In general, the examiner should be able to feel vibration from the hand-held tuning fork
for 5 seconds longer on his distal forefinger than a normal subject can at the great toe
(e.g. examiner’s DIP joint of the first finger versus patient’s toe). If the examiner feels
vibration for 10 or more seconds on his or her finger, then vibration is considered
decreased. A trial should be given when the tuning fork is not vibrating to be certain that
the patient is responding to vibration and not pressure or some other clue. Vibration is
scored as 1) present if the examiner senses the vibration on his or her finger for < 10
seconds, 2) reduced if sensed for ≥ 10 or 3) absent (no vibration detection.)