Gross Motor and Balance Tests

Performance Evaluation Tool
NCM 104
GROSS MOTOR AND BALANCE TESTS
I. Purpose:
1. To examine proprioception and cerebellar function.
II. Assessment:
1. Inquire if the client has history of loss of consciousness, or fainting.
III. Planning:
1. Prepare the client.
2. Prepare the area/room to be used.
IV. Procedure:
PROCEDURE 5 4 3 2 1 REMARKS
1 Explain to the client what you are
going to do, why it is necessary,
and how he or she can cooperate.
Discuss how the results will be
used in planning further care or
treatments.
2 Provide for client privacy.
3 Walking Gait
Ask the client to walk across the
room and back, and assess the
client’s gait.
4 Romberg’s Test
Ask the client to stand with feet
together and arms resting at the
sides, first with eyes open, then
closed.
5 Standing On One Foot w/ Eyes

Closed
Ask the client to close his eyes
and stand on one foot. Then the
other. Stand close to the client
during this test
6 Heel – Toe Walking

Ask the client to walk a straight
line placing the heel of one foot
directly in front of the toes of the
other foot.
7 Toe or Heel Walking

Ask the client to walk several
steps on the toes then on the heels.
8 Secure patient’s comfort and

safety.
9 Document all the findings
V. Evaluation:
1. Assess the client’s posture, gait, and balance, as well as identify any variations
from normal.
2. Report significant deviations from normal to the physician.
TOTAL SCORE:____________________________
Name:__________________________ Instructor’s Signature:______________________

Level & Block:____________________ Date:____________________________________
NCM 104
FINE MOTOR TESTS FOR UPPER EXTREMITIES
I. Purpose:
1. To examine proprioception and cerebellar function
II. Assessment:
1. Inquire if the client has history of presence of pain in the upper extremities, as
well as onset and aggravating and alleviating factors, tingling or numbness,
tremors or tics, and paralysis.
III. Planning:
2. Prepare equipment to be used:
i. Chair
IV. Procedure:
going to do, why it is necessary, and
how he or she can cooperate. Discuss
how the results will be used in
planning further care or treatments.
3 Finger to Nose Test

Ask the client to abduct and extend
the arm at shoulder height and
rapidly touch the nose alternately
with one index finger and then the
other.
4 Have the client repeat the test with

eyes closed if the test is performed
easily
5 Alternating Supination and Pronation

of Hands on Knees
Ask the client to pat both knees with
the palms of both hands and then
with the backs of the hands
alternately at an ever increasing rate.
6 Finger to Nose and to the Nurse’s

Finger
Ask the client to the client to touch
the nose and then your index finger
held at a distance of about 45cm at a
rapid and increasing rate
7 Fingers to Fingers
Ask the client to spread the arms
broadly at shoulder height and then
bring the fingers together at the
midline, first with the eyes open and
then closed, first slowly and then
rapidly.
8 Fingers to Thumb (Same Hand)

Ask the client to touch each finger of
one hand to the thumb of the same
hand as rapidly as possible.
9 Secure patient’s comfort and safety.
V. Evaluation:
1. Accurately assess client’s movements while performing the procedures
2. Identify any variations.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
FINE MOTOR TESTS FOR LOWER EXTREMITIES
I. Purpose:
1. To examine proprioception and cerebellar function
II. Assessment:
1. Inquire if the client has history of presence of pain in the lower extremities, as
well as onset and aggravating and alleviating factors, tingling or numbness,
tremors or tics, and paralysis.
III. Planning:
i. Bed or chair
IV. Procedure:
treatments.
3 Ask the patient to lie supine

position
4 Heel Down Opposite Shin

Ask the patient to place the heel of
one foot just below the opposite
knee and run the heel down the
shin to the foot
5 Repeat with another foot. The

patient can also be placed in
sitting position
6 Toe or Ball of Foot to the Nurse’s

Finger
Ask the client touch your finger
with the large toe of each foot

safety.

V. Evaluation:
1. Accurately assess client’s movements and coordination while performing the
procedures.
2. Determine any variations.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
TEST OF LIGHT – TOUCH SENSATION
I. Purpose:
1. To assess the light-touch sensation of symmetric areas of the body.
II. Assessment:
1. Inquire if the client has history of numbness, pain or paralysis in the
extremities, as well as onset and aggravating and alleviating factors.
III. Planning:
i. Cotton ball
ii. Pen
IV. PROCEDURE
3 Ask the client to close the eyes and to

respond by saying “yes” or “no”
whenever the client feels the cotton
wisp touching his skin
4 With the wisp of cotton, lightly touch

one specific spot and then the same
spot on the other side of the body.
5 Test areas on the forehead, cheek.

