Ch. 7 Neurological Asessment

• Meningeal - The three connective tissue layers that surround the Spinal fluid

  Signs: stiff, painful and/or inflated spine
• Babinski 

  • Test by sliding something along the bottom of the foot

   (in adults foot curls, in baby’s foot flare out)
• Upper Body:

  • Deltoid C5, C6 (bend arm push against arm, then push down, and then back)
  • Biceps C5, C6 (bend arm, pull above the wrist)
  • Triceps C6, C7, C8 (push right above the wrist)
  • Extensor carpi radialis C5, C6 (ush bent back of the wrist)
  • Abductor policis breuis T1 (push and pull thumb)
  • Interossei C8-T1 (pull apart fingers, have patient squeeze fingers)
• Lower Body:

  • Iliopsoas- L1, L2, L3 (muscle the flexes the hip) (push against thigh)
  • Quadriceps - L2, L3, L4 (push down on feet)
  • Hamstrings L5-S2 (pull right above ankle)
  • Tibialis Anterior - L1-L5 (have patient curl ankle inward, and push against it)
  • Gastrocnemius/soleus - S1, S2 (have patient push down on hand)
• Dermatomes - nerves that are connected to the skin
• Cervical Dermatome: C1-C8
• Olfactory Nerve (1)

  1. Have your lab partner close both eyes and plug one nostril. Hold a familiar smell under the open nostril and ask him/her to identify it. Test the other nostril with a different smell.
• Optic Nerve (2)

  1. Ask your lab partner to cover one eye. Hold the printed material

  approximately 18 inches away and have them read two sentences. Repeat the procedure using the other eye.
• Oculomotor (3), Trochlear (4), & Abducens (5) Tested together

  1. Hold your forefinger about 18 inches away from partner’s eyes. Ask your partner to follow your finger with his/her eyes as you draw the letter “H”. Partner’s eyes should move together as they follow your finger with their eyes. Head should not move. B. Shine the penlight into your partner’s eye from approximately 8 inches away. Pupil should constrict immediately. Repeat with other eye.
• Trigeminal Nerve (6)

  1. Put your fingertips on your partner’s temples & ask him/her to clench their teeth. Place your finger on the masseter muscles, placing your fingertips on his/her jaw & ask them to clench their teeth. B. Have partner close both eyes. Lightly touch his/her forehead, cheek, and jaw on both sides of the face using a cotton ball. Have them tell you when they feel the cotton touching them.
• Facial Nerve (7)

  1. Have your partner raise their eyebrows, frown, smile and puff out their cheeks. B. Have your partner tightly close their eyes & resist your gentle attempts to open them.
• Acoustic Nerve (8)

  1. Stand 2 feet slightly behind your partner’s right side. Whisper several numbers and see if they can repeat them. Repeat on other side.
• Glossopharyngeal (9) & Vagus (10)

  1. Place your hand on your lab partner’s throat & ask him/her to swallow.
• Spinal Accessory Nerve (11)

  1. Place your hand against partner’s cheek and have them turn their head as your apply resistance. B. Place your hands on your partner’s shoulders & have him/her shrug their shoulders as you apply resistance.
• Hypoglossal Nerve (12)

  1. Have our partner stick out their tongue. Note any deviations. B. Ask your partner to move the tongue from side to side.
• Sensory:

  • General Points
  • test/touch somewhere
  • Vibration
  • Tuning fork
  • Joint position sense
  • "This is up" "this is down"
  • Pain
  • Temperature
  • Light touch
  • howevering
  • Double simultaneous stimulation
  • Test/touch 2 points at once
  • Graphestia
  • draw symbol on patient’s hand
  • Stereognosis
  • place object in patient’s hand, have them identify it
  • Romberg sign
  • Have patient stand up and close eyes
• Coordination

  1. Truncal stability
  2. Can’t keep posture good
  3. Fine finger movements
  4. thumb-finger
  5. Toe tapping
  6. The ball of their foot should be able to tap your hand
  7. Finger-nose-finger
  8. Tell patient to touch your finger then touch their nose
  9. Heel-knee-shin
  10. Have patient take their heels and rub it on the shin of the other leg
  11. Rapid alternating movements
  12. Hand folding/flipping-clapping
• 1. Mental Status
  2. “FOGS”
  3. F - Family story of memory loss
  4. O - Orientation
  5. G - General Information
  6. S - Spelling &/or numbers
  7. Recognition of objects