Neurologic Assessment

• Mental Status

  1. Assess orientation and memory.
  2. Orientation involves people, time and place.
  3. Memory includes short - term (immediate recall), recent and remote memory.
• LOC 


  It is the single most sensitive indicator of changes in the neurologic status of a client.
• Level of Consciousness

  • Level I. Conscious, coherent, cognitive (3 C's).
• Level of Consciousness

  • Level III. Stuporous; responds only to noxious, strong or intense stimuli, e.g, sternal pressure, trapezius pinch, pressure at the base of the nail or supraorbital area; very strong light or very loud sound.
• Level of Consciousness

  • Level II. Confused, drowsy, lethargic, somnolent, obtunded.
• Level of Consciousness

  Level IV.

  • Light coma: response is only grimace or withdrawing limb from pain, primitive and disorganized response to painful stimuli.
  • Deep coma: absence of response to even the most painful stimuli.
• GCS is an objective measure to describe LOC.
• Glasgow Coma Scale

  The three areas assessed are eye opening, motor response and verbal response.
• Glasgow Coma Scale

  Eye Opening

  • 4 - Spontaneous

  • 3 - To sound

  • 2 - To painful stimuli

  • 1 - No eye opening
• Glasgow Coma Scale

  Verbal Response

  • 5 - Oriented
  • 4 - Confused
  • 3 - Inappropriate words
  • 2 - Incomprehensible sounds
  • 1 - No Response
• Glasgow Coma Scale

  Motor Response

  • 6 - Obeys command
  • 5 - Localizes painful stimuli
  • 4 - Withdraw from pain
  • 3 - Decorticate (abnormal flexion)
  • 2 - Decerebrate (abnormal extension)
  • 1 - No response.
• Sensory Function

  Tests for sensory function assess the functioning of the parietal lobe.
• Agnosia is inability to perceive sensory stimuli.
• Motor Function

  If the frontal lobe is affected, the client experiences inability to performmotor activities.
• Apraxia is inability to perform fine motor activities (done by fingers).
• Agraphia is inability to write.
• Romberg test 


  The test is done by asking the client to stand with the feet together and the eyes closed or the client is asked to walk in an imaginary line
• Romberg test is done to assess cerebellar function (sense of equilibrium).
• Ataxia is uncoordinated movement, characterized by wide - base stance and swaying manner of walking.
• • Weakness ("paresis")
  • Paralysis ("plegia")
• • Flaccidity (hypotonicity)
  • Rigidity (hypertonicity)
• • Atrophy (loss of muscle volume)
  • Hypertrophy (increase in muscle volume)
• • Bradykinesia (slow muscle movement not associated with weakness).
  • Akinesia (absence of muscle movement not associated with weakness).
• Coordination. Assessed by:

  • FTNT (finger-to-nose-test)
  • H-K-T (heel-to-knee-to-toe test)
• Station is posture; gait is manner of walking.