The Neurological System

Neurological Exam 5 Components

Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory

Mental Status Examination

Examination - ABCT
Appearance Behavior Cognition Thought

processes (thought content & perceptions)

Mini Mental State Exam Glasgow Coma Scale

Assessing LOC: Glasgow Coma Scale

Eye opening

Verbal responsiveness

Motor responsiveness
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Glasgow Coma Scale

Physical Examination Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not stimulated Obtunded- sleeps most times, difficult to arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for arousal; responds to stimuli Coma- no response (Jarvis CH 2)
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Cranial Nerves

On old Olympus Towering Tops a

Finn and German Viewed some hops.

I Olfactory II Optic III Occulomotor IV Trochlear V Trigeminal VI Abducens

VII - Facial VIII Auditory (V-C) IX - Glossopharyngeal X - Vagus XI Spinal Accessory XII - Hypoglossal
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Neurological: Physical Examination

Sensory System Function

With eyes closed Interpret sensations Discriminate side to side Examine in detail if: Reduced sensation Numbness or pain Motor or reflex abnormal Skin changes

Be specific: tell me where I

Physical Examination Sensory Function Tests:

Touch
Light

touch 1st then Pain & Temperature

Vibration Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination

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Sensory Function Tests: Sensory Exam: Light Touch

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Sensory Function Tests: Sensory Exam: Vibration

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Sensory Function Tests: Proprioception: Position sense

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Sensory Function Tests: Stereognosis

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Sensory Function Tests: Graphesthesia

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Sensory Function Tests: Two-point discrimination

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Sensory Function Tests: Dermatomes

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Motor Examination
Symmetry, size, and presence f involuntary movements Full ROM of joints Check strength against resistance

Neuro patients: Assess hand grips and foot pushes if bedridden

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Cerebellar Function
1. Gait and posture Heel to toe in straight line Walking on toes and heels Hop on one foot Note width of gait

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Cerebellar Function, cont 2. Coordination of hands and legs RAM nose to examiners finger heel to shin coordination
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Cerebellar Function, cont RAM

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Cerebellar Function, cont Nose to - Finger Test

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Cerebellar Function, cont Heel to Shin

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Cerebellar cont
Romberg: Stand upright, place feet together, then close eyes loss of balance means + Romberg test
3.

Be prepared to protect client from falling!

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4 types of Reflexes
Abdominal Reflex

Superficial (abdominal reflex, Cremasteric reflex) Visceral (pupillary response to light) PERRL Pathologic
+

Cremastic Reflex

Babinski in adults

DTRs (e.g. knee)

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Reflexes-Cont: PERRL/PERRLA

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Reflexes-Cont:
Babinskis Reflex (Adult)

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Reflexes-Cont: Reflex Arc Deep Tendon Reflex

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Reflexes-Cont:
Deep Tendon Reflexes
Technique

Position limb so muscle is slightly stretched Reflex hammer should strike tendon briskly to stretch tendon Get patient to relax

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BRACHIORADIALIS

BICEPS

ACHILLES/PLANTAR TRICEPS

PATELLAR DEEP TENDON REFLEXES

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Grading of DTRs
4+ 3+ 2+ 1+ 0

very brisk brisker than average average, normal diminished, low normal no response

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Assessment Guide: Neurological

LOC: alert, comatose, lethargic, obtunded GCS Eye opening: spontaneously, to speech, to pain Verbal Response: oriented, confused, inappropriate, incomprehensible Motor Response: obeys, command, localizes pain, withdraws, flexion, extension

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Assessment Guide : cont..

Seizure
Describe:

tonic clonic, absence, status epilepticus Timing: once at 10 am; 2 pm and 2:45 pm

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Altered mental status: yes, no Aphasia: present, none Intelllectual functioning: intact; short attention span, dementia, memory loss Itnerventions in use:

Seizure

precautions: side rails padded, oral airway at bedside Med List: Klonopin, Aricept, Neurontin, Dilantin, etc.

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