Neurological System

Cerebellar Function

Balance Tests:

1. Romberg Test: patient stands with eyes closed and balances on one foot for 5 seconds - negative Romberg test, patient maintains posture without swaying.

2. Gait: have patient walk normally, eyes closed, heel-to-toe, and heel-to-toe backwards - gait is smooth, rhythmic, and coordinated.

Coordination and Skill Movements:

1. Rapid Alternating Movements: flip hands on thighs, increase speed - rapid alternating movements are smooth and coordinated.

2. Finger-to-Finger: patient touch each finger with thumb and back.

3. Finger-to-Nose: patient touch your finger then their nose / arms out wide and eyes closed: touch nose with alternating hands - finger-to-finger/nose test accurate and coordinated.

4. Heel-to-Shin: run heel of foot up and down opposite shin - heel-to-shin test smooth and accurate.

Sensory System

Spinothalamic Tract:

1. Pain: use disposable pin and have patient point and say sharp or dull - pain sensation intact and symmetric.

2. Light Touch: use cotton wisp and have patient point - light touch sensation intact and symmetric.
   

Posterior Column Tract: 

1. Vibration: Strike tuning fork and place on big toe/bony joints, ask when does it stop - vibration sense intact.

2. Position: Raise toe/finger up or down and ask them to identify it - position sense intact.

3. Tactile Discrimination:

   1. Stereognosis: place familiar object in hand and ask to identify - stereognosis intact.

   2. Graphesthesia: draw number on palm and ask to identify - graphestesia intact.

   3. Two-Point Discrimination: use paperclip to deetermine minimal distance they perceive two points - two-point discrimination within normal limits.

   4. Extinction: touch both sides of body simultaneously - no extinction, patient feels bilateral stimuli.

   5. Point Location: patient pointing to where they were touched (will happen during other tests) - point location intact.

Neurological Recheck

LOC: assess orientation (person/place/time) and speech - patient is alert and oriented x3, speech is clear and unbroken.

Motor Function: have patient squeeze both hands,  have patient push their foot down (gas pedal) while resisting with your hand - motor function intact and streng is equal bilaterally.

Pupillary Response: shine light in each eye - pupils equal, round, and reactive to light.

Vital Signs: assess BP, HR, RR, T, SpO₂.

Glasgow Coma Scale (GCS): score out of 15 - GCS 15/15.

BLANK