is present then comment on:
-Form: horizontal/vertical/ mixed-Type: jerky/pendular
-Direction (named according to the fast component) & if uni or biderctional

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The Trigeminal nerve

Q: Examine the Motor Functions of the Trigeminal nerve:
A-Inspection: assess the contour of each muscle, any abnormalities
1. Temporalis: in the temporal fossa, superior to the zygomatic arch
2. Masseters: in front the angle of the mandible
3. Pterygoids: ask the patient to open his mouth and notice any deviation from an
imaginary line extending vertically from tip of nose to the upper & lower inter-
incisior notch, ask the patient to move his jaw sideways and to protrude &
retract-his jaw
B-Power assessment:
Temporalis:
• Proper positioning: place your fingers on the Temporalis muscle,
• Proper instructions and performance: ask patient to clench his jaw then
releases feel the contraction of the muscle under your fingers
Masseters:
• Proper positioning: the examiners places his fingers along the anterior border
bilaterally
• Proper instructions and performance: ask patient to clench his jaw the examiner
fingers will move forward.
Pterygoids:
• Proper positioning: the examiner puts one hands under the patient chin and the
other hand fixes the patient's head to avoid neck flexion.
• Proper instructions and performance: ask the pt to open his mouth against
resistance the examiner feels the strength of the muscles
Q: Examine the Sensory Function of the Trigeminal nerve:
1. Proper stimulus: detect pain by wooden stick
2. Proper performance: detect pattern of sensory loss (hemi, nuclear, peripheral
nerve) by comparing both sides, the periphery & central parts, with angle of
mandible

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Q: Examine The jaw reflex:

1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed.
2. Proper positioning: The examiner places his finger horizontally over the chin of
the patient with the mouth midway open and jaw relaxed
3. Proper application of the stimulus: the hammer strikes on the examiner's finger
from above→ downward
4. Notice the response: look at the contracting jaw.
Q: Examine the Corneal & conjunctival reflex:
1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed.
2. Proper positioning:The patient is asked to look faraway from the direction of the
coming stimulus,
3. Proper application of the stimulus : the stimuli is, brought from the side of the
patient and delivered at the upper cornea. Use different pieces of cotton for
each eye.
4. Notice the response: blinking of both eyes.
The Facial nerve
Q: Examine the Motor Functions of the facial nerve:
A. Inspection: Notice: Asymmetry especially at forehead corregations, naso-labial fold,
difference in muscle contour on either side (atrophy/hypertrophy), abnormal movement
B. Power Assessment: Ask the patient to:
• Proper instructions and performance: Ask the pt to:
1. Elevate eye brows: note asymmetry in forehead corrugation
2. Close eyes: note embedding of eyelashes into eyes and symmetry of upper facial
contraction (NB: try to open them with your little fingers if the eye opens the
there is weakness).
3. Grin and retract angles of the mouth exposing his teeth: note and symmetry of
lower facial contraction and teeth on either side.
4. Pull the corners of the mouth down : note the platysma.
5. Others: whistle, puff cheeks, pucker..

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Q: Elicit the Glabellar reflex:

1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed.
2. Proper positioning: The patient is asked to look downwards
3. Proper application of the stimulus : Tap on the glabella from behind of the pt,
repeatedly.
4. Notice the response: repeated blinking that habituates.
Q: Examine the Sensory Function of the Facial nerve:
Testing is limited to taste sensation
− Explain the test and instruct the patient prior starting as he will not be able to
speak during the tests:
− The tongue is protruded and will remain so throughout the test.
− The patient will signal (raise hand) if he can identify the substance tested(10 sec)
− A damp applicator stick dipped into sugar, salt/ lemon, vinegar
− Applied on dorsum of the tongue between ant 1/3 mid 1/3
− Mouth is rinsed between tests
The Vestibulocochlear nerve
Q: Test the cochlear portion of the vestibule-cochlear nerve:
1. Whisper/ watch test: done in each ear, either whisper unpredictable words or
use the click of the watch's hands
2. Rinne Test (tunning fork 128, 256, 512Hz):
− Proper positioning: An activated fork is placed on the mastoid process first then
immediately in front of the ear
− Proper instructions: ask the patient which is louder OR wait till it is no longer
heard at the mastoid then put in front of the ear where it still should be
audible.
3. Weber Test
− Proper positioning: A vibrating tuning fork is placed in the midline of the skull
(vertex/ mid-forehaed)
− Proper instructions: ask the pt if the sound is heard equally.

