| Physical Exam Element |
How to Perform Examination |
Abnormal Findings |
| Nystagmus/Smooth Pursuits |
- Examiner’s finger moving horizontally, progressively more rapidly, stopping centrally
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- Jerky/jumpy eye movements
- > 1 beat of nystagmus at center of visual field
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| Fast Saccades |
- Examiner’s fingers shoulder-width apart (horizontal) and forehead-chest distance (vertical)
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- Symptom provocation (headache, dizziness, eye fatigue, fogginess), red/watering eyes
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| Gaze Stability |
- Child fixes gaze on examiner’s thumb while nodding yes and then shaking head no side to side
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- Symptom provocation (headache, dizziness, eye fatigue, fogginess), red/watering eyes
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| Near-point Convergence |
- Child holds object with letters at arm’s length, brings toward face until becomes double
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- Letters become double at
> 6 cm from forehead (must measure!)
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| Monocular Accommodation |
- Child holds object with letters at arm’s length with 1 eye covered, brings toward face until becomes blurry
- Repeat with contralateral eye covered
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- Letters become blurry at (must measure!):
- For children age 12 and younger: ≥ 10 cm
- For children age 13 and older:
≥ 12 cm
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| Complex Tandem Gait |
- Tandem heel-toe gait (5 steps each):
- Forward eyes open
- Forward eyes closed
- Backward eyes open
- Backward eyes closed
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- Scored on a scale of 0-24:
- 1 point is given for each step off the straight line (0-5 for each of the four conditions)
- 1 point is given for sway (raising of arms for stability or any truncal movement; 0-1 for each of the four conditions)
- An abnormal examination occurs at a score of ≥ 5 out of 24
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