6 Parts: o Mental Status o Cranial Nerves o Sensory Function o Motor Function o Cerebellar Function o Reflexes 1. Cranial Nerves

Neurologic Assessment
- 6 parts:
o Mental status
o Cranial nerves
o Sensory function
o Motor function
o Cerebellar function
o Reflexes
1. Cranial Nerves
Cranial Nerve Impulse Function
I. Olfactory Sensory Carries small impulses from nasal mucous membrane to brain
II. Optic Sensory Carries visual impulses from eye to brain
III. Oculomotor Motor Contracts eye muscles to control eye movement (inferior, lateral,
medial, superior), constricts pupils, elevates eyelids
IV. Trochlear Motor Contracts one eye muscle to control inferomedial eye movement
V. Trigeminal Sensory Carries sensory impulses of pain, touch, and temperature from face
to brain
Motor Influences clenching and lateral jaw movements (biting, chewing)
VI. Abducens Motor Controls lateral eye movements
VII. Facial Sensory Controls sensory fibers for taste on anterior 2/3 of tongue and
stimulates secretions from salivary glands (submaxillary and
sublingual), and tears from lacrimal glands
Motor Supplies facial muscles and affects facial expressions (smiling,
frowning, closing eyes)
VIII. Acoustic Sensory Contains sensory fibers for hearing and balance
Vestibulocochlear
IX. Glossopharyngeal Sensory Contains sensory fibers for taste on posterior 2/3 of tongue and
sensory fibers of the pharynx that result in the “gag reflex” when
stimulated
Motor Provides secretory fibers to the parotid salivary glands, promotes
swallowing movements
X. Vagus Sensory Carries sensations from the throat, larynx, heart, lungs, bronchi,
GI tract, and abdominal viscera
Motor Promotes swallowing, talking, and production of digestive juices
XI. Spinal Accessory Motor Innervates neck muscle (sternocleidomastoid, trapezius) that
promote movement of the shoulders and head rotation
XII. Hypoglossal Motor Innervates tongue muscles that promote the movement of food
and talking
2. Sensory Function
a. Primary sensation
 Light touch – mediated with small and large nerve fibers tested with cotton
 Pain – conveyed with small unmyelinated fibers; Pin-prick Test
 Vibration sense – ankles and knuckles; patient reports when vibration is lost; test for symmetry
b. Cortical and Discriminatory Sensation
 Stereognosis – ability to recognize an object by touch and tests sensory interpretation
 Inability (astereognosis) suggests lesion in sensory cortex of parietal lobe
 Graphesthesia – ability to recognize shape traced on skin
 Inability suggests either:
o Parietal lobe of side opposite the hand tested
o Damage to dorsal columns pathway at any point between tested point and
contralateral parietal lobe
 Kinesthesia – ability to distinguish movement
3. Motor Function
- Abnormality of motor system are assessed by evaluating muscle size, tone, tenderness, strength, and
involuntary/abnormal muscle movement (chorea, athetosis)
- Muscle tone can be decreased (flaccid) or increased (spasticity)
- Look for symmetry between sides of the body
- Graded from 0-5
4. Cerebellar Function
- Cerebellum is responsible for balance and coordination
o Romberg Test – evaluated proprioception and cerebellar function
o Finger to Nose Test – assess ataxia
o Heel to Shin (HTS) Test – assess coordination in lower extremities
5. Reflex Testing
- Evaluation of deep tendon reflexes (DTRs) examines the spinal reflex arc
- DTRs are usually tested by tapping on a tendon with fingers or a reflex hammer. This causes a
stretching of certain muscles and results in contraction
- When damage occurs to higher centers (upper motor neuron), the spinal reflex arc is uninhibited and
the DTRs are hyperactive
- When damage occurs to peripheral nerves or dorsal roots (lower motor neuron), the spinal reflex arc is
interrupted and the DTRs are decreased
- The rapidity and strength should be symmetric
- Reflexes often tested are: biceps, brachioradialis, triceps, patellar, Achilles
a. Testing Biceps
- Patient’s arms partially flexed at elbow with palm down
- Place thumb on bicep tendon, strike thumb with reflex hammer
- Look for contraction of bicep muscle and slight flexion of forearm
b. Testing Triceps
- Support upper arm, left forearm hangs free
- Strike tricep tendon above elbow with broad side of hammer
- Look for extension of lower arm, contraction of tricep muscle
c. Testing Brachioradialis
- Patient rests forearm on abdomen or lap
- Strike radius 1-2 inches above wrist
- Watch for flexion and supination of forearm
d. Testing Patellar
- Patient sits with knees flexed
- Strike patellar tendon just below patella
- Watch for contraction of quadreps muscle and extension of knee
e. Testing Ankle
- Dorsiflex foot and ankle
- Strike Achille’s tendon
- Watch and feel for plantar flexion at ankle
f. Testing Plantar Reflex (Babinski)
- Stroke lateral aspect of the sole of each foot with the reflex hammer or key
- Observe for plantar flexion
g. Testing Abdominal Reflex
- Use blunt objects
- Stroke abdomen lightly on each side in an inward and downward direction
- Note contraction of abdominal muscle and deviation of the umbilicus toward stimulus
Grading Scale
0 Absent, pathologic, upper and lower motor neurons

1+ Diminished
2+ Normal
3+ Brisker than normal, not necessarily pathologic
4+ Hyperactive, often pathologic, nervous system disease
Gait and Stance
- Act of walking requires integration of peripheral and central nervous system

- Look at rate, rhythm, and character of movements
- May aid in diagnosis of specific neurologic disorders
o Shuffling gait (Parkinsons disease)
o Ataxia

6 Parts: o Mental Status o Cranial Nerves o Sensory Function o Motor Function o Cerebellar Function o Reflexes 1. Cranial Nerves

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6 Parts: o Mental Status o Cranial Nerves o Sensory Function o Motor Function o Cerebellar Function o Reflexes 1. Cranial Nerves

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Neurologic Assessment

0 Absent, pathologic, upper and lower motor neurons

Gait and Stance

- Act of walking requires integration of peripheral and central nervous system

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