NEUROLOGICAL EXAM
Technique and Normals Abnormalities
Cerebellar Testing Tandem walking Pt walks heel to toe in a straight
- line
Balance Normal - pt can walk straight &
stay balanced
Romberg’s Test Stand behind the pt; pt stands
feet together eyes open for 20-
30s, then eyes closed
Note steadiness
Pronator Drift Pt stands eyes closed, arms
straight palms up; explain for
20-30s, watch for arms to
pronate; tap the arms briskly
downward and watch for
smooth return
Hop in Place On each foot in turn
Normal position sense, muscle
strength, coordination
Coordination Rapid rhythmic Tap knees with fronts and
alternating movement – backs of hands quickly; tap
both upper and lower bottoms of feet on hands
extremities Note speed, rhythm,
smoothness
Point-to-point testing Finger-to-nose: close eyes,
touch your finger to your nose
Heel-to-shin: slide your heel
down your opposite shin
Sensory Testing Pain Distinguish btwn dull and sharp,
*bilaterally 3 dermatomes on upper and 3
Compare the on lower extremity
same area on
both sides of the Temperature Cold – only 1 dermatome
body; distal to If pain was absent then you
proximal would test temp
Light touch Using a cotton wisp, touch
EYES CLOSED
three dermatomes bilaterally on
the upper and lower extremities
“Close your eyes and point to
where you feel this”
Vibration Place the tuning fork on the
MTP of the big toe, and the
MCP of the thumb
Tell me when you feel it stop
Position Sense Close your eyes; this is up, this
is down with the big toe; hold
the sides of the toe
(+) Ataxia; sensitive to UMN
lesion (ie. MS)
Crooked line of walk, widens
base to maintain balance,
staggering, loss of balance.
(+) = sways, falls, widens base
of feet to avoid falling
-cerebellar ataxia w/ eyes open
-sensory ataxia w/ eyes closed,
loss of position sense
(+) Poor position correction,
loss of proprioception
(+) decreased cerebellar fxn or
↓ muscle strength
*elderly: have them sit down,
then stand
(+) dysdiadochokinesia: slow,
clumsy, sloppy response, occurs
with cerebellar disease
Note motion accuracy,
clumsiness, intention tremor 
cerebellar disease
Dysmetria: clumsy movement
with overshooting the mark
Past pointing: constant deviation
to one side
Tests lateral spinothalamic tract
Hypoalgesia = ↓ pain sensation
Tests lateral spinothalamic tract
Tests anterior spinothalamic
tract
Hypoesthesia = decreased
sensation
Anesthesia = absent touch
Tests posterior spinothalamic
tract
Loss of vibration sense occurs
with peripheral neuropathy
Tests posterior spinothalamic
tract
 Discriminative Sterognosis Place an object in each hand to Tests posterior spinothalamic
Sensation identify tract
Asteriogenosis=inability to ID
object correctly. Occurs with
stroke.
Two Point Discrimination One dermatome bilaterally on Positive test = sensory cortex
both upper and lower lesion
extremities – varies based on
area being tested
Motor System Inspection Body position with mvmt at rest. tremors, tics, fasciculation’s
Symmetry Muscle atrophy, winging of the
scapula, paralysis
Muscle Tone Move pts four relaxed limbs and Note spasticity, rigidity and
assess any resistance symmetry

Muscle Strength AROM: squat, reach behind Compare sides, note any
shoulder and touch opposite paresis or paralysis
scapula, extend arms and make Grade muscle strength:
a fist, then open the hands

REFLEXES Deep tendon reflexes Biceps: C5, C6 – find the Grading:

*bilaterally & biceps tendon and hit your 0 – no response
symmetrically thumb 1 – low (e.g. LMN lesion)
Triceps C6, C7 – 2 – average
Reinforcement: Brachioradialis C5, C7 – 3 – brisker (may indicate
Clench teeth – upper slightly pronate and hit above disease – UMN lesion)
Pull hands – lower the wrist 4 – very brisk indicative of
Patellar L2, L3, L4 – disease – clonus may be
Achilles S1 - slightly dorsiflex present = short, jerky
foot contractions of the same muscle

Superficial Abdominal Above umbilicus – T8, T9, T10 (+) disease of pyramidal tracts
Reflexes Below umbilicus – T10, T11,
T12
Stroke all 4 quadrants of the
belly from outside in
Cremasteric Stroke inside of thigh, up the
*explain leg, watch to see if the same
side testicle raises
Tests L1, L2
Pathological Babinski’s sign Stroke up the lateral bottom (+) dorsiflexion of big toe and
Reflexes and across the ball of the foot fanning of other toes in adults
Normal – adults feet flex and
toes curl in, babies feet flex,
toes fan out
Tests L5, S1
Meningeal Signs Neck Pain Pain the neck upon resisted
– choose 1 flexion (don’t let me move your
head)
Brudzinski’s sign Flex pts head
(+) pt flexes hip and knees
Kernig’s sign Flex the pts leg at the hip and
knee, extend the knee
(+) bilateral pain and ↑
resistance to extending the
knee