Student                                  Date      

                                     NEUROLOGICAL ASSESSMENT
        ...
Cranial Nerves             HOW TESTED           RESPONSE (PEER)      RESPONSE (CLIENT)
        Pupils                     ...
RESPONSE (PEER)          RESPONSE (CLIENT)
                              HOW TESTED
                                      ...
RESPONSE (PEER)          RESPONSE (CLIENT)
                             HOW TESTED
                                       ...
RESPONSE (PEER)          RESPONSE (CLIENT)
                              HOW TESTED
                                      ...
RESPONSE (PEER)          RESPONSE (CLIENT)
                        HOW TESTED
                                            ...
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Neuro Assessment Worksheet.doc

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Neuro Assessment Worksheet.doc

  1. 1. Student       Date       NEUROLOGICAL ASSESSMENT Diagnosis:       RESPONSE (PEER) AREA TESTED HOW TESTED RESPONSE (CLIENT) (describe behavior) (describe behavior) Central function                   Level of Consciousness Mental Status                   Orientation Affect                   Memory                   Calculation                   Judgment/Insight                   (Abstract thinking) 40
  2. 2. Cranial Nerves HOW TESTED RESPONSE (PEER) RESPONSE (CLIENT) Pupils                   Size Shape                   Equality                   Reaction to light                   Accommodation                   Consensual Light                   Reflex Convergence                   Conjugate                   movements Peripheral vision                   Reading ability                   41
  3. 3. RESPONSE (PEER) RESPONSE (CLIENT) HOW TESTED (describe behavior) (describe behavior) Nose                   Smell Auditory                   Hearing Rhine test                   Weber test                   Face                   Motor facial Motor: trigeminal                   Sensory: trigeminal                   42
  4. 4. RESPONSE (PEER) RESPONSE (CLIENT) HOW TESTED (describe behavior) (describe behavior) Mouth                   Sensory: facial Gag reflex                   (Sensory/Motor) Glosso-pharangeal Hypoglossal                   Neck and Shoulders                   Spinal Accessory (motor) Sensory                   Upper and Lower Extremities Pain                   Temperature                   43
  5. 5. RESPONSE (PEER) RESPONSE (CLIENT) HOW TESTED (describe behavior) (describe behavior) Light touch                   Positioning                   Stereognosis                   Motor                   Upper and Lower Extremities: Muscle strength                   Muscle tone                   Muscle coordination                   44
  6. 6. RESPONSE (PEER) RESPONSE (CLIENT) HOW TESTED (describe behavior) (describe behavior) Reflexes:                   Biceps                   Triceps                   Brachioradial                   Achilles                   Gait                   Balance                   45

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