To test all skilled acts, therefore none must make sure whether there is cerebellar or other ataxia, other sensory impairment and motor paralysis. The skilled acts tested for must reflect the previously normal accomplishment of the person examined, hence may vary with different patients. Picking up small objects, buttoning a coat, touching the finger with the thumb and playing an instrument have already been mentioned. A specimen of the handwriting may be obtained by asking the patient to sign his name or write some familiar phrase. Tremulousness, micrographia, omission, or transpositions of letters are looked for.

The tremor and micrographia of paralysis agitans the wild scrawl of the multiple sclerotic, the omission and transposition of letters of the paretic are characteristic. To test articulatory speech the patient is engaged in ordinary conservation. One notes slowing, tremulousness, scanning, explosiveness, slurring of letters, syllables and words and stammering. The scanning, staccato speech which is observed in multiple sclerosis, the quivering, explosive articulation betraying a cerebellar component, the tremulous, slurring speech of general paresis, the slow speech of striatal rigidities, the paralytic, nasal speech of bulbar paralysis.

The explosive barely understood speech of spastic supranuclear bulbar or pseudobulbar palsy can frequently be brought out either in conversation or by mean of test phrases. The latter are especially employed when general paresis is suspected. One makes use of words containing linguals and labials, l’s and r’s, b’s and p’s, and t’s and d’s. Thus, Constantinople was the capital of Turkey, third riding artillery brigade, Lillibulero, irretrievable; Peter piper picked a pack of picked peppers, round the rugged rock the ragged rascal ran. The tests for aphasia and apraxia are described in the chapter on Aphasia.