NEUROLOGICAL

EXAMINATION
1.SUBJECTIVE EXAMINATION :
a.Name.
b.Age.
c.Gender.
d.Occupation.
e.Handedness/ dominance.
f. I.P no.
g.D.O.A.
h.Provisonal diagnosis
i.Reffered by
j.Laboratory reports
k. Chief Complaints.
l. History.
m. Vital Signs.
n. General Observation.

.
 On palpation
oTenderness
oTemperature
oSpasm/difference in tissue tension
oSwelling
2. OBJECTIVE EXAMINATION :
A.Higher Mental Functions.
Cognitive disabilities, perceptual
disabilities.
B.CRAINAL NERVE EXAMINATION:
C. SENSORY EXAMINATION :
-- Superficial sensations.
-- Deep sensations.
-- Cortical sensations
D. MOTOR EXAMINATION :
 Muscle tone.
Reflexes
 Muscle Power / Voluntary grading.
 ROM

 Muscle tightness.
Assessment of spasticity/rigidity if any
E. BALANCE :1) Static.
2) Dynamic.
F. CO-ORDINATON : 1)Non-equilibrium tests.
2) Equilibrium tests.
G. GAIT:
H. Bladder and Bowel
Examination.

I. ANS dysfunction.
J. Functional Evaluation.

K. Investigations
done/investigation required.

L. Diagnosis.

M.Problem list.

N. Aims and Means.

CHIEF COMPLAINS:-

1)PAIN.
2)ADL DIFFICULTIES.
3)WEAKNESS.
4)SENSORY PROBLEMS.
5)BALANCE PROBLEMS.
6)ANY OTHER RELATED COMPLAINS.
.
g CHIEF COMPLAINS :

1] Pain : Onset.
Precipitating factors.
Quality. [ type ]
Relieving factors.
Site.
Duration.
2] A.D.L Difficulties : Ambulation.
Bed activities.
Dressing.
Eating.
Toilet activities.

3] Weakness : Side.
Site.
Duration. [ in terms of ADL ]

4] Sensory Problems : Partial or Total.

5] Balance Problems : Fall during walking, sitting,
getting up, visual disturbances, dizziness etc.
 HISTORY :
1] Present History : Date and mode of onset. Mechanism of
injury, mode of transportation, conscious/ unconscious,
bleeding from nose, eyes, ear. .
Nature and Severity.
Site.
Duration and Frequency.
Associated symptoms. [ headache, nausea,
vomit.]
Aggravating and reliving factors.

2] Past Medical History : General health prior to the onset of

present
illness.
h/o DM, Hypertension, injuries etc.
Hospitalization and Operations.
Pregnancies and miscarriages.
Allergies and Medication.
Physiotherapy Treatment.
Prognosis of Past illness.

3] Personal History : Personal Habits. [ smoking, alcohol, drugs ]

Marital History.
4] Family History : Similar symptoms among relatives.
Herediatary diseases. [ MD, etc]
{Infectious diseases. [ TB ]}

5] Economical History : Occupation. [ income ]

Source of income.
Expense of family.
6)Drug history:
6] Social History : Education. [ Pt, spouse, family members ]
7] Environmental History : Home. [ Location, no. of rooms, type
of toilet, no. of steps, width of passage etc..]
Occupation. [ type of work with
intensity and duration, polluting industries near by.. ]

i] VITAL SIGNS : Temperature.

Blood Pressure.
Heart rate.
Respiratory rate.
 general observation:

• Built. • Trophic changes. [ skin (

• Posture. dry, scaly, shiny),
• Mode of Ventilation. nails. ]
• Type of Respiration.
• Wound, oedema,
• Pattern of Respiration.
sutures, etc.
[ Symmetric/Asymmetric ]
• External appliances.
• GAIT
[ Urinary cathater, IV lines,
Splints, drainage tubes..]
 OBSERVATION….

