NEUROLOGICAL

ASSESSMENT
The neurological examination
There are seven primary elements to the
neurological examination.
1. Mental state assessment,
2. Cranial nerve assessment,
3. Motor function (proprioception cerebellar
function),
4.Sensory function,
5.Reflexes,

6.Assessment of the conscious state
and,

7.Additional assessments and
procedure, such as observing
respiratory pattern, pupillary
responses and posturing.


1.Mental state assessment
The mental state assessment is usually assessed
during the interview process.

2.Cranial Nerve Assessment
The cranial nerves are peripheral nerves that
originate in the brain rather than the spinal
cord. Although each of the cranial nerves has
motor or sensory functions, four also possess
parasympathetic abilities as well.



If cranial nerve is deemed to be
functioning in approriately or not
at all, then it is reasonable to suspect
trauma or a lesion either directly to the
nerves or in the cerebral hemisphere.
3.Motor Function (Proprioception and
cerebellar function)

Both proprioception and cerebellar
function are umbrella terms to describe
motor function.They responsible for
pocture, balance and coordination.


Testing of the motor function involves
the following areas :
Rapid, rhythmic, alternating
movements,
Accuracy of movements, and
Balance ( equilibrium and gait )



4.Sensory Function
During sensory function testing both
primary and cortical discriminatory
sensations are examined. To assess
sensation accurately, each major
peripheral nerve pathway should be looked
at.This can be achieved by evaluating the
hand, distal arms, abdomen, feet, and
distal portion of llegs.


Information on what the patient can expect as
well as what is expected of them.
Initially, use minimal stimulation, increasing it
until the patient is able to become aware of
it.One side of the body should be compared
with the other.
As all testing is done with the patients
eyes closed,it is vital that you provide
Normal findings are:
Minimal difference contralaterally,
Appropriate interpretation of sensation,
Ability to discriminate between sides of the
body, and
Location of the sensation and whether
proximal or distal to the previous stimuli.
Abnormal findings are:
Anaesthesia (absence of touch sensation),
Hypoanaesthesia (disminished sense of touch),
Paraesthesia(tingling or numbness),
Analgesia(pain insensitivity),
Hypoalgesia(diminished pain sensation) and,
Hyperalgesia(increased pain sensation)
You should document any abnormal findings.Often
the best way doing this is to draw a picture
outlining areas where abnormalities were detected.

The areas that are assessed to
determine sensory function are as
follows.
PRIMARY SENSORY FUNCTION
Assess:
superficial touch,
Superficial pain,
Temperature and deep pressure,
Vibration, and
Position of joints (kinesthetic sensation).
CORTICAL SENSORY FUNCTION

Assess:
Stereognosis,
Two-point discrimination,
Extinction phenomenon,
Graphesthesia, and
Point location.

REFLEXES
The final part of the neurological examination is
the assesment of superficial and deep tendon
reflexes (DTRs)
The six superficial reflexes: corneal,gag,
abdominal,plantar,cremasteric and anal.When
the cranial nerves are tested, the gag and corneal
reflexes are assessed as part of this.Other
superficial reflexes, such as cremastric and anal,
are quite invasive and should also only be
performance if a genitourinary or sacral spine
lesion is suspected.
Deep tendon reflexes (DTRs)
When testing DTRs it is important that the patient
is relaxed and that the muscle is partilly
stretched.Aim to deliver the blows as short,
snappy sctions, using just enough force to get a
response.
Always asess from side to side:ideally the same
response should be seen bilaterally.DTRs, whilst
quite subjective, are assessed using a four-point
grading scale.Essentially, it comes down to
practice and experience in order to feel
comfortable grading DTRs.
Grading Scale
Use the following scale:
4+ Very brisk,
hyperactive with of
diseaseclonus,indicati
ve

3+ Brisker than
average, may indicate
disease
2+ average, normal
1+ Diminished, low
normal
1
7. Additional assessment
Respiratory assessments
Changes in respiratory patters can assists in
identifying the level of brsin stem dysfunction
or injury.
Kussmaul respirations are such one expample.
As intracranial pressure raises, breathing
patterns tend to change.
Pupillary response

An unconscious patient,or patient receiving
sedation or neuromuscular blocking agents,
the pupillary response may actually be one of
the few signs available for u.
The pupils are assessed for the shape,
symmetry and response to light.