GeNERAL Directions For ADMINISTRATION IMPORTANT: Before starting, examiners should practice the test procedure so they can easily administer the tasks, and record and score the responses. It is important to note that administration and scoring instructions (including age based scoring guidelines) have been updated or clarified from the QNST:3. Please read the directions and review the Record Form carefully to familiarize yourself with these changes. Before beginning testing, the examiner should briefly explain the general nature and purpose of the testing, for example: “We're going to look at how well you can do some simple motor movements,” and briefly answer any questions the Person may have about it. For most examinees itis sufficient to tell them that the Purpose of testing is to determine how well they can move and balance. Detailed explanations are best left until after testing has concluded ‘Once testing begins, do not engage in any casual conversation until the testing, is finished. Attempts by the examinee to engage the examiner in conversation during testing are significant behavioral observations, though, and should be noted on the Record Form. The cover of the Record Form provides spaces in which to record examinee identification information prior to the start ofthe test session. Tasks are scored as they are performed, so the scoring instructions are presented withthe administration directions. Recorpinc Responses ‘As the examinee completes each task, observe for evidence of the listed errors. If errors are observed, circle the corresponding score (1 or 3). Tasks completed correctly, without errors, receive a score of 0. When scoring the QNST-3R it is important not to be overly critical (one does not want to set impossible standards for the examinee), but rather to note any inconsistencies or deficits that could be \dicative of underlying difficulties with perception and/or motor planning and execution. Please note that for Tasks 5, 6, and 10 an additional element (poor left-right discrimination) is documented by checking the box when observed, and then scored in Task 12. Leftright performance differences are also documented for Tasks 2, and 5 through 11, but not scored. Each task has a space for comments, including behavioral irregularities (which are scored in Task 13), and other motor quality or performance problems not scored as errors. Section 3: Administration and Scoring 21SCORING ‘theca score for each task is the sum ofthe error scores, Calculate the ray va tga adminstred and indicat it onthe space provided below the testing is completed, transfer all task raw Scores to the ‘of the Record Form. Information on how to convert aces provided on the front 0 raters to functional categories is provided in Section 4: Interpretation, score for task’s “Score” column, Wher QNST-3R Task INSTRUCTIONS Warm-Up Task: Hand. ‘Purpose: This task provides an op} and make qualitative observations of handedness, grip, and writing qualit and then to write an age-appropriate sentence o give the examiner an opportunity to note reversal portunity to develop rapport with the examinee fine motor skills involved in writing, including 1 The examinee is asked to write his or her name six to eight words, Such sentences Is or poor letter formation ‘Materials needed: © Pen + Back page of Record Form ‘Administration; Remove the back page of the Record Form, and place the blank side of the page and pen in front of the examinee. SAY; “Please write your name right here at the top of this paper.” Provide adequate time for the examinee to write as much of his or her name as possible ‘SAY: “Now I'm going to give you a sentence to write. Try this.” Slowly dictate sentence, such as “He isa big old dog” or “I saw a big pig in the barn.” You may repeat the sentence once, if necessary. Discontinue if the examinee is unable to perform. : This task is not scored. The Record Form provides space for descriptions of hand preference and pencil grip, and observations that might indicate need for vision assessment. ‘Task 1: Figure Recognition and Production umpase: This task assesses visual form recognition and visual-motor skills. The examinee is asked to name and copy a set of five basic shapes. : “: © Pen * Back page of Record Form eet ok Ree eed 22 Quick Neurological Screening Test —3RAdministration: Turn over the back page of the Record Form so that the five figures are visible, and place the form in front of the examinee. SAY: “Can you tell me what this figure is?” Point to each figure until they have all been named. If the examinee cannot name a figure, the examiner may name it but should note the difficulty on the Record Form. SAY: “Now draw them for me.” Give a general indication of placement for the drawings by putting a finger alongside the circle and moving it rapidly down the