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The Neurological System

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Neurological Exam 5 Components

Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory

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Mental Status Examination

Examination - ABCTAppearanceBehaviorCognitionThought processes (thought content &

perceptions) Glasgow Coma Scale

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Assessing LOC:Glasgow Coma Scale

Eye opening

Verbal responsiveness

Motor responsiveness

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Glasgow Coma Scale

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Physical Examination

Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not

stimulated Obtunded- sleeps most times, difficult to

arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for

arousal; responds to stimuli Coma- no response

(Jarvis CH 2)

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Neurological: Physical Examination

Sensory System Function

With eyes closedInterpret sensationsDiscriminate side to side

Examine in detail if:Reduced sensationNumbness or painMotor or reflex abnormalSkin changes

Be specific: “tell me where I touch”

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Physical Examination

Sensory Function Tests:

Touch Light touch 1st then Pain & Temperature

Vibration Kinesthesia/Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination

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Sensory Function Tests:

Sensory Exam: Light Touch

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Sensory Function Tests:

Sensory Exam: Vibration

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Sensory Function Tests:

Proprioception: Position sense

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Sensory Function Tests:

Stereognosis

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Sensory Function Tests:

Graphesthesia

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Sensory Function Tests:

Two-point discrimination

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Motor Examination

Symmetry, size, and presence of involuntary movements

Full ROM of joints Check strength against resistance

Neuro patients: Assess hand grips and foot pushes if bedridden

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Cerebellar Function

1. Gait and posture

2. More specific tests Heel to toe in straight

line Walking on toes and

heels Hop on one foot

Note width of gait

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Cerebellar Function, con’tCoordination of hands

Rapid Alternating Movements

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Cerebellar Function, con’t Coordination of hands

Nose –to - Finger Test

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Cerebellar Function, con’t Coordination of legs

Heel to Shin Test

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Cerebellar con’t

3. Romberg:

Stand upright, place feet together, then close eyes

loss of balance means + Romberg test

Be prepared to protect client from falling!

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Reflexes Superficial

(abdominal reflex, Cremasteric reflex)

Abdominal Reflex

Cremastic Reflex

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Reflexes-Cont: Visceral (pupillary response to light)

PERRL/PERRLA

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Reflexes-Cont: Pathologic + Babinski in adults

Babinski’s Reflex (Adult)

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Reflexes-Cont: Reflex Arc – Deep Tendon Reflexes

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Reflexes-Cont: Deep Tendon Reflexes

Technique

Position limb so muscle is slightly stretched

Reflex hammer should strike tendon briskly to stretch tendon

Get patient to relax

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BRACHIORADIALIS BICEPS

TRICEPS

PATELLAR

ACHILLES/PLANTAR

DEEP TENDON REFLEXES

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Grading of DTRs

4+ very brisk 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 no response