Neurologic

EXAMINATION
Mental Status
Inspection
Appearance Language
Orientation Reasoning
Attention Span Judgment
Memory
 Mental Status
Normal Findings
able to respond to stimuli at the same lower level of strength
as most people who are functioning without neurologic
abnormality.

Abnormal Findings
Client is passive
-Disorientation
-Confusion
-Poor judgment and reasoning
Mental Status
Pathophysiology
global impairment of brain functions
caused by a disease, illicit drugs, an
infection, or one of many other causes.
 Cranial Nerves
I. Olfactory Nerve
Inspection
check if the air can move freely through each
nostril
check if the client can smell aromatic
substances
Normal Findings
the client can convey the sense of smell
air can move freely through each nostril
 Cranial Nerves
I. Olfactory Nerve
Abnormal Findings
🡪 inability to recognize odors
🡪 distortion in the sense of smell
Pathophysiology
🡪 head trauma
🡪 nasal and paranasal sinus disease
 Cranial Nerves
2. Optic Nerve
Inspection
🡪 Visual Acuity
🡪 Visual Confrontation
🡪 Color Perception

Observe For:
Ocular Symmetry
Eye Lid Symmetry
 Cranial Nerves
2. Optic Nerve
Normal Findings
🡪 pupils appear symmetric
🡪 20/20 sharpness or clarity of vision at a distance
Pathophysiology
🡪 the iris of the client is affected 🡪 head trauma
🡪 medical condition
Cranial Nerves
3. Oculomotor Nerves
4. Trochlear Nerves
6. Abducens Nerves

Inspection
🡪 Pupillary Reactions to Light
Cranial Nerves
3. Oculumotor, 4. Trochlear, & 6. Abducens
Nerves
🡪 Extraocular Movements
Observe for: Ptosis (drooping eyelid)
Cranial Nerves
Normal Findings
🡪 Equal pupil size, equal and consensual response to
light and accommodation.

Abnormal Findings
🡪abnormal movement of upward and downward gaze
Cranial Nerves
Abnormal Findings
🡪 client is having double vision
🡪 inability to abduct the eye

Pathophysiology
🡪 nerve damage and injury
🡪 brain stem lesions
Cranial Nerves
5. Trigeminal Nerve
SENSORY
Inspection
🡪 observe how the client response to the touch and
where the client felt the touch
Normal Findings
🡪 client indicates the right sensory perception
Cranial Nerves
5. Trigeminal Nerve
SENSORY
Abnormal Findings
🡪 feeling has an abnormal quality to it described
as different, uncomfortable, or burning

Pathophysiology
🡪 abnormal response to such stimuli
Cranial Nerves
5. Trigeminal Nerve
MOTOR
Inspection
🡪 muscle symmetry
Palpation
🡪 palpate the temporal and
masseter muscles
Cranial Nerves
5. Trigeminal Nerve
Normal Findings
🡪symmetrical movement and strength
Abnormal Findings
🡪 disturbances of movement
Pathophysiology
🡪 motor disorders
Cranial Nerves
CORNEAL REFLEX
Inspection
🡪 Observe for blinking and tearing in the eye.
At the same time, observe whether his other eye
blinks.
Normal Findings
🡪 A prompt bilateral reflex closure of the
eyelids
Cranial Nerves
Abnormal Findings
🡪 Absence of corneal reflex

Pathophysiology
🡪 Various disorders affecting the
trigeminal nerve
Cranial Nerves
7. Facial Nerve
Sensory Function
Series of facial expressions

Inspection
🡪 Observe for facial symmetry with the
patient’s relaxed expression.
🡪 Observe for Any Facial Droop or Asymmetry
Cranial Nerves
7. Facial Nerve
Normal Findings
🡪 symmetry of facial features with various
expressions
🡪 ability to identify varieties of flavor

Abnormal Findings
🡪 unusual facial movements
🡪 unable to identify each taste when placed
correctly on the tongue surface
Cranial Nerves
7. Facial Nerve
Pathophysiology
🡪 upper motor neurons are
affected
🡪 dysfunction of facial nerve
 Cranial Nerves
8. Acoustic Nerve
Auditory Function
Romberg Test
INSPECTION
🡪 Observe the client’s ability to hear the loudness and pitch of
sounds
🡪 Observe the subject for 20 seconds and note any swaying
or falling
 Cranial Nerves
8. Acoustic Nerve
Normal Findings
🡪 hearing is across the full range of speech
🡪 the client maintains balance and stability while standing

