Examination Procedure Either before or after completing the examination procedure, observe the patient unobtrusively, at rest (eg, in waiting room). The chair to be used in this examination should be a hard, firm one without arms.

• Ask patient to remove shoes and socks.
• Ask patient whether there is anything in his or her mouth (ie, gum, candy, etc) and if there is, to remove it.
• Ask patient about the current condition of his or her teeth. Ask patient if he or she wears dentures. Do teeth or dentures bother patient now?
• Ask patient whether he or she notices any movements in mouth, face, hands, or feet. If yes, ask to describe and to what extent they currently bother patient or interfere with his or her activities.
• Have patient sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at entire body for movements while in this position.)
• Ask patient to sit with hands hanging unsupported. If male, between legs, if female and wearing a dress, hanging over knees. (Observe hands and other body areas.)
• Ask patient to open mouth. (Observe tongue at rest within mouth.) Do this twice.
• Ask patient to protrude tongue. (Observe abnormalities of tongue movement.) Do this twice.
• Ask patient to tap thumb with each finger as rapidly as possible for 10–15 seconds; separately with right hand, then with left hand. (Observe facial and leg movements.)
• Flex and extend patient's left and right arms (one at a time). (Note any rigidity.)
• Ask patient to stand up. (Observe in profile. Observe all body areas again, hips included.)
• Ask patient to extend both arms outstretched in front with palms down. (Observe trunk, legs, and mouth.)
• Have patient walk a few paces, turn, and walk back to chair. (Observe hands and gait.) Do this twice.

Instructions:

Complete examination procedure before making ratings. Rate highest severity observed.