General Neuro Assessment

• Vision - Visual Screen

  ask questions - blurred/double vision, glass check, be aware of prev eye conditions (glaucoma), ask what is pt's baseline
• Vision - Tracking

  keep head still, follow fingers

  looking for smooth pursuit in all directions
• Vision - Visual Fields

  testing peripheral vision

  keep looking at my nose, hold fingers each side of head + wiggle one side, then the other and both

  move around, pt points to what side they can see moving
• Vision - Double/Blurred Vision

  cover one eye up

  hold fingers up in front of face

  how many fingers can they see

  change eyes
• ROM

  establish any pre-existing limitations - total hip/knee replacements, OA/RA ...

  explore passively + can they achieve full PROM - note any limitations/restrictions

  move passively thru diff speeds to get an idea of muscle tone - high/low, spasms, stiffness

  explore actively

  look at key joints holistically (whole body)
• Strength

  use MRC scale

  look at main areas - shoulder, elbow, wrist, hip, knee + ankle

  if unable to lift agaisnt gravity - offer active assistance to help w grading

  
• Sensation

  many diff types of sensation - light/deep, pain, temp, vibration, joint position sense

  main assessment looks at detecting light tough first

  test unaffected side then affected side

  apply light touch w cotton wool

  if pt can't talk, get them to touch/ point where they felt being touched
• Proprioception

  assessment of joint position sense - ability to detect where your body is in space + time

  start w most distal joint - distal phalange of thumb + big toe

  eyes closed moving the pt's distal joint up/down a few degrees ask them to identify whether pos it up/down

  test best out of 5

  if the pt can't identify these movments w eyes closed, test the next most proximal joints (e.g. testing the ankes if toe movement isn't perceived or wrist)
• Co-ordination

  ability to perform smooth, controlled movement

  repeatedly execute a sequence of movements smoothly + accurately

  upper limb - pt touches nose then physio finger, get them to perform at diff speeds, physio can move finger to test co-ordination

  lower limbs - supine, pt rus heel up +down shin on opp leg
• Balance

  sitting - static unsupported (r they holding onto bed/chair), dynamic - touching physio hand, reaching

  standing - use of aids/arms, unsupported, reaching out of BOS, narrowing BOS, eyes open/closed, tandem walking, single leg stand

  sit to stand to walking
• Mobility

  rolling - sitting, standing - use of aids, verbal cues, prompts, assistance

  use of aids/assistance in walking

  gait pattern - stance, step length, heel strike, intiation, freezing, festination

  stairs - use of aids/rails, foot clearance, control, weight acceptance