HIGHER MENTAL FUNCTIONThe examination of higher mental function constitutes an integral part of the clinical evaluation of cortical function. However, a detailed assessment is time consuming and is not carried out routinely. For all practical purposes, we need a simple instrument to screen for cognitive dysfunction. It is extremely unlikely that a higher rating of mental function will be assessed on the MRCPCH examination. In the section below, we have presented modified mental assessment questions, suitable for children over four years old and focusing on five areas of cognitive functions, namely orientation, concentration of attention, l recording, recall and language. (Acronym – ROARS)o Registration• Can you identify three objects by name?o Orientation (person, place and time)• What is your name?• Are you a boy or a girl?• Where do you live?• Where are you right now?• How old are you?• What time is it?o Attention-concentration• Can you count from 1, 2, 3…?• Can you count backwards from 20 to 1?o Recall (immediate)• Show them three common items and ask them to remember them. Speech (Language) • Observe the fluency and articulation of normal speech • Name the parts of the body • Simple command “take the toy from my hand and put it on the table” • Repeat a simple sentence (with a verb and a name)• Reading – “can you read your name”• Writing – “Write your name”• Copy a simple drawingMOTOR EXAMINATION OF THE UPPER LIMB• Inspection posture – Note the resting posture. Look for abnormal bending, unusual rotation, or scratching of the hand. Always compare with the other side for more symmetry. In a hemiplegic child, the upper limb is flexed at the shoulder and elbow with adduction and pronation of the a...... middle of paper ...... defects or sensory impairment). In order to assess the functional capacity of the upper limbs and their performance, the following tests can be carried outo Give an object and see how it is receivedo Ask to write on paper or draw a figureo Ask how to “comb your hair”• Examination of the backo Motor examination of the upper extremity is only complete after performing the upper back examination.o Inspection – Look for muscle wasting, scapula separation, and surgical scars.o Power (in addition to the upper extremity muscles the shoulder girdle – see above) Serratus anterior (C5, C6, C7): “Stand in front of the wall and push it with your hands”. Look behind to see the lower scapula winging. Infraspinatus (C5, C6): “with arms at sides, bend both elbows 90º and rotate arms outward (rotation external)", while you provide resistance against external rotation.