Good morning, everyone!

Today we will be demonstrating the assessment procedure for the

neurologic system.
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Starting off with the preparation, we have the needed equipment namely the:

 Soap for the olfactory test

 Snellen chart and a magazine/newspaper for the optic test
 Ophthalmoscope to view retina
 Pen light for pupillary response test
 Paper clip for sensory function test
 Cotton for corneal reflex test
 Applicator dipped in salt, sugar, and lemon juice
 Tuning fork for Romberg Test and Rinne Test
- The Romberg test is a neurological test that is used to assess a person’s balance
and proprioception.
- Rinne test compares bone and air conduction sounds.
 Tongue depressor for glossopharyngeal test
 Water for swallow test
 Reflex hammer
- Is used to elicit deep tendon reflexes

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Moving on to pre-assessment, we have the general things to consider before performing

the assessment, the:
• Biographical data
• History of present health concern (COLDSPA)
• Personal health history
• Family health history
• Lifestyle and Health Practices
• Review of Systems

After collecting the mentioned data

 Greet the client and introduce yourself

Good morning, Maam. I am Claire Montibon. I will be your attending nurse today.

 Explain to the client what you will do, why is it necessary, and how she can
cooperate.
Today I will be assessing your neurologic system to detect any abnormalities or changes
in brain and nerve function. This is necessary because such abnormalities will impact
your overall health and well-being. You can cooperate by following my stated instructions
for me to be able to assess you accurately.

 Wash hands and observe appropriate infection control procedures.

This will prevent infection and contamination and will protect the attending health care
provider and the client.

 Provide for client privacy

You can do this by closing doors and windows.
 This will help build trust and this can also allow us to provide more comfort during
assessment for the client.

 Put the client in a comfortable and appropriate position

The assessment might take some time so the comfort of the client during the duration is
important

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For the assessment proper, it is subdivided into 5 parts, the:

 Cranial Nerves
 Motor and Cerebellar Systems
 Sensory System
 Reflexes
 Test for Meningeal Irritation of Inflammation
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CRANIAL NERVES
1) Test CN I (olfactory)
- Have the client sit at your eye level.
- Ask the client to clear nose for any mucus. Close eyes and occlude one nostril then
identify the scent of the soap.
- Repeat with the other nostril.
 In older clients their sense of smell may be decreased.
NF – Client should be able to identify the scent correctly in each nostril.

2) Test CN II (optic)
- Assess vision in each eye.
NF – vision should be 20/20 in 20ft.

- Assess near vision by asking client to read a magazine or newspaper paragraph.

NF – Able to read 14inch without difficulty.

- Assess visual fields of each eye by confrontation.

NF – Should have full visual fields.

- View retina and optic disc of each eye using an ophthalmoscope.

NF – round red reflex should present. optic disc is 1.5 mm and retina pink.

3) Test CN III (oculomotor) and CN VI (abducens)

- Inspect margins of the eyelids
NF – eyelid should cover about 2mm of the iris

- Assess extraocular movements. If nystagmus is noted determine the direction of fast

and slow phases.
NF – eyes should move smoothly and coordinated in all directions.

- Assess pupillary response using penlight.

NF – Illuminated pupils should constrict and opposite constrict simultaneously.
 4) Assess CN V (trigeminal)
- Test motor function by asking client to clench teeth while u palpate the temporal and
masseter muscle for contraction.
NF – Contraction should be bilaterally.

- Test sensory function by touching forehead, cheeks, and chin with sharp and dull side
of paper clip.
NF – Client should be able to identify sharp and dull sensation and in which location.

- Test corneal reflex by asking client to look up and away while lightly touching cornea
with fine wisp of cotton.
NF – eyelids should blink bilaterally

5) Test CN VII (facial)

- Ask the client to
a. Smile
b. Frown and wrinkle forehead
c. Show teeth
d. Puff out cheeks
e. Purse lips
f. Raise eyebrows
g. Close eyes tightly against resistance
NF – Movement of such should be symmetric

- Touch anterior 2/3 of the tongue with a moistened applicator dipped in salt, sugar, or
lemon juice.
NF – client should be able to identify correct flavor

6) Test CN VIII (acoustic/vestibulocochlear)

- Perform whisper, weber, and rinne test.
NF – Client should hear whispered words, vibration heard equally, AC > BC

7) Test CN IX (glossopharyngeal) and X (vagus)

- Test motor function by asking client to say “ah” while using tongue depressor
NF – Uvula and soft palate rise bilaterally and symmetrically

- Check the client’s ability to swallow.

