NEUROLOGICAL

ASSESSMENT
 Assessing motor function
• When assessing motor function, you'll want to look at
both sides of your patient's body simultaneously. On
inspection, note any asymmetry of muscle; unilateral
atrophy will often indicate weakness. To assess the upper
extremities, have your patient raise his arms parallel to
the floor or bed, and then have him resist when you try
to push them down.You'll do the same for the lower
extremities, having him raise his legs and resist when
you push them down. You can also have him grasp your
fingers in his fist, and then ask him to let go. If he can't
let go on command, it's indicative of neurologic injury.
Assessing motor function
GRADING MOTOR STRENGTH
Pronantor drift

To test for pronator drift, have your patient close his eyes so he can't
compensate and extend his arms, palms up, in front of him. Look for one arm to sway
from its original position: a subtle indicator of weakness.
Pronantor drift
Assessing pupillary response

• Now, we'll move on to pupillary response. Along with

eye motion, pupillary response is controlled by
cranial nerves III, IV, and VI. Normal pupils are of
the same size bilaterally, about 2 to 6 mm and round
(see Visualizing pupil size). About 15% of people
have one pupil up to 1 mm smaller than the other; this
is a normal variant known as anisocoria.
Assessing pupillary response
• To check pupil reactivity, bring a small beam of light
in from the outer canthus of one eye; the normal
response is for both pupils to react equally and
briskly. Keep in mind that medications, surgery, and
blindness can affect pupil size, shape, and reactivity.
The hallmark sign of severe neurologic injury is a
change in pupil size and reactivity. Eye motion is
tested by asking your patient to follow your finger as
you trace the letter H in front of him. This is known
as extraocular movement, or EOM. Document any
inability to follow your finger.
Rapid Neurological Exam
Checklist
Mental Status:
• Alertness - Does patient seem to be aware of what is
going on and able to communicate appropriately
• Orientation - Does patient know who they are, how
old are they, where they are, what date/day it is, what
have they been doing
• Memory* - Ask patient to remember an three objects
then later in the exam ask the patient to recall the
objects
• Calculation* - Have patient count backwards from
100 by sevens
Cranial Nerves

• Eyes - Can patient see, is vision normal, is eye

movement normal
• Hearing - Can patient hear equally in both ears, is
hearing normal
• Smell - Can patient smell (coffee, peppermint, etc.)
• Facial Muscles - Is the face equal in muscle tone and
control, have patient smile
• Tongue - Can patient control tongue movement, it
should stick straight out
Cranial Nerves
• Gag Reflex - Does the "Adam's Apple" move when
patient swallows
• Facial Sensation - Can patient feel light touch equally
on both sides of their face
• Shoulders - Can patient raise their shoulders equally
against resistance
• Muscle Strength against resistance (using 0-5 scale):
• Arms:
• Lift arms away from side
• Push arms towards side
Arms
• Pull forearm towards upper arm
• Push forearm away from upper arm
• Lift wrist up
• Push wrist down
• Squeeze examiners finger
• Pull fingers apart*
• Squeeze fingers together*
Legs
• Lift legs up
• Push legs down
• Pull legs apart*
• Push legs together*
• Pull lower leg towards upper leg
• Push lower leg away from upper leg
• Push feet away from legs
• Pull feet towards legs
Sensory
• Sensory (have patient close eyes while checking
sensory perception):
• Light Touch* - Can patient feel light touch equally on
both sides of the body
• Sharp/Dull - Can patient distinguish between a sharp
or dull object on both sides of the body
• Hot/Cold* - Can patient distinguish between a hot or
cold object on both sides of the body
Coordination
• Coordination* (on any test requiring a patient to
stand make sure someone is there to support them):
• Have the patient touch their nose with their index
finger of each hand with eyes shut
• Have the patient rapidly slap one hand on the palm of
the other, alternating palm up and then palm down -
test both sides
• Have the patient walk heel to toe in a straight line -
forwards and backwards
Coordination
• While standing, have the patient touches the heel of
one foot to the knee of the opposite leg, and while
maintaining this contact, 
• have them run the heel down the shin to the ankle -
test each leg
• With eyes closed, have the patient stand with feet
together and arms extended to the front, palms up
 REFLEXES
• A reflex action often involves a very simple nervous
pathway called a reflex arc. A reflex arc starts off with
receptors being excited. They then send signals along a
sensory neuron to your spinal cord, where the signals are
passed on to a motor neuron. As a result, one of your
muscles or glands is stimulated.
• The part of the brain that controls reflexes is the
cerebellum. The cerebellum regulates motor reflexes and
is also involved in the synchronization of balance and
muscles. The brainstem links and transmits messages to
the spinal cord from the brain, regulating functions such
as respiration, heart rate, and alertness.
REFLEXES
REFLEXES