1. The Neurological System

2. Neurological Exam 5 Components
Mental status
Cranial nerves
Reflexes
Motor- includes Cerebellar function
Sensory

3. Mental Status Examination
Examination - ABCT
Appearance
Behavior
Cognition
Thought processes (thought content & perceptions)
Glasgow Coma Scale

4. Assessing LOC: Glasgow Coma Scale
Eye opening
Verbal responsiveness
Motor responsiveness

5. Glasgow Coma Scale

6. Levels of Consciousness
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)

7. 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 touch”
Check both sides

8. Sensory Function Tests: Touch Vibration
Physical Examination
Sensory Function Tests:
Touch
Light touch 1st then Pain & Temperature
Vibration
Kinesthesia/Proprioception: Position sense
Stereognosis
Graphesthesia
2-point discrimination

9. Sensory Function Tests: Sensory Exam: Light Touch

10. Sensory Function Tests: Sensory Exam: Vibration

11. Sensory Function Tests: Proprioception: Position sense

12. Sensory Function Tests: Stereognosis

13. Sensory Function Tests: Graphesthesia

14. Sensory Function Tests: Two-point discrimination

15. Motor Examination
Symmetry, size, and presence of involuntary movements
Full ROM of joints
Check strength against resistance
Neuro patients: Assess hand grips and foot pushes if bedridden

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

17. Cerebellar Function, con’t Coordination of hands
Rapid Alternating Movements

18. Cerebellar Function, con’t Coordination of hands
Nose –to - Finger Test

19. Cerebellar Function, con’t Coordination of legs
Heel to Shin Test

20. Cerebellar con’t Romberg:
Stand upright, place feet together, then close eyes
loss of balance means + Romberg test
Be prepared to protect client from falling!

21. Reflexes Superficial (abdominal reflex, Cremasteric reflex)
Cremastic Reflex
Abdominal Reflex

22. Reflexes-Cont: Visceral (pupillary response to light)
PERRL/PERRLA

23. Reflexes-Cont: Pathologic + Babinski in adults
Babinski’s Reflex (Adult)

24. Reflexes-Cont: Reflex Arc – Deep Tendon Reflexes

25. 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

26. BICEPS BRACHIORADIALIS ACHILLES/PLANTAR TRICEPS PATELLAR
DEEP TENDON REFLEXES

27. Grading of DTRs 4+ very brisk 3+ brisker than average
2+ average, normal
1+ diminished, low normal
0 no response