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Level of � Hyperalert � Lethargic � Stuporous consciousness � Irritable � Obtunded � Comatose Neuromuscular � uninhibited � diminished � diminished/absent control � over-reactive � spontaneous � spontaneous movement motion Muscle tone � normal � delicate hypotonia � flaccid � gentle distal � robust distal � intermittent Posture flexion flexion decerebration Tendon reflexes � overactive � overactive � decreased/absent Complex reflexes Suck � weak � weak/absent � absent Moro � strong � weak � absent Autonomic � basic � common � each methods operate sympathetic parasympathetic depressed Pupils � mydriasis � miosis � mid-place, often unequal � poor light reflex Respirations � spontaneous � spontaneous � periodic apnoea � occasional episodes apnoea episodes � variable, often Heart fee � tachycardia � bradycardia bradycardia 19. 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