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NEUROLOGI

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

1. Trochlear - Test for upward eye movement


inspect for conjugate movements and
nystagmus
CRANIAL NERVE
EXAM: CN V:
TRIGEMINAL NERVE
The trigeminal nerve is the largest of the
cranial nerves
1. The patient should have his or her eyes
closed during the testing procedure.
2. Touch cotton to forehead, cheeks, and jaw.
Sensitivity to superficial pain is tested in
these same three areas by using the sharp and
dull ends of a broken tongue blade.
3. Alternate between the sharp point and the
dull end. Patient reports “sharp” or “dull”
with each movement.
CRANIAL NERVE
EXAM: CN V:
TRIGEMINAL NERVE
4. If responses are incorrect, test for
temperature sensation.
5. Test tubes of cold and hot water are used
alternately. While patient looks up, lightly
touch a wisp of cotton against the temporal
surface of each cornea. A blink and tearing
are normal responses.
6. Have patient clench and move the jaw from
side to side. Palpate the masseter and
temporal muscles, noting strength and
equality.
CRANIAL NERVE
EXAM: CN VI:
ABDUCENS NERVE
1. Abducens - Test for lateral eye movement
2. 3 cranial nerves are usually tested
together because they control the
function of the extra ocular eye
muscles.
- The functions include eyelid elevation,
constriction of the pupils, and movement of
the eye through the six cardinal
directions.
CRANIAL NERVE
EXAM: CN VII:
FACIAL NERVE
Sensory test
1. The facial nerve is also a mixed cranial nerve
with both sensory and motor components.
2. The sensory component includes the sense of
taste on the anterior two- thirds of the
tongue. The testing of the sensory component
is often deferred, unless changes are noted in
the health history interview.
CRANIAL NERVE
EXAM: CN VII:
FACIAL NERVE
Sensory test
3. When tested, have the patient stick out
his or her tongue and test each side
separately.
4. The taste is sweet and pleasant, but
different from the standard sweet taste.
Test ability to discriminate between
sugar and salt.
CRANIAL NERVE
EXAM: CN VII:
FACIAL NERVE
Motor :
1. Observe for facial tics. Then, ask the
patient to perform the following
movements: raise his or her eyebrows,
close his or her eyelids tightly, puff
out his or her cheeks, smile, and
frown.
2. Observe for weakness or asymmetry of
muscle movement.
CRANIAL NERVE
EXAM: CN VII:
FACIAL NERVE
Motor :
3. Abnormal findings of upper motor
neuron lesion, lower motor neuron
lesion, or a stroke can cause
weakness or paralysis of the facial
muscles.
4. Have the patient rinse his or her
mouth with water between tests.
CRANIAL NERVE EXAM:
CN VIII: ACOUSTIC
(VESTIBULOCOCHLEAR) NERVE
The acoustic nerve has two divisions:
cochlear and vestibular.
1. The cochlear division is involved in
hearing- Do weber and rinnes test
2. The vestibular division is involved
in the sense of balance, which
includes equilibrium, coordination,
and orientation is space.
3. First, examine the patient’s ear
canals for obvious blockages or
malformation.
CRANIAL NERVE EXAM:
CN IX: GLOSSOPHARYNGEAL
NERVE

Assess patient’s ability to swallow and


discriminate between sugar and salt on
posterior third of the tongue.
CRANIAL NERVE EXAM:
CN X: VAGUS NERVE
The glossopharyngeal and vagus nerves are
usually tested together. In the pharynx, CN IX
is primarily sensory, and CN X is mostly
motor.
1. observe the patient as he or she swallows a
small amount of water.
2. Ask if he or she frequently chokes on food
or has trouble swallowing. Dysphagia
(difficulty swallowing ) can often be seen
after neurosurgical procedures or CVA
(stroke.)
CRANIAL NERVE EXAM:
CN X: VAGUS NERVE

3. Depress a tongue blade on posterior tongue, or


stimulate posterior pharynx to elicit gag
reflex. Note any hoarseness in voice.
4. Check ability to swallow. Have patient say
“ah.” Observe for symmetric rise of uvula and
soft palate
CRANIAL NERVE EXAM:
CN XI: ACCESSORY NERVE
1. Assess the trapezius & sternocleidomastoid
2. Trapezius – examiner place the hands on
patient shoulder, ask the patient TO shrug his
/her shoulder.
3. Observe strength
4. Sternocledoid- examiner place hands on one
cheek and ask the patient to turn his/her head
against hand as the movement is resisted
5. Repeat the test on opposite
6. Abnormality - CVA
CRANIAL NERVE EXAM:
CN XII: HYPOGLOSSAL NERVE

1. The hypoglossal nerve is tested by asking the


patient to open his or her mouth, stick out
his or her tongue, and wiggle it side to side.
2. While patient protrudes the tongue, note any
deviation or tremors. Test the strength of the
tongue by having patient move the protruded
tongue from side to side against a tongue
depressor.
CRANIAL NERVE EXAM:
CN XII: HYPOGLOSSAL NERVE