Abnormal Findings
🡪 unable to detect the sound produced
🡪the sound identified is not accurate to the voice test
🡪unable to maintain balance with their eyes closed.
 Cranial Nerves
8. Acoustic Nerve
Pathophysiology
🡪 lesions in the external auditory canal
🡪 ear infection
🡪 head injury
Cranial Nerves
9. Glossopharyngeal & 10. Vagus Nerve
Inspect and observe for:
presence of nasal or hoarse quality to voice.
a gag reflex followed by a swallow

Normal Findings
elicits gag reflex
uvula should rise symmetrically
Cranial Nerves
Abnormal Findings
difficulty in swallowing
gag reflex is not present

Pathophysiology
Glossopharyngeal nerve lesions
abnormalities of esophageal motility
Cranial Nerves
11. Spinal Accessory Nerve
Inspection
🡪 observe neck and shoulders for symmetry evidence
of fasciculations

🡪 observe the shoulder contour for hollowing,

displacement, or winging of the scapula
Cranial Nerves
11. Spinal Accessory Nerve

Palpation
🡪 palpate the
sternocleidomastoid with
your hand.
Cranial Nerves
11. Spinal Accessory Nerve
Normal Findings
🡪 Flexion of the neck by both
sternocleidomastoid muscles.

🡪 Elevation of the shoulder by the trapezius.

Cranial Nerves
11. Spinal Accessory Nerve
Abnormal Findings
🡪 abnormal contraction of
sternocleidomastoid from the
trapezius muscle

Pathophysiology
🡪 unilateral weakness of trapezius and sternocleidomastoid's
 Cranial Nerves
12. Hypoglossal Nerve
Inspection
🡪 Listen to the articulation of the client's words.
🡪Inspect for the appearance of tongue

Normal Findings
🡪 Draws the tongue upwards
🡪 Retracts the tongue and depresses its side
 Cranial Nerves
12. Hypoglossal Nerve
Abnormal Findings
🡪 inability of the tongue to be protruded
🡪 scalloped appearance of the tongue

Pathophysiology
🡪 Hypoglossal Nerve Lesions
🡪 infection
🡪 trauma
 Motor
A. Muscle Bulk
Inspection
Look for symmetry, inspecting both proximally and
distally
Note any deformities

Palpation
Palpate muscles to assess the bulk
 Motor
Normal Findings
No evidence of atrophy or loss of
muscle bulk
Symmetrical
No evidence of deformities

Abnormal Findings
Atrophy - wasting or thinning of
muscle mass.

Pathophysiology
occur due to poor nutrition, age,
and genetics
 Motor
B. Spontaneous Movements
Inspection
Examine especially wasting or hypertrophy,
fasciculation, and involuntary movements.

Normal Findings
No evidence of involuntary movements such as
tremor.
 Motor
Abnormal Findings
Fasciculations - brief, fine,
irregular twitches of the
muscle visible under the
skin.

Myoclonus - sudden, brief,

and sometimes repetitive
muscle contraction.
 Motor
Chorea - is a quick,
distal dance-like
movement.

Tremor -rhythmic
shaking movement in one
or more parts of your
body.
 Motor
Pathophysiology
Fasciculation - spontaneous depolarization of lower
motor neuron.

Myoclonus - a disturbance of the brain or spinal cord.

Chorea - overactivity of the neurotransmitter dopamine

in the areas of the brain that control movement.

Tremor- various lesions in the brain stem, extrapyramidal

system cerebellum can cause tremors.
 Motor
C. Muscle tone
resistance felt by the examiner when moving a joint
passively through its range of motion .
Site to check tone:
- Upper Extremities: Wrist and elbow joint
- Lower Extremities: Knee level, ankle joint
•Observe for increased and decrease of tone
 Motor
Normal Findings
No evidence of spasticity and flaccidness

Abnormal Findings
Hypotonia - too little muscle tone at rest
Hypertonia - too much muscle tone. It's 2 types are:
Spasticity - increased tone throughout the range of motion, and
there's a sudden release.
Rigidity - increased tone throughout the range of motion.
 Motor
Pathophysiology
Hypotonia - a breach in the reflex arc,
cerebellar disease, spinal shock

Hypertonia - caused by upper neuron lesions

which result from injury, disease, or conditions
involving damage to the central nervous
 Motor
Muscle Strength
- Test strength by having the patient move against your
resistance
- Work from proximal to distal
0/5 – No muscle movement
1/5 – Visible muscle movement, but no movement at the joint
2/5 – Movement at the joint, but not against gravity
3/5 – Movement against gravity, but not against added resistance
4/5 – Movement against resistance, but less than normal
5/5 – Normal strength
Reflexes
IPPA
Percussion
a method of tapping body parts with fingers,
hands, or small instruments as part of a
physical examination.
Reflexes

Reflex test- This test assesses

the reaction of motor pathways
and sensory responses.
Reflexes
Deep Tendon Reflexes
A. Biceps (C5, C6) The patient's
arm should be partially flexed at the
elbow with the palm down.
- There should be a reflex
contraction of the biceps brachii
muscle (elbow flexion).
Reflexes
B. Triceps (C6, C7) Support the
upper arm and let the patient's
forearm hang free.
The triceps brachii muscle must
elicits involuntary contraction
C. Brachioradialis (C5, C6) Have the
patient rest the forearm on the abdomen
or lap. In Brachioradialis we must, watch
for flexion and supination of the forearm.
Reflexes
D. Abdominal (T8, T9, T10, T11,
T12) Use a blunt object such as a
key
or tongue blade.
Note the contraction of the
abdominal muscles and
deviation of the umbilicus
towards the stimulus
Reflexes
E. Knee (L2, L3, L4) Have the patient sit or lie down with the knee
flexed.
Note contraction of the quadraceps and extension of the knee.

F. Ankle (S1, S2) Dorsiflex the foot at

the ankle.
Watch and feel for plantar flexion at
the ankle.
Knee Reflex Ankle Reflex
Reflexes
Clonus
rapid rhythmic
contractions of same
muscle
Observe for
rhythmic oscillations
 Reflexes
Plantar Response (Babinski)
Normal Findings:
- Note movement of the toes, normally flexion (withdrawal).
Abnormal Findings:
-Extension of the big toe with fanning
of the other toes is abnormal in other than a
young child. This is referred to as a positive
Babinski
Reflexes
Tendon Reflex Grading Scale
Reflexes
Normal Findings
Involuntary; nearly instantaneous movement in
response to a stimulus.

Normal vigor and briskness of response, but strength

of the response depends partly on the strength of the
stimulus
Reflexes
Normal Findings
Plantar flexion normal range of motion from 20
to 50 degrees from resting position
Presence of flexion and extension

Abnormal Findings
Absence/Diminished DTRs
Hyperactive reflexes with clonus
Rhythmic contraction of leg muscles
Reflexes
Pathophysiology
Pyramid Tract Lesions
Neuropathy or Lower Motor Neuron
Disorder
Guillain-Barre Syndrome
Sensory
Inspection
- Observe the patient ability to feel and reacts by
touching various parts of the body, bilaterally, with
a pen or another blunt item while the client has
their eyes closed.
Sensory
1. Light Touch
- Test both area of the upper extremities and lower extremities
using a cotton tip applicator or our fingers.
Sensory
Normal findings
If there is no difference or pain felt.

Abnormal findings
If the other side is different over the other one.
Can be described burning (paresthesia) or
painful (dysesthesia). Light touch causing pain
would be allodynia.
Sensory
2. Pain
- Test both area of the upper
extremities and lower extremities
using neurotip pin or alternatives
like sharp wooden stick or safety
pin.
Sensory
Normal Findings
The patient should be able to identify the sensation
as sharp.
If the sensation is the same.

Abnormal Findings
If the sharp sensation is decreased or lost.
Sensory

3. Temperature
- A cold test tube or tuning fork
is commonly used to assess
temperature sensation.
Sensory
Normal Findings
If the patient can identify the cold and hot.
No difference between left and right side of upper and lower
extremities.

Abnormal Findings
The patient is unable to distinguish the
difference between a hot and cold.
Sensory
4. Vibration
-It is tested by using a 128 Hz
tuning fork and placing the
vibrating instrument over a
bone.
Sensory
Normal findings
-If the patient felt the vibration on both left and right
side.

Abnormal findings
-Vibratory sensation is decreased on the right great toe
compared to the left.
-If there is difference.
Sensory
5. Position Sense
-Patient should determine the
direction of movement as you
move the great toe upward
or downward.
Sensory
Normal Findings
If identify correctly the direction or movement of the toe.

Abnormal Findings
Inability to identify the directions of the movements may
be seen in posterior column disease or peripheral
neuropathy (e.g., as seen with diabetes or chronic alcohol
abuse).
Sensory
Discriminative Sensations
These tests are dependent on touch and position
sense, they cannot be performed when the tests
above are clearly abnormal.
Sensory
1. Graphesthesia
-Draw a number on the patient’s
palm using a pen cap, paper clip,
or your finger and let them identify
the number.
Sensory
Normal findings
-If they identify it correctly.

Abnormal findings
-When patient has more difficulty identifying numbers
written in the right or left hands.
Sensory
2. Stereognosis
- Place a familiar object in the patient’s
hands and let
them identify what it is.

Normal findings
They can identify it without looking.

Abnormal findings
Wrong identifying the item or object.
Sensory
3. Two Point Discrimination
- Two-point discrimination is tested by using calipers or a
fashioned paper clip.

Normal findings
Identify correctly

Abnormal findings
Unable to identify it
 COORDINATION
A. Rapid Alternating Movements

Coordination -Look
for rate, rhythm,
amplitude, and
accuracy.
 COORDINATION
Normal Findings
Able to perform with speed and
accuracy

Abnormal Findings
Dysdiadochokinesia

Pathophysiology
Dysdiadochokinesia - multiple sclerosis
or cerebellar abnormalities
 COORDINATION
B. Finger to Nose Testing
 COORDINATION
Normal Findings
Able to do this at a reasonable
rate of speed, trace a straight
path, and hit end points
accurately.

Abnormal Findings
Dysmeria

Pathophysilogy
Dysmetria - Cerebellar damage
 COORDINATION
C. Heel - to - shin
 COORDINATION
Normal Findings
The patient is dragging hell on the shin in a straight line.

Abnormal Findings
Loss of motor strength
Cerebellar lesion

Pathophysiology
Cerebellar lesion- results in cerebellar outflow tremor or
postural tremor.
Station & Gait
Station – the
way a client
stands.

Gait – the way

a client walks.
Station & Gait
Station
Inspection
Standing or sitting upright
Unsteadiness or swaying
Bent/slumped over or leaning to one side
Station & Gait
Station
Normal Findings
The client is able to stand still with her feet less
than shoulder-width apart, maintain an upright
posture, and feet together.
Station & Gait
Station
Abnormal Findings
Loss of Proprioception - when there is a reduction in the
awareness of posture, weight, movement, and limb position.

Muscle Weakness - debility, loss of function, and

asymmetry.
Station & Gait
Gait
Inspection – ask the patient to:
1. Walk across the room, turn, and come back.
2. Walk heel-to-toe in a straight line.
3. Walk on their toes in a straight line.
4. Walk on their heels in a straight line.
Station & Gait
Gait
Normal Findings
– the client is able to walk smoothly, effortlessly, and
with arms swinging easily at the sides. Turns are also
smooth. There should be normally associated movement
of their upper extremities.
Station & Gait
Gait
Normal Findings
1. Walk Heel – Toe (Tandem Gait) - The patient should be
able to balance without falling or stepping to the side.

2. Walk on Toes and Heels – The patient should be able to

balance as well as able to test the strength of their distal lower
extremities.
Station & Gait
Gait
Abnormal Findings
Cerebellar Ataxia (unsteady gait) – the client cannot stand
with feet together.

Shuffling Gait – possible occurrence of Parkinson’s

disease. The client turns in a much-stiffed manner.
Station & Gait
1.

2.
Station & Gait
Gait
Abnormal Findings
Scissors Gait – thighs overlap each other with every step.

Foot Drop (cannot walk on heels) – client slaps the foot

down hard on the ground.
Station & Gait
3.

4.
Neurologic
EXAMINATION