A presentation that talks about the Human Nervous System, the cranial nerves and the Neuro Assessment required to check if the nervous system is functioning properly.

1. Sreedevi Menon
Staff Nurse
FNSW
1
NEUROLOGICAL ASSESSMENT

2. Contents
2
 Introduction
 Objectives
 Neurologic Examination
 Cranial Nerve Examination
 Motor System Assessment
 Age Related Changes in the
Neurological System
 Conclusion

3. Objectives
3
At the end of this lecture participates will be able to:
 Define neurological assessment.
 Identify the purpose of performing the neurological
examination.
 List the main five components of neurological
assessment.
 Outline what to assess in mental status.
 Describe how to assess the cranial nerves.
 Identify motor system assessment.
 Identify sensory examination.
 Explain examination of motor reflexes.
 Describe age related to neurological changes.

4. Introduction
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The nervous system consists of the central
nervous system (CNS), the peripheral
nervous system, and the autonomic
nervous system. The CNS includes the
brain and spinal cord.
Nervous
System
Central Nervous
System (CNS)
Brain
Spinal
Code
Peripheral
Nervous
System (PNS)
Autonomic
Nervous System

5. Introduction
5
Neurologic
Assessment
Cerebral
Function
Cranial
Nerves
Motor
System
Reflexes
A neurological
assessment is
composed four
components:
1. Cerebral
Function
2. Cranial Nerves
3. Motor System
4. Reflexes

6. DEFINITION
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 A neurological examination (also
called a neuro-exam) is a systematic
process that includes a variety of
tests and observations. It may be
performed with instruments, such as
lights and reflex hammers, and
usually does not cause any pain to
the patient.

7. 7
When is a Neurological
Examination Performed?

8.  During a routine physical assessment
 Following any type of trauma
 To follow the progression of a disease
 If the person has any of the following complaints:
 Headaches
 Blurry vision
 Change in behavior
 Fatigue
 Change in balance or coordination
 Numbness or tingling in the arms or legs
 Decrease in movement of the arms or legs
 Injury to the head, neck, or back
 Fever
 Seizures
 Slurred speech
 Weakness
 Tremors
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9. 9
How is a Neurological
Examination conducted?

10. MENTAL STATUS –
 Appearance
 Behavior
 Dress
 Grooming
 Personal Hygiene
 Posture & Gestures
 Movements, Facial Expressions
 Motor Activity
 Manner of Speech
 Level of Consciousness (GCS) 10
General appearances and
movements

11. INTELLECTUAL FUNCTION-
 Assess patient's immediate recall by
asking the patient to repeat a
sequence of numbers.
 Assess patient's recent memory by
asking him to give details of
instructions given earlier in the
assessment.
11

12. THOUGHT CONTENT-
During the interview, it is important to
assess the patient's thought content.
Are the patient's thoughts
spontaneous, natural, clear, relevant,
and coherent?
12

13. EMOTIONAL STATUS-
Is the patient's affect natural and even,
or irritable and angry, anxious,
apathetic, or euphoric?
Does his or her mood fluctuate
normally, or does the patient
unpredictably swing from joy to
sadness during the interview?
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14. PERCEPTION-
The examiner may consider more
specific areas of higher cortical
function. Agnosia is the inability to
interpret or recognize objects seen
through the special senses.
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15. MOTOR ABILITY-
Assessment of cortical motor integration
is carried out by asking the patient to
perform a skilled act (throw a ball,
move a chair, etc.).
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16. LANGUAGE ABILITY-
The person with normal neurologic
function can understand and
communicate in spoken and written
language.
16

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THE CRANIAL NERVES
There are
12 cranial
nerves in
the human
body.