Hand lower arm, abdomen, foot and
lower leg. Check a specific area of the
limb first.
6 Ask the client to point to the spot

where the touch was felt.
7 If areas of sensory dysfunction are

found, determine the boundaries of
sensation by testing responses about
every 2.5cm in the area.
8 Make a sketch of the sensory loss area

for recording purposes.
V. Evaluation:
1. Accurately perform procedures.
2. Detect any abnormal responses to touch stimuli and abnormal sensation.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
PAIN SENSATION
I. Purpose:
1. Determine client’s ability to discriminate between “sharp” and “dull”
sensations.
II. Assessment:
III. Planning:
2. Prepare equipment/materials to be used:
i. Tongue depressor
ii. Sterile pin or syringe
IV. PROCEDURE
PROCEDURE 555 5 DDD 4 3 2 1 REMARKS
1 Explain to the client what you are going
to do, why it is necessary, and how he
or she can cooperate. Discuss how the
results will be used in planning further
care or treatments.
2 Wash hands and observe appropriate

infection control procedures.
4 Ask the client to close his eyes and to

say “sharp”, “dull” or “don’t know”
when the sharp or dull end of the
broken tongue depressor is felt.
5 Alternately, use the sharp and dull end

of the sterile pin or needle to lightly
prick designated anatomic areas at
random. The face is not tested in this
manner.
6 The face is not included to be tested in

this manner.
7 Allow at least 2 seconds between each

test.

V. Evaluation:
1. Perform procedures well.
2. Identify any abnormal sensation.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
TEMPERATURE SENSATION
I. Purpose:
1. To determine the ability to discriminate between “hot” and “cold” sensations.
II. Assessment:
III. Planning:
i. Test tubes
ii. Hot and cold water
IV. PROCEDURE
1 Explain to the client what you are going
to do, why it is necessary, and how he
or she can cooperate. Discuss how the
results will be used in planning further
care or treatments.
3 Touch skin areas with test tubes filled

with hot or cold water.
4 Have the client respond by saying

“hot”, “cold” or “don’t know”
V. Evaluation:
2. Detect any abnormal sensation.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
POSITION OR KINESTHETIC SENSATION
I. Purpose:
1. To examine middle fingers and the large toes for the kinesthetic sensation
(sense of position)
II. Assessment:
III. Planning:
i. Table or Chair
IV. Procedure:
treatments.
3 The middle fingers and large toes

are tested
4 To test the fingers:

Support the client arms with one
hand and hold the client’s palm in
the other.
To test the toes:

Place the client’s heels on the
examining table
5 Ask the client to close his eyes
6 Grasp a middle finger or a big toe

firmly between your thumb and
index finger, and exert the same
pressure on both sides of the finger
or toe while moving it.
7 Move the finger or toe until it is

up, down or straight out, and ask
the client to identify the position.
8 Use a series of brisk up-and-down
movements before bringing the
finger or toe suddenly to rest in
one of the 3 positions.

safety.
V. Evaluation:
2. Detect any variations in kinesthetic sensation (sense of position) of middle
fingers and large toes.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
TACTILE DISCRIMINATION
I. Purpose:
1. To examine the ability to sense whether one or two areas of the skin are being
stimulated by pressure, ability to recognize objects by touching and manipulating
them, and ability to perceive touch on one side of the body when two symmetric
areas of the body are touched simultaneously.
II. Assessment:
III. Planning:
i. Pins
ii. Paper clips
iii. Blunt instrument
IV. PROCEDURE
treatments.
3 Ask the client to close his eyes
4 One and Two Point

Discrimination:
Alternately stimulate the skin
with 2 pins simultaneously and
then with one pin then ask the
client if he feels 1 or 2 pinpricks
5 Stereognosis:
Place familiar objects in the
clients hand and ask the client if
he recognize it
6 If the client is unable to

manipulate an object, write a
number or letter on the client’s
palm using a blunt instrument and
ask the client to identify it.
7 Extinction Phenomenon:
Simultaneously stimulate 2
symmetric areas of the body, such
as the thighs, cheeks or hands

safety.
V. Evaluation:
2. Describe any abnormal findings in objective terms e.g., “When asked to count
backwards by threes, client made seven errors and completed the task in 4
minutes”.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
ASSESSMENT OF LANGUAGE
I. Purpose:
1. To determine any defects or difficulty in speech, or writing, comprehending
spoken or written language.
II. Assessment:
1. Inquire if the client has history of speech disorder.
III. Planning:
i. Reading material
ii. Pictures
IV. PROCEDURE
treatments.
3 If the client displays difficulty

speaking:
Point to common objects and ask
the client to name them.
4 Ask the client to read some words

and to match the printed and
written words with pictures.
5 Ask the client to respond to

simple verbal and written
commands.

