nervous

• The essential processes of the brain and nervous system are key to understand why health care providers perform neurological assessment
• The whole body will suffer, once disruption to any of these processes occur
• This module will discuss neurological history questions and exam techniques
• Learning Objectives


  • Recognize the importance of performing Neurological Assessment
  • Outline logical and systematic approach in performing neurological assessment
  • Describe and report abnormal neurological assessment findings
• Neurological examination


  A series of simple questions and tests that provide crucial information about the nervous system
• Components of Assessment


  • A Comprehensive history
  • A neurologic physical examination
  • General and specific neurodiagnostic studies
• In the clinical practice, a neurologic examination begins with an assessment of mental status. The assessment of mental status relies on a comprehensive one-on-one interview, it is beyond the scope of this module
• Neurological Assessment


  1. Evaluate the mental status of the client

  2. Conduct Mental Status Examination
• Perception


  • Agnosia: inability to interpret or recognize objects
  • Language ability: Aphasia – inability to use and understand written and spoken words
• Test for cerebellar and postural function

  1. Walking gait

  2. Romberg test

  3. Standing on one foot with eyes closed

  4. Heel-toe walking

  5. Toe or heel walking

  6. Fine motor tests, finger to nose

  7. Alternating supination and pronation of hands on knees

  8. Finger to nose to the nurse's finger

  9. Fingers to fingers

  10. Fingers to thumb

  11. Heel to opposite shin

  12. Toe or ball of the foot to the nurse's finger
• Tandem Walking


  Toe or heel walking, ask the patient to walk across the room under observation, note gross gait abnormalities, walk heel to toe across the room, then on their toes only, and finally on their heels only
• Romberg's test


  Patient stand still with their heels together, ask the patient to remain still and close their eyes for about 8-10 secs, if the patient loses their balance, the test is positive
• Finger to Nose & Finger to nose to the nurse's finger

  Point-to-point test, nose as the base, point in any direction, patient accurately performs the task: normal, patient develops tremor when approaching the target: intention tremor, patient misses the target: past-pointing or dysmetria
• Alternating supination and pronation of hands on knees

  Sitting Position, palms up + palms down + alternating, if the patient is able to do the task with normal rate and rhythm—Normal, if movements are irregular, disorganized, dysrhythmic, uncoordinated—dysdiadochokinesia
• Fingers to Fingers


  Sitting Position, client joins his both right and left fingers together, while finger are together, client will try to make a space of each finger one at a time, if the patient is able to do the task with normal rate and rhythm—Normal, if movements are irregular, disorganized, dysrhythmic, uncoordinated—dysdiadochokinesia
• Fingers to Thumb


  Sitting Position, with one hand, point fingers and thumb straight up, touch your thumb to each finger, one finger at a time
• Heel to Opposite Shin


  Best done in the supine position but can be on sitting position, ask the patient to lift one leg up and place the heel on the shin of the other leg, and then smoothly rub it along the shin down toward the toes, the test is abnormal if movement is irregular or the heel falls off the leg
• Toe of patient's foot to the nurse's finger

  Best done on sitting position, ask the patient to lift one leg up and finger of the nurse, the test is abnormal if movement is irregular
• Sensory Function


  1. Light Touch sensation

  2. Pain Sensation

  3. Temperature Sensation

  4. Position or Kinesthetic Sensation

  5. Tactile Discrimination: Stereognosis
• Light Touch sensation


  Use wisp of cotton, ask clients to close both eyes and tell you what they feel and where, examine the spinal segments sequentially, normal findings: correctly identifies light touch, deviated findings: anesthesia, hypoesthesia, hyperesthesia
• Pain Sensation


  Establishing a baseline for sharpness before examining the limb, test pin prick sensation down each limb and over the trunk, ask the patient to report if the quality of sensation changes, deviated findings: analgesia, hypoalgesia, hyperalgesia
• Temperature Sensation


  Only tested when pain sensation is abnormal, test tubes, hot & cold H2O, this deficit is in the same distribution as the pain deficit noted when testing sharp sensation
• Position or Kinesthetic Sensation

  Passive movement of extremity, finger or big toe up and down, hold by sides between thumb and index finger, if position sense is impaired, move proximally to next joint
• Tactile Discrimination: Stereognosis


  Ask the patient to close their eyes and identify the object you place in their hand, astereognosis refers to the inability to recognize objects placed in the hand
• Cranial Nerves


  • CN I Olfactory
  • CN II Optic
  • CN III Oculomotor
  • CN IV Trochear
  • CN V Trigeminal
  • CN VI Abducens
  • CN VII Facial
  • CN VIII Auditory
  • CN IX Glossopharyngeal
  • CN X Vagus
  • CN XI Spinal Accessory
  • CN XII Hypoglossal