The document provides details about conducting a neurological assessment, including subjective and objective components. The subjective assessment involves collecting information from the patient about their medical history, complaints, and social history. The objective assessment consists of observing the patient, palpating areas, and performing examinations of things like cranial nerves, motor function, reflexes, coordination, and other body systems. The assessment is used to formulate a problem list and provisional diagnosis to guide the patient's treatment plan.

1. Presentation
on:
Neurological
Assessment
Aishwarya
Patil B.P
.T.
Final year

2. INTRODUCTION:
Assessment:
“The art of evaluation,judgement and gauging
a given situation in the most efficient way
possible.
In the medical scenario, the above means the same, with
respect to a patient’s medical condition and its
subsequent treatment plan.

3. Medical assessment is divided
into 2 parts:
A.Subjective Assessment: Information from client’s point
of view, including concerns, feelings, thoughts and
perceptions, by the form of a 2-way interview.
B.Objective Assessment: A set of facts, representing
patient’s current health status based upon various forms
of observation, examination and carefully drafted
techniques that help the medical professional in getting
details about the patient.

4. A.Subjective assessment:
Demographic data:
Name:
Age/Gender:
Address:
Contact Information:
Patient Status: Conscious/Semi-Conscious/Unconscious.
(Semi-Conscious states include: Pseudocoma (Locked-in
Syndrome), Catatonia, Delirium, Dementia, Amnesia.)
Chief Complaints: As narrated by the patients, according to
his/her vocabulary, comfort and time.

5. These include:
Inability to- move one/both, UL or LLof one/both sides.
Inability to- move eyes, mouth, eat, chew, hear.
Problems with- balance, coordination, equilibrium,
headache Convulsions, spells or any other sensory
disturbances.
Weakness/pain in one/both UL or LL.
Synergy Patterns. (Primitive movements that dominate reflex and
voluntary effort when spasticity is present following a
cerebrovascular accident.)

6. History
:
H/o present illness:Allowed to narrate according to him/her.
But following pointers should be noted:
Onset/Duration
. Mental State.
Speech
Disturbances.
Consciousness.
Special senses.
Headache
mentions. Sleep
Pattern..
Movement
.

7. Past Medical History:
History of the following:
llnesses: Hereditary, Congenital, Infectious, Rheumatic
etc. Surgery, Trauma.
Travel History.
Vaccination Status.
History of Blood
Transfusion. History of
Childbirth.
History of past/ongoing
medications. History of any
Allergies.

8. Personal History:
Residence: Type of house patient is living
in. Marital History.
Occupation and Occupational
Hazards. Educational Status.
Habits/Addictions (Tea,Coffee, Tobacco, Alcohol, Marijuana, Narcotics
and other Psychoactive drugs).
Hours of Sleep and Exercise.

9. Family History:
Type of Family
(Nuclear/Joint). No. of
Members.
Consanguinity.
Other diseases running in the family
(HTN,DM,IHD,Anxiety, Schizophrenia)

10. Socioeconomic History:
Economic Status. (Income Information, about if the patient
is above/below B.P.L.)
Housing Status. (Hut, Makeshift house, Single/Double storey
house, Apartments, mansion etc.)
Nutritional Status.(Helps in assessment of nutrition deficiency
disorders) Other Social Problems.
Type of locality the Patient resides in. (Slums, Gated
colonies, Apartment complex etc.)

11. H/o Pain: SOCRATES mnemonic.
Site and Side– Where is the pain? Or the maximal site of the pain.
Onset – When did the pain start, and was it sudden or gradual?
Include also whether it is progressive or regressive.
Character – What is the pain like? An ache?
Stabbing? Radiation – Does the pain radiate
anywhere?
Associations – Any other signs or symptoms associated with the
pain? Time course – Does the pain follow any pattern?
Exacerbating/relieving factors – Does anything change the
pain? Severity – How bad is the pain?