3. The tongue should be midline. Observe for


asymmetry, atrophy, or fasciculations.
Carotid endarterectomy is a common cause of
dysfunction of CN XII.
ASSESSMENT02
OF THE
LEVEL OF
CONSCIOUSN
ESS
Razel Gan
LEVEL
OF CONSCIOUSNESS
(LOC)
• the most important aspect of the
neurologic examination
•  focuses on two areas: 1)
evaluation of arousal or alertness
and 2) appraisal of content of
consciousness or awareness
• the most important aspect of the
neurologic examination
•  focuses on two areas: 1)
evaluation of arousal or alertness
and 2) appraisal of content of
consciousness or awareness
LEVEL OF
CONSCIOUSN
ESS
CONSCIOUSNESS &
COGNITION
1. Observing the patient’s appearance and
behavior, noting dress, grooming and
personal hygiene. Posture, gestures,
movements, and facial expressions often
provide important information about the
patient. 
2. Assessing orientation to time, place, and
person
3. Assessment of immediate and remote memory
is also important. 
4. Immediate – asking the patient to repeat 6
digit forward & backward 
5. Recent – what was the breakfast/ dinner
6. Remote – birthday / childhood
INTELLECTUAL
FUNCTION
1. A person with an average IQ can repeat
seven digits without faltering and can
recite five digits backward. 
2. The examiner might ask the patient to
count backward from 100 or to subtract 7
from 100, then 7 from that, and so forth
(called serial 7s). 
3. The capacity to interpret well-known
proverbs tests abstract reasoning, which
is a higher intellectual function. for
example, does the patient know what is
meant by “a stitch in time saves nine”? 
INTELLECTUAL
FUNCTION
4. Assess intellectual capacity - for
example, how are a mouse and dog or
pen and pencil alike? 
5. Can the patient make judgments about
situations: for example, if the
patient arrived home without a house
key, what alternatives are there?
THOUGHT
CONTENT 
1. interview -Are the patient’s
thoughts spontaneous, natural,
clear, relevant, and coherent? 
2. Does the patient have any fixed
ideas, illusions, or
preoccupations? 
3. What are his or her insights into
these thoughts? 
4. Preoccupation with death or morbid
events, hallucinations, and paranoid
ideation are examples of unusual
thoughts or perceptions that require
further evaluation.
EMOTIONAL
STATUS 
1. Is the patient’s affect (external
manifestation of mood) natural and
even, or irritable and angry,
anxious, apathetic or flat, or
euphoric?
2.  Does his or her mood fluctuate
normally, or does the patient
unpredictably swing from joy to
sadness during the interview? 
3. Is affect appropriate to words and
thought content? 
4. Are verbal communications consistent
with nonverbal cues?
LANGUAGE
ABILITY 
1. The person with normal neurologic
function can understand and
communicate in spoken and written
language. 
2. Does the patient answer questions
appropriately? 
3. Can he or she read a sentence from a
newspaper and explain its meaning? 
4. Can the patient write his or her name
or copy a simple figure that the
examiner has drawn? 
5. A deficiency in language function is
called aphasia.
LEVEL OF
CONSCIOUSNESS 
1. Consciousness is the patient’s
wakefulness and ability to
respond to the environment. 
2. Level of consciousness is the
most sensitive indicator of
neurologic function. 
3. To assess level of
consciousness, the examiner
observes for alertness and
ability to follow commands. 
LEVEL OF CONSCIOUSNESS 
• Glasgow Coma Scale
- Most widely recognized tool
- provides a common language for
communication between multi-disciplinary
groups
- Used internationally

The highest possible score on the GCS is


15, and the lowest score is 3. A score of
7 or less on the GCS usually indicates
coma.
03
ASSESSME
NT FOR
SENSORY
FUNCTION
Vanessa Ruelo
Position or
Temperature
Touch sensation Pain sensation kinesthetic Vibration
sensation
(proprioception)
SENSATION
Tactile sensation is assessed by
lightly touching a cotton wisp or
fingertip to corresponding areas on
each side of the body. The sensitivity
of proximal parts of the extremities is
compared with that of distal parts, and
the right and left sides are compared
PAIN AND
TEMPERATURE
SENSATIONS
1. Determining the patient’s sensitivity to a
sharp object can assess superficial pain
perception.
2. The patient is asked to differentiate
between the sharp and dull ends of a broken
wooden cotton swab or tongue blade; using a
safety pin is inadvisable because it breaks
the integrity of the skin.
PAIN AND
TEMPERATURE
SENSATIONS
3. Both the sharp and dull sides of the object
are applied with equal intensity at all
times, and the two sides are compared.
4. Use the hot and cold object for skin to
determine the hot and clod sensation
VIBRATION AND
PROPRIOCEPTION
1. Are transmitted together in the posterior
part of the cord.
2. The handle of the vibrating fork is placed
against a bony prominence, and the patient
is asked if he or she feels a sensation and
is instructed to signal the examiner when
the sensation ceases.
3. Common locations used to test for vibratory
sense include the distal joint of the great
toe and the proximal thumb joint.
VIBRATION AND
PROPRIOCEPTION
4. If the patient does not perceive the
vibrations at the distal bony prominences,
the examiner progresses upward with the
tuning fork until the patient perceives the
vibrations.
5. As with all measurements of sensation, a
side-to-side comparison is made.
POSITION SENSE
OR
PROPRIOCEPTION
May be determined by asking the patient
to close both eyes and indicate, as the
great toe or index finger is alternately
moved up and down, in which direction
movement has taken place. Vibration and
position sense are often lost together,
frequently in circumstances in which all
other sensation remains intact.
04
ASSESSMENT
OF MOTOR
FUNCTION

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.

• The gag reflex is elicited by gently touching


the back of the pharynx with a cotton-tipped
applicator, first on one side of the uvula and
then the other. Positive response is an equal
elevation of the uvula and “gag” with
stimulation. Absent response on one or both
sides can be seen following a stroke.
SUPERFICIAL REFLEXES
• The plantar reflex is elicited by stroking
the sole of the foot with a tongue blade or
the handle of a reflex hammer. Stimulation
normally causes toe flexion.
THANK
YOU!

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