page. If an examine has questions, such as “Does it have to be the same size?” the examiner’ response should be nondirective, for example, “You can make the figures any way you like; there is no right or wrong way.” ‘iter the drawings have been completed, ask the examinee to identify any differences between the Record Form figures and his or her own drawings. SAY: “Can you tell me some differences between this figure and the one you drew?” Point first to the presented figure and then to examinee’s reproduction. Observational considerations: The following should be noted in the Task 1 Comments: * Ifthe examinee has dificulty visualizing and verbalizing any differences between the figures shown and his or her reproductions, * Ifthe examinee exhibits delays or confusion in naming the figures. * Ifthe examinee uses unusual approaches to pattern reproduction, such as feathered lines, or lack of consistency in directionality (sometimes draws clockwise and sometimes counterclockwise) Score | Criteria (0_| Tasks completed correctly without enor. 1_| Examine names fewer than five figures. ¢. [1 _| Arranges figures horizontally across the page does not draw each next to example) 4. | _1_| Draws extremely quickly or carelessly, or unusually slowly and cautiously. @. | 1 | Size of drawings difers greatly from examples (about half the size or twice as large) orf drawings are extremely regular. % | 1 | Turns the paper to an unusual angle or rotates paper more than 35 degrees while drawing ‘OR completes figure by turning oF moving the paper instead of moving the pen. Consistently angles figures tothe left or right. Talks self through the motor actions to complete the drawing, Poor closure (gaps or significant overlap where lines should meet) in one or more figures. See examples in Figure 3.1 eee eee ‘Age 10 or over: Poor angle execution (corners are rounded, flattened, or ‘dog eared). See ‘examples in Figure 3.1 Tremor or visible shaking when drawing any straight line. Section 3: Administration and Scoring 23FIGURE3.1 Closure and Angle Execution Ov eal a Abnormal Closure ‘) o Normal Closure Normal Angle Execution Abnormal Angle Execution 24 Quick Neurological Screening Test—3R _Task 2: Palm Form Recognition Purpose: This task assesses graphesthesia, the ability to use the sense of touch to interpret writing or drawing on the skin. The examinee is asked to identify, solely by fee!, numbers drawn upside dawn on the palm of each hand. ‘Materials needed: + Eraser end of pencil, pen cap, or finger Administration: NOTE: I the examinee is 8 or younger, the examiner frst asks the examinee to write the numerals one (1) through nine (9) on paper to be sure the examinee knows them. Thisalso allows the examiner tonote any idiosyncratic numeral formation (e.g, 4for 4). This procedure is alsa useful with anyone (regardless of age) if severe disability is suspected. Ifthe examinee does not know all the numerals, this task should not be administered. Have the examinee place both hands, palms up, on the respective knees and then close his or her eyes. SAY; “I'm going to write some numbers on the palm of your hand. This will be the top (touch part closest to wrist) and this will be the bottom (touch part closest to fingers)” Use the word “number" rather than “numeral” to make sure the examinee understands the directions. “Close your eyes and see if you can tell me what number I’m writing. What number is this?” Using the forefinger, pen cap, or eraser end of a pencil: + write the numerals 3, 9, 5, and 7, one at a time and in that order, in the examinee’s right hand; «write 2, 8, 4 and 6, one ata time and in that order, in the examinee’s left hand. ‘The prompt may be repeated with each new numeral presented. The examinee is to identify each numeral at the time it is presented. The examiner should use the ‘examinee’ idiosyncratic numeral formations in this task. Observational considerations: The following should be noted in the Task 2 ‘Comments: ‘+ Ifthe examinee displays unusual reactions to touch, such as pulling away, rubbing, or complaints about tickling LR difference: If the examinee has a significant difference in performance between right and left hands, check the box “Note L-R difference” for Task 2, Section 3: Administration and Scoring 25a.| 0 [Taskis completed comectly, without erors b. | 1 _| Requests more than one repetition of any number. 1__| Responds with letter instead of number. 