Assessing the neurological system

The 3 main things are.. 

1.reflexes
2.sensation and..
3. muscle power

1. Reflexes can be tested at certain points on the body using a reflex hammer.. you have to be taught
where the particular points are. eg. the quads reflex is when you tap below your knee cap and your knee
straightens.

2. Look up dermatomes of the body. Each dermatome is supplied by a different part of the spinal cord.
When you touch these dermatomes (with a tissue or fingers) you should check if the person has the same
sensation on both sides of the body.

3. Muscle power is tested in all parts of the body. Again you would have to learn the particular sequence
from someone trained, or perhaps a book or something. Basically all muscles are tested for strength
against resistance.

Thats mainly for the body. In terms of the brain, there are a million things you could assess. Obviously
there'l be CT scans etc, and also you could test speech, cognition, orientation, co-ordination etc.

Term Definition
   

  Occlude one nostril and ask patient to inhale

through other nostril. Repeat with other nostril.
 
 
How do you assess the Olfactory Nerve?
Ask patient to smell and identify familiar smells
(coffee, vanilla, peppermint).

Term Definition
   

   

  Snellen Test (for far sight) and Rosenbaum Test

(for near sight).
 
 
How do you assess the Optic Nerve?
 Also test for pupil constriction using your pen
light.

Term Definition
   

   

  Test pupil constriction using your pen light.

   

How do you assess the Oculomotor Nerve? Ask patient to raise and lower eyelids

(open and close eyes).

Term Definition
   

   

  Administer the Convergence Test.

   

How do you assess the Trochlear Nerve? (Ask patient to follow your pen with their eyes as
you move it toward their nose and then down.)

Term Definition
   

   

  Ask patient to clench jaw.

  Use fingertip or penlight to lightly stroke

forehead and cheeks and ask patient to identify
How do you assess the Trigeminal Nerve? where on their face they are being touched.

Term Definition
   

   
    

  Administer the Six Cardinal Gazes.

How do you assess the Abducens Nerve?

(Ask patient to follow your pen light as you move

it vertically up and then down, then diagonally
from upper left to lower right and upper right to
lower left.)

Term Definition
   

   

  Ask patient to do the following:

   

How do you assess the Facial Nerve? Smile

Frown
Show Teeth
Raise Eyebrows

Puff Out Cheeks

Term Definition
   

   

  Whisper Test: Ask patient to cover left ear. Stand

to right of patient, out of view, about a foot away,
  and whisper. Have patient repeat what you said.
Same for other ear.
How do you assess the Auditory Nerve?
 

Administer Weber and Rinne tests.

Term Definition
   
    

   

  Ask patient to open their mouth and say, "Ahh,"

and use the depressor to test their gag reflex by
How do you assess the Glossopharyngeal Nerve? stroking the posterior 2/3 of their tongue.

Note the ability to swallow.

Term Definition
   

   

   

   

How do you assess the Vagus Nerve? Note patient's ability to speak and swallow.

(Often can be observed throughout interview and

when assessing the Glossopharyngeal Nerve.)

Term Definition
   

   

  Ask the patient to shrug their shoulders. Then

push down on their shoulders and have them
  shrug against resistance.

How do you assess the Spinal Accessory Nerve?  

Ask the patient to turn their head to the left and

to the right. Then push against their cheek while
they turn against resistance.

Term Definition
    

   

  Ask the patient to stick out their tongue. Then ask

them to move it to the right and the left.
 
 
How do you assess the Hypoglossal Nerve?
With your hand against the patient's cheek, ask
them to push against the inside of each cheek with
their tongue.

Assessment Scales
Glasgow Coma Scale

Eye Opening E

spontaneous 4

to speech 3

to pain 2

no response 1

Best Motor Response M

To Verbal Command:  

obeys 6

To Painful Stimulus:  

localizes pain 5

flexion-withdrawal 4

flexion-abnormal 3

extension 2

no response 1

Best Verbal Response V

oriented and converses 5

disoriented and converses 4

inappropriate words 3

incomprehensible sounds 2

no response 1

E + M + V = 3 to 15

 90% less than or equal to 8 are in coma

 Greater than or equal to 9 not in coma
 8 is the critical score
 Less than or equal to 8 at 6 hours - 50% die
 9-11 = moderate severity
 Greater than or equal to 12 = minor injury
Coma is defined as: (1) not opening eyes, (2) not obeying commands, and (3) not uttering understandable words.