Neurologic Assessment

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Health Assessment
Anatomy and Physiology Review

NERVOUS SYSTEM

• Highly integrated and complex system

• Main function: responsible for control of cognitive
function and both voluntary and involuntary
activities
• 2 principal parts:
– Central Nervous System
– Peripheral Nervous System
• Basic cell: NEURON
Nervous System Division
Central Nervous System

BRAIN

• Largest portion of the CNS

• Covered and protected by the meninges, the
CSF and the bony structure of the skull

• Parts:
– Cerebrum
– Cerebellum
– Diencephalon
– Brainstem
 Brain

CEREBRUM

• Largest portion of the brain

• The outermost layer, the cerebral matter is

composed of gray matter

• Cerebral cortex is responsible for all

conscious behavior by enabling the
individual to perceive, remember,
communicate and initiate movements
 Brain
Four lobes of the Cerebrum
• Frontal lobe
– Helps control voluntary skeletal movement, speech, emotions
and intellectual activities

• Parietal lobe
– Conscious awareness of sensation and somatosensory stimuli,
including temperature, pain and shape

• Occipital lobe
– Contains visual cortex that receives stimuli from the retina and
interprets visual stimuli in relation to past experience

• Temporal lobe
– Interprets auditory stimuli and contains olfactory cortex that
transmits impulses related to smell
Brain
DIENCEPHALON
• THALAMUS
– Gateway to cerebral

• HYPOTHALAMUS
– autonomic control center; influences activities such as BP, HR, force of
heart contraction, digestive motility, RR and depth and perception of
pain, pleasure and fear; regulates body temperature, food intake, water
balance and sleep cycles

• EPITHLAMUS
– Controls mood and sleep cycles; contains the choroid plexus where CSF
is formed

• SUBTHALAMUS
– contains the nerve tracts and nuclei which are associated with the basal
ganglia and are involved in controlling motor function
 Brain
BRAINSTEM
• Contains the midbrain, pons and medulla
oblongata

• Located between the cerebrum and spinal cord

• Connects pathways between the higher and

lower structures

• influences BP by controlling vasoconstriction

and also regulates RR, depth, and rhythm as
well as vomiting, hiccuping, swallowing,
coughing and sneezing
 Brain
CEREBELLUM
• located below the cerebrum and behind
the brain stem

• coordinates stimuli from the cerebral

cortex to provide precise timing for skeletal
muscle coordinations and smooth
movements

• assists with maintaining equilibrium and

muscle tone
Central Nervous System

SPINAL CORD
• continuation of the medulla

• passes through the skull at the foramen magnum

and continues through the verterbral column to
the first lumbar vertebra

• meninges, CSF and bony vertebrae protect the

spinal cord

• transmits impulses to and from the brain via the

ascending and descending pathways
REFLEX

• stimulus-response activities of the body

• fast, predictable, unlearned, innate and

involuntary reactions to stimuli*

• may be simple and take place at the level

of the spinal cord with interpretation at the
cerebral level
Peripheral Nervous System

CRANIAL NERVES

• originate in the brain and serve various parts

of the head and neck*

• the vagus nerve is the only CN to serve a

muscle and body region below the neck

• the composition of the cranial nerve fibers

varies producing sensory nerves, motor
nerves and mixed nerves
Peripheral Nervous System

SPINAL NERVES
• 31 pairs of nerves that arise from the spinal cord

• categorized by the region of the vertebral column

from which they emerge

• all are mixed nerves because they contain axons of

both sensory and motor neurons

• grouped into networks or plexuses: cervical,

brachial, lumbar and sacral
Neurologic
Assessment
 PREPARATION

• Gather and assemble equipment and supplies

• Introduce yourself

• Verify patient with 2 identifiers (JCAHO)

• Explain the procedure and its significance

• Wash hands
 PREPARATION

• Prepare the client

- client can sit on the examination table, edge
of bed (as long as he/she is comfortable)
- client must wear the hospital gown
- get vital signs
Mental Status
Assessment
 MENTAL STATUS ASSESSMENT

• Note general appearance:

hygiene, facial expression, body
posture/language, motor activity,
speech and ability to follow
directions
 MENTAL STATUS ASSESSMENT
• Assess degree of wakefulness/ alertness/ level of
consciousness

• Assess neuro vital signs using the Glasgow Coma

Scale
 Stimulation Techniques:
 Trapezius Squeeze
 Sternal rub
 Supraorbital Pressure

