NEC long form version 4



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

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 (( 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) 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 _____________________________

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