Brief Neurologic Exam

Brief Neurologic Exam

Mental Status
■ Impression: Observe affect, mood, appearance, behavior, cognition, and grooming.
■ Speech: Assess for clarity and coherence.
■ LOC: Is Pt alert, lethargic, stuporous, or obtunded?
■ Orientation: Person, place, time, and/or situation.

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.

Reflexes
■ Tendon Reflexes.
■ Babinski (Plantar Reflex): Stroke lateral aspect of sole of each foot with reflex hammer. Normal response is flexion (withdrawal) of toes. Positive Babinski is characterized by extension of big toe with fanning of other toes (abnormal).
■ Clonus: With knee supported in partially flexed position, quickly dorsiflex 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 sitting position or do 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 or her nose and your index finger alternately several times. Continually change the position of your finger during 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 proprioceptive or vestibular problem.
■ Proprioception: While standing, instruct Pt to close eyes and alternate touching his or her index fingers to nose.

Sensory
■ Using your finger and a toothpick, instruct Pt to distinguish between sharp and dull sensations. Compare left to right, with Pt’s eyes closed.