Table 5.6.

Modifications in neurological examination if severe cognitive impairment is present

Test	Original method	Modification
Visual fields	Count fingers	Detect hand motion or blink to threat
Eye movements	Track examiner’s finger	Track examiner’s face or patient’s own finger
Strength	Resist movement of examiner	Maintain limbs in antigravity position after release
UMN screen	Pronator drift	Symmetry of arm rolling
Proprioception	Detect joint movements with eyes closed	Train on task with eyes open first and/or perform Romberg
Lower extremity coordination	Heel-knee-shin	Toe to examiner’s finger