Neurological Assessment and Brain Function: Key Concepts for Health Professionals

Central and Peripheral Nervous System

Components manage sensory processing, motor control, speech, cognition, and vital autonomic functions.

Frontal Lobe

Responsible for personality, behavior, emotions, and intellect.

Precentral Gyrus

Controls voluntary body movements.

Broca's Area

Manages the motor aspect of speech; damage to this area results in expressive aphasia.

Parietal Lobe

Primary center for sensation processing.

Occipital Lobe

Responsible for visual processing.

Temporal Lobe

Manages hearing, taste, and smell.

Wernicke's Area

Manages speech comprehension; damage to this area causes receptive aphasia.

Basal Ganglia

Controls motor functions, learning, and cognition.

Thalamus

Processes sensory information (except smell) and regulates attention, consciousness, memory, and emotions.

Hypothalamus

Regulates body temperature, hunger, thirst, mood, and sleep cycles.

Cerebellum

Controls balance and coordinated muscle movements.

Brainstem

Houses the nuclei for Cranial Nerves III through XII and manages essential life functions, including heart rate, blood pressure, respiratory rate, gag and swallowing reflexes, pupillary light reflexes, and sleep/wake cycles.

Focused Neurological Assessment

Draws components from a comprehensive physical exam to evaluate neurological integrity.

Speech & Cognition Assessment

Evaluate speech clarity, level of consciousness (awakeness/arousal), orientation, and ability to follow commands.

Motor & Coordination Assessment

Assess upper and lower extremity motor strength, movement coordination, and gait.

Cranial & Facial Integrity Assessment

Inspect facial symmetry, pupil light responses, and swallowing function.

Sensory Assessment

Screen for paresthesia (altered sensation/numbness).

Level of Consciousness & Orientation

Patient is awake (or easily aroused) and Alert & Oriented to person, place, time, and situation (AAOx4).

Expected Speech Findings

Speech is clear, fluent, and appropriate.

Facial Symmetry

Facial features and smile are symmetrical with no facial drooping.

Pupils

PERRLA (Pupils Equal, Round, Reactive to Light, and Accommodating).

Motor Strength & Coordination

Hand grasps and leg pushes are equal bilaterally; motor movements and gait are steady and coordinated.

Swallowing Assessment

Swallows without difficulty and denies dysphagia.

Sensory Findings

Patient denies paresthesia.

Expressive Aphasia

Broca area injury.

Receptive Aphasia

Wernicke area injury.

Ataxia

Uncoordinated movement or unsteady gait.

Flaccid / Spastic Tone

Loss of muscle tone (flaccid) or pathologically increased muscle tone/rigidity (spastic).

Paralysis / Hemiplegia / Paraplegia

Total loss of motor function; weakness/paralysis affecting one side of the body (hemiplegia) or lower extremities (paraplegia).

Atrophy

Muscle wasting or loss of tissue mass.

Involuntary Movements

Tremors (involuntary rhythmic shaking), fasciculations (rapid localized muscle twitches), or clonus (rapid, rhythmic muscle contractions).

Cranial Nerve Testing

Isolates motor and sensory functions originating from the brainstem (CN III-XII).

Glasgow Coma Scale

Used for acute altered mental status, traumatic brain injury (TBI), stroke, or drug/alcohol toxicity to track changes in mentation.

BE-FAST Tool

Screening tool used for rapid recognition of acute cerebrovascular events.

Coordination & Proprioception Assessment

Evaluated via the Romberg test, proprioception testing, deep tendon reflexes (DTRs), and gait testing.

Sensory Tests

Include superficial pain and touch perception, two-point discrimination, extinction phenomenon, stereognosis (identifying an object by touch), and graphesthesia (identifying a number written on the skin).

Primitive Reflexes in Infants

Rooting: Present from birth to 3-4 months; Palmar Grasp: Present from birth to 2-3 months; Moro Reflex: Present at birth, diminishes at 3-4 months, and disappears by 6 months; Plantar Reflex (Babinski Sign): A positive Babinski reflex is an expected normal finding up to 16 to 24 months of age.

Normal Age-Related Changes

Diminished sensory perception (smell, taste, hearing, sight); Reduced or absent gag reflex and slower deep tendon reflexes; Shorter, shuffling gait with increased joint flexion and decreased extension; Increased vulnerability to polypharmacy side effects impacting cognition or stability.