NEUROLOGIC

ASSESSMENT
Lecture by: M.K. Sastry
Program Director,
Post Graduate Studies and PhD Program
 Structure and Function
Central Nervous System (CNS)
 Cerebral cortex

 Frontal lobe

 Parietal lobe

 Occipital lobe
 Structure and Function
Central Nervous System (CNS)
 Cerebral cortex

 Wernicke’s area

 Broca’s area

 Basal ganglia
 Structure and Function
Central Nervous System (CNS)
 Thalamus

 Hypothalamus

 Cerebellum
 Structure and Function
Central Nervous System (CNS)
 Brainstem

 Midbrain

 Pons

 Medulla
 Structure and Function
Central Nervous System (CNS)
 Spinal cord
 Structure and Function
Pathways of the CNS
 Crossed representation

 Sensory pathways

 Spinothalamic tract

 Posterior (dorsal) column

 Structure and Function
Pathways of the CNS
 Motor pathways

 Corticospinal or pyramidal tract

 Extrapyramidal tracts

 Cerebellar system
 Structure and Function
Pathways of the CNS
 Upper motor neurons

 Lower motor neurons

Cerebral Cortex
Components of the Central Nervous
System
Sensory Pathways
 Subjective Data—
Health History Questions

 Headache

 Head injury

 Dizziness/vertigo

 Seizures
 Subjective Data—
Health History Questions

 Tremors

 Weakness
 Objective Data—
The Physical Exam

 Preparation

 Screening neurologic examination

 Complete neurologic examination

 Neurologic recheck
 Objective Data—
The Physical Exam

 Equipment needed

 Penlight

 Tongue blade

 Cotton swab
 Objective Data—
The Physical Exam

 Equipment needed

 Cotton ball

 Tuning fork (128 or 256 Hz)

 Percussion hammer
 Objective Data—The Physical Exam

 Equipment needed

 Occasionally need: familiar

aromatic substance
 Objective Data—The Physical Exam

Test Cranial Nerves

 I—Olfactory
 II—Optic
 III—Oculomotor,
 IV—Trochlear,
 V—Abducens
 Objective Data—The Physical Exam

Test Cranial Nerves

 VI—Trigeminal
 Motor function
 Sensory function
 Corneal reflex
 Objective Data—The Physical Exam

Test Cranial Nerves

 VII—Facial

 Motor function

 Sensory function
 Objective Data—The Physical Exam

Test Cranial Nerves

 VIII—Acoustic (vestibulocochlear)

 IX—Glossopharyngeal,
 Objective Data—The Physical Exam

Test Cranial Nerves

 X—Vagus

 Motor function

 Sensory function
 Objective Data—The Physical Exam

Test Cranial Nerves

 XI—Spinal accessory

 XII—Hypoglossal
 Objective Data—The Physical Exam

Motor System—Inspect and palpate

 Muscles

 Size

 Strength

 Tone
 Objective Data—The Physical Exam

Motor System—Inspect and palpate

 Muscles

 Involuntary movements
 Objective Data—The Physical Exam

Motor System—Inspect and palpate

 Cerebellar function
 Balance tests

 Gait

 Tandem walking
 Objective Data—The Physical Exam

Motor System—Inspect and palpate

 Cerebellar function
 Balance tests

 Romberg’s test

 Shallow knee bend

 Objective Data—The Physical Exam

Motor System—Inspect and palpate

 Cerebellar function
 Coordination and skilled movements

 Rapid alternating movements

 Finger-to-finger test
 Objective Data—The Physical Exam

Motor System—Inspect and palpate

 Cerebellar function
 Coordination and skilled movements

 Finger-to-nose test

 Heel-to-shin test
 Objective Data—The Physical Exam

Sensory System
 Person is alert, cooperative, and
comfortable.
 Guidelines for sensory testing.
 Objective Data—The Physical Exam

Sensory System
 Spinothalamic tract.

 Pain.

 Temperature.

 Light touch.
 Objective Data—The Physical Exam

Sensory System
 Posterior column tract

 Vibration

 Position (kinesthesia)
 Objective Data—The Physical Exam

Sensory System
 Posterior column tract

 Tactile discrimination (fine touch)

 Stereognosis

 Graphesthesia
 Objective Data—The Physical Exam

Sensory System
 Posterior column tract

 Tactile discrimination (fine touch)

 Two-point discrimination

 Extinction
 Objective Data—The Physical Exam

Sensory System
 Posterior column tract

 Tactile discrimination (fine touch)

 Point location
Objective Data—The Physical Exam

 Test the stretch or deep tendon

reflexes.

 Technique

 Grading
Objective Data—The Physical Exam

 Test the stretch or deep tendon

reflexes.

 Reinforcement

 Biceps reflex
Objective Data—The Physical Exam

 Test the stretch or deep tendon

reflexes.

 Triceps reflex

 Brachioradialis reflex
Objective Data—The Physical Exam

 Test the stretch or deep tendon

reflexes.

 Quadriceps reflex
Objective Data—The Physical Exam

 Test the stretch or deep tendon

reflexes.

 Achilles reflex (“ankle jerk”)

 Clonus
 Objective Data—The Physical Exam

 Test the superficial reflexes

 Abdominal reflex

 Cremasteric reflex

 Plantar reflex
 Objective Data—The Physical Exam

 Neurologic recheck

 Level of consciousness

 Person

 Place
 Objective Data—The Physical Exam

 Neurologic recheck

 Level of consciousness

 Time

 Motor function
 Objective Data—The Physical Exam

 Pupillary response

 Vital signs

 Glasgow Coma Scale (GCS)

 Pupillary Changes
 Oculomotor response (Cranial nerve
III).
 Size, equality, and roundness of pupils
assessed.
 Size measured in millimeters.
 Pupillary Changes
 Evaluated for symmetry in size and
response to light stimulus.
 Brisk, sluggish, non-reactive.

 Consensual reaction of opposite pupil

at same time.
Pupillary Changes to Light
 Pupillary Changes
 Assess accommodation by holding
finger 4-6 inches from client’s nose
and then pull out to 18 inches.
 Pupillary Changes
 As finger moves away pupil will
accommodate by dilating, as finger
moves closer, constricting.
 PEARLA- Pupils equal and reactive to
light and accommodation.
 Motor Function
 Ability to follow commands

 Muscle tone
 Muscle strength

 Coordination
 Motor Function
 Balance (Romberg test)

 Posturing (Decorticate, Decerebrate)

 Sensory Function
 Tactile sensation

 Pain
 Temperature

 Vibratory sensation

 Tactile discrimination
 Reflexes
 Superficial

 Deep tendon
 Biceps

 Triceps

 Patellar
 Reflexes
 Achilles

 Plantar (Babinski Response)

 Assess Speech and Hearing
 Clear and appropriate.

 Confused.
 Inappropriate.

 Garbled.
 Assess Speech and Hearing
 Aphasia (Expressive,
Receptive).
 Limited hearing.

 Use of hearing aids.

Sample Charting
 Sample
Charting
Sample Charting
Thank You