Nervous System Examination

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Arousal-Alert

Wakefulness

Arousal-Lethargy

Loud voice needed

Arousal-Obtunded

Loud voice+shake

Arousal-Stupor

Loud voice+vigorous shake

Arousal-Coma

Responds to noxious stimulus

Attention-Digit repetition

Accurately repeat up to 7 numbers

Attention-Vigilance

Recognize letter when given a series of different letters

Mental Status-Arousal

Alert, lethargy, obtunded, stupor, coma

Metal Status-Attention

Digit repetition, vigilance

Mental Status-Orientation

Person, place, time

Mental Status-Language

Oral fluency, comprehension, articulation

Mental Status-Proverb interpretation

Abstract reasoning/higher-association cortex function

Mental Status-Calculations

Simple math skills

Mental Status-Writing

Spatial and language skills

Mental Status-Constructional ability

drawing complex figures, manipulation blocks

Mental Status

Arousal and attention, orientation ,language, memory, proverb interpretation, calculations, writing, constructional ability

Mental Status-Memory

Short-term and remote

Vision & Visual Fields

Pupillary light reflex, acuity, visual fields, eye movement, vestibulo-ocular reflex

Vision & Visual Fields-Pupillary light reflex

CN II (sensory) and CN III (motor)

Vision & Visual Fields-Acuity

Ability to read close/far (CN II)

Vision & Visual Fields-Visual fields

Test 1 eye at a time, document peripheral, superior, inferior fields (CN II)

Vision & Visual Fields-Eye movement

Up, down, medial (CN III), look to nose (CN IV), lateral (CN VI)

Vision & Visual Fields-Vestibulo-ocular reflex

Keep eyes on object while head moves (CH VIII)

Reflexes

Deep tendon, posturing, decorticate, decerebrate, plantar, frontal release, gag, cremasteric, analwink

Reflexes-Posturing

Abnormal reflexes

Reflexes-Decorticate

Flexion UE, extension LE

Reflexes-Decerebrate

Extension of both UE and LE

Reflexes-Plantar

positive or negative Babinski

Reflexes-Frontal reflexes

grasp, root, suck reflexes

Reflexes-Gag

Palate elevation (CN IX, X)

Reflexes-Cremasteric

L1-2

Reflexes-Anal wink

S2-4

Tone

Resistance to Passive Stretch (flaccidity, hypotonicity, hypertonicity, spasticity, rigidity,

Tone-Flaccidity

Absence of muscle tone

Tone-Hypotonicity

Decreased

Tone-Hypertonicity

Increased

Tone-Spasticity

Velocity-dependent

Tone-Rigidity

bidirectional, not velocity-dependent

Motor Face & Neck

CN: III, V, VII, IX, X, XI, XII

Eye open

CN III

Facial expression

VII

Muscles mastication

V

Tongue

XII

Sternocleidomastoid and upper trapezius muscles

XI

Coordination

Extremity, dysmetria, dysrhythmia, dysdiadochokinesia, tremor, trunk, muscle activation

Coordination-Extremity

finger to nose, heel to shin, finger or toe tapping, rapid alternating movement (RAM)

Coordination-Dysmetria

Overshoot/undershoot

Coordination-Dysrhythmia

Abnormal timing

Coordination-Dysdiadochokinesia

Difficulty with RAM

Coordination-Tremor-Postural

Arms held out

Coordination-Tremor-Intention

During movement

Coordination-Tremor-Resting

At rest

Coordination-Muscle activation

Coactivation, difficulty scaling movement, slowed reaction/movement time

Balance

Romberg, postural strategies, reaching, sensory

Balance-Romberg

Feet together, arms crossed, eyes closed-general test for vestibular dysfunction (VIII)

Balance-Postural strategies

Test for ankle, hip, stepping strategies with displacement center of mass

Balance-Reaching

Test limit of stability

Balance-Sensory

Romberg eyes open/closed, hard/foam surface; tests reliance on vision/proprioception

Sensation

Somatic, face, Taste, cortical

Sensation-Somatic

light tough, proprioception, pain, temperature, 2-point

Sensation-Face

CN V

Sensation-Taste

CN VII, IX

Anterior 2/3 of tongue taste

CN VII

Posterior 1/3 of tongue taste

CN IX

Sensation-Cortical

Kinesthesia, stereognosis, graphesthesia

Strength-Paralysis

Loss of Voluntary movement

Strength-Weakness

Inability to generate enough force to move

Strength-Tests

Via muscle group (hip flexors), spinal segment (L2), or peripheral nerve (femoral nerve)

Strength-Tests-Methods

Manual muscle test, dynamometer, electromyography isokinetic testing

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