ADReS Score Sheet

Patient’s Name: ___________________________________________________ Date: _________________________


1. Visual fields: Shade in any areas of deficit. two circle representing the patient's both, right and left eyes

2. Visual acuity: _________________ OU

Was the patient wearing corrective lenses? If yes, please specify: ______________________________________

3. Rapid pace walk: ____________ seconds

Was this performed with a walker or cane? If yes, please specify: ______________________________________

4. Range of motion: Specify ‘Within Normal Limits’ or ‘Not WNL.’ If not WNL, describe.

Right
Left
Neck rotation
 
 
Finger curl
 
 
Shoulder and elbow flexion
 
 
Ankle plantar flexion
 
 
Ankle dorsiflexion
 
 

Notes:

5. Motor strength: Provide a score on a scale of 0-5.

Right
Left
Shoulder adduction
 
 
Shoulder abduction
 
 
Shoulder flexion
 
 
Wrist flexion
 
 
Wrist extension
 
 
Hand grip
 
 
Hip flexion
 
 
Hip extension
 
 
Ankle dorsiflexion
 
 
Ankle plantar flexion
 
 

6. Trail-Making Test, Part B: ____________ seconds

7. Clock drawing test: Please check ‘yes’ or ‘no’ to the following criteria.

Yes
No
All 12 hours are placed in correct numeric order, starting with 12 at the top
 
 
Only the numbers 1-12 are included (no duplicates, omissions, or foreign marks)
 
 
The numbers are drawn inside the clock circle
 
 
The numbers are spaced equally or nearly equally from each other
 
 
The numbers are spaced equally or nearly equally from the edge of the circle
 
 
One clock hand correctly points to two o’clock
 
 
The other hand correctly points to eleven o’clock
 
 
There are only two clock hands
 
 

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