1._| Does not recognize presented number. Nort blind, this task should not be administered, = IF there is any known vision impairment or if the examinee is legally Purpose: This task assesses ocular smooth pursuits, the ability to smoothly track moving object. The examinee is asked to track a moving pencil in vertical and horizontal planes without moving his or her head. Materials needed: + Pencil with eraser Eve Preference: Eye preference is checked by asking the examinee to hold a rolled sheet of paper with both hands as a “telescope” to sight on a doorknob or other object. The preferred eye is the one used to look through the tube. Note eye preference in the space provided on the Record Form. ‘Administration: Hold the pencil, eraser end up, at the examinee’s eye level, about 18 inches directly in front or his or her midline. SAY: “Follow this with your eyes.” Point to the eraser end of the pencil: * First move the pencil in a shoulderwide, straight horizontal motion bback and forth at least four times, and observe the smoothness of the examinee’s eye movements. The pencil should be moved at a rate that keeps pace withthe natural rhythm of the examinee’s eye movements. Next, move the pencil once horizontally, but stop at midline. Then move the pencil up and down vertically, again stopping at midline (i.e., do not continue the vertical movement downward past midline), Note whether the examinee’s eyes stop when the pencil stops, or if they continue moving before coming back to refocus, ‘+ Finally, move the pencil in a strai least four times, movements If the examinee moves his or her head instea the pencil, make no initial correction, Note the pro movements with the following directions to check eye tracking ight vertical motion up and down at ‘and again observe the smoothness of the examinee’s eye id of eyes alone when following Hblem, and then re —.. Ke 26 Quick Neurological Screening Test—3R (a‘Score | Criteria SAY: “Hold your head still and let just your eyes follow the pencil.” It is acceptable to caution a distractible yee who cannot focus on the stimulus and whose eyes dart to other objects in the room by saying, “Watch the pencil.” If the prompt needs to be repeated, note this as a behavioral observation in the Task 3 Comments. Observational considerations: The following additional observations should be noted in the Task 3 Comments: * If the examinee demonstrates problems visually crossing the midline, including losing focus at midline or noticeable visual jumps or bobbles when crossing midline. + Ifthe examinee overshoots the visual target when it is stopped at midline and has trouble refocusing. + Ifthe examinee is only able to visually focus with one eye (the other eye appears to drift or is clearly not focused on the target) “Task is completed correctly, without errors. ‘Moves head while tracking. Jerkiness or other abnormal eye movements with horizontal tracking. Jerkiness or other abnormal eye mavernents with vertical tracking Inability to visually fixate on target or distractability interfering with tacking Task 4: Sound Patterns NOTE: If there is any known hearing loss, this task should not be administered. Purpose: This task assesses the ability to motorically and vocally reproduce a series of sound patterns. It provides an opportunity to evaluate auditory short-term memory and rhythmic awareness. Administration: Motor Sequence Sit ata table facing the examinee. Place your hands palms down on the table and instruct the examinee to do the same. NOTE: If the examinee is 8 or younger and fails to execute the task successtully, ask the examinee to reproduce the sounds by clapping both hands together, as demonstrated by the examiner. Then score only on the lapped responses. There is no penalty for initial errors in this case Section 3: Administration and Scoring 27ing, my hands on the 2 SAY: “I'm going to ake Cori yer? Sabot oad table. | want you to watch me and listen. sag will always tag the table. Sometimes I wil stop and start again’ Denials by using both hands to tap out any sequence for practice, such 25 ps, 1-second pause, 3 taps) or 2 ~4 (2 taps, 1-second pause, 4 taps). SAY; “When I'm finished, I want you fo make the same pattern I made, Do you understand? Try one with your eyes open.” Tap 2 2 2 pattern with both hands. “Now close your eyes and listen to the pattern | make. When I’m Srshed, VI say, ‘OK, now you do it’ Listen.” Tap a 1 ~ 3 pattern with both hands and then ‘cue the examinee to repeat the pattern with eyes closed. Now present the first pattern below and continue until all four have been presented. The examinee's eyes should be closed for each pattern. During the first three patterns, the taps should all be atthe same rate. The last pattern is a rhythmic “door knocking” sequence (i.e., “shave and a haircut, two bits”), and includes both long and short tap patterns. For each pattern the examinee correctly repeats, place a check in the box provided on the Record Form, You can caution the examinee with “Wait” or “Listen” if he or she begins too soon. This is the only case where itis allowable to repeat the demonstration of the pattern, * 2-1-2. taps, 1-second pause, 1 tap, 1-second pause, 2 taps) ae © 3-1-2-3 ‘+ Rhythmic sequence (long, short, short, long, long, pause, short, short) Oral Sequence Present sound pattems orally saying the word “dot” in the same patterns used for the motor presentation, The examinee’s eyes should be open for this task. For each pattern the examinee correctly repeats, place a check in the box provided on the Record Form. Observational Considerations: The following should be noted in ‘Comments: ioted in the Task 4 + Ifthe examinee repeats sound patterns but does not meet the criteria for the 3-point “perseverates” error. + Hfthe examinee does notwaltto star until the sound patter i completed 28 Quick Neurological Screening Test—3R aScore | Criteria a. [0 [Tasks completed correctly, without errors. b. | 1 | Misses only one motor sequence. if two or more motor sequences are missed, do NOT score this error. Score the 3-point error (element i) below. | 1 | Unusal mode of reproduction, such as alternating hands while tapping, using one hand, or lapping hands (ages 8 and over). 1. | Misses only one oral sequence. iftwo or more oral sequences are missed, do NOT score this error. Score the 3-point error (element j below. e.| 1. [Speech or voice irregularities, such as lisp, staccato delivery, or extreme monotone. Describe in Comments. 4. | 1_[Visibly distracted by environmental noises & | 1 _[ Reverses all or pat ofa pattern, th. |_1._ [Successful only withthe final rhythmic pattern in either mode. i. | 3. | Misses two or more motor sequences. If this error is scored, do NOT score the 1-point error (element b) for missing ane motor sequence, i. [ 3. | Misses two or more oral sequences. If this error is scored, do NOT score the 1-point error (element d for missing one oral sequence. | 3 | Perseverates (produces a sound pattern more than two times) on atleast two patterns in oral andlor motor modes. If pattern is repeated only once, or if there is perseveration on only ‘one pattern, do not score this eror but note in the Comments ‘Task 5: Finger to Nose ‘Purpose: This task assesses kinesthetic awareness, anti-gravity motor control, and, left-right discrimination skills The examinee is asked to touch a finger to his or her nose and then the examiner's hand in a repeating pattern, with eyes closed ‘Administration: Sit facing the examinee with feet flat on the floor and instruct the ‘examinee to also sit with feet flat on floor. Hold up your right hand with the index finger extended, SAY: “Hold up this finger.” Do NOT say “right” or “left,” as this task is a check of the examinee's left-right discrimination. +The examinee should hold up the right hand. If the examinee holds up the left hand (mirroring the action), check the box “Exhibits poor L-R discrimination” for this task, but do NOT make any verbal correction, SAY: “Touch the tip of your nose like this.” Demonstrate the action by touching the tip of the examinee’s nose with your right index finger. Now hold up your left hand with palm open, at army’ length in front of the examinee. “Now reach out and touch the palm of my hand. Keep going back and forth.” Demonstrate how the ‘examinee should go back and forth between the tip of the nose and the palm, “Find Section 3: Administration and Scoring 29(pause) Now close both eyes and keep vee continue with the action for ive 2e repeats the action Your way with your eyes open, if you like. i ” examin going until | tell you to stop.” Let the exam nt or six repetitions. “Now do it with your other hand.” Examine five of six times with the other hand. Observe the path of the examinee's movements and note the cbesned in hich the examinee's hand wanders in space, the rate and accuracy W" which Thovcraminee finds the tip of his or her nse, and the steadiness of the examinees deeaer or temors at rst or during the final part ofthe movement Also nate any unusual posturing of body or extremities, such a8 an elbow kept flexed or the wuhole body rocking forward when the examinee reaches to fouch the examiners hand. Observational considerations: The following should be no! ‘Comments: ted in the Task 5 © Ifthe examinee is successful only if the hand or arm is held in a certain ‘unusual position. + Ifthe examinee gets better with practice. + If the examinee performs noticeably better hand). LER difference: if the examinee has a significant difference in performance between right and left hands, check the box “Note L-R difference” for Task 5. with one hand (note which (0 _| Tasks completed corecty, without errors. [1 [Motions are unusually fast or slow: cc. | 1 [Moves hand consistently to right or left of target in space (examiner's hand). Moves hand consistently to top or bottom of target in space (examiner's hand). Misses tip of nose by 1/2 to 1 inch, ‘Misses tip of nose by more than 1 inch, SEG Random or unsteady contral of movement. ‘Task 6: Thumb and Finger Circle Purpose: This task assesses fine motor coordination, proprioceptive awareness, and leftright discrimination skills. The examinee . 