NEUROLOGICAL EXAMINATION FOR CHILDREN
Ram Kairam, Claudia Chiriboga, and Jennie Kline
Revised version for OPT study ages 24-36 months
New York State Psychiatric Institute
Sergievsky Center, Department of Neurology, and Department of Pediatrics
Columbia University
Department of Pediatrics
St. Luke's\Roosevelt Hospital Center
722 West 168th Street, Box 53, New York, NY 10032
© 1991
NEC_LF.004 NEUROLOGICAL EXAMINATION FOR CHILDREN OPT Version 05/07/2007
┌──┬──┬──┬──┬──┬──┬──┬──┬──┐
Study number │ │ │ │ │ │ │ │ │ │
└──┴──┴──┴──┴──┴──┴──┴──┴──┘
┌──┬──┐
Study type (26 or 38 month visit) │ │ │
└──┴──┘
┌──┐
Version of examination │OP│
└──┘
┌──┬──┬──┐
Child's initials │ │ │ │
└──┴──┴──┘
F M L
┌──┬──┐
Site 01=MN; 02=KY; 03=MS; 04:NY │ │ │
└──┴──┘
┌──┬──┬──┐
Examiner's initials │ │ │ │
└──┴──┴──┘
F M L
┌──┬──┐ ┌──┬──┐ ┌──┬──┐
Date of examination │ │ │/│ │ │/│ │ │
└──┴──┘ └──┴──┘ └──┴──┘
Month Day Year
Hour Minute
┌──┬──┐ ┌──┬──┐ ┌──┬──┐
Date of birth │ │ │/│ │ │/│ │ │
└──┴──┘ └──┴──┘ └──┴──┘
Month Day Year
© 1991: Kairam, Chiriboga, and Kline Page 1
Sex ┌──┐
1. Boy │ │
2. Girl └──┘
1st Measure 2nd Measure
┌──┬──┐ ┌──┐ ┌──┬──┐ ┌──┐
Head circumference (cms.) │ │ │.│ │ │ │ │.│ │
└──┴──┘ └──┘ └──┴──┘ └──┘
VISION AND OCULAR MOVEMENTS [Awake, no crying]
Looks at person/object ┌──┐
│ │
1. Looks └──┘
2. Does not look
Follows face/object across midline ┌──┐
│ │
1. Follows └──┘
2. Does not follow
Right Left
Eye movements on following face/object ┌──┐ ┌──┐
│ │ │ │
1. Eye movements full └──┘ └──┘
2. Eye fails to adduct
3. Eye fails to abduct
4. Eye fails to adduct or abduct
Horizontal nystagmus on following face/object (LF) ┌──┐
│ │
1. None └──┘
2. Eyes beat to the right
3. Eyes beat to the left
4. Eyes beat in both directions
Upper sclera visible (LF) Right Left
┌──┐ ┌──┐
1. No │ │ │ │
2. Yes, light in center of pupil └──┘ └──┘
3. Yes, light above center of pupil
Lower sclera visible (LF) ┌──┐ ┌──┐
│ │ │ │
1. No └──┘ └──┘
2. Yes
Upper eyelid ┌──┐ ┌──┐
│ │ │ │
1. Does not touch pupil └──┘ └──┘
2. Covers less than one half of pupil
3. Covers one half or more of pupil
Right Left
Nystagmus on casual gaze ┌──┐ ┌──┐
│ │ │ │
1. Absent └──┘ └──┘
2. Present: note type ______
Eye movements on casual gaze (LF) ┌──┐ ┌──┐
│ │ │ │
1. No deviation └──┘ └──┘
2. Eye deviates outward
3. Eye deviates inward
4. Alternating deviation both eyes
Pupil size at rest (LF) ┌──┐
│ │
1. Right equal to left └──┘
2. Right greater than left
3. Left greater than right
Light on eye, room lights off (LF) ┌──┐
Light on R eye │ │
1. Pupils constrict equally ├──┤
2. Right pupil constricts more than left Light on L eye │ │
3. Left pupil constricts more than right └──┘