• Attitude of limbs. (spastic pattern)

Flexor synergy : shoulder -flexion, abduction, Er. elbow – flexion,
forearm supination, wrist finger –flexion
Extensor synergy: shoulder extension, adduction, IR elbow-
extension, forearm pronation, wrist and fingters in extension

• Involuntary movements (tremor, nystagmus, associated

reactions)
• External aids
• Psychological features
 OBSERVATION

• Wasting :-

Right Left Wasting

NEUROLOGICAL ASSESSMENT 18
 On palpation
• Tenderness Gradings:
• • Grade I: Patient complains of pain
• • Grade II: Patient complains of pain and winces
• • Grade III: Patient winces and withdraws the joint
• • Grade IV: Patient will not allow palpation of the joint
• Temperature
• Spasm/difference in tissue tension
• Swelling
• tone
 OBJECTIVE EXAMINATION :

a. Higher Mental Functions :

•Level of consciousness :
Alert,
drowsy (ready to fall a sleep),
stupor (insensible- only responding to base
stimuli such as pain) confused,
delirium (disorganized thoughts, aggressive
behavior), coma.
GLASGOW COMA SCALE:---
 OBJECTIVE EXAMINATION…..

• Behaviour [ attitude, co-operation ].

• Emotional status. [ depression, euphoria,
calm, emotional liability, fear ]
ORIENTATION:

TIME:
PLACE:
DAY,YEAR:
PERSON:
a. Memory:- [1) immediate memory(digit span),
remote, visual and verbal.]
2)Short term memory,
3) long term memory
Amnesia [antegrade, retrograde.]
• A)antegrade - refers to the inability to create new
memories due to brain damage
•B) retrograde- refers to inability to recall memories
before onset of amnesia.
Calculation ( according to education level and
capabilities of pt.)
Reasoning and problem solving [ answering simple
questions with reasons]
Judgement.
 Attention
Attention is the ability to select and attend to a specific
stimulus while simultaneously suppressing extraneous
stimuli.
• Sustained: maintain a consistent response during a
continuous activity
• Selective: capacity to attend a task despite environmental
visual or auditory stimuli.
• Alternating: move flexibly bet tasks and responds
appropriately to demands of each.
• Divided: capacity to respond simultaneously to 2 or more
tasks or stimuli when all are relavant
 b. Cognitive/ perceptual Abilites : like..

 Speech – aphasia [ expressive, receptive,

global ].
 Agnosia – visual, auditory, tactile,
anasognosia ].
 Apraxia – ideational, ideomotor,
constructional ]
 Aphasia
• General term used to describe an acquired
communication disorder caused by brain
damage and is characterized by an impairment
of language comprehension, formulation, and
use. (seen in 30 to 37% of stroke)
 classification
• Fluent aphasia (wernicke’s/receptive) :
speech flows smoothly with variety of
grammatical construction and preserved
melody. Auditory comprehension is impaired.
Thus, pt demonstrates difficulty in
comprehending spoken language and in
following commands. (lesion located in
auditory association cortex in left lateral
temporal lobe)
• Non fluent aphasia (broca’s aphasia/
expressive): flow of speech is slow and hesitant,
vocabulary is limited. Speech production is
labored while comprehension is good. (lesion is
located in premotor area in left frontal lobe)
• Global aphasia: is severe aphasia with
impairments of both production and
comprehension. Limit the pt ability to learn and
impedes successful outcomes in rehab.
Cognition: High level cognition:
Attention disorders
• Sustained attention
• Selective attention
• Volition
• Divided attention • Planning
• Alternating attention • Purposive action
Memory disorders • Effective performance.
• Immediate recall/ short
term
• Long term
 Perceptual assessment
• Body scheme/body • Unilateral neglect
• Anosognosia
image disorders
• Somatoagnosia
• Right left discrimination
• Finger agnosia

• Figure ground discrimination

• Form constancy
• Spatial relation • Spatial relations
disorder (complex • Topographical disorientation
perception) • Depth and distance perception
• Vertical disorientation
• Agnosias • Visual object agnosia
• Auditory agnosia
• Tactile agnosia

