Neurologic System Lecutre
Neurologic System Lecutre
Neurologic System Lecutre
Cotton
Tuning Fork
Penlight
Ophthalmoscope
Vision Screeners
Reflex Hammer
Orange
Key
PPE
As the patient enters the room, check the following:
Posture and motor behavior
Dress, grooming and personal hygiene
Facial expression
Speech manner, mood and relation to persons and
things around him
KNOWLEDGE
Ask the patient to name five animals, colors, cities, etc. another way to
test this area is to ask the patient to tell you the meaning of proverb or
metaphor. For example, explain:
Too many cooks spoil the soup.
A penny saved is a penny earned.
A stitch in time saves nine.
The Olfactory Nerve (CN I) is simply tested by offering something
familiar for the patient to smell and identify. For example, orange, coffee
or vinegar.
The Optic Nerve (CN II) is tested in five ways:
1. Acuity
2. Color
3. Fields
4. Reflexes
5. Fundoscopy
Visual Acuity
Visual acuity is tested using Snellen charts. If the patient
normally wears glasses or contact lenses, then this test
should be assessed both with and without their vision
aids.
Color
Color vision is tested using Ishihara charts which
identifies patients who are color blind.
Visual Field
Perform confrontational visual field testing by asking the
patient to look directly at you while you wiggle one of
your fingers in each of the four quadrants.
Visual Reflexes
Test corneal light reflex and
pupillary reaction to light to both
eyes.
Fundoscopy
Finally fundoscopy should be
performed on both eyes by
using ophthalmoscope.
The Oculomotor Nerve (CN III),
Trochlear Nerve (IV) and Abducens
Nerve (CN VI) are involved in the
movements of the eye.
Initially test the sensory branches by lightly touching the face with a
piece of cotton ball followed by a blunt paper clip in three places on
each side of the face:
To test the motor supply, ask the patient to clench their teeth together,
observing and feeling the bulk of the masseter and temporalis muscles.
To carry out the Rinne’s test, place a sounding tuning fork on the
patient’s mastoid process and then next to their ear and ask which is
louder. To carry out the Weber’s test, place the tuning fork base down in
the center of the patient’s forehead and ask if it is louder in either ear.
Normally it should be heard equally in both ears.
The Glossopharyngeal Nerve (CN IX) provides sensory supply to the
palate. It can be tested with the gag reflex or by touching the arches of
the pharynx. The Vagus Nerve (CN X) provides motor supply to the
pharynx.
Asking the patient to speak gives a
good indication to the efficacy of
the muscles. The uvula should be
observed before and during the
patient saying “aah.” Check that it
lies centrally and does not deviate
on movement.
The Accessory Nerve (CN XI) gives motor supply to the trapezius and
sternocleidomastoid muscles. To test it, ask the patient to shrug their
shoulders and turn their head against resistance.
The Hypoglossal Nerve (CN XII) provides motor supply to the muscles
of the tongue.
Observe the tongue for any signs of wasting or fasciculation. Ask the
patient to stick their tongue out. If the tongue deviates to either side, it
suggests a weakening of the muscles on that side.
A. Assess bilateral muscle strength and muscle tone.
o Inspect the muscle group for size.
o Compare the right side with left side.
o Look for any asymmetry.
o See musculoskeletal assessment.
o Finger to nose
o Rapid alternating movements
o Heel to shin test
o Fine motor test
o Romberg’s test
Perform the finger to nose test by placing your index finger about two feet from
the patient’s face. Ask them to touch the tip of their nose with their index finger
then the tip of your finger. Ask them to do this as fast as possible while you
slowly move your finger. Repeat the test with the other hand.
Dysmetria is the clinical term for the inability to perform point to point
movements due to over or under projecting ones fingers.
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.
TEMPERATURE
To test temperature sensation, use test tube
filled with hot and cold water. But the most
practical approach is to touch the patient with
a tuning fork as the metal feels cold.
TOUCH
To test touch sensation, use a wisp of cotton
ball to touch the client. DO not press down on
the skin or touch areas of the skin that have
hair. Instruct patient to point area being
touched.
PROPRIOCEPTION
Hold the distal phalanx of the thumb on either
side so that you can flex the interphalangeal
joint. Show the patient as you move the finger
up and down. Ask the patient to close eyes
and move the joint a few times and hold it in
a position and ask the patient if it is in up or
down position.
STEREOGNOSIS
With eyes closed, place a familiar object like
a paper clip or key in the patient’s hand and
ask the patient to identify it. Repeat with
another object in the other hand.
GRAPHESTHESIA
With eyes closed, use a blunt instrument like
pen to write a number on the palm of the
patient’s hand. Ask the patient to identify the
number. Repeat with another number on the
other hand.
CORNEAL REFLEX
Do this by lightly touching the cornea with the
cotton wool. This should cause the patient to
shut their eyelids.
Abnormal finding: No blinking
BRACHIORADIALIS REFLEX
Strike tendon with flat side of
hammer.
1. Triceps Reflex
2. Patellar Reflex
3. Achilles Reflex
1 2 3
https://www.youtube.com/watch?v=Sqb8icF6QhE