12. Birth History: Natural Labour/C-section/TOLAC
Developmental History: Proper appearance and disappearance
of appropriate developmental milestones.

13. Developmental
Milestones:

14. Red Flags seen in developmental
milestones:

15. B. Objective assessment:
-ON OBSERVATION.
-ON PALPATION.
-ON EXAMINATION.

16. -ON OBSERVATION: Following pointers are seen;
● Ambulatory status
(Independent/Dependent/using appliances)
● Ventilatory status (Independent/Dependent)
● General
condition(Normal/Distressed/Indifferent/Belligerent
)
● Gait (Normal/Abnormal)
● Facial Symmetry
● Built (Endomorphic/Mesomorphic/Ectomorphic)
● Postural Assessment (In all views, Ant., Post.,
Lateral.)

18. ● External Appliances (Sensory Aids, Mobility
Aids, Ventilator, Catheter)
● Attitude of the limb (In all positions)
● Presence of :
Edema, Rashes, Any deformity, Scars,Bandages,Open
wounds, Abnormal Bony Contours,Abnormal Skin
Colour.
● Speech (Normal/Abnormal)
● Sores (Bed/Decubitus/Vascular/Diabetic)
● Movements (Presence of any abnormal movements).

19. -ON PALPATION:
● Muscle Tone (Normal/Abnormal).
● Swelling (Blood, Synovial Fluid, Callus,
Acute, Chronic, Edematous).
● Skin:
Trophic changes (Dry, Moist, Oily,
Scaly) Temperature
Scar
● Tenderness (By Grading).
● Pain (By VAS or NPRS)

21. VAS and NPRS scales

22. -ON EXAMINATION: Consists of the
thorough examination of the following:
● General Examination.
● Higher Mental Functions.
● Sensorium.
● Motor part.
● Reflexes.
● Coordination.
● Equilibrium.
● Balance.
● Functional.
● Other Systems of the Body.

23. ● General Exam:
-Vitals.
-Nutritional Status. (From BMI, Skin, Hair,
Eyes, Conjunctiva, tongue)
-Cardiorespiratory Assessment.

24. ● Higher Mental Functions:
-Level of consciousness.
-Attention.
-Orientation.
-Language —fluency, comprehension,
repetition, naming, reading,
writing.
-Memory —immediate recall, recent, remote.
-Higher intellectual function—general knowledge,
abstraction,
judgment,insight,reasoning.

25. Level of Consciousness is assessed by GCS (Glasgow
Coma Scale).

26. Higher Mental Functions are examined by MMSE
(Mini Mental State Exam).

28. ● Sensory Exam:- 1.Cranial nerve
examination:

30. Sensory
assessment:
● Superficial – touch, pain, temperature, pressure
● Deep – joint movement sense, joint position sense, vibration
● Combined – tactile localization, 2 point discrimination
stereognosis, barognosis, graphesthesia

35. Sensory grading
1-intact – normal accurate
response. 2-decreased – delayed
response.
3exaggerated – increased sensitivity or awareness of stimulus
after it has ceased.
4inaccurate – inappropriate perception to given
stimulus. 5-absent – no response.
6-inconsistent or ambiguous – response inadequate to assess.

38. ● Motor Assessment:
-Movement Evaluation: ROM (AROM & PROM)
End Feel
Capsular
Patterns MMT
Limb Length Measurement
Joint Position (Open&Close
Packed)
-Functional Evaluation: Postural Changes
ADL
Gait
LOOK FOR SYNERGYPATTERNS(Primitive movements
that dominate reflex and voluntary effort when spasticity
is present following a cerebrovascular accident)

39. -Muscle Tone Examination: Done according to
Modified Ashworth Scale.

40. -Muscle Girth Measurement- For checking the wasting
of muscles.
-Muscle Power- MMT scale, by MRC.