• Ask questions to assess orientation to:

– Time
– Place
– Person
Level of Consciousness

Alert, responds immediately and fully to commands - may or may

Awake
not be fully oriented

Inability to think rapidly and clearly; There is impaired judgment

Confused
and decision making

The beginning of loss of consciousness; There is disorientation in

Disoriented place, impaired memory and a loss of recognition of self which is
the last to deteriorate
Level of Consciousness

can be aroused by stimuli (not pain), i.e. shaking and will then respond to
questions or commands; remains aroused as long as stimulation is applied if
Obtundation
not will fall asleep; questions are answered with minimal response; during the
arousal, client responds but may be confused

a condition of deep sleep or unresponsiveness; client can only be aroused or

caused to make a motor or verbal response by vigorous and repeated
Stuporous
external stimulation (painful); the response initiated is often withdrawal or
grabbing at stimulus

no motor response to the external environment or to any stimuli, even deep

Comatose pain; there is no arousal to any stimulus; reflexes may be present, abnormal
movement (posturing) to pain may be present
MENTAL STATUS ASSESSMENT
• Assess Memory:
Immediate Recall
• utter 3 words and ask patient to repeat immediately and after
5 minutes
• Example: Pencil, grape and car

Recent Memory
• ask events that occurred minutes or few hours ago
• Ask patient what he/she had for breakfast

Remote Memory
• ask events in remote past or historical events that can be
answered by general population
MENTAL STATUS ASSESSMENT
• Assess mood and affect and the appropriateness

• Assess intellectual capacity: fund of knowledge and

calculation ability

– Fund of knowledge – ask about current events

– Calculation Ability- Serial Seven TEST

MENTAL STATUS ASSESSMENT
• Assess thought content: ask to interpret a proverb,
insight or a situation to assess judgment

• Assess language and comprehension

Cranial Nerves
Assessment
CRANIAL NERVES ASSESSMENT

CN Name Function Specific Functions Test(s)

I Olfactory Sensory Sense of Smell Smell

Visual Acuity
II Optic Sensory Sense of Sight
Visual Fields

Movement of the eyeball

(superior, medial and Pupil Reaction
III Oculomotor Motor inferior recti and inferior Eye Movement
oblique)

Movement of the
IV Trochlear Motor eyeball (superior Eye Movement
oblique)
CRANIAL NERVES ASSESSMENT

CN Name Function Specific Functions Test(s)

Sensory: sensations from scalp, Clench Teeth

face, teeth Open Jaw
V Trigeminal Both Motor: contraction of the chewing Sensation: forehead,
muscles cheek, chin

Movement of the eyeball

VI Abducens Motor Eye Movement
(lateral rectus)

Raise Eyebrows
Frown
Sensory: sense of taste in the
Close Eyes Tight
VII Facial Both anterior 2/3 of the tongue
Smile
Motor: muscles for facial expression
Show Teeth
Taste
CRANIAL NERVES ASSESSMENT

CN Name Function Specific Functions Test(s)

Vestibulo-
Sense of hearing, balance and
VIII cochlear/ Sensory Hearing
equilibrium
Acoustic

Sensory: sense of taste in the Movement of Uvula

Glossopha-
IX Both posterior 1/3 of the tongue and Palate when
ryngeal Motor: muscle for swallowing saying “Ah”

Sensory and motor to the pharynx, Gag Reflex

X Vagus Both larynx and muscles for swallowing Hoarseness
CRANIAL NERVES ASSESSMENT

CN Name Function Specific Functions Test(s)

Shrug shoulders
Spinal Contraction of the neck and against resistance
XI Motor
Accessory shoulder muscle Turn head against
resistance

Stick tongue out

Tongue movement (swallowing
XII Hypoglossal Motor and speech)
Tongue in cheek
against resistance
CRANIAL NERVES
CRANIAL NERVE ASSESSMENT
• CN 1: OLFACTORY

• instruct client to close eyes

• test one nostril at a time with the opposite

side occluded using 3 materials (e.g. soap,
coffee, toothpaste)

• Note: Do not use ammonia or alcohol (triggers

trigeminal nerve)
CRANIAL NERVE ASSESSMENT
• CN 2: OPTIC

• Assess visual acuity using:

– Snellen’s Chart for distance vision
– Newspaper for near vision

• Perform this examination in a well-lit room and make

certain that if the patient wears glasses, they are
wearing them during the exam.
• Hold the chart 14 inches from the patient’s face and
cover the one of their eyes completely with their hands.
• Have them repeat the test on the opposite eye and note
visual acuity for each eye.
CRANIAL NERVE ASSESSMENT
• CN 2: OPTIC

• Assess visual fields by confrontation test

• CONFRONTATION TEST
 Measures peripheral vision compared to examiner
 Both examiner and patient cover one eye with a card, stand
about 2 feet and maintain eye contact
 Advance finger, starting from periphery and ask patient to say
“now” when the finger is first visible
 Inability to see when the examiner sees suggests peripheral
field loss
CRANIAL NERVE ASSESSMENT
• CN V: Trigeminal

• Motor Function:
 ask client to clench teeth and palpate the masseter muscles just above the mandibular
angle
 Normal: jaw strength equal bilaterally

• Sensory Function:
 Assess light and blunt touch using cotton ball and paper clip
 Tell patient to close their eyes and say “sharp” and “dull” when they feel an object touch
their face
 Allow them to see the object before examination to alleviate any fear of being hurt
 Using cotton ball to test light sensation and paper clip to dull sensation. Touch the
following direction:
 Forehead (ophthalmic)
 Cheeks (maxillary)
 Chin (mandibular)

 Normal result: Sensation intact and equal bilaterally

CRANIAL NERVE ASSESSMENT
• CN V: Trigeminal
• Assess Corneal Reflex
 Ask patient to look at a distant object and
then approaching laterally, touch the cornea
and look for eye to blink.
 Repeat on the other eye
CRANIAL NERVE ASSESSMENT
• CN VII: Facial

• inspect face noting any facial asymmetry

including drooping, sagging or
smoothing of normal facial creases*

• ask client to raise eyebrows, close eyes

tightly, purse lips, draw back the corners
of the mouth in an exaggerated smile,
frown and puff out both cheeks**

• test taste on the anterior 2/3 of the

tongue using different tastes (sugar,
vinegar, salt, etc)***
CRANIAL NERVE ASSESSMENT
• CN VIII: Acoustic/Vestibulocochlear

• test grossly the cochlear part by having

the client close his eyes and indicate
when a ticking watch or the rustling of
the examiner’s fingertips is heard as
the stimulus is brought closer to the
ear*

• perform Romberg’s test for balance**

CRANIAL NERVE ASSESSMENT
• CN VIII: Acoustic/Vestibulocochlear
• ROMBERG’S TEST
 Instruct patient to stand with his feet together with arms positioned at the
sides
 The clinician asks the patient to first stand quietly with eyes open, and
subsequently with eyes closed. The patient tries to maintain his balance.
For safety, it is essential that the observer stand close to the patient to
prevent potential injury if the patient were to fall. When the patients closes
his eyes, he should not orient himself by light, sense or sound, as this
could influence the test result and cause a false positive outcome.
 This position is to be maintained for 10 seconds
 The Romberg test is positive when the patient is unable to maintain
balance with their eyes closed. Losing balance can be defined as
increased body sway, placing one foot in the direction of the fall, or even
falling.
CRANIAL NERVE ASSESSMENT
• CN IX and X: Glossopharyngeal & Vagus

• perform gag reflex test by touching the pharynx

with tongue depressor on the left and afterwards on
the right side, observing the normal gag or cough
(bilateral contraction of palatal muscles)*

• have the client phonate the ‘ah’ noting bilateral

symmetry of elevation of soft palate**

• lightly hold the client’s throat on either side, ask the

client to swallow, note symmetry
CRANIAL NERVE ASSESSMENT
• CN XI: Spinal Accessory

• ask to shrug shoulders against

resistance, turn head against
resistance

• note the smooth contraction of

sternocleidomastoid and trapezius
muscles, symmetry, atrophy or
fasciculations
CRANIAL NERVE ASSESSMENT
• CN XII: Hypoglossal
• ask client to protrude tongue*

• ask the client to retract tongue

• ask the client to protrude tongue and move

it to the right and then to the left; note ease
movement and equality of movement

• test the strength of the tongue by asking

the client to push against the inside of the
cheek with the tip of the tongue; provide
resistance by pressing one or two fingers
against the client’s outer cheek; repeat on
the other side
 Motor
Assessment
MOTOR ASSESSMENT
• Observe muscle bulk or size, atrophy , hypertrophy, compare left to right,
proximal to distal, note posture symmetry

