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How engaged and oriented is the patient to the presenting
concern? Is he or she able to articulate and speak coherently? Does
the speech have regular rate and prosody? Do there appear to be
any language comprehension difficulties? What is the mood and affect
of the patient? Does he or she make good eye contact?
Is the face symmetric, and is the patient able to demonstrate
a good range of facial expression? Is there any eyelid or facial
What is the sitting posture of the patient? If the
patient moves around during the interview, does there appear to
be any asymmetry? Are there any extraneous movements, such as tics
or choreiform movements? Can he or she get up and down from the
chair without using the armrests (i.e., good proximal muscle strength)?
Does the patient have a high-stepping gait, sometimes
seen in sensory neuropathies (Friedrich's ataxia, vitamin
Are there any tremors or clumsiness noted during the
Is there any toe walking (a potential sign of lower
extremity spasticity) or asymmetry of arm swing while walking (a
potential sign of mild limb paresis)?
Character of weakness
Spastic paralysis with hypertonia
Flaccid paralysis with hypotonia
Accompanying encephalopathy, developmental delay, intellectual disability,
Asymmetric if due to cortical lesion
Decreased or absent
Babinski reflex positive
Babinski reflex not present
Fasciculations and fibrillations
Note. DTR = deep