• Apraxia • Ideomotor apraxia

• Ideational apraxia
• Constructional apraxia
 Unilateral neglect
• Inability to register and integrate sitmuli and
perceptions from one side of the body (body
neglect) and the environment or hemispace
(spatial neglect), which is not due to sensory
loss. ( right cerebral infraction – 12 to 49% of
stroke)
• Lesion in inferior sup
sup region of rt parietal
lobe
 Unilateral neglect
Clinically
• Pt ignore left half of body when dressing
(sleeve)
• Forget to shave to left side
• Women – make up
• Neglect to wear from affected side
• Does not eat from left half of plate
• Always turn to right
 Unilateral neglect
Assessment techniques
• Behavioural inattention test (BIT) (drawing)
• Pt is asked to perform a personal ADL like
dressing, therapist observes the performance.
 Anosognosia
• Lack of awareness of the presence or severity of
one’s paralysis.
Clinically :pt maintains that there is nothing
wrong and may disown the paralyzed limb,
• Not taking any responsibility towards paralyzed
limb
• Tendency to cover the paralyzed limb all the
time
• Lesion (non dominant parietal lobe)
 Anosognosia
• Assessment:
• Talking to pt.
• pt is asked what happened to the arm or leg?
• Whether he or she is paralyzed?
• How the limb feels, and why it can not be
moved?
• Pt may deny the paralysis, fabricate reasons
why a limb does not move the way it should.
 Somatoagnosia
• Is a lack of awareness of the body structure
and the relationship of body parts to oneself
or to others.
• Somatoagnosia is also referred to as
autopagnosia or simply body agnosia.
• Pt with this deficit may display difficulty
following instructions that require
distinguishing body parts and may be unable
to imitate movts of therapist
 Somatoagnosia
• The patient may have difficulty performing transfer
activities because he or she does not perceive the
meaning of terms related to body parts: for example. "
Pivot on your leg and reach for the armrest with your
hand.
• In addition, a patient with a body scheme disorder will
have difficulty dressing.
• Patients may have a hard time participating in exercises
that require some body parts to be moved in relation to
other body parts: for example, 'Bring your arm across
your chest and touch your shoulder."
 Somatoagnosia
• Lesion Area. The lesion site is often the
dominant parietal lobe.
 Somatoagnosia
Assessment:
• Pt is requested to point to body parts named by
therapist (on him/therapist/picture)
• Show me your chin/feet. Point your back.
• Pt is asked to imitate the movement.
questions about relationship body parts

• Are your knees below your head?

