Comprehensive Notes on Cranial Nerves, Sensory/Motor Assessment, and Special Tests

Cranial Nerves

• Facial Nerve (VII):

  • Motor: Supplies muscles of the face.

    • Make a crease in the forehead.

    • Close eyes tightly.

    • Puff out the cheeks.

    • Smile with teeth.

  • Sensory: Two-thirds anterior of the tongue.

• Vestibulocochlear Nerve (VIII):

  • Sensory: Hearing and balance; transmits information.

  • Conductive Hearing Loss: Damage from the outside to the inside of the ear canal.

  • Sensorineural Hearing Loss: Damage to the auditory nerve.

  • Air Conduction: Outer, middle, and inner ear.

  • Bone Conduction: Skull to inner ear.

    • Conductive hearing loss can be affected.

    • Sensorineural hearing loss is only affected.

Tests for Hearing

• Cochlear (Hearing) Crude Test:

  • Put finger on the ear hole and say a number quietly; tell the patient to repeat it.

• Weber Test (for vibration):

  • Hit tuning fork with your elbow, then put it on the midline of the skull.

    • If the patient hears louder, it indicates a conductive problem (patient hears, sensory is normal).

• Rinne Test:

  • Activate the tuning fork and put it on the mastoid bone.

    • If the patient hears air conduction more than bone conduction, this indicates sensorineural hearing loss.

Vestibular System

• Vertigo: Dizziness.

• Dix-Hallpike Test:

  • Sitting with head turned 45°, quickly lay the patient down; this may induce dizziness.

Esophageal Nerve

• Sensory: One-third posterior of the tongue, gag reflex.

• Elevation.

• Check for any swelling.

• Regulates digestion, blood pressure (BP), heart rate (HR), breathing, and saliva production.

Accessory Nerve

• Muscle power.

  • Trapezius: Shoulder elevation.

  • Sternocleidomastoid: Head resistance.

Hypoglossal Nerve

• Supplies motor function to the tongue.

• Problem with talking may indicate an issue.

Sensory Assessment

Superficial Sensation

• Patient should have closed eyes.

• Pain: Use a pin or sharp object.

• Touch: Light touch.

• Temperature:

  • Hot: Water at 45°C.

  • Cold: Water at 5-10°C.

Deep Sensation

• Pressure: Thumb or fingertip.

• Vibration: Tuning fork.

• Position Sense:

  • Static: Romberg Test.

  • Kinesthetic: Dynamic Range of Motion (RoM) movement.

Combined & Cortical Sensation (High-Level Sensory)

• Tactile Localization (Superficial Pain Assessment).

• Stereognosis: Identifying objects.

• Two-Point Discrimination: Sensory.

• Double Simultaneous Stimulation.

• Graphesthesia.

Motor Assessment

• Muscle Tone

  • Spasticity: Velocity more than resistance.

  • Rigidity: Resistance more than velocity.

    • Cogwheel: Resistance with shaking.

    • Lead Pipe: Constant resistance.

  • Hypotonia

    • Floppy baby test

    • Impaired epilepsy tone

  • Akinesia

    • Cataplexy

Bowel & Bladder Assessment

• Neurogenic Bladder (Reflex & Spasticity):

  • Above S2-S4 (Conus Medullaris).

  • Detrusor muscle and sphincter muscle reflex: Incomplete emptying, which reflects urine into the kidney.

• LMN (Lower Motor Neuron) Neurogenic Bladder (Below S2-S4 Conus Medullaris):

  • Loss of reflex, diffuse external sphincter muscle.

Balance & Coordination

• Swaying calls prevent balance.

• Balance: The ability to maintain the center of gravity without falling.

• Romberg Test:

  • Standing with feet close together, eyes open then closed; check if the patient sways to the side or front to back.

• Single Leg Stand:

  • Stand on one leg.

  • Positive: sway side to side, or front to back

• Alternative Standing Test:

  • Dynamic test: standing on one leg, then after a few seconds shift to the other leg.

• Wobble Board Test:

  • The patient can walk.

• Coordination: The ability to move more than one thing at the same time.

• Finger-to-Nose Test.

  • Can have balance but not coordination. (ataxia)

• Finger-to-Examiner Test.

• Alternative Finger-to-Nose Test.

• Heel-Shin Test.

• Circle-Drawing Test with Upper Limb.

• Circle-Drawing Test with Lower Limb.

• Tandem Walking Test:

  • Putting heel in front of toes.

• Hurdle Walking Test:

  • Sticks in front of the patient; the patient should cross over the objects without touching them.

• Alternative Box Walking Test:

  • Four boxes are placed in front of the patient on the floor; ask the patient to walk inside them.

• Eight-Drawing Walking Test:

  • Walking in an eight shape.

Special Tests

Lumbar Tests