F: Functional; appears N or only slight impairment

WF: Weak Functional; moderate impairment that affects the degree of active motion
NF: Nonfunctional; sever impairment
0: absent

MMT

MS

EXTRAOCULAR
MUSCLES

Rectus
(SIML)
Oblique (IS)
^

EYE TRACKING

EYE OPENING

Levator
palpebra
e
superioris

POSITION

Head in
neutral
Looking
straight
ahead
Dont
move
head
sitting

PROCEDURE

INSTRUCTIO
N

Move fingers in
cardinal
direction (1-7)
Test each eye
Test both

Follow my
fingers with
your eyes
only

Immediate
tracking in a
smooth
motion over
full range
Complete
excursion

Not possible to distinguish

accurately

Test both eyes

Thumb is placed
over opened
eyelid
R: downward

Open your
eyes wide.
Dont let
me close
them

Complete N
range
Agains light
manual R
Iris fully visible

Iris- partially
covered
Takes no R
(+) cxn of
frontalis

Addtnl caution

WF

NF

Unable to
open.
Iris-covered

Eye closing

Orbicularis
oculi

sitting

1. ask px to open
and close eyes
first, BOTH and
EACH

Close your
eyes as
tightly as
you can

Closes eyes
tightly c R
Iris not visible

sR
incomplete
closure
small
amount
of sclera/
no iris

n/a
iris
iris - visible

2. R fr thumb and
index
3. attempt to open
Frowning

Corrugator
supercilii

Ask px to frown
Thumb (R)
R: moves
eyebrows apart

Frown. Dont
let me
erase it

Completes N
range
c +R

Shallow
wrinkles
sR

Slight motion

Raising
eyebrows

Frontal
belly of
occipitofr
ontalis

Thumb R above
eyebrows
R: downward

Raise your
eyebrows
as high as
you can

Shallow
wrinkles
sR

Slight motion

Wrinkling the
bridge of
the nose

Procerus

Wrnkle your
nose

Shallow
creases
sR

Slight motion

Lip closing

Orbicularis
oris

R on beside the
bridge of nose c
thumb
R is given laterally
Px compress and
protrudes lips

Completes mvt
Horizontal
wrinkles are
prominent
cR
Prominent
creases
cR

Purse your
lips

Complete close
cR

Closes but
no R

Slight movt
n/a to bring
lips
together

Suck in your
cheek.
Dont let
me push it
out

Perform
correctly
cR

Performs
but no R

Slight mvt

Cheek
compressio
n

buccinator

R: tongue
depressor
placed
diagonally
across both lips
(inward)
Px: compresses
cheek
R: TD inside flat
side lying

Jaw opening

Lateral
pterygoid
Suprahyoid
ms

Jaw closure

Masseter
Temporalis
Medial
pterygoid

Lateral jaw
dev

Med (C/L)
& Lat
(I/L)
pterygoid

Jaw protrusion

Tongue
protrusion

Tongue dev

Tongue retxn

agains cheek
(outward)
Px opens mouth c
R

Anterior
fibers of
genio

Complete c R
3 stacked
fingers

2 stacked
fingers
Can take
some R

Minimal
motion
No R

Clench your
teeth
together as
tight as you
can

Closes mouth
tightly
Not able to open
mouth
Strong mg
group
Assess by
incisor teeth
not lip
Laterally 3
upper teeth
(10cm)

Closes jaw;
but can
open
mouth
with min
R
Motion is
decreased
to lateral
movt
One upper
tooth
Min R

Closes but no
R

Push jaw
forward.
Dont let
me push t
back

Complete
Lower teeth in
front of upper
+ space

Slightly
forward
- space
Min R

Slight movt
No R

S: over the head

R: tip of tongue c
tongue dep;
backward

Stick out your

tongue

Reaches
margin of
lips

R: along the side;

direction is
opposite the
attempted dev

Stick out your

tongue and
move it to
the R/L

Completes ROM
cR
extend beyond
lips
Completes ROM
cR
reaches some
part of cheek

Min protrusion
Tongue does
not clear
mouth
Dev slightly

R: grasp ant.
Tongue c gauze
pad; forward

Stick out your

tongue.
Youre

Completes ROM
cR
returns to RP

Returns to
RP c min
R

R: cupped under
chin; upward
R: chin is grasped
btwn thumb and
index;
downward

Deviate to R then
to L
R: against jaw
Stabilize: opposite
temple of the
head
Powerful movt