• Assess muscle strength or power using appropriate scoring:

 Ask to push & pull against resistance of examiner’s hand as it opposes flexion and
extension
 Ask to offer resistance at shoulder, elbow, wrist, hips, knees, ankles
 Assess strength of upper extremities by pronator drift
MOTOR ASSESSMENT
• TESTING FOR MUSCLE STRENGTH- UPPER EXTREMITIES

 DELTOID- ask the patient to raise both their arms in front of them simultaneously as
strongly as they can while the examiner provides resistance
 UPPER EXTREMITY- Perform Pronator Drift
 Ask patient to extend and raise both arms in front of them as if they are carrying a pizza
 Ask patient to keep their arms in place while they close their eyes and count to 10
 NORMAL RESULT: arms will remain in place
 POSITIVE PRONATOR DRIFT- affected arm will pronate and fall

 BICEPS MUSCLE
 Test the strength of lower arm flexion by holding patient’s wrist from above and instructing them
to “flex their hand up to their shoulder”.
 Provide resistance at the wrist
 Repeat and compare with the opposite arm
MOTOR ASSESSMENT

 TRICEPS MUSCLES
 Have the patient extend their forearm against the examiner’s resistance
 Make certain that the patient begins their extension from a fully flexed position because this part
of movement is most sensitive to loss of strength
 WRISTS/ FOREARM EXTENSOR- Wrist extension- Ask patien to extend wrist while examiner
resists the movement
 HANDS and FINGERS
 Test patient’s grips by having the patient hold the examiner’s finger in their fist tightly and
instructing them not to let go while the examiner attempts to remove them. Normally examiner
cannot remove their fingers. This tests the forearm flexors and intrinsic hand muscles.
 Have the patient abduct or “fan out” all of their fingers. Instruct patient to not allow the examiner
to compress them back in. Normally, patient can resist the examiner
 Thumb Opposition- Tell patient to touch the tip of their thumb to the tip of their pinky finger. Apply
resistance to the thumb with your index finger. Repeat with the other thumb
MOTOR ASSESSMENT

MUSCLE STRENGTH PRONATOR DRIFT BICEPS MUSCLE TRICEPS MUSCLE WRIST

FOR DELTOID

FOREARM FLEXOR Finger abduction Thumb Opposition

MOTOR ASSESSMENT
• TESTING FOR MUSCLE STRENGTH- LOWER EXTREMITIES

 HIP FLEXION- ask patient to lie down and raise each leg separately while examiner resist.
Repeat and compare with the other leg. This tests the iliopsoas muscles.
 LEGS ADDUCTION- place your hands on the inner thigh of the patient and ask them to bring both
legs together. This tests the adductors of Medial Thigh
 LEGS ABDUCTION – place your hands on the outer thighs and ask the patient to
move their legs apart. This tests the gluteus maximus and gluteus minimus.
 HIPS EXTENSION- instruct the patient to press down on the examiner's hand which is placed
underneath the patient’s thigh. Repeat and compare to the other leg. This tests the gluteus
maximus.
 KNEE EXTENSION- hold knee from the side and applying resistance under the ankle and
instructing the patient to pull the lower leg towards their buttock as hard as possible. Repeat with
the other leg. This teststhe hamstrings.
MOTOR ASSESSMENT
 ANKLE DORSIFLEXION- hold top of the ankle and have the patient pull their foot up towardstheir
face as hard as possible. Repeat with the other foot. This tests the muscles in the anterior
compartment of the lower leg.
 ANKLE PLANTAR FLEXION - Hold the bottom of the foot, ask the patient to "press down on the
gas pedal" as hard as possible. Repeat with the other foot and compare. This tests the
gastrocnemius and soleus muscles in the posterior compartment of the lower leg
 TOE - ask the patient to move the large toe against the examiner's resistance "up towards the
patient's face". This tests the extensor halucis longus muscles
MOTOR ASSESSMENT

