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What are important basic concepts in neuro exams?
- watch for symmetry
- OBSERVE without telling them first
- watch for details
- be aware of distractions
- dont be predictable or they'll guess
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What are some CN damages you can see just through basic observation?
- ptosis (III)
- facial droop (VII)
- hoarseness (X)
- can't articulate words (V, VII, X, XII)
- eye position (III, IV, VI)
- asymetric pupils (II, III)
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How do you test the olfactory I nerve?
- identify common smells
- not commonly tested
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How do you test for optic II nerve?
- visual acuitiy (snellen chart)
- visual fields (hands to side and wiggle fingers, as pt which side)
- pupillary light reflex (watch for direct and consensual response)
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How do you test the oculomotor nerve III?
follow an object with eyes, no head movement
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Do you keep your glasses/contacts in when testing the optic nerve?
yes
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How do you test the trochlear nerve IV?
- same as oculomotor
- follow an object with eyes, no head movement
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How do you test the trigeminal nerve V?
- temporal and masseter strength (open mouth, clench teeth)
- sensation of pain (use shar object on forehead, jaw & cheeks)
- corneal reflex (don't do if have contacts or lasic eye surgery)
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How do you test the abducens nerve VI?
lateral movements of the eye
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How do you test the facial nerve VII?
- observe for asymmetry/droop
- observe movemetnts (eyebrow raise, smile to frown, show teeth, puff cheeks)
- Bells's palsy (paralysis of mm inervated by VII)
- salvation and tear production can be affected
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How do you test the vestibulocochlear nerve VIII?
- make noise at varying distance of the ear
- should be symmetrical
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How do you test the vagus nerve X?
- have pt swallow
- say 'AHHH'
- voice abnormalities
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How do you test the Accessory nerve XI?
- MMT traps and SCM
- watch for trap assymetry
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How do you test the hypoglossal nerve XII?
- observe tongue movements- shouldn't deviate or protrude
- listen for disarticulations
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What are basic observations of a motor exam?
- involuntary movements/spasms
- muscle symmetry
- atrophy
- gait analysis
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How do you test muscle tone?
- pt need to relax and perform flex/ext of wrist, elbow, ankle, and knee
- watch for flaccidy, increased tone, or catching sensation
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How do you test clonus?
- support knee with pt in supine and quickly DF foot
- observe for oscillation- sustained or non sustained
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How do you test muscle strength?
- MMT
- 0-5
- 3= full range against gravity
- 2- have to move into anti-gravity position
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How do you test muscle coordination?
- alternate pronation/supination
- finger to nose
- alternate tapping toes
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What is the Romberg test?
- use gait belt and have pt stand feet together for 15 seconds without support
- + test = instability
- indicated vestibular or proprioceptive problems
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How do you test gait?
- normal walking
- heel to toe
- tandem
- heel
- hop
- squat
- lunge
- sit to stand
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What are the relfexes?
- Biceps: C5-C6
- Triceps: C6-C7
- Brachioradialis: C5-C6
- Patellar: L2-L4
- Achilles: S1-S2
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What is the Babinski Sign?
- probe on lateral part of foot
- normal= toe flexion
- + = big toe extension and fanning of toes
- indicates UMN lesion
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What is some basic info to perform sensory exams?
- have pt close eyes
- don't be predictable or pt will guess
- watch for symmetry
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How do you test for light touch?
- light touch both sides simultaneously with a cutip and see if pt has sensation difference
- do with a sharper object to feel "scratch"
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How do you test position sense??
have pt close eyes, move big toe up and down then have pt tell you their toe position
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How do you test pain?
use sharp objects to test dermatomes
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How do you test temperature?
- not necessary to test if other sensory exams are nomral
- will usually say if they can't feel when the shower gets too warm
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How do you test discrimination?
- graphesthesia: use blunt object to draw and # and ask patient to identify it
- stereognosis: ask pt to identify familiar objects with vision
- 2 pt discrimination: open a paper clip and see if pt can distinguish between 1 or 2 point and determine minimal distance they can distinguish
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