CRANIAL NERVES

Health Assessment
NERVOUS SYSTEM

 CENTRAL NERVOUS SYSTEM

 PERIPHERAL NERVOUS SYSTEM
Spinal Nerves
Cranial Nerves
CRANIAL NERVES

 12 pairs of cranial nerves

 These nerves are responsible for carrying information and connecting the
brain to different parts of the body
 Emerge directly from the brain without passing through the spinal cord
 They are part of the peripheral nervous system that relates the brain to the
cranial and cervical structures ( head and the neck)
 2 Functions: a. Sensory
b. Motor- Somatic and Parasympathetic
*Somatic- innervates skeletal muscles
* Parasympathetic- innervates glands, smooth muscles
and cardiac muscles
12 Pairs of Cranial Nerves
 I- Olfactory Nerve
 II- Optic Nerve
 III- Oculomotor
 IV- Trochlear
 V- Trigeminal
 VI- Abducens
 VII- Facial or Intermediate
 VIII- Vestibulo-Cochlear
 IX-Glossopharyngeal
 X-Vagus
 XI-Accessory
 XII-Hypoglossal
I- Olfactory Nerve
Fxn: Smell Type: Sensory

 Assessment Technique  Normal Response

 Do not test routinely  Client is able to identify different
smell with each nostril separately
 Indications: loss of smell d/t head
and with eyes closed
trauma, abnormal mental status
and when presence of intracranial
pressure is suspected
 Abnormal Findings
 Ask the client to smell and identify
 Air passages are occluded with
the smell of cologne with each
URTI or sinusitis
nostril separately and with the
eyes closed.  Ansomnia- decrease or loss of smell
occurs bilaterally with tobacco or
smoking, allergic rhinitis and
cocaine use
II- Optic Nerve
Fxn: Vision Type: Sensory

 Assessment Technique  Normal Response

 The client should be able to read
with each eye and both eyes.
 Test Visual Acuity – Snellen Chart
and Near Vision Test

 Test Visual Fields- Confrontation

Test
SNELLEN CHART
Place in a well lit spot at eye level
Position client in 20 ft from the chart
Shield one eye with an opaque card (* Using
own fingers may tempt clien to peek)
If they wear glasses or contact lenses leave
them on (* Remove reading glasses)
Ask client to read Chart to the smallest line
of letters possible.
NORMAL RESPONSE
20/20
ABNORMAL RESPONSE
Hesistancy, squinting,leaning forward and
misreading letters
• The larger the denominator, the poorer
the vision
• >20/30- refer to opthalmologist
NEAR VISION TEST

 Provide adequate lighting and ask client to read from a reading material held
at a distance of 36 cm. (14 in.).

 Abnormal Findings
 The person moves the card farther away
CONFRONTATION TEST
Client will be asked to cover one eye, fixing
your gaze on the examiner's eyes.
The examiner will then conduct finger
movements, bringing his or her hands into
your visual field from the sides.
Because your vision is divided into four
quadrants in your brain, the examiner will
hold up fingers in each quadrant.
You will say how many fingers you see
without actually looking at them, thus testing
your peripheral, or side, vision.
ABNORMAL FINDINGS
Peripheral Field Loss- Refer to an optometrist
for more precise testing
III- Oculomotor
Fxn and Type: Motor- most EOM movements; Parasympathetic- pupil constriction
and lens shape
 Assessment Technique  Normal Response
 Reaction to light: Using a penlight  Illuminated pupil should constrict.
and approaching from the side,
shine a light on the pupil. Observe
the response of the illuminated
pupil. Shine the light on the pupil
again, and observe the response of
the other pupil.

 Reaction to accommodation: Ask  Pupils constrict when looking at a

client to look at a near object and near object, dilate when looking at
then at a distant object. Alternate a distant object, converge when
the gaze from the near to the far near object is moved towards the
object. Next, move an object nose
towards the client’s nose.
 PERRLA
IV- Trochlear
Fxn: Down and Inward movements of the eye; Type: Motor

 Assessment Technique  Normal Response

 Hold a penlight 1 ft. in front of the

client’s eyes. Ask the client to  Client’s eyes should be able to
follow the movements of the follow the penlight as it moves.
penlight with the eyes only. Move
the penlight upward, downward,
sideward and diagonally.
VI- Abducens
Fxn: Lateral Movement of eye; Type: Motor

 Assessment Technique  Normal Response

 Hold a penlight 1 ft. in front of the  Both eyes coordinated, move in
client’s eyes. Ask the client to unison with parallel alignment.
follow the movements of the
penlight with the eyes only. Move
the penlight through the six
cardinal fields of gaze.
Abnormal Findings in CN 3,4,6
Eye movement is not parallel. Failure to follow
in a certain direction indicates weakness of an
extraocular muscle or dysfunction of cranial
nerve innervating it.
Ptosis- occurs due to dysfunction of the muscles
that raise the eyelid or their nerve supply (CN 3)
Strabismus- condition in which the eyes do not Ptosis
properly align with each other when looking at
an object
Nystagmus-
Rhythmic, oscillating motions of the eyes
V- Trigeminal
Fxn and Type: Motor- muscles of mastication; Sensory- sensation of face,scalp,
cornea
 Assessment Technique
 Motor Fxn: Assess muscles of
mastication by palpating temporal
and masseter muscles as person
clenches teeth. Try to separate
jaws by pushing down on the chin.
 Normal Response
 Muscles should feel equally strong
on both sides. Cannot push chin
down.
 Abnormal Findings
Decreased strength on one or both
sides. Asymmetry in jaw movement.
Pain with clenching of teeth
V- Trigeminal (cont.)

