15 Brief Kinesthesia Test

Attachment 15
Brief Kinesthesia Test1

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX

1. Name of test
2. Estimate of time it will
take to complete the final
form of the test (i.e.,
subject burden during
norming)
3. Number of items
expected to be in the final
form of the test
4. Instructions to subjects

Brief Kinesthesia Test2
1 minute

4 plus 1 practice item

“Point your finger like this.”
“I am going to move my finger from point A to B, like this.”
“Now let’s move your finger from point A to point B and then
back to point A. I am going to help you.”
“Now, take your finger back to B by yourself.”
If the participant completes the task correctly, say: “That’s
right.” If the participant does not complete task correctly, repeat
the instructions above.
“Now, we are going to do this again so you can feel it without
looking this time. Here is point A; now we are going to point
B. Now I am moving you back to point A. Find point B.”
“We are using this box to block your vision. I will move your
finger from location A to B and then back to A. Then, I want
you to move it back to B by yourself. Ready?”
For the next three trials:
“Again, I will move your finger from location A to B and then
back to A. Then, I want you to move it back to B by yourself.
Ready?”
Now let’s use your other hand to do the pointing.
(then same instructions as for the other hand)

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 208927974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX
5. Screen shots of 2-3
representative items

6. Copies of recording
forms or screen shots of
scores recorded

Instructions about how to record the person's responses:
Mark the participant’s number on the test sheet where the
fingertip landed.
Score Sheet:
The red dotted line is the space you measure.
………………………………the red dot is the mark you place
from the ……………………………………….fingertip.

B

A

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 208927974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX

Brief Kinesthesia

2
2

1

43

6

3

1. R long, crossed

Cm

2. L medium

Cm

3. R medium

Cm

4. L long, crossed

Cm

1

Mark where the tip of the finger touches the paper.

Mark the spot which the fingertip touches,
And draw a line to the appropriate arrow tip.
After testing,
measure in cm. the distance to the arrow tip,
and record response in the box above, right.

B

A

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive,
MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address

Kinesthesia practice item

A----------B

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive,
MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address