18. CRANIAL NERVE I
 Olfactory Nerve
This is the nerve of smell. Thepatient may be asked to
identifydifferentsmells withhis/hereyes closed.
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19. CRANIAL NERVE II
 Optic Nerve
This nerve carries vision to the brain. A visual test may be
given and thepatient'seye may be examinedwitha
special light.
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20. CRANIAL NERVE III
 Oculomotor
This nerve is responsible for pupilsize and certain
movements of the eye. The patient'sdoctor may
examinethe pupil (the black part of the eye).
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21. CRANIAL NERVE IV
 Trochlear Nerve
This nerve also helps withthe movement of theeyes.
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22. CRANIAL NERVE V
 Trigeminal Nerve
This nerve allows for many functions,includingtheability
to feel theface, inside themouth,and move themuscles
involved withchewing.
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23. CRANIAL NERVE VI
 Abducena
Nerve
Thisnerve helpswiththe
movementoftheeyes.
Thepatientmay be
askedtofollowa lightor
fingertomove theeyes.
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24. CRANIAL NERVE VII
 Facial Nerve
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25. CRANIAL NERVE VIII
 Acoustic Nerve
This is thenerve of hearing.
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26. CRANIAL NERVE IX
 Glossopharyngeal Nerve
This nerve in involved withtaste and swallowing.
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27. CRANIAL NERVE X
 Vagua Nerve
This nerve is mainlyresponsible for theability to
swallow, the gagreflex,some tasteand part of speech .
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28. CRANIAL NERVE XI
 Accessory Nerve
This nerve is involved inthe movement of theshoulders
and neck.
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29. CRANIAL NERVE XII
 Hypoglossal Nerve
The finalcranial nerve is mainly responsible for
movementof thetongue.
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30. MOTOR SYSTEM ASSESSMENT-
Assessment of the motor system
includes evaluation of:
Evaluation of Bilateral Muscle
Strength,
Coordination & Balance Tests and
Sensory System Assessment.
Be sure to assess bilaterally and
compare findings.
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31. MUSCLE STRENGTH
 Examine the arm and leg muscles looking for
atrophy and abnormal movements such as tremors
 perform passive range of motion exercises and
note any resistance
 instruct the patient to bend the forearm up at the
elbow (flexion) while you hold the patient’s wrist
exerting a slight downward pressure
 test the triceps by having the patient extend his arm
while you push against his wrist
 Ensure that the patient follows instructions to
release the hand when assessing grip strength
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32. COORDINATION AND BALANCE TESTS
Coordination can be checked by
having the patient close the eyes and
touch the finger to the nose
Coordination can also be assessed
by having the patient perform rapid
alternating movements (RAMs).
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33. FINGER-TO-NOSE TEST
 Askthe client toextend botharmsfromthe sides ofthe body.
 Askthe client tokeep botheyes open.
 Askthe client totouchthe tipofthe nosewithright indexfinger,andthenreturnthe right
armtoanextendedposition.
 Askthe client totouchthe tipofthe nosewithleft indexfinger,andthenreturnthe left
armtoanextendedposition.
 Repeatthe procedureseveral times.
 Askthe client toclosebotheyes andrepeatthe alternatingmovements 33

34. FINGER-TO-NOSE TEST
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35. SENSORY SYSTEM ASSESSMENT
 Instruct the patient to keep his eyes
closed during all the tests. Compare
one side with the other, noting whether
sensory perception is bilateral.
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36. REFLEXES TO CHECK:
I. Biceps
Flex patient’s arm at the elbow and rest his forearm on his thigh with the
palm up. Place yourthumb firmly on the biceps tendon in the antecubital
fossa. Strike your thumb with the hammer.The elbow and forearm should
flex, and the biceps muscle should contract.
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37. II. TRICEPS
The triceps tendon istested withthepatient’s arm flexed
at a 90° angle. Supporting thearm withyour hand, strike
the triceps tendon on theposterior arm just above the
elbow. The tendon should contract and the elbow
extend.
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38. III. BRACHIORADIALIS
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Have thepatientrest his slightly flexed
arm on his lap withthe palm facing
downward. Strike the posterior arm
about two inches above the wrist on
the thumbside. The forearm should
rotate laterallyand thepalm turn
upward

39. IV. PATELLAR
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Danglethe patient’s legs over
theside of the bed. Place
your handon the patient’s
thighand strike thedistal
patellar tendon just below
the kneecap. The normal
response is contraction of the
quadriceps muscle with
extensionof the knee.

40. V. ACHILLES
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Have thepatient dorsiflex (point downward) his
foot slightly and lightlytap the Achilles’s tendon
on theposterior anklearea. A slight jerking of the
foot should be seen.

41. VI. ABDOMINAL REFLEX
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-Use a blunt object such as a key or tongueblade.
-Stroke theabdomen lightlyon each side in an inward and
downward direction.
-Note thecontraction of theabdominal muscles and deviation of
the umbilicus towards the stimulus.

42. VII. Plantar reflex (Babinski)
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-Stroke thelateral aspect of the sole of
each foot with the end of a reflex
hammeror key.
-Observe for planterflexionof thefoot

43. GRADING REFLEXES
AnalysisObservation
Very brisk, hyperactive, with clonus
(rhythmic oscillations between flexion and
extension)
4+
Brisker than average; possibly but not
necessarily indicative of disease
3+
Average; normal2+
Somewhat diminished; low normal1+
No response0
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Reflexes are usuallygraded on a 0 to 4+ scale.

44.  Older people may not realize the air
temperature is too cold or too warm.
 Vision is affected by aging.
 Hearing decreases because of natural or
mechanical means.
 By the time a person reaches the age of 80,
brain weight may be as much as 10% less
than what it was.
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Muchof thepatient'sneurologicfunctionis assessed
duringthe historyand duringearlyparts ofphysical
examination.Muchcanbe learnedfrom thespeech
patterns,mentalstatus,gait,stance,motorpower,and
coordinationduringthenurse-patientsinteraction.
CONCLUSION

46. References
1.Retrived on 24/03/2013
http://nursinglink.monster.com/
training/articles/240-physicalassessment
2.Retrived on
24/03/2013http://medicalcenter.osu.edu/patie
ntcare/healthcare-services/nervous-system
3. C.Smeltzer,Suzanne (2009) RN,EdD,FAAN,
text book of medical & surgical. 9th edition,
philadeilphia: Lippincott
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