Introduces self
0
1

Confirms name & age of patient
0
1

Explains & gains consent
0
1

Checks pain/numbness/paraesthesia/handedness
0
1

Exposes patient from waist down
0
1

General inspection for walking aids, deformities, asymmetries, resting tremor, dyskinesia
0
1

Closer inspection for fasciculations, cafe au lait spots, scars, wasting
0
1

Checks tone in all muscles with patient relaxed. Checks for cogwheel rigidity
0
1

Checks for clonus
0
1

MRC graded power of extension and flexion at the hip
0
1

MRC graded power of extension and flexion at the knee
0
1

MRC graded power of plantar and dorsiflexion
0
1

MRC graded power of extension and flexion of the toe
0
1

Knee jerk reflex using reinforcement if needed
0
1

Ankle jerk reflex using reinforcement if needed
0
1

Babinksi reflex
0
1

Tests coordination with heel shin test
0
1

If able asks patient to stand, then stand on toes and heels supporting patient throughout
0
1

Assesses patient gait
0
1

Thanks patient and offers help to redress
0
1

Washes hands
0
1

Requests full neurological exam
0
1

Summarises appropriately with only key findings
0
1

Offers appropriate differential diagnoses
0
1

Patient global score
0
1
2
Potential differentials
  • Stroke
    • Walking aids
    • Flexed upper limb and extended lower limb posturing
    • Spastic rigidity 
    • Unilateral upper motor neurone lesion
  • Gait & Coordination abnormalities (see G&C examination for differentials)
  • Bilateral weakness
    • Multiple sclerosis (may be asymmetrical)
    • Spinal cord compression
    • Motor neurone lesion (no sensory component)