General Scoring Considerations:

In the form below, green highlights indicate normal findings, yellow highlights indicate abnormal findings that do not necessarily have functional significance, whereas red highlights indicate abnormalities that are expected to have functional significance for the child. An abnormality with functional significance would be an impairment that has an impact on the child’s daily function and/or is associated with significant developmental delay (e.g., not walking at 24 months), and/or requires therapy such as physical therapy or treatment with medicine or surgery (e.g., Botox or baclofen for spasticity; eye patch/surgery for esotropia). When the scoring criteria for normal versus abnormal status vary at different ages for particular exam findings, the color coding at 6 months is used, but scoring differences at 12 and/or 24 months are marked with an asterix and explanatory note. The categories of “can not assess (CNA)” were excluded from analysis. Findings noted in the category “Other” were examined on a case-by-case basis to determine whether the findings were normal or abnormal.

Categories of Abnormality

Abnormalities on the neurologic exam form were grouped as follows:

Head circumference:

Mental status: arousal status: question 6

Cranial nerves: Any definite abnormality of cranial nerve function-section C

Hearing and vision, questions 10, 11, 12, 13, 20

Posture and tone: questions 21, 24, 30, 36, 40, 43, 44, 45, 46, 50, 53, 54, 55, and 56

Strength: questions 22, 23, 28, 34, 41, 51

Deep tendon reflexes: questions 31, 37, 47, 57

Gait: question 59

Primitive reflexes: questions 60, 61, 62, 63, 64, 65, 66

1.	Date of the Neuro Exam

2. Exam conditions:

Good	Fair	Poor, reason _______________

A. CRANIUM

3. Head Circumference (corrected for age):

Percentile
< 2%
2-25%
26-50%
51-75%
76-98%
>98%
CNA, specify __________________

4. Cranial Shape

Characteristic
Normal
Abnormal, specify_______________

5. Fontanel / Sutures

Characteristic
Flat
Sunken * Abnormal at 24 mo
Bulging
Closed * Normal at 12 and 24 mo
Sutures separated
CNA, specify __________________
Other, specify __________________

B. MENTAL STATUS

6. Arousal Status

Description
Awake/interaction sustained/quiet	Eyes closed / not open to pain, purposeful withdrawal
Awake/ crying	Eyes closed / stereotypic posturing to pain (decerebrate/decorticate)
Awake / interaction transient	Eyes closed / no response to pain (nail bed pressure)
Eyes closed / self-rousing	CNA, specify ______________________
Eyes closed / sustained open to pain	Other, specify ______________________
Eyes closed / not sustained open to pain

C. CRANIAL NERVES

7. Eye Position, Check all that apply

Characteristic
Normal
Gaze preference ………………	If yes, check all Left Right that apply Superior Inferior
Esotropia………………………	If yes, check one Left Right
Exotropia………………………	If yes, check one Left Right
Hypertropia……………………	If yes, check one Left Right
Hypotropia…………………….	If yes, check one Left Right
CNA, specify _______________
Other, specify _______________

8. Eye Movements

Characteristic
Normal / complete……………………….	If yes, skip to question 10
Abnormal / incomplete
CNA, specify ______________________
Other, specify ______________________

9. Extraocular Muscle Palsy, Check all that apply

Characteristic
No palsy present
Palsy present III nerve: ………………….	If yes, specify Left Right
Palsy present IV nerve: ………………….	If yes, specify Left Right
Palsy present VI nerve: ………………….	If yes, specify Left Right
CNA, specify __________________
Other, specify __________________

10. Vision

Characteristic
Fixes / follows
Fixes / not following
Blinks to threat
Blinks to light
No blink to light
CNA, specify __________________
Other, specify __________________

11. Visual Fields

Characteristic
Normal
Abnormal ……………………….	If yes, specify Right Left abnormal quadrants Superior Inferior
CNA, specify _______________
Other, specify _______________

12. Pupils

Characteristic
Normal
Unequal / unreactive
…If yes, specify larger: Left Right and, specify unreactive: Left Right
Unequal / reactive
…If yes, specify larger Left Right
Equal / unreactive
CNA, specify _______________
Other, specify _______________

13. Fundi

Characteristic
Normal
Papilledema
…If yes, specify Left Right
Optic atrophy
…If yes, specify Left Right
CNA, specify _______________
Other, specify _______________