41. ● Reflex Examination:
a. Primitive Reflexes: Reflex actions originating in the central
nervous system that are exhibited by normal infants, but
not neurologically intact adults, in response to particular
stimuli. These reflexes are suppressed by the
development of the frontal lobes as a child transitions
normally into child development.
Older children and adults with atypical neurology (e.g.,
people with cerebral palsy) may retain these reflexes and
primitive reflexes may reappear in adults. Reappearance may
be attributed to certain neurological conditions including
dementia (especially in a rare set of diseases called
frontotemporal degenerations), traumatic lesions, and strokes.

43. b. Superficial
Reflexes:

44. c. Deep Tendon Reflexes
Biceps (C5,C6)
Triceps (C7,C8)
Patellar (L2,L3,L4)
Hamstrings (L5,S1,S2)
Ankle (S1,S2)
d. Also check: Babinski sign, for ruling out UMN
lesion.

46. ● Coordination assessment:
a. Non equilibrium:
Finger to nose
Finger to therapist
finger Finger to finger
Alternate nose to finger
Finger opposition
Mass grasp Pronation / Supination
Rebound Tapping (hand & foot)
Pointing and past pointing
Alternate heel to knee & heel to
toe Toe to examiner’s finger
Heel on shin
Drawing a circle (hand & Foot)
Fixation / position holding (UL&
LL)

47. Grading
5- Normal performance
4- minimal impairment – able to accomplish activity with
slightly less than normal speed and skill
3- moderate impairment – able to accomplish activity but
coordination deficits very noticeable movements are
slow, awkward and unsteady
2 – severe impairment – able only to initiate activity
without completion
1-Activity impossible

48. ● Equilibrium:
Standing – normal
posture Standing – vision
occluded Standing – feet
together Standing on one
foot
Standing – forward trunk flexion and return back to
neutral
Standing – lateral trunk
flexion Walk – tandem
walking
Walk – along a straight line
Walk – place feet on foot
marks Walk – sideways
Walk – backward

49. Grading
4- able to accomplish activity
3 – can complete activity, needs minor help to
maintain balance
2- Can complete activity with moderate to maximal
help 1-Activity impossible

50. ● Balance
assessment Berg
balance scale
Score-around 56
indicates Functional
balance.
Score<45 indicates higher
risk of falls.

51. Apart from Berg Balance scale, Functional balance grading
can be used. The grading is as follows:
Normal – able to maintain balance without support.
Accepts maximal challenge and can shift weight in all
directions.
Good – able to maintain balance without support. Accepts
moderate challenge and can shift weight although limitations
are evident
Fair – able to maintain balance without support cannot tolerate
challenge cannot maintain balance while shuffling weight Poor
– patient requires support to maintain balance

52. ● Functional Exam:
Done by FIM (Functional Independence Measure) scale, which is
a tool that explores an individual's physical, psychological and
social function. The tool is used to assess a patient's level of
disability as well as change in patient status in response to
rehabilitation or medical intervention.

55. ● Other body systems that should be examined are as
follows:
1. Integumentary system
2. Musculoskeletal system
3. Bowel and Bladder activity
4. Autonomic Changes

56. After following all above procedures, a PROBLEM LISTis
formulated, with patient’s inputs.
This is followed by formation of a PROVISIONALDIAGNOSIS
with DIFFERENTIAL DIAGNOSIS.
Post this the patient is referred for higher centres for:
-Biochemical/Hematological Investigations.
-Radiological Investigations.
Then, a FINAL DIAGNOSIS is made.

57. MANAGEMENT:
A. Medical
B. Surgical
C. PHYSIOTHERAPY MANAGEMENT

58. PHYSIOTHERAPY MANAGEMENT:
● GOALS:
Short Term: Pain management, Increase efficiency,
Symptom management, Introducing coping
strategies.
Long Term: Improve-motor learning,sensory &
motor function,Increase flexibility & movement &
strength.
● INTERVENTIONS:
-Manual Therapy.
-Exercise Therapy.
-Electrotherapy.