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The Glossopharyngel and Vagus nerves

Q: Test the motor component of the Glossopharyngeal & Vagus nerves
A. Inspection: ask the pt to open his mouth widenote the palate and uvula at rest (notice
being in the central position),
B. Power assessment:
1. Proper positioning & instructions: ask the patient to open his mouth wide
and ask him to say 'AAA'
2. Proper, performance: notice the elevation of the soft palate, free mobility of
the uvula and its midway position focusing on its root.
Q: Examine the Gag reflex.
1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed.
2. Proper positioning: ask the patient to open his mouth wide
3. Proper application of the stimulus: Touch each side of the soft palate(Rt/Lt)
with a tongue blade.
4. Notice the response: Notice constriction & elevation of the oropharynx.
5. Compare the activity on the two sides.
The Accessory nerve
Tests are limited to the spinal portion of the nerve (2 muscles)
Q: Examine the motor component of the Accessory nerve
Sternomastoid
A. Inspection for: muscle contour, abnormal movement, abnormal head position
(backward), asymmetry.
B. Power assessment:
1. Proper position & Proper instructions:
− with the patient's neck erect, he is asked to turn his head to one side each time.
− ask the patient to bend his neck against resistance to assess both
sternomastoids.
2. Proper performance: examiner applies resistance while palpating the contracting SM.

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Trapezius
A. Inspection for: muscles contour, asymmetry, abnormal position: head bent
forward, shoulder sagging.
B. Power assessment:
1. Proper position &Proper instructions:
a) Pt is asked to shrug his shoulders
b) Pt is asked to abducts his arm >90°
2. Proper performance: examiner applies resistance while the pt performs the
previous movements.
The Hypoglossal nerve
Q: Examine the motor component of the Hypoglossal nerve
A. Inspection: while tongue is inside the oral cavity with torch's light, inspect for
contour (atrophy) abnormalities (eg: fasciculations) & position.
B. Power assessment:
1. Proper position &Proper instructions:
− Ask the pt to protrude tongue notice its midway position along an imaginary line
extending vertically between tip of nose and upper& lower inter-incisors notch.
− Ask the pt to move it sideways and out & in , up & down…slowly then rapidly
2. Proper performance: Palpate the tongue while it is pressing against the inside
cheek

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Motor System Examination

Examination of the Motor functions include:
1. Inspection for: of the muscle contour and the presence of abnormal movement
2. Examination of muscle tone
3. Examination of muscle power
4. Examination of reflexes.
Examination of the muscle contour (to detect presence of atrophy/hypertrophy):
− Inspection: compare for asymmetry by looking tangentially notice for flattening,
hollowing or bulging.
− Palpate: the normal feeling of a muscle is semi-elastic which regain shape when
compressed, hypertrophic muscles may be firm if true or doughy if pseudo.
Atrophic muscles are soft, floppy but sometimes fibrotic & wasted.
− Test: measure the circumference of the muscle from fixed landmarks & compare
both sides.
Examination for the presence of abnormal movement
Inspect for involuntary movement and notice: Rate, Rhythm, Relation to rest/
posture/active movement
Percussion: directly on the muscle to provoke fasciculation/ myotonic phenomenon.
Examination of muscle tone
Q: Assess the tone at the Shoulder Joint
− Ask the patient to relax
− Position: The examiner is positioned behind the patient, placing his hands in
both axillae of pt
− Performance: Shrug the pt's shoulders up & down slowly with complete range of
motion then increase the speed.
− Compare both sides
Q: Assess the tone at the elbow joint.
− Ask the patient to relax
− Position & Performance: Passive flexion and extension of the elbow slowly with
complete range of motion then increase the speed

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− Compare both sides

Q: Assess the tone at the wrist joint.
− Ask the patient to relax
− Position & Performance: Passive flexion and extension of the wrist slowly with
complete range of motion then increase the speed or by shaking up & down.
− Compare both sides
Q: Assess the tone at the at Hip joint
− Ask the patient to relax
− Position & Performance: Roll each extended limb and notice range of movement.
− Compare both sides
Q: Assess the tone at the at knee joint
− Ask the patient to relax
− Position & Performance:
1. Passive flexion and extension of the knee slowly with complete range of
motion then increase the speed...OR
2. The patient sits on the bed's edge and the examiner extends both legs to the
horizontal level then releases them…normally both legs swing with
progressive decline and stops afte6-7 oscillations
− Compare both sides
Q: Assess the tone at the ankle joint.
− Ask the patient to relax
− Position & Performance: Passive flexion and extension of the ankle slowly with
complete range of motion then increase the speed or by shaking up & down.
− Compare both sides