2 is a mci the thumb to each of the fingers in sequence. Sop om eles by waiting ‘Administration: Sit facing the examines >aminee with feet flat on the floor ‘examinee to also sit with feet flat on floor, Hold up your aut a EEE 30 Quick Neurological Screening Test—3R _—dSAY: “Make a circle with your thumb and forefinger. Watch me first. ! want ‘you to touch each finger fo your thumb and go down the line. Then start over and keep doing it while I watch.” Demonstrate three times at a rate of one complete sequence every 4 to 5 seconds, starting with the index finger and ending with the litle (pinky) finger. Repeat “Start over” at least once. While demonstrating, the examiner may have to caution an impulsive examinee with “Wait until I finish.” Do NOT indicate which hand the examinee should SAY: “OK, now you di use. **The examinee should hold up the right hand. Ifthe examinee holds up the left hand (mirroring the action), check the box “Exhibits poor L-R discrimination” for this task, but do NOT make any verbal correction, The examinee should continue until all observations are made, through three sequences. SAY: “Now do it with your other hand.” The examinee again repeats the movements. Stop the examinee after three sequences. Observational considerations: The following should be noted in the Task 6 ‘Comments: + Ifthe examinee gets better with practice. + Ifthe examinee tires easily and performance deteriorates, LR difference: Ifthe examinee has a significant difference in performance between right and left hands, check the box “Note L-R difference” for Task 6. Criteri Task is completed correctly, without errors. al] o wb. [1 [Reverses patter at least one time, stating with litle inger and ending with forefinger. ‘c. |_1_| Overflow or mirror movements, even sight in fingers of opposite hand. &] 1 [Makes fat, small, o incomplete circle with thumb and fingers. See examples in Figure 3.2. @. | 1 [Able to complete task only if hand is directly in front and tured toward self; concentrating intently and body tense. . |_3_| Excessive body movement or twitching on opposite side. &: [3 _| Skips finger in sequence or shows confusion about next finger atleast two times Section 3: Administration and Scoring 31FIGURE 3.2 Thumb and Finger Closures Normal thumb and finger circle Abnormally Nat circle — wT v rea Incomplete circle closure Small circle and tense position Rapidh Sm Task Purpose: This task assesses diadochokinesis, the ability to make rapid alternating movements. The examinee is asked to rapidly pronate and supinate both forearms simultaneously. ‘Administration: Sit facing the examinee with feet flat on the floor and instruct the examinee to also sit with feet flat on floor. SAY: “Put your hands on your knees like this and watch me.” Demonstrate by rotating hands from prone (palms down) to supine (palms up) position, slowly at first, and then rapidly. SAY: “Now you doit. Turn your hands over and back, over and back, slowly. Now I want to see how fast you can do it” The examinee repeats the movements for atleast 8 seconds, Do not comment on the correctness or efficiency ofthe performance. ttmay be necessary t0 ask the examinee to “keep going” for a few exta seconids to obsene any subtle motor dysfunction. i 32 Neurologic ning T 3Observational considerations: The following should be noted in the Task 7 Comments: ‘+ If there is twitching or unusual finger motions, particularly if noted in only one hand + Ifthe examinee tires easily and performance deteriorates. + Ifthe examinee cannot mi tain a steady rhythm, LRadifference: If the examinee has a significant difference in performance between Fight and left hands, check the box “Note L-R difference” for Task 7. Score | Criteria a. | 0 | Taskis completed correctly, without errs b. | 1 [Floppy rotation oF unusual finger motion. c. |__| Rapid, careless motions, or overly slow, cautious, and mechanical motions. | 1 _[ Rigid or tense finger position and double hand bounce, e| 3 | Very large (1 foot in diameter) circular motions £. | 3. | Asymmetry during rotation hands not moving exactly together). This is easiest to observe by watching the position of the thumbs relative to each other Purpose: This task assesses proprioceptive processing and the ability to sustain muscle contraction and antigravity posture. The examinee is asked to maintain arms, legs, and tongue extended with eyes closed. The examiner has the opportunity to observe muscle tone and to assess for tremor. ‘Administration: Sit facing the examinee and instruct the examinee to also sit SAY: “Watch me first, then I will help you. Keep your back from resting against the chair. Then put your feet straight out like this. Now put your