Professional Documents
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CAL
ASSESSMEN
T
Canas, Patricia
Gan, Razel
Ruelo, Vanessa
Aquino, Camile
Guillano, Christabelle
BSN III
NERVOU
S
SYSTEM
The nervous system maintains
internal order within the body by
coordinating the activities of
muscles and organs, receives input
from sense organs, trigger
reactions, generating learning and
understanding, and providing
protection from danger.
NERVOU
S
SYSTEM
The nervous system in a human is
made of the brain, spinal cord,
sensory organs and all the neurons
that serve as communication
channels between the various
organs of the body. It is
primarily made of a single type
of cell called the neuron.
NEURON
varies in shape and size depending
upon their function and location.
All neurons have three different
parts – dendrites, cell body and
axon
Dendrites
- These are branch-like
structures that receive
messages from other neurons
and allow the transmission of
messages to the cell body.
NEURON
Cell Body
- Each neuron has a cell body with a
nucleus, Golgi body, endoplasmic
reticulum, mitochondria and other
components.
Axon
- Axon is a tube-like structure that
carries electrical impulse from the
cell body to the axon terminals that
passes the impulse to another
neuron.
Synapse
- It is the chemical junction between
the terminal of one neuron and
dendrites of another neuron.
TABLE OF CONTENTS: NEUROLOGICAL
ASSESSMENT
CRANIAL NERVE
01 EXAM
Patricia Canas MOTOR
LEVEL OF 04 FUNCTION
Camile Aquino
02 CONSCIOUSNESS
Razel Gan
SENSORY 05 REFLEXES
Christabelle Guillano
03 FUNCTION
Vanessa Ruelo
01
CRANIAL
NERVE
EXAM
Patricia Canas
The cranial nerves are a set of twelve
nerves that originate in the brain. Each
has a different function for sense or
movement.
—Cranial Nerves
12 CRANIAL
NERVES
12 CRANIAL
NERVES
CRANIAL NERVE
EXAM: CN I:
OLFACTORY NERVE
1. The sense of smell is tested by having
the patient occlude one nostril and
close his or her eyes.
2. The examiner then takes a non
irritating substance and places it
near the non occluded nostril. The
patient is asked to identify familiar
odors (coffee, tobacco). Each nostril
is tested separately
3. Repeat the process for the opposite
side using a different scent.
CRANIAL NERVE
EXAM:
CN II: OPTIC NERVE
1. The optic nerve testing includes assessment
of both visual acuity and visual fields.
2. Each eye is examined separately while the
patient covers the other one.
3. Visual acuity is tested by having the patient
read a Snellen chart from 20 feet away
4. Have the patient start with one eye covered
and read the lines from top to bottom
(largest to smallest letters).
5. Record the lowest line that the patient can
read with 50% accuracy.
SNELLE
N
CHART
CRANIAL NERVE
EXAM:
CN III: OCULOMOTOR
NERVE
1. Test for eye movement toward the nose
2. inspect for conjugate movements and
Evaluate papillary size and test for
pupillary reactivity to light
3. inspect ability to open eyelids.
CRANIAL NERVE
EXAM: CN IV:
TROCHLEAR NERVE
Camile Aquino
MOTOR
ABILITY
1. A thorough examination of the motor
system includes an assessment of
muscle size and tone as well as
strength, coordination, and
balance.
2. The patient is instructed to walk
across the room, if possible, while
the examiner observes posture and
gait. The muscles are inspected,
and palpated if necessary, for
their size and symmetry.
3. Any evidence of atrophy or
involuntary movements (tremors,
tics) is noted.
MOTOR
ABILITY
1. Muscle tone (the tension present in
a muscle at rest) is evaluated by
palpating various muscle groups at
rest and during passive movement.
2. Resistance to these movements is
assessed and documented.
Abnormalities in tone include
spasticity (increased muscle tone),
rigidity (resistance to passive
stretch), and flaccidity.
MUSCLE
STRENGTH
1. Assessing the patient’s ability to flex
or extend the extremities against
resistance tests muscle strength.
2. The function of an individual muscle or
group of muscles is evaluated by
placing the muscle at a disadvantage.
The quadriceps, for example, is a
powerful muscle responsible for
straightening the leg.
3. Once the leg is straightened, it is
exceedingly difficult for the examiner
to flex the knee. If the knee is flexed
and the patient is asked to straighten
the leg against resistance,
MUSCLE
STRENGTH
1. weakness can be elicited. The
evaluation of muscle strength compares
the sides of the body to each other.
For example, the right upper extremity
is compared to the left
2. upper extremity. Subtle differences in
strength may be evaluated by testing
for drift. For example, both arms are
out in front of the patient with palms
up; drift is seen as pronation of the
palm, indicating a subtle weakness
that may not have been detected on the
resistance examination.
RATE MUSCLE
STRENGTH
• 5 indicates full power of
contraction against gravity and
resistance or normal muscle
strength;
• 4 indicates fair but not full
strength against gravity and a
moderate amount of resistance or
slight weakness;
• 3 indicates just sufficient
strength to overcome the force of
gravity or moderate weakness;
RATE MUSCLE
STRENGTH
• 2 indicates the ability to move
but not to overcome the force of
gravity or severe weakness;
• 1 indicates minimal contractile
power (weak muscle contraction can
be palpated but no movement is
noted) or very severe weakness;
• 0 indicates no movement.