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Q: Examine the power at………

− Proper position:
− Proper instructions for the patient to test the muscle:
▪ Ask the patient to do the movement without applying resistance, if done
successfully repeat it while applying resistance: (either the patient holds a
position & the examiner tries to move it or, the patient tries to move & the
examiner resists). If the patient fails to actively move against gravity, repeat
after elimination of the effect of gravity.
▪ Grade the muscle power (0-5)
− Proper performance: Fix the joint proximal to the tested joint and apply
adequate resistance to assess power (as required).
− Compare both sides.
Principle movements at the shoulder joint:
1. Abduction/Adduction
2. Flexion/Extension
3. Lateral rotation/Medial rotation.
Principle movements at the elbow joint:
1. Flexion/Extension
2. Pronation /supination.
Principle movements at the wrist joint: Flexion/Extension, ulnar/radial deviation
Principle movements at the fingers
Abduction/adduction
Extension/flexion
Opposition of thumb and little finger.
Principle movements at the hip joint:
1. Abduction/Adduction
2. Flexion/Extension
3. Lateral rotation/Medial rotation.
Principle movements at the knee joint: Flexion/Extension

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Principle movements at the ankle joint:

1. Planter Flexion /Dorsiflexion
2. Inversion eversion
Principle movements at the back: Flexion/Extension
Examination for Subtle Weakness: Pronator drift

Reflexes
Deep reflexes (general rules):
1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed, the examiner may distract his attention.
2. Proper exposure to see or feel the contracting muscle.
3. Proper positioning: causing slight stretch to the examined muscle.
4. Proper application of the stimulus:
• Tool: a heavy rubber hammer
• The Strike should be quick, forceful, direct and crisp.
• Hold the hammer near the end of its handle and spin through the finger tips,
acting from the wrist not the elbow.
5. Notice the response, if hyper-reflexia is noted examine for clonus.
6. Compare the response on the two sides.
****** If no response occurs → use reinforcement.
Deep Reflexes in the Upper limb Deep Reflexes in the Lower Limb
Normal 1. Biceps Reflex Normal 1. Knee
2. Brachioradialis Reflex 2. Ankle
3. Triceps Reflex
Pathological Finger Reflex Pathological Patellar
Adductor

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Superficial Reflexes (stimulation of the skin or mucous membranes by light touch or

scratch):
Q: Elicit the Abdominal Reflex:
1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed, the examiner may distract his attention.
2. Proper position & exposure: while pt is supine expose the abdomen from the
level of the nipple till ASISs
3. Proper application of the stimulus: stimulation of the skin by light touch or
scratch directed from outwards inwards: in the upper third →along the costal
margin, in the mid third toward the umbilicus and in the lower third along the
inguinal ligament.
4. Notice the response: contraction of the abdominal muscles, pulling the
umbilicus towards the stimulus
5. Compare the response in the six quadrants.
Q:Elicit the Planter Reflex
1. Explain the reflex to the patient before performing it, to maintain the patient
relaxed, the examiner may distract his attention.
2. Proper position & exposure: while pt is supine, with knee extended, expose
with bare feet till knee
3. Proper application of the stimulus: stimulation of the skin by scratch (different
methods..see book)..eg: Babiniski: stroke slowly the lateral aspect of the sole
starting from the heel stopping at the metatarsopharyngeal joints short of the
base of the Big toe. Avoid too medial scratch (not to provoke grasp reflex)
avoid quick application ( to allow time for the response to occur)
4. Notice the response: planter flexion of the toes
5. Compare the response of both sides
Q: Elicit clonus in the Upper Limb (wrist):
• Proper position: holding the pt's forearm with one hand above the bed
• Proper performance: sudden sustained wrist extention with the other
examiner's hand

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Q: Elicit clonus in the Lower Limb (patella and ankles):

Patella:
• Proper position: pt is supine, the examiner graspss the patella tightly between
his thumb & index
• Proper performance: the examiner displays the patella upwards followed by
sudden, sustained downward displacement
Ankle:
• Proper position: the pt's hip and knee flexed, the examiner supports the leg
with his hand under knee or calf musles..
• Proper performance: grasp the pt's foot and apply passive planter flexion to
the ankle, followed by sudden sustained dorsiflexion
Q: Elicit signs of meningeal irritation in LL (Stretch signs: Brudzinski / Lassegue /
Kernig)
• Proper positioning: pt lies supine, Kernig :pt’s hip & knee flexed and the
examiner extends the knee. Lasseague: pt's LL extended and the examiner
attempts to raise it flexing hip with the knee extended Brudzinski: passive
flexion of one hip
• Examine the other LL.