• Which is on top of your head, your feet or hair?
 Right and left discrimination
• Inability to identify the right and left sides of
one’s own body and that of the examiners,
including inability to execute movements in
response to verbal commands.
• Clinically : not able to differentiate bet right
and left.
• Lesion: parietal lobe of either hemisphere
 Right and left discrimination
Assessment
• Patient is asked to point to body parts on
command:
• Right ear, left foot, right arm etc…
 Finger agnosia
• Inability to identify the fingers of one’s own
hands or of the hands of examiners, includes
difficulty in naming the fingers on command.
• Lesion is located in parietal lobe (angular
gyrus)
• Acalculia, agraphia
 Finger agnosia
Assessment: (sauguet’s test)
• Pt is asked to name the fingers touched by PT, with eyes
open (five times) and if successful, with eyes closed (five
times)
• The pt is asked to point to the fingers named by therapist
on pt’s own hand (10 times), therapist hands (10 times),
and on schematic model (10times)
• Pt is asked to point to the equivalent finger on a life sized
picture when each finger is touched by PT
• Pt asked to imitate finger movements: I,e curl the index
finger
Spatial relation disorders
 Figure ground discrimination
• Inability to visually distinguish a figure from
the background in which it is embedded.
Clinically
• Can not locate items in a pocketbook or
drawer
• Can not judge about the stairs
• Lesion: parieto occipital lesion
 Figure ground discrimination
Assessment
• Ayres figure ground test
• Pt is asked to
distinguish the 3 objects
in an embedded test
picture from a possible
selection of sex items.
 Figure ground discrimination
• Pt may be asked to find
out the white towel
from white sheet
• Asked to pint out the
sleeve, buttons, and
collar of white shirt
 Form discrimination
• Inability to perceive or attend to subtle
differences in form and shape.
• clinically: Pt may get confuse for (pen with
tooth brush; cane with crutch)
• Lesion: parieto-temporo-occipital
 Form discrimination
• Assessment:
• Number of items similar in shape and different
In size are presented to patients (pencil, pen,
straw, toothbrush, watch, key, coins)
• Each object I presented several times in
different positions (ie upside down)
 Spatial relation
• Inability to perceive the relationship of one
object in space to another object.
• Clinically: difficulty in dressing, difficulty to
place the cutlery, plate, spoon in proper
places. Difficulty in perceiving the relative
positions of the hands of clock.
• Lesion: inferior parietal lobe
 Spatial relation
• Assessment
• Therapist draws a picture of clock and then
asks the pt to fill in the numbers and draw in
the hands to designate a particular time.
• Two or three objects are placed on a piece of
paper and pt is asked to duplicate the pattern
 Position in space
• Inability to perceive and to interpret spatial
concepts such as up, down, under, over, in,
out, infront of, etc..
• Clinically if a pt is asked to raise the arm above
the head during assessment or place the feet
on the footrests the pt may behave as if he or
she does not know what to do
• Lesion: parietal lobe, non dominant
 Topographical disorientation
Assessment:
• Pt is asked to describe or to draw a familiar
route, such as the block on which he or she
lives, the layout of his or her house.
 Depth and distance perception
• Inaccurate judgment of direction, distance and
depth
• Clinically pt may have difficulty navigating
stairs and other ADL
• Lesion: posterior right hemisphere in sp visual
association areas
 Depth and distance perception
• Assessment
• Pt is asked to take or to grasp an object that
has been placed on a table
• Pt is asked to fill a glass of water.
 Vertical disorientation
• Refers to distorted perception of what is
vertical, can affect motor performance in gait
and posture.
• Lesion: nondominant parietal lobe
 Vertical disorientation
Assessment
• Therapist holds a cane vertically and then
turns it sideways to a horizontal plane. Pt is
asked to turn it back to the original position.
 HIGHER FUNCTIONS
• Consciousness :- (Glasgow Coma Scale)
• Memory :- (Immediate recall, Short term, Long
term)
• Speech :-
• Reading and writing :-
• Orientation :- (Time, Space, Person)
• Attention:
• Perception:
NEUROLOGICAL ASSESSMENT 60
 CRANIAL NERVE EXAMINATION
1. Olfactory
2. Optic
3. Occulomotor
4. Trochlear
5. Trigeminal
6. Abducent

NEUROLOGICAL ASSESSMENT 61
 CN I - OLFACTORY
ORIGIN: Cerebral hemisphere
INNERVATION: Nasal mucous membranes.
FUNCTION: Sense of smell
DYSFUNCTION: Anosmia

CLINICAL EVALUATION
) Use familiar
substances, i.e. coffee,
lemon, garlic, etc.
) Test each nostril
separately.
 CN II - OPTIC
CLINICAL EVALUATION
)VISUAL ACUITY: Snellen chart for
distant vision, newspaper or fingers for
near vision.
)VISUAL FIELDS: Confrontation.