arms straight out, palms down, and spread your fingers just as wide as you can. Then Vill ask you to close your eyes and stick out your tongue like this.” Demonstrate, holding the position for a few seconds. SAY: “Vl ask you to stay that way for about 30 seconds while 1 check everything,” With a young child, offer to assist him or her step by step, SAY: “Pat your feet out. Now put your arms out.” Fell the examinee what will happen next, so as not to startle him or her. SAY: “I’m going to touch your arms here (point to the examinee’s upper arm) and your legs here (point to the calves) andl your fingertips (point to them). Now ‘close your eyes. Stretch your fingers as wide apart as you can. Keep your back Section 3: Administration and Scoring 33from resting against the chair, Now stick out your NBU6 and stay that way while Took at everything.” Check arms and calves for mi ruse tone, and touch fingertips lightly to check “i observations, remind the examinee to for tremor. If necessary to complete maintain the directed position. Observational considerations: The following should be noted in the Task 8 Comments ether is twitching or other unusual movements of body, hands, head) or tongue «ifthe examinee Is unable or unwilling to keep eyes closed for duration of task LER difference: Ifthe examinee has a significant diference in performance between right and left sides ofthe body, check the box *Note L-R difference” for Task 6 _ Ln nee Score | Criteria (0 _| Task is completed correctly, without errors. 3 | Small, random involuntary movements (not temo in fingers, tongue, limbs, or head. This type of movements less regular and even, and may be more observable than tremor ‘unusually taut and rigid (this may be | 3 | Hypertonia or hypotonia. Hypertonic muscle are sn held in extension, dificult to detect). Hypotanic muscles are flabby and soft, even wher ‘Unable to hold extremities in extended position. Extremities drift toward the floor. ‘Unable to hold body position. Trunk and head move forward involuntarily. If scoring this error do NOT also score for extremity drift (element d). & | 3 | Unusual finger postion. See examples in Figure 3.3. & |_ 3 [Weistalip. See example in Figure 3.3. [ Observable tremor or twitch. 34 — Quick Neurological Screening Test—3RFIGURE 3.3 Normal hand position Normal hand position Waist dip Unusual finger position Severe clawing of Fingers Clawing of Fingers ‘Task 9: Tandem Wall, ‘Purpose: This task assesses balance, motor planning, and kinesthetic awareness. ‘The examinee is asked to walk for 10 feet heel-to-toe in a straight line forward and, backward, with eyes open, and then forward with eyes closed. Administration: SAY: “Pretend there is a straight line here and walk along it. | want you to. watch me, and then I'l watch you. Put your heel against your toe and stay on the line” Demonstrate while talking SAY: “OK, now you do it” Observe the examinee. SAY: “Now walk backward the same way.” Observe the examinee. SAY: “Now walk forward with your eyes closed.” Observe the examinee. Section 3: Administration and Scoring 35 edObservational considerations: The following should be noted in the Task 9 Comments: If the examinee tires easily and performance deteriorates. the examinee gets better with practice. Ifthe examinee uses irregular or unusual hand positions. Hf the examinee is unable or unwilling to keep eyes close’ task 1d for duration of LR iference: the examinee has a significant difference in performance between right and left sides of the body, check the box “Note L-R difference’ for Task 9. Score | Criteria o Task is completed correctly, without errors. Noticeably more difficulty walking backward than forward (with eyes open). Noticeably more dificulty walking forward with eyes closed. Irregular hand position, such as when one hand curls in and one curls out Crosses midline or veers to one side (left or righ Cannot maintain heel-to-toe walk. Talks wide steps or steps on own toes. Pigeon-toed (toes pointed toward each other, not straight ahead) and bent knees. Fle ||? |? / F | Poor balance or difficulty maintaining upright posture. Involuntary movements not related to maintaining balance. ‘Task 10: Stand on One Leg Buurpase: This task assesses balance and left-right discrimination skills. The examinee is asked to balance on each foot for 10 seconds, first with eyes open and then with eyes closed. SAY: using the “I want you to stand on one foot while | count to 10.” Demonstrate, Fight foot first, but do NOT use the words right or let. Count aloud while the examinee stands on one foot **The examinee should balance on the right foot. Ifthe examinee balances on the left foot (mirroring the action), check the box “Exhibits poor L-R discrimination” for this task, but do NOT make any verbal correction, SAY: ““Now stand on your other foot while I count to 10.” Count aloud while the examinee stands on one foot. SAY: “Now close your eyes and stand on your other foot again while 1 count to 10.” Count aloud while the examinee stands on one foot, 36 — Quick Neurological Screening Test—3RObservational considerations: The following should be noted in the Task 10 Comments: * If there is observable weakness or tremor, * Ifthe examinee is unable or unwilling to keep eyes closed for duration of task, LR difference: If the examinee has a significant difference in performance between right and left sides of the body, check the box “Note L-R difference” for Task 10. Score | Citra 2 |_0 [Tsk completed covey witout eno [1 Poor balance c.