14. Facial Movement

Characteristic
Normal
Weak Symmetric
…If yes, specify lesion LMN UMN
Weak Asymmetric
…If yes, specify lesion LMN UMN and specify Left Right
CNA, specify __________________
Other, specify __________________

15. Facial Sensation (touch or pin-prick)

Characteristic
Normal
Decreased / absent
…If yes, specify Left Right
CNA, specify __________________
Other, specify __________________

16. Tongue

Characteristic
Normal
Weak …………………………	If yes, specify Left Right and, fasciculations Yes No
CNA, specify_________________
Other, specify ________________

17. Palate (spontaneous movement or response

to gag reflex test)

Characteristic
Normal
Weak , if yes, specify : Left Right
CNA, specify __________________
Other, specify __________________

18. Suck

Characteristic
Normal
Present but weak
Present but with incoordinate swallowing
Absent
CNA, specify __________________
Other, specify __________________

19. Jaw Jerk

Characteristic
Absent
Present
Present with clonus
CNA, specify _________________
Other, specify __________________

20. Hearing (response to whisper/bell as appropriate for age)

Characteristic
Responds age appropriately to stimulus
Decreased response to stimulus
…If yes, specify Left Right
No response to loud clap
CNA, specify __________________
Other, specify __________________

D. MOTOR SYSTEM: TRUNK

If yes, specify. Check all that apply torticollis scoliosis kyphosis other, specify _____________ 21. Trunk Posture

Characteristic
Normal
Abnormal……………………………
CNA, specify ________________

22. Trunk Strength

Trunk Flexor (pull-to-sit / to resistance)

Characteristic
Normal
Weak
None
CNA, specify _______________________
Other, specify _______________________

23. Trunk Extensor

(ventral suspension / to resistance)

Characteristic
Normal
Weak
None
CNA, specify __________________
Other, specify __________________

24. Trunk Tone

Characteristic
Normal
Hypotonic
Hypertonic-spastic
Hypertonic- rigid
Dystonic
CNA, specify __________________
Other, specify __________________

If yes, specify type. Check all that apply chorea athetosis myoclonus choreoathetosis ballism tremor 25. Trunk Spontaneous Movement

Characteristic
Normal
Decreased
Absent
Dystonic
Dyskinetic…………………………..
Ataxic
CNA, specify ________________

26. Trunk Sensation

Characteristic
Normal response to light touch
Normal response to pin-prick, not light touch
Responds to deep pain only (nail bed pressure), other than stereotypic
No response to deep pain (nail bed pressure)
CNA, specify __________________
Other, specify __________________

E. MOTOR SYSTEM: EXTREMITIES

27. Right Arm: Overall

Characteristic
Normal…………………………………	If yes, skip to question 33
Abnormal

28. Right Arm Strength:

Characteristic
Normal
Antigravity plus resistance………..	Proximal > Distal
Antigravity………………………....	If yes, specify Proximal = Distal Distal > Proximal
Movement not antigravity…………
No movement
CNA, specify __________________
Other, specify __________________

29. Right Arm Spontaneous Movement:

If yes, specify type. Check all that apply chorea athetosis myoclonus choreoathetosis ballism tremor Characteristic
Normal
Decreased
Absent
Dystonic
Dyskinetic……………………………
Ataxic
CNA, specify __________________

30. Right Arm Tone

Characteristic
Normal
Hypotonic
Hypertonic – spastic
Hypertonic – rigid
Dystonic
CNA, specify __________________
Other, specify __________________

31. Right Arm Reflexes

Characteristic
Present / normal
Absent
Present / depressed
Hyperactive
Clonus, 3 or more beats
CNA, specify __________________
Other, specify __________________

32. Right Arm Sensation

Characteristic
Normal response to light touch
Normal response to pin-prick, not light touch
Responds to deep pain only (nail bed pressure), other than stereotypic
No response to deep pain (nail bed pressure)
CNA, specify __________________
Other, specify __________________

33. Left Arm: Overall

Characteristic
Normal………………………………..	If yes, skip to question 39
Abnormal

34. Left Arm Strength:

Characteristic
Normal
Antigravity plus resistance…………	Proximal > Distal
Antigravity…………………………	If yes, specify Proximal = Distal Distal > Proximal
Movement not antigravity………….
No movement
CNA, specify __________________
Other, specify __________________

