Motor examination: | ||
---|---|---|
0 = normal; 2 = weak | ||
Great toe extension | Left _____ | Right_____ |
Total both sides (out of 4) | __________ | |
Pin sensation: | ||
0 = normal | ||
1 for each segment with reduced sensation: | Left _____ | Right_____ |
2 for each segment with absent sensation: | Left _____ | Right_____ |
Total both sides (out of 24) | ||
| ||
Allodynia or hyperesthesia: | ||
0 = normal | ||
1 if present in toes or foot: | Left _____ | Right_____ |
Total both sides (out of 2) | __________ | |
Large fibre sensation: | ||
0 = normal; 1 = diminished; 2 = absent | ||
Great toe vibration: | Left _____ | Right_____ |
Time: | Left _____ s | Right_____ s |
Great toe joint position: | Left _____ | Right_____ |
Total both sides (out of 8) | __________ | |
Deep tendon reflexes: | ||
0 = normal; 1 = diminished; 2 = absent | ||
Ankle: | Left _____ | Right_____ |
Total both sides (out of 4) | __________ | |
Total score (out of 42) | __________ |