The Neurological System
1
Neurological Exam 5
Components
Mental status
 Cranial nerves
 Reflexes
 Motor- includes Cerebellar function
 Sensory

2
Mental Status Examination

Examination - ABCT
 Appearance
 Behavior
 Cognition
 Thought
processes (thought content &
perceptions)

Glasgow Coma Scale
3
Assessing LOC:
Glasgow Coma Scale

Eye opening

Verbal
responsiveness

Motor
responsiveness
4
Glasgow Coma Scale
5
Physical Examination





Levels of Consciousness
Alert- awake or easily aroused
Lethargic- not fully alert, drifts off when not
stimulated
Obtunded- sleeps most times, difficult to
arouse (loud noise, vigorous shaking or pain)
Stupor- need persistent loud noise or pain for
arousal; responds to stimuli
Coma- no response
(Jarvis CH 2)
6
Neurological: Physical Examination
Sensory System Function


With eyes closed
Interpret sensations
Discriminate side to side
Examine in detail if:
Reduced sensation
Numbness or pain
Motor or reflex abnormal
Skin changes
Be specific: “tell me where I touch”
7
Physical Examination
Sensory Function Tests:

Touch
 Light
touch 1st then Pain & Temperature
Vibration
 Kinesthesia/Proprioception: Position sense
 Stereognosis
 Graphesthesia
 2-point discrimination

8
Sensory Function Tests:
Sensory Exam: Light Touch
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Sensory Function Tests:
Sensory Exam: Vibration
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Sensory Function Tests:
Proprioception: Position sense
11
Sensory Function Tests:
Stereognosis
12
Sensory Function Tests:
Graphesthesia
13
Sensory Function Tests:
Two-point discrimination
14
Motor Examination
Symmetry, size, and presence of
involuntary movements
 Full ROM of joints
 Check strength against resistance


Neuro patients: Assess hand grips and
foot pushes if bedridden
15
Cerebellar Function
1.
2.
Gait and posture
More specific
tests
 Heel to toe in
straight line
 Walking on toes
and heels
 Hop on one foot
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Cerebellar Function, con’t
Coordination of hands
Rapid Alternating Movements
17
Cerebellar Function, con’t
Coordination of hands
Nose –to - Finger Test
18
Cerebellar Function, con’t
Coordination of legs
Heel to Shin Test
19
Cerebellar con’t
Romberg:
Stand upright, place
feet together, then
close eyes

loss of balance
means + Romberg
test
3.
Be prepared to protect
client from falling!
20
Reflexes

Superficial
(abdominal reflex,
Cremasteric reflex)
Cremastic Reflex
Abdominal Reflex
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Reflexes-Cont: Visceral (pupillary
response to light)
PERRL/PERRLA
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Reflexes-Cont: Pathologic
+ Babinski in adults
Babinski’s Reflex (Adult)
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Reflexes-Cont:
Reflex Arc – Deep Tendon Reflexes
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Reflexes-Cont:
Deep Tendon Reflexes
Technique



Position limb so muscle is
slightly stretched
Reflex hammer should
strike tendon briskly to
stretch tendon
Get patient to relax
25
BRACHIORADIALIS
BICEPS
ACHILLES/PLANTAR
TRICEPS
PATELLAR
DEEP TENDON REFLEXES
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Grading of DTRs
4+
 3+
 2+
 1+
0

very brisk
brisker than average
average, normal
diminished, low normal
no response
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