35. Left Arm Spontaneous Movement:

If yes, specify type. Check all that apply chorea athetosis myoclonus choreoathetosis ballism tremor Characteristic
Normal
Decreased
Absent
Dystonic
Dyskinetic……………………………
Ataxic
CNA, specify __________________

36. Left Arm Tone

Characteristic
Normal
Hypotonic
Hypertonic – spastic
Hypertonic – rigid
Dystonic
CNA, specify __________________
Other, specify __________________

37. Left Arm Reflexes

Characteristic
Present / normal
Absent
Present / depressed
Hyperactive
Clonus, 3 or more beats
CNA, specify __________________
Other, specify __________________

38. Left Arm Sensation:

Characteristic
Normal response to light touch
Normal response to pin-prick, not light touch
Responds to deep pain only (nail bed pressure), other than stereotypic
No response to deep pain (nail bed pressure)
CNA, specify __________________
Other, specify __________________

39. Right Leg: Overall

Characteristic
Normal…………………………………	If yes, skip to question 49
Abnormal

If yes, specify. Check all that apply frog leg hemiplegic scissoring other 40. Right Leg Posture

Characteristic
Normal
Abnormal ………………………… ……
CNA, specify __________________

41. Right Leg Strength

Characteristic
Normal
Antigravity plus resistance…………	Proximal > Distal
Antigravity…………………………	If yes, specify Proximal = Distal Distal > Proximal
Movement not antigravity………….
No movement
CNA, specify __________________
Other, specify __________________

42. Right Leg Spontaneous Movement:

If yes, specify type. Check all that apply chorea athetosis myoclonus choreoathetosis ballism tremor Characteristic
Normal
Decreased
Absent
Dystonic
Dyskinetic……………………………
Ataxic
CNA, specify __________________

R 43. Right Hip Adductor Angle (between femur and midline with hip & knees flexed)

Characteristic
45-60 degrees
Less than 45 degrees
Greater than 60 degrees
CNA, specify __________________
Other, specify __________________

44. Right Leg Popliteal Angle

(between femur and tibia with hip flexed)

Characteristic
90 - 120 degrees
Less than 90 degrees
Greater than 120 degrees
CNA, specify __________________
Other, specify __________________

45. Right Achilles Angle

(between sole & tibia with knees extended)

Characteristic
60 – 90 degrees
Greater than 90 degrees
Less than 60 degrees
CNA, specify __________________
Other, specify __________________

46. Right Leg Tone

Normal
Hypotonic
Hypertonic – spastic
Hypertonic – rigid
Dystonic
CNA, specify __________________
Other, specify __________________

47. Right Leg Reflexes

Characteristic
Present / normal
Absent
Present / depressed
Hyperactive
Clonus, 3 or more beats
CNA, specify __________________
Other, specify __________________

48. Right Leg Sensation:

Characteristic
Normal response to light touch
Normal response to pin-prick, not light touch
Responds to deep pain only (nail bed pressure), other than stereotypic
No response to deep pain (nail bed pressure)
CNA, specify __________________
Other, specify __________________

49. Left Leg: Overall

Characteristic
Normal	If yes, skip to question 59
Abnormal

If yes, specify. Check all that apply frog leg hemiplegic scissoring other 50. Left Leg Posture

Characteristic
Normal
Abnormal ……………………………….
CNA, specify __________________

51. Left Leg Strength

Characteristic
Normal
Antigravity plus resistance…………	Proximal > Distal
Antigravity…………………………	If yes, specify Proximal = Distal Distal > Proximal
Movement not antigravity………….
No movement
CNA, specify __________________
Other, specify __________________

52. Left Leg Spontaneous Movement:

If yes, specify type. Check all that apply chorea athetosis myoclonus choreoathetosis ballism tremor Characteristic
Normal
Decreased
Absent
Dystonic
Dyskinetic……………………………
Ataxic
CNA, specify __________________

53. Left Hip Adductor Angle (between femur and midline with hip & knees flexed)

Characteristic	L
45-60 degrees
Less than 45 degrees
Greater than 60 degrees
CNA, specify __________________
Other, specify __________________

54. Left Leg Popliteal Angle

(between femur and tibia, with hip flexed)

Characteristic
90 - 120 degrees
Less than 90 degrees
Greater than 120 degrees
CNA, specify __________________
Other, specify __________________

55. Left Leg Achilles Angle

(between sole & tibia with knees extended)

Characteristic
60 – 90 degrees
Greater than 90 degrees
Less than 60 degrees
CNA, specify __________________
Other, specify __________________

56. Left Leg Tone

Characteristic
Normal
Hypotonic
Hypertonic – spastic
Hypertonic – rigid
Dystonic
CNA, specify __________________
Other, specify __________________

57. Left Leg Reflexes

Characteristic
Present / normal
Absent
Present / depressed
Hyperactive
Clonus, 3 or more beats
CNA, specify __________________
Other, specify __________________

58. Left Leg Sensation:

Characteristic
Normal response to light touch
Normal response to pin-prick, not light touch
Responds to deep pain only (nail bed pressure), other than stereotypic
No response to deep pain (nail bed pressure)
CNA, specify __________________
Other, specify __________________

F. GAIT

59. Gait, Check all that apply

Characteristic	Age appropriateness
Walking * N/A at 6 mo	Age appropriate? Yes No * Yes and no are impossible at 6 mo * Yes and no are not highlighted at 12 mo * Yes is normal at 24 mo * No is not highlighted at 24 mo
Cruising * N/A at 6 mo * Abnormal at 24 mo	Age appropriate? Yes No * Yes and no are impossible at 6 mo * Yes and no are not highlighted at 12 or 24 mo * No is abnormal at 24 months
Not walking or cruising * Abnormal at 12 and 24 mo	Age appropriate? Yes No * Yes and no are normal at 6 mo * Yes and no are not highlighted at 12 mo * No is abnormal at 24 mo
Direction
Abnormal – hemiplegic,………………...	If yes, specify Left Right
Abnormal – diplegic…………………….	If yes, specify Left Right
Abnormal – immature (e.g. toe-walking)
Abnormal – ataxic………………………	If yes, specify Left Right
Abnormal – dystonic……………………	If yes, specify Left Right
CNA, specify __________________
Other, specify __________________

G. PRIMITIVE REFLEXES

For each reflex, select the location of abnormality and specify type if applicable

60. Moro

Age appropriate? Yes No

Symmetric
…If yes, specify Complete Incomplete * Abnormal at 12 and 24 mo
Asymmetric …If yes, specify abnormal side Left Right
Absent
CNA, specify _________________
Other, specify _________________

61. Stepping

Age appropriate? Yes No

Symmetric
…If yes, specify Complete Incomplete * Abnormal at 12 and 24 mo
Asymmetric …If yes, specify abnormal side Left Right
Absent
CNA, specify _________________
Other, specify _________________

62. ATNR

Age appropriate? Yes No

Symmetric
…If yes, specify Complete Incomplete * Abnormal at12 and 24 mo
Asymmetric …If yes, specify abnormal side Left Right
Absent
CNA, specify _________________
Other, specify _________________

63. Parachute Age appropriate? Yes No

* No is abnormal at 24 mo

Symmetric
…If yes, specify Complete Incomplete * Complete is normal at 12 and 24 mo * Incomplete is abnormal at 12 and 24 mo, with uncertain significance at 12 mo
Asymmetric …If yes, specify abnormal side Left Right
Absent *Abnormal with uncertain signficiance at 12 or 24 mo
CNA, specify _________________
Other, specify _________________

64. Righting

Age appropriate? Yes No

* No is abnormal at 12 and 24 mo

Symmetric
…If yes, specify Complete Incomplete * Incomplete is abnormal at 12 and 24 mo
Asymmetric …If yes, specify abnormal side Left Right
Absent * Abnormal at 12 and 24 mo
CNA, specify _________________
Other, specify _________________

65. Babinski

Age appropriate? Yes No

Symmetric
…If yes, specify Complete Incomplete
Asymmetric …If yes, specify abnormal side Left Right
Absent
CNA, specify _________________
Other, specify _________________

66. Plantar Grasp

Age appropriate? Yes No

Symmetric * Abnormal at 12 and 24 mo
…If yes, specify Complete Incomplete
Asymmetric …If yes, specify abnormal side Left Right
Absent
CNA, specify _________________
Other, specify _________________