COORDINATION
• Cerebellar and basal ganglia influence
on the motor system is reflected in
balance control and coordination.
• Coordination in the hands and upper
extremities is tested by having the
patient perform rapid, alternating
movements and point-to- point testing.
• First, the patient is instructed to pat
his or her thigh as fast as possible
with each hand separately.
COORDINATION
• Then the patient is instructed to
alternately pronate and supinate the
hand as rapidly as possible.
• Last, the patient is asked to touch
each of the fingers with the thumb in
a consecutive motion. Speed, symmetry,
and degree of difficulty are noted.
• Point-to-point testing is accomplished
by having the patient touch the
examiner’s extended finger and then
his or her own nose. This is repeated
several times.
COORDINATION
• Coordination in the lower extremities
is tested by having the patient run the
heel down the anterior surface of the
tibia of the other leg. Each leg is
tested in turn.
• Ataxia is defined as incoordination of
voluntary muscle action, particularly
of the muscle groups used in activities
such as walking or reaching for
objects.
• Tremors (rhythmic, involuntary
movements) noted at rest or during
movement suggest a problem in the
anatomic areas responsible for balance
and coordination.
BALANCE /ROMBERG TEST
• Ask the clients stand still with
their heels together. Ask the
clients to remain still and close
their eyes.
• Result: if the clients loses their
balance after standing still with
their eye closed. This is positive
Romberg.
GAIT TESTING
• To check ability to stand and walk:
• Ask the patient to walk across the
room, turn, and come back towards you.
Pay particular attention to, difficult
to walk and indicate upper extremities
weakness.
• Difficulty getting up from a chair, Can
the patient easily arise from a sitting
position. Problems with this activity
might suggest proximal muscle weakness,
a balance problem, or difficulty
initiating movements.
• Ask the clients to walk on heels is the
most sensitive way to test foot
dorsiflextion.
05
ASSESSME
NT FOR
REFLEXES
Christabelle Guillano
REFLEX TESTING
01 02 03
Biceps Reflex Triceps Brachio
Reflex Radialis
Reflex
04 05
Patellar Achilles
Reflex Reflex
BICEPS REFLEX TESTING
• Triceps (C7C8- Radial Nerve):
• This is most easily done with the client
seated.
• The biceps reflex is elicited by striking
the biceps tendon over a slightly flexed
elbow
• The examiner supports the forearm with one
arm while placing the thumb against the
tendon and striking the thumb with the
reflex hammer.
• The normal response is flexion at the
elbow and contraction of the biceps.
TRICEPS REFLEX TESTING
• To elicit a triceps reflex, the patient’s
arm is flexed at the elbow and positioned
in front of the chest.
• The examiner supports the patient’s arm
and identifies the triceps tendon by
palpating 2.5 to 5 cm (1 to 2 inches)
above the elbow.
• A direct blow on the tendon normally
produces contraction of the triceps muscle
and extension of the elbow.
BRACHIO RADIALIS
• With the patient’s forearm resting on the
lap or across the abdomen, the
brachioradialis reflex is assessed.
• A gentle strike of the hammer 2.5 to 5 cm
(1 to 2 inches) above the wrist results in
flexion and supination of the forearm
PATELLAR REFLEX
TESTING
• Achilles (s1,s2 - Sciatic Nerve):
• This is most easily done with the clients
seated, feet dangling over the edge of the
exam table.
• The patellar reflex is elicited by
striking the patellar tendon just below
the patella.
• The patient may be in a sitting or a lying
position. If the patient is supine, the
examiner supports the legs to facilitate
relaxation of the muscles.
• Contractions of the quadriceps and knee
extension are normal responses.
ACHILLES REFLEX
TESTING
• To elicit an Achilles reflex, the foot is
dorsiflexed at the ankle and the hammer strikes
the stretched Achilles tendon.
• This reflex normally produces plantar flexion.
• If the examiner cannot elicit the ankle reflex
and suspects that the patient cannot
relax, the patient is instructed to kneel on a
chair or similar elevated, flat surface.
• This position places the ankles in dorsiflexion
and reduces any muscle tension in the
gastrocnemius.
• The Achilles tendons are struck in turn, and
plantar flexion is usually demonstrated
BABINSKI REFLEX
• The clients may either sit or lies
supine.
• Use the handle end of your reflex hammer,
which is solid and comes to a point.
• Start at the lateral aspects of the foot,
near the apply gentle, steady pressure
with the end of the hammer as you move
medial, stroking across this area.
• A well-known pathologic reflex indicative
of central nervous system disease
affecting the corticospinal tract.
SUPERFICIAL REFLEXES
• The corneal reflex: using a clean wisp of
cotton and lightly touching the outer corner of
each eye on the sclera. The reflex is present
if the action elicits a blink. A stroke or
brain injury might result in loss of this
reflex, either unilaterally or bilaterally.