Horizontal Gaze Nystagmus Instructions

1. Please remove your glasses (if worn).
2. Put your feet together, hands at your side. Keep your head still and look at and follow this stimulus with your eyes only.
3. Keep looking at the stimulus until told the test is over.
4. Do not move your head.
5. Do you understand the directions?

Walk and Turn Instructions

1. Put your left foot on the line, then place your right foot on the line ahead of your left, with the heel of your right foot against the toe of your left foot.
2. Do not start until I tell you to do so.
3. Do you understand? (must receive affirmative response)
4. When I tell you to begin, take 9 heel-to-toe steps on the line (demonstrate) and take 9 heel-to-toe steps back down the line.
5. When you turn on the ninth step, keep your front foot on the line and turn taking several small steps with the other foot (demonstrate) and take 9 heel-to-toe steps back down the line.
6. Ensure you look at your feet, count each step out loud, keep your arms at your side, ensure you touch heel-to-toe and do not stop until you have completed the test.
7. Do you understand the instructions?
8. You may begin.
9. If the suspect does not understand some part of the instructions, only the part in which the suspect does not understand should be repeated.

One-Leg-Stand Instructions

1. Stand with your feet together and your arms at your side (demonstrate)
2. Maintain position until told otherwise.
3. When I tell you, I want you to raise one leg, either one, approximately 6 inches off the ground, foot pointed out, both legs straight and look at the elevated foot. Count out loud in the following manner: 1001, 1002, 1003, 1004 and so on until told to stop
4. Do you understand the instructions?
5. You may begin the test.

Horizontal Gaze Nystagmus Test

___ Lack of smooth pursuit: Left eye

___ Lack of smooth pursuit: Right eye

___ Distinct and sustained nystagmus at maximum deviation: Left eye

___ Distinct and sustained nystagmus at maximum deviation: Right eye

___ Onset of nystagmus prior to 45 degrees: Left eye

___ Onset of nystagmus prior to 45 degrees: Right eye

___ Check for vertical gaze nystagmus

___ TOTAL CLUES OBSERVED (6 max)

Walk and Turn Test

___ Can’t keep balance during instructions

___ Starts too soon

___ Stops walking

___ Misses heel-to-toe

___ Steps off line

___ Uses arms for balance

___ Improper turn

___ Incorrect number of steps

___ TOTAL CLUES OBSERVED (8 max)

One-Leg Stand Test

___ Sways while balancing

___ Uses arms to balance

___ Hopping

___ Puts foot down

___ Foot raised

___ TOTAL CLUES OBSERVED (4 max)