Brief Neurological Exam
Mental Status
■ Impression: Observe affect, mood, appearance, and grooming.
■ Speech: Assess for clarity and coherence.
■ LOC: Is the Pt alert, lethargic, stuporous, or obtunded?
■ Orientation: Person, place, and time.
Cranial Nerves
■ See Cranial Nerve Assessment.
Motor
■ Inspect: Involuntary movements, muscle symmetry, atrophy.
■ Muscle tone: Flex and extend wrists, elbows, ankles, and knees; slight, continuous resistance to passive movement is normal. Note any decreased (flaccid) or increased (rigid or spastic) muscle tone.
■ Motor strength: Have Pt move against your resistance and score accordingly (see Muscle Strength Grading Scale).
Reflexes
■ Tendon Reflexes: (see Deep Tendon Reflex Grading Scale).
■ Babinski (Plantar Reflex): Stroke the lateral aspect of the sole of each foot with a reflex hammer. Normal response is flexion (withdrawal) of the toes. A positive Babinski is characterized by extension of the big toe with fanning of the other toes (abnormal).
■ Clonus: With knee supported in a partially flexed position, quickly dorsiflex the foot. Rhythmic oscillations positive clonus.
Gait/Balance
■ Observe gait while Pt walks across room and comes back.
■ Have Pt walk heel-to-toe or on heels in a straight line.
■ Have Pt hop in place on each foot.
■ Have Pt stand from a sitting position or do a shallow knee bend.
Coordination
■ Rapid Alternating Movements: Instruct Pt to tap tip of thumb with tip of index finger as fast as possible.
■ Point-to-Point Movements: Instruct Pt to touch his/her nose and your index finger alternately several times. Continually change the position of your finger during the test.
■ Romberg Test: Be prepared to catch Pt! Request that Pt stand with feet together, eyes closed for 10 seconds. If Pt becomes unstable, test is positive, indicating a proprioceptive or vestibular problem.
Sensory
■ Using your finger and a toothpick, instruct the Pt to distinguish between sharp and dull sensations. Compare left to right, with Pt’s eyes closed.
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