Neurological Assessment

• Level of consciousness is the first aspect of neurologic examination to deteriorate, often with changes being subtle and requiring careful monitoring.
• Pouring of warm water into the left ear leads to eye movement to the right and a direction of nystagmus is on the left (same side).
• Do not confuse the direction of nystagmus (COWS rule) and the direction of motion of eyes.
• Orientation vs disorientation, person, place & time, and consciousness are categories of consciousness.
• The following terms are commonly used to describe a decreased level of consciousness: full consciousness, lethargy, obtundation, and coma.
• Especially useful for evaluating patients during the acute stages of head injury or traumatic brain injury (TBI), neurologic assessment includes a level of consciousness examination.
• Tandem gait or reflex action is an involuntary and nearly instantaneous movement in response to a stimulus.
• Cranial Nerve: XII is known as the Hypoglossal Nerve and is responsible for assessing the client's speech for hoarseness.
• Dysdiadokinesia, or inability to do this, may be indicative of cerebellar disease.
• The Heel-To-Shin Test involves having the patient move the heel of one foot up and down along the top of the other shin.
• Cranial Nerve: IX is known as the Glossopharyngeal Motor Nerve and is responsible for the movement of the tongue from side to side, up and down.
• The Finger To Nose Test should be performed at a reasonable rate of speed, tracing a straight path, and hitting the end points accurately.
• A reflex is made possible by neural pathways called reflex arcs which can act on an impulse before that impulse reaches the brain.
• Romberg test is used to assess patients with truncal ataxia caused by damage to the cerebellar vermis or associated pathways, as they tend to have a wide-based, unsteady gait, and become more unsteady when attempting to keep their feet close together.
• Sensory functions of Cranial Nerve: IX include applying tastes on the posterior tongue for identification.
• The sternocleidomastoid muscle can be tested for contraction by having the client shrug their shoulders and then observing and palpating the contraction.
• Rapid Alternating Finger Movements can be tested by asking the patient to touch the tips of each finger to the thumb of the same hand.
• The movement should be fluid and accurate.
• Cranial Nerve: XI is known as the Spinal Accessory Nerve and is responsible for testing the strength and articulation of the tongue by having the client push the tongue to the side of the mouth against resistance applied to the cheek.
• Coordination, gait & equilibrium functions of the nervous system include the Finger To Nose Test, where the patient is instructed to move their index finger between your finger and their nose.
• Cranial Nerve: X is known as the Vagus Nerve and is responsible for assessing the strength of the sternocleidomastoid and upper trapezius muscles by asking the client to move the head against resistance of your hand.
• Dysmetria, or missing the mark, may be indicative of disease.
• The gag reflex can be tested by gently touching the posterior pharyngeal wall with a tongue depressor.
• Nervous system functions include controlling cognitive and voluntary behavioral processes, as well as subconscious and involuntary bodily functions.
• The most important aspect of a neurologic examination is the level of consciousness, which often deteriorates first and changes can be subtle, requiring careful monitoring.
• Level of consciousness is composed of two components: arousal, which is alertness, and awareness, which is content.
• Arousal is assessed through orientation, which is the ability to recognize the person, place, and time.
• Awareness is assessed through orientation, which is the ability to recognize the person, place, and time.
• Decreased level of consciousness can be described as full consciousness, where the patient is alert, attentive, and follows commands.
• Lethargy is a state where the patient is drowsy but awakens, although not fully, to stimulation and, once awake, remains attentive.
• Obtundation is a state where the patient is difficult to arouse and needs constant stimulation in order to follow a simple command.
• If any of the reflexes appear hyperactive, perform the Jendrassik maneuver.
• A reflex rating of 4+ is very brisk, hyperreflexive, with clonus.
• Feel for oscillations between flexion and extension of the foot indicating clonus.
• A reflex that is only elicited with reinforcement is rated as 0.
• In the absence of clonus, normally nothing is felt.
• Reinforcement for deep tendon reflexes is accomplished by asking the patient to clench their teeth or, if testing lower extremity reflexes, having the patient hook together their flexed fingers and pull apart.
• The Jendrassik maneuver involves holding the relaxed lower leg in your hand and sharply dorsiflexing the foot and holding it dorsiflexed.
• Dorsiflexion of the foot is a deep tendon reflex with a rating of 5+, characterized by sustained clonus.
• A reflex rating of 1+ is low normal, diminished.