KHS 205 Practical 1

I Olfactory

Assess smell- have the person describe the smell of something placed under the nose- (coffee beans in a cup)

II Optic

Test Vision- Have patient stand 20ft away from snellen eye chat. Have them cover one eye and read the smallest line they can see.

III Oculomotor, IV Trochlear, VI Abducens

Test eye movement (extraocular movements) - ask patient to follow movement of your finger with their eyes only, holding their head still. Move fingers slowly, stopping briefly at each point. Look for smooth, coordinated eye movements.

• side-to-side

• up and down

• trace a large “X”

• trace a large letter “H”

Oculomotor can also be tested assessing pupil constriction after opening the eyes

V Trigeminal

Facial sensation and chewing- ask patient to close their eyes and identify areas touched. Use a cotton wisp to gently touch these areas of face

• forehead

• upper eyelid

• cheek

• upper lip

• chin

Ask patient to open and close jaw, clench teeth

VII Facial

Assess muscles of facial expression and test ability to taste an item on the front of tongue

Ask patient to

• smile

• show teeth

• puff checks out

• raise eyebrows

VIII Vestibulocochlear

Test hearing and balance

Balance

1. ask patient to stand with their feet together, arms by their side, eyes closed.

2. look for extreme sway or imbalance that causes the patient to catch themselves, move their feet, or open their eyes

Hearing

3. Whisper a 2 digit number in one ear at a time and have them repeat it

IX Glossophrayngeal, X Vagus

Swallowing and speech-

1. ask patient to swallow. obeserve the movement of the throat- observe for difficulty swallowing

2. ask patient to say vowels. observe clear speech and assess any horseness in their voice

3. ask patient to open their mouth and say “ah”- observe that the uvula is in the midline position (deviation of uvular= damage to vagus n.)

Xi Spinal Accessory

Assess movement of trapezius and sternocleidomastoid- ask patient to turn their head side to side and to shrug shoulder

XII Hypoglossal

Assess position of tongue- ask patient to stick out their tongue. assess the position of the tongue to see if it is centered and pointing straight out or down (if injured, tongue will deviate to side of damaged n.)