safety.
V. Evaluation:
2. Detect any abnormal findings.
3. Report significant variations to the physician.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
ASSESSMENT OF ORIENTATION
I. Purpose:
1. To determine the client’s orientation to time, place, and person by tactful
questioning.
II. Assessment:
1. Inquire if the client has history of disorientation to time, place, or person.
III. Planning:
IV. PROCEDURE
3 Ask the client the city or residence,

time of day, date, day of the week, or
names of family members. Or ask
direct questions like “Where are you
now?” or Ask client to state his or her
full name
V. Evaluation:
1. Accurately assess client’s orientation to time, place or person.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
ASSESSMENT OF MEMORY
I. Purpose:
1. To determine client’s difficulty with memory.
II. Assessment:
1. Inquire if the client has history of loss of memory.
III. Planning:
IV. PROCEDURE
how he or she can cooperate.
Discuss how the results will be used
in planning further care or
treatments.
3 Ask the client about difficulty with

memory.
4 If problems are apparent:

Three categories of memory are
tested
5 To assess immediate recall:

a. Ask the client to repeat a series of
three digits e.g 7-4-3, spoken slowly.
b. Gradually increase the number of
digits. e.g., 7-4-3-2-5, until the client
fails to repeat the series correctly.
c. Start again with a series of three
digits, but this time ask the client to
repeat them backward.
6 To assess recent memory:

a. Ask the client to recall the recent
events of the day.
b. Ask the client to recall
information given early in the
interview. e.g., name of doctor
c. Provide the client with three facts
to recall, e.g., a color, an object, an
address and ask the client to recall
all three items.
7. To assess remote memory:
Ask the client to describe a previous
illness or surgery e.g., 5 years ago,
or birthday or anniversary.
V. Evaluation:
1. Accurately assess client’s memory.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________
NCM 104
ASSESSMENT OF LEVEL OF CONSCIOUSNESS
I. Purpose:
1. To determine client’s level of consciousness.
II. Assessment:
1. Inquire if the client has history of loss of consciousness, or fainting.
III. Planning:
2. Prepare equipment/materials to be used:
i. Glasgow Coma Scale
IV. PROCEDURE
(Depending on a situation of a client)
3 Assess eye response.
4 Assess motor response.
5 Assess verbal response.
V. Evaluation:
1. Accurately assess and measure client’s level of consciousness.
2. Appropriately describe responses based on Glasgow Coma Scale.
TOTAL SCORE:____________________________

Level & Block:____________________ Date:____________________________________

Gross Motor and Balance Tests

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Performance Evaluation Tool

GROSS MOTOR AND BALANCE TESTS

2 Provide for client privacy.

5 Standing On One Foot w/ Eyes

6 Heel – Toe Walking

7 Toe or Heel Walking

8 Secure patient’s comfort and

9 Document all the findings

Name:__________________________ Instructor’s Signature:______________________

FINE MOTOR TESTS FOR UPPER EXTREMITIES

2 Provide for client privacy.

3 Finger to Nose Test

4 Have the client repeat the test with

5 Alternating Supination and Pronation

6 Finger to Nose and to the Nurse’s

8 Fingers to Thumb (Same Hand)

9 Secure patient’s comfort and safety.

10 Document all the findings

Name:__________________________ Instructor’s Signature:______________________

FINE MOTOR TESTS FOR LOWER EXTREMITIES

2 Provide for client privacy.

3 Ask the patient to lie supine

4 Heel Down Opposite Shin

5 Repeat with another foot. The

6 Toe or Ball of Foot to the Nurse’s

7 Secure patient’s comfort and

8 Document all the findings

Name:__________________________ Instructor’s Signature:______________________

TEST OF LIGHT – TOUCH SENSATION

2 Provide for client privacy.

3 Ask the client to close the eyes and to

4 With the wisp of cotton, lightly touch

5 Test areas on the forehead, cheek.

6 Ask the client to point to the spot

7 If areas of sensory dysfunction are

8 Make a sketch of the sensory loss area

Name:__________________________ Instructor’s Signature:______________________

2 Wash hands and observe appropriate

3 Provide for client privacy.

4 Ask the client to close his eyes and to

5 Alternately, use the sharp and dull end

6 The face is not included to be tested in

7 Allow at least 2 seconds between each

8 Secure patient’s comfort and safety.

9 Document all the findings

Name:__________________________ Instructor’s Signature:______________________

2 Provide for client privacy.

3 Touch skin areas with test tubes filled

4 Have the client respond by saying

5 Secure patient’s comfort and safety.

6 Document all the findings

Name:__________________________ Instructor’s Signature:______________________

POSITION OR KINESTHETIC SENSATION

3 The middle fingers and large toes

4 To test the fingers:

To test the toes:

5 Ask the client to close his eyes

6 Grasp a middle finger or a big toe

7 Move the finger or toe until it is

9 Secure patient’s comfort and

10 Document all the findings

Name:__________________________ Instructor’s Signature:______________________

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature:

Name:____ Instructor’s Signature: