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NEUROLOGICAL EXAM

Technique and Normals Abnormalities


Cerebellar Testing Tandem walking Pt walks heel to toe in a straight (+) Ataxia; sensitive to UMN
- line lesion (ie. MS)
Balance Normal - pt can walk straight & Crooked line of walk, widens
stay balanced base to maintain balance,
staggering, loss of balance.
Romberg’s Test Stand behind the pt; pt stands (+) = sways, falls, widens base
feet together eyes open for 20- of feet to avoid falling
30s, then eyes closed -cerebellar ataxia w/ eyes open
Note steadiness -sensory ataxia w/ eyes closed,
loss of position sense
Pronator Drift Pt stands eyes closed, arms (+) Poor position correction,
straight palms up; explain for loss of proprioception
20-30s, watch for arms to
pronate; tap the arms briskly
downward and watch for
smooth return
Hop in Place On each foot in turn (+) decreased cerebellar fxn or
Normal position sense, muscle ↓ muscle strength
strength, coordination *elderly: have them sit down,
then stand
Coordination Rapid rhythmic Tap knees with fronts and (+) dysdiadochokinesia: slow,
alternating movement – backs of hands quickly; tap clumsy, sloppy response, occurs
both upper and lower bottoms of feet on hands with cerebellar disease
extremities Note speed, rhythm,
smoothness
Point-to-point testing Finger-to-nose: close eyes, Note motion accuracy,
touch your finger to your nose clumsiness, intention tremor 
Heel-to-shin: slide your heel cerebellar disease
down your opposite shin Dysmetria: clumsy movement
with overshooting the mark
Past pointing: constant deviation
to one side
Sensory Testing Pain Distinguish btwn dull and sharp, Tests lateral spinothalamic tract
*bilaterally 3 dermatomes on upper and 3 Hypoalgesia = ↓ pain sensation
Compare the on lower extremity
same area on
both sides of the Temperature Cold – only 1 dermatome Tests lateral spinothalamic tract
body; distal to If pain was absent then you
proximal would test temp
Light touch Using a cotton wisp, touch Tests anterior spinothalamic
EYES CLOSED
three dermatomes bilaterally on tract
the upper and lower extremities Hypoesthesia = decreased
“Close your eyes and point to sensation
where you feel this” Anesthesia = absent touch
Vibration Place the tuning fork on the Tests posterior spinothalamic
MTP of the big toe, and the tract
MCP of the thumb Loss of vibration sense occurs
Tell me when you feel it stop with peripheral neuropathy
Position Sense Close your eyes; this is up, this Tests posterior spinothalamic
is down with the big toe; hold tract
the sides of the toe
Discriminative Sterognosis Place an object in each hand to Tests posterior spinothalamic
Sensation identify tract
Asteriogenosis=inability to ID
object correctly. Occurs with
stroke.
Two Point Discrimination One dermatome bilaterally on Positive test = sensory cortex
both upper and lower lesion
extremities – varies based on
area being tested
Motor System Inspection Body position with mvmt at rest. tremors, tics, fasciculation’s
Symmetry Muscle atrophy, winging of the
scapula, paralysis
Muscle Tone Move pts four relaxed limbs and Note spasticity, rigidity and
assess any resistance symmetry

Muscle Strength AROM: squat, reach behind Compare sides, note any
shoulder and touch opposite paresis or paralysis
scapula, extend arms and make Grade muscle strength:
a fist, then open the hands

REFLEXES Deep tendon reflexes Biceps: C5, C6 – find the Grading:


*bilaterally & biceps tendon and hit your 0 – no response
symmetrically thumb 1 – low (e.g. LMN lesion)
Triceps C6, C7 – 2 – average
Reinforcement: Brachioradialis C5, C7 – 3 – brisker (may indicate
Clench teeth – upper slightly pronate and hit above disease – UMN lesion)
Pull hands – lower the wrist 4 – very brisk indicative of
Patellar L2, L3, L4 – disease – clonus may be
Achilles S1 - slightly dorsiflex present = short, jerky
foot contractions of the same muscle

Superficial Abdominal Above umbilicus – T8, T9, T10 (+) disease of pyramidal tracts
Reflexes Below umbilicus – T10, T11,
T12
Stroke all 4 quadrants of the
belly from outside in
Cremasteric Stroke inside of thigh, up the
*explain leg, watch to see if the same
side testicle raises
Tests L1, L2
Pathological Babinski’s sign Stroke up the lateral bottom (+) dorsiflexion of big toe and
Reflexes and across the ball of the foot fanning of other toes in adults
Normal – adults feet flex and
toes curl in, babies feet flex,
toes fan out
Tests L5, S1
Meningeal Signs Neck Pain Pain the neck upon resisted
– choose 1 flexion (don’t let me move your
head)
Brudzinski’s sign Flex pts head
(+) pt flexes hip and knees
Kernig’s sign Flex the pts leg at the hip and
knee, extend the knee
(+) bilateral pain and ↑
resistance to extending the
knee