| + [Unable to do wit ees dosed &| + | Seiten aiferece in abilty to sand on one fot compre othe eer Note which fot is more difficult, a © | 1 | Balances by anual posturing hooking aed oo behind oposite er bacing Ia opt Task 11: Skipping Purpose: This task assesses balance, motor planning, and bilateral coordination, The examinee is asked to skip across the room. Administration: SAY: “Skip across the room for me.” Demonstrate forall ages. If individuals are shy about skipping, the examiner can SAY: “Skip across the room, like athletes do in training.” ‘Observational considerations: The following should be noted in the Task 11 Comments: + Ifthe examinee tires easily and performance deteriorates. + Ifthe examinee gets better with practice. + Ifthe examinee uses irregular or unusual hand positions. LER difference: If the examinee has a significant difference in performance between right and left sides of the body, check the box “Note L-R difference” for Task 11 Section 3: Administration and Scoring 37 aa] 0 [Tasks completed conectly, without erors b.| 1 [Poor balance. c.]_1_ [Clumsy skipping o takes multiple extra steps. a. | 1 _| Skipping is asymmetric, Hops oF skips on only one foot. 3_| Age 8 or over: Unwilling o attempt or unable to perform task Task 12: Left-Right Discris This section is scored using performance from three other tasks (5, 6, and 10). Scores are determined by observing whether the examinee holds up the right hand when the examiner uses the right hand to demonstrate Finger to Nose (Task 5) and Thumb and Finger Circle (Task 6), and whether the examinee mirrors the leg stance demonstrated by the examiner for Stand on One Leg (Task 10). Each of these poor left-right discrimination responses should be scored as 1. ‘Task 13: Behavioral Irregularities This final task is scored from general observations of the examinee’s behaviors | during the entire test session. After the examinee leaves, the examiner should record any behavior that seemed out of the ordinary during any of the tasks. In addition, the following motor anomalies should be noted in the Comments section | of the Record Form: ‘+ Poor motor planning isnoted when the examinee cannotimplement motor acts or cannot visualize and then imitate the examiner's demonstrated activity, such as during Tandem Walk (Task 9) and Skipping (Task 11). * Poor ability to sequence should be noted when the examinee uses reversals on Sound Patterns (Task 4) or has difficulty with Thumb and Finger Circle (Task 6) ‘+ Poor rhythm sense can be noted when the examinee cannot perform the rhythm sequence in Sound Patterns (Task 4) or moves in a generally jerky, non-flowing way. 38 Quick Neurological Sereening Test—3R eescore | Gr ‘a |_0 | No behavioral iregularities noted. b. | 1 | Unusual behaviors, including (but not limited to) hair twisting, scratching, racking, excessive gesturing, and excessive mood swings. | 1 | Perseveration across multiple tasks. Repeated, persistent or compuslsive behavior or continued performance of tasks or focus on a topic when it was no longer appropriate Do NOT score here if perseveration only seen during Task 4, Sound Patterns. | 1 | Talks excessively. fe | _1_| Social withdrawal #. [1 [Fidgeting or excessive touching & | 1 | Defensiveness (such as frequent explanations or excuses for performance, or declarations about how well the examinee is doing) or anxiety beyond the frst task (for example, ongoing excessive concern about performance or unwillingness to attempt tasks with eyes closed). bh. | 1 | Excitability, distractibility, or impulsivity, such as poor attention span and starting tasks before the examiner has finished demonstrations. Motor Observation Leftright differences can be observed on Tasks 2, and 5 through 11. Observe and compare how the examinee uses one side of the body versus the other side. Record the number of tasks for which left-right difference were identified. If the examinee has considerably more difficulty on one side than on the other, or if the two sides perform very differently, this should be described in detail in the Comments. Section 3: Administration and Scoring 39