The Neuro Exam

• Vitals should be checked before therapy, during therapy, and after therapy.
• Do not perform therapy if HR is above 120 at rest.
• Be cautious with therapy if HR is below 60 at rest.
• Do not perform therapy if BP is greater than 180/110. Be cautious if it is below 90/60.
• Do not perform therapy if O2 is less than 92%.
• Do not perform therapy is blood glucose is below 70 or above 250.
• Absent reflexes are given a 0
• A slight contraction during reflex testing is considered a 1+
• Normal reflexes are given a 2+
• A brisk contraction during reflex testing is considered a 3+
• An abnormally high response during reflex testing is given a 4+
• 0 and 4+ are always considered abnormal during reflex testing.
• Babinski is positive if the toes extend and abduct in response to the test.
• Clonus is positive if the foot bounces multiple times. This should be timed or counted.
• Hoffman's Sign is positive if there is flexion of the thumb and 2nd finger after a flick of the 3rd nail.
• UMN signs are weakness, increased tone, spasticity, hyperreflexia, and the reemergence of primitive reflexes.
• LMN signs are weakness, decreased tone, hyporeflexia, fasciculations, and atrophy.
• After a significant spinal cord injury, the patient will initially present with LMN signs.
• Equilibrium reactions and protective reactions are found in the cortex.
• Right reactions are found in the midbrain.
• Primitize reflexes are found in the brain stem and spinal cord.
• During the grasp reflex, the patient will have strong flexion of the toes or fingers after firm pressure is applied to the palmer or plantar side.
• The olfactory nerve identifies smells.
• Anosmia is the inability to smell or identify a smell.
• Olfaction should only be tested one side at a time with a nonoxious odor.
• The optic nerve is tested with visual acuity and fields, or blink to threat.
• The patient should be wearing glasses or contacts if they normally use them to see during optic nerve testing.
• Deficits to the optic nerve include blindness and field deficits or cuts.
• The job of the oculomotor nerve is the pupillary reflex, accommodation or lens and voluntary movement of the eye.
• The oculomotor nerve is tested by shining a light into each eye and convergence.
• Both eyes should constrict when a light is shone in one.
• Deficits to the oculomotor nerve result in no pupillary constriction, lateral strabismus (lazy eye), and anisocoria (different pupil sizes).
• The job of cranial nerves three, four, and six are extraocular movements. This is tested with smooth pursuits and saccadic eye movements.
• Deficits to cranial nerves 3, 4, and 6 may include ptosis (drooping of eyelid) and strabismus (eyes not working together).
• Cranial nerve three turns the eye up, down, and inward. It also elevates the eyelid.
• Cranial nerve four turns the eye down when adducted.
• Cranial nerve six turns the eye out.
• The trigeminal nerve performs sensation of the face and mastication.
• The trigeminal nerve is tested through facial sensation and masseter motion.
• The trigeminal nerve is also responsible for the corneal reflex.