 Assessment Technique  Normal Response

 Sensory Function: With client eyes  Client should be able to respond to
closed, test light touch sensation light and deep sensation
by touching a cotton wisp to
forehead, cheek and chin. Let
client say YES whenever the touch
is felt.
 To test deep sensation, use
alternating blunt and sharp ends of
an object. Let client say blunt for  Abnormal Findings
blunt sensation and sharp for sharp  Decrease or unequal sensation
sensation.
V- Trigeminal (cont.)

 Assessment Technique  Normal Response

 Corneal Reflex: While client looks  blink reflex on both eyes
forward, lightly touch lateral
cornea of eye with cotton wisp
(* Remove contact lenses)
 Abnormal Findings
 No blink occurs with lesions of
cranial nerve 5 and CN 7 paralysis
VII- Facial
Type and Fxn: Motor: facial muscles, close eyes, labial speech
Sensory: taste on anterior 2/3 on the tongue
Parasympathetic: Saliva and Tear Secretion

 Assessment Technique  Normal Response

 Motor: Ask client to smile, raise  Client performed various facial
the eyebrows, frown, and puff out expressions without any difficulty
cheeks, close eyes tightly. and able to distinguish varied
tastes.

 Sensory: Ask client to identify

various tastes placed on tip and
sides of tongue. *(Do not test
routinely)
 Abnormal Findings
Loss of movement and asymmetry of
movement; (Bells palsy)
VIII- Vestibulo-Cochlear
Fxn: Hearing and equilibrium Type: sensory

 Assessment Technique
 Hearing Acuity
-Voice Test
- Rinnes Test
- Weber’s Test
 Balance/ Equilibrium
- Observe Gait
- Heel to toe walking
- Romberg Test
VIII- Vestibulo-Cochlear (cont.)
 VOICE TEST  Normal Response
Test one ear at a time The person repeats each word
correctly after you say it.
Mask hearing in the other ear
*( placing one finger on the tragus and
rapidly pushing it in and out of the
auditory meatus)
With head 1-2 ft from the person’s ear
whisper slowly some two syllable
words *(Shield your lips so the person
cannot do lip reading)
VIII- Vestibulo-Cochlear (cont.)
 RINNE’S TEST  WEBER’S TEST
 2xAC> BC – Positive Rinne’s Test  -Lateralization- should be heard
equally
VIII- Vestibulo-Cochlear (cont.)

 RINNE’S TEST hearing loss  WEBER’S TEST hearing loss

 Conductive hearing loss  Conductive hearing loss

BC= AC or BC>AC (Negative Rinne’s Sound lateralizes to poorer ear
test)

 Sensorineural hearing loss

 Sensorineural hearing loss
Sound lateralizes to better ear
Normal ratio of AC> BC is intact but
sound is diminished overall. That is,
person hears poorly both ways
VIII- Vestibulo-Cochlear (cont.)
 Assessment Technique  Normal Response
 GAIT  The gait is smooth rhythmic and
effortless, arm swing is
Let and observe patient walk up to 20
coordinated, turns are smooth.
ft, turns and return to the starting
point
 TANDEM WALKING/ HEEL TO TOE  Person can walk straight and stay
balanced
Ask the person to walk an straight line
in heel to toe fashion
 ROMBERG TEST
Ask client to stand up with feet Person can maintain posture with
together, close eyes and hold position. closed eyes.
Ask the person to have shallow knee Demonstrates position sense and
bend or hop in place, first on one leg muscle strength
and on the other.
Abnormal Findings during balance test
 REGULAR GAIT
 Stiff immobile posture, staggering or reeling
 Lack of arm swing or rigid arms
 Unequal rhythm of steps
 Ataxia- uncoordinated or unsteady gait
 TANDEM WALK
 Crooked line of walk
 An ataxia not present on regular walk may appear now
 ROMBERG TEST
 Positive Romberg Test-Loss of balance when closing the eyes
IX-Glossopharyngeal
Fxn and Type: Motor: pharynx ( phonation and swallowing)
Sensory: Taste on posterior 1/3 of tongue, pharynx ( gag reflex)
Parasympathetic: parotid gland, carotid reflex
 Assessment Technique  Normal Response
 Ask the client to say “ah” and have  Client should be able to elicit gag
the patient yawn to observe reflex and swallow without any
upward movement of the difficulty.
soft palate.
 Elicit Gag Reflex- touching the
 Abnormal Response
pharyngeal wall with gag reflex
 Absence or asymmetry of soft
 Note Ability to swallow
palate movement
X-Vagus
Fxn and Type: Motor: pharynx and larynx (talking and swallowing)
Sensory: General Sensation from carotid body, csrotid sinus,
pharynx and viscera
Parasympathetic: carotid reflex

 Assessment Technique  Normal Response

 Ask the patient to swallow and  The client should be able to
speak (note hoarseness) swallow without difficulty and
speak audibly.

 Abnormal Findings
 Hoarse or brassy voice occurs with
vocal cord dysfunction
XI-Accessory
Fxn and Type: Motor: movement of trapezius and sternomastoid muscles

 Assessment Technique  Normal

 Examine sternomastoid and
trapezius muscle for equal size.
 Ask client to shrug shoulders
against resistance from your hands
and turn head to side against
resistance from your hand (repeat
for other side).
 Client should be able to shrug
shoulders and turn head from side
to side.Response
 Abnormal Findings
 Atrophy and Muscle Weakness or
Paralysis
XII. Hypoglossal
Fxn and Type: Motor: movement of tongue

 Assessment Technique  Normal Response

 Inspect the tongue  The client should be able to move
tongue without any difficulty.
 Ask client to protrude tongue at
midline and then move it side to
side.

 Abnormal Findings
 Atrophy, Fasciculations and tongue
deviates to sides (toward the
paralyzed side)
THANK YOU!