CONFRONTATION METHOD

PERIMETRY
 CN III - OCULOMOTOR
ORIGIN: Midbrain
INNERVATION: EOM's; eyelid; ciliary; and sphincter of iris.
FUNCTION: Eye movement inward (medially), upward, downward, and outward; pupil
Constriction, shape and equality; elevates upper eyelid; accommodation reflex.
DYSFUNCTION:Unable to look up, down, or medial (dysconjugate gaze); ptosis, pupil
dilatation - bilateral or ipsilateral, and loss of accommodation reflex.
CLINICAL EVALUATION
) Observe for eye opening and symmetry.
) Direct light response - brisk, sluggish, or non-reactive.
) Consensual response - present or absent.
) Pupil size and shape.
) Accommodation.
) Extraocular movement (EOM's) (Abducens).
EYE OPENING & SYMMETRY OF EYE MOVEMENT

LIGHT RESPONSE
OCCULAR MOVEMENT
CRANIAL NERVE FUNCTION & MUSCLE INNERVATION
RELATIVE TO EYE MOVEMENT

Superior rectus Inferior oblique

CN III CN III

Lateral rectus Medial rectus

CN VI CN III

Inferior rectus Superior oblique

CN III CN IV
 SO4 LR6
CN IV - TROCHLEAR CN VI - ABDUCENS

ORIGIN: Midbrain ORIGIN: Pons

INNERVATION: Superior oblique muscle.
FUNCTION: Down and inward movement of
the eye.
DYSFUNCTION: Loss of downward, inner
movement of eye, dysconjugate gaze.
INNERVATION: Lateral rectus muscle.
FUNCTION: Outward, lateral movement of
eye.
DYSFUNCTION: Loss of lateral eye
movement, dysconjugate gaze.

CLINICAL EVALUATION

) Extraocular movements (EOM's)

) CN IV (Trochlear) and CN VI tested with CN III (Oculomotor)
 CN V - TRIGEMINAL
ORIGIN: Pons. The sensory nucleus extends from the pons to the
midbrain, and also to the medulla and spinal cord.

INNERVATION: Three branches of CN V:

Ophthalmic, maxillary, & mandibular.
Motor innervation to masseter & temporal
muscles. Sensory innervation to skin &
mucous membranes in head; teeth, tongue,
external auditory canal, and cornea.
FUNCTION: Sensation of pain, touch, hot,
& cold; motor movement of masseter &
temporal muscles.
Nerve Root Patterns

Brain Stem = Onion

skin sensory deficit
DYSFUNCTION: Loss of sensation - if affecting all
three branches, indicative of peripheral injury.

Brainstem or upper cervical cord injury may result in loss of

sensation to one or more branches of the trigeminal nerve.

- Loss of corneal reflex.

- Paresthesia and/or severe pain indicative

of nerve compression or irritation (Trigeminal neuralgia)

-Deviation of jaw, loss of sensation.

Inability to bite down and chew, inability to close jaw.
 CN V - TRIGEMINAL
CLINICAL EVALUATION

) SENSATION: Test with patients eye closed. Evaluate pain,

temperature, & light touch to jaw, cheeks, and forehead.
Observe response and symmetry.

) MOTOR: Open jaw, check for deviation. Have patient bite

down, palpate masseter and temporal muscles. Move jaw
laterally against resistance to evaluate weakness or
paralysis.

) CORNEAL REFLEX: Cotton wisp across cornea,

observe for blink (function of CN III)

)JAW JERK: Tap lower jaw with mouth open - check for
slight elevation of mandible.
 CN VII- FACIAL
ORIGIN: Pons & medulla.
INNERVATION: Anterior two-thirds of tongue; facial muscles,
scalp, ear, and neck.
FUNCTION: - Control of facial muscles (expressions)
- Motor limb of blink & corneal reflexes
- Secretion of salivary & lacrimal glands
- Sensation of taste, anterior two-thirds tongue.
DYSFUNCTION:
Motor = Facial asymmetry - Ipsilateral weakness/paralysis,
right or left, indicative of damage to motor nucleus or peripheral
component (lower motor neuron lesion) EX: Bell's palsy
Contralateral weakness/paralysis of lower face indicative of
contralateral motor cortex damage (upper motor neuron lesion) or
hemispheric lesion, i.e. massive CVA.
Bilateral weakness or paralysis , E.g. myasthenia gravis or Guillian
Barre.

Parasympathetic -Loss or excessive tearing or salivation

Sensory= Loss of taste
Combined problem = speech difficulty and
drooling/difficulty handling food
 CN VII - FACIAL
CLINICAL EVALUATION
MOTOR FUNCTION:

) Observe for facial symmetry

) Ask patient to wrinkle forehead, puff
cheeks, smile, show teeth, open eyes
against resistance, and whistle.
SENSORY FUNCTION:
) Test each side of tongue separately.
) Test for sweet (tip of tongue); sour (sides
of tongue); salty (over most of tongue, but
concentrated on sides).
) Give sip of water between tastes.
NEUROLOGICAL ASSESSMENT 74
 CN VIII - vestibulocochlear
ORIGIN: Pons and medulla
INNERVATION: Cochlear - ear
Vestibular - ear
FUNCTION: Cochlear - Hearing
Vestibular - Balance, maintenance of body position, and proprioception.
DYSFUNCTION (Cochlear)
- Unilateral deafness
- Loss of sound appreciation
- Tinnitis
- (Rinne Test) AC >BC or both diminished indicative of nerve damage,
BC> AC middle ear disease.
- (Weber Test) Lateralization to good ear is nerve damage, lateralization to
bad ear is, middle ear disease.
DYSFUNCTION (VESTIBULAR)
- Vertigo
- Balance disturbances

Vestibular branch normally not tested unless patient gives history of vertigo or balance
Disturbance history is positive, caloric testing is done by physician.
 CN VIII - vestibulocochlear
CLINICAL EVALUATION
) HEARING: Test bilaterally,
whisper or watch tick

) CONDUCTION: Weber (place at

mid of head) and Rinne
tests(mastoid and then ear
canal) (Differentiate between
conduction deafness and nerve
deafness)
Rinne Test: Evaluates air (AC) and bone
conduction (BC). Place the base of a vibrating
tuning fork on the mastoid process until patient
can no longer hear sound; then quickly move
tuning fork near ear canal. Ask the patient if he
hears it, compare hearing times.
Rinne test: AC > BC normal result.
 A normal weber test has a patient reporting the sound
heard equally in both sides. In an affected patient, if the
defective ear hears the Weber tuning fork louder, the
finding indicates a conductive hearing loss in the
defective ear. In an affected patient, if the normal ear
hears the tuning fork sound better, there is
sensorineural hearing loss on the other (defective) ear.
 CN IX- GLOSSOPHARYNGEAL
and CN X - VAGUS
Glossopharyngeal (IX) Vagus (X)

ORIGIN: Medulla Medulla

Mucous membranes of tonsils, Muscles of larynx, pharynx, and

pharynx, posterior one-third of soft palate. Parasympathetic
INNERVATION:
tongue, pharyngeal muscles, innervation of thoracic and
carotid sinus and carotid body abdominal viscera.

Muscles of larynx, pharynx, and

soft palate;- Sensation conveyed
Taste from posterior one-third of
from the heart, lungs, digestive
FUNCTION: tongue - Afferent limb of gag,
tract, carotid sinus, & carotid
swallow, and cardiac reflexes.
body; Efferent limb of gag and
swallow

Loss of gag & swallow reflex; Loss

DYSFUNCTION: Loss of taste; Neuralgia of carotid sinus & oculocardiac
reflex; Dysphagia
 CN IX-GLOSSOPHARYNGEAL
&
CN X-VAGUS
CLINICAL EVALUATION
CN IX and X considered jointly, actions are seldom compared separately; they are
always tested together.
- Evaluate voice quality (hoarseness or dysarthria)
- Ask patient to open mouth, say "ah", observe for
elevation of soft palate, midline position of uvula.
- Gag reflex, bilaterally
- Swallowing
- Taste (bitter) posterior one-third tongue*

Negative Findings
- Loss of voice quality, (dysarthria or hoarseness)
- Deviation of uvula toward non-paralyzed side *usually not tested
- Swallowing difficulty or nasal regurgitation
- Vagal irritation (bradycardia)
 CN XI - SPINAL ACCESSORY
ORIGIN: Medulla
INNERVATION: Sternocleidomastoid & trapezius muscles
FUNCTION: Motor function sternocleidomastoid & trapezius
DYSFUNCTION: Muscle weakness.
CLINICAL EVALUATION
) Palpate trapezius muscle as patient
shrugs shoulders against resistance;
evaluate strength.

) Ask patient to turn head to one side

and push against examiners hand,
palpate and evaluate strength of
sternocleidomastoid muscle.

) Evaluate both right and left side,

compare for symmetry.
 CN XII -Hypoglossal
ORIGIN: Medulla
INNERVATION: Muscles of the tongue
FUNCTION: Movement of the tongue
DYSFUNCTION:
Unilateral
Flaccid paralysis (peripheral lesion)
- Tongue deviates to side of lesion.
- Isilateral atrophy
- Fasciculation Bilateral
Spastic paralysis (cortical pathways) Flaccid paralysis (medullary lesion,
- Tongue deviates to opposite side of MG)
lesion - Dysphagia
- No atrophy - Dysarthria
- Dysarthria and ataxia of tongue - Difficulty chewing food
DERMATOMES
NEUROLOGICAL ASSESSMENT 83
NEUROLOGICAL ASSESSMENT 84
NEUROLOGICAL ASSESSMENT 85
NEUROLOGICAL ASSESSMENT 86
NEUROLOGICAL ASSESSMENT 87
NEUROLOGICAL ASSESSMENT 88
NEUROLOGICAL ASSESSMENT 89
 GRADING OF DTR
0 – No visible or palpable muscle contraction
1+ - Slight or sluggish muscle contraction with
little or no joint movement
2+ - Slight muscle contraction with slight joint
movement
3+ - Clearly visible, brisk muscle contraction with
moderate joint movement
4+ - Strong muscle contraction with one to three
beats of clonus
5+ - Strong muscle contraction with sustained
clonus
NEUROLOGICAL ASSESSMENT 90
 MOTOR EXAMINATION
• Tone :- (Modified Ashworth Scale)
• Reflexes:-
• Tightness :-
• ROM :-
• MMT :- (Oxford Scale)
• VOLUNTARY CONTROL :- (Bobath, Brunstorm)

NEUROLOGICAL ASSESSMENT 91
 Modified Ashworth Score Criteria
0 - No increase in muscle tone
1 - Slight increase in muscle tone, manifested by a catch and
release, or by minimal resistance at the end of the ROM when
the affected part(s) is moved into flexion or extension
1+ - Slight increase in muscle tone, manifested by a catch,
followed by minimal resistance throughout the remainder
(less than half) of the ROM
2 - More marked increase in muscle tone through most of the
ROM, but affected part(s) easily moved.
3 - Considerable increase in muscle tone through most of the
ROM, passive movement is difficult.
4 - Affected part(s) rigid in flexion or extension

NEUROLOGICAL ASSESSMENT 92
 REFLEXES:-
 Deep tendon Reflexes :
 Jaw Jerk. (5th nerve)
 Biceps. (C5, C6)
 Triceps. (C6, C7)
 Knee jerk. (L2, L3, L4)
 Ankle jerk. (S1, S2)

 Pathological Reflexes :
 Grasp.
 Hoffman.
 Waternberg sign.
 Oxford Scale
0 – Total paralysis of muscle
1 – Movement is not possible, only flicker
contraction can be palpable
2 – Movement is possible in gravity eliminated
position in full range of motion
3 – Movement is possible against gravity in full
range of motion
4 – Movement is possible against gravity with
minimal resistance in full range of motion
5 – Movement is possible against gravity with
maximal resistance
NEUROLOGICAL ASSESSMENT 94
 VOLUNTARY CONTROL TESTING
• GRADE 0 : NO CONTRACTION
• GRADE 1: FLICKER OF CONTRACTION PRESENT OR
INITIATION OF MOVEMENT
• GRADE 2: HALF RANGE OF MOTION IN SYNERGY OR
ABNORMAL PATTERN
• GRADE 3: FULL RANGE OF MOTION IN SYNERGY OR
ABNORMAL PATTERN
• GRADE 4: INITIAL HALF RANGE IS PERFORMED IN ISOLATION
AND THE LATTER HALF IN PATTERN
• GRADE 5: FULL RANGE OF MOTION IN ISOLATION BUT GOES
INTO PATTERN WHEN RESISTANCE IS OFFERED
• GRADE 6: FULL RANGE OF MOTION ISOLATION AGAINST
RESISTANCE.
 CO-ORDINATION TESTS
• NON EQUILIBRIUM:
• Finger to nose test :-
• Finger to finger test :-
• Dysdiadochokinesia :-
• Knee to heel test :-
• EQUILIBRIUM:
• Tandem walking
• Walking sideways
• Single leg standing
NEUROLOGICAL ASSESSMENT 96
 BALANCE TESTS
• Sitting Static
Dynamic
• Standing Static
Dynamic

NEUROLOGICAL ASSESSMENT 97
 FUNCTIONAL BALANCE SCALE (Static)
Normal – Patient is able to maintain steady
balance without support
Good – Patient is able to maintain balance
without support
Fair – Patient is able to maintain balance with
handhold
Poor – Patient requires handhold and assistance
Nil – No balance

NEUROLOGICAL ASSESSMENT 98
 FUNCTIONAL BALANCE SCALE (Dynamic)

Normal - Accepts maximal challenge and can shift

weight in all direction
Good – Accept moderate challenge, able to
maintain balance while picking object off floor
Fair – Accepts minimal challenge, able to maintain
balance while turning head or trunk
Poor – Unable to accept challenge or move
without loss of balance
Nil – No balance
NEUROLOGICAL ASSESSMENT 99
 GAIT EXAMINATION
• Independently or With assistance?
• Step length
• Step width
• Stride length
• Stance time
• Cadence

NEUROLOGICAL ASSESSMENT 100

stride length step length

NEUROLOGICAL ASSESSMENT 101

 AUTONOMOUS NERVOUS SYSTEM
EXAMINATION
• Sweat function test
Examination is required
in spinal cord disorders,
neuropathy,
peripheral nerve injuries.

NEUROLOGICAL ASSESSMENT 102

• BOWEL AND BLADDER EXAMINATION :
 Type – UMN / LMN.
 Type of Catheter.
 Bowel Control.
 FUNCTIONAL ASSESSMENT
• Grooming
• Dressing
• Bathing
• Toileting
• Transferring
• Ambulation
• Feeding
• Housekeeping

NEUROLOGICAL ASSESSMENT 104

DIFFERENT SCALES:

•BERG BALANCE SCALE:

•FIM:
•BARTHEL SCALE:
•STREAM:
•FUGL MEYER SCALE:
•UPRDS.
•ANY MANY OTHER SCALES RELATED TO
PARTICULAR NEUROLOGICAL CONDITION.
INVESTIGATIONS DONE/INVESTIGATIONS
REQUIRED.:-

DIAGNOSIS:-
• PROBLEM LIST :
i. Pain.
ii.Motor power.
iii.Sensory loss.
iv.Abnormal Tone.
v. Musculoskeletal abnormalities.
vi.Postural abnormalities.
vii.Balance disorders.
viii.Gait disorders.
ix.Inco-ordination.
x. Bowel & Bladder problems.
xi.ADL problems.
• AIMS & MEANS :
i. To relieve Pain.
ii.To improve muscle Power.
iii.To improve sensation. (Sensory re-education)
iv.Normalization of Tone.
v. Correction of musculoskeletal problems.
vi.To correct Posture.
vii.To improve Balance.
viii.To improve Coordination.
ix.Gait Re-education.
x. Bladder & Bowel retraining.
xi.To train ADL Functions.
THANK YOU