BOND
Dr. Jonathan Pincus
(to be completed by a trained clinician)

       DATE:           TIME (24hr): 

Choose the best answer:

Yes / No

[]   []   1. Nuchocephalic reflex
[]   []   2. Glabellar blink
[]   []   3. Visual tracking impaired
[]   []   4. Snout reflex
[]   []   5. Suck reflex
[]   []   6. Grasp reflex
[]   []   7. Paratonia arms
[]   []   8. Paratonia legs
[]   []   9. Lateral gaze impersistence
[]   [] 10. Eye closure/tongue protrusion - impersistence
[]   [] 11. Double simultaneous stimulation - (face-hand test)
[]   [] 12. Spelling “world” - cannot perform
[]   [] 13. Luria 3-step (3-step motor sequence) - impaired
[]   [] 14. Luria 2-step (palm/fist alternating reciprocal) - impaired
[]   [] 15. Word fluency (letter fluency) - less than 15 in 1 minute
[]   [] 16. Antisaccade suppression - impaired

    

TEXT FOR YOUR RECORDS

(BOND  maximum score = 16)

0   -     4    normal, depending on age, education, complaints
5   -     8    mild
8   -   11    moderate
12 -  16    severe

Electronic form developed at the Palo Alto Veterans Affairs Hospital
  by Wes Ashford, M.D., Ph.D.
Neither the BOND nor this electronic form are protected by copyright.
There is no individual or agency that takes responsibility for the results obtained
with this test or this form.