Hip FLEXION Legs Adduction Legs Abduction Hips Extension

Knee Extension Dorsiflexion of the Ankle plantar Flexion

ankle TOE
Scale for Muscle Strength

Rating Explanation Strength Classification

5 Active motion against full resistance Normal

4 Active motion against some resistance Slight weakness

3 Active motion against gravity Average weakness

2 Passive ROM (assisted by examiner) Poor ROM

1 Slight flicker or contraction Severe weakness

0 No muscular contraction Paralysis

MOTOR ASSESSMENT
• TEST for RANGE OF MOTION
MOTOR ASSESSMENT
• Assess muscle tone:
 Move limbs through passive ROM. Note for hypotonia or flaccidity, hypertonia or spasticity

• Observe abnormal involuntary movements such as tics, tremors, myoclonus, chorea

and dystonia
Cerebellar
Assessment
CEREBELLAR ASSESSMENT
• Assess for balance; note for posture while
standing; Gait
• Gait is evaluated by having the patient walk across the room.
Ask patient to walk heel to toe (tandem gait) across the room,
then on their toes only and finally on their heel only.
Normally, these maneuvers are possible without too much
difficulty
Note for the amount of arm swinging
• Perform Romberg’s Test
• Observe patient rising from sitting position
CEREBELLAR ASSESSMENT
• Assess Coordination: : perform FTNT, Pronation/
Supination of hands, Heel to Shin Test.

 FTNT (Fingers to Nose Test)

 Ask the patient to extend their index finger and touch their
nose, and then touch the examiner's outstretched finger with
the same finger.
 Ask the patient to go back and forth between touching their
nose and examiner's finger.
 Once this is done correctly a few times at a moderate cadence,
ask the patient to continue with their eyes closed.
 Normally this movement remains accurate when the eyes are
closed. Repeat and compare to the other hand.
CEREBELLAR ASSESSMENT
• Assess Coordination: : perform FTNT, Pronation/
Supination of hands, Heel to Shin Test.

 Pronation/Supination
 Ask the patient to place their hands on their thighs and then
rapidly turn their hands over and lift them off their thighs.
 Once the patient understands this movement, tell them to
repeat it rapidly for 10 seconds.
 Normally this is possible without difficulty. This is considered a
rapidly alternating movement.
CEREBELLAR ASSESSMENT
• Assess Coordination: : perform FTNT, Pronation/
Supination of hands, Heel to Shin Test.

 Heel to Shin Test

 With the patient lying supine, instruct him or her to place their
right heel on their left shin just below the knee and then slide it
down their shin to the top of their foot. .
 Have them repeat this motion as quickly as possible without
making mistakes.
 Have the patient repeat this movement with the other foot. An
inability to perform this motion in a relatively rapid cadence is
abnormal.
 Sensory
Assessment
SENSORY ASSESSMENT
• Assess the patient’s ability to identify Light
Touch

 Using a wisp cotton, touch various parts of the body,

including feet, hands, arms, legs, abdomen and
face.
 Touch random locations & use random time intervals.
 Ask the patient to say "yes" or "now' when the
stimulus is perceived. Be sure to
 test the different dermatomes.
 Rationale: Test the tract carrying the sensation to the
brain (posterior column pathway)
SENSORY ASSESSMENT
• Assess the patient’s ability to distinguish
difference between sharp and Dull

 Ask the client to say 'sharp" or "dull" when something

sharp or dull is felt.
 Use the sharp or blunt end of the safety pin.
 Rationale: Test the tract carrying the sensations of
pain (spinothalamic) to the brain
SENSORY ASSESSMENT
• 13 areas to perform light touch and test for sharp and dull

The corresponding nerve root for each area tested :

1. posterior aspect of the shoulders (C4)
2. lateral aspect of the upper arms (C5)
3. medial aspect of the lower arms (T1)
4. tip of the thumb (C6)
5. tip of the middle finger (C7)
6. tip of the pinky finger (C8)
7. thorax, nipple level (T5)
8. thorax, umbilical level (T10)
9. upper part of the upper leg (L2)
10. lower-medial part of the upper leg (L3)
11. medial lower leg (L4)
12. lateral lower leg (L5)
13. sole of foot (S1)
SENSORY ASSESSMENT
• Assess the patient’s ability to feel vibrations

 Set a tuning fork in motion and place it on bony parts

of the body, such as the toes, ankle, knee, iliac crest,
spinal process, fingers, sternum, wrist or elbows.
 Ask the client to say "now when the vibration is
perceived and "stop" when it is no longer felt.
 Rationale: Test the tract carrying the sensation of
vibration to the brain (posterior column pathway)
SENSORY ASSESSMENT
• Test position Sense

