neurological health assessment

what is being evaluated in a neurologic assessment

cranial nerves 1-12

mental status

motor function

sensory function

reflex function

what is the CNS made up of

brain and spinal cord

what is PNS made up of

all nerve fibers outside of brain and spinal cord

cranial nerves

spinal nerves and all their branches

what are the functions of the 4 brain lobes

frontal lobe: decision making, thinking, impulse control, planning, executive functions, behavior, speech, movement

parietal lobe: sense of taste and touch, fine motor skills

temporal lobe: hearing, language, and memory
occipital lobe: vision

what are parts of the spinal cord in the CNS

ascending tracts
dorsal columns (located on the back)
descending tracts
pyramidal tract
extrapyramidal tract

do cranial nerves enter or exit the brain

exit

how many spinal nerve pairs are there, and name how many pairs are in each category (5 total categories)

31 total
8 cervical
12 thoracic

5 lumbar
6 sacral
1 coccygeal nerve

what are dermatomes

areas of skin that send sensory info (location, temperature, texture, pain, etc)

what part of the nervous system are SNS and PNS a part of

autonomic nervous system

what does the autonomic nervous system control

involuntary functions of cardiac and smooth muscle and glands

what neurotransmitters are relevant to the autonomic NS

epinepherine, adrenaline, acetycholine

what are the 4 different kinds of reflexes, and define them

deep tendon: involuntary movements caused by quick stretching of the muscle tendon

superficial: movements elicited by lightly stroking skin or mucous membranes
visceral: involuntary automatic responses of internal organs

neonatal: automatic primitive motor responses present in healthy infants that dissappear as the brain matures

what is the function of the somatic system, and which part of the nervous system is it under, and what are the 2 divisions of it

under peripheral nervous system
function: communicate with sense organs and voluntary muscles)

2 divisions: afferent/sensory (sensory input to the brain), efferent/motor (motor output away from brain)

when do u perform a screening neurological assessment

on well people who have no significant findings in subjective history

when should a complete neurological assessment be performed

on people who have neurological concerns or who have shown signs of neurological deficits

when should a neuro recheck be performed

on people who have neuro deficits and require periodical assessments

what should be checked during a mental status assessment

level of alertness (a&ox4) and appropriate responses

what causes a pupil to be nonreactive or unilateral (only one eye dilates instead of both) during a perrla exam

increased intracranial pressure

what are palpebral fissures

opening between upper and lower eyelid (visible part of eye)w

what should be assessed when examining palpebral fissures

that they are equal and that eyes close completely

what is ptosis, and what are potential causes

drooping of upper eyelid
caused by: myasthenia gravis (chronic autoimmune disorder where immune system blocks signals between nerves and muscles)

what are the cat whiskers in CN3,4,6 assessments used for

6 cardinal positions of gaze

what is strabismus

deviated gaze or limited movement, causing one pupil to face differently

what is nystagmus and potential causes

back and forth oscillation of the eyes
cause: disease of the vestibular system, cerebellum, or brain stem

what is cn 1 and how is it assessed

olfactory, assess by having pt identify familiar odors one nostril at a time

what is cn 2 and how is it assessed

optic nerve, assessed with visual acuity and visual fields

what is cn 3, 4, and 6 and how are they assessed

oculomotor, trochlear, abducens
assessed with cat whisker finger movement to examine eye movements and pupillary light reflex

what is CN 5 and how is it assessed

trigeminal, controls facial sensation and chewing muscles
assess by touching forehead, cheek, and jaw with cotton ball and have patient verify where the sensation occurred
assess chewing movements by having patient clench jaw, and palpating masseter and temporalis muscles to ensure they are equal

what is CN 7 and how is it assessed

facial nerve
have pt smile, frown, raise brows, puff cheeks, etc. and assess mobility and facial symmetry

what indicates abnormal cn7 assessment, and what may be causes

loss of movement or assymmetry
cns problems like stroke, or pns problems like bells palsy

what is cn8 and how is it assessed

acoustic/vestibulocochlear
whisper on sides of pt ear and have them repeat what they heard on each ear

what is cn9 and how is it assessed

glossopharyngeal
with taste test on back of tongue, or have patient say “ahh” and watch for movement of uvula and soft palate to rise midline

what is cn 10 and how is it assessed

vagus
gag reflex tested with tongue depressor w

what is cn 11 and how is it assessed

accessory
have pt shrug shoulders and turn head against pressure placed on these muscles by you

what is cn 12 and how is it assessed

hypoglossal
have pt stick out tongue and ensure it comes out at the midline with no tremors

how is coordination assessed (motor function)

have pt move their thumb to their pointer, then middle, then ring, then pinky finger

how is gait (motor function) assessed

have pt walk 10-20 ft and turn and return to starting point
normal: steady smooth and effortless
abnormal: stiff immobile posture, staggering, unequal step rhythm, etc.

how is balance (motor function) assessed

with the romberg test: have pt stand w feet together and arms at sides and then close eyes. monitor for swaying or falling

how is pronator drift assessed (motor function)

have pt hold arms straight ahead of them with the palms up. pt should maintain this position for 10 seconds
abnormal results: arms too weak to stay up, one arm droops, palms turn inwards (toward midline) which could indicate a possible upper motor neuron disorder

how to assess for sensation

sharp/dull test where pt identifies sensation with their eyes closed. ensure to assess in various locations of each extremity.

what is stereogenesis/astereogenesis

stereo: being able to identify objects based on touch and feeling in hand
astereo: inability to identify objects based on touch and feeling in hand
be sure to test both hands

how are reflexes ranked (0 to 4+)

0 = no response
1+ = weak response
2+ = average and expected

3+ = brisker than average but still considered normal
4+ = very brisk, hyperactive (indicative of disease)

explain plantar/babinski reflex test and results

stroke bottom of foot from heel to ball of foot in an upside down j shape
negative (normal) result is toes curling inward
positive (abnormal) result is dorsiflexion (bending upwards towards leg) of foot and fanning of toes

• can be caused by brain injury, stroke, brain tumor, lou gehrig disease, ms, spinal cord injury