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Examination of the Sensory System

Superficial Sensations: pain and crude touch
General Rules:
1. Explain to the patient what will be done
2. Ask the patient to close his eyes
3. Demonstrate in an area expected to be normal how the stimulus feels like.
4. Begin Testing by:
− Apply the stimulus
− Ask the patient about the type of the stimulus(don't suggest)
− Ask the patient about its location.
− Continue testing according to the expected pattern of affection
− Compare side to side, distal to proximal
− Repeat to confirm your findings.
5. Some areas are more sensitive than the others as: ante-cubital fossa, neck and
supraclavicular fossa
6. When examining for pain with a pinprick: hold the wood-stick at its very end,
perpendicular to the examined surface, between thumb and finger tips..diseard
after using.
7. When examining for Light Touch use a cotton or tissue and avoid hairy area.
8. Ask in a way to suggest that both are alike not different…if there is different
ask, the patient to estimate its degree eg: if the sensation in the normal =100
pounds then the sensation on the affected side
9. Always proceed from areas of lesser sensitivity to greater.
10.Avoid applying stimuli with short spacing (special summation) or too frequent &
rapid (temporal summation)..better use irregular intervals to avoid anticipation.
Deep Sensation: vibration, movement, position, pressure.
Q-Test for sense of position
1. Explain to the patient what will be done
2. Ask the pt to close his eyes
3. Begin Testing in the Upper Limb at distal inter-pharyngeal joint and in the
lower limb at the metatarsal joint of the Big toe
4. Hold the digit from its sides, pulling the other fingers away from it.
5. Apply as little pressure as possible to eliminate clues from variation in pressure.
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6. Move the joint up and down in tiny increments till the patient is aware of the
movement
7. Ask the pt to identify the position of his joint.
8. Repeat to confirm your findings and check for patient's consistency.
Q-Test for sense of movement:
1. Explain to the patient what will be done
2. Ask the pt to close his eyes
3. Begin Testing in the Upper Limb at distal inter-pharyngeal joint and in the
lower limb at the metatarsal joint of the Big toe
4. Hold the digit from its sides, pulling the other fingers away from it.
5. Apply as little pressure as possible to eliminate clues from variation in pressure.
6. Move the joint up and down in tiny increments till the patient is aware of the
movement
7. Ask the pt to identify whether his joint is moving or not
8. Repeat to confirm your findings and check for patient's consistency
Q-Test for vibration sense (tuning fork 128):
1. Explain the Test to the patient and verify the sense of vibration: you may place
the non-vibrating tuning fork on the pt's bony prominence and tell the pt 'this
is touch', then struck the tuning fork and apply it while vibrating and say to the
pt 'this is vibration’
2. Ask the pt to close his eyes.
3. Sites which may be Tested:
4. In the Upper Limb at distal inter-pharyngeal joint →IP joint →metacarpal heads
→ styloid processes
5. In the lower limb and back/chest to neck: start at the metatarsal joint of the Big
toe → metatarsal heads→ malleoli → tibial tuberousity → ASIS → sacrum →
spinous processes of vertebrae → sternum → clavicle
6. Begin the test at Lower Limb, hold till the pt feels no longer vibrations. Then
move to the next proximal joint if vibration is still perceived then vibration is
impaired and the examiner must proceed proximally till a level that has normal
response is reached.
7. Repeat for consistency
8. Compare with the other side

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Q- Elicit a test to verify Muscle sense

The test is done by applying deep pressure to the muscles eg : squeezing Gastrocnemius
muscle.
1. Explain to the patient what will be done
2. Ask the pt to close his eyes
3. Note that the patient can feel and locate the site of pressure.
Q- Elicit a test to verify Nerve sense
The test is done by applying finger pressure to thesuperficial nerves
1. Explain to the patient what will be done
2. Ask the pt to close his eyes
3. Note that the patient can feel and locate the site of pressure.
NB: Sites of palpation of superficial nerves:
Great auricular n: The patient tums his/her head to one side, thus this steno-mastoid
muscle is stretched, the great auricular nerve courses anteriorly and superiorly across
the muscle towards the earlobe.
Ulnar nerve: The forearm of the patient is bent at 90°-110° over the arm. The
examiner uses his left hand to palpate the right ulnar nerve and vice versa. The nerve
can be palpated first at the elbow in the olecranon groove, between the olecranon
and the medial epicondyle of the humerus. Then it can be felt and evaluated
immediately above the groove.
Radial cutaneous nerve: The radial cutaneous nerve is palpated at the wrist. It can be
rolled under the tips of the examiner's fingers as it crosses the lateral border of the
radius just proximal to the wrist and courses onto the dorsum of the hand. The radial
cutaneous nerve can also be palpated as it rolls round the 2nd metacarpal bone.
Median nerve: The median nerve is felt in front of the wrist when the wrist joint is
semi- flexed, proximal to the flexor retinaculum. It is often easier to see than to
palpate due to the presence (if present) of the tendon of the palmaris longus muscle.

