Neuro examination
General inspection
End of bed right side
Bedside clues ( walking aids , catheter , IV drip)
Upper Limb
Inspection
Tone ( resting tone
reduced/normal/increased)
****** always ask if
patient in pain*******
Comment : muscle tone
are normal/reduce
/increased
Power
Grade
0- Paralysis
1- Flicker
2- Gravity exclude
3- Against gravity
4- Some resistance
5- Normal
Comment : muscle power
are 5/5 bilaterally
Lower Limb
Abnormal posture
Muscle wasting
Fasciculation ( see on both side)
Abnormal movements ( tremor at rest Parkinson )
Motor system
1. Elbow ( flex and 1. Roll leg ( side to side)
extend ) hold elbow 2. Pull leg up and let go
joint 3. Rotate ankle ( hold ankle )
2. Wrist ( flex, extend 4. Sharply dorsiflex the foot
,pronate ,supinate ) (look for ankle clonus
recurrent ankle plantar flexion
due to hypertonia )
1. Shoulder 1. Hip abduction&
abduction& adduction adduction (push towards
2. Elbow -flexion and & pull apart )
extension ( pull away, - Flexion and extension
push away) stabilise (straighten leg and
elbow joint then push
3. Wrist flexion and contralaterally)
extension (straighten 2. Knee ( secure knee joint )
& bend ) stabilise - Flexion and extension
wrist joint & hand ( bend knee and
griped straighten knee from
4. Finger flexion & bend position)
extension( push )
hold at palm 3. Ankle( secure ankle joint)
- Abduction ( push dorsiflex ( straighten
finger close) ankle )
hold at palm - Plantarflex ( bend
- Adduction ( try to ankle )
pull the paper 4. Toes ( secure the toe at
sheet from the distal interphalangeal
fingers ) joint)
5. Thumbs abduction -dorsiflex ( straighten )
adduction -plantarflex ( bend)
- Pincer grip ( try
breaking the grip )
- Grip strength ( ask
patient to grip
your finger and
you try to pull
finger away from
her grip)
Reflexes Try twice only , if cannot Reinforcement ( jendrassiks
Comment: appreciate try reinforcement( manoeuvre) pull apart
0 ( absent) clench teeth) interlocking fingers
+ (present but reduced) 1. Biceps reflex( thumb 1. Knee reflex( bend knee
++(normal) at bicep tendon) and one arm below the
+++(increased) 2. Triceps reflex ( strike knee to support strike
++++( greatly directly) infrapatellar tendon
increase/clonus) 3. Brachioradialis reflex quadriceps contraction)
****muscle must contract (two fingers ,5 cm 2. Ankle reflex ( bend knee
to appreciate tendon while from wrist ) but down dorsiflex foot
resting **** to expose achilles
tendon gastrocnemius
contraction)
3. Plantar reflex (blunt object
stroke from lateral border
of foot to big toe
plantarflexion of big toe )
Coordination ( test 1. Finger nose test ( 3x 1. Heel shin test
cerebellum) fully outstretch arm) 2. Foot tapping test
Comment : no past pointing ,
no intention tremor and finger
nose test is normal
2. Pronate and supinate
hand on the dorsum
of the other hand
Comment : hand
coordination is normal
and no dysdiadochokinesis
Sensory system ( eye closed)
Light touch ( with cotton
wool) ask equal or not
on both side
Comment : light touc
sensation normal equal
Test normal area ( sternum )
bilaterally
Test dermatome
Pain
ask equal or not on both
side
Comment : pain sensation
normal equal bilaterally
Vibration Use 128Hz
Comment : vibration Place at chest ( test area )
sensation normal equal Place at distal phalanx
bilaterally -appreciate the vibration?
-appreciate when it stop ?

Proprioception Hold distal phalanx

Comment : proprioception Move up and down
normal equal bilaterally Tell distal phalanx position
Examination of gait Ask patient to walk normally
Comment : gait is normal, Ask patient to walk heel to toe
negative Rombergs test Ask the patient to walk on toes
Ask patient to walk on heels
Rombergs test feet closed
together close eye