NF – no hoarseness noted

8) Test CN XI (Spinal accessory)

- Ask client to shrug shoulder against resistance to assess trapezius muscle.
NF – there should be a strong contraction of trapezius muscle

- Ask client to resist against force by turning right and left to assess
sternocleidomastoid muscle.
NF – strong contraction on the side opposite the turned face
 9) Test CN XII (hypoglossal)
- Ask client to protrude tongue against resistance to assess strength and mobility.
NF – bilateral strength

MOTOR AND CEREBELLAR SYSTEMS

1) Assess condition and movement of muscles for the size and symmetry of muscle group.
NF – should be bilateral or vary at least 1cm only

Older clients tend to have reduced muscle mass due to degeneration

2) Assess strength and tone of all muscle group

NF – should contract voluntarily and all muscle group should have equal resistance

3) Note any unusual involuntary movements

NF – should be no fasciculations, tics, or tremors

Older clients normally have hand or head tremors or dyskinesia

4) Evaluate gait and balance (ask client to walk naturally)

NF – gait is steady and opposite arm swing

Older clients may have slow and uncertain gait.

5) Ask client to walk in heel-to-toe fashion

NF – client should be able to maintain balance but older clients may fine this step difficult

6) Perform Romberg test

NF – no to little minimal swaying

7) Ask client to stand on one foot and to bend the knee the leg the client is standing on
NF – should be able to balance

8) Assess coordination. Ask client to touch nose first with right index finger then left index
finger and repeat 3 times.
NF – Client should be able to touch nose smoothly and accurately

9) Assess rapid alternating movements. Ask client to touch each finger and increase speed
NF – client should be able to do this but older clients will find this difficult due to decreased
reaction time and flexibility

10) Ask client to put palms on lap and rapidly move up and down

11) Perform heel to shin test

NF – client should be able to run each heel smoothly down each shin

SENSORY SYSTEM
 1) Assess light touch, pain, and temperature sensations. (use cotton, paper clip soft and
sharp side)
NF – client should be able to identify light touch

2) Test vibratory sensation with a tuning fork.

NF – client should be able to identify sensation

3) Test sensitivity by asking client to close their eyes while bilaterally holding toes/fingers
and move it up and down.
NF – client should be able to identify direction of movements

4) Assess tactile discrimination (fine touch)

NF- client should be able to identify objects

5) Test localization by briefly touching and asking client the points touched
NF – client should be able to identify area touched

6) Test extinction by simultaneously touching the client in same area on both sides

REFLEXES
1) Test deep tendon reflexes. Use reflex hammer
NF – client should be able to maintain points touched

2) Test biceps reflex

NF – elbow flexes and contraction is felt or seen

3) Assess brachioradialis reflex

NF – flexion and supination of forearm

4) Test triceps reflex

NF – elbow extends, triceps muscles contracts

5) Assess patellar reflex

NF – knee extends, quadriceps muscle contracts

6) Test Achilles reflex

NF – plantarflexion of the foot

7) Test ankle clonus

NF – no rapid contractions or oscillations are elicited

8) Assess plantar reflex

NF – flexion of the toes

9) Test abdominal reflex

NF – abdominal muscles should contract

10) Test cremasteric reflex (male clients)

NF – scrotum elevates on stimulated side
TEST MININGEAL IRRITATION OR INFLAMMATION
If you suspect a meningeal irritation or inflammation ---

Make sure there is no injury and ask client to lay supine

NF – neck is supple and can easily bend head and neck forward

Test for Brudzinski sign as you flex neck, watch hips and knees’ reaction to your maneuver
NF – hip and knees should remain relaxed and motionless

Test for Kernig sign by flexing leg at both hip and knee then straighten knee
NF – no pain should be felt. Discomfort behind knee during full extension occurs normal in some.