Bilater cxn
of Med. &
Lat.
Pterygoid

Post. Fibers
of
genioglos
sus
Geniogloss
us +
other

Open your
mouth as
wide as you
can

R: cups chin;
horizontally

Px
protrude
then
move it
laterally
Tongue
protrude
d

Reaches
corners of
mouth

Min dev
No R

No R
haltingly

Styloglosss
us

Posterior
elevation of
tongue

Palate
Stylo

Channeling
the tongue
Tipping/curling
of tongue

Genio
Intrinsic ms
S&I
longitudi
nal

Elevation and
adduction of
soft palate

LVP
TVP
Palatogloss
us
Musculus
uvulae

Occlusion of
Nasopharyn
x

Palatophary
ngeus
(CN7)

Constriction of
pharyngeal
wall

Px
elevates
the the
post.
tongue

R: tongue dep on
ant. 1/3 to avoid
gag reflex;
down and
backward; use
lower teeth as
fulcrum

Protrude
tongue
and
curls it
to touch
the
philtrum
Use
tongue
dep

none

sR

Mirror /
feather
nose
px opens
mouth
wide
and
says

If no motion
during ahhh
>Apply bilateral
stimulus to
pharyngeal wall

gonna pull
it back
while I
apply some
R
Rock the
tongue
blade back
and forth on
the middle
Push against
the stick

Completes ROM
cR
tongue rises
reaching the
hard palate

Reaches
hard
palate c
min R

touch your lip

c upper
tongue

Completes ROM
cR
touching
philtrum

Does not
reach
philtrum

Use highpitched to
say Ahaaa

Uvula elevates;
remains in the
midline
Narrowing of
fauces

Blow on my
fingers

No leakage of
air fr nose

Uvulasluggish
and may
dev to
other side
Arches may
be
assymetri
cal
Min leakage

Brisk cxn of post

pharyngeal
wall

Slight mvt

Reaches hard
palate s
occlusion

Almost no
movt frm
uvula and
arches

Heavy mirror
clouding/
ruffling
feather
Trace of
motion

Ahhh c
high
pitched
voice
use
tongue
dep
Elevation of
larynx in
swallowing

Grasp larynx with

thumb and
index on ant.
throat

swallow

Elevates
20mm
Movt is quick
and ctrlled

Normal and
slightly
limited
Sluggish
and irreg

Excursion less
than N
Aspiration
may occur

Vocal cord abd add (post and lat Crycoaretynoids)

Look for: hoarseness, pitch and tone range, breathlessness, nasal quality speech, dysarthia
1.
2.
3.
4.

State your name

Sing several note on musical scale; first at low then high pitch
Repeat 5x, staccato, interrupted sound: Akh, Akh, Akh
Cough

MMT

MS

CAPITAL
EXTN

Rectus
capitis
posterior
(min &
maj)
Longissimu
s capitis
Obliquus
capitis
S&I
Upper trapz
Splenius
cap
Semispinali

POSITI
ON
5-3:
Prone
c
head
off
table
2-0:
supin
e,
head
on
table

PROCEDURE
R: occiput;
downward
S:
overhanging
head
Px extn head
by tilting
chin upward
in a nodding
movt

INSTRUCTIO
N
5-4: Look at
the wall
3: Look at
the wall
2-0: Tilt your
chin up;
Look back
at me
dont lift
your head

5
Complete
ROM
s cervical
extn
c max R

Complete
ROM
C
cervical
/
Mod R

Complete ROM
No R

1-0

S: B hands under
occiput

2: LOM
1: palpation at
the base of
occiput just
lateral to skull

Cervical
extn

s cap
Spinalis cap
Longissimu
s cervicis
Semispinali
s cervicis
Iliocostalis
cervicis
Splenius cer
Upper trapz
Spinalis
cerv

5-3:
Prone
c
head
off
table
2-0:
supin
e

R: parieto
occipital;
downward
S:
overhanging
head
Px extn head
WITHOUT
tilting chin

5-4: push up
on my
hand but
keep
looking on
the floor

2: small range of
neck / by pushing
into PTs hand
Classic 1 & 0

3: lift your
forehead fr
my hand;
keep
looking on
the floor
2-0: push
your head
down to
my hand

Combin
ed
neck /

Prone
all
throu
gh
out

R: parieto
occipital;
downward
+ forward

5-4: lift your

head and
look at the
ceiling

S:

3:

overhanging
head
Px extn head
WITHOUT
tilting chin
P: base of
occiput

raise..from
my hand
and look
up the
ceiling
2-0: try to