NAME: Loejjie Estacio

PATIENT: Larissa Nyogue

DATE: 11/10/14

ASSESSMENT GUIDE FOR THE NEUROLOGIC SYSTEM

AREAS OF CONCENTRATION
SUBJECTIVE DATA:
HISTORY OF PRESENT
ILLNESS: seizures or convulsion
and sequence of events leading up
to and after the episode, pain, gait
disorder, weakness or parasthesias,
associated symptoms: confusion,
memory deficits, trouble speaking
or understanding, paralysis, severe
headache, vision changes, pain,
shortness of breath, spasms,
stiffness of joints, sensory deficits,
loss of bowel or bladder function;
medications, tremors (PQRST).
PREVIOUS HX: trauma
(brain/spinal cord), CVA,
meningitis, CV problems, HTN,
PVD, DM; family hx of ETOH,
epilepsy, Alzheimers, learning
disorders, HTN, thyroid disease,
DM. Hand, eye, foot dominance,
ability to perform ADL,
occupational hazards i.e. lead
exposure, sleeping pattern, ETOH,
substance abuse, mood altering
drugs.

OBJECTIVE DATA:

MENTAL STATUS:
Appearance and behavior
Emotional stability
Cognitive ability
Speech and language

FINDINGS

Stress
Bloated lactose intolerant
Chronic headaches- tired
4 hours

Right handed
Walk 20-30minutes

The above components of the physical

exam are assessed throughout the
encounter with the patient.
Perform the Min-Mental State
Examination **(see separate
handout).
Glasgow Coma Scale performed for
suspicion of brain injury.

Patients score: 30 points- no signs of

memory/ mental deficit.

CRANIAL NERVES:
**See separate handout on testing of
cranial nerves and perform.

Cranial Nerve test passed.

PROPRIOCEPTION AND
Patient performed all exercises efficiently
CEREBELLAR FUNCTION:
Coordination and fine motor skills.
Rapid rhythmic alternating
movements: with the patient sitting
have them alternatively pat their
knees with the palms and backs of
their hands gradually increasing
speed. Alternatively have the
patient touch their thumb with each
fingertip gradually increasing
speed. Observe for speed and
smoothness of action.
Accuracy of movements: with their
eyes open, ask your patient to touch
your finger (held 18 inches from
them) then their nose and then your
finger while you place your finger
in multiple positions. Alternatively
with their eyes closed have them
alternate touching their nose with
their index finger. Alternatively
have them run their heel down each
shin in a straight line. Observe for
speed and smoothness and
accuracy.
Equilibrium:
1. Romberg test: have patient
stand with arms at their
sides, feet together, eyes
open at first and then closed,
(be sure to stand near your

patient to prevent falling).

Observe for excessive
swaying/falling to one side.
2. Have patient stand with feet
slightly apart and push
patient at the level of the
shoulders backward; patient
should recover balance
immediately.
3. Have patient stand on 1 foot
with eyes closed and arms at
their side; balance should be
maintained for at least 5
seconds.
4. Have patient hop on 1 foot
with eyes open; should be
able to perform for 5
seconds without loss of
balance.
Gait:
1. Observe patient, eyes open,
walking without shoes down
a hallway; observe for arm
movement, smoothness and
steadiness.
2. Observe patient, eyes open,
walk heel to toe forward and
then backward with arms at
their sides. Observe for
balance, staggering.

SENSORY FUNCTION:
PRIMARY:
Evaluate the sensation of soft and
sharp with the patients eyes closed
on the following areas:
1. Hands
2. Lower arms
3. Abdomen
4. Feet
5. Lower legs
This evaluates superficial pain and
superficial touch. **If a deficit is found in
either of these areas then testing for
sensation of temperature (touch with heat
and cold), deep pressure (squeeze

trapezius, calf or bicep).

Patient able to feel all vibrations.

Vibration (use of a tuning fork on

bony prominences). Patient should
feel sensation with eyes closed.
Position of joints: Move a finger or
toe up or down and ask patient to
tell you the position with their eyes
closed.
**Dont forget about the use of a
monofilament in the diabetic patient to
determine peripheral neuropathy.

Patient able to tell position of fingers.

CORTICAL:
Stereognosis: place an object in
Patient identified all objects.
your patients hand and with their
eyes closed ask them to identify it.
Extinction Phenomenon: touch your
patient with a sharp object in 2
places (hand and cheek), ask how
many stimuli they feel with their
eyes closed.
Patient identified letters.
Graphesthesia: with a blunt object
write a letter in the palm of the
patients hand and ask them to
identify the letter (eyes closed)
Patients identified pinch location.
Point location: with their eyes
closed have them identify (point to)
an area that you have just touched
with a sharp instrument.
REFLEXES:
SUPERFICIAL:
Plantar reflex: Stroke the lateral
side of the sole of the foot from the
heel up and across the base of the
toes (ball of the foot), there should
be dorsiflexion of all toes in the
adult patient. Dorsiflexion of the
great toe indicates a + Babinski
which is abnormal (except in
children).
DEEP TENDON REFLEXES:
Graded on a scale of 0-4+ with 0 being no
response, 1 being sluggish, 2 being normal/
expected, 3 being more brisk and 4 being

brisk or hyperactive.
Brachioradial: Flex the patients
arm to 45 degrees and rest their
forearm on top of your arm with the
hand slightly pronated, strike the
brachioradial tendon (1-2inches
above wrist) to elicit pronation of
the forearm and flexion of the
elbow.
Patellar: flex the patients knee to
90 degrees, allow the leg to hang
loosely, strike below the patella and
elicit extension of the lower leg.

Ravida 2014

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