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Lateral popliteal nerve (Common peroneal nerve): The lateral popliteal nerve can be
palpated, with the knee joint semi-flexed, in the popliteal fossa, just medial to the
biceps femoris tendon and, it passes round the neck of as the fibula.
Posterior tibial nerve:The posterior tibial nerve is palpable as it passes posteriorly
and inferiorly to the medial malleolus.

Cortical Sensation
Tactile localization, Tactile discrimination, Stereognosis ,Graphothesis and Perceptual
rivalry.
1. Ensure that superficial & deep sensations are intact (rapid screening).
2. Explain to the patient what will be done
3. Ask the pt to close his eyes
4. Begin Testing for:
− Tactile Localization:apply the stimulus with pin prick and ask the pt to localize
− Tactile discrimination: use compass/ paper clip, 2 types 'static' and 'moving.
The static test involves holding the compass in place for few seconds with
randomly delivering one-point or two-point and the minimal distance that can
be discerned as two is determined as the examiner progressively brings the 2
points closer. The 'moving test' involves drawing the compass slowly across
the area tested and again randomly delivering one-point or two-point.
− Stereognosis: put a familiar object in the palm of the patient's hand and ask
the patient to identify it.
− Graphothesis: use a dull object to write letters/ numbers or shapes on the pt's palm
− Perceptual rivalry: apply 2 light touch/pinprick stimuli simultaneously on 2
homologous sites, on both sides.
5. Compare both sides

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Examination of Coordination
Q: Elicit Finger to nose (detects intention kinetic tremors:
1. Proper instructions: The pt is asked to extend his arm then move it to touch the
tip of the index finger to the tip of his nose, first time slowly then rapidly,
2. Repeat the test with the patient's eye closed.
3. Examined both limbs
Q:Elicit Finger to Doctor's finger test:
1. Proper instructions: pt is asked to touch the tip of the Dr's index finger, the Dr.
may then move his finger and the pt tries to follow it.
2. Examined both limbs
Q:Elicit Finger to finger test :
1. Proper instructions: abduct both arms horizontally, then bring the tips exactly
to touch each other, slowly first then rapidly.
2. Repeat the test with the patient's eye closed
Q:Elicit Heel to knee test :
1. Proper positioning: The pt is asked to raise his leg up, bring his heel exactly on
his knee, and slide it straight down the shin of tibia till the big toe, he may bring
it back to the knee again.
2. Repeat the test with the patient's eye closed
3. Examine both limbs
Q: Elicit Rapid Alternating Movements (RAMs) test:
• Repeated pronation/supination, repeated patting on the thighs, one hand on
the other hand, tapping the foot on the ground
• Compare both sides, NB: note the rate, rhythm and accuracy
Q: Elicit buttoning and unbuttoning test:
• Ask the patient to button and unbutton his uniform.
• Repeat the test with the patient's eye closed

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Q: Elicit the Rebound Test:

• Proper instructions: Ask the pt to : Adduct his arm, flex elbow with forearm
supinated, hand fisting.
• Proper performance: The examiner pulls with one hand on the wrist
attempting to extend elbow with the pt resisting and the other hand protecting
the pt's face, the examiner suddenly releases his resistance and watch for the
pt's response The examiner suddenly releases his pull.
• Compare the other side.
Q:Examine the Stance & Gait
Station:
1. Ask the pt to stand with his feet close to each other→note any swaying →
repeat with eyes closed and ensure to the pt that he is supported by the
examiner's arms standing close to him (Rhomberg Test).
2. Ask the pt to stand on toes then on heels
3. Ask the pt to stand tandem
4. Ask the pt to stand on one foot... repeat with eyes closed.
5. The examiner may give the pt a slight push to detect mild imbalance...front/
back/ sideways.
Gait:
1. Ask the pt to walk spontaneously, check the width of the base and reciprocal
arm swing
2. Ask the pt to walk on toes then on heels
3. Ask the pt to tandem walk.
4. Ask the pt to hop on either foot.
5. Ask the pt to walk briskly , stop on command and make quick turns.
6. Ask the pt to walk sideways.

Good Luck

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