Neurological Evaluation

III BPT

Dr Moh’d Irshad Qureshi

MPT (Neuro)
Professor and HOD
Dept of Neurophysiotherapy
 SPECIFIC LEARNING OBJECTIVES

• At the end of session the learner should be able to

learn:
- Memory and its types.
- Evaluation of Calculation, Abstract thinking insight and
Judgement.
- Speech and language evaluation.
- Method of I & II cranial nerve evaluation
 Memory
• Memory is the process of registration, retention, and
recall of past experience, knowledge, and ideas.

• Immediate memory (immediate recall) refers to the

immediate registration and recall of information after an
interval of a few seconds (e.g., repeat after me) short list
of words of unrelated objects (e.g., pony, coin, pencil)
• Short-term memory (STM) (recent memory) refers to the
capability to remember current, day-to-day events (e.g.,
what was eaten for breakfast, date)

• Or ask the patient to recall name of objects remembered

during IMT

• Long-term memory (LTM) (remote memory) refers to the

recall of facts or events that occurred years before (e.g.,
birthdays, anniversary, historic facts)

• Patient recall events or persons from his or her past (Where

were you born? Where did you go to school? Where do/did
you work?).
 Calculation
• Ask the patient to count forward and backward, to coins or to
make changes.

• Inability to calculate is k/a Dyscalculia. (s/o Dominant perietal

lobe lesion)

• Ability depends upon native intellegence.

• Basic calculation like 2+2 to be used to begin. After initial

success complexity to increased to subtraction multiplication
etc

• Note: Aphasic patient may have difficulty in calculation

 Abstract Thinking
• Ability to think abstractly is typically tested asking the
patient to describe similarities and differences.

• Difference b/w apple and banana, elephant and tiger

(Simple)

• Difference b/w lie and mistake (Complex)

 Insight and Judgement
• Common Insight and Judgement questions are- What
would you do if you find a sealed, addressed, stamped,
letter on the side walk? or what if you smelled smoke in
your house?
 Speech and Language
• Phonation defined as production of vocal
sounds without word formation.

• Language is a mechanism for expressing

thoughts and ideas as follows:
- by speech (auditory symbol)
- by writing (Written symbol)
- by Gesture

• So language may be regarded as means of

expressing or communicating feelings or
thought using symbols.
• Language is a function of cerebral cortex
 Types of speech sounds
• Labial eg B,P, M, W
• Modified labials O, U
• Labiodental eg F, V
• Lingual T, D, L, R
• Tongue point or alveolar
sounds eg S, Z, Sh,Zh
• Dental or tougue blade
sounds eg F
 Cranial Nerves Examination
1. Olfactory (Sensory Nerve)
- This is responsible for the sensation of smell
- Thee smell is tested by the use of non-irritating volatile
oils or liquids.
- Each nostril is examined separately when the other is
closed.
• The substances most commonly used are clove oil, rose
water, eucalyptus oil, aesofoetida, coffee powder,
turpentine oil, etc

• Patient is asked to breathe heavily and then identify the

smell.

• Inability to smell properly is called as anosmia

 2. Optic nerve (Sensory)

• Tested for
- Visual acuity
- Colour vision
- Visual field.
 Visual acuity

• Tested for both distant and

near vision.

• Distance vision is checked by

use of Snellen test charts. The
chart is placed at a distance of
20 feet or 6 meters and the
patient is asked to read it. Each
eye is examined separately.
• Near vision can be tested by
use of Jaeger’s test types.

• It consists of paragraphs
that are printed in a
successive coarser type.
The finest is numbered 0
and the coarser one that
consists of letter that is
relatively biggest is marked
as 7 and the patient has
to read through the whole thing.
 Colour vision
• Tested for identifying or matching colours.

• Day blindness and night blindness to be tested.

 Visual field
• Visual field is tested by using the confrontation method.

• Method: examiner stands with one eyelid closed in front

of the patient at 2-3 feet distance who also closes his
opposite eye. (If P:RE Ex:LE)
• The other eye of the patient is fixed on the examiner’s
nose similarly the examiner fixes his eye on the patient’s
nose.

• A pencil or finger may be used as a test object. The object

is moved in the visual field at an angle of 90-degree
starting from the center. The patient should be able to see
the object without moving the eyeball from the fixed
point.
 SUMMARY

• Memory and its types.

• Evaluation of Calculation, Abstract thinking insight and

Judgement.

• Speech and language evaluation.

• Method of I & II cranial nerve evaluation

 EXPECTED QUESTIONS
a) Define memory. Enumerate its type.

b) Discuss method of evaluation for calculation.

c) What is abstract thinking

d) Enumerate all cranial nerves

e) Discuss method of screening evaluation of I & II cranial nerve

 REFERENCES
1. Physical Rehabilitation - Schmitz, Thomas, O'Sullivan,
Susan, Fulk, George- Sixth Edition

2. Textbook of Rehabilitation- S.Sunder 3rd edition

3. Cash Text book of Neurology for Physiotherapist - by

Patricia A. Downie
THANK YOU