Neurological Flow

Front 1

1. Responsiveness

Back 1

Alert, lethargic, responds to verbal stimulation, touch or pain, comatose

Front 2

2. Orientation

Back 2

Person, place, time

(ask pt name, date and location)

Front 3

3. General assessment

Back 3

Posture, obvious extremity weakness or asymmetry

Front 4

4. CN II - optic

Back 4

1. Assess visual acuity bilaterally
2. Assess peripheral fields bilaterally
3. Ophthalmoscopic exam

Front 5

5. Pupillary reaction

Back 5

In by 2 out by 3

Combination CN II sensory and CN III motor - direct/consensual

Front 6

6. CN III - occulomotor

Back 6

evaluate for ptosis

Front 7

7. EOM

Back 7

Comination CN III, IV, VI, performed properly to include fields of gaze

Front 8

8. CN V - trigeminal

Back 8

1. Motor branch: have pt clench the teeth palpating muscles of mastication

2. Sensory branch: test sensation to light touch in each branch of the trigeminal

3. Corneal reflex (student state but do not test)

Front 9

9. CN VII - facial

Back 9

1. Motor branch
a. Facial symmetry - nasolabial fold, facial range of motion
b. Close eyes - think of 7 as a hook pulling the eyelid down

2. Sensory branch
- student tests for taste in the anterior 2/3rds of tongue

Front 10

10. CN VIII -acoustic

Back 10

1. Test hearing - performs general screening hearing test bilaterally

2. Vestibular function - assess for nystagmus (may be stated during EOM exam)

Front 11

11. CN IV - glossopharyngeal

Back 11

State tests for taste to posterior 1/3rd of tongue

Front 12

12. Gag reflex

Back 12

Describe only - combination sensory CN IX and motor CN X

In by 9 out by 10

Identify deviation of uvula as away from side of neurological lesion

Front 13

13. CN X - vagus

Back 13

1. Have patient open mouth and say "ahh" assessing for symmetrical rise of uvula

2. Assess for dyphonia - innervates the larynx

Front 14

14. CN XI - spinal accessory

Back 14

1. Have pt rotate head from 90 degrees to midline - SCM

2. Have pt shrug shoulders - traps

Front 15

15. CN XII - hypoglossal

Back 15

1. Observe tongue for fasciculations
2. Have pt stick tongue outward
3. Identify deviation of tongue toward side of neurological lesion

Front 16

16. MOTOR tests

Back 16

1. Inspection of involuntary movements and muscle atrophy
2. Strength testing
3. Bilateral comparison

Front 17

17. What are the levels of 0 - 5 mean in strength testing?

Back 17

0 = no muscle twitch with attempted movement of muscle group
1 = twitch only of muscle with attempted movement
2 = movement against horizontal plane only
3 = movement against gravity but not against resistance
4 = movement against gravity and some resistance
5 = movement against full resistance

Front 18

18. Shoulder abduction

Back 18

axillary, C5

Front 19

19. Elbow flexion

Back 19

musculocutaneous, C5-6

Front 20

20. Elbow extension

Back 20

radial, C7

Front 21

21. Wrist flexion

Back 21

Median, C6,C7,C8

Front 22

22. Wrist extension

Back 22

Radial, C6

Front 23

23. Finger adduction

Back 23

Ulnar, C8,T1

Front 24

24. Finger abduction

Back 24

Ulnar, C8,T1

Front 25

25. Thumb abduction perpendicular to the plane

Back 25

Median, C8,T1

Front 26

26. Hip adduction

Back 26

Obturator, L2,L3

Front 27

27. Hip abduction

Back 27

Superior gluteal, L4,L5

Front 28

28. Knee extension

Back 28

Femoral, L4

Front 29

29. Knee flexion

Back 29

Sciatic, S1

Front 30

30. Dorsiflexion

Back 30

Deep peroneal, L4-L5

Front 31

31. Plantarflexion

Back 31

Tibial, S1

Front 32

32. Sensory symmetries

Back 32

Test for symmetry:

C4 (shoulders)
C6 (thumbs)
C8 (5th finger)
T1 (forearm)
T4 (nipple line)
T10 (umbilicus)
L2 (anterior thigh)
L4 (medial calf)
L5 (lateral calf)
S1 (lateral foot)

Front 33

33. Sensory exam techniques

Back 33

1. Light touch - cotton wisp - combo posterior column and spinothalamic tract
2. Sharp vs. dull comparison - spinothalamic
3. Temperature - state only, tests spinothalamic
4. Vibration - using 128 Hz tuning fork, posterior column, distal to proximal
5. Proprioception - posterior column
6. Discrimination: extinction

Front 34

34. Reflexes 0 - 4 definitions

Back 34

0 = no response
1 = diminished but present
2 = normal
3 = somewhat increased reflex
4 = greatly increased reflex

Hyporeflexia suggests LMN
Hyperreflexia suggests UMN

Front 35

35. Biceps reflex

Back 35

C5-6

Front 36

36. Brachioradialis

Back 36

C5-6

Front 37

37. Triceps

Back 37

C6-7

Front 38

38. Patellar

Back 38

L2-4

Front 39

39. Achilles

Back 39

S1-2

Front 40

40. Babinski's sign

Back 40

Stroke lateral plantar surface of foot and cross medially at the ball

Normal = state as first digit plantarflexes

Abnormal: state as first digit dorsiflexes - indicates upper motor neuron disease

Front 41

41. Cerebellar function tests

Back 41

A. Seated exam
1. Rapid alternating movements
2. Finger to nose testing
3. Pronator drift - arms forward, palms up, eyes closed
4. Heel to shin

B. Gait
C. Tandem walk - heel to toe
D. Romberg - feet together, arms out, palms up, eyes closed