4. Neither pupil constricts
Right Left
REFLEXES [Awake, no crying] ┌──┐ ┌──┐
Biceps reflex │ │ │ │
1. Muscle contraction, no limb displacement ├──┤ ├──┤
2. Muscle contraction, with limb displacement Knee jerk │ │ │ │
3. Muscle contraction accompanied by clonus ├──┤ ├──┤
4. No reflex elicited Ankle jerk │ │ │ │
└──┘ └──┘
Ankle clonus [Awake, no crying] ┌──┐ ┌──┐
│ │ │ │
1. Clonus absent └──┘ └──┘
2. Transient clonus (< 5 beats)
3. Sustained clonus (³ 5 beats)
4. Spontaneous clonus
Crossed adductor response [Awake, no crying] ┌──┐ ┌──┐
│ │ │ │
1. Absent └──┘ └──┘
2. Present
Upgoing toe [Awake, no crying] ┌──┐ ┌──┐
│ │ │ │
1. Absent └──┘ └──┘
2. Present
8. Two informative trials not obtained
Right Left
Rigidity on extension [Awake, no crying] ┌──┐ ┌──┐
Elbow extension │ │ │ │
1. Absent ├──┤ ├──┤
2. Present Knee extension │ │ │ │
8. Not assessed, including spastic limb └──┘ └──┘
ANGLES (in degrees) [Awake, no crying](Code 7 for contractures)
Adductor Angle: (each leg from midline) Right Left ┌──┐ ┌──┐
1) > 40 degrees (low tone) │ │ │ │
2) between 20-40 degrees (normal tone) └──┘ └──┘
3) <20 degrees (high tone)
Popliteal angle
1) > 120 degrees (low tone) ┌──┐ ┌──┐
2) between 90-120 degrees(normal tone) │ │ │ │
3) < 90 degrees (high tone) └──┘ └──┘
Ankle angle (on dorsiflexion) Right Left
1) < 90 (normal tone) ┌──┐ ┌──┐
2) 90-120 (high tone) │ │ │ │
3) > 120 (very high tone) └──┘ └──┘
Head during pull-to-sitting from SUPINE position ┌──┐
[Awake, no crying] │ │
└──┘
1. Head aligned with spine or flexed forward for 90% of pull
2. Head lags, eyes toward ceiling
3. Head lags, eyes toward back of room
Sitting duration [Awake] ┌──┐
│ │
1. Sits unsupported for 1 MINUTE or more └──┘
2. Does not sit for 1 minute or more
Right Left
Grasps red ring [Awake, no crying] ┌──┐ ┌──┐
│ │ │ │
1. Grasps └──┘ └──┘
2. Does not grasp
Picks up Cheerio [Awake, no crying] ┌──┐ ┌──┐
│ │ │ │
1. Picks up with thumb and forefinger └──┘ └──┘
2. Picks up with several fingers opposed to thumb
3. Scoops into palm
4. Touches but does not pick it up
5. Makes no movement toward pellet
Finger-to-nose-to-finger testing--6 targets
[Cooperative, 36+ months]
(code 7 if child cannot perform 6 excursions)
┌──┐ ┌──┐
Number of excursions off target │ │ │ │
├──┤ ├──┤
Number of excursions with ataxia │ │ │ │
└──┘ └──┘
CRAWLING AND WALKING [Awake]
Observe child in underclothes or in tight top and shorts.
Walks independently for at least 6 feet
1. Does task
2. Does not do task
GAIT FOR CHILDREN WHO WALK INDEPENDENTLY [Awake]
Have child walk a distance of 6 feet, turn around,and walk back. Repeat task, observing from side.
1. Absent
2. Present
7. Child does not walk independently Right Left
┌──┐ ┌──┐
Knee flexion │ │ │ │
├──┤ ├──┤
Knee hyperextension │ │ │ │
├──┤ ├──┤
Toe walking │ │ │ │
├──┤ ├──┤
Circumducting gait │ │ │ │
├──┤ ├──┤
Decreased arm swing │ │ │ │
├──┤ ├──┤
Cortical arm posture │ │ │ │
├──┤ ├──┤
Dystonic arm posture │ │ │ │
└──┘ └──┘
┌──┐
Scissoring │ │
├──┤
Broad-based gait │ │
├──┤
Stumbles while walking │ │
├──┤
Falls while walking │ │
├──┤
Stumbles while turning around │ │
├──┤
Falls while turning around │ │
└──┘
Symmetry of voluntary limb movements [Awake] ┌──┐
Upper │ │
1. Activity symmetric ├──┤
2. Asymmetric, less on right Lower │ │
3. Asymmetric, less on left └──┘
4. No spontaneous movement
Opisthotonus [Awake, no crying] ┌──┐
│ │
1. Absent └──┘
2. Present
Right Left
Cortical fist [Awake, no crying] ┌──┐ ┌──┐
│ │ │ │
1. Never └──┘ └──┘
2. 1+ minute duration at least once
3. Nearly all or all the time
Arms Legs
┌──┐ ┌──┐
Abnormal movements [Awake] Limb dystonia │ │ │ │
└──┘ └──┘
1. None ┌──┐ ┌──┐
2. On right side only Spontaneous limb tremors │ │ │ │
3. On left side only ├──┤ ├──┤
4. On both sides Induced limb tremors │ │ │ │
└──┘ └──┘
┌──┐ ┌──┐
Chorea │ │ │ │
└──┘ └──┘
┌──┐ ┌──┐
Athetosis of extremities │ │ │ │
└──┘ └──┘
FACIAL SYMMETRY WHILE CRYING or SMILING or GRIMACING
[Awake, crying, smiling, or grimacing]
Eyes when closed ┌──┐
│ │
1. Both of same width └──┘
2. Right eye closed less than left
3. Left eye closed less than right
Depth of nasolabial folds ┌──┐
│ │
1. Right equal to left └──┘
2. Right flatter than left
3. Left flatter than right
4. Both sides flat
Angle of mouth ┌──┐
│ │
1. Symmetric └──┘
2. Deviates to right (right facial weakness)
3. Deviates to left (left facial weakness)
State during most of the examination ┌──┐
│ │
1. Awake, no crying └──┘
2. Awake, crying
3. Asleep
4. Lethargic
5. Coma
HISTORY FROM CARETAKER
Which hand does your child prefer to use? ┌──┐
│ │
1. Right hand └──┘
2. Left hand
3. Neither hand
Additional neurological history:
CLINICAL NEUROLOGICAL DIAGNOSIS DISTRIBUTION SEVERITY
1. None 1. None
2. General 2. Mild
3. Axial 3. Moderate
4. Limb 4. Severe
TONE ┌──┐ ┌──┐
Hypotonia │ │ │ │
├──┤ ├──┤
Hypertonia │ │ │ │
└──┘ └──┘
DIAGNOSIS BY STUDY EXAMINER
Normal neurological examination ┌──┐
1) Yes │ │ 2) No If no, note diagnosis below └──┘
1. Right 2. Left
DIAGNOSIS 7. Not applicable
DIAGNOSIS BY STUDY EXAMINER CODE
00. Normal neurological examination ┌──┬──┐ ┌──┐
│ │ │ │ │
01. Cranial neuropathy └──┴──┘ └──┘
02. Hearing impairment ┌──┬──┐ ┌──┐
│ │ │ │ │
03. Hypertonic diplegia/diparesis └──┴──┘ └──┘
04. Hypertonic hemiplegia/hemiparesis ┌──┬──┐ ┌──┐
│ │ │ │ │
05. Hypertonic tetraplegia/tetraparesis └──┴──┘ └──┘
06. Hypotonic diplegia/diparesis ┌──┬──┐ ┌──┐
│ │ │ │ │
07. Hypotonic hemiplegia/hemiparesis └──┴──┘ └──┘
08. Hypotonic tetraplegia/tetraparesis
09. Macrocephaly (> 95% for sex and age)
10. Microcephaly (< 5% for sex and age)
11. Myelopathy
12. Myopathy
13. Peripheral neuropathy
14. Seizures, febrile only
15. Seizures, afebrile
16. Visual impairment
17. Other neurologic condition ______
8, 88, 888 = Not assessed
9, 99, 999 = Not in state Page 8