 Direction when you move a part of client’s body

(move fingers or toes up or down with eyes closed;
kinesthesia)
 Unable to identify direction in which body part is
moved may be a sign of sensory cortex problem

 Having the patient, eyes closed, report if their large toe is

"up" or "down" when the examiner manually moves the
patient's toe in the respective direction.
 Repeat on the opposite foot and compare. Make certain
to hold the toe on its sides, because holding the top or
bottom provides the patient with pressure cues which
make this test invalid.
Cortical Sensory
Assessment
CORTICAL SENSORY FUNCTION
• Test for Stereognosis, the ability to identify
an object without seeing it

 Instruct the client to close both eyes and place an

object on the client's hand.
 Ask the client to identify the object without seeing it.
 Rationale: Test sensory cortical Function
 Astereognosis refers to the inability to recognize
objects placed in the hand.
CORTICAL SENSORY FUNCTION
• Test for Graphesthesia, the ability to
perceive writing on skin

 Instruct the client to close both eyes. Using a non-

cotton end of the applicator or the base of the pen,
scribe a number such as "3" into the palm of the
client's hand.
 Ask the patient to identify the number, and then
repeat the procedure on the other hand.
 Rationale: Test sensory cortical Function (parietal
lobe)
CORTICAL SENSORY FUNCTION
• Assess the patient’s ability to discriminate
between two points

 Simultaneously touch the client with two stimuli over

a given area using the unpadded end of two
applicators.
 Vary the distance between the two points according
to the body region being stimulated. The more distal
the location, the more sensitive the discrimination.
 Rationale: Test sensory cortical Function (parietal
lobe)
Reflexes
REFLEXES

 Have the patient sit up on the edge of the

examination bench with one hand on top of the
other, arms and legs relaxed. Instruct the patient to
remain relaxed.
 Rationale: Promotes comfort and easy access to the patient. Valid
results are best obtained when patient is relaxed

 Reflexes should be graded on a 0-4 scale: Tendon

Reflex Grading:

GRADING DESCRIPTION
0 ABSENT
1 HYPOACTIVE
2 NORMAL
3 HYPERACTIVE
4 CLONUS
REFLEXES
• Assess the Biceps Reflex (C5, C6)

 Support the client's arm with your non-dominant hand

and arm.
 The arm needs to be slightly flexed at the elbow with
palm up.
 Place your thumb or finger firmly on the biceps tendon.
 Strike your finger with the reflex hammer.
 You should feel the response even if you can't see it.
 Rationale: Checks the biceps flexion reflex carried by
spinal nerves C5, C6
REFLEXES
• Assess the Triceps Reflex (C6, C7)

 Support the client's elbow with your non-dominant

hand.
 Strike the triceps tendon above the elbow with the
broad side of the hammer.
 If the patient is sitting or lying down, flex the patient's
arm at the elbow and hold it close to the patient's chest
 . RATIONALE: Checks the triceps extension reflex
carried by spinal nerves C6, C7, C8
REFLEXES
• Assess the Patellar Reflex (L2, L3, L4)

 Have the patient sit or lie down with the knee flexed.
 Strike the patellar tendon just below the patella.
 Note contraction of the quadriceps and extension of
the knee.
 RATIONALE: Checks the patellar extension reflex
carried by spinal nerves L2, L3, L4
REFLEXES
• Assess the Achilles Tendon Reflex (S1)

 Dorsiflex the foot at the ankle.

 Strike the Achilles tendon.
 Watch and feel for plantar flexion at the ankle.
 Rationale: Checks the Achilles tendon plantar
flexion reflex carried by spinal nerves S1, S2
REFLEXES
• Assess the Abdominal Reflexes (T9,
T10, T11, T12)

 Use a blunt object such as a key or tongue blade.

 Stroke the abdomen lightly on each side in an
inward and downward direction above (T8, T9, T10)
and below the umbilicus (T10, T11, T12).
 Note the contraction of the abdominal muscles and
deviation of the umbilicus towards the stimulus.
 Rationale: Checks function of spinal nerves T9,
T10, T11, T12
REFLEXES
• Assess for Cremasteric Reflex • Assess for Anal Reflex
REFLEXES
• Test for Meningeal Irritation
– Assess for Kernig’s Sign
– Assess for Brudzinski’s Sign
 #rciconnects

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