3. INTRODUCTION
A Neurological Examination is the assessment of sensory neuron and motor
response especially reflexes to determine whether the nervous system is impaired
.This typically include physical examination and a review of the patient medical
history ,but not deeper investigation such as neuroimaging . It can be used both
screening tool and as investigation tools.
The purpose of neurological examination is to determine the presence or absence
of disease in the nervous system .
Nurses are involved in examining the neurological and physical status of the patient
as part of the total physical assessment .
4. DEFINITION
• A Neurological Examination is an essential component of a comprehensive
physical examination . It is the systemic examination that survey the functioning
of nerves deliver sensory information to the brain and carrying motor commands
(peripheral nervous system) and impulses back to the brain for processing and
coordinating (central nervous system )
5. PURPOSES
1. INTEGRATION OF COGNITIVE FUNTION.
2. DIFFERENTIAL DIAGNOSIS TO CONFIRM OR CLARIFY A DIAGNOSIS .
3. TREATEMENT PLANNING .
4. A SERIES OF QUESTION AND TESTS TO CHECK BRAIN,SPINAL CORD AND
NERVE FUNCTIONING .
6. ASPECTS OF NEUROLOGICAL
EXAMINATION
• Level of consciousness .
• Mental status examination .
• Special cerebral functions.
• Cranial nerve function
• Motor function
• Sensory function
• Cerebellar function .
• Reflexes
7. 1. LEVEL OF CONSCIOUSNESS
Assessment of level of consciousness includes following categories :-
A. Alertness:- patient is awake, responds immediately and appropriately to all
verbal stimuli .
B. Lethargy :- Patient is drowsy and inattentive but arouses easily frequently off
to sleep.
C. Stuporous :- He arouses with great difficulty and co-operates minimally when
stimulated .
8. D. Semi-comatose:- The patient has lost his ability to respond to verbal stimuli
. There is some response to painful stimuli . Little motor function is seen .
E. Comatose :- When the patient is stimulated there is no response to verbal or
painful stimuli , no motor activity is seen .The Glasgow coma scale is widely
used to measure the patient’s level of consciousness.
9. 2. MENTAL STATUS EXAMINATION
• The component of mental status examination include the assessment for
following categories ; General appearance , speech , thought process , mood
cognitive functioning , attention ,concentration , orientation , memory , general
knowledge , abstract reasoning , judgement &insight .
10. 3, SPECIAL CEREBRAL FUNCTIONS
• Assess for agnosia , apraxia and aphasia .
• Agnosia :- inability to recognize common objects through the senses .
• Apraxia :- patient cannot carry out skilled act in the absence of paralysis .
• Aphasia :- inability to communicate.
12. 5. MOTOR FUNCTION
Assessing of motor function involves assessing for muscle size , muscle strength,
,muscle tone ,muscle co-ordination , gait and movement .
Muscle size :- inspect all major muscle group bilaterally for symmetry ,
hypertrophy and atrophy
Muscle Strength :- Assess the power in ,major muscle group against resistance .
Assess and rate muscle strength on a 5 point scale in all four extremities ,
compairing one side with other .
13. • Muscle Tone:- Assess muscle tone while moving each extremities through its
range of passive motion . When tone is decreased (hypotonicity), the muscle are
soft flabby or flaccid ;when tone is increased (hypertonicity) , the muscles are
resistant to movement rigid or spastic . Note the presence of abnormal flexion or
extension posture .
• Muscle coordination :- Disorder related to coordination indicate cerebellar or
posterior column lesions
14. • Gait and station ;- Assess gait station by having the patient stand still , walk and in
tandem (One foot in front of the other in a straight line ) Walking involved the
function of motor , power , sensation , and coordination . The ability to stand
quietly with the feet together requires coordinating and intact proprioception
(sense of body position )
• Movement :- Examine the muscle for the fine and gross abnormal movement .
Move all the point through a full range of passive motion . Abnormal finding
include pain , joint ,contracture and muscle resistance.
15. 6. SENSORY FUNCTION
• Sensory assessment involves testing for touch , pain , vibration , and
discrimination .
• A complete sensory examination is possible only on a conscious and co-operative
patient
• Always test sensation with patient’s eye closed
• Help the patient to relax and keep warm .
• Conduct sensory assessment systematically .
• Test a particular area of body , and then test the corresponding area on the other
side .
16. 7. ASSESSMENT OF CEREBELLAR
FUNCTION
• For evaluation of balance and co-ordination the tests used are :-
• A. finger to finger test :- it is performed by instructing the patient to place her
index finger on the nurse’s index finger . He is asked to repeat this for several
times in succession on both sides .
• B. finger to nose test :- tell the patient to extend his index finger and then touch
the tip of his nose several times in rapid succession . This test is done with the
patient’s eyes both open and closed .
17. • C. Romberg test :- here the nurse instruct the patient to stand with his feet
together with arms positioned at his sides . He is told to close his eyes . This
position is maintained for 10 second . This test is considered positive only if there
is actual loss of balance .
• D. Tandom walking test :- This is tested by having the patient assume a normal
standing position . He is then instructed to walk over heel on a straight line .any
unsteadiness , lurching or broadening of the gait base is noted .
18. 8. REFLEX ACTIVITY
• Reflex testing evaluates the integrity of specific sensory and motor pathways .
• Reflex activity assessment , always a part of neurological assessment , provides
information about the nature , location , and progression of neurologic disorders.
• Normal reflexes :- two types of reflexes are normally present
• 1. Superficial or cutaneous reflexes
• 11. Deep tendon muscle – stretch reflexes .
19. LIST OF TEST
• MINI MENTAL STATUS EXAMINATION .
• CRANIAL NERVE EXAMINATION .
• MOTOR SYSTEM .
• DEEP TENDON REFLEXES .
• SENSATION .
• CEREBELLUM FUNCTION .
20. SUPERFICIAL REFLEXES DEEP TENDON REFLEXES
• Abdominal reflexes
• Plantar reflexes
• Corneal reflexes
• Pharyngeal (gag) reflexes
• Cremasteric reflex
• Anal reflex
• A bicep jerk ( forearm flexion)
• A triceps jerk ( forearm extension)
• A brachioradial jerk
• A knee jerk , quadriceps jerk or
patellar reflex
• An ankle jerk
22. LIST OF ARTICLES
• COTTON APPLICATOR
• FLASH LIGHT
• MISCELLANEOUS ITEMS OF VARIED SHAPES AND SIZE (COIN ,KEY, MARBLE )
• OPHTHALMOSCOPE
• OTOSCOPE
• COLORED PENCIL
• PIN WITH SHARP AND BLUND END
• REFLEXES HAMMER
• TAPE MEASURE
• TUNING FORK
• SNELLEN CHART
• STOPPERED VIAL CONTAINING ;PEPERMINT , OIL OF CLOVES , COFFEE , SOAP .
23. • SUGAR , SALT , AND VINEGAR
• COLD AND HOT WATER
• WATCH WITH SECOND HAND
24. HEALTH HISTORY
• An important aspect of the neurological assessment is the history of present
illness .
• The initial interview provides an excellent opportunity to systematically explore
the patient’s current condition and related events while simultaneously observing
overall appearance mental status, posture ,movement, and affect.
• Depending on the patient condition ,the nurse may need to rely on yes or no
answer to questions on a review of the medical record or input from the family of
a combination of these .
26. PHYSICAL EXAMINATION
RESPONSE SCALE SCORE PATIENT SCORE
Eye opening - Spontaneous 4
- To voice 3
- To pain 2
- None 1
Verbal - Normal conversation 5
Response - Disorientation conversation 4
- Words , but not coherent 3
- No words , only sound 2
- None 1
- Localized pain 5
- Withdraw to pain 4
27. RESPONSE SCALE SCORE PATIENT SCORE
Motor response decorticate posture 3
decerbate posture 2
Total NONE 1
28. EXAMINATION OF THE HIGHER CEREBELLAR FUNCTION
• DOMINANT HEMISPHERE
• Listen to language pattern
• Ask the patient to name object
• Does the patient read correctly ?
• Ask the patient to perform numerical calculation ?
• Can the patient recognize object ?
29. • NON DOMINANT HEMISPHERE
• Note patient ability to find his way around the word or his home .
• Can the patient dress himself
• Note the patient ability to copy a geometrical pattern .
• MEMORY TEST
• Immediate memory
• Recent memory
• Remote memory
• Verbal memory
• Visual memory
30. MINI MENTAL STATUS EXAMINATION
• Orientation
• Registration
• Attention and calculation
• Recall
• Language and praxis
31. NURSES ROLE IN NEUROLOGICAL EXAMINATION
• Provide a calm, suitable environment.
• Collect the personal data with patient and family members
• Set the equipment needed for neurological examination.
• Assess the current level of consciousness , monitor vital parameters- temperature , pulses
respiration blood pressure , pupillary reaction , whether decerebating or decorticating
• Thorough mental status examination should be done and recorded accurately
• Assessment of cranial nerves should be done correctly and recorded .
• Assessment of motor, sensory and cerebellar functions should be done and be recorded
accurately.
32. • During the examination , she should maintain a good support with the patient
and family members.
• She should instruct the procedure correctly and then they should be asked to do
it .
• Should be informed to the concerned unit doctors if there is a change .
33. SUMMARY
• A neurological exam , also called a neuro exam , is an evaluation of a person’s
nervous system that can be done in the healthcare provider’s office . It may be
done with instrument , such as light , hammers. It usually does not cause any pain
to the patient
34. CONCLUSION
• The contribution of neurological assessment is considered as part of the function
of a multidisciplinary team which should deal with